Prodromes of first-episode psychosis: how can we challenge nonspecificity?

Prevention of functional psychosis is a major concern of modern psychiatry. The aim is to avoid biological and psychosocial deterioration at the earliest possible stage of the illness. The term "prodrome" has become crucial for identification of the very early stage. Recent years have yielded intensive research effort in defining prodromal signs and symptoms; however, the conclusion of most researchers is that they are nonspecific. We present the descriptive and phenomenological findings of the prodrome concept. Although prodromes are nonspecific, their discrepancy with persisting social impairment over time is a frequently encountered and highly alarming feature in young at-risk individuals. The inclusion of phenomenological findings may suggest the presence of psychosis-like inner experiences already as early as the prodromal phase, and thus bears in itself the question of the starting point for psychopharmacological and psychosocial treatment. Finally, a decision pathway for clinicians is proposed in their difficult task of identifying young individuals at risk.