Schizophrenia is a lifelong mental health condition in which people experience hallucinations and delusions that skew their perception of reality. While the condition onset varies from person to person, it typically occurs in three phases: ¹

• The prodromal phase
• The active phase
• The recovery phase

Throughout this article, we’ll take a deeper look at these phases of schizophrenia and how they impact a person’s life.

What is Prodromal Schizophrenia?

Prodromal schizophrenia is the first and earliest stage of the condition. During this period, a person may notice changes in how they think, feel, or behave. However, it’s unlikely they’ll begin to experience symptoms of schizophrenia, such as hallucinations or delusions. ²

This phase of schizophrenia doesn’t occur in everyone. In fact, some people may experience symptoms so mild that they don’t even realize the disease is progressing. For this reason, it’s difficult for medical professionals to understand how long prodromal schizophrenia lasts.

In fact, most people at this stage will notice their own symptoms before others around them do. With that said, the person who struggles may pass it off as just a random bout and not consider serious treatment.

In some cases, people think they experience side effects from medication. Or that they struggle with another condition, such as anxiety, depression, or stress.

The prodromal phase of schizophrenia typically begins during the adolescent years but can hold off until young adulthood. ³

Prodromal Schizophrenia Symptoms

As mentioned, those in the prodromal phase typically experience mild symptoms, many of which aren’t noticeable. It’s not until the active phase that a person will start to notice symptoms commonly found in schizophrenia.

However, some people with prodromal schizophrenia may notice: ⁴

• Anxiety
• Concentration problems
• Difficulty with sleep
• Early signs of memory loss
• Fatigue
• Lack of appetite
• Loss of motivation
• Mood swings

According to “The Diagnostic and Statistical Manual of Mental Disorders,” there are nine specific symptoms an individual must experience to be diagnosed with schizophrenia. These include:

• Abnormal behavior
• Deviation in speech quality
• Impairment to regular functioning
• Lack of personal hygiene and grooming
• Loss of energy
• Social withdrawal
• Strange experiences
• Unusual behaviors
• Weakened or inappropriate responses

Diagnosing Prodromal Schizophrenia

Out of all three stages, diagnosing prodromal schizophrenia is the most difficult. Since symptoms aren’t apparent and those struggling likely won’t make an issue of them, these symptoms are typically overlooked for other mental health conditions, such as depression.

For these reasons, it’s unlikely for schizophrenia to be diagnosed before the active phase.

Still, doctors may pinpoint certain aspects of schizophrenia during the prodromal phase that lead to a proper diagnosis. For example, they may recognize that someone in your family has struggled with schizophrenia and therefore, can conclude you’re more susceptible to it. ⁵

Other risk factors for schizophrenia include being exposed to an environment where toxins and viral infections are present. ⁶

To come to a proper diagnosis, your doctor can run several tests. These include psychiatric and pediatric evaluations.

However, schizophrenia diagnosis has made a lot of progress over the last few decades. And doctors are now equipped with more tools that can lead to proper treatment. These include:

• Bonn Scale for the Assessment of Basic Symptoms (BSABS)
• Comprehensive Assessment of ARMS (CAARMS)
• Scale for Prodromal Symptoms (SOPS)
• Structured Interview for Prodromal Symptoms (SIPS)

It’s worth discussing these tests with your doctor if you believe you or a loved one is struggling with prodromal schizophrenia. Furthermore, it’s worth noting that a 2001 study found the Bonn Scale for the Assessment of Basic Symptoms (BSABS) was very effective in detecting early stages of the condition. ⁷

How to Treat Prodromal Schizophrenia

Since there is no cure for schizophrenia, treatment involves the reduction of symptoms to the point where a person can go on to live a normal life. To do this, patients will take a combination of medication and psychotherapy. ⁸

It should be noted that treatment typically occurs when symptoms are most apparent (in the active phase). It may be difficult to treat symptoms in the prodromal phase as they aren’t as obvious to your doctor.

For example, if you don’t yet experience hallucinations or delusions, it’s unclear which symptoms to target with medication and psychotherapy.

Medication

Currently, there is no medication available to target the prodromal phase of schizophrenia. However, several exist to relieve symptoms during the active phase.

The most common of these are antipsychotics (such as Abilify, Rexulti, and Zyprexa) which can help to relieve delusions and hallucinations.

Depending on symptoms, a person may also receive antidepressants or mood stabilizers to reduce potential triggers of psychosis, such as stress.

Psychotherapy

If you are diagnosed with prodromal schizophrenia, you’ll likely be recommended a form of psychotherapy. These can come in various shapes and sizes, including individual or group therapy.

However, the most prominent psychotherapy for schizophrenia is cognitive behavioral therapy (CBT). This involves the patient finding the source of their symptoms and negative thought patterns and developing coping mechanisms to overcome symptoms. ⁹

Final Word

If you struggle with prodromal schizophrenia, it’s going to be difficult to treat as there currently are no set-and-stone treatment procedures. However, through psychotherapy, it’s likely that by identifying symptoms early, you’ll prevent the condition from becoming worse.

If you have a loved one who you believe is in the prodromal phase of schizophrenia, it’s important to contact a doctor. While treatment and diagnosis methods aren’t 100% accurate, they can determine whether or not your loved one struggles with another condition.

References

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² George M, Maheshwari S, Chandran S, Manohar JS, Sathyanarayana Rao TS. Understanding the schizophrenia prodrome. Indian J Psychiatry. 2017 Oct-Dec;59(4):505-509. doi: 10.4103/psychiatry.IndianJPsychiatry_464_17. PMID: 29497198; PMCID: PMC5806335.

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⁴ Larson MK, Walker EF, Compton MT. Early signs, diagnosis and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders. Expert Rev Neurother. 2010 Aug;10(8):1347-59. doi: 10.1586/ern.10.93. PMID: 20662758; PMCID: PMC2930984.

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⁶ Janoutová J, Janácková P, Serý O, Zeman T, Ambroz P, Kovalová M, Varechová K, Hosák L, Jirík V, Janout V. Epidemiology and risk factors of schizophrenia. Neuro Endocrinol Lett. 2016;37(1):1-8. PMID: 26994378.

⁷ Klosterkötter J, Hellmich M, Steinmeyer EM, Schultze-Lutter F. Diagnosing schizophrenia in the initial prodromal phase. Arch Gen Psychiatry. 2001 Feb;58(2):158-64. doi: 10.1001/archpsyc.58.2.158. PMID: 11177117.

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⁹ Morrison AK. Cognitive behavior therapy for people with schizophrenia. Psychiatry (Edgmont). 2009 Dec;6(12):32-9. PMID: 20104290; PMCID: PMC2811142.