The Prodrome

Here’s a question I find interesting: what’s it like to ‘lose your mind’? When do you begin to lose touch with reality, and how? Do you just wake up that way one morning? We talk about sane and psychotic like they’re separate things, but are they?

There are several causes of psychosis, but I’m going to talk here about one of the most common: schizophrenia. Most people don’t become ill until their late teens or early twenties. We know genes are important and complications at birth can also contribute – so the factors before or on the day you were born can trigger a disease that doesn’t start until you’re twenty. It’s fascinating and mostly true, but not entirely.

There’s a period of time between not-yet-schizophrenia and full-blown schizophrenia, and this phase is called the prodrome. This is the time when you’re beginning to lose touch with reality. Of course the experience varies for different people, but in general, at first, it doesn’t feel all that far from normal.

Have you ever had trouble ignoring a buzzing light or a loud fan or someone tapping their feet? That’s normal enough. (I personally want to round up all foot tappers and give them a stern talking-to.) But imagine that these annoying background sensations start happening too often or they won’t go away. That’s one way psychosis could begin.

Have you ever thought you heard someone say your name in a crowded room, only to look around and not see anyone you know? You might have heard something real or just imagined it. But if you’re prodromal, you might hear things more often, or hear them when you’re alone. You aren’t psychotic yet; you know that what you’re hearing isn’t real. But as the sounds get louder and their words get clearer, you begin to believe that they might be.

One more. Have you ever thought that certain people didn’t like you? You probably have because it’s probably true; most of us aren’t universally liked (but feel free to lie to yourself and say that you are – I do). You might start to feel this way about more and more people, or start thinking that they’re planning something bad. You might begin to distrust everyone around you.

The symptoms of schizophrenia vary a lot across patients. Likewise, prodromal signs vary. But if we could accurately identify the signs and catch people while they’re still in the prodrome, we could treat them before they get truly sick. It could save lives. Recently, a group of clinics working with at-risk youths have banded together to form the North American Prodrome Longitudinal Study, which will pool their results to identify those signs. Godspeed, people! We’re counting on you.

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