Schizophrenia Prodrome

Medically Reviewed by Jabeen Begum, MD on April 19, 2024
6 min read

If you have schizophrenia or know someone who does, you're probably familiar with symptoms such as hallucinations and delusions. But you may not realize that warning signs can show up before a full-blown episode. When that happens, it's called a prodrome or prodromal period.

About 75% of people with schizophrenia go through a prodrome phase. It may last a few weeks, but for some people, these signs slowly worsen over several years.

You may notice changes in yourself before your friends and family do. Once your loved ones do become aware, they might try to explain these changes as "just a phase" you're going through or due to something stressful in your life. Because of that, many people don't seek help until later on, when more serious symptoms start to emerge.

Signs that you have prodromal schizophrenia include trouble with your memory or difficulty paying attention and staying focused.

Mood swings and depression can happen. You may have anxiety and feel guilty about things or mistrust others. You could even have thoughts of suicide.

Another sign is a lack of energy. You could have weight loss , lose interest in meals, and get sleep problems.

You might lose interest in things you once cared about and avoid socializing with family and friends. There could be a decline in your level of achievements at work or school.

Your friends may notice changes in how you look. You might not keep up with hygiene like you used to.

Some other things that you or others might become aware of:

  • Hearing or seeing something that's not there
  • A strange way of writing or talking
  • An angry, scared, or bizarre response to loved ones
  • Extreme interest in religion or the occult

If you or someone you love shows any of the above signs, see a doctor right away. The symptoms of prodrome are subtle and easy to miss. Many also overlap with other mental health issues, such as depression and substance misuse.

To rule out other health problems, your doctor may order lab tests and imaging tests. You'll also be asked to answer detailed questions about your health, feelings, thoughts, and daily habits. How you respond will help your doctor decide if you are in a schizophrenia prodrome and if so, what kind.

To reach the right diagnosis, your family doctor may refer you to a psychiatrist who treats schizophrenia. They'll check if you have been showing prodromal symptoms of schizophrenia such as impaired social, self-care, or occupational skills over the last 6 months, with at least 1 month of active symptoms. They'll also check for other typical symptoms of schizophrenia required for diagnosis, such as:

  • Disorganized speech
  • Delusions
  • Hallucinations
  • Disorganized behavior
  • Negative symptoms that harm your ability to function. They're often confused with clinical depression symptoms and include:
    • Social withdrawal
    • Affective flattening -- lack of expression, reduced body language
    • Alogia -- lack of speech/slow to speak
    • Anhedonia -- lack of interest or pleasure in activities
    • Avolition -- decreased motivation and goal-directed activity

Different types of schizophrenia prodrome are still being defined and researched, but there are various ways to describe these prodromal symptoms. 

Attenuated psychosis syndrome (APS)

The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), added attenuated psychosis syndrome (APS) as a condition to be further studied. In APS, for at least once a week within the past month, you have symptoms linked to psychosis -- a break from reality. These can include:

  • Hallucinations or strange thoughts
  • Disorganized speech -- it could be vague or overelaborate
  • Delusions -- you might distrust people, or feel like you're better or smarter than others

Brief limited intermittent psychotic symptoms (BLIPS) or brief intermittent psychotic symptoms (BIPS)

In these cases, you may have symptoms similar to those of APS, but they come and go. BLIPS may last no more than a week, while BIPS could last 3 months.

Genetic risk and deterioration syndrome (GRDS). Your doctor may decide you have this type of prodrome if a close family member, such as a parent or sibling, also has psychosis. Or you may show signs of what's called schizotypal personality disorder (SPD). People with SPD are often loners who show little trust in others and behave oddly.

If you have GRDS, your mental health will also have declined greatly within the past year.

With any of these conditions (APS, BLIPS, BIPS, GRDS), you may have a high risk of developing a psychotic disorder, so it's important to see a doctor for a proper diagnosis.

Based on your symptoms, your doctor will come up with a treatment plan that can best help you.

This will likely include:

Medication. Your doctor may suggest antipsychotics. This type of drug can lessen prodrome symptoms and prevent psychosis. Teens and young adults who have mild symptoms may also do well with antidepressants.

Counseling. Cognitive behavioral therapy (CBT) helps you change your thoughts, feelings, and how you act. It can also teach you ways to manage hallucinations and delusions so they don't take over your life.

CBT works well for people with schizophrenia. Although more studies are needed to show how much it helps during the prodromal period, research shows that it could lower your chances of more severe psychosis.

Alternative treatments. There's some evidence that a lack of fatty acids in your diet can worsen a prodrome. A daily omega-3 fish oil capsule may help manage your symptoms. Your doctor can decide if this might be a useful part of your treatment.

If you or a loved one shows early signs of schizophrenia, it's important to talk to a doctor. People who seek help early, while they're still in a prodromal period, respond better to schizophrenia treatment.

Identifying that you or a loved one has schizophrenia prodrome can be challenging, but it's important to talk to a doctor if you see signs of it. Symptoms include emotional and behavioral changes such as mood swings, trouble concentrating, sleep issues, and avoiding social activities. The earlier treatment begins, the greater the chance of getting better and managing the condition through medication, therapy, and other community support.

What happens in the prodromal phase of schizophrenia?

In the prodromal phase of schizophrenia, your behavior will start to change and you'll display symptoms of psychosis. This could happen over several weeks or even years. Some symptoms include:

  • Memory problems
  • Trouble paying attention and staying focused
  • Mood swings and depression
  • Thoughts of suicide
  • Anxiety
  • Mistrust in others
  • Lack of energy
  • Weight loss
  • Sleep problems
  • Losing interest in activities you used to enjoy
  • Reduced performance at school or work
  • Poor hygiene
  • Hearing or seeing something that's not there
  • A strange way of writing or talking
  • An angry, scared, or bizarre response to loved ones
  • Extreme interest in religion or the occult

What is the difference between schizophrenia and prodrome schizophrenia?

The difference between them lies in the intensity, frequency, and duration of symptoms of psychosis. When symptoms reach a point where they need immediate treatment with antipsychotic medication, the prodromal phase ends. It can be tough to identify exactly when someone is in the prodrome stage, so it's important to watch for changes in a loved one's behavior to spot the signs.

What is a prodromal episode of psychosis?

A prodromal episode of psychosis is when you experience symptoms of psychosis, and it then leads to a full psychotic episode. With intervention, sometimes it's possible to prevent psychosis.

When do the first signs of schizophrenia typically emerge?

Schizophrenia typically starts in late adolescence and early adulthood, around your mid-to-late 20s. It rarely starts before age 13, but it could also start later, around your mid-30s.