The 7 prodromal symptoms of schizophrenia

Schizophrenia it is one of the most disabling mental health problems of all currently recognized. Its chronic course is marked by a notable decline in the quality of life, both for those who suffer from it and for those around them.

As a disorder, and due to the aura of mystery that surrounds its clinical expression, it has been the subject of many works audiovisuals in which some of its facets have been oversized while others have barely had representation.

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

However, in the first place we will delve into a brief description of the characteristic symptoms of the disease when it has already been 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 pictures

. Two large groups of symptoms that are specific to it can be distinguished: positive and negative.

This basic typology, originally proposed by Crow, has remained a valid classification for decades due to its simplicity. Broadly speaking, the positive symptoms describe an "excess" and the negative ones 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 can compromise any sensory modality, and the latter constitute a more or less articulated set of ideas that the person uses to explain the reality of it (although they lack an objective substrate enough). Often an iron credibility is attributed as much to some as to others, being resistant to all evidence that could contradict them.

The most common hallucinations are auditory ones, expressed as human voices that directly allude to the patient or that interact with each other in a conversation in which this is the main issue. 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 her abnormal perceptual experiences, and whose content may be more or less credible (as would be the case with delusions of persecution that take place in paranoid schizophrenia) or be absurd and strange to the cultural environment (contact with beings from other dimensions, colorful reincarnations, superhuman capacities, etc.).

Disorganized or meaningless language is also frequently appreciated. Verbal expression seems to be affected by syntactic formulas without an apparent grammatical order and by the formation of neologisms (invented words), as well as by phrases without logical connection or by a discourse that tends towards the derailment. All of this suggests the underlying presence of formal thought disturbances.

Negative symptoms

The negative symptoms are the great unknown for most people, although they contribute in a decisive way to the disability of those who suffer from this condition. In addition, they are clinical expressions resistant to the usual pharmacological treatment (antipsychotics that act as antagonists of dopamine on the four brain pathways in which this neurotransmitter).

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

It is also important to note that the presence of other mental health problems is frequent 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.

Hereinafter we will delve into the initial symptoms of schizophrenia, that 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. With regard to schizophrenia, they describe the time interval between the first suggestive signs of a problem (notable changes with respect to previous patterns of behavior and thinking) and the appearance of the psychosis itself bliss. About 75% of people with schizophrenia have gone through this phase in the first place.

Below we will delve into each of the prodromal symptoms that have been highlighted in the scientific literature. Their duration can 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 obvious symptoms during prodrome of schizophrenia. The person withdraws from social life and remains outside the family dynamics.

You may spend a great deal of time cloistered in your own room or remain emotionally distant, even when find themselves in situations where a certain degree of interaction is expected (meetings, for example), the integrity of their links.

2. Changes in the development of daily activities

In the event that the person has an active work or academic life, or is committed to family or other responsibilities, During this stage, a very important neglect of these can be seen.

There is an abandonment of the activities carried out on a daily basis, which may translate into the impossibility of maintain their involvement in different areas (loss of employment, academic failure, breakdown of romantic relationship, etc.).

3. Impoverishment of personal hygiene and grooming

There is a very significant neglect of the most basic personal care, such as brushing teeth or showering. In this phase, the person may have an untidy physical appearance and show no interest in changing the situation, even in the face of explicit demand from others. This circumstance is a common source of conflict within the family, and can seriously disturb coexistence.

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

4. Anxiety and depression

Both anxiety and depression are especially disabling prodromal symptoms of schizophrenia, since they contribute to the impairment of affective life. They can be expressed as marked swings in mood, emotional dejection, agitation, or nervousness. At other times they manifest in the form of constant and disproportionate anger, which encourages the presence of conflict.

Usually these symptoms acquire a sufficient entity to satisfy 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 attention Independent.

5. Poor language and thought

At this stage, the first signs of impoverishment in the use of language and thought make their 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 properly psychotic disorder.

The evidence highlights the affectation of the following cognitive processes: speed of information processing (ability to manage resources necessary to deal 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 carry out 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 an action plan aimed at achievement of a goal or the resolution of a demanding situation) and social cognition (coding, storage, retrieval and use of information associated with the dynamics social; including identifying the expectations of others).

All of them could contribute in some way to other prodromal symptoms, such as loss of employment or social isolation, and must be promptly evaluated by a professional in the neuropsychology.

6. Strange or obsessive ideas

In this time period, the presence of recurring ideas around a specific topic can be noticed, on which all daily activities are structured. The axis of vital gravitation can shift abruptly towards these issues, which for the most part had not been addressed before by the person. It is, therefore, an obsessive thought that displaces habitual concerns to a second order of relevance.

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

7. Insomnia

Sleep difficulties are also a common symptom in the prodromal phase of schizophrenia. They can arise in any of its possible forms: initial (conciliation of sleep), maintenance (constant interruptions during the night) and early awakening (ending sleep earlier than wanted).

In some cases there is an alteration of the Cardiac rhtyms, 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 are so frequently overlooked, is of paramount importance. This is so because not only do they attend in the months prior to the development of the complete picture, but they can also serve as indicators of the imminent onset of an acute episode in people who have already received the diagnosis. So that, its identification allows anticipating the appropriate prophylactic and therapeutic measures.

However, it is important to note that the presence of these symptoms does not necessarily imply that will develop the disorder in the future, as this happens only in 20% to 40% of all cases. It is an alarm signal of which it is essential to be aware, to start up 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. and Schulz, S. (2006). The Schizophrenia Prodrome. American Journal of Psychiatry, 163 (3), 376-380.