What Is Prodromal Schizophrenia?
Schizophrenia is a complex psychotic disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a manual that psychologists and doctors frequently use to diagnose mental illnesses. Understanding schizophrenia can mean understanding the different forms schizophrenic episodes can take, such as the prodromal phase of schizophrenia, which can involve minor symptoms that indicate a psychotic episode may happen soon. If you believe you may be living with schizophrenia or experiencing prodromal symptoms, working closely with a licensed mental health professional may help you receive an accurate diagnosis and information on how to manage symptoms.
What is schizophrenia?
In the fifth edition of the DSM, schizophrenia is classified as a mental illness under the “Schizophrenia Spectrum and Other Psychotic Disorders” category. According to the DSM-5, several symptoms must be present for this condition to be officially diagnosed, including two or more of the following:
- Delusions (False beliefs that are maintained despite evidence against them)
- Hallucinations (Sensory perceptions that are not truly occurring)
- Disorganized speech and behavior
- Catatonia
- Paranoia
- Negative symptoms, such as diminished emotional expression
- Decreased function in significant areas of life
In general, for diagnosis to take place, symptoms must last at least six months, including at least one month of symptoms in the “active phase.” In addition, other psychotic and psychological disorders must be ruled out.
In the prior edition of the DSM, schizophrenia was organized into different categories, including paranoid schizophrenia, disorganized schizophrenia, catatonic schizophrenia, undifferentiated schizophrenia, and residual schizophrenia. In the DSM-5, all schizophrenia presentations are labeled under the schizophrenia spectrum, which may showcase the wide range of symptoms and experiences people with this condition can have.
Not everyone with schizophrenia shows the same symptoms. Because schizophrenia is considered a spectrum, people may experience a few of the above symptoms while not experiencing others. Some people with schizophrenia struggle more with paranoia, whereas others may experience frequent episodes of catatonia, which can involve becoming non-verbal and non-moving or having uncontrollable and unusual movements.
What is the schizophrenia prodrome?
Types of schizophrenia episodes
To understand the prodromal period, understanding the different types of schizophrenia episodes an individual might be diagnosed with can be helpful, including the following:
- First episode, currently in an acute episode
- First episode, currently in partial remission
- First episode, currently in full remission
- Multiple episodes, currently in acute episode
- Multiple episodes, currently in partial remission
- Multiple episodes, currently in full remission
- Continuous
Acute episodes of schizophrenia tend to occur suddenly, causing symptoms of the disorder to appear. Depending on the symptoms, this episode may be considered a psychotic episode. Partial remission generally refers to residual symptoms and only partial fulfillment of disorder criteria. Meanwhile, full remission typically refers to a period during which no disorder symptoms are present.
After one’s first episode, their episodes are normally categorized in the “multiple episodes” category. Continuous episodes can refer to “symptoms fulfilling the diagnostic symptom criteria of the disorder, remaining for the majority of the illness course.” In this case, residual or remission periods tend to be very short or non-existent.
The prodromal phase of schizophrenia usually occurs after a person has experienced their first episode and before all following episodes. Prodromal symptoms can be defined as those that are often present for the individual as a warning sign that a full episode may soon occur. Understanding these warning signs can help someone with schizophrenia prepare by taking their medication, reaching out for help, or implementing a safety plan.
Prodromal warning signs
Prodromal stage warning signs can differ for everyone, depending on their unique symptom presentation and experiences. However, commonly reported signs can include those listed below:
- Anxiety
- Depression
- Mood swings
- Sleep disturbances
- Irritability
- Anger
- Suicidal ideation
- Social withdrawal
- Changes in work performance
- Changes in appetite and eating habits
- Minor paranoia
- Refusal to partake in responsibilities
- Difficulty partaking in self-care
- Cognitive changes, such as memory and attention loss
- Lack of speed in social reasoning and emotional processing
- Weight changes
- A lack of energy or changes in sleep patterns
- A loss of interest in previously enjoyed activities
It can be helpful to pick up on prodrome warning signs in the early stage before an episode occurs, as this can give you time to set up a safety system. When you first notice mood and behavioral changes, reaching out to your primary care physician to discuss treatment options or contacting a therapist to explore coping strategies to work through your next episode may be helpful.
A provider can use clinical practice guidelines to assess basic symptoms and build a treatment plan for reducing transient psychotic symptoms. You might also write a plan for yourself to refer to when struggling to connect with reality.
If you are experiencing suicidal thoughts or urges, call the 988 Suicide & Crisis Lifeline at 988 or text 988 to talk to a crisis provider over SMS. They are available 24/7 to offer support. 988 also offers an online chat for those with an internet connection.
Types of prodrome
There are several types of prodrome an individual might experience, which may not necessarily precede an episode in every case. Below are a few of these types to discuss with your provider:
- Attenuated positive symptom prodromal syndrome (APS): APS often involves minor delusions, hallucinations, or disorganization at least once per week within a month, getting gradually worse over the course of a year.
- Genetic risk and deterioration prodromal syndrome (GRDS): Someone may experience GRDS if they are diagnosed with schizotypal personality disorder or have a first-degree relative with a psychotic disorder. This type is usually not seen in schizophrenia.
- Brief intermittent psychosis prodromal syndrome (BIPS): BIPS can cause episodes of brief, intermittent psychosis. These episodes may not meet the criteria to be considered a full episode. Symptoms may be present for at least a few minutes a day at least once a month.
Approximately 85% of prodromal cases fall under the attenuated positive symptom prodromal syndrome category.
Treatment options for prodromal schizophrenia
If you’re living with schizophrenia and have noticed prodromal phases before your episodes, there are a few treatment options you can consider to better cope and move forward.
Medication
Taking medication for schizophrenia in the prodromal phase before an episode may reduce symptom severity during the episode. Studies show that typical and atypical antipsychotics may be used to reduce prodromal symptom severity or the risk of progression to a full episode. However, each individual is unique, so talk to your doctor to develop a treatment plan for your situation.
Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis.
Monitoring
It may be beneficial to have someone you trust monitor you for symptoms to help you catch when a prodromal phase may be occurring. Alternatively, consider marking frequent sessions with a case manager, social worker, therapist, or care provider to check in on your symptoms, mood, and worries. Having someone to talk to before an episode can help you know when it might be beneficial to implement a new safety plan or start building resources for yourself.
Therapy
Talking to a therapist can be another way to receive support during the prodromal phase of schizophrenia. A therapist can guide you as you work through symptoms and build a safety plan for yourself. However, it can be challenging to reach an in-person therapist if you’re struggling to practice self-care or remember appointments.
In these cases, online therapy platforms like BetterHelp may be more convenient. Online platforms generally enable you to meet with a therapist via phone, video, or live chat sessions from home or any location with an internet connection. In addition, you can find potentially valuable resources like journaling prompts and worksheets assigned by your therapist.
Studies show that online therapy may be effective for individuals experiencing first-episode psychosis. A recent study found that online therapy typically reduced symptoms in those experiencing first-episode psychosis, with results similar to studies on face-to-face treatment.
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