Basic symptoms of schizophrenia

Course

Several factors interact prior to the development of basic symptoms, including predisposed vulnerability, environmental stressors, and support systems. Recent work in the field of neural oscillation has demonstrated that defective excitatory and inhibitory signalling in the brain during development plays an important role in the formation of basic symptoms. These signalling disturbances can lead to cognitive deficits that result in the future appearance of more complicated symptoms of the disorder. The interaction of these factors increases the risk for the development of basic symptoms of schizophrenia. It is important to identify when a person is exposed to these factors to prevent, modify, or delay the onset of basic symptoms through early intervention. The recognition of these basic symptoms in the prodromal phase can lead to early intervention in psychosis that aids in the delay or prevention of schizophrenia. Such early interventions include cognitive behavioural therapy (CBT) or the use of antipsychotic drugs.

Basic symptoms are subjective and can be subtle. It may be difficult for the person to realize that something is wrong and tell someone else, especially without being asked directly. Often, the person will try to adapt and cope with the symptoms. Functioning becomes impaired when people reach their adaptive capacity. In the period leading up to the first episode of schizophrenia, uncharacteristic basic symptoms first appear and are followed by the onset of more characteristic basic symptoms and, finally, psychosis.

Basic symptoms often appear several years before the onset of psychosis, but are often preceded by the onset of self-disorders. They may sometimes appear and then disappear before appearing again much later, where they occur as part of an outpost syndrome. At one point, uncharacteristic basic symptoms will appear, which comprise various disturbances of mood, emotions, drive, thought, and attention that can occur in many other disorders, followed by the characteristic basic symptoms, which comprise disturbances of thought, perception, and attention, along with minor reality distortion, that are associated with schizophrenia in particular. Afterward, attenuated symptoms of psychosis or brief periods of psychosis will appear, before culminating in the emergence of full-blown psychosis. At any stage before psychosis, the person will attempt to cope with the basic symptoms, which might conceal the problems from others; once the person reaches the limit of their ability to compensate, however, the problems will become evident to others and cause impairment. Poorer long-term outcomes such as increases in relapses, increases in hospitalizations, and poorer social/occupational functioning are associated with the age of onset of these symptoms, suggesting the importance of early intervention.

After the resolution of psychosis, basic symptoms may follow one of 3 courses: Psychosis and the basic symptoms may resolve completely allowing the restoration of normal functioning; they may remit but remain at an uncharacteristic level, with relapses of psychosis; or the characteristic basic symptoms may remain creating a deficit syndrome dominated by negative symptoms.