Prodromal phase of schizophrenia: Diagnostic perspectives and therapeutic opportunities

Objective: In this paper we describe a clinical experience of psychopharmacological treatment in a group of young subjects with basic symptoms and social and job dysfunction. This condition is considered as a potential warning sign of schizophrenic disorder. This paper analyses the efficacy of two atypical antipsychotic drugs in the treatment of these subjects (risperidone and olanzapine). Methods: Twelve subiects (10 male and 2 female) were enrolled in the study; age ranged 18 to 29 years (mean age 23.7; SD ± 4.7). They were selected at the outpatient unit, where they were seen for problems of social and job adjustment. All subjects showed clinically significant basic symptoms at the Frankfurter Beschewerde Fragebogen scale. Atypical antipsychotic drugs were administered to all subjects: 5 mg/die of olanzapine to six subjects and 2 mg/die of risperidone to the other subjects. All subjects have been tested before and during psychopharmacological treatment (at 2, 4 and 8 weeks). Results: A significant amelioration of basic symptoms and social adjustment during the psychopharmacological treatment was observed. No significant differences were observed between subjects treated with olanzapine and subjects treated with risperidone. Conclusion: These clinical observations suggest that atypical antipsychotic drugs, administered to subjects with basic symptoms, during a short time period, may induce an improvement of mental functioning areas, a reduction of basic symptoms and increased social adaptation. Currently, there is no general agreement on specific diagnostic criteria for basic symptomatology as a prodromal phase of schizophrenia. Nevertheless we suggest that the diagnosis and the psychopharmacological treatment of basic symptomatology may be useful, given the neurodevelopmental origin of schizophrenic disorder and the undisputed advantage of early psychopharmacological therapy.