Recognizing the Early Indicators of Schizophrenia

For the best patient outcomes, early intervention in schizophrenia is key.

In this video, Christoph Correll, MD, professor of psychiatry and molecular medicine, Zucker School of Medicine at Hofstra/Northwell, New York, reviews some of the key prodromal and accentuated psychotic symptoms may serve as early indicators of schizophrenia. Dr Correll also offers guidance on how to navigate conversations with patients and their caregivers regarding early diagnosis and treatment interventions, especially when there is some reluctance to accept the diagnosis.

For more expert insights, visit the Schizophrenia Excellence Forum right here on Psych Congress Network.

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Read the Transcript

Christoph Correll, MD: Hi, I'm Christoph Correll, Professor of Psychiatry and Molecular Medicine at the Zucker School of Medicine at Hofstra/Northwell in New York. I'm also Professor and Chair of Child and Adolescent Psychiatry at the Charité University in Berlin, Germany. Welcome to this program.

Psych Congress Network (PCN): What are some key prodromal and accentuated psychotic symptoms that can serve as early indicators of schizophrenia? How do you approach assessment and diagnosis for these symptoms in your own clinical practice?

Dr Correll: We know that the first episode of psychosis is preceded by a so-called prodromal phase. Prodromos means the early noise that something makes when it appears, before it appears. Longitudinal studies have shown that it's basically anxiety symptoms, some cognitive decline, depression, and then that enters into this fear of attenuated positive symptoms. So they hear noises or see shadows. There might be some suspicious ideas that have not yet crystallized and are not full-fledged delusions. There might be an initial thought disorder that, again, is milder in nature.

When these symptoms occur, it's better to actually monitor the patient, maybe work with CBT, have healthy lifestyle, that they sleep well, that they don't use drugs that could then push these emerging symptoms into full psychosis. How do you measure this? You ask patients about it. There is also a rating scale that can be used as a self-rating tool. But I think most people don't usually use that. It's asking about these symptoms. Then, when there is substance use in the mix, it's hard. You need to differentiate that, try to work with a client, and also have the environment, the caretakers, the families, be in the boat, so that they look for worsening of these symptoms, that we can treat people with antipsychotics as early as the first signs of full psychosis emerge.

PCN: How do you approach discussions with your patients and their families about the importance of early intervention and the available treatment options, particularly when there's some resistance or reluctance to a diagnosis?

Dr Correll: When someone is psychotic, I mentioned before, it's a very incisive moment. There are multiple ways of responding to this. People are in shock. People are in denial. People are angry. People want to just get out of this situation and not accept that there might be an illness. They might question, "Is it really the right diagnosis?" I think what's important here is education, but also building a relationship, even when patients initially might say, "I don't want to have any treatment," or family members say, "It can't be that he has this diagnosis. It must be something else." So I think building trust, offering information, and then working, over time, to have patients understand, and their family members, that early intervention with an antipsychotic is really crucial. Giving them data. If all fails, maybe also have a peer counselor or someone who's gone through this and has experienced that it's bad to let time pass and have psychosis take hold of someone's brain and life. That can also help build a relationship and initiate treatment in a timely fashion.

Christoph Correll, MD, is Professor of Psychiatry at The Zucker School of Medicine at Hofstra/Northwell, New York, USA, and Professor and Chair of the Department of Child and Adolescent Psychiatry, Charité University Medicine, Berlin, Germany. He is board certified in general psychiatry and child and adolescent psychiatry, having completed both residencies at The Zucker Hillside Hospital, NY. Since 1997, he has been working in New York, USA, and since 2017 he is also working in Germany again. Dr. Correll focuses on the early identification and treatment of youth and adults with severe mental illness, clinical trials, epidemiology, psychopharmacology, meta-analyses, and physical health in mental health. Since 2014, the beginning of this metric, he has been listed every year by Clarivate/Web of Science as one of the “most influential scientific minds” and “top 1% cited scientists in the area of psychiatry.”