The Prodromal Phase of the Depressive Psychosis

Early Identification and Intervention in Depressive Disorders: Towards a Clinical Staging Model

“…Fava and Tossani [31] reviewed the evidence for this, drawing predominantly on association studies. The authors emphasized three key issues: (1) that anxiety and irritability are commonly observed in the prodromal phase of depression [30,32,33,34,35]; (2) that subthreshold or minor depression is implicated as a risk factor for the development of major depression, which reinforces the notion that depressive symptoms occur on a continuum rather than in discrete categories [36,37,38], and (3) that these symptoms are present in the first and subsequent episodes of major depression, which may inform efforts toward relapse prevention [31]. Building on Fava’s work, this notion of a prodrome has the potential to provide a recognizable point of intervention to prevent the onset of a first episode.…”

Prodromal stage of major depression

“…Four symptom patterns emerged: (i) sudden‐onset depressions (associated with melancholic features and bipolar disorder); (ii) gradual‐onset depressions, where mood disorder takes months to develop and is related to common stressful life events; (iii) neurotic‐onset depressions, commonly preceded by anxiety disorders; and (iv) ‘fluctuating onset’ depressions, in which symptoms displayed considerable fluctuations in severity before reaching full force 48 . Hopkinson interviewed 43 patients suffering from ‘depressive psychosis’ 49 . About 30% showed a prodromal phase characterized by ‘tension and vague feelings of anxiety’, and less other symptoms such as indecision and impaired concentration.…”

“…48 Hopkinson interviewed 43 patients suffering from 'depressive psychosis'. 49 About 30% showed a prodromal phase characterized by 'tension and vague feelings of anxiety', and less other symptoms such as indecision and impaired concentration. Other studies dealt with the rapidity of onset of depressive symptoms.…”

Prodromal Symptoms and Intermittent Drug Medication in Mood Disorders

“…While a rapid build-up of mania in one to seven days was typical (Bunney et al, 1972;Carlson and Goodwin, 1973;Post et al, 1981), the speed of onset of major depression appeared to be more varied. A rapid onset of symptoms was associated with bipolar illness and the endogenous subtype of depression (Hays, 1964;Hopkinson, 1965;Young and Grabler, 1985) as weil as with organic afTective syndromes (Fava et al, 1987); a very gradual onset of depressive symptoms was also reported, whether or not superimposed on another psychiatrie disorder. In Hopkinson's study (1965), about 30 % of patients showed a prodromal phase characterized by "tension and vague feelings of anxiety" and more seldom symptoms such as indecision and impaired concentration.…”