Introduction

Prodromal symptoms occurring before the first-ever onset or relapse of schizophrenia were observed a long time ago. In 1861 the pioneer of modern, scientifically oriented psychiatry, the Berlin-based psychiatrist Wilhelm Griesinger [1], described a melancholic prodromal stage that tends to precede psychosis. Kraepelin [2] described a series of ''minor changes in mood, which may be recurrent or persist for weeks, months or even for years as the only premonitory signs of an imminent mental disorder''. The main symptoms of this ''stage of the prodrome'' were ''increased irritability and moodiness, restlessness, unmotivated spells of high or frequently low spirits... Further prodromal signs that can be observed frequently are absent-mindedness, lack of interest or markedly increased activity''.

Bleuler [3] called this premonitory stage latent schizophrenia and described it as characterized by irritability, introversion and eccentric behaviour. He put forward the hypothesis, later revived by Hafner [4] and Maier et al. [5], that the underlying disease process may come to a halt at any stage of its early development. Such a process ending prematurely may bring forth mild, nonpsychotic symptoms such as schizoid or schizotypal personality disorders.

In the period during and following World War I research on the topic lacked in vigour, but was soon resumed by Sullivan [6] in a hope of finding reliable early prognostic indicators of psychosis as a basis for early treatment. Proceeding from a psychoanalytical-psychodynamic theory, Sullivan based his explicatory models on neurotic reaction patterns, such as hysteria, neurasthenia and obsessive-compulsive reactions. The sequence of these reaction patterns at the prodromal stage of psychosis

Early Detection and Management of Mental Disorders.

Edited by Mario Maj, Juan Jose? Lopez-Ibor, Norman Sartorius, Mitsumoto Sato and Ahmed Okasha. ©2005 John Wiley & Sons Ltd. ISBN 0-470-01083-5.

was seen by Sullivan as a hierarchical sequence of neurotic defence mechanisms adopted to fend off more severe psychopathology as the disorder progresses.

After Sullivan's unsuccessful endeavours to find reliable prognostic indicators of incipient psychosis, Cameron [7,8] set out to study the prodromal stage of schizophrenia in greater detail by clinical methods. Cameron [7] was also the first to assess the duration of untreated psychosis (DUP): 32.4% of the patients he studied had suffered from more or less rapidly accumulating psychotic symptoms for up to six months from their onset until first admission, 17.5% for six months to two years and 48.1% for more than two years. He found [8] that 83% of these patients first admitted because of schizophrenia had suffered a prepsychotic prodromal stage marked by deteriorating functioning, affective blunting, social withdrawal and bizarre thoughts and convictions. In most cases the prepsychotic prodromal stage showed a smooth transition to paranoid delusions and other positive symptoms of full-blown psychosis.

Cameron defined the DUP by two timepoints that can be determined fairly reliably, i.e. by onset of psychotic symptoms and first admission. For this reason his estimates can be compared with results based on similar definitions from more recent studies, as reflected in the similarity of the results [9,10] presented in Table 1.1.

BiPolar Explained

BiPolar Explained

Bipolar is a condition that wreaks havoc on those that it affects. If you suffer from Bipolar, chances are that your family suffers right with you. No matter if you are that family member trying to learn to cope or you are the person that has been diagnosed, there is hope out there.

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