Prodromal Schizophrenia: Signs & Symptoms

The symptoms of schizophrenia typically develop around the age of adolescence, and young adulthood for men. Whereas they tend to develop during a woman’s late 20’s or 30’s, however, this is not always the case. Symptoms may develop suddenly or gradually. There are three phases of schizophrenia, the prodromal phase, active phase, and residual phase. Depending on where you live, you might be told that there a four stages to schizophrenia including the previous three, as well as the relapse phase.

Prodromal schizophrenia is typically the first phase of oncoming schizophrenia. The symptoms of the prodromal phase are often vague and easy to miss, they tend to mimic other disorders making it difficult to be noticed; particularly in teenagers, as the symptoms may not seem unusual for someone of that age, hence why schizophrenia often goes undiagnosed at this point. This phase can last for weeks or months, and at times, even up to several years. The symptoms of the prodromal phase are typically triggered by stress and stressful events, such as upcoming exams, the death of a family member or friend, bullying, and numerous other causes of stress. Comorbid disorders can be rather common during this period.

Individuals who are experiencing the prodromal phase of schizophrenia are often adolescents or young adults who are experiencing mild to moderate disturbances in perception, cognition, stress tolerance, energy levels, language, and motor function. The symptoms which develop during the prodromal phase tend to develop gradually, an individual may start to lose interest in their hobbies and usual pursuits, they may withdraw from friends and family, resulting in isolation. Individuals within the prodromal phase may find that they are easily confused, have difficult concentrating, are intensely preoccupied with religion, philosophy, the paranormal, and conspiracies.

The prodrome / prodromal phase of schizophrenia is not a full psychotic break, rather a display of abnormal behaviour similar to, but not as severe as that which is seen in psychotic patients.

Please do not use this as a diagnostic tool, the symptoms which have been previously mentioned are typical of the prodromal phase, however, these symptoms can be due to other causes or mental illnesses. Therefore if you have any concerns or display any of the previously mentioned symptoms, please speak to your doctor or psychiatrist.

Disorganized Thoughts and Behaviour

Disorganized thoughts are something I’ve been struggling a lot with lately; making it increasingly difficult to write, communicate, or do anything for that matter.

What are Disorganized Thoughts?

When a person is experiencing disorganized thinking it can be extremely difficult to concentrate as thoughts can come and go rapidly. Resulting in the person being easily distracted and unable to focus. At times, thoughts cannot be organized into logical sequences, therefore making the thoughts become disorganized and fragmented.

Disorganized thinking becomes noticeable to others during conversation. This is because those affected by disorganized thinking will often lose their train of thought during conversations, or they may jump from subject to subject at random even when the subjects are not associated with each other, as well as speech becoming that disorganized that it may not make sense at all.

What is Disorganized Behaviour?

There are four key noticeable areas when looking at disorganized behaviour. These include a decline in daily functioning, a lack of inhibition and impulse control, unpredictable or inappropriate emotional responses, and behaviour that appears to be bizarre or have no real purpose. However, the range of severity of disorganized behaviour can be drastic. Whereas disorganized behaviour can involve a neglect of self-care behaviours, it can also include things such as not dressing according to the weather, or they may continuously mutter to themselves. With disorganized behaviour almost anything is possible.

A decline in daily functioning may cause the person to become unhygienic, stop eating or drinking and such behaviours; rendering them unable to look after themselves. A lack of inhibition and impulse control can lead to dangerous or risk taking behaviours, which can threaten the affected person’s safety.  Unpredictable and inappropriate emotional responses may cause the person to appear happy when receiving bad news, and seem sad when receiving good news. This can affect the person’s relationships with others as they may appear to be rude and arrogant, when this is not the case. Bizarre behaviour, or behaviour with no real purpose can include almost anything; such as any of the things that were previously mentioned (continuously muttering to themselves).

Coping with Disorganized Thoughts and Behaviour

Coping with disorganized thoughts and behaviour can be particularly difficult as well as distressing for the affected person. It also comes with the obstacle of a lack of insight, making us unaware as to what is really going on. This can also lead to isolation if others do not respond well to the way we are currently behaving. Therefore I do not have any methods of coping with disorganized thoughts and behaviour, other than mindfulness meditation. I previously mentioned this in another article; mindfulness meditation allows the affected person to deal with their thoughts and feelings in a healthier way. Furthermore, the more mindfulness meditation is practised, the more effective it will become.

The Positive and Negative Symptoms of Schizophrenia: in Detail

The symptoms of schizophrenia are divided into two categories, which are positive and negative symptoms.

The positive symptoms are something that changes the behaviour or thoughts of an individual. Whereas the negative symptoms signify a withdrawal or lack of function that would be expected in a healthy individual. However it is important to note that the following symptoms are not specific to schizophrenia, and could be the result of many different issues.

Positive Symptoms of Schizophrenia:

The positive symptoms of schizophrenia include hallucinations, delusions, confused thoughts, and a change in behaviour and thoughts.

Hallucinations

There are various types of hallucinations. Including visual, auditory, tactile and olfactory.

Visual

Visual hallucinations are when an individual sees things which are not really there, although they seem very real to the person experiencing the hallucination. A common type of a visual hallucination is when a person sees what are known as ‘shadow people’. Seeing bugs crawling on walls or on your skin is another common visual hallucinations. Not all hallucinations are necessarily frightening, but they can cause extreme distress to the individual, which may lead to harming behaviour of oneself, or others. Although harming others is very uncommon.

Auditory

Auditory hallucinations vary greatly from individual to individual. An auditory hallucination is a false perception of hearing sounds such as voices or music, without any real auditory stimuli. Auditory hallucinations vary greatly from person to person. People experiencing auditory hallucinations can hear multiple voices or a singular voice at one time; the sounds heard by those suffering from these hallucinations may seem like they are coming from a direct source, such as a TV, radio, or computer speakers. Other times, these sounds may not be coming from any particular source.

Tactile

Tactile hallucinations are when one feels things without them actually being there. A common type of tactile hallucinations is bugs crawling on or under the skin. These hallucinations are more likely to cause self-harming behaviour as the individual tries to rid of these bugs through scratching and picking at their skin.

Olfactory

Olfactory hallucinations are when an individual can smell something which does not really exist within the present environment. Odours detected by those experiencing these hallucinations can differ vastly from person to person. These smells can often be unpleasant, however that is not always the case.

Delusions

Similarly to hallucinations, there are also many types of delusions. This includes delusions of control, nihilistic delusions, delusional jealousy, delusions of guilt or sin, delusions of one’s mind being read, delusions of reference, delusions of grandeur, erotomania, delusions of persecution, religious delusions and somatic delusions.

These delusions can then be divided into two categories, which are bizarre delusions and non-bizarre delusions. Delusions of control, nihilistic delusions, thought insertion, thought withdrawal and thought broadcasting are typically considered bizarre delusions. Whereas persecutory, grandiose, somatic and religious delusions are considered to be non-bizarre. Most delusions of guilt, jealousy, and that of the mind being read would also be considered non-bizarre.

Delusions of Control

This is a false belief that external forces are controlling ones thoughts, feelings, and actions. A common delusion of control is that the government is controlling the person via satellites.

 Nihilistic Delusions

A nihilistic delusion is the belief that oneself, a part of the person’s body, or the real world does not exist or has been destroyed.

Delusional Jealousy

Also known as morbid jealousy, delusional jealousy is the belief that one’s significant other is cheating or having an affair based on unfounded evidence.

Delusions of Guilt / Sin

This is a false feeling for very intense guilt or remorse, though the person experiencing this delusion is in no way responsible for what they feel guilty for.

Delusions of One’s Mind being Read:

This is the belief that other people know and can read the persons thoughts. However, it is important to note that this is different from thought broadcasting.

Delusions of Reference

Delusions of reference is the belief that ordinary events, objects or the behaviour of others has a significant meaning to the person.

Delusions of Grandeur

Grandiose delusions are the belief that oneself is a celebrity, person of high status or a powerful entity (commonly god or the devil).

Erotomania

This is the belief that another person (usually of high status) is in love with the person experiencing the delusion.

Delusions of Persecution

This is the belief that oneself is being conspired against, attacked, spied on, harassed or persecuted. A common delusion of persecution is that the person is being spied on by the FBI, CIA, or a similar organization.

Religious Delusions

A religious delusion is any delusion with a religious foundation, this delusion can occur in consequence with other delusions such as delusions of grandeur.

Somatic Delusions

A somatic delusion is when the person believes that their organs, a part of their body, or bodily function is abnormal or changed.

Thought Disorder (Confused Thoughts)

When a person is suffering from a psychotic episode, their thoughts may become muddled and ‘hazy’. This can cause difficulty in both speech and writing, which other people can find hard to understand. They may find difficulty concentrating and drift from one idea to another, even when they are not associated with each other.

Changes in Behaviour and Thoughts

The person’s behaviour and thoughts may become disorganized and unpredictable. The way in which they dress and present themselves may seem odd or eccentric to others. Their behaviour may be inappropriate, or they can become extremely agitated for little to no reason, resulting in shouting and swearing which others may find threatening. However, people with schizophrenia rarely resort to violence.

Another common characteristic seen in people with schizophrenia is paranoia. Paranoia is particularly distressing to the individual, which often results in extreme isolation. Those with schizophrenia may also experience intrusive thoughts / images, thought withdrawal and thought broadcasting. Intrusive thoughts / images are thoughts / images which the individual feels are being placed there by someone else, or that their thoughts are not their own, these thoughts can be very distressing and unpleasant, however they do vary greatly from person to person. Thought withdrawal is the feeling that thoughts are disappearing from one’s mind, or are being stolen by someone else. Thought broadcasting is when the person believes their thoughts are being broadcasted for other people to hear or be aware of.

Negative Symptoms of Schizophrenia:

The negative symptoms of schizophrenia can often cause difficulty in making and maintaining relationships, as well as having a severe impact on the individual’s everyday life. The people around the individual suffering from these symptoms often mistake them as the individual being purposely lazy, difficult and rude.

Loss of Interest and Motivation in life and activities

With schizophrenia, there is a significant loss of interest and motivation in both life and activities. Hobbies and interest which were once enjoyed by the person, may seem uninteresting and unpleasant. The inability to experience pleasure is known as anhedonia. People with schizophrenia may become extremely lethargic, resulting in them spending most of their time in bed or doing things which require little effort, such as watching television.

Lack of Concentration

Concentrating can prove to be significantly difficult for the person. This can lead to the person being unable to complete simple tasks or take part in conversations.

Social Withdrawal

Individuals with schizophrenia may isolate themselves, and prefer to spend the majority of their time in solitude. Social withdrawal is not always associated with paranoia, rather the person suffering from schizophrenia has a general lack of contact with the world around them.

Inappropriate Emotional Responses and Feeling Disconnected from your Feelings

A person may have blunted emotional responses, or react with inappropriate emotions when communicating with others. This can include laughing when being told sad news, or being sad or irritated when being told good news. Other times a person suffering from schizophrenia may appear emotionless, with a blank facial expression. This is known as the ‘flat affect’.

Sexual Problems

In individuals with schizophrenia, there may be significant or complete loss of libido. The person may also not be able to achieve an orgasm, or find extreme difficulty in doing so.