Basic symptoms and ultrahigh risk criteria: symptom development in the initial prodromal state

Symptom development during the prodromal phase of psy-chosis was explored retrospectively in first-episode psycho-sis patients with special emphasis on the assumed time-related syndromic sequence of ‘‘unspecific symptoms (UN)–predictive basic symptoms (BS)–attenuated psy-chotic symptoms (APS)–(transient) psychotic symptoms (PS).’ ’ Onset of syndromes was defined by first occurrence of any of their respective symptoms. Group means were inspected for time differences between syndromes and influ-ence of sociodemographic and clinical characteristics on the recalled sequence. The sequence of ‘‘UN–BS/APS–PS’’ was clearly supported, and both BS and, though slightly less, APS were highly sensitive. However, onset of BS and APS did not show significant time difference in the whole sample (N = 126; 90 % schizophrenia), although when each symptom is considered independently, APS tended to occur later than first predictive BS. On descrip-tive level, about one-third each recalled an earlier, equal and later onset of BS compared with APS. Level of education showed the greatest impact on the recall of the hypothesized sequence. Thereby, those with a higher school–leaving certificate supported the assumed sequence, whereas those of low educational background retrospec-tively dated APS before BS. These findings rather point out recognition and recall bias inherent to the retrospective design than true group characteristics. Future long-term prospective studies will have to explore this conclusively. However, as regards the criteria, the results support the no-tion of BS as at least a complementary approach to the ul-trahigh risk criteria, which may also allow for an earlier detection of psychosis. Key words: psychosis/early course/phenomenology/early initial prodromal state/late initial prodromal stat