Characteristics of the Retrospectively Assessed Prodromal Period in Hospitalized Patients With First-Episode Nonaffective Psychosis: Findings From a Socially Disadvantaged, Low-Income, Predominantly African American Population

Objective: Because many heterogeneous symptoms and substantial psychosocial impairment develop during the prodrome of nonaffective psychosis, it is imperative to further characterize the prodrome, both retrospectively and prospectively. This study describes the prodromal period of 109 hospitalized first-episode patients from an urban, socially disadvantaged, predominantly African American population.

Method: Detailed data were gathered using established measures. Diagnoses of psychotic disorders were determined with the Structured Clinical Interview for DSM-IV Axis I Disorders. The prodromal period was described, exploratory factor analysis was conducted to assess the latent structure of 14 prodromal features, and patients with and without a retrospectively determined prodrome were compared on a number of sociodemographic and clinical variables.

Results: Some 76 patients (69.7%) had an identifiable prodrome, and the median duration of the prodrome was 107.7 weeks. The most prevalent prodromal features were deterioration in role function (65.8%), suspiciousness (63.2%), social withdrawal (60.5%), and trouble with thinking (57.9%). Factor analysis revealed 3 factors, termed depressive/deficit, subthreshold positive, and brief, intermittent psychotic symptoms, which were highly consistent with recently described prodromal syndromes in prospective research efforts. Patients without an identifiable prodrome had higher mean social functioning scores—in social engagement, prosocial, and employment domains—compared to those with an identifiable prodrome. Only 11 participants (14.5%) had sought professional help during the prodrome.

Conclusions: Given the highly variable duration and phenomenology of the prodrome, and the fact that relatively few individuals in this sample had sought professional help during their prodromal period, further research is needed to inform efforts aimed at identification of and intervention during the prodromal period of nonaffective psychosis.

J Clin Psychiatry

Submitted: September 4, 2008; accepted June 5, 2009.

Online ahead of print: May 4, 2010 (doi:10.4088/JCP.08m04678yel).

Corresponding author: Michael T. Compton, MD, MPH, Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, 49 Jesse Hill Jr Drive, SE, Room #333, Atlanta, GA 30303 ([email protected]).