History
Schizophrenia is very individual. The so-called “1/3” rule is known with regard to the course of the disease, which states that in one third of patients the symptoms occur once and then never reoccur. A second third has recurrent “relapses” and a third remains in a so-called “residual state” in which there are no acute positive symptoms (see below), but a general and permanent drop in performance.
Often the disease progresses in the 3 phases mentioned below, which can vary in length. However, it can also be chronic without this phase. A distinction is made between three different phases of the disease.
- The prodromal stage: At this stage, there are no classic symptoms (see below) of schizophrenia. Rather, the general ability to perform decreases at first. The affected person has more and more difficulties to concentrate on his work or other tasks of daily life.
It often loses interest in his fellow men, his work, but also in his appearance and personal hygiene. There is often a marked social withdrawal, an increase in anxiety and sleep disturbance. Occasionally, delusions (see below) may be heard or increasingly confused thinking may be noticed.
- The florid (flowering) stage: In this phase, which is the actual disease phase, the symptoms listed below occur.
These symptoms must occur almost continuously for a month or more to be diagnosed as schizophrenic. In some cases this phase is triggered by psychosocial stress.
- The residual phase This third phase is reminiscent of the prodromal phase in terms of symptoms.As a rule, acute symptoms no longer occur, but the patient is not yet “back to normal”. It often leads to a kind of exhaustion with an increased need for sleep and to depression (postpsychotic depression).
This phase can only last for a short time, with the result that the patient regains almost his old ability to perform and can lead a life as before. However, it is also possible that the patient continues to suffer from “residual symptoms” and remains in the residual phase. Unfortunately, this patient is less likely to have a complete resolution of the symptoms.
It is often observed that after years of residual symptoms, another florid phase follows, which then passes back into the residual phase. It is difficult to predict which patient will “recover” to some extent (full remission) after an initial psychotic episode and who will remain severely impaired in life. Research has shown that the probability of a favorable outcome is higher if the person had a successful life before the disorder (high pre-morbid level of role fulfillment), if the disorder was preceded by a distressing event, if it started abruptly without a long prodromal phase, or if it occurred in middle age.
Most psychiatric illnesses begin with a so-called prodromal phase, in which the first abnormalities in the patient already appear, but no typical symptoms are yet pronounced.
This stage can begin years before the actual psychosis. The first signs are usually not delusions or other typical characteristics of schizophrenia, but rather negative symptoms such as depression and social withdrawal. The patients are restless, plagued by worries and their ability to think and concentrate is impaired, their perception becomes increasingly consumed and they lose touch with reality.
They often feel an approaching threat, which can later turn into a delusion in the course of the psychosis. Unfortunately, the first signs are very unspecific and could just as well be an expression of other problems and illnesses, such as depression. In many cases the relatives report in retrospect that the patient had already become strange years before the psychosis and had withdrawn more and more. More specific signs are then only expressed months to weeks before the onset of the psychosis, when delusions or hallucinations appear.
