Symptomatology of the initial prodromal phase in schizophrenia

The initial prodromal symptoms in schizophrenia were studied in 100 DSM-diagnosed patients and 100 controls. The median number of symptoms in the patients and the controls was 8 (range 2-13) and 0 (range 0-5), respectively. Patients developed symptoms indicating social, occupational, and affective dysfunction, whereas the controls' symptoms included magical content and disturbance in mood. There were significant differences in the frequency of several symptoms appearing in the subtypes. Initial prodromal symptoms were classified into negative, positive-prepsychotic, and positive-disorganization categories. Patients with the disorganized subtype were more likely to have had negative symptoms in the prodromal state, and patients with the paranoid subtype were more likely to have had positive symptoms in the prodromal state. Observation of the course of symptoms from the prodromal to the psychotic state revealed that 58 percent of the symptoms showed increased intensity, 21 percent remained unchanged, 5 percent decreased, 3 percent evolved into other affective difficulties, 9 percent progressed into delusions, 1 percent progressed into hallucinations, and 3 percent disappeared. The Global Assessment of Functioning Scale showed that functioning is differentially affected among the subtypes even in the prodromal phase. These findings provide a better understanding of the initial prodromal state of schizophrenia, the signs and symptoms that best define it, and their prognostic significance.