The period of time leading up to the first episode of psychosis in schizoaffective disorder has not been well studied. However, pre-schizophrenia is characterised by non-specific symptoms described as schizotaxia, the pre-prodromal period, and the prodrome.[18]Tsuang MT, Stone WS, Faraone SV. Understanding predisposition to schizophrenia: toward intervention and prevention. Can J Psychiatry. 2002 Aug;47(6):518-26.
http://www.ncbi.nlm.nih.gov/pubmed/12211879?tool=bestpractice.com
[19]Yung AR, McGorry PD. The prodromal phase of first-episode psychosis: past and current conceptualizations. Schizophr Bull. 1996;22(2):353-70.
http://www.ncbi.nlm.nih.gov/pubmed/8782291?tool=bestpractice.com
These changes in thoughts, mood, and behaviour prior to the start of psychotic symptoms constitute an ‘at-risk mental state’. People with an at-risk mental state are at much higher risk of developing psychosis than the general population with up to one third going on to develop psychosis.[20]Stafford MR, Jackson H, Mayo-Wilson E, et al. Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ. 2013 Jan 18;346:f185.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548617
http://www.ncbi.nlm.nih.gov/pubmed/23335473?tool=bestpractice.com
Research has shown that it may be possible to identify people with an at-risk mental state:[20]Stafford MR, Jackson H, Mayo-Wilson E, et al. Early interventions to prevent psychosis: systematic review and meta-analysis. BMJ. 2013 Jan 18;346:f185.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548617
http://www.ncbi.nlm.nih.gov/pubmed/23335473?tool=bestpractice.com
They may present with distress and/or a decline in their social functioning in conjunction with transient or attenuated psychotic symptoms
They should be referred to an early intervention in psychosis service for assessment
Treatment with cognitive behavioural therapy can reduce the risk of transition to psychosis, but treatment with antipsychotic medication is not effective.
Data on schizophrenia and early-phase psychosis indicate that early detection and intervention is beneficial for most patients.[21]McGrath J, Emmerson WB. Fortnightly review. Treatment of schizophrenia. BMJ. 1999 Oct 16;319(7216):1045-8.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1116843
http://www.ncbi.nlm.nih.gov/pubmed/10521199?tool=bestpractice.com
[22]Harding CM. Course types in schizophrenia: an analysis of European and American studies. Schizophr Bull. 1988;14(4):633-43.
http://www.ncbi.nlm.nih.gov/pubmed/3064287?tool=bestpractice.com
[23]Ciompi L. Catamnestic long-term study on the course of life and aging of schizophrenics. Schizophr Bull. 1980;6(4):606-18.
http://www.ncbi.nlm.nih.gov/pubmed/7444392?tool=bestpractice.com
[24]Howes OD, Whitehurst T, Shatalina E, et al. The clinical significance of duration of untreated psychosis: an umbrella review and random-effects meta-analysis. World Psychiatry. 2021 Feb;20(1):75-95.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801839
http://www.ncbi.nlm.nih.gov/pubmed/33432766?tool=bestpractice.com
[25]Correll CU, Galling B, Pawar A, et al. Comparison of early intervention services vs treatment as usual for early-phase psychosis: a systematic review, meta-analysis, and meta-regression. JAMA Psychiatry. 2018 Jun 1;75(6):555-65.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137532
http://www.ncbi.nlm.nih.gov/pubmed/29800949?tool=bestpractice.com
[26]Puntis S, Minichino A, De Crescenzo F, et al. Specialised early intervention teams for recent-onset psychosis. Cochrane Database Syst Rev. 2020 Nov 2;11(11):CD013288.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013288.pub2/full
http://www.ncbi.nlm.nih.gov/pubmed/33135811?tool=bestpractice.com