Prodrome in Psychiatry – An Epiphany

  • Shabika Paramathy Khajamohaideen Department of Psychiatry, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India.
  • Kailash Sureshkumar Department of Psychiatry, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India.
  • Shabeeba Z Kailash Department of Psychiatry, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India.
  • Sivabackiya Chithiravelu Department of Psychiatry, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Tamil Nadu, India.
Keywords: Prodrome, Psychiatry, Schizophrenia, Bipolar, Depression


Prodromal symptoms in mental disorders develop weeks to months, even years, before the onset of the disorder. Most individuals manifest at least one prodromal symptom and seek medical help, but often the diagnosis is missed unless they present with complete symptoms indicating the onset of illness. As early identification and intervention at the prodromal stage can decrease the intensity or delay the progression of illness, knowledge about prodrome is mandatory.

How to cite this article:
Khajamohaideen SP, Sureshkumar K, Kailash SZ, Chithiravelu S. Prodrome in Psychiatry - An Epiphany. Chettinad Health City Med J. 2023;12(1):95-100.



Colman A. A dictionary of psychology. Oxford University Press; 2009.

Yung AR, Phillips LJ, McGorry PD, McFarlane CA, Francey S, Harrigan S, Patton GC, Jackson HJ. Prediction of psychosis: a step towards indicated prevention of schizophrenia. Br J Psychiatry Suppl. 1998;172:14-20. [PubMed] [Google Scholar]

George M, Maheshwari S, Chandran S, Manohar JS, Rao TS. Understanding the schizophrenia prodrome. Indian J Psychiatry. 2017;59:505-9. [PubMed] [Google Scholar]

Yung AR, McGorry PD. The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophr Bull. 1996;22:353-70. [PubMed] [Google Scholar]

World Health Organization. Investing in mental health. Geneva: World Health Organization; 2003. [Google Scholar]

Hafner H, Maurer K, Loffler W, an der Heiden W, Hambrecht M, Schultze-Lutter F. Modeling the early course of schizophrenia. Schizophr Bull. 2003;29:325-40. [PubMed] [Google Scholar]

Larson MK, Walker EF, Compton MT. Early signs, diagnosis and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders. Expert Rev Neurother. 2010;10:1347-59. [PubMed] [Google Scholar]

Hafner H, an der Heiden W, Behrens S, Gattaz WF, Hambrecht M, Loffler W, Maurer K, Munk-Jorgensen P, Nowotny B, Riecher-Rossler A, Stein A. Causes and consequences of the gender difference in age at onset of schizophrenia. Schizophr Bull. 1998;24:99-113. [PubMed] [Google Scholar]

Sharma LP, Reddy YC. Obsessive-compulsive disorder comorbid with schizophrenia and bipolar disorder. Indian J Psychiatry. 2019;61:S140-8. [PubMed] [Google Scholar]

Rabin RA, Goodman MS, George TP, Barr MS. Neurobiology of comorbid substance use disorders in mental illness: a closer look at the underlying commonalities between cannabis and schizophrenia. Curr Addict Rep. 2014;1:261-71. [Google Scholar]

Bechdolf A, Veith V, Schwarzer D, Schormann M, Stamm E, Janssen B, Berning J, Wagner M, Klosterkotter J. Cognitive-behavioral therapy in the pre-psychotic phase: an exploratory study. Psychiatry Res. 2005;136:251-5. [PubMed] [Google Scholar]

Hill M, Shannahan K, Jasinski S, Macklin EA, Raeke L, Roffman JL, Goff DC. Folate supplementation in schizophrenia: a possible role for MTHFR genotype. Schizophr Res. 2011;127:41-5. [PubMed] [Google Scholar]

Weickert TW, Goldberg TE, Mishara A, Apud JA, Kolachana BS, Egan MF, Weinberger DR. Catechol-O-methyltransferase val108/158met genotype predicts working memory response to antipsychotic medications. Biol Psychiatry. 2004;56:677-82. [PubMed] [Google Scholar]

Martin DJ, Smith DJ. Is there a clinical prodrome of bipolar disorder? A review of the evidence. Expert Rev Neurother. 2013;13:89-98. [PubMed] [Google Scholar]

Perugi G, Fornaro M, Marennani I, Canonico PL, Carbonatto P, Mencacci C, Muscettola G, Pani L, Torta R, Vampini C, Parazzini F, Dumitriu A, Angst J; Come To Me Study Group. Discriminative hypomania checklist-32 factors in unipolar and bipolar major depressive patients. Psychopathology. 2012;45:390-8. [PubMed] [Google Scholar]

Skjelstad DV, Malt UF, Holte A. Symptoms and signs of the initial prodrome of bipolar disorder: a systematic review. J Affect Disord. 2010;126:1-13. [PubMed] [Google Scholar]

Vieta E, Salagre E, Grande I, Carvalho AF, Fernandes BS, Berk M, Birmaher B, Tohen M, Suppes T. Early intervention in bipolar disorder. Am J Psychiatry. 2018;175:411-26. [PubMed] [Google Scholar]

Correll CU, Olvet DM, Auther AM, Hauser M, Kishimoto T, Carrion RE, Snyder S, Cornblatt BA. The Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P): description and validation in a psychiatric sample and healthy controls. Bipolar Disord. 2014;16:505-22. [PubMed] [Google Scholar]

Colom F, Lam D. Psychoeducation: improving outcomes in bipolar disorder. Eur Psychiatry. 2005;20:359-64. [PubMed] [Google Scholar]

Fava GA, Tossani E. Prodromal stage of major depression. Early Interv Psychiatry. 2007;1:9-18. [PubMed] [Google Scholar]

Seligman ME. Learned helplessness. Ann Rev Med. 1972;23:407-12. [Google Scholar]

Abramson LY, Metalsky GI, Alloy LB. Hopelessness depression: a theory-based subtype of depression. Psychol Rev. 1989;96:358-72. [Google Scholar]

Fava GA, Grandi S, Canestrari R, Molnar G. Prodromal symptoms in primary major depressive disorder. J Affect Disord. 1990;19:149-52. [PubMed] [Google Scholar]

Pede VB, Jaiswal SV, Sawant VA. Study of prodromal and residual symptoms of depression. Ind Psychiatry J. 2017;26:121-7. [PubMed] [Google Scholar]

Bech P. Clinical Interview for Depression and Related Syndromes [CIDRS]. Engelsk ed. Hillerød; 2011. 44 p. [Google Scholar]

Paykel ES. The clinical interview for depression: development, reliability and validity. J Affect Disord. 1985;9:85-96. [PubMed] [Google Scholar]

Conus P, Ward J, Lucas N, Cotton S, Yung AR, Berk M, McGorry PD. Characterisation of the prodrome to a first episode of psychotic mania: results of a retrospective study. J Affect Disord. 2010;124:341-5. [PubMed] [Google Scholar]

Jackson A, Cavanagh J, Scott J. A systematic review of manic and depressive prodromes. J Affect Disord. 2003;74:209-17. [PubMed] [Google Scholar]

Smith JA, Tarrier N. Prodromal symptoms in manic depressive psychosis. Soc Psychiatry Psychiatr Epidemiol. 1992;27:245-8. [PubMed] [Google Scholar]

Fava GA, Savron G, Rafanelli C, Grandi S, Canestrari R. Prodromal symptoms in obsessive-compulsive disorder. Psychopathology. 1996;29:131-4. [PubMed] [Google Scholar]

Pauls DL, Alsobrook JP, Goodman W, Rasmussen S, Leckman JF. A family study of obsessive-compulsive disorder. Am J Psychiatry. 1995;152:76-84. [PubMed] [Google Scholar]

Brakoulias V, Perkes IE, Tsalamanios E. A call for prevention and early intervention in obsessive compulsive disorder. Early Interv Psychiatry. 2018;12:572-7. [PubMed] [Google Scholar]

Dar R, Kahn DT, Carmeli R. The relationship between sensory processing, childhood rituals and obsessive–compulsive symptoms. J Behav Ther Exp Psychiatry. 2012;43:679-84. [PubMed] [Google Scholar]

Fineberg NA, Dell’Osso B, Albert U, Maina G, Geller D, Carmi L, Sireau N, Walitza S, Grassi G, Pallanti S, Hollander E, Brakoulias V, Menchon JM, Marazziti D, Ioannidis K, Apergis-Schoute A, Stein DJ, Cath DC, Veltman DJ, Ameringen MV, Fontenelle LF, Shavitt RG, Costa D, Diniz JB, Zohar J. Early intervention for obsessive compulsive disorder: an expert consensus statement. Eur Neuropsychopharmacol. 2019;29:549-65. [PubMed] [Google Scholar]

Spartz EJ, Freeman GM Jr, Brown K, Farhadian B, Thienemann M, Frankovich J. Course of neuropsychiatric symptoms after introduction and removal of nonsteroidal anti-inflammatory drugs: a pediatric observational study. J Child Adolesc Psychopharmacol. 2017;27:652-9. [PubMed] [Google Scholar]

Gobin V, Steendam KV, Denys D, Deforce D. Selective serotonin reuptake inhibitors as a novel class of immunosuppressants. Int Immunopharmacol. 2014;20:148-56. [PubMed] [Google Scholar]

Lopresti AL. Curcumin for neuropsychiatric disorders: a review of in vitro, animal and human studies. J Psychopharmacol. 2017;31:287-302. [PubMed] [Google Scholar]