Clinical phenomenology of the prodrome for psychosis

Summary

Psychosis is typically preceded by a prodrome, which begins with nonspecific symptoms like anxiety and depression before more specific negative and attenuated positive symptoms emerge. Prospective diagnostic criteria, developed from retrospective studies, show high reliability in research settings. Individuals assessed as at clinical high risk (CHR) are five to seven times more likely to progress to psychosis than those not at risk, and they also experience functional and cognitive impairment and distress. CHR diagnosis rates are low in general epidemiology studies, supporting validity, but substantially higher in clinical epidemiology studies, indicating CHR is an important but often overlooked clinical entity. Several areas needing additional research are identified.

Study at a glance

Abstract

More than 100 years of retrospective studies show that psychosis is usually preceded by a prodrome. Nonspecific symptoms such as anxiety and depression precede more specific negative and attenuated positive symptoms. Prospective diagnostic criteria have been developed based on the retrospective work. The prospective criteria have shown high reliability in the research context, and follow-up studies demonstrate that those assessed as at clinical high risk (CHR) are five to seven times more likely to progress to psychosis as those who are not. Functional and cognitive impairment and distress accompany the increased risk. CHR diagnosis rates in general epidemiology studies are low, supporting validity, but rates in clinical epidemiology studies are substantially higher, suggesting that CHR constitutes an important but often overlooked clinical entity. Despite this importance, several areas in need of additional research effort are identified.