Schizophrenia Early Signs

How early is early?

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Are there specific warning signs marking the onset of schizophrenia?

The short answer to this question is, unfortunately, no. There aren't any specific signs.The longer (and better) answer is that early diagnosis is possible provided that an in-depth examination and history are obtained.

Early diagnosis of schizophrenia relies on of carefully probing for signs and symptoms of psychological distress, getting a comprehensive assessment of the patient's ability to function at work/school and interpersonal functioning.supplemented by a careful family history (as a indicator of risk), 

What does a "comprehensive assessment" mean?

First and foremost that the assessment should not rely exclusively on data obtained from mental status examination and the patient's history. Rather the examination and history are to be supplemented with information from other sources (collateral information) - ideally people who are in contact with the patient on a regular basis.

A statement that "all is well" made by an individual who appears to be in distress has a one meaning when a family member confirms that all is indeed well and the apparent distress is rather a way of being in the world but a completely different meaning when a family member states that their relative says that "all is well" as he is commanded to do so by his imagined tormentors' voices which otherwise would command him to harm himself. Information about the patient's ability to engage in productive or fun activities, carry things through, and socialize with family and friends is essential in understanding to what extent (if any) the patient's symptoms result in changes in overall functioning.

In terms of the examination and history, in addition to the standard questions about mental symptoms, medications and drug use, sleep and appetite, the physician might engage in a more open ended exploration of the patient's view of the word, beliefs, values, interests and abilities, with a special emphasis on relationship and search for meaning.

Do patients experience full blown hallucinations or overt delusions early on?

Not necessarily. However, early on patients might have a range of unusual experiences such as an increased sensibility to sounds or light or an increased sense of apparently disparate things being connected in ways that are personally meaningful. It is not uncommon to feel like that the world is a hostile place and people are not to be trusted or, alternatively, feel like special intuitions, talents or abilities are manifesting. This type of experiences need to be carefully considered, especially when they are at odds with how things were before (e.g. friendly adolescent no longer going out because he can't trust his friends).

Are "unusual" perceptions, feelings, thoughts or behaviors enough to make a diagnosis of schizophrenia?

No, they are not. Such experiences, among other perceptions, feelings or thoughts that while not overly strange or bizarre are slightly outside of the normal range, are not "diagnostic".

 Nevertheless, they should be carefully assessed as part of the bigger picture as painted by the collateral information.

If the "unusual" experiences are not sufficient, what else is needed to make a diagnosis?

An assessment of the patient's overall functioning. If schizophrenia-like experiences result in a change in the patient's ability to function then a diagnosis of schizophrenia should be considered.

Is it important to diagnose schizophrenia early?

Yes. Early diagnosis is the basis for early intervention, which has been shown consistently to result in better course and prognosis in schizophrenia.

Further reading:

Worldwide Early Diagnosis & Treatment Centers for Psychosis & Schizophrenia

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