ABSTRACT
To determine the prodromal symptoms of schizophrenia in the pathways to help-seeking. A cross-sectional study. The Department of Psychiatry, the Aga Khan University, Karachi, from 2008 to 2009. A total of 93 patients were interviewed in the pathways to care of schizophrenia. The diagnosis was based on ICD-10 criteria. The pathways to care were assessed through a semi-structured questionnaire. The onset, course and symptoms of psychosis were assessed through Interview for Retrospective Assessment at Age at Onset of Psychosis [IROAS]. Fifty five [59%] participants were male while 41% [n=38%] were female. Using IROAS, 108 symptoms were identified as concerning behaviour. Alternatively, 60 [55%] concerning behaviours were reported in the open-ended inquiry of the reasons for help seeking as assessed by the pathways to care questionnaire with a statistically significant difference between most symptoms category. The difference was most pronounced [p < 0.001] for depressed mood [66%], worries [65%], tension [63%], withdrawal/mistrust [54%] and loss of self-confidence [53%]. Thought withdrawal [22%] and passivity [15%] were elicited only through structured interview [IROAS]. When symptoms were categorized together, about 83% of the subjects presented with affective and non-specific prodromal symptoms. Roughly, 10% of the subjects presented with positive symptoms and 3% presented with the negative symptoms of psychosis. The non-specific, affective symptoms appear to predominate the prodromal phase of the illness. Prodromal symptoms of schizophrenia include non-specific, affective symptoms. Attention needs to be paid on identifying the prodromal symptoms and change in social functioning in order to identify those who are at risk of longterm psychosis