Prodromal symptoms: a "risk" for patients or psychiatrists?

The question of prodromal symptoms of psychosis already raised by Bleuler, in the last years, became one of the major issues in psychiatry: on one hand, emerges the importance to identify the initial signs and symptoms of the disease in order to start a treatment as soon as possible and improve the course of such a serious illness significantly. On the other hand, the early symptoms clearly show all their lack of specificity and their difficult use as a predictive tool. Research on psychotic-like experiences seems a good example to clarify the long standing problem of predictability of symptoms and signs present in the pre-psychotic phase of illness. Undoubtedly the elevated presence of psychotic- like experiences in the general population induces us to corroborate the idea that a psychotic illness develops along a continuum that starts from a vulnerability as a base to reach a frank disease, but only in particular conditions. Consequently, the psychotic illness should be regarded as a highly dynamic disease that develops in interaction with environmental stressors. We can speak of initial symptoms, therefore, like a syndrome at risk of psychotic development from the intrinsic point of view of the disease itself; however, we consider the continuous research into possible core symptoms, which are qualitatively specific to psychosis, to be indispensable, as it may improve our ability to better understand the psychopathological progression into the development of frank psychosis and may allow us to refine our capacity to identify subjects really at risk.