The Prodromal Phase of What?
This thesis is a a metapsychiatric and interdiciplinary analysis of the Prodromal Phase of Schizophrenia.
Prodromes of schizophrenia or prodromes of psychosis are a relatively new and expanding field of interest in psychiatric research. They are seen by some researchers as the initial symptom of having schizophrenia and have become a crucial topic in early psychosis research and intervention.
In this thesis current psychiatric research publications were analysed and eleven prospectively psychotic patients were interviewed. The research publications analysed were applyed on the information given by the patients, and the analysis showed that it was easy to find prodromes or prodrome-like phenomena in all the collected interviews. In addition a second analysis was performed on the material, a phenomenological psychological analysis, showing a more subject-oriented dimension of the interviews. This led to a further aim, analysing what explanations could be given of these phenomena.
There are probably many possibilities of getting the diagnosis of schizophrenia, but the examples in this study show that long-term abuse, often sexual actually can trigger psychiatric conditions corresponding to the definition of “prodromes of schizophrenia” according to some psychiatric publications as well as “schizophrenia” according to DSM
and ICD. This means that trauma and/or neglect proved to be a likely partial causal condition of the prodrome- like phenomena or schizophrenia to occur.
However, trauma has not been shown to be a necessary condition for the occurrence of prodrome-like phenomena or schizophrenia.
In the discussion of the results some consequences deriving from using different interpretations and explanations of the phenomena are analysed, for example using the prodromes of psychosis for the assessments of a coming psychosis, especially schizophrenia. I emphasize, because of the results of the phenomenological case analyses, the value of several dimensions of understanding prodrome-like phenomena as well as schizophrenia and schizophrenia-like conditions, especially as early as the initial phase.
Keywords: Schizophrenia, trauma, prodromal phase, prodromal phenomenon, qualitative method, causality.
THE PRODROMAL PHASE OF PSYCHOSIS
The aim of the project is to give an interdisciplinary description and analysis of the prodromal phase of psychosis. My intention is to analyse the use of current definitions and to characterize the subjective experiences of persons who have experienced at least one episode of psychotic symptoms.
The prodromal phase is potentially important as a defining marker of risk for progression to psychotic illness and as a platform for investigating novel treatments to prevent a transition to psychosis (Heinssen et al, Informed Consent in Early Psychosis Research. Schizophrenia Bull 2001: 27:571-83). The prodromal phase, however, is a relatively new field of interest within psychiatry. The current fast accumulation of new knowledge will most certainly raise several ethical questions and may even challenge psychiatry as a discipline.
This study is a theoretical metapsychiatric study which analyses definitions of the ‘prodromal phase’ and ‘prodromes’ used in psychiatry at a metalevel of understanding. Eleven patients have been interviewed about their experiences and current international research has been analysed. The analyses are done with a phenomenological approach and from the perspective of philosophy of science.
Prodrome-like phenomena were found in all patients. However, it was obvious that these phenomena were caused by experiences early in life.
I argue that current research interprets the prodrome theories diversely, which might lead to different potential uses. I discuss how strong the relation is between prodromes of psychosis and schizophrenia as usually defined, which leads on to a discussion about the validity of interpretations.
The project is part of the doctoral programme at the Institution for Health and Society at the University of Linköping, Sweden, and the practical work is done at a local hospital in Northern Norway. Two professors are supervisors for the project, Lennart Nordenfelt, who is professor of philosophy, specialized in the concept of health and Lisbet Palmgren, professor of psychiatry, with a specialization in patients with schizophrenia.
The project is made possible through founding from Nordlandsykehuset, Helse Nord, NNPF and Josef and Haldis Andresens legat in Norway.
The project is due to plans, dissertation in late 2008.
- november 2008
- Professor Lennart Nordenfelt