Recognizing the early stages of psychotic relapse is a key to effective
management of patients with schizophrenia, said Dr. Marvin I. Herz at the APA
annual meeting.

Prodromal (or early stage) signs, which often precede a psychotic episode by 2 or more days, include sudden onset of

• insomnia,
• tension,
• anxiety,
• inability to concentrate,
• restlessness, and
• depression.

'You can pickup on sudden change behaviors, said Dr. Herz, professor of
psychiatry at University of Rochester (NY) School of Medicine and Dentistry.

Among the examples he gave were sudden withdrawal from social interaction,
excessive preoccupation with religious ideas, and drastic changes of
appearance such as shaving the head, or suddenly wearing exaggerated make-up
when previously the patient wore none.

According to Gerard E Hogarty, of the Western Psychiatric Institute,
Pittsburgh, the prodrome manifests' as affective behavior.

Look for signs of affective dysregulation such as increased irritability,
unfounded sadness, or ill-defined anxiety.

'Do a thorough history. Ask patients if they remember what was going on
before their previous episodes,' Mr. Hogarty advised Dr. Herz stressed,'There is
no substitute for knowing your patients. It would be helpful to have biological or
laboratory markers [for impending psychotic episodes], but we don't.

He and Mr. Hogarty believe patients and their families can be taught to
recognize the patients prodromal signals, opening a window of several days in
which to intervene by adjusting medication doses or supportive therapy.