Background: In schizophrenia research, early detection in the initial prodr
ome before first psychotic episodes is a major topic. Therefore, the progno
stic accuracy of initial prodromal symptoms was examined prospectively.
Methods: The study sample was composed of patients referred to outpatient d
epartments of German psychiatric university departments, because of diagnos
tic problems, between 1987 and 1991, They were examined with the Bonn Scale
for the Assessment of Basic Symptoms and the Ninth Version of the Present
State Examination to detect an incipient schizophrenic disorder. Of 385 pat
ients showing no schizophrenia-characteristic symptoms, between 1995 and 19
98, 110 with and 50 without initial prodromal symptoms were followed up and
reexamined with the same instruments for a transition to schizophrenia.
Results: During a mean follow-up period of 9.6 years. 79 (49.4%) of the 160
patients had transited to schizophrenia. The absence of prodromal symptoms
excluded a subsequent schizophrenia with a probability of 96% (sensitivity
: 0.98, false-negative predictions: 1.3%), whereas their presence predicted
schizophrenia with a probability of 70% (specificity: 0.59; false-positive
predictions: 20%). Certain disturbances, such as thought interference, dis
turbances of receptive language, or visual distortions, predicted schizophr
enia, even with a probability up to 91% (specificity: 0.85-0.91; false-posi
tive predictions: 1.9%-7.5%).
Conclusions: The Bonn Scale for the Assessment of Basic Symptoms operationa
lization of prodromal symptoms performed well in the early detection of sch
izophrenia. It therefore might be useful for the prediction of the disorder
, especially if it is further refined to select those items with particular
ly high prognostic accuracy.