The prodrome is a period during which an individual experiences some
symptoms and/or a change in functioning, which can signal the impending onset of a mental health disorder. It is otherwise known as the prodromal phase when referring to the
subsyndromal stage or the early
abnormalities in behavior, mood, and/or cognition before illness onset. Early detection of the prodrome can create an opportunity to administer appropriate early interventions quickly to try to delay or decrease the intensity of subsequent symptoms.
Schizophrenia Schizophrenia was the first disorder for which a prodromal stage was described. People who go on to develop schizophrenia commonly experience non-specific negative symptoms such as
depression,
anxiety, and
social isolation. Although a majority of individuals who experience some of the symptoms of schizophrenia will never meet full diagnostic criteria, approximately 20–40% will eventually be diagnosed with schizophrenia. One of the challenges of identifying and treating the prodrome is that it is difficult to predict who, among those with symptoms, are likely to meet full criteria later.
Duration The prodromal phase in schizophrenia can last anywhere from several weeks to several years, and
comorbid disorders, such as
major depressive disorder, are common during this period.
Identification/assessments Screening instruments include the Scale of Prodromal Symptoms and the PROD-screen.
Signs and symptoms of the prodrome to schizophrenia can be assessed more fully using
structured interviews. For example, the Structured Interview for Prodromal Syndromes, are both valid and reliable methods for identifying individuals likely experiencing the prodrome to schizophrenia or related
psychotic-spectrum disorders. There are ongoing research efforts to develop tools for early detection of at-risk individuals. This includes development of risk calculators and methods for large-scale population screening.
Interventions Describing the schizophrenia prodrome has been useful in promoting
early intervention. Although not all people who are experiencing symptoms consistent with the prodrome will develop schizophrenia,
randomized controlled trials suggest that intervening with medication and/or
psychotherapy can improve outcomes. However, side effects of medication, such as sedation and weight gain, can still occur.
Bipolar disorder Symptomology There is also growing evidence that there is a prodromal phase before the onset of
bipolar disorder. Although a majority of individuals with bipolar disorder report experiencing some symptoms preceding the full onset of their illness, the prodrome has not yet been described systematically. Descriptive reports of bipolar prodrome symptoms vary and often focus on nonspecific symptoms of
psychopathology, making identification of the prodromal phase difficult. The most commonly observed symptoms are too much energy, elated or depressed mood, and alterations in sleep patterns. There are no prospective studies of the prodrome to bipolar disorder, but in the Longitudinal Assessment of Manic Symptoms (LAMS) study, which followed youth with elevated symptoms of
mania for ten years, approximately 23% of the sample met the bipolar criteria at the baseline and 13% of which did not meet the criteria at baseline eventually were diagnosed with bipolar disorder.
Duration The reported duration of the prodrome to bipolar disorder varies widely (mean = 27.1 ± 23 months);
Identification/assessments Symptoms consistent with the prodrome to bipolar disorder can be identified through
semi-structured interviews such as The Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P), and the Semi-structured Interview for Mood Swings and
symptom checklists like the
Young Mania Rating Scale (YMRS) and the
Hamilton Depression Scale (HAM-D).
Interpersonal and Social Rhythm Therapy (IPSRT) may be beneficial for youth at risk of developing the disease by helping to stabilize their sleep and
circadian patterns.
Psychoeducational Psychotherapy (PEP) may be protective in individuals at risk of developing bipolar disorder and are associated with a four-fold reduction in risk for conversion to bipolar disorder. This research needs to be explored further, however, it is currently thought to produce improvements in decreased stress due to
social support and improved functioning through the skills developed in PEP. PEP can prove especially beneficial for individuals presenting transitional mania symptoms as it can assist caregivers in recognizing prodromal mania symptoms and knowing the next steps towards early intervention. ==In neurological conditions==