[Early diagnosis in schizophrenia: a mission for the general practitioners?]

Schizophrenia represents a relatively frequent disease within the population with a prevalence of 1 %. Despite a consistent therapeutic equipment at doctors' disposal, the evolution of this disease remains globally rather unfavourable. For a long time, the classic concept from Magnan "bouffée délirante aiguë" was considered as the main mode of entrance of the schizophrenia. Now, in most cases, the beginning of the disease is progressive and insidious. Two phases in the evolution of the disease before appearance of true psychotic symptoms are described: a premorbid phase and a prodromic phase. The early care of this disease has a major impact for the prognosis. The Duration of Untreated Psychosis (DUP) is correlated to an unfavourable evolution of the disease. It is advisable to reduce the delay of first care by locating prematurely the patients developing a psychosis. Because of their central place in our health care system, the general practitioners have a major role in this screening. The clinical symptoms of the prodromic phase are rather heterogeneous and little specific. The general practitioners must be made sensitive to search the symptoms suggesting an entrance to the psychosis and to allow a care adapted to these patients. But they are relatively little exposed to the psychotic disorders and must be supported in their mission by specialized centers.