The 7 prodromal symptoms of schizophrenia

We analyze the early symptoms of this disease.

Schizophrenia is one of the most disabling of all currently recognized mental health problems. Its chronic course is marked by a marked decline in the quality of life of both the sufferer and his or her environment.

As a disorder, and due to the aura of mystery surrounding its clinical expression, it has been the subject of many audiovisual works in which some of its facets have been overemphasized while others have hardly been represented.

The initial phase of the disease, for example, tends to go unnoticed even by the vast majority of patients and families. It is at this time that the prodromal symptoms of schizophrenia manifest themselves, which will be the core of this text.

However, we will first delve into a brief description of the characteristic symptoms of the disease when it is fully established.

• Recommended article: "The 6 types of schizophrenia (and associated characteristics)".

What is schizophrenia

Schizophrenia is a disorder included in the general category of psychotic disorders.. Two main groups of symptoms can be distinguished: positive and negative symptoms.

This basic typology, originally proposed by Crow, has remained a valid classification for decades because of its simplicity. Broadly speaking, positive symptoms describe an "excess" and negative symptoms a "deficit" in the manifestation of the disease.

Positive symptoms

The positive symptoms of schizophrenia are hallucinations and delusions. The former describe anomalous perceptual experiences that may involve any sensory modality, and the latter constitute a more or less articulated set of ideas that the person wields to explain his or her reality (although they lack a sufficient objective substratum). Often a strong credibility is attributed to both, being resistant to any evidence that may contradict them.

The most common hallucinations are the auditory onesThe most common hallucinations are auditory, expressed as human voices directly alluding to the patient or interacting with each other in a conversation in which the patient is the main subject. The content of the message is usually congruent with the mood of the recipient. Visual or tactile hallucinatory perceptions would follow in order of frequency.

Delusions involve an accumulation of ideas through which the person tries to give meaning to his or her abnormal perceptual experiences, and whose content may be more or less credible (as in the case of delusions of persecution in paranoid schizophrenia) or absurd and strange to the cultural environment (contact with beings from other dimensions, various reincarnations, superhuman abilities, etc.).

A disorganized or nonsensical language is also frequently observed.. Verbal expression seems to be affected by syntactic formulas with no apparent grammatical order and by the formation of neologisms (invented words), as well as by sentences with no logical connection or by a discourse that tends towards derailment. All this suggests the underlying presence of formal thought disturbances.

Negative symptoms

Negative symptoms are the great unknown for most people, although they contribute in a decisive way to the disability of the person suffering from this condition. Moreover, they are clinical expressions resistant to the usual pharmacological treatment (antipsychotics that act as dopamine antagonists on the four brain pathways in which this neurotransmitter is involved).

The negative symptoms are the following: apathy (motivational decline or disinterest), abulia (loss of will to engage in daily life activities), alogia (impoverishment of thought and language) and anhedonia (difficulty in experiencing pleasure in situations that previously provided it). In addition, there may coexist alterations in key cognitive processes for development (memory, attention, social cognition, etc.).

It is also important to note that other mental health problems are frequently present as the time of living with schizophrenia progresses. The most common are major depression and some anxiety disorders, as well as the presence of suicidal ideation. It should be noted that, contrary to popular belief, people with schizophrenia are no more violent or dangerous than the general population.

In what follows we will delve into the initial symptoms of schizophreniathat is, what in specialized terminology is known as prodromal expression.

Prodromal symptoms of schizophrenia

Prodromal symptoms include all those early clinical expressions of a disease.. As far as schizophrenia is concerned, they describe the time interval between the first signs suggestive of a problem (marked changes from previous patterns of behavior and thinking) and the onset of psychosis itself. Approximately 75% of people with schizophrenia have gone through this phase first.

In the following we will elaborate on each of the prodromal symptoms that have been highlighted in the scientific literature. Their duration may be limited to only a few weeks or extend over many years, but in any case they represent an abrupt break in the way the person acted and thought.

1. Social isolation

Social isolation is one of the most evident symptoms during the prodrome of schizophrenia.. The person withdraws from social life and remains outside the family dynamics.

She may spend a great deal of time cloistered in her own room or remain emotionally distant, even when she is in situations where a certain degree of interaction is expected (meetings, for example), affecting the integrity of her bonds.

2. Changes in the development of daily activities

If the person has an active work or academic life, or is involved in family or other responsibilities, during this stage there may be a neglect of daily activities, during this stage a very important neglect of these activities can be appreciated..

There is an abandonment of daily activities, which may result in the impossibility of maintaining their involvement in different areas (loss of employment, academic failure, breakup of the romantic relationship, etc.).

3. Impoverishment of personal hygiene and cleanliness

A very important neglect of the most basic personal care, such as brushing teeth or taking a shower, can be observed.. In this phase, the person may show an untidy physical appearance and show no interest in changing the situation, even at the explicit request of others. This circumstance is a common source of conflict within the family and can seriously disrupt coexistence.

There may also be a deterioration in physical appearance due to a sedentary lifestyle or lack of exercise, with a substantial change in eating habits leading to a very noticeable loss or increase in weight (and alteration of anthropometry). On some occasions, the changes that occur in the body structure are dramatic.

4. Anxiety and depression

Both anxiety and depression are particularly disabling prodromal symptoms of schizophrenia, as they contribute to the impairment of the patient's mental state.as they contribute to the impairment of the affective life. They can be expressed as very marked mood swings, emotional dejection, agitation or nervousness. On other occasions they manifest themselves in the form of constant and disproportionate anger, which encourages the presence of conflicts.

Usually these symptoms acquire sufficient entity to meet the diagnostic criteria of different mental disorders in their respective areas (such as major depression, panic disorder, social anxiety, etc.), becoming a comorbid problem that requires independent attention.

5. Poor language and thinking

At this stage, the first signs of impoverished language and thinking debut.. In fact, many authors point to an initial impairment of cognitive processes, although this is more subtle than that observed during the development of the psychotic disorder itself.

The evidence highlights the impairment of the following cognitive processes: speed of information processing (ability to manage the resources needed to cope with the demands of the situations we face), sustained attention (prolonged maintenance of the focus of attention on a stimulus) and working memory (ability to retain the information required to successfully perform a task in which one is involved).

Other findings also suggest some degree of decline in verbal memory (word recall), problem solving (ability to articulate a plan of action aimed at achieving a goal or resolving a demanding situation) and social cognition (encoding, storage, retrieval and use of information associated with social dynamics; including identifying the expectations of others).

All of these may contribute in some way to other prodromal symptoms, such as loss of employment or social isolation, and should be evaluated by a neuropsychological professional in a timely manner.

6. Bizarre or obsessive ideas

In this temporary period, the presence of recurrent ideas around a specific theme, on which all daily activities are structured, may be noticed. The axis of vital gravitation can abruptly shift towards these issues, most of which had not been addressed before by the person. It is, therefore, an obsessive thought that shifts the usual concerns to a second order of relevance.

Schizotypal personality disorder (maintenance of beliefs considered strange by the environment and impoverishment of affective expression) favors a structure or foundation on which a later psychosis can be built, and has been considered an important risk factor, so that at this stage a recrudescence of this previous symptomatology could be observed.

7. Insomnia

Sleeping difficulties are also a common symptom in the prodromal phase of schizophrenia. They can arise in any of their possible forms: of onset (conciliation of sleep), of maintenance (constant interruptions during the night) and of premature awakening (termination of sleep earlier than desired).

In some cases a disturbance of circadian rhythms is observed, so that the person goes to bed and wakes up excessively late.

Why are prodromal symptoms important?

Knowledge of the prodromal symptoms of schizophrenia, although they often go unnoticed, is of paramount importance. This is because they not only occur in the months prior to the development of the full picture, but can also serve as indicators of the imminent onset of an acute episode in people who have already received the diagnosis. Thus, their identification makes it possible to anticipate the measures to be taken, their identification makes it possible to anticipate appropriate prophylactic and therapeutic measures..

However, it is important to note that the presence of these symptoms does not necessarily imply that the disorder will develop in the future, as this happens in only 20% to 40% of all cases. It is an alarm signal of which it is essential to be aware, in order to set in motion all the assistance devices that may be appropriate.

Bibliographic references:

• George, M., Maheswari, S., Chandran, S. and Manohar, J.S. (2017). Understanding the Schizophrenia Prodrome. Indian Journal of Psychiatry, 59(4), 505-509.

• White, T., Anjum, A. y Schulz, S. (2006). The Schizophrenia Prodrome. American Journal of Psychiatry, 163(3), 376-380.