Assessing Prodromal Symptoms Before Psychotic Relapses

The first attempts at systematically assessing prodromal signs retrospectively were made in the context of targeted antipsychotic therapy of relapses. The advantages of this procedure are that the prodromal symptoms of relapses are not as remote in time as those of the first episode and that their prognostic efficiency can be prospectively validated [100105]. The results obtained were valuable, but of insufficient predictive power, presumably due to differences in the type of prodromal signs included in the assessments and insufficient monitoring of their development over time.

In addition it is unclear whether the first psychotic episode is preceded by an interindividually identical pattern of prodromal symptoms and whether the prodromal symptoms in each individual case undergo changes in type and sequence. Meanwhile, intraindividual stability is presumed in clinical practice, and on that basis educational interventions are being offered particularly in relapse-oriented, targeted and crisis-intervention therapy [74,106-109].

Table 1.4 The ten most frequent earliest signs of schizophrenia (independent of the course) reported by the patients

Total

Men

Women

(n = 232)

(n = 108)

(n = 124)

%

%

%

Restlessness

19

15

22

Depression

19

15

22

Anxiety

18

17

19

Trouble with thinking and concentration

16

19

14

Worrying

15

9

20

Lack of self-confidence

13

10

15

Lack of energy, slowness

12

8

15

Poor work performance

11

12

10

Social withdrawal, distrust

10

8

12

Social withdrawal, communication

10

8

12

All items were tested for gender differences. Only "worrying" showed a significant difference (p < 0.05).

Source: modified from Hafner et al. [10] by permission of Springer-Verlag.

All items were tested for gender differences. Only "worrying" showed a significant difference (p < 0.05).

Source: modified from Hafner et al. [10] by permission of Springer-Verlag.

Various items from scales for the identification of early signs and symptoms of psychotic relapses [102,110] have been integrated in subsequently generated instruments for the assessment of onset and early course in schizophrenia [24-26,111,112].

Systematic studies of the onset and prodromal symptoms of schizophrenia have relied on retrospective assessments of representative samples of first-episode cases of schizophrenia. Table 1.4, taken from the ABC Schizophrenia Study, shows the ten most frequent initial symptoms. These symptoms are equally frequent in men and women, except worrying, an item which is also more frequent in women in population studies. The majority of these items belong to two symptom dimensions, the affective-depressive and the negative one. The early occurrence of indicators of functional impairment, such as trouble with thinking and concentration or loss of energy, pointed to a risk of early consequences of the disorder in terms of global dysfunction and social decline.

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