Table of ContentsView AllTable of ContentsPhasesSymptomsTypesRisk FactorsDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Phases
Symptoms
Types
Risk Factors
Diagnosis
Treatment
Symptoms of prodromal schizophrenia can be subtle or easily attributed to another condition, likeanxietyor even normal changes in adolescence. While the hallmark symptoms ofschizophreniaincludehallucinationsand a disconnect from reality, it can take years for these more advanced symptoms to appear.
Prodromal schizophrenia is the earliest stage of brain degeneration, though not everyone exhibits the same symptoms. During this phase, people begin experiencing pre-psychotic mild or moderate changes in perceptions and behavior, but don’t yet have delusions and more serious difficulties.
This article discusses the symptoms of prodromal schizophrenia and how it is diagnosed and treated. It will help you to better identify and understand these symptoms.
Verywell / Jessica Olah
What Is Schizophrenia Prodrome?
Schizophrenia prodrome, or the prodromal phase, is the earliest phase. As such, it’s commonly diagnosed only after a person has entered the active schizophrenia phase. One estimate suggests that 75% of the patients with schizophrenia may pass through the stages of prodromal symptoms.
During the active (acute) phase, symptoms are most noticeable and potentially damaging to a person’s life. Friends and family will notice marked differences in their loved one, but the person may not be able to recognize or acknowledge the changes.
The residual phase occurs after active schizophrenia. In this phase, symptoms are much less obvious and may even be in remission but could still be present to some degree. Entering this phase doesn’t mean you’ll never enter an active phase again, though.
Phases of SchizophreniaSchizophrenia was once seen as an early stage of dementia. Later, it was described as psychosis with a chronic course that unfolds throughout life.While everyone diagnosed with schizophrenia will experience the active phase, they may not experience the prodromal (before) or residual (after) phases.
Phases of Schizophrenia
Schizophrenia was once seen as an early stage of dementia. Later, it was described as psychosis with a chronic course that unfolds throughout life.While everyone diagnosed with schizophrenia will experience the active phase, they may not experience the prodromal (before) or residual (after) phases.
The 3 Phases of Schizophrenia
What Are the Symptoms of Prodromal Schizophrenia?
Prodromal symptoms are generally seen as nonspecific symptoms of schizophrenia (those involving an absence of normal interactions and functioning) that evolve over time.
Symptoms can fluctuate in intensity, severity, and length of time. They can begin in adolescence and the teenage years, although they may not be recognized and understood until a schizophrenia diagnosis is made later in life (a retrospective diagnosis).
Small changes to personality and behavior or normal routine may be some of the first signs of prodromal phase schizophrenia. They may occur in adolescence and the teen years, although it may be dismissed as just a phase or diagnosed instead as anxiety ordepression.
Common early signs andsymptoms of schizophreniainclude:
Some of the prodromal signs, such as a significant change in personal hygiene and a worrisome drop in grades or job performance, can also be early warning signs of other issues, including psychosis or detachment from reality.
If your child or teen starts showing the above signs and symptoms, talk to a pediatrician or mental health professional as soon as possible.
Psychosis vs. Schizophrenia: What’s the Difference?
Types of Prodrome
There are two main patterns the prodrome takes. Again, you likely won’t know for sure which type is applicable until later schizophrenia phases. These two types are:
These symptom patterns were later divided into five more patterns of disturbances (areas of most difficulty), including disturbances in:
Prodrome phase can also be categorized in three different ways:
How Is Childhood Schizophrenia Diagnosed?
What Are the Risk Factors?
There’s still much to learn about the underlying causes of schizophrenia, but there are certain risk factors closely linked to the psychotic disorder.
In addition to trauma, other risk factors include:
Keep in mind that risk factors do not necessarily indicate a cause of schizophrenia, which is a complex mental health condition. It’s also important to remember that prodromal schizophrenia is hard to identify because it lacks thecharacteristic symptoms of schizophrenia.
For example, a person may be diagnosed with a mood disorder but later develop active schizophrenia without going through a prodromal phase, which further complicates getting an accurate diagnosis.
The fact that prodromal schizophrenia co-occurs with other mental illnesses or substance use disorders, or arises during the hormonal changes of adolescence, adds to the complexities.
Symptoms in AdolescentsIn adolescence, symptoms may be dismissed as “just a phase” or chalked up to hormones and teen angst. The stereotypes about the teen years often involve emotions, mood management, and behavior. That makes it hard for parents, teachers, and caregivers to distinguish normal teen stuff from prodromal schizophrenia.
Symptoms in Adolescents
In adolescence, symptoms may be dismissed as “just a phase” or chalked up to hormones and teen angst. The stereotypes about the teen years often involve emotions, mood management, and behavior. That makes it hard for parents, teachers, and caregivers to distinguish normal teen stuff from prodromal schizophrenia.
Researchers have been working on ways to diagnose prodromal schizophrenia earlier on, rather than retrospectively. Earlier detection means minimizing the time between when the illness starts and first psychosis. It also offers more room for the prevention of psychological and social disruptions (work, school, friendships, etc.) associated with active schizophrenia.
Generally, someone in the prodromal stage will have two or more symptoms (like odd beliefs) in a milder form for at least six months.
How Schizophrenia Is Officially Diagnosed
Some diagnostic tools that have been used to assess for schizophrenia include:
Diagnosis will ultimately depend upon the affected individual taking action and talking to a medical professional. This can be a major barrier to diagnosis, especially if the person doesn’t have a strong support network to encourage them to get help.
Schizophrenia is treated with medications that target symptoms ranging from psychotic symptoms (treated with antipsychotics), to depressive and anxiety-related symptoms that are treated with antidepressants and anti-anxiety medications.
Therapy with a trained professional can help a person develop healthier coping skills, manage substance use disorders, and work on their relationships with others.
Substance use disorders are among the most common comorbid illnesses affecting the outlook for people with prodromal schizophrenia. Psychoactive substances like cannabis can also influence the onset of psychosis and are a known risk factor for schizophrenia, although the cause-and-effect is unclear and findings are not always consistent.
Seeking help for psychiatric symptoms before they begin to create personal, interpersonal, and professional problems is always the best-case scenario for an outlook when it comes tomental illness. Staying the course of treatment will also be a major factor in overall outlook and outcome.
Mental Health ResourcesIf you or a loved one are struggling with prodromal schizophrenia, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat800-662-4357for information on support and treatment facilities in your area.
Mental Health Resources
If you or a loved one are struggling with prodromal schizophrenia, contact theSubstance Abuse and Mental Health Services Administration (SAMHSA) National Helplineat800-662-4357for information on support and treatment facilities in your area.
Summary
Prodromal schizophrenia is the earliest stage of schizophrenia. Not all people with schizophrenia experience this phase. Hallmark symptoms of the prodromal stage include nervousness, anxiety, depression, difficulty concentrating, excessive worrying, and more.
Prodromal schizophrenia can be especially hard to identify because these symptoms are related to many other conditions. There are very small differences between diagnoses that may not seem major, but they can mean a lot when it comes to getting the right diagnosis and treatment.
Early detection can make a big difference for patients with schizophrenia. If you or a loved one are experiencing symptoms, seek help from a medical professional. Be sure to tell your healthcare providers about any substance use, as it’s essential information for getting the right assistance.
11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bosnjak Kuharic D, Kekin I, Hew J, Rojnic Kuzman M, Puljak L.Interventions for prodromal stage of psychosis.Cochrane Database Syst Rev. 2019 Nov 1;2019(11):CD012236. doi:10.1002/14651858.CD012236.pub2.George M, Maheshwari S, Chandran S, Manohar JS, Sathyanarayana Rao TS.Understanding the schizophrenia prodrome.Indian J Psychiatry. 2017;59(4):505-509. doi:10.4103/psychiatry.IndianJPsychiatry_464_17Zhang Z, Zhang R, Qin P, Tan L.Cognitive dysfunction and negative symptoms in patients with schizophrenia and their first-degree relatives from simplex and multiplex families.Neuropsychiatr Dis Treat. 2018 Dec 5;14:3339-3348. doi:10.2147/NDT.S179534National Institutes of Mental Health.Understanding psychosis.Gibson LE, Alloy LB, Ellman LM.Trauma and the psychosis spectrum: a review of symptom specificity and explanatory mechanisms.Clin Psychol Rev.2016 Nov;49:92–105. doi:10.1016/j.cpr.2016.08.003Okkels N, Trabjerg B, Arendt M, Pedersen CB.Traumatic Stress Disorders and Risk of Subsequent Schizophrenia Spectrum Disorder or Bipolar Disorder: A Nationwide Cohort Study.Schizophr Bull. 2017;43(1):180-186. doi:10.1093/schbul/sbw082Modabbernia A, Velthorst E, Gennings C, et al.Early-life metal exposure and schizophrenia: A proof-of-concept study using novel tooth-matrix biomarkers.Eur Psychiatry. 2016;36:1–6. doi:10.1016/j.eurpsy.2016.03.006Khademvatan S, Saki J, Khajeddin N, et al.Toxoplasma gondii Exposure and the Risk of Schizophrenia.Jundishapur J Microbiol. 2014;7(11):e12776. doi:10.5812/jjm.12776Holder SD, Wayhs A.Schizophrenia.Am Fam Physician. 2014 1;90(11):775-82.Wang P, Yan CD, Dong XJ, Geng L, Xu C, Nie Y,et al.Identification and predictive analysis for participants at ultra-high risk of psychosis: A comparison of three psychometric diagnostic interviews.World J Clin Cases. 2022 Mar 16;10(8):2420-2428. doi:10.12998/wjcc.v10.i8.2420.Shrivastava A, Johnston M, Terpstra K, Bureau Y.Cannabis and psychosis: Neurobiology.Indian J Psychiatry. 2014 Jan-Mar;56(1):8-16. doi:10.4103/0019-5545.124708
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Bosnjak Kuharic D, Kekin I, Hew J, Rojnic Kuzman M, Puljak L.Interventions for prodromal stage of psychosis.Cochrane Database Syst Rev. 2019 Nov 1;2019(11):CD012236. doi:10.1002/14651858.CD012236.pub2.George M, Maheshwari S, Chandran S, Manohar JS, Sathyanarayana Rao TS.Understanding the schizophrenia prodrome.Indian J Psychiatry. 2017;59(4):505-509. doi:10.4103/psychiatry.IndianJPsychiatry_464_17Zhang Z, Zhang R, Qin P, Tan L.Cognitive dysfunction and negative symptoms in patients with schizophrenia and their first-degree relatives from simplex and multiplex families.Neuropsychiatr Dis Treat. 2018 Dec 5;14:3339-3348. doi:10.2147/NDT.S179534National Institutes of Mental Health.Understanding psychosis.Gibson LE, Alloy LB, Ellman LM.Trauma and the psychosis spectrum: a review of symptom specificity and explanatory mechanisms.Clin Psychol Rev.2016 Nov;49:92–105. doi:10.1016/j.cpr.2016.08.003Okkels N, Trabjerg B, Arendt M, Pedersen CB.Traumatic Stress Disorders and Risk of Subsequent Schizophrenia Spectrum Disorder or Bipolar Disorder: A Nationwide Cohort Study.Schizophr Bull. 2017;43(1):180-186. doi:10.1093/schbul/sbw082Modabbernia A, Velthorst E, Gennings C, et al.Early-life metal exposure and schizophrenia: A proof-of-concept study using novel tooth-matrix biomarkers.Eur Psychiatry. 2016;36:1–6. doi:10.1016/j.eurpsy.2016.03.006Khademvatan S, Saki J, Khajeddin N, et al.Toxoplasma gondii Exposure and the Risk of Schizophrenia.Jundishapur J Microbiol. 2014;7(11):e12776. doi:10.5812/jjm.12776Holder SD, Wayhs A.Schizophrenia.Am Fam Physician. 2014 1;90(11):775-82.Wang P, Yan CD, Dong XJ, Geng L, Xu C, Nie Y,et al.Identification and predictive analysis for participants at ultra-high risk of psychosis: A comparison of three psychometric diagnostic interviews.World J Clin Cases. 2022 Mar 16;10(8):2420-2428. doi:10.12998/wjcc.v10.i8.2420.Shrivastava A, Johnston M, Terpstra K, Bureau Y.Cannabis and psychosis: Neurobiology.Indian J Psychiatry. 2014 Jan-Mar;56(1):8-16. doi:10.4103/0019-5545.124708
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Bosnjak Kuharic D, Kekin I, Hew J, Rojnic Kuzman M, Puljak L.Interventions for prodromal stage of psychosis.Cochrane Database Syst Rev. 2019 Nov 1;2019(11):CD012236. doi:10.1002/14651858.CD012236.pub2.George M, Maheshwari S, Chandran S, Manohar JS, Sathyanarayana Rao TS.Understanding the schizophrenia prodrome.Indian J Psychiatry. 2017;59(4):505-509. doi:10.4103/psychiatry.IndianJPsychiatry_464_17Zhang Z, Zhang R, Qin P, Tan L.Cognitive dysfunction and negative symptoms in patients with schizophrenia and their first-degree relatives from simplex and multiplex families.Neuropsychiatr Dis Treat. 2018 Dec 5;14:3339-3348. doi:10.2147/NDT.S179534National Institutes of Mental Health.Understanding psychosis.Gibson LE, Alloy LB, Ellman LM.Trauma and the psychosis spectrum: a review of symptom specificity and explanatory mechanisms.Clin Psychol Rev.2016 Nov;49:92–105. doi:10.1016/j.cpr.2016.08.003Okkels N, Trabjerg B, Arendt M, Pedersen CB.Traumatic Stress Disorders and Risk of Subsequent Schizophrenia Spectrum Disorder or Bipolar Disorder: A Nationwide Cohort Study.Schizophr Bull. 2017;43(1):180-186. doi:10.1093/schbul/sbw082Modabbernia A, Velthorst E, Gennings C, et al.Early-life metal exposure and schizophrenia: A proof-of-concept study using novel tooth-matrix biomarkers.Eur Psychiatry. 2016;36:1–6. doi:10.1016/j.eurpsy.2016.03.006Khademvatan S, Saki J, Khajeddin N, et al.Toxoplasma gondii Exposure and the Risk of Schizophrenia.Jundishapur J Microbiol. 2014;7(11):e12776. doi:10.5812/jjm.12776Holder SD, Wayhs A.Schizophrenia.Am Fam Physician. 2014 1;90(11):775-82.Wang P, Yan CD, Dong XJ, Geng L, Xu C, Nie Y,et al.Identification and predictive analysis for participants at ultra-high risk of psychosis: A comparison of three psychometric diagnostic interviews.World J Clin Cases. 2022 Mar 16;10(8):2420-2428. doi:10.12998/wjcc.v10.i8.2420.Shrivastava A, Johnston M, Terpstra K, Bureau Y.Cannabis and psychosis: Neurobiology.Indian J Psychiatry. 2014 Jan-Mar;56(1):8-16. doi:10.4103/0019-5545.124708
Bosnjak Kuharic D, Kekin I, Hew J, Rojnic Kuzman M, Puljak L.Interventions for prodromal stage of psychosis.Cochrane Database Syst Rev. 2019 Nov 1;2019(11):CD012236. doi:10.1002/14651858.CD012236.pub2.
George M, Maheshwari S, Chandran S, Manohar JS, Sathyanarayana Rao TS.Understanding the schizophrenia prodrome.Indian J Psychiatry. 2017;59(4):505-509. doi:10.4103/psychiatry.IndianJPsychiatry_464_17
Zhang Z, Zhang R, Qin P, Tan L.Cognitive dysfunction and negative symptoms in patients with schizophrenia and their first-degree relatives from simplex and multiplex families.Neuropsychiatr Dis Treat. 2018 Dec 5;14:3339-3348. doi:10.2147/NDT.S179534
National Institutes of Mental Health.Understanding psychosis.
Gibson LE, Alloy LB, Ellman LM.Trauma and the psychosis spectrum: a review of symptom specificity and explanatory mechanisms.Clin Psychol Rev.2016 Nov;49:92–105. doi:10.1016/j.cpr.2016.08.003
Okkels N, Trabjerg B, Arendt M, Pedersen CB.Traumatic Stress Disorders and Risk of Subsequent Schizophrenia Spectrum Disorder or Bipolar Disorder: A Nationwide Cohort Study.Schizophr Bull. 2017;43(1):180-186. doi:10.1093/schbul/sbw082
Modabbernia A, Velthorst E, Gennings C, et al.Early-life metal exposure and schizophrenia: A proof-of-concept study using novel tooth-matrix biomarkers.Eur Psychiatry. 2016;36:1–6. doi:10.1016/j.eurpsy.2016.03.006
Khademvatan S, Saki J, Khajeddin N, et al.Toxoplasma gondii Exposure and the Risk of Schizophrenia.Jundishapur J Microbiol. 2014;7(11):e12776. doi:10.5812/jjm.12776
Holder SD, Wayhs A.Schizophrenia.Am Fam Physician. 2014 1;90(11):775-82.
Wang P, Yan CD, Dong XJ, Geng L, Xu C, Nie Y,et al.Identification and predictive analysis for participants at ultra-high risk of psychosis: A comparison of three psychometric diagnostic interviews.World J Clin Cases. 2022 Mar 16;10(8):2420-2428. doi:10.12998/wjcc.v10.i8.2420.
Shrivastava A, Johnston M, Terpstra K, Bureau Y.Cannabis and psychosis: Neurobiology.Indian J Psychiatry. 2014 Jan-Mar;56(1):8-16. doi:10.4103/0019-5545.124708
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
