What Is Schizophrenia Prodrome?

If you have schizophrenia or know someone who does, you're probably familiar with symptoms like 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.

What the Warning Signs Look Like

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 severe symptoms start to emerge.

Signs that you may be in a prodrome include trouble with your memory or problems with 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 lack of energy. You could have weight loss or no interest in meals. Sleep problems could crop up.

You might lose interest in things you once cared about and back away from socializing with family and friends. There could be a drop-off in your level of achievements at work or school.

Your friends may notice changes in how you look. You might not be keeping 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

How You Get a Diagnosis

If you or someone you love shows any of these signs, see a doctor right away. The symptoms of prodrome are subtle and easy to miss. Many also overlap with other mental health issues, like 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.

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Types of Prodrome

You might have one of these kinds of prodrome:

Attenuated positive symptom prodromal syndrome (APS). At least once a week within the past year, you have symptoms linked to psychosis -- a break from reality. These can include things like:

  • Strange thoughts
  • Delusions (strong belief in things that aren't true)
  • Distrust of people
  • Feeling like you're better or smarter than others

Brief intermittent psychosis prodromal syndrome (BIPS). If you have this type of prodrome, you may have symptoms like APS, but they come and go.

Genetic risk and deterioration prodromal syndrome (GRDS). Your doctor may decide you have this type of prodrome if a close family member, like 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.

What to Expect

Based on the type of prodrome you have, your doctor will come up with a treatment plan that can best help you.

This will likely include:

Drugs. 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, some 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 make a prodrome worse. 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.

WebMD Medical Reference Reviewed by Smitha Bhandari, MD on October 19, 2018

Sources

SOURCES:

Expert Review of Neurotherapeutics: "Early signs, diagnosis and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders."

Indian Journal of Psychiatry: "Understanding the Schizophrenia Prodrome."

Mayo Clinic: "Schizophrenia," "Schizotypal Personality Disorder."

Current Psychiatry: "Schizophrenia Prodrome: An Optimal Approach."

Mental Health America: "Schizophrenia."

Schizophrenic Research: "Psychosis Risk Screening with the Prodromal Questionnaire -- Brief Version (PQ-B.)"

Schizophrenia Bulletin: "The Prodromal Phase of First-Episode Psychosis: Past and Current Conceptualizations."

Social Psychiatry and Psychiatric Epidemiology: "Measuring attitudes towards mental health using social media: investigating social media and trivialization."

The American Journal of Psychiatry: "The Schizophrenia Prodrome."

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