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You are here : Health.am > Health Centers > Mental Health - DepressionSchizophrenia • • The Course of Schizophrenia

Stages of schizophrenia

Schizophrenia • • The Course of SchizophreniaMay 11, 2009

Researchers have identified three stages of schizophrenia:

Prodromal Stage. The first stage is called the prodromal stage and refers to the year before the illness appears. The term prodrome is derived from the Greek word prodromos, meaning “something that comes before and signals an event”.10 In medical terms, a prodrome refers to the early symptoms and signs of an illness that come before the characteristic symptoms appear.

For example, chicken pox is described as having a prodrome of a few days characterized by fever,  headache,  and loss of appetite. This is followed by the rash more commonly associated with chicken pox, making definitive diagnosis possible.

People in the prodromal stage of schizophrenia often isolate themselves, stay alone in their bedroom a lot and stop spending time with family or friends. Their school or work performance suffers and they may show signs of decreased motivation, loss of interest in activities, and inappropriate or blunted emotions.

The signs of the prodromal stage are not specific to schizophrenia. That is, someone who is experiencing these behaviors might be depressed or have some other problem. That is why one cannot identify the prodromal stage until the active phase is reached. Until a patient experiences psychotic symptoms, a physician cannot diagnose schizophrenia.

Interestingly, signs of the prodromal stage have been identified as early as childhood. Some innovative research by Elaine Walker and her colleagues at Emory University has involved examining childhood home movies of adults with schizophrenia, and without schizophrenia. Raters, who were unaware of which children had schizophrenia as adults, found that the children who were to develop schizophrenia as adults were often clumsy and awkward.

Although clumsiness is not unique to children who will develop schizophrenia, this sign is seen significantly more often in children at risk for the disorder. Thus, signs of schizophrenia might be present several years before psychotic symptoms emerge.

Family members can be invaluable when it comes to identifying the prodrome of schizophrenia.11 Relatives might sense that something “isn’t quite right” with their family member, even if they’re not certain whether it is just a bad mood, a normal developmental stage, or the influence of alcohol or illegal drugs.

Family members of patients with schizophrenia have identified several behaviors that indicated to them that something was wrong with their relative. Although the prodromal signs differ from patient to patient, nearly all family members of schizophrenia patients indicate that their relative experienced social withdrawal.  Following,  you will find 10 examples of behaviors that relatives of schizophrenia patients noticed in their family member during the prodromal stage of schizophrenia.

Remember that many behaviors that are part of the prodrome are within the normal range of experience.

Acute Stage.  When someone is experiencing psychotic symptoms such as hallucinations, delusions, or grossly disorganized behavior, they are said to be in the acute or active stage of schizophrenia. The active phase indicates full development of the disorder. When patients are in the active phase, they appear psychotic. Their behavior may become so extreme or bizarre that hospitalization is necessary. Once a patient is brought to medical attention, a mental health professional will observe the patient, question the patient, and question the patient’s family members if they are available. The goals of the first assessment are to ascertain when the strange behaviors began, how long they have lasted, and rule out the use of alcohol or drugs. Patients who are grossly psychotic are difficult to interview, so they might be treated with antipsychotic medication upon admission. Indeed, patients in the active phase of schizophrenia often need antipsychotic medication to alleviate their symptoms.  With medication,  many symptoms of schizophrenia disappear. If not treated with medication, this phase may last for several weeks or months. In fact, without treatment, the active phase may go on indefinitely. In very rare instances, the active phase resolves itself and symptoms disappear without treatment.

Some patients have only one episode of schizophrenia, entering the active stage only once. It is more common for patients with schizophrenia to experience multiple episodes of the disorder, with brief periods of being free of symptoms between episodes. For many patients, the active phase is characterized by positive symptoms.

Residual Stage. The final stage of schizophrenia is called the residual stage. The features of the residual phase are very similar to the prodromal stage. Patients in this stage do not appear psychotic but may experience some negative symptoms such as lack of emotional expression or low energy. Although patients in the residual stage do not have delusions or hallucinations, they may continue to experience strange beliefs. For example, when Kevin is in the residual stage of schizophrenia, he might still be convinced that his coworkers don’t like him, even if he no longer believes that they are broadcasting a radio show about him.


Heather Barnett Veague, Ph.D.
Heather Barnett Veague attended the University of California, Los Angeles, and received her Ph.D. in psychology from Harvard University in 2004. She is the author of several journal articles investigating information processing and the self in borderline personality disorder. Currently, she is the Director of Clinical Research for the Laboratory of Adolescent Sciences at Vassar College. Dr. Veague lives in Stockbridge, Massachusetts, with her husband and children.

References

  1. National Alliance on Mental Illness, "About Mental Illness." Available online. URL: http://www.nami.org/template.cfm?section=By_Illness. Accessed February 22, 2007.
  2. American Experience, "People and Events: Recovery from Schizophrenia." Available online. URL: http://www.pbs.org/wgbh/amex/nash/ peopleevents/e_recovery.html. Accessed February 22, 2007.
  3. John F. Nash Jr., "Autobiography." Availalable online. URL: http://nobelprize.org/economics/ laureates/1994/nash-autobio.html. Accessed May 10, 2007.
  4. Sylvia Nasar, A Beautiful Mind. New York: Simon and Schuster, 1998, 335.
  5. American Experience,"Transcript." Available online. URL: http://www.pbs.org/wgbh/amex/nash/filmmore/pt.html. Accessed February 22, 2007.
  6. See note 2.
  7. Robert L. Spitzer et al., eds., DSM-IV-TR Casebook: A Learning Companion to the Diagnostic and Statistical Manual of Mental Disorders. 4th ed., Text Revision. (Washington, DC: American Psychiatric Publishing, 2004), 189 - 90.
  8. H. Hafner et al., "The Influence of Age and Sex on the Onset and Early Course of Schizophrenia." British Journal of Psychiatry 162 (1993): 80 - 86.
  9. E. Fuller Torrey, Surviving Schizophrenia: A Manual for Families, Consumers and Providers, 3rd ed. New York: Harper Perennial, 1995, p. 79.
  10. G.A. Fava and R. Kellner, "Prodromal Symptoms in Affective Disorders." American Journal of Psychiatry 148 (1991): 828 - 830.
  11. British Columbia Schizophrenia Society, "Basic Facts about Schizophrenia," Available online. URL: http://www.mentalhealth.com/book/ p40-sc02.html#Head_4. Downloaded on November 13, 2006.
  12. Quoted in J.N. Butcher, S. Mineka, and J.M. Hooley, Abnormal Psychology. Pearson: Boston, 2004.
  13. Harrison et al., "Recovery from Psychotic Illness: A 15- and 25-year International Follow-up Study." British Journal of Psychiatry 178 (2001): 506 - 517.
  14. N.C. Andreasen, "The Role of the Thalamus in Schizophrenia." Canadian Journal of Psychiatry 42 (1997): 27 - 33.
  15. J. Hooley and S. Candela, "Interpersonal Functioning in Schizophrenia." In Oxford Textbook of Psychopathology, edited by T. Million, P.H. Blaney, and R.D. Davis. New York: Oxford University Press, 1999.
  16. J.D. Hegarty et al., "One Hundred Years of Schizophrenia: A Meta Analysis of the Outcome Literature." American Journal of Psychiatry 151, no. 10 (1994): 1409 - 1416.
  17. E.Q. Wu et al., "The Economic Burden of Schizophrenia in the United States in 2002." Journal of Clinical Psychiatry 66, no. 9 (2005): 1122 - 1129.
  18. C. Wallace, P.E. Mullen, and P. Burgess, "Criminal Offending in Schizophrenia over a 25-year Period Marked by Deinstitutionalization and Increasing Prevalence of Comorbid Substance Use Disorders." American Journal of Psychiatry, 161 (2004): 716 - 727.
  19. Suicide and Mental Health Association International, "NARSAD Publishes Top 10 Myths About Mental Illness Based on Nationwide Survey." Available online. URL: http://suicideandmentalhealth associationinternational.org/factsmythsment.html. Accessed February 22, 2007.

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