Understanding and Recognising Prodromal Schizophrenia in Teens

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Schizophrenia is a complex mental health disorder that usually develops during adolescence or early adulthood. Schizophrenia looks a bit different in each person and can involve many different experiences and behaviours. A young person might receive a diagnosis of schizophrenia if they experience hallucinations, see or believe things that others don’t, or experience disorganised thinking or speech.

Many young people and adults with schizophrenia fully recover with treatment or see an improvement in their symptoms. Others successfully manage the disorder and the symptoms they experience, living full and satisfying lives. In many cases, early treatment and other interventions can prevent the disorder from fully developing in the first place.

Over the past decades, researchers have noticed that most young people experience milder, ‘attenuated’ symptoms of schizophrenia in the years before the onset of the disorder. They have also observed other patterns of behaviour that often precede the illness, such as social isolation or school failure.

Experts believe that intervening in the prodromal stage may stop some cases of prodromal schizophrenia from developing into more intense symptoms. By learning to understand and recognise prodromal symptoms, parents, guardians, teachers, and community members may be able to stop the early signs of schizophrenia and help young people to receive the support and care they need.

Schizophrenia as a Neurodevelopmental Disorder

Many scientists characterise schizophrenia as a neurodevelopmental disorder. Neurodevelopmental disorders emerge from the way a young person’s brain develops, usually due to a combination of genetics, early life experiences (like childhood trauma), and other environmental factors (like the place someone lives or the experience of a distressing event). 

Researchers think that several different factors may play a role in the development of schizophrenia, including:

  • genetics
  • changes in brain chemicals during pregnancy or early childhood, such as a viral infection
  • childhood experiences of trauma
  • using certain psychoactive substances

In certain groups of young people, prodromal symptoms are more common. A research paper analysing 87 different studies found that:

  • in mental health settings, 16-36% of young people met the criteria for prodromal syndrome
  • in groups of young people with disruptive behaviours, but who were not seeking treatment, 13% met the criteria

Neurodevelopmental models explain that certain traits or experiences make it more likely that a young person will develop the disorder. They can also describe common pathways in the development of the disorder, including certain symptoms that may precede its onset. As a result, identifying these risk factors or symptoms may allow for early intervention and treatments that prevent the condition from developing into a full diagnosis.

What Are the Symptoms of Prodromal Schizophrenia in Teens?

Prodromal psychosis, or prodromal schizophrenia, refers to the set of symptoms that children and adolescents often experience in the years before they meet the criteria for a schizophrenia diagnosis. Experts have collected and described these symptoms as a psychosis-risk syndrome known as Clinical High Risk for Psychosis. Some of its symptoms include:

  • Experiencing psychosis symptoms such as perceptual disturbances, unusual thoughts, or disorganised speech, but at a lower intensity than is usually seen in schizophrenia
  • Experiencing psychosis symptoms at an intense level at least once a month, but without causing the levels of distress or impairment associated with a diagnosis
  • Starting to find aspects of thinking and behaving more difficult than before and having a first-degree relative with a diagnosis of a psychosis disorder
  • Experiencing a particular pattern of change in stress tolerance, motivation, thinking, or perception

Some researchers include other symptoms, such as school failure and social isolation, as symptoms of prodromal schizophrenia.

If you’re concerned about changes in a young person’s behaviours, there are several signs to look out for. These include:

  • difficulty concentrating or maintaining attention
  • difficulty remembering things or interpreting events in a different way than other people
  • paranoid or anxious thoughts
  • social withdrawal
  • neglecting self-care
  • changes in mood
  • changes in friend groups
  • difficulties sleeping
  • low mood
  • lack of motivation

It’s important to remember that these signs may have many explanations other than prodromal schizophrenia. Most of the symptoms also resemble characteristics of mood disorders, such as anxiety, depression, or bipolar disorder. If you’re worried about a young person, don’t jump to any conclusions by yourself. Instead, a mental health professional can work with a young person to sensitively and accurately interpret their symptoms so that they can receive the care that they need.

How Often Does Prodromal Schizophrenia Develop into Schizophrenia?

Research suggests that about 1 in 5 young people with prodromal schizophrenia eventually reach the criteria for a schizophrenia diagnosis. About 4 in 5 of those who do not develop schizophrenia or another psychotic disorder go on to develop other mental health disorders like anxiety or depression. 

Studies have found that around 75% of people diagnosed with schizophrenia experience a prodromal stage, although many people may not have noticed at the time. Sometimes, subtle changes in personality or behaviour may be explained away by diagnoses of other mood disorders or perceived as normal changes that happen as a young person grows up.

How Can You Treat Prodromal Schizophrenia in Young People?

For young people with prodromal schizophrenia, there are lots of different types of support that may help prevent their symptoms from intensifying and reduce the chance that they’ll develop the full disorder. Some of these treatments include:

  • Anti-depressant medications
  • Anti-psychotic medications
  • Cognitive-behavioural therapy

Research has found that medication that decreases stress levels can help prevent the intensifying of psychosis symptoms in individuals who have genetic vulnerabilities to the disorder. One study found that among individuals taking medication in combination with cognitive-behavioural therapy, only 1 in 10 people went on to develop schizophrenia in the following 6 months, compared to around 1 in 3 people who were not receiving treatment.

For some young people, treatment may prevent the development of psychotic episodes completely. For others, it may delay the onset of such episodes, lessen their intensity, and help them to develop the skills they need to manage them. By learning to prepare for difficult periods, building a wide support network, and knowing the kind of support they may require if things do get worse, young people with both prodromal and diagnosed schizophrenia can continue to live full and productive lives.

The Wave Clinic: A Safe-Haven for Young People

The Wave Clinic is a specialist treatment centre for young people, providing trauma-focused care for mental health concerns. We offer a whole-person approach to recovery, supporting young people to find their place in life, reconnect with themselves, develop enriching relationships with others, and plan fulfilling futures. We believe that no young person should feel left behind or overlooked, ensuring inclusion, fairness, and exemplary treatment across our treatment programs.

At The Wave, we combine exceptional clinical care with education, practical activities, community work, and a gap year experience to help young people grow in every aspect of themselves. We provide a safe haven where young people have the security and space they need to build a full and sustainable recovery.

We understand how difficult it can be if your child is experiencing mental health issues. We’re here to answer any questions you may have and offer ongoing support. Contact us today.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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