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The “Prodromal” Patient: Both Symptomatic and At-Risk

Published online by Cambridge University Press:  07 November 2014

Scott W. Woods ,
Tandy J. Miller  and
Thomas H. McGlashan
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Abstract

This article discusses conceptual issues relevant to the prospective diagnosis of the schizophrenic prodrome. Recent efforts to diagnose these patients with operational criteria based on current symptoms are reviewed. Symptomatic patients so identified appear to be treatment-seeking and to have mild cognitive impairments. In addition to being currently symptomatic, these patients are imminently at risk for progression of illness and development of schizophrenia. Data from three international centers suggest that this risk is approximately 40% over the next year of follow-up if untreated. The implications of the reviewed data for the appropriateness of the term “prodromal” and for treatment/prevention research for these patients are discussed.

Type
Feature Articles
Information
CNS Spectrums , Volume 6 , Issue 3: New Perspectives on Examining Neuropsychiatric Disorders , March 2001 , pp. 223 - 232
Copyright
Copyright © Cambridge University Press 2001

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References

REFERENCES

1.Bleuler, E. Dementia Praecox or the Group of the Schizophrenias. New York, NY: International Universities Press; 1911.Google Scholar
2.Sullivan, HS. The onset of schizophrenia. Am J Psychiatry. 1927;7:105–134.CrossRefGoogle Scholar
3.Kablinger, AS, Freeman AM: Prodromal schizophrenia and atypical antipsychotic treatment. J Nerv Merit Dis. 2000; 188 (10): 642–652CrossRefGoogle ScholarPubMed
4.McGorry, P. Preventive strategies in early psychosis: verging on reality. Br J Psychiatry Suppl. 1998;172:1–2.CrossRefGoogle ScholarPubMed
5.McGlashan, TH. Early detection and intervention of schizophrenia: rationale and research. Br J Psychiatry Suppl. 1998;172:3–6.CrossRefGoogle ScholarPubMed
6.Stephenson, J. Schizophrenia researchers striving for early detection and intervention. JAMA. 1999;281:1877–1888.Google ScholarPubMed
7.McGlashan, TH. Early detection and intervention with schizophrenia. Schizophr Bull. 1996;22:197–398.CrossRefGoogle ScholarPubMed
8.Wyatt, RJ. Neuroleptics and the natural course of schizophrenia. Schizophr Bull. 1991;17:325–351.CrossRefGoogle ScholarPubMed
9.Moscarelli, M. Health and economic evaluation in schizophrenia: implications for health policies. Acta Psychiatr Scand Suppl. 1994;382:84–88.CrossRefGoogle ScholarPubMed
10.Helgason, L. Twenty years' follow-up of first psychiatric presentation for schizophrenia: what could have been prevented? Acta Psychiatr Scand. 1990;81:231–235.CrossRefGoogle ScholarPubMed
11.Rabiner, CJ, Wegner, JT, Kane, JM. Outcome study of first-episode psychosis. I: Relapse rates after 1 year. Am J Psychiatry. 1986;143:1155–1158.Google ScholarPubMed
12.Johnstone, EC, Crow, TJ, Johnson, AL, MacMillan, JF. The Northwick Park Study of first episodes of schizophrenia. I. Presentation of the illness and problems relating to admission. Br J Psychiatry. 1986;148:115–120.CrossRefGoogle ScholarPubMed
13.Crow, TJ, MacMillan, JF, Johnson, AL, et al.A randomised controlled trial of prophylactic neuroleptic treatment. Br J Psychiatry. 1986;148:120–127.CrossRefGoogle ScholarPubMed
14.Lo, WH, Lo, T. A ten-year follow-up study of Chinese schizophrenics in Hong Kong. Br J Psychiatry. 1977;131:63–66.CrossRefGoogle ScholarPubMed
15.Loebel, AD, Lieberman, JA, Alvir, JM, Mayerhoff, DI, Geisler, SH, Szymanski, SR. Duration of psychosis and outcome in first-episode schizophrenia. Am J Psychiatry. 1992;149:1183–1188.Google ScholarPubMed
16.Schroder, J, Bachmann, S, Weimer, D, et al.Duration of untreated psychosis is associated with a poor treatment response in schizophrenia. Schizophr Res. 1999;36:9–10.Google Scholar
17.Gunduz, H, Alvir, J, Woerner, M, et al.The impact of duration of untreated psychosic symptoms on treatment response of delusions and hallucinations. Schizophr Res. 1999;36:18.Google Scholar
18.Quinn, J, Moran, M, Lane, A, et al.Duration of initially untreated psychosis as a primary predictor of poor long term outcome over the lifetime trajectory of schizophrenia. Schizophr Res. 1999;36:29.Google Scholar
19.Hopkins, RS, White, CJ, Montague, L, et al.Duration of initially untreated psychosis (DUP) and outcome 10 years after onset. Schizophr Res. 1999;36:42.Google Scholar
20.May, PR, Tuma, AH, Dixon, WJ, et al.Schizophrenia: a follow-up study of the results of five forms of treatment. Arch Gen Psychiatry. 1981;38:776–784.CrossRefGoogle ScholarPubMed
21.Wyatt, RJ, Green, MF, Tuma, AH. Long-term morbidity associated with delayed treatment of first admission schizophrenic patients: a re-analysis of the Camarillo State Hospital data. Psychol Med. 1997;27:261–268.CrossRefGoogle ScholarPubMed
22.Robinson, DG, Woerner, MG, Alvir, JM, et al.Predictors of treatment response from a first episode of schizophrenia or schizoaffective disorder. Am J Psychiatry. 1999;156:544–549.CrossRefGoogle ScholarPubMed
23.Chen, EY, Dunn, EL, Chen, RL, et al.Duration of untreated psychosis and symptomatic outcome among first episode schizophrenic patients in Hong Kong. Schizphr Res. 1999;36:15.Google Scholar
24.Barnes, TR, Hutton, SB, Chapman, MJ, Mutsatsa, S, Puri, BK, Joyce, EM. West London first-episode study of schizphrenia: clinical correlates of duration of untreated psychosis. Br J Psychiatry. 2000;177:207–211.CrossRefGoogle Scholar
25.Ho, BC, Andreasen, NC, Flaum, M, Nopoulos, P, Miller, D. Untreated initial psychosis: its relation to quality of life and symptom remission in first-episode schizophrenia. Am J Psychiatry. 2000;157:808–815.CrossRefGoogle ScholarPubMed
26.Craig, TJ, Bromet, EJ, Fennig, S, Tanenberg-Karant, M, Lavelle, J, Galambos, N. Is there an association between duration of untreated psychosis and 24-month clinical outcome in a first-admission series? Am J Psychiatry. 2000;157:60–66.CrossRefGoogle Scholar
27.McGlashan, TH, Johannessen, JO. Early detection and intervention with schizophrenia: rationale. Schizophr Bull. 1996;22:201–222.CrossRefGoogle ScholarPubMed
28.Beasley, CM, Dellva, MA, Tamura, RN, et al.Randomised double-blind comparison of the incidence of tardive dyskinesia in patients with schizophrenia during long-term treatment with olanzapine or haloperidol. Br J Psychiatry. 1999;174:23–30.CrossRefGoogle ScholarPubMed
29.Jeste, DV, Lacro, JP, Bailey, A, et al.Lower incidence of tardive dyskinesia with risperidone compared with haloperidol in older patients. J Am Geriatr Soc. 1999;47:716–719.CrossRefGoogle ScholarPubMed
30.Yung, AR, McGorry, PD. The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophr Bull. 1996;22:353–370.CrossRefGoogle ScholarPubMed
31.Yung, AR, McGorry, PD. The initial prodrome in psychosis: descriptive and qualitative aspects. Aust N Z J Psychiatry. 1996;30:587–599.CrossRefGoogle ScholarPubMed
32.Hafner, H, Maurer, K, Loffler, W, et al.The epidemiology of early schizophrenia: influence of age and gender on onset and early course. Br J Psychiatry Suppl. 1994;23:29–38.CrossRefGoogle Scholar
33.Varsamis, J, Adamson, JD. Early schizophrenia. Can Psychiatr Assoc J. 1971;16:487–497.CrossRefGoogle ScholarPubMed
34.Moller, P, Husby, R. The initial prodrome in schizophrenia: searching for naturalistic core dimensions of experience and behavior. Schizophr Bull. 2000;26:217–232.CrossRefGoogle ScholarPubMed
35.Davidson, M, Reichenberg, A, Rabinowitz, J, Weiser, M, Kaplan, Z, Mark, M. Behavioral and intellectual markers for schizophrenia in apparently healthy male adolescents. Am J Psychiatry. 1999;156:1328–1335.CrossRefGoogle ScholarPubMed
36.Klostarkotter, J, Schultze-Lutter, F, Gross, G, Huber, G, Steinmeyer, EM. Early self-experienced neuropsychological deficits and subsequent schizophrenic diseases: an 8-year average follow-up prospective study. Acta Psychiatr Scand. 1997;95:396–404.CrossRefGoogle Scholar
37.Klosterkotter, J, Hellmich, M, Schultze-Lutter, F. Is the diagnosis of schizophrenic illness possible in the initial prodromal phase to the first psychotic manifestation? [in German] Fortschr Neurol Psychiatr. 2000;68(suppl 1):S13–S21.Google Scholar
38.Olin, SC, Mednick, SA. Risk factors of psychosis: identifying vulnerable populations premorbidly. Schizophr Bull. 1996;22:223–240.CrossRefGoogle ScholarPubMed
39.Chapman, LJ, Chapman, JP, Kwapil, TR, Eckblad, M, Zinser, MC. Putatively psychosis-prone subjects 10 years later. J Abnorm Psychol. 1994;103:171–183.CrossRefGoogle ScholarPubMed
40.Kwapil, TR. Social anhedonia as a predictor of the development of schizophrenia-spectrum disorders. J Abnorm Psychol. 1998;107:558–565.CrossRefGoogle ScholarPubMed
41.Kwapil, TR, Miller, MB, Zinser, MC, Chapman, J, Chapman, LJ. Magical ideation and social anhedonia as predictors of psychosis proneness: a partial replication. J Abnorm Psychol. 1997;106:491–495.CrossRefGoogle ScholarPubMed
42.Yung, AR, McGorry, PD, McFarlane, CA, Jackson, HJ, Patton, GC, Rakkar, A. Monitoring and care of young people at incipient risk of psychosis. Schizophr Bull. 1996;22:283–303.CrossRefGoogle ScholarPubMed
43.Yung, AR, Phillips, LJ, McGorry, PD, et al.Prediction of psychosis: a step towards indicated prevention of schizophrenia. Br J Psychiatry Suppl. 1998;172:14–20.CrossRefGoogle ScholarPubMed
44.Jackson, HJ, McGorry, PD, McKenzie, D. The reliability of DSM-III prodromal symptoms in first-episode psychotic patients. Acta Psychiatr Scand. 1994;90:375–378.CrossRefGoogle ScholarPubMed
45.Jackson, HJ, McGorry, PD, Dudgeon, P. Prodromal symptoms of schizophrenia in first-episode psychosis: prevalence and specificity. Compr Psychiatry. 1995;36:241–250.CrossRefGoogle ScholarPubMed
46.McGorry, PD, McFarlane, C, Patton, GC, et al.The prevalence of prodromal features of schizophrenia in adolescence: a preliminary survey. Acta Psychiatr Scand. 1995;92:241–249.CrossRefGoogle ScholarPubMed
47.Miller, TJ, McGlashan, TH, Woods, SW, et al.Symptom assessment in schizophrenic prodromal states. Psychiatr Q. 1999;70:273–287.CrossRefGoogle ScholarPubMed
48.Kendler, KS, Diehl, SR. The genetics of schizophrenia: a current, genetic-epidemiologic perspective. Schizophr Bull. 1993;19:261–285.CrossRefGoogle ScholarPubMed
49.Kendler, KS, McGuire, M, Gruenberg, AM, Spellman, M, O'Hare, A, Walsh, D. The Roscommon Family Study. II. The risk of nonschizophrenic nonaffective psychoses in relatives. Arch Gen Psychiatry. 1993;50:645–652.CrossRefGoogle ScholarPubMed
50.Kendler, KS, McGuire, M, Gruenberg, AM, O'Hare, A, Spellman, M, Walsh, D. The Roscommon Family Study. IV. Affective illness, anxiety disorders, and alcoholism in relatives. Arch Gen Psychiatry. 1993;50:952–960.CrossRefGoogle ScholarPubMed
51.Kendler, KS, Karkowski-Shuman, L, Walsh, D. The risk for psychiatric illness in siblings of schizophrenics: the impact of psychotic and non-psychotic affective illness and alcoholism in parents. Acta Psychiatr Scand. 1996;94:49–55.CrossRefGoogle ScholarPubMed
52.Miller, TJ, Woods, SW, Davidson, L, et al.Description and Assessment of Prodromal States. Chicago, Ill: American Psychiatric Association; 2000:116.Google Scholar
53.Eaton, WW, Radawi, M, Melton, R. Prodromes and precursors: epidemiologic data for primary prevention of disorders with slow onset. Am J Psychiatry. 1995;152:967–972.Google ScholarPubMed
54.McGlashan, TH, Miller, TJ, Woods, SW. A scale for the assessment of prodromal symptoms and states. In: Miller, TJ, Mednick, SA, McGlashan, TH, Libiger, J, Johannessen, JO, eds. Early Intervention in Psychotic Disorders. Dordrecht, The Netherlands: Kluwer Academic Publishers. In press.Google Scholar
55.Miller, TJ, McGlashan, TM. Early identification and intervention in psychotic illness. Connecticut Med. 2000;64:339–341.Google ScholarPubMed
56.Preda, A, Miller, TJ, Lifshey Rosen, J, et al.Treatment histories of patients in schizophrenic prodromal states. Annual Meeting of the American Psychiatric Association; New Orleans, La. May 2001.Google Scholar
57.McGorry, PD, Phillips, LJ, Yung, AR. Personal communication.Google Scholar
58.Hawkins, KA, Hoffman, RE, Ritchie, AJ. Neuropsychological Markers of Susceptibility: Syllabus and Scientific Proceedings. Chicago, Ill: American Psychiatric Association; 2000:117.Google Scholar
59.World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. JAMA. 2000;284:3043–3045.CrossRefGoogle Scholar
60.Turkington, D, Kingdon, D. Cognitive-behavioural techniques for general psychiatrists in the management of patients with psychoses. Br J Psychiatry. 2000;177:101–106.CrossRefGoogle ScholarPubMed
61.Sensky, T, Turkington, D, Kingdon, D, et al.A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Arch Gen Psychiatry. 2000;57:165–172.CrossRefGoogle ScholarPubMed
62.Wexler, BE, Anderson, M, Fulbright, RK, Gore, JC. Preliminary evidence of improved verbal working memory performance and normalization of task-related frontal lobe activation in schizophrenia following cognitive exercises. Am J Psychiatry. 2000;157:1694–1697.CrossRefGoogle ScholarPubMed
63.McGorry, PD. Approaches to early treatment: how early? Does it make a difference? How safe is it? NIMH Conference on Early Recognition and Treatment of Schizophrenia and Ripolar Disorder in Children and Adolescents; May 10-11, 1999; Washington, DC.Google Scholar
64.McGorry, P. Preventive interventions in the prepsychotic phase: panacea, pipedreams, or Pandora's box? Presented at the Second International Conference on Early Psychosis; NY, NY; April 1, 2000.Google Scholar
65.Larsen, TK. Personal communication.Google Scholar