What to Know About the Prodromal Phase in Schizophrenia

Schizophrenia is a chronic mental disorder. This condition skews a person’s perception of reality. It distorts how a person thinks and behaves. In its active phase, a person with schizophrenia will experience symptoms such as hallucinations, delusions, and disorganized speech and thinking. However, a person with this condition won’t experience these symptoms all the time.

Schizophrenia occurs in three phases. They are the prodromal phase, the active phase, and the recovery phase.

Schizophrenia is often associated with positive symptoms such as hallucinations and delusions. However, schizophrenia occurs in phases and symptoms that don’t always include hallucinations and delusions.

This article describes what to expect in the prodromal phase of schizophrenia, describes the symptoms of this phase, and explains how it's diagnosed and treated.

What Is the Prodromal Phase?

The term "prodrome" refers to the early stage and symptoms of any condition. Here, a person might notice changes in the way they feel, think, or behave. However, they won’t experience symptoms such as disorganized thought or behavior, hallucinations, or delusions.

Not everyone with schizophrenia will experience this phase of the condition. In some instances, symptoms might be so mild that they go unnoticed until the disease progresses into the active phase. 

During the prodromal phase, a person with schizophrenia is more likely to notice their symptoms before people around them.

It typically starts out feeling like there has been a slight shift in feelings, thoughts, and behaviors. Most people assume these are side effects of some medication they might be on, symptoms of another condition they might have, such as depression, anxiety, or stress.

The prodromal phase most commonly begins in teenagehood or young adulthood.

Symptoms of the Prodromal Phase

Symptoms experienced in the prodromal phase are barely recognizable. Additionally, symptoms at this stage are similar to symptoms during the recovery phase. The recovery phase of schizophrenia occurs after the active phase. During the recovery phase, a person with schizophrenia will no longer experience positive symptoms like hallucinations and delusions. 

Some of the symptoms a person might experience during the prodromal phase of schizophrenia include: 

• Mood swings 
• Anxiety 
• Trouble sleeping (this could either be sleeping for too long or finding it difficult to fall asleep)
• Difficulty concentrating 
• Early signs of memory loss 
• Loss of appetite 
• Lack of motivation 
• Fatigue 

In the past, "The Diagnostic and Statistical Manual of Mental Disorders" listed nine specific symptoms that marked the prodromal phase of schizophrenia. Although this list has been removed from the manual, they are still in line with the recognizable symptoms of the prodromal phase in schizophrenia.

These symptoms are: 

1. Blunted or inappropriate responses 
2. Social withdrawal 
3. Peculiar behavior 
4. Loss of energy 
5. Impairment in regular functioning 
6. Impairment in personal hygiene and grooming 
7. Having odd beliefs 
8. Digression in quality of speech 
9. Unusual experiences 

Diagnosing Schizophrenia in the Prodromal Phase 

Making a diagnosis of schizophrenia in the prodromal phase is typically tricky. This is because the symptoms exhibited in this stage of the condition usually mirror other mental health conditions such as depression.

One of the risk factors of developing schizophrenia is having a family history of the condition. If someone in your family has schizophrenia and you begin to notice some of the symptoms of the prodromal phase, it’s crucial to speak to a doctor as soon as you can. Other risk factors include environmental factors such as exposure to toxins or viral infections.

Your doctor might conduct several tests to rule out other conditions with similar symptoms to get a definitive diagnosis. You’ll also be required to undergo a psychiatric evaluation with a licensed psychiatrist who has experience diagnosing and treating schizophrenia.

The advantages of diagnosing schizophrenia in its prodromal phase can’t be overemphasized. This is why extensive research continues to be done into the topic to provide diagnostic tools to help identify the condition in this stage.

Some tools which have been developed and used include: 

• Structured Interview for Prodromal Symptoms (SIPS)
• Scale for prodromal symptoms (SOPS)
• Comprehensive assessment of ARMS (CAARMS)
• Bonn Scale for the Assessment of Basic Symptoms (BSABS)

In a 2001 study of techniques for diagnosing schizophrenia in the prodromal phase, researchers found that the Bonn Scale for the Assessment of Basic Symptoms effectively detected the condition in its early stages.

How Is the Prodromal Phase Treated?

There is currently no cure for schizophrenia. However, decades of research into the condition have resulted in various treatments that make the active symptoms of the disorder manageable and help a person living with this condition lead a relatively normal life.

With the proper treatment, a person with this condition can go through life without experiencing a recurrence of the active phase (i.e., a phase highlighted by symptoms such as hallucinations and delusions).

Medication

While several medications are available for treating schizophrenia in its active phase, these medications are targeted at symptoms that do not exist in the prodromal phase.

Antipsychotics such as Abilify, Zyprexa, and Rexulti are used to manage symptoms such as delusions and hallucinations.

Antidepressants and mood stabilizers have also been used to reduce stress which could trigger psychosis symptoms in a person with this condition. 

Psychotherapy 

If a diagnosis of schizophrenia is made in the prodromal phase, psychotherapy is typically the first point of treatment. It typically involves individual therapy, group therapy, and cognitive-behavioral therapy. 

Summary

There have been several misconceptions about schizophrenia because of the nature of its active symptoms. In the past, a person with this condition might have been misdiagnosed as having a split personality disorder. Today, due to extensive research which continues to be done into understanding the condition, we have a better understanding of what it is and what treatment for it entails. 

A person with schizophrenia will require treatment throughout their life. While early and efficient treatment is vital for a person living with schizophrenia, so is active emotional support from family and loved ones.