What is Prodromal Psychosis

Outpatient clinic for patients with psychosis prodromes

MANNHEIM (bd). The first signs of schizophrenia often appear many years before the first psychotic episode. However, since these prodromes are often very unspecific, they are usually not recognized or otherwise assigned. The Central Institute for Mental Health (ZI) in Mannheim now offers an early detection clinic in order to recognize the onset of psychosis in good time. The aim is to carry out a risk assessment very early on, to alleviate the suffering of the patient as early as the prodromal phase and to avoid the progression of the disease. "We want to offer help in good time, before those affected get into serious crises and the impairments affect relationships, work and training," describes the head of the Mannheim early detection clinic, private lecturer Dr. Mathias Zink the facility opposite the "Ärzte Zeitung".

The suffering can already be alleviated in the prodromal stage

The longer someone goes untreated, the harder it is to achieve a full cure and restore social and professional performance, Zink said. And finally, it is also important to banish the risk of suicide in the event of a manifesting psychosis. According to Zinc, this is an often underestimated problem in the early stages of the disease.

Very often the young people themselves have a clear feeling that something has changed. Those affected in the prodromal phase experience emotional changes primarily in the form of depression and a decrease in general performance. Familiar people also often noticed changes and social withdrawal, said Zink.

But the symptoms are often unspecific and are therefore often explained with typical problems in adolescence. They are also present in other mental disorders. That is why they are often not associated with the onset of psychosis, even by doctors.

Suspicion, sleep problems and brooding are early symptoms

In addition to the core areas of affect, performance and social behavior, other complaints can occur that are rated as a risk constellation for psychoses: sleep disorders and reduced appetite, slowing down of language and movements, reduced energy and drive, brooding, reduced contact ability, distrust and irritability as well as inner tension . Even at this stage, an outpatient diagnosis should urgently take place, according to the psychiatrist - before symptoms such as delusions, alienation, hallucinations, fears of alleged threats and persecution occur.

The diagnostics in the Mannheim early detection clinic comprises several modules: In addition to the detailed current anamnesis, the previous treatments and the sociobiography, risk factors for psychoses are recorded in detail. These are, on the one hand, genetic and, on the other hand, biographical factors such as migration, life events associated with stress and the consumption of psychotropic substances. Especially the early onset and high-dose abuse of cannabinoids is considered to be an important psychosis trigger, according to zinc.

In addition to standardized questionnaires such as CAARMS *, ERIraos ** are also used as checklists and standardized interviews for further diagnostics. This instrument was developed in the working group of the former ZI director Professor Heinz Häfner and is based on many years of research on the early course of schizophrenic and affective psychoses, in which the IRAOS *** was used. With these instruments, the risk of the onset of psychosis can be estimated with great certainty in about three outpatient appointments, said Zink.

Out of 100 people in an advanced prodromal phase, around 30 will develop fully developed psychosis according to the ICD-10 criteria within one year. Even with a beginning prodromal phase, there is still at least a ten percent risk of psychosis.

Multimodal therapy for those at risk of psychosis

The patients at increased risk receive multimodal therapy in the early detection clinic of the ZI. This consists of close personal and telephone contacts. In pharmacotherapy, the focus is on antidepressant substances. If psychotic symptoms are already shown in a still mild form, new, well-tolerated second-generation antipsychotics may be indicated in the individual case and after detailed information.

The psychotherapeutic spectrum is diverse and includes, for example, problem-focused psychoeducation with an explanation of what a psychosis is, how to deal with it and which therapies are possible. In addition, there is metacognitive training aimed at changes in thinking, perception and social cognition that are typical of psychosis.

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