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The early phase of schizophrenia and prediction of outcome

This review covers psychiatric research into the true onset of schizophrenia and its implications for the early diagnosis, differential diagnosis, therapy, prevention and general understanding of schizophrenia. Mayer-Gross's classical 1932 work anticipated some aspects of the basic symptom concept, which has been gradually developed since the 1950s. The precursor syndromes of the basic symptom concept are characterized by experiential dynamic and cognitive symptoms (in contrast to the disorders of behavior and expression of the third revised Diagnostic and statistical manual of mental disorders), usually recognizable only through patients' self reports. Patients are aware of their deficits and develop coping strategies. Basic symptoms can be assessed by a standardized survey, the Bonn Schedule for the Assessment of Basic Symptoms. Prepsychotic precursor syndromes, on average, precede the first psychotic episode as prodromes for 3.3 years and as outpost syndromes tor 10 years. Certain first-rank symptoms of schizophrenia develop from certain transition-relevant cognitive basic symptoms, contrary to Kraepelinian-type course models. Except in anosognosia schizophrenias, the basic symptoms come first, followed by positive psychotic symptoms and, finally, negative symptoms. The Bonn prospective early-recognition study suggests that many seemingly neurotic and psychopathic conditions are prepsychotic basic stages of endogenous psychoses and indicates that early recognition and therapy improves long-term prognosis.