Understanding a Prodromal Schizophrenia Diagnosis: Recognizing Symptoms and How Residential Treatment Can Help

One important thing to understand about schizophrenia is that it often progresses through stages. Most people first go through a prodromal stage, transition to an active stage, and finally see symptoms ease into a residual stage. Every person has a unique experience and may skip a stage, go through them for different durations or at different ages, and have symptoms of varying severity.

• Prodrome. The idea of a prodromal phase of schizophrenia dates back more than 100 years but has only recently been fully accepted. Symptoms include a range of unusual behavioral changes. The prodrome typically lasts for several years and causes many of the social consequences of schizophrenia.
• Active. This is when true psychosis begins and when an individual can be diagnosed with schizophrenia. It causes the characteristic symptoms of delusions, hallucinations, changes in motor behaviors, inappropriate emotional responses, and confused, disordered thoughts and speech.
• Residual. The active stage of schizophrenia is not indefinite. It often reverts to milder symptoms, similar to those seen in the prodrome. Many people go back to the active phase from here.

The recognition of the prodromal phase makes earlier interventions possible, which improves the prognosis for someone ultimately diagnosed with schizophrenia. If someone in your life has started acting unusual and is exhibiting troubling behavioral or personality changes, do not take them lightly.

Reach out to get help, to get a diagnosis, even just to see your loved one’s doctor or pediatrician. Be aware of the symptoms and signs of prodromal schizophrenia so you can act quickly:

• Social isolation and withdrawing from friends, family, and activities
• Anxiety
• Irritability
• Difficulty focusing, paying attention, and making decisions
• Apathy and lack of motivation
• Changes in sleep habits
• Neglecting personal hygiene
• Inappropriate reactions or emotional responses to people and situations

Prodromal schizophrenia often begins in the teenage years or in the 20s. This can make some of the signs difficult to distinguish from typical teen or young adult behaviors. Be especially concerned if someone you know well is behaving in ways that are particularly unusual for them.

Since experts began to recognize this early phase, they have been able to develop more focused treatments to delay onset of active schizophrenia and for better overall outcomes. Treatment for prodromal schizophrenia usually includes the same elements as for schizophrenia. What is most important is to create and adjust treatment for the specific needs of each individual.

• Medications. Patients with schizophrenia usually take antipsychotics to control symptoms like delusions and hallucinations. Those in the prodrome may benefit from these, but they may also do better with other medications. Some studies have found that medications that reduce stress, like antidepressants, anti-anxiety drugs, and mood stabilizers, can help manage early symptoms.
• Psychological interventions. This is a crucial element of treatment and includes several strategies. Cognitive behavioral therapy helps patients challenge their own negative thinking and delusions; stress management strategies help reduce symptoms and improve coping skills; social skills training helps patients interact with others in more positive ways and develop better relationships; and psychoeducation for patients and their families improves communication, understanding of the disease, and support strategies.
• Dietary supplements. Studies have shown that supplementation with omega-3 fatty acids can reduce symptoms in several mental illnesses including schizophrenia. These fats may actually reduce or delay the transition from prodromal to active schizophrenia and psychosis.

Most of the research into treatment for schizophrenia has involved patients in the active phase. However, researchers have found that using many of these same strategies, adjusted as needed, help people in the prodromal stage cope and have better outcomes.