Schizophrenia Daily News Blog

Early Symptoms of Schizophrenia

Norman RM, Scholten DJ, Malla AK, Ballageer T.
Early signs in schizophrenia spectrum disorders.
J Nerv Ment Dis. 2005 Jan;193(1):17-23.

This study focuses on early signs of schizophrenia. It is known that generally people who experience dramatic symptoms of schizophrenia, such as delusions and hallucinations, generally have a period of time before the illness in which they suffer from disturbances of their thinking and other problems. Most commonly they are seen to have decreased motivation, decreased concentration, sleep changes, behavioral changes, loss of functional ability in work/school, social withdrawal, problems with anger, anxiety, and lower energy. It can be difficult to put these symptoms together with the onset of schizophrenia however because these are similar symptoms to many other psychiatric disorders. The authors of this study attempt to specifically look at the before onset or prodromal symptoms such that one can make a more accurate prediction of functioning for potential schizophrenia patients at one year later.

The description of early signs in schizophrenia may be helpful for many reasons. It has been hypothesized in the past that the prodromal symptoms may most closely resemble the residual symptoms that one might have after treatment is initiated. Whether that theory is true is somewhat debatable, however it is well accepted that early symptoms should be looked at for prognostic value as well as to sharpen early diagnosis.

The authors followed 96 patients and rated them for various signs and symptoms. Subjects could be enrolled in the study only if they had been treated for no longer than one month previously. They were also excluded if their current symptoms precluded their ability to give a meaningful history of their past symptoms. An interview was conducted in which the subject was asked questions about when they first began to have difficulties in social/work/school settings. The interview sought to differentiate between personality characteristics (like shyness) that the subject had always had and tried to focus on the symptoms that may have coincided with their onset of symptoms (the beginning of the prodrome.) The interviewer asked about 25 specific symptoms based on the “instrument for the retrospective assessment of the onset of schizophrenia.” They were also asked if there were possible signs/symptoms that were not included as part of that list that they felt should be mentioned. Patients were also assessed for a history of substance abuse. While some consider that to highlight a possible onset of the prodrome, the authors did not consider that to be the case, but did keep the substance use data to help understand the role that substances might have in early signs of mental illness.

After compiling the lists of symptoms for each subject, the authors tabulated that the most common early symptoms were typically in the social/behavioral arena. The most common was decreased social/occupational functioning (over 70%) and the second was social withdrawal (just over 50%). From these tabulations, the authors created 5 overall factors to further analyze the data. These factors took combinations of symptoms into account based on complicated mathematical formulas. They can be summarized into the following five categories: dysphoria, functioning, psychobiological, preoccupation, irritability/aggression.

Looking at the data after one year, only the “functioning” group of symptoms showed any significant findings. People with a higher score in the functioning category (more significant impairment) showed more negative symptoms at one year duration. Conversely, those with a higher score in the psychobiological score (depression/anxiety, restlessness, insomnia) often showed lesser dysfunction with respect to positive symptoms at one year.

There has been research in the past that has showed that depression did not portend an increase in positive symptoms, but this study actually showed that mood symptoms were protective of hallucination/delusions. However, due to many limitations in this study, it is hard to make a firm conclusion that mood symptoms are protective. Rather, one could say that this is further evidence that depression does not portend a worse prognosis in someone with new onset psychosis. It is also possible that the mood symptoms contributed to the original pre-psychotic pattern and that with adequate correction of the depression, some of the psychosis abated. There is a lot of room on the psychosis spectrum for mood related psychosis of varying degrees and in these pre-psychotic patients, perhaps for those with prominent mood symptoms there was a greater contribution towards the psychotic pattern from their mood than for the other patients. Additionally, there is the possibility that the mood reflects underlying stressors in the patient’s life. These stressors are likely to remit and concurrently the level of dysfunction may remit similarly if stress is a prominent factor. It was noted more than 25 years ago that stress-related psychosis were more responsive to treatment; perhaps because of the different mechanism involved than a classic schizophrenia pattern. Ultimately, more work will need to be done to further elucidate the relationship between early onset signs of psychosis and the impact of mood and stress and how it relates to prognosis.

Click here for the article on PubMed