The initial prodrome of schizophrenia: different duration, different underlying deficits?

In light of various suggestions concerning underlying deficits and transition patterns, approaching the initial schizophrenic prodrome is a multifaceted enterprise. Recently, the prodromal phase has largely been viewed as a singular concept. However, observations of greatly varying prodromal time courses prompted us to investigate whether these differences suggest the existence of diverse prodrome subtypes. Our sample consisted of 160 patients from the Cologne Early Recognition study. The 79 patients transiting from prodrome to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition schizophrenia were divided into 3 time groups according to the length of the prodromal state and compared for their initial symptomatology. We found differences in the prominent clinical picture not only regarding single symptoms but also in logistic equations calculated for each group including cognitive deficits only. Our results indicate different underlying deficits: disturbances in bottom-up and top-down loop processes associated with a long prodrome and in top-down processes with medium prodrome, and a deficient central integrating system with short prodrome.