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Dr Ayedh Talha

PRODROMALPSYCHOSIS

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Prodrome Prodrome refers to the early symptoms of an illness which precede

the

manifestation of the fully developed disorder

Most research on the prodrome in psychosis has been conducted in

individuals with schizophrenia

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Symptoms Yung & Mcgorry study:

A prodromal phase was detected in all cases

Duration from 3 days to 6 years

Sleep disturbance 100%

Anxiety 86%

Irritability 86%

Deterioration in role functioning 76%

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Con. Symptoms depressed mood (76%)

social withdrawal (71%),

Poor concentration 71%

suspiciousness (71%),

loss of motivation (68%),

perceptual disturbances (62%),

motor changes (62%)

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weight loss (57%).

A sense of confusion, perplexity and

bewilderment 50%

Obsessive-compulsive symptoms 19%

Suicidal thoughts 24%

Self harm 15%.

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Defining Prodromal State The boundary between different but not psychotic (pre -psychotic) and frankly psychotic

is often

Blurred

transient

psychotic symptoms, attenuated (subclinical) psychotic symptomsor family

history plus functional decline

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PANSS definition

was defined byTransient psychosissymptoms that scored 4 or more for

hallucinations,4 or more for delusions, or 5 or more forconceptual disorganizations, lasted

less than one week and resolved

without antipsychotic

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were defined byAttenuated symptoms

the presence of symptoms that scored3 for delusions, 2-3 for hallucinations, 3-

4 for suspiciousness or 3-4 for on

conceptual disorganisation

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Definition of At-Risk-Mental-State State and trait risk factors

1. First degree relative with any history of psychotic disorder or

bipolar disorder or schizotypal personality disorder.

2. Reduction on GAF* scale of 30% or more points from premorbid

level

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Attenuated psychotic symptoms

1. At least one of ideas of reference, odd beliefs or magical

thinking,perceptual disturbance, digressive speech or thought,odd behaviour or appearance.

2. The symptom occurs at least several times per week.

3. The change in mental state has been present for at least one

week

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Transient psychotic symptoms At least one of: Perceptual disturbance or hallucinations, ideas of

reference, magical thinking or delusions, digressive speech, orformal thought disorder, odd behaviour or appearance.

Duration of each is less than one week and resolves

spontaneously

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DSM 5 PROPOSED DEF Attenuated Psychotic Symptoms Syndrome

All six of the following: a) Characteristic symptoms: at least one of the following in attenuated f

with intact reality testing, but of sufficient severity and/or frequency that it isnot discounted or ignored;

(i) delusions

(ii) hallucinations

(iii) disorganized speech

b) Frequency/Currency: symptoms meeting criterion A must be present inthe past month and occur at an average frequency of at least once per week inpast month

c) Progression: symptoms meeting criterion A must have begun in orsignificantly worsened in the past year;

d) Distress/Disability/Treatment Seeking: symptoms meeting criterion A sufficiently distressing and disabling to the patient and/or parent/guardian tolead them to seek help

e) Symtpoms meeting criterion A are not better explained by any DSM-5diagnosis, including substance-related disorder.

f) Clinical criteria for any DSM-V psychotic disorder have never been m

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Predictors for Psychosis in Individuals with Prodromal

Symptoms

long duration of prodromal symptoms (>900 days),

poor functioning (GAF score 15;

BPRS psychotic subscale score >2)

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depression (HRSD score >18)

disorganization (SANS attention score >1)

Cannabis dependence

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Intervention in the Prodromal Phase broad variety of non-specific symptoms

risk of false positives

Lack of standard treatment

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Recommended approaches Early recognition, easy access to care and close follow-up

treatment for syndromes such as depression, anxiety or substanceuse

Family education and support

antipsychotic medication can affect the natural course of psychoticdisorders

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The first intervention study conducted in PACE examined theefficacy of atypical neuroleptics plus CBT compared to standardtreatment (such as antidepressants, anxiolytics and moodstabilisers) in 33 individuals

35.7% of those receiving standard care developed psychosis

only 9.7% of those who received atypical neuroleptics and CBT

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In 2 years after ceasing treatment, only 2 more individuals fromthe specific treatment group developed psychosis

The mean dose of risperidone in the PACE intervention studywas 1.3 mg (range 0.5-2.0 mg).

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When to use antipsychotics rapid deterioration is occurring, the risk of suicide is very high and treatment of any depression

had proved ineffective

when aggression or hostility is increasing and poses a risk toothers.

low doses of atypical medications are

preferred and should be regarded as a therapeutic trial for alimited period

the medication may be continued with the patients consent for

a further 6 months to 2years

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Thank youThank you