Schizophrenia is one of the most debilitating mental health problems of all currently recognized. Its chronic course is marked by a remarkable deterioration in the quality of life, both for those who suffer from it and their environment.
As a mess, and due to the halo of mystery that surrounds its clinical expression, it has been the subject of numerous audiovisual works in which some of its facets have been oversized while others have barely been represented.
The initial phase, for example, tends to go unnoticed, even by the vast majority of patients and families. It is at this stage that the prodromal symptoms of schizophrenia appear, which will be at the heart of this text.
However, first we will delve into a brief description of the characteristic symptoms of the disease when it is already fully established.
What is schizophrenia
Schizophrenia is a disorder included in the general category of psychotic images. Two main groups of symptoms can be distinguished: positive and negative.
This basic typology, originally posed by Crow, has remained a valid classification for decades for its simplicity. In general, the positive symptoms describe an “excess” and the negative a “deficit” in the manifestation of the disease.
The positive symptoms of schizophrenia are hallucinations and delusions. The former describe abnormal perceptual experiences which can compromise any sensory modality, and the latter constitute a more or less articulated set of ideas that the person uses to explain his reality (although they do not have a sufficient objective substrate). . Iron’s credibility is often attributed to both, being resistant to any evidence that might contradict them.
The most common hallucinations are auditory hallucinations, Expressed as human voices that refer directly to the patient or interact with each other in a conversation in which the patient is the main subject. The content of the message is generally in accordance with the mood of the recipient. Visual or tactile hallucinatory perceptions follow them in order of frequency.
Delusions involve an accumulation of ideas through which the person tries to make sense of their abnormal perceptual experiences, and the content may be more or less believable (as would be the case with delusions of persecution that take place in schizophrenia. paranoid) or be absurd and strange to the cultural environment (contact with beings of other dimensions, various reincarnations, superhuman capacities, etc.).
Disorganized or meaningless language is also often seen. Verbal expression seems to be affected by syntactic formulas without apparent grammatical order and by the formation of neologisms (invented words), as well as by sentences with no logical connection or by discourse that tends to derail. All of this suggests the underlying presence of formal alterations in thought.
Negative symptoms are the big unknown for most people, although they are a major handicap for those who suffer from this disease. In addition, they are clinical expressions resistant to the usual pharmacological treatments (antipsychotics acting as dopamine antagonists on the four cerebral pathways in which this neurotransmitter is involved).
The negative symptoms are: apathy (motivational decline or disinterest), abulia (loss of will to engage in activities of daily living), allergy (impoverishment of thought and language) and anhedonia (difficulty in experiencing pleasure in situations that previously provided it). In addition, alterations in key cognitive developmental processes (memory, attention, social cognition, etc.) can coexist.
It is also important to note that the presence of other mental health problems is common as the time of coexistence with schizophrenia progresses. The most common are major depression and certain anxiety disorders, as well as the presence of suicidal thoughts. It should be noted that, contrary to popular belief, people with schizophrenia are neither more violent nor more dangerous than the general population.
From now on, we will delve deeper into the early symptoms of schizophrenia., That is, what specialized terminology is known as prodromal expression.
Prodromal symptoms of schizophrenia
Prodromal symptoms include all of those early clinical expressions of disease. As for schizophrenia, they describe the time interval between the first signs suggestive of a problem (noticeable changes from previous patterns of behavior and thinking) and the onset of psychosis itself. About 75% of people with schizophrenia went through this phase in the first place.
Below, we will take a closer look at each of the prodromal symptoms highlighted in the scientific literature. Their duration may be limited to just a few weeks or extend over several years, but in any case, they represent a sharp break in the way the person acted and thought.
1. Social isolation
Social isolation is one of the most obvious symptoms of schizophrenia prodromes. The person withdraws from social life and remains on the margins of the family dynamic.
You may spend a lot of time cloistered in your own bedroom or remain emotionally distant, even when you are in situations where some degree of interaction is expected (meetings, for example) your integrity is affected by their bonding.
2. Changes in the development of daily activities
In the event that the person has an active professional or academic life, or is engaged in family or other responsibilities, during this step, a very significant neglect of these can be appreciated.
There is an abandonment of the activities that he carries out on a daily basis, which can lead to the impossibility of maintaining his involvement in different areas (job loss, school failure, relationship breakdown, etc.).
3. Impoverishment of personal hygiene and cleanliness
There is a very important oversight of the most basic personal care, such as brushing your teeth or showering.. At this point, the person may show a messy physical appearance and show no interest in changing the situation, even when faced with the explicit request of others. This circumstance is a common source of conflict within the family and can seriously disrupt coexistence.
There may also be a deterioration in physical appearance due to a sedentary lifestyle or lack of exercise, with a substantial change in eating habits resulting in very noticeable weight loss or gain (and a modification of anthropometry). Sometimes the changes that take place in the body structure are dramatic.
4. Anxiety and depression
Anxiety and depression are particularly debilitating prodromal symptoms of schizophrenia., As they contribute to the detriment of emotional life. They can be expressed as very marked swings in mood, emotional depression, restlessness or nervousness. At other times, they manifest as constant and disproportionate anger, which promotes the presence of conflict.
Usually, these symptoms acquire sufficient entity to meet the diagnostic criteria for different mental disorders in their respective areas (such as major depression, panic disorder, social anxiety, etc.), becoming a comorbid problem that requires independent care.
5. Poor language and thought
At this point, the first signs of impoverishment in the use of language and thought begin.. In fact, many authors report an initial impairment of cognitive processes, although this is more subtle than that observed during the development of the psychotic disorder. himself.
The evidence highlights the impact of the following cognitive processes: speed of information processing (ability to manage the resources necessary to cope with the demands of the situations we are faced with), sustained attention (prolonged maintenance of the concentration of the patient). attention to a stimulus) and working memory (ability to retain the information necessary to successfully perform a task in which one is involved).
Other findings also suggest some decline in verbal memory (word evocation), problem solving (ability to articulate a plan of action to achieve a goal or resolve a demanding situation), and social cognition. . Encoding, storage, retrieval and use of information associated with social dynamics; including identifying the expectations of others).
All of them could contribute in some way to other prodromal symptoms, such as job loss or social isolation, and should be evaluated in a timely manner by a professional neuropsychologist.
6. Weird or obsessive ideas
During this period, you may notice the presence of recurring ideas around a specific topic, on which all daily activities are structured. The vital gravity axis can suddenly shift towards these problems, most of which the person has not previously addressed. It is therefore an obsessive thought that shifts the usual concerns to a second order of relevance.
Schizotypal personality disorder (maintenance of beliefs viewed as odd by the environment and impoverishment of emotional expression) provides a structure or basis on which subsequent psychosis can be built, and has been viewed as a significant risk factor. , so that at this stage an upsurge of this previous symptomatology could be observed.
Difficulty sleeping is also a common symptom in the prodromal phase of schizophrenia. They can occur in any of its possible forms: onset (sleep reconciliation), maintenance (constant interruptions during the night) and early awakening (end of sleep earlier than desired).
In some cases, altered circadian rhythms can be observed, so that the person falls asleep and wakes up too late.
Why are prodromal symptoms important?
Knowledge of the prodromal symptoms of schizophrenia, although they very often go unnoticed, is of paramount importance. This is because not only do they agree in the months leading up to the development of the full picture, but they can also serve as indicators of the imminent onset of an acute episode in people who have already been diagnosed. Therefore, its identification makes it possible to anticipate the opportune prophylactic and therapeutic measures.
However, it is important to note that the presence of these symptoms does not necessarily imply that the disorder will develop in the future, as it occurs in only 20% or 40% of all cases. This is an alarm signal that it is essential to be aware of, to set in motion all the care devices that may be appropriate.
George, M., Maheswari, S., Chandran, S., and Manohar, JS (2017). Understanding the prodrom of schizophrenia. Indian Journal of Psychiatry, 59 (4), 505-509.
White, T., Anjum, A. and Schulz, S. (2006). The prodrom of schizophrenia. American Journal of Psychiatry, 163 (3), 376-380.