Prodromal Schizophrenia: Symptoms, Diagnosis, & Treatment

What Is Schizophrenia Prodrome?

In general, schizophrenia prodrome refers to the first stage of schizophrenia, and usually develops in adolescence or young adulthood. Schizophrenia is a mental health condition that consists of a complex set of symptoms including hallucinations, delusions, mood changes, and cognitive disturbances. This disorder is typically categorized into three phases, all of which can vary quite a bit from person to person. Thus, not everyone experiences prodrome in the same way, if at all.

The three phases of schizophrenia include:

• Prodrome: The prodrome phase occurs when a person exhibits subclinical symptoms, but does not meet criteria for a diagnosis of schizophrenia.
• Active: This is the phase of schizophrenia which occurs once a person displays clinical levels of symptoms that meet criteria for the disorder. The active phase can occur multiple times.
• Residual: The residual phase follows an active phase and refers to when the most intense symptoms subside. A person will still experience some remaining symptoms, but is no longer in an active phase. Many individuals may still meet criteria for schizophrenia, but with milder symptoms.

Prodromal Schizophrenia Symptoms

The specific symptoms of schizophrenia experienced during the prodrome depend on the individual. Most commonly, a person will have symptoms that mirror those of schizophrenia as a whole, but at a lower level of intensity. They may face challenges in their day-to-day lives, relationships, at school or work, or when managing their finances.

Symptoms of prodromal schizophrenia may include:

• Hallucinations
• Delusions
• Difficulty with thinking and/or speaking
• Difficulty feeling or expressing emotions
• Sensory or motor problems
• Symptoms of depression
• Symptoms of anxiety
• Impaired sleep

Individuals of Clinical High Risk (CHR)

By definition, those in the prodromal phase of schizophrenia will later enter the active phase of schizophrenia and meet criteria for diagnosis. However, not everyone who experiences symptoms of psychosis will develop schizophrenia.

Individuals considered at Clinical High Risk (CHR) are non-schizophrenic, but exhibiting brief psychotic symptoms. Of this population, only between 15-25% will meet criteria for schizophrenia within two years.¹ Roughly 72% of those who never meet criteria may achieve complete resolution of symptoms, while 33% of those who do meet criteria may achieve remission.²

Subgroups of individuals who are CHR or ultrahigh risk (UHR) for schizophrenia include:

• Attenuated psychotic syndrome (APS): This is a relatively new diagnosis, but includes less intense psychotic symptoms than usual for schizophrenia or another psychotic disorder. However, symptoms are still severe enough to impact the person’s life.
• Brief limited and intermittent psychotic symptoms (BLIPS): BLIPS are short-lived psychotic symptoms which co-occur with another mental health condition. People with BLIPS are rarely in a prodromal phase as their symptoms do not last–but, this is possible.
• Genetic risk and deterioration syndrome (GRD): GRD is a broad category for people who have been screened for familial risk of psychosis and possess two or more additional risk factors (i.e., worsening social functioning). There is no indication that GRD increases likelihood of meeting criteria for schizophrenia later on.

How Is Prodromal Schizophrenia Diagnosed?

A prodrome cannot be ‘diagnosed’ in the traditional sense, as it is not officially recognized as a specific disorder by the DSM or ICD. Furthermore, a “prodrome” is only such if it is followed by an active phase. Therefore, one must wait to see if an active phase occurs to know for sure if prodrome occurred.

Identifying early symptoms of prodromal schizophrenia is possible, and doing so can help a person receive the support they need. The sooner one starts treatment, the more successful it can be. Despite a lack of a schizophrenia diagnosis, individuals can still be treated for what they are experiencing. This is essential when working to reduce the likelihood of passing from the prodromal to the active phase.

Outlook for Prodromal Schizophrenia

Knowing one is at risk for developing schizophrenia can greatly impact their life. When possible, a person should consider a treatment program that is specifically designed for individuals who are also of CHR or UHR.

Those who may be in the prodromal phase and are at CHR of developing schizophrenia should avoid all non-prescribed substances. These can bring on psychotic episodes or worsen current episodes. It’s also important to maintain a routine that focuses on getting sufficient sleep, nutrition, movement, and social connection.

Prodromal Schizophrenia Treatment

The prodrome phase of schizophrenia is typically treated using the same or similar approaches used in the treatment of schizophrenia. However, the best options include specialty programs, such as UCLA’s Center for Assessment and Prevention of Prodromal States (CAPPS) or Rutgers NJ Promise/Clinical High Risk for Psychosis.^3,4

These programs include assessments, family therapy, and individual skills training. Focuses include psychoeducation, addressing positive and negative symptoms, teaching coping skills, goal setting, and many other beneficial modalities. However, while specialty programs are most recommended, other options that factor in these techniques are available as well.

Medication

Medications may be prescribed for certain people in the prodromal phase of schizophrenia. These may include antipsychotics that can help address hallucinations or delusions. In some cases, medication for depression may also be recommended to treat accompanying symptoms.

Psychosocial Interventions

Along with specialty programs, individual therapy may be helpful when treating prodromal schizophrenia. Experiencing psychotic symptoms can be frightening, but remember that you are not alone in your struggles. When seeking therapy, finding the right therapist who has experience with schizophrenia and related issues is essential.

Therapy options for those experiencing prodromal schizophrenia may include:

• Cognitive behavioral therapy (CBT): CBT can help reduce the impact of delusions, anxiety, and depression. It can also teach a person how to identify certain symptoms, the impact these have on their behaviors, and make conscious efforts to improve their well-being.
• Social skills training (SST): Some people in the prodromal phase struggle with social interactions. SST and related therapies help target specific concerns by increasing one’s confidence and teaching useful skills.
• Family therapy: Family therapy is often important for people who are newly experiencing psychotic symptoms. It can help every family member work together to support the individual with prodromal schizophrenia.
• Group therapy: There are many group therapy options for prodromal schizophrenia. These can often help a person learn more about their symptoms, identify coping skills, gain insights about themselves, work on individual goals, and connect with fellow group members.
• Peer support: Peers are people who have similar lived experiences- in this case, people who have psychosis too. Peers can help support you in your recovery in a range of ways, from working together on your recovery goals to meeting together in the community to try out a new coping skill.