Schizophrenia Prodrome Research Articles

2 core experiential and 4 behavioural dimensions of the initial prodrome in schizophrenia emerged

2 core experiential and 4 behavioural dimensions of the initial prodrome in schizophrenia emerged

97. The hillside RAPP clinic: why the sudden interest in the schizophrenia prodrome?

97. The hillside RAPP clinic: why the sudden interest in the schizophrenia prodrome?

The initial prodrome in schizophrenia: searching for naturalistic core dimensions of experience and behavior.

The scientific exploration of prepsychotic detection and intervention in psychosis has just commenced. To identify developing psychosis at prodromal stages, it is important to learn how patients and families perceive initial prodromes naturalistically. We must understand better what we are going to detect, because the essential components of this phase, particularly the subjective experiences, remain unsettled. In a series of 19 first episode DSM-IV schizophrenia patients, we explore prodromal phenomena in depth and identify potential core dimensions. On the basis of our findings, we describe experiences and behaviors that appear to be essential components of initial prodromes. The subjects reported serious difficulties interpreting and talking about prodromal experiences at the time these occurred, causing delayed identification. We report detailed reasons for this, pointing out vulnerable aspects of at-risk assessments. From eight proposed groups of experiences, two are highlighted as tentative core dimensions: "disturbance of perception of self" and "extreme preoccupation by and withdrawal to overvalued ideas." Four potential dimensions of prodromal behavior are also identified: (1) quit school, university, or job, or major school truancy, (2) marked and lasting observable shift of interests, (3) marked and lasting social passivity, withdrawal, or isolation, and (4) marked and lasting change in global appearance or behavior. We argue that the findings, the phenomena, and their significance in prodromes are valid because they are logical and coherent in light of clinical experience as well as the empirical literature of a full century.

The symptom onset in schizophrenia (SOS) scale: Test-retest reliability

The ability to detect individuals at high risk for developing schizophrenia before they express the disease will lead to targeted early intervention. It has been proposed that subjects at risk share a core deficit with people who already have schizophrenia. This includes cognitive impairment, affective symptoms, social isolation and decline in social functioning. In a sample of 104 help-seeking patients from a specialised outpatient clinic we investigated how well two different sets of criteria define the at-risk group and capture this core deficit. One set of criteria is the well-established ultra high-risk model of McGlashan et al. [McGlashan 2001 (SIPS) McGlashan, T. H., Miller, T. J., Woods, S. W., et al. (2001) Structured Interview for Prodromal Syndromes (Version 3.0, unpublished manuscript). New Haven, Connecticut: PRIME Research Clinic, Yale School of Medicine.]; the other criteria were those defined by Cornblatt et al. [Cornblatt, B., Lencz, T., Smith, C.W., Correll, C.U., Auther, A., Nakayama, E., 2003. The schizophrenia prodrome revisited: a neurodevelopmental perspective. Schizophr. Bull. 29, 633–651.]. There was considerable overlap in the two sets of criteria. However, when the basic symptoms of Klosterkötter [Klosterkötter, J., Hellmich, M., Steinmeyer, E.M., Schultze-Lutter, F., 2001a. Diagnosing schizophrenia in the initial prodromal phase. Arch. Gen. Psychiatry, 58, 158–164.] were included in the McGlashan et al. model, a more narrow and homogeneous group was defined.

Prevalence of depressive symptoms early in the course of schizophrenia.

The rate of depressive symptoms early in the course of schizophrenia was determined. Seventy subjects with recent-onset schizophrenia were followed for 5 years by using semistructured interview instruments. The initial assessment included ratings of each criterion A symptom of a DSM-III-R major depressive episode. The rates of symptoms experienced with at least moderate severity were calculated, and an algorithm based on DSM identified subjects meeting the criteria for a major depressive episode. Four symptoms were present to at least a moderate degree in a majority of subjects, while no symptom was present in fewer than 12% of subjects. More than one-third of the subjects met the algorithmic criteria for a major depressive episode at the time of intake. Depressive symptoms are common early in the course of schizophrenia. This finding is consistent with other recent data and has potential implications for current diagnostic and treatment practices.

279. The hillside rapp clinic: intervention during the schizophrenia prodrome

cognitive impairmentin healthy volunteersthat resembles aspects of schizophrenia.This similarity has been viewed as evidence for the involvement of the NMDA receptor is schizophrenia.We utilized subanesthetic doses of the NMDA antagonist, ketamine, to induce formal thoughtdisorder in healthy volunteers.Thoughtdisorder was assessedwith the Scale of the Assessmentof Thought,Language,and Communication(TLC). Formal thought disorder in schizophrenic patients was similarly assessed with the TLC. We analyzed both groups of TLC ratings utilizing factors, as well as individual items and comparedthe two. Total TLC scores did not differ significantly between groups. Similarly, scores on the unidimensional seventy factor did not significantlydiffer; the positiveandnegativefactorsdid not significantlydiffer; and the verbal productionand disconnection factors failed to significantlydiffer. Of individualTLC items, only perseveration differed significantly between the two groups; with Bonferroni correction, no items differed significantly. Among the schizophrenicpatients,highest item scores were in povertyof speech, circumstantiality, loss of goal and poverty of content. In healthy volunteers receiving ketamine, highest scores were in the items for poverty of speech, circumstantiality,loss of goal and perseveration. These data suggestthat ketamine-inducedthoughtdisorderin healthy volunteersresembles schizophrenicthoughtdisorder.

The prevalence of prodromal features of schizophrenia in adolescence: a preliminary survey.

In most cases of schizophrenia the onset of frank psychosis is preceded by a period of prodromal features. This period has been relatively neglected by researchers and is potentially important in promoting early intervention. The prevalence of DSM-III-R schizophrenia prodrome symptoms was assessed as part (n = 657) of a large (n = 2525) questionnaire-based survey of high school students. Individual symptoms were highly prevalent and the prevalence of DSM-III-R prodromes ranged from 10 - 15% to 50%. Despite methodological weaknesses, the data suggest that DSM-III-R prodromal features are extremely prevalent among older adolescents and unlikely to be specific for subsequent schizophrenia. Clinically these features cannot be regarded as sufficient evidence of early schizophrenia and more accurate predictors of incipient schizophrenia need to be defined.