Changes in mood, thinking patterns, and behavior often appear before psychosis.
Signs of schizophrenia don’t necessarily begin with hallucinations or delusions. Subtle changes in mood, thinking, or behavior may start years before classic symptoms of schizophrenia.
This early stage is known as schizophrenia prodrome or prodromal schizophrenia.
For most people, changes are so subtle that this stage is only diagnosed later, once psychosis — or the active stage of schizophrenia — sets in. If the prodromal stage is detected, monitored, and treated, a person’s overall outlook can improve significantly.
Learning more about symptoms and treatments for this first stage of schizophrenia can help you or your loved one access the right support.
Schizophrenia prodrome is the first phase of schizophrenia.
During this time, the symptoms of schizophrenia start to emerge subtly. In the prodromal phase, a person might experience changes in mood, thinking, and behavior. They may last anywhere from a week to a few years.
Changes in social activity and ideology may be seen as natural personality shifts. The onset of schizophrenia typically occurs in older teenagers or 20-somethings, so signs of schizophrenia prodrome can seem like the typical behavior that comes with growing up.
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Since signs are subtle and can mimic other mental health conditions, a diagnosis of schizophrenia and the prodromal phase usually occurs after someone has entered the active phase.
Catching this beginning phase while it’s happening is also challenging because the person experiencing symptoms usually doesn’t notice them. It’s the people closest to them that may pick up on a change.
There are three phases of schizophrenia:
- Prodromal phase: beginning phase, when symptoms are subtle
- Active phase: symptoms, including episodes of psychosis, that significantly impair one’s day-to-day life
- Residual phase: symptoms of active phase lessen, often with treatment and management, but a return to active phase is possible
Experts have developed ultra high risk (UHR) criteria to help identify people at high risk of developing a first episode of psychosis within a few years.
Identifying UHR people is important since it can sometimes help prevent the onset of a full psychotic disorder or delay the first episode of psychosis and reduce the severity of symptoms.
People in the high risk category may have more severe prodromal symptoms, reduced levels of daily functioning, and have a family history of psychotic disorders.
Diagnosis of UHR requires at least one of the following three features, which are often called the types of prodrome:
- Attenuated psychotic syndrome (APS). APS may involve moderate delusions, hallucinations, or disorganized speech at least once per week within the last month. The symptoms become progressively worse within the last 12 months.
- Brief limited and intermittent psychotic symptoms (BLIPS). Episodes of psychosis resolve on their own without the use of antipsychotics. Symptoms are present for at least several minutes a day at least once a month.
- Genetic risk and deterioration syndrome (GRDS). The person meets the criteria for schizotypal personality disorder or has a first-degree relative with a psychotic disorder. People with GRDS have a
30%decrease in functioning over the past month, as compared with 12 months ago.
The APS group is considered the core high risk subgroup, as it represents 85% of UHR cases, according to a 2016 research article. When APS is detected by a trained clinician, the person has a 29% risk of developing psychosis within the next 2 years.
Some recent evidence suggests that the GRDS subgroup may not necessarily be at greater risk for full psychosis.
Symptoms of prodromal schizophrenia include:
- concentration and attention difficulties
- trouble remembering things or skewed interpretation of events
- anxiety or paranoid thinking
- social withdrawal or isolation
- neglecting personal hygiene
- change of ideology or social circle
- mood changes
- sleeping problems
- low motivation or depression
- changes in diet or weight
For instance, a person might be experiencing anxiety with odd thinking patterns and behaviors. These could be symptoms of prodromal schizophrenia, but they could also be symptoms of obsessive-compulsive disorder (OCD).
Therefore, it’s important to keep an open mind and not jump to conclusions. If you think you’re experiencing several of the above symptoms, seek care from a healthcare or mental health care professional.
Why is it difficult to notice or diagnose this phase?
Prodromal schizophrenia can be difficult to detect because it often looks like other mental health conditions, such as depression or OCD. It may also be mistaken for typical teenage behavior or withdrawal.
How long can prodromal schizophrenia last?
Prodromal schizophrenia may last anywhere from a week to a few years. Symptoms may come and go, but they often become progressively worse over time.
How is prodromal schizophrenia treated?
Some people with mild to moderate positive symptoms (hallucinations or delusions) are placed on low-dose antipsychotic medications.
Some people may begin a form of cognitive behavioral therapy (CBT).
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In general, a treatment plan for the prodromal stage will depend on the person’s particular symptoms and what their mental health care team thinks is best.
Treatment for schizophrenia prodrome typically has two goals: manage the current symptoms and reduce the risk of developing a psychotic disorder.
Do these treatments work?
Researchers found that any type of intervention — including CBT and low-dose antipsychotics — significantly reduced the risk of first-episode psychosis both at 12 months and at 2 to 4 years.
However, these protective effects diminished over time, suggesting that it’s important to remain vigilant and create a plan for treating active schizophrenia as the years progress.
If you’re having symptoms of prodromal schizophrenia, let a healthcare professional or mental health care professional know. That way, if you do have an episode of psychosis, the proper care will already be in place.
If you think your loved one is showing signs, talk with them about getting support.
In some cases, treatment may prevent psychosis altogether. But even if an episode can be delayed, it gives a person time to finish their education, develop stronger life skills, and create a wider supportive social network.
While the outlook is much better for people who receive treatment during the prodromal stage, symptoms are difficult to catch. Give yourself grace if you or your loved one has been diagnosed in the active stage.
With ongoing treatment, people with schizophrenia can manage symptoms and live rich lives.
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