Schizophrenia is one of the most disabling mental health problems of all those currently recognized. Its chronic course is marked by a notable decline in the quality of life, both of the sufferer and those around them.
As a disorder, and due to the aura of mystery that surrounds its clinical expression, it has been the subject of many audiovisual works in which some of its facets have been overstated while others have barely been represented.
The initial phase of it, for example, tends to go unnoticed even by the vast majority of patients and families. It is at this moment when the prodromal symptoms of schizophrenia manifest, which will be the core of this text.
However, first we will delve into a brief description of the characteristic symptoms of the disease when it has already fully established.
Schizophrenia is a disorder included in the general category of psychotic conditions Two large groups of symptoms can be distinguished: positive and negative.
This basic typology, originally proposed by Crow, has remained a valid classification for decades due to its simplicity. Broadly speaking, positive symptoms describe an “excess” and negative symptoms a “deficit” in the manifestation of the disease.
The positive symptoms
The positive symptoms of schizophrenia are hallucinations and delusions. The former describe anomalous perceptual experiences that can compromise any sensory modality, and the latter constitute a more or less articulated set of ideas that the person uses to explain their reality (despite the fact that they lack a sufficient objective substrate). They often attribute iron credibility to both, being resistant to any evidence that could contradict them.
The most common hallucinations are auditory ones , expressed as human voices that refer directly to the patient or that interact with each other in a conversation in which this is the main issue. The content of the message is usually congruent with the mood of the person receiving it. Visual or tactile hallucinatory perceptions would follow in order of frequency.
Delusions involve a cluster of ideas through which the person tries to give meaning to their abnormal perceptual experiences, and whose content may be more or less credible (as would be the case of delusions of persecution that occur in paranoid schizophrenia). ) or be absurd and strange for the cultural environment (contact with beings from other dimensions, varied reincarnations, superhuman abilities, etc.).
Disorganized or meaningless language is also frequently seen Verbal expression seems to be affected by syntactic formulas without an apparent grammatical order and by the formation of neologisms (invented words), as well as by phrases without logical connection or by discourse that tends towards derailment. All of this suggests the underlying presence of formal alterations in thinking.
The negative symptoms
Negative symptoms are largely unknown to most people, despite the fact that they contribute decisively to the disability of those who suffer from this condition. Furthermore, they are clinical expressions resistant to the usual pharmacological treatment (antipsychotics that act as dopamine antagonists on the four brain pathways in which this neurotransmitter is involved).
The negative symptoms are the following: apathy (motivational decline or disinterest), abulia (loss of will to engage in activities of daily living), alogia (impoverishment of thought and language) and anhedonia (difficulty experiencing pleasure in situations that they previously provided it). In addition, alterations in key cognitive processes for development (memory, attention, social cognition, etc.) may coexist.
It is also important to highlight that the presence of other mental health problems is common as the time of living with schizophrenia progresses. The most common are major depression and some anxiety disorders, as well as the presence of suicidal ideation. It should be noted that, contrary to popular belief, people with schizophrenia are no more violent or dangerous than the general population.
From now on we will delve into the initial symptoms of schizophrenia that is, what in specialized terminology is known as prodromal expression.
Prodromal symptoms of schizophrenia
Prodromal symptoms include all those early clinical expressions of a disease Regarding schizophrenia, they describe the time interval between the first signs suggestive of a problem (notable changes with respect to previous patterns of behavior and thinking) and the appearance of psychosis itself. Approximately 75% of people who suffer from schizophrenia have gone through this phase first.
Below we will delve into each of the prodromal symptoms that have been highlighted in the scientific literature. Their duration may be limited to only a few weeks or extend over many years, but in any case they represent an abrupt break in the way the person acted and thought.
1. Social isolation
Social isolation is one of the most evident symptoms during the prodromes of schizophrenia The person withdraws from social life and remains on the margins of family dynamics.
She may spend a large amount of time cloistered in her own room or remain emotionally distant, even when in situations where a certain degree of interaction is expected (meetings, for example), affecting the integrity of her bonds.
2. Changes in the development of daily activities
In the event that the person has an active work or academic life, or is committed to family or other responsibilities, During this stage a very important neglect of these can be seen
There is an abandonment of the activities they carried out on a daily basis, which can translate into the impossibility of maintaining their involvement in different areas (loss of employment, academic failure, breakup of a romantic relationship, etc.).
3. Impoverishment of personal hygiene and cleanliness
There is a very significant neglect of the most basic personal care, such as brushing teeth or showering In this phase, the person may have an unkempt physical appearance and show no interest in changing the situation, even in the face of explicit demands from others. This circumstance is a common source of conflict within the family, and can seriously disrupt coexistence.
A deterioration in physical appearance may also appear due to a sedentary lifestyle or lack of exercise, with a substantial change in eating habits that leads to a very notable weight loss or gain (and alteration of anthropometry). On some occasions, the changes that occur in the body structure are dramatic.
4. Anxiety and depression
Both anxiety and depression are especially disabling prodromal symptoms of schizophrenia , since they contribute to the deterioration of emotional life. They can be expressed as very marked swings in mood, emotional depression, agitation or nervousness. On other occasions they manifest themselves in the form of constant and disproportionate anger, which encourages the presence of conflicts.
Usually these symptoms acquire a sufficient entity to satisfy the diagnostic criteria of different mental disorders in their respective areas (such as major depression, panic disorder, social anxiety, etc.), becoming a comorbid problem that requires independent attention. .
5. Poverty of language and thought
At this stage the first signs of impoverishment in the use of language and thought debut In fact, many authors point out an initial impairment of cognitive processes, although this is more subtle than that observed during the development of the psychotic disorder itself.
The evidence highlights the impairment of the following cognitive processes: speed of information processing (ability to manage the resources necessary to deal with the demands of the situations we face), sustained attention (prolonged maintenance of the focus of attention on a stimulus) and working memory (ability to retain the information required to successfully carry out a task in which one is involved).
Other findings also suggest some degree of decline in verbal memory (evocation of words), problem solving (ability to articulate a plan of action aimed at achieving a goal or resolving a demanding situation), and social cognition (encoding, storage , recovery and use of information associated with social dynamics; including the identification of the expectations of others).
All of them could contribute in some way to other prodromal symptoms, such as loss of employment or social isolation, and should be promptly evaluated by a neuropsychology professional.
6. Strange or obsessive ideas
In this period of time, the presence of recurring ideas can be noticed around a specific topic, around which all daily activities are structured. The vital axis of gravitation can shift abruptly towards these issues, most of which had not been addressed by the person before. It is, therefore, an obsessive thought that displaces habitual concerns to a second order of relevance.
Schizotypal personality disorder (maintenance of beliefs considered strange by the environment and impoverishment of affective expression) provides a structure or foundation on which a subsequent psychosis can be built, and has been considered an important risk factor, so in At this stage, a worsening of this previous symptomatology could be observed.
7. Insomnia
Sleep difficulties are also a common symptom in the prodromal phase of schizophrenia. They can arise in any of their possible forms: onset (falling asleep), maintenance (constant interruptions during the night) and early awakening (ending sleep earlier than desired).
In some cases, an alteration of circadian rhythms is seen, so that the person goes to bed and wakes up excessively late.
Why are prodromal symptoms important?
Knowledge of the prodromal symptoms of schizophrenia, although they often go unnoticed, is of capital importance. This is because they not only occur in the months prior to the development of the full picture, but they can also serve as indicators of the imminent appearance of an acute episode in people who have already received the diagnosis. So that, Its identification allows anticipating the appropriate prophylactic and therapeutic measures
However, it is important to note that the presence of these symptoms does not necessarily imply that the disorder will develop in the future, as this only happens in 20% or 40% of all cases. This is an alarm signal of which it is key to be aware, to implement all the assistance devices that may be appropriate.
