Schizophrenia prodromal

Woods SW, Thomas L, Tully E, Hawkins KA, Miller TJ, et al. 2004. Effects of oral glycine in the schizophrenia prodrome. Schiz Res. 70 79. 

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... 

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. 

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. 

Kablinger AS, Freeman AM. Prodromal schizophrenia and atypical antipsychotic treatment. J Nerv Ment Dis 2000 188(10) 642-652. 

Muller and Schoneich (1992) also reported on favorable experience with intensive outpatient psychotherapy combined with antipsychotic drug treatment. On the basis of a before-and-after comparison over 2x5 years in a university outpatient clinic, they were able to show that the duration of rehospitalizations required by 89 patients could be reduced from a mean of 10 weeks to 2 weeks per year when a special schizophrenia outpatient service offering individualized psychotherapy and psychosocial treatment was available to the patients instead of the routine psychiatric outpatient service. A beneficial effect of psychotherapy was demonstrated both in those patients taking antipsvchotics continuously for long-term prophylaxis and in those taking the drugs intermittently when prodromal symptoms appeared in order to prevent relapse. 

Patients with this condition manifest the symptoms of an acute exacerbation of schizophrenia, with symptoms lasting at least one month, but they make a complete recovery, with the prodromal, active, and residual phases remitting in less than 6 months. 

Herz M (1985) Prodromal symptoms and prevention of relapse in schizophrenia. J Clin... 

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

Both medical iflnesses and medications can cause psychiatric symptoms. The rapidity of onset of psychiatric symptoms is an important clue that a medical cause may be present. Most chronic mental illnesses have a prodromal period, whereas medically based psychiatric symptoms often have a more rapid onset of symptoms. Patients over age 40 at first presentation are more likely to have a medical cause for their psychiatric symptoms because major psychiatric illnesses such as schizophrenia and bipolar disorder usually first present in adolescence or early adulthood. A family history of physical illnesses with a psychiatric component, such as Huntington s chorea or systemic lupus erythematosus, may provide an additional clue. 

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