First-Episode Psychosis: Past and Current Conceptualizations

The initial prodrome in psy-chosis is potentially important for early intervention, identifica-tion of biological markers, and understanding the process of be-coming psychotic. This article re-views the previous literature on prodrome, including descriptions of symptoms and signs, and pat-terns and durations of prodromes in both schizophrenic and affec-tive psychoses. Early detailed de-scriptions, achieved through mainly anecdotal reports, are compared with current concep-tualizations, such as the DSM-III-R checklist of mainly be-havioral items, which seeks to enhance reliability of measure-ment but at the expense of ade-quately describing the full range of phenomena. Current confusion about the nature of prodromal features and concerns regarding the reliability of their measure-ment are highlighted. This article proposes an alternative model for conceptualizing prodromal changes (the hybrid/interactive model) and discusses the dif-ferent ways to view this phase. The need for a more systematic evaluation of the prodromal phase in first-episode psychosis is emphasized