Prodromal Phase

When approaching the treatment of schizophrenia, it is best to view the illness in one of four distinct phases prodromal phase, acute phase, maintenance phase, and residual phase. Let us take a look at the treatment options at each of these phases of the illness. 

This is the first phase of illness occurring before the start of overt psychotic symptoms. During this phase, patients so seldom come to clinical attention that we know very little about the appropriateness of various treatment options. It may be that early intervention can alter the course and lessen the ultimate severity of the illness, but this is far ahead of our current knowledge about schizophrenia. 

The symptoms during this phase of illness are not particularly specific to schizophrenia. They often resemble, in many respects, depression or even one of the Cluster A personality disorders. The decision to initiate antipsychotic medication at this stage depends on the degree of certainty of the diagnosis, the severity of the symptoms, and the risk and benefits of the medication. 

In cases where there is a strong family history of schizophrenia and the symptoms are particularly ominous, many clinicians will recommend antipsychotic treatment during the prodromal phase. Low doses of an atypical antipsychotic (other than clozapine) probably offer the best promise of a treatment response with a minimal risk of problematic side effects. 

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Leading up to the first break, most individuals with schizophrenia go through a prodromal phase of illness. This prodrome is a departure from the patient s usual behavior, but patients seldom seek treatment during this phase. The prodromal symptoms are usually limited to negative symptoms of apathy or social isolation or to lesser variants of the positive symptoms taking the form of eccentric beliefs or a... 

Most effective when given during the prodromal phase. 

Klosterkotter J, Hellmich M, Steinmeyer EM, Schultze-Lutter F. 2001. Diagnosing schizophrenia in the initial prodromal phase. Arch Gen Psychiatry 58 158-164. 

A typical course following a whole body exposure to a source ot penetrating radiation Mtvdves an filial prodromal phase with syipploms such as nausea, vomiting, fatigue and possibly fever and diar-... 

Diagnosis. The prodromal phase is characterized by headache, malaise, fever, and chills, followed in 1 or 2 days by neuralgic pain and 2 or 3 days later by hot, flushed, hyperesthesia and edema of the involved dermatome(s).The skin overlying the affected area then erupts with a single crop of clear vesicles. The vesicles are distributed on only one side of the face and almost never cross more than 1 to 2 mm beyond the midline (Figure 23-17). These vesicles then become yellow and turbid and by day 7 to 10 form deep scab-like eschars. 

Prodromal phase This is characterized by such vague complaints as weakness, mental slowness, short memory, reduced working capacity, insomnia, headache, and anxiety. These sjmptoms can easily be dismissed as non-specific, and can persist for more than 2 years before further signs develop. In general, however, the course is gradually progressive toward the symptoms of the next phase. 

A new approach to the study of the effects of hormone replacement therapy on the breast is to examine breast density, using mammography and the Wolfe classification. In a randomized study of 166 menopausal women, using this technique, there was increased breast density after 6 months of treatment eight times more commonly in those who took estradiol and norethisterone acetate than in those who took tibolone (167). The significance of this increased density is not clear, but it should for the present be regarded as undesirable, perhaps representing the prodromal phase of more serious complications. 

Outbreaks may begin with a prodromal phase of up to 24 hours before any visible signs appear, during which the area on or around the lips begins to tingle, burn or itch. 

Slapped face with sharp, raised borders sparing circumoral area and bridge of nose appears between prodromal phase and before onset of rash on body... 

Occurs only in prodromal phase (prior to onset of rash)... 

Clinical Course of Radiation Sickness. The three syndromes described follow a similar clinical pattern that can be divided into three phases an initial or prodromal phase occurring during the first few hours after exposure a latent phase, which becomes shorter with increasing dose and the manifest phase of clinical illness. 

A. Prodromal Phase. The initial phase of prodromal symptoms is characterized by the relatively rapid onset of nausea, vomiting, and malaise. This is a nonspecific clinical response to acute radiation exposure. It is not diagnostic of the degree of radiation injury however, in the absence of associated trauma and an early onset, it does suggest a large radiation exposure. The duration of this prodromal phase is short, generally a few hours, and the incapacitation should not be severe enough to warrant evacuation of military personnel away from their units. 

C. Radiation Injury Severe. These casualties are judged to have received a radiation dose that is potentially fatal. Nausea and vomiting will be almost universal for persons in this group. The prodromal phase may also include prompt explosive bloody diarrhea, significant hypotension, and signs of necrologic injury. These patients should be sorted according to the availability of resources. Patients should receive symptomatic care. Lymphocyte analysis is necessary to support this classification. 

A person with smallpox is sometimes contagious with onset of fever (prodrome phase), but the person becomes most contagious with the onset of rash. At this stage the infected person is usually very sick and not able to move around in the community. The infected person is contagious until the last smallpox scab falls off. 

The first symptoms of smallpox include fever, malaise, head and body aches, and sometimes vomiting. The fever is usually high, in the range of 101 to 104 degrees Fahrenheit. At this time, people are usually too sick to carry on their normal activities. This is called the prodrome phase and may last for 2 to 4 days. 

Smallpox may be contagious during the prodrome phase, but is most infectious during the first 7 to 10 days following rash onset. 

Prodromal phase In an infectious disease, the short period during which non-specific symptoms such as malaise and headache sometimes appear. 

The decades-long prodromal phase over which AD develops suggested slow but progressive accumulation of aluminium in susceptible cell types of AD-vulnerable brain regions to toxic levels by old age, giving rise to AD neuropathology without rapid neuronal lysis. 

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