Psychiatric Quarterly

, Volume 74, Issue 4, pp 313–332 | Cite as

A Qualitative Research Study of the Evolution of Symptoms in Individuals Identified as Prodromal to Psychosis

  • Cheryl Corcoran
  • Larry Davidson
  • Rachel Sills-Shahar
  • Connie Nickou
  • Dolores Malaspina
  • Tandy Miller
  • Thomas McGlashan


Because schizophrenia is difficult to treat and exacts large personal and societal costs, there is an effort underway to identify adolescents and young adults at high risk for psychosis. Theory-derived criteria of subthreshold positive symptoms identify a “prodromal” or clinically at-risk population who have conversion rates to psychosis of 40 to 50% within one to two years. However, further characterization of the psychosis prodrome by qualitative research methods could increase the predictive value of the “prodromal” designation. We conducted open-ended interviews with 20 parents of prodromal adolescents that focused on changes observed. The narratives fell into two thematically distinct subgroups, identified as “declining” and “never normal.” The prodromal adolescents described as “declining” had a higher subsequent rate of conversion to psychosis than did the “never normal” group. Although preliminary, these results suggest that a trajectory of change in personality, relationships, and behavior from an essentially normal baseline may be consistent with increased risk for psychosis among prodromal adolescents.

qualitative research families prodrome psychosis early intervention 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    National Advisory Mental Health Council: Health care reform for Americans with severe mental illness: Report of the National Advisory Mental Health Council. American Journal of Psychiatry 150:1447-1465, 1993.Google Scholar
  2. 2.
    Solomon P, Draine J: Subjective burden among family members of mentally ill adults: Relation to stress, coping, and adaptation. American Journal of Orthopsychiatry 65(3):419-427, 1995.Google Scholar
  3. 3.
    Tarrant CJ, Jones PB: Precursors to schizophrenia: do biological markers have specificity? Canadian Journal of Psychiatry 44(4):335-349, 1999.Google Scholar
  4. 4.
    Jones P, Cannon M: The new epidemiology of schizophrenia. Psychiatric Clinics of North America 21(1):1-25, 1998.Google Scholar
  5. 5.
    Amminger GP, Pape S, Rock D, et al: Relationship between childhood behavioral disturbance and later schizophrenia in the New York High-Risk Project. American Journal of Psychiatry 156(4):525-530, 1999.Google Scholar
  6. 6.
    Ott SL, Allen J, Erlenmeyer-Kimling L: The New York High-Risk Project: Observations on the rating of early manifestations of schizophrenia. American Journal of Medical Genetics 105(1):25-27, 2001.Google Scholar
  7. 7.
    Erlenmeyer-Kimling L: Early neurobehavioral deficits as phenotypic indicators of the schizophrenia genotype and predictors of later psychosis. American Journal of Medical Genetics 105(1):23-24, 2001.Google Scholar
  8. 8.
    Kendler KS, Gallagher TJ, Abelson JM, et al: Lifetime prevalence, demographic risk factors, and diagnostic validity of nonaffective psychosis as assessed in a US community sample. The National Comorbidity Survey. Archives of General Psychiatry 53(11):1022-1031, 1996.Google Scholar
  9. 9.
    Parnas J, Cannon TD, Jacobsen B, et al: Lifetime DSM-III-R diagnostic outcomes in the offspring of schizophrenic mothers. Results from the Copenhagen High-Risk Study. Archives of General Psychiatry 50(9):707-714, 1993.Google Scholar
  10. 10.
    Yung AR, McGorry PD, McFarlane CA, et al: Monitoring and care of young people at incipient risk of psychosis. Schizophrenia Bulletin 22(2):283-303, 1996.Google Scholar
  11. 11.
    McGorry PD, Yung AR, Phillips LJ: "Closing In": What features predict the onset of first-episode psychosis within an ultra-high-risk group?, in The Early Stages of Schizophrenia. Edited by Zipursky RB, Schulz SC. Washington, DC, American Psychiatric Publishing, 2002.Google Scholar
  12. 12.
    Miller TJ, McGlashan TH, Rosen JL: Diagnosis and symptom assessment in the schizophrenia prodrome: Psychometrics from the PRIME Research Clinic. Schizophrenia Research 49 (1-2 Supplement):6, 2001.Google Scholar
  13. 13.
    Davidson L, McGlashan TH: The varied outcomes of schizophrenia. Canadian Journal of Psychiatry 42(1):34-43, 1997.Google Scholar
  14. 14.
    Edwards J, Maude D, McGorry PD, et al: Prolonged recovery in first-episode psychosis. British Journal of Psychiatry 172(33):107-116, 1998.Google Scholar
  15. 15.
    Haas GL, Garratt LS, Sweeney JA: Delay to first antipsychotic medication in schizophrenia: Impact on symptomatology and clinical course of illness. Journal of Psychiatric Research 32(3-4):151-159, 1998.Google Scholar
  16. 16.
    Miller TJ, McGlashan TH, Woods SW, et al: Symptom assessment in schizophrenic prodromal states. Psychiatric Quarterly 70(4):273-287, 1999.Google Scholar
  17. 17.
    Moller P, Husby R: The initial prodrome in schizophrenia: Searching for naturalistic core dimensions of experience and behavior. Schizophrenia Bulletin 26(1):217-232, 2000.Google Scholar
  18. 18.
    Olin SS, Mednick SA: Risk factors of psychosis: Identifying vulnerable populations premorbidly. Schizophrenia Bulletin 22(2):223-240, 1996.Google Scholar
  19. 19.
    Davidson L: Phenomenological research in schizophrenia: From philosophical anthropology to empirical science. Journal of Phenomenological Psychology 25:104-130, 1994.Google Scholar
  20. 20.
    Wertz FJ: From everyday to psychological description: Analyzing the moments of a qualitative data analysis. Journal of Phenomenological Psychology 14:197-241, 1983.Google Scholar
  21. 21.
    Giorgi A: Psychology as a human science: A phenomenologically based approach. New York, Harper and Row, 1970.Google Scholar
  22. 22.
    Kumra S, Jacobsen LK, Lenane M, et al: "Multidimensionally impaired disorder":Is it a variant of very early-onset schizophrenia? Journal of the American Academy of Child and Adolescent Psychiatry 37(1):91-99, 1998.Google Scholar
  23. 23.
    Phillips LJ, Velakoulis D, Pantelis C, et al: Non-reduction in hippocampal volume is associated with higher risk of psychosis. Schizophr Research 58(2-3):145-158, 2002.Google Scholar

Copyright information

© Human Sciences Press, Inc. 2003

Authors and Affiliations

  • Cheryl Corcoran
    • 1
  • Larry Davidson
    • 2
  • Rachel Sills-Shahar
    • 2
  • Connie Nickou
    • 2
  • Dolores Malaspina
    • 1
  • Tandy Miller
    • 2
  • Thomas McGlashan
    • 2
  1. 1.New York State Psychiatric Institute/Columbia UniversityNew York
  2. 2.Department of PsychiatryYale School of MedicineNew Haven

Personalised recommendations