Early Schizophrenia

Abstract

This is a report of a phenomenological and descriptive study of forty-four patients seen early in their first hospitalization for schizophrenia. Most patients had a prodromal phase (median duration 30 months) during which the commonest symptoms were decreased drive and dysphoria. Symptomatology was often similar to that of a reactive depression; there was no instance resembling endogenous depression. A prodromal triad of deterioration in school or work performance, schizoid withdrawal and anergia was identified and this may have some diagnostic use. Twelve of the fifteen patients who exhibited this triad had also experienced disturbed flow of thought. Some patients experienced increased sexual drive, usually towards the end of the prodromal phase or in early overt psychosis. Some also reported regular fluctuations in symptomatology; these cycles, usually of a few good days and a few bad days, occurred in the prodromal phase and/or early overt psychosis. The transition to manifest psychosis was usually quite abrupt. An oneirophrenic experience, termed a ‘complex state”, was common either at the beginning of psychosis or soon thereafter. In the ‘complex state” a number of symptoms are experienced together or in such rapid succession that separating them is artificial. Perplexity and emotional arousal, usually dysphoric, are always present, and there is invariably at least one symptom of disturbed perception or delusion. Perceptual disturbances may affect any modality and often more than one; the perceptual alterations may be simple or complex. Disturbances of visual perception were reported more frequently than might have been expected, tending to be associated with good prognosis. Motor blocking, slowing or inco-ordination may occur, and although clouding of consciousness was experienced as part of the complex state, it was not possible to document this satisfactorily. Delusions usually developed within complex states or more commonly as explanations of them, so that the concept of primary delusion may be invalid. These findings were further discussed with particular reference to the work of Conrad and Chapman.

Pathways to schizophrenic psychosis: A LISREL-tested model of the unfolding of the schizophrenic prodrome

“…Reviewing the literature on the process of psychotic decompensation in schizophrenia (e.g., Arieti, 1955;Cameron, 1938;Chapman, 1966;Conrad, 1958;Sullivan, 1962;Varsamis & Adamson, 1971), the authors claimed to have noted a remarkable concordant description not only of identifiable premonitory features but also of a regular and sequential unfolding of psychological states before and during psychotic breakdown. Given this uniformity, it was felt to be relatively simple to construct a comprehensive picture of the decompensation process in which five stages of onset were discerned:…”

“…Indeed, this is precisely the reason why some prodromal features, such as social withdrawal and general decreased drive (see, e.g., Varsamis & Adamson, 1971), are termed uncharacteristic, whereas others, such as delusional thinking and perceptual disturbances (e.g., Chapman, 1966;Møller & Husby, 2000), which are often interpreted as attenuated psychotic symptoms, have been called relatively specific. However, in both Kraepelin's (1913) and Bleuler's (1911) original characterization of schizophrenia (or dementia praecox), the so-called "Grundsymptome" (fundamental symptoms) constitute the most defining and specific features of the disorder, whereas hallucinations and delusions (and also catatonic symptoms) are held to be only accessory and highly unspecific.…”

“…For instance, in Varsamis and Adamson's (1971) retrospective study five symptom categories could be distinguished-e.g., "disturbances of affect," "disturbances of drive," and "changes in the relation to the environment"-that included such features as anxiety, suspiciousness, slowed thinking, and schizoid withdrawal. Another example is Møller and Husby's (2000) investigation in which eight groups of prodromal experience were discernede.g., "disturbance of perception of self," "neuroticlike disturbances," and "attenuated delusional ideas or perceptions"-as well as four dimensions of prodromal behavior, e.g., "shifts of interest," and "withdrawal and extreme social avoidance.…”

Prediction and prevention of transition to psychosis in young people at incipient risk for schizophrenia

“…Keith and Matthews [1991] defined the prodromal phase of psychotic disorders as “a heterogenous group of behaviors temporally related to the onset of psychosis” (p. 53) that impacts on thought processes, emotions and behavior. Some authors have stated that virtually all patients with schizophrenia have experienced a prodromal phase of illness whilst others have reported that some patients experience a very rapid onset of symptoms at acute intensity with very little or no prodromal component [Varsamis and Adamson, 1971].…”

The Ultra High Risk Approach to Define Psychosis Risk

“…Typical prodromal symptoms include sleep disturbance, lowered mood, irritability, anxiety and decline in school or work performance [2,4,5]. This clinical picture could be the result of a number of conditions, such as major depression, substance abuse and physical illness, as well as a psychotic prodrome.…”