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{{short description|Premonitory signs or symptoms of disease}}
In [[medicine]], a '''prodrome''' is an early [[Medical sign|sign]] or [[symptom]] (or set of signs and symptoms, referred to as '''prodromal symptoms'''<ref name=":6" />) that often indicates the onset of a [[disease]] before more diagnostically specific signs and symptoms develop. More specifically, it refers to the period between the first recognition of a disease's symptom until it reaches its more severe form.<ref name=":6">{{Cite book |last=Oliwenstein |first=Lori |url=https://books.google.com/books?id=3LUqIqfwY4gC&pg=PA348 |title=Psychology Today Taming Bipolar Disorder |publisher=Penguin |year=2004 |isbn=978-1-4406-9631-2 |pages=348 |language=en}}</ref> It is derived from the Greek word ''prodromos'', meaning "running before".<ref>{{cite book|title=Mosby's Medical Dictionary | edition = 8th | publisher=Elsevier|year=2009|isbn=9780323049375|url=http://medical-dictionary.thefreedictionary.com/prodrome}}</ref> Prodromes may be [[non-specific symptoms]] or, in a few instances, may clearly indicate a particular disease, such as the prodromal [[migraine aura]].
For example, [[fever]], [[malaise]], [[headache]] and lack of appetite frequently occur in the prodrome of many [[Infection|infective]] disorders. A prodrome can be the early precursor to an episode of a chronic [[neurological]] disorder such as a [[migraine]] headache or an [[epileptic seizure]], where prodrome symptoms may include [[euphoria]] or other changes in [[mood (psychology)|mood]], [[insomnia]], [[abdominal aura|abdominal sensations]], disorientation, [[aphasia]], or [[photophobia|photosensitivity]]. Such a prodrome occurs on a scale of days to an hour before the episode, where an [[aura (symptom)|aura]] occurs more immediate to it.<ref>{{Cite journal |date= 2004|title=The Premonitory Symptoms (Prodrome): A Tertiary Care Study of 893 Migraineurs |url=https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2004.04168.x |journal=Headache: The Journal of Head and Face Pain |language=en |volume=44 |issue=9 |pages=865–872 |doi=10.1111/j.1526-4610.2004.04168.x |issn=0017-8748 |via=Headache Journal|last1= Kelman|first1= Leslie|pmid= 15447695}}</ref>
[[Pre-labor|Prodromal labour]], mistakenly called "false labour," refers to the early signs before labour starts.<ref name="APA">{{cite web |title=Prodromal Labor |url=https://americanpregnancy.org/labor-and-birth/prodromal-labor/ |website=American Pregnancy Association |date=8 June 2018}}</ref>
==In mental health==
The prodrome is a period during which an individual experiences some [[symptom]]s and/or a change in functioning, which can signal the impending onset of a mental health disorder.<ref>{{cite journal | vauthors = Zeschel E, Correll CU, Haussleiter IS, Krüger-Özgürdal S, Leopold K, Pfennig A, Bechdolf A, Bauer M, Juckel G | display-authors = 6 | title = The bipolar disorder prodrome revisited: Is there a symptomatic pattern? | journal = Journal of Affective Disorders | volume = 151 | issue = 2 | pages = 551–60 | date = November 2013 | pmid = 23932736 | doi = 10.1016/j.jad.2013.06.043 }}</ref> It is otherwise known as the prodromal phase when referring to the [[subsyndromal]] stage or the early [[Abnormality (behavior)|abnormalities]] in behavior, mood, and/or cognition before illness onset.<ref>{{cite journal | vauthors = Bauer M, Juckel G, Correll CU, Leopold K, Pfennig A | title = Diagnosis and treatment in the early illness phase of bipolar disorders | journal = European Archives of Psychiatry and Clinical Neuroscience | volume = 258 Suppl 5 | issue = S5 | pages = 50–4 | date = November 2008 | pmid = 18985295 | doi = 10.1007/s00406-008-5009-z | s2cid = 529703 }}</ref> Early detection of the prodrome can create an opportunity to administer appropriate early interventions quickly to try to delay or decrease the intensity of subsequent symptoms.<ref>{{cite journal |last1=Meter |first1=Anna Van |last2=Youngstrom |first2=Eric | name-list-style = vanc |date=2018-10-01|title=22.1 Early Identification of Bipolar Disorder: A Meta-Analytic Approach |journal=Journal of the American Academy of Child & Adolescent Psychiatry |volume=57|issue=10|pages=S302|doi=10.1016/j.jaac.2018.07.740 |s2cid=149989676 }}</ref>
===Schizophrenia===
{{See also|Schizophrenia#Onset}}
[[Schizophrenia]] was the first disorder for which a prodromal stage  was described.<ref name=":0">{{cite journal | vauthors = George M, Maheshwari S, Chandran S, Manohar JS, Sathyanarayana Rao TS | title = Understanding the schizophrenia prodrome | journal = Indian Journal of Psychiatry | volume = 59 | issue = 4 | pages = 505–509 | date = 2017 | pmid = 29497198 | pmc = 5806335 |doi = 10.4103/psychiatry.IndianJPsychiatry_464_17  |doi-broken-date = 1 November 2024  |doi-access=free}}</ref> People who go on to develop schizophrenia commonly experience non-specific negative symptoms such as [[Depression (mood)|depression]], [[anxiety]] symptoms, and [[social isolation]].<ref name=":0" /> This is often followed by the emergence of attenuated [[positive symptoms]] such as problems with communication, perception, and unusual thoughts that do not rise to the level of [[psychosis]].<ref name=":0" /> Closer to the onset of psychosis, people often exhibit more serious symptoms like pre-[[delusion]]al unusual thoughts, pre-[[Hallucination|hallucinatory]] perceptual abnormalities or pre-thought disordered speech disturbances.<ref name=":0" /> As positive symptoms become more severe, in combination with [[negative symptoms]] that may have begun earlier, the individual may meet the diagnostic criteria for schizophrenia.<ref name=":1">{{cite journal | vauthors = McGlashan TH, Miller TJ, Woods SW | title = Pre-onset detection and intervention research in schizophrenia psychoses: current estimates of benefit and risk | journal = Schizophrenia Bulletin | volume = 27 | issue = 4 | pages = 563–70 | date = 2001-01-01 | pmid = 11824483 | doi = 10.1093/oxfordjournals.schbul.a006896 | doi-access = free }}</ref> Although a majority of individuals who experience some of the symptoms of schizophrenia will never meet full diagnostic criteria, approximately 20–40% will eventually be diagnosed with schizophrenia.<ref name=":2">{{cite journal | vauthors = Larson MK, Walker EF, Compton MT | title = Early signs, diagnosis and therapeutics of the prodromal phase of schizophrenia and related psychotic disorders | journal = Expert Review of Neurotherapeutics | volume = 10 | issue = 8 | pages = 1347–59 | date = August 2010 | pmid = 20662758 | pmc = 2930984 | doi = 10.1586/ern.10.93 }}</ref> One of the challenges of identifying and treating the prodrome is that it is difficult to predict who, among those with symptoms, are likely to meet full criteria later.{{citation needed|date=December 2021}}<ref>{{Cite book |title=Treatment Implications of the Schizophrenia Prodrome |date=2010 |pmc=3136161 |last1=Kaur |first1=T. |last2=Cadenhead |first2=K. S. |series=Current Topics in Behavioral Neurosciences |volume=4 |pages=97–121 |doi=10.1007/7854_2010_56 |pmid=21312398 |isbn=978-3-642-13716-7 }}</ref>
==== Duration ====
The prodromal phase in schizophrenia can last anywhere from several weeks to several years, and [[Comorbidity|comorbid disorders]], such as [[major depressive disorder]], are common during this period.<ref>{{cite journal | vauthors = Rosen JL, Miller TJ, D'Andrea JT, McGlashan TH, Woods SW | title = Comorbid diagnoses in patients meeting criteria for the schizophrenia prodrome | journal = Schizophrenia Research | volume = 85 | issue = 1–3 | pages = 124–31 | date = July 2006 | pmid = 16650735 | doi = 10.1016/j.schres.2006.03.034 | s2cid = 41802693 }}</ref>
==== Identification/assessments ====
[[Screening (medicine)|Screening]] instruments include the Scale of Prodromal Symptoms<ref>{{cite journal | vauthors = Klaassen RM, Velthorst E, Nieman DH, de Haan L, Becker HE, Dingemans PM, van de Fliert JR, van der Gaag M, Linszen DH | display-authors = 6 | title = Factor analysis of the scale of prodromal symptoms: differentiating between negative and depression symptoms | journal = Psychopathology | volume = 44 | issue = 6 | pages = 379–85 | date = 2011 | pmid = 21847005 | doi = 10.1159/000325169 | s2cid = 25328195 | url = https://research.vu.nl/en/publications/417a5ecc-db27-442b-a307-0f7ae5ff8dac }}</ref><ref name=Miller2003>{{cite journal | vauthors = Miller TJ, McGlashan TH, Rosen JL, Cadenhead K, Cannon T, Ventura J, McFarlane W, Perkins DO, Pearlson GD, Woods SW | display-authors = 6 | title = Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability | journal = Schizophrenia Bulletin | volume = 29 | issue = 4 | pages = 703–15 | date = 2003-01-01 | pmid = 14989408 | doi = 10.1093/oxfordjournals.schbul.a007040 | url = https://academic.oup.com/schizophreniabulletin/article/29/4/703/1887836 | doi-access = free }}</ref> and the PROD-screen.<ref>{{cite journal | vauthors = Heinimaa M, Salokangas RK, Ristkari T, Plathin M, Huttunen J, Ilonen T, Suomela T, Korkeila J, McGlashan TH | display-authors = 6 | title = PROD-screen--a screen for prodromal symptoms of psychosis | journal = International Journal of Methods in Psychiatric Research | volume = 12 | issue = 2 | pages = 92–104 | date = 2003 | pmid = 12830303 | doi = 10.1002/mpr.146 | pmc = 6878465 }}</ref><ref>{{cite journal | vauthors = Daneault JG, Stip E | title = Genealogy of instruments for prodrome evaluation of psychosis | language = English | journal = Frontiers in Psychiatry | volume = 4 | pages = 25 | date = 2013 | pmid = 23616773 | pmc = 3629300 | doi = 10.3389/fpsyt.2013.00025 | doi-access = free }}</ref>
[[Medical signs|Signs]] and symptoms of the prodrome to schizophrenia can be assessed more fully using [[structured interview]]s. For example, the Structured Interview for Prodromal Syndromes,<ref>{{cite journal | vauthors = Miller TJ, McGlashan TH, Woods SW, Stein K, Driesen N, Corcoran CM, Hoffman R, Davidson L | display-authors = 6 | title = Symptom assessment in schizophrenic prodromal states | journal = The Psychiatric Quarterly | volume = 70 | issue = 4 | pages = 273–87 | date = 1999-12-01 | pmid = 10587984 | doi = 10.1023/A:1022034115078 | s2cid = 22928488 }}</ref><ref name=Miller2003/> and the Comprehensive Assessment of At Risk Mental States (CAARMS)<ref>{{cite journal | vauthors = Yung AR, Yuen HP, McGorry PD, Phillips LJ, Kelly D, Dell'Olio M, Francey SM, Cosgrave EM, Killackey E, Stanford C, Godfrey K, Buckby J | display-authors = 6 | title = Mapping the onset of psychosis: the Comprehensive Assessment of At-Risk Mental States | journal = The Australian and New Zealand Journal of Psychiatry | volume = 39 | issue = 11–12 | pages = 964–71 | date = 2005 | pmid = 16343296 | doi = 10.1080/j.1440-1614.2005.01714.x | s2cid = 145477493 }}</ref> are both valid and reliable methods for identifying individuals likely experiencing the prodrome to schizophrenia or related [[Spectrum disorder#Psychosis|psychotic-spectrum disorders]].
There are ongoing research efforts to develop tools for early detection of at-risk individuals. This includes development of risk calculators<ref>{{cite journal | vauthors = Fusar-Poli, P, Rutigliano, G, Stahl, D, Davies, C, Bonoldi, I, Reilly, T, McGuire, P | year = 2017 | title = Development and validation of a clinically based risk calculator for the transdiagnostic prediction of psychosis | journal = JAMA Psychiatry | volume = 74 | issue = 5 | pages = 493–500| doi = 10.1001/jamapsychiatry.2017.0284 | pmid = 28355424 | pmc = 5470394 }}</ref> and methods for large-scale population screening.<ref>{{cite journal | vauthors = Raket LL, Jaskolowski J, Kinon BJ, Brasen JC, Jönsson L, Wehnert A, Fusar-Poli P | year = 2020 | title = Dynamic ElecTronic hEalth reCord deTection (DETECT) of individuals at risk of a first episode of psychosis: a case-control development and validation study | journal = The Lancet Digital Health | volume = 2 | issue = 5 | pages = e229–e239 | doi = 10.1016/S2589-7500(20)30024-8| pmid = 33328055 | doi-access = free }}</ref>
==== Interventions ====
Describing the schizophrenia prodrome has been useful in promoting [[Early intervention in psychosis|early intervention]]. Although not all people who are experiencing symptoms consistent with the prodrome will develop schizophrenia, [[randomized controlled trial]]s suggest that intervening with medication and/or [[psychotherapy]] can improve outcomes.<ref name=":2" />  Interventions with evidence of [[Efficacy (pharmacology)|efficacy]] include [[antipsychotic]] and [[antidepressant]] medications, which can delay conversion to psychosis and improve symptoms, although prolonged exposure to antipsychotics has been associated with adverse effects including [[Tardive dyskinesia]], an irreversible neurological motor disorder.<ref name=":2" /> [[Psychotherapy]] for individuals and families can also improve functioning and [[symptomatology]]; specifically [[Cognitive behavioral therapy|cognitive behavioral therapy (CBT)]] helps improve [[coping strategies]] to decrease positive psychosis symptoms.<ref name=":2" /> Additionally, [[Omega-3 fatty acid|omega-3 fish oil supplements]] may help reduce prodromal symptoms.<ref name=":2" /> Current guidelines suggest that individuals who are at "high risk" for developing schizophrenia should be monitored for at least one to two years while receiving psychotherapy and medication, as needed, to treat their symptoms.<ref>{{cite journal | title = Clinical practice guidelines. Treatment of schizophrenia | journal = Canadian Journal of Psychiatry | volume = 50 | issue = 13 Suppl 1 | pages = 7S–57S | date = November 2005 | pmid = 16529334 | author1 = Canadian Psychiatric Association }}</ref>
===Bipolar disorder===
==== Symptomology ====
There is also growing evidence that there is a prodromal phase before the onset of [[Bipolar disorder|bipolar disorder (BD)]].<ref name=":3">{{cite journal | vauthors = Howes OD, Lim S, Theologos G, Yung AR, Goodwin GM, McGuire P | title = A comprehensive review and model of putative prodromal features of bipolar affective disorder | journal = Psychological Medicine | volume = 41 | issue = 8 | pages = 1567–77 | date = August 2011 | pmid = 20836910 | pmc = 3687203 | doi = 10.1017/S0033291710001790 }}</ref> Although a majority of individuals with bipolar disorder report experiencing some symptoms preceding the full onset of their illness, the prodrome to BD has not yet been described systematically. Descriptive reports of bipolar prodrome symptoms vary and often focus on nonspecific symptoms of [[psychopathology]], making identification of the prodromal phase difficult. The most commonly observed symptoms are too much energy, elated or depressed mood, and alterations in sleep patterns.<ref name=":4">{{cite journal | vauthors = Van Meter AR, Burke C, Youngstrom EA, Faedda GL, Correll CU | title = The Bipolar Prodrome: Meta-Analysis of Symptom Prevalence Prior to Initial or Recurrent Mood Episodes | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 55 | issue = 7 | pages = 543–55 | date = July 2016 | pmid = 27343882 | doi = 10.1016/j.jaac.2016.04.017 }}</ref> There are no prospective studies of the prodrome to bipolar disorder, but in the Longitudinal Assessment of Manic Symptoms (LAMS) study, which followed youth with elevated symptoms of [[mania]] for ten years,<ref>{{cite journal | vauthors = Horwitz SM, Demeter CA, Pagano ME, Youngstrom EA, Fristad MA, Arnold LE, Birmaher B, Gill MK, Axelson D, Kowatch RA, Frazier TW, Findling RL | display-authors = 6 | title = Longitudinal Assessment of Manic Symptoms (LAMS) study: background, design, and initial screening results | language = English | journal = The Journal of Clinical Psychiatry | volume = 71 | issue = 11 | pages = 1511–7 | date = November 2010 | pmid = 21034684 | pmc = 3051351 | doi = 10.4088/JCP.09m05835yel }}</ref> approximately 23% of the sample met BD criteria at the baseline and 13% of which did not meet the criteria for BD at baseline eventually were diagnosed with BD.<ref>{{cite journal | vauthors = Findling RL, Youngstrom EA, Fristad MA, Birmaher B, Kowatch RA, Arnold LE, Frazier TW, Axelson D, Ryan N, Demeter CA, Gill MK, Fields B, Depew J, Kennedy SM, Marsh L, Rowles BM, Horwitz SM | display-authors = 6 | title = Characteristics of children with elevated symptoms of mania: the Longitudinal Assessment of Manic Symptoms (LAMS) study | journal = The Journal of Clinical Psychiatry | volume = 71 | issue = 12 | pages = 1664–72 | date = December 2010 | pmid = 21034685 | pmc = 3057622 | doi = 10.4088/JCP.09m05859yel }}</ref>
==== Duration ====
The reported duration of the prodrome to BD varies widely (mean = 27.1 ± 23 months);<ref name=":4" /> for most people, evidence suggests that the prodromal phase is likely to be long enough to allow for intervention.<ref>{{Cite journal |last2= Lim|first2= S.|last3= Theologos|first3= G.|last4= Yung|first4= A. R.|last5= Goodwin|first5= G. M.|last6= McGuire|first6= P.|date= 2011|title=A comprehensive review and model of putative prodromal features of bipolar affective disorder |journal=Psychological Medicine |volume=41 |issue=8 |pages=1567–1577 |doi=10.1017/S0033291710001790 |issn=0033-2917 |pmc=3687203 |pmid=20836910|last1= Howes|first1= O. D.}}</ref>
==== Identification/assessments ====
Symptoms consistent with the prodrome to BD can be identified through [[semi-structured interview]]s such as The Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P),<ref>{{cite journal | vauthors = Correll CU, Olvet DM, Auther AM, Hauser M, Kishimoto T, Carrión RE, Snyder S, Cornblatt BA | display-authors = 6 | title = The Bipolar Prodrome Symptom Interview and Scale-Prospective (BPSS-P): description and validation in a psychiatric sample and healthy controls | journal = Bipolar Disorders | volume = 16 | issue = 5 | pages = 505–22 | date = August 2014 | pmid = 24807784 | pmc = 4160534 | doi = 10.1111/bdi.12209 }}</ref> and the Semi-structured Interview for Mood Swings<ref>{{cite journal | vauthors = Ozgürdal S, van Haren E, Hauser M, Ströhle A, Bauer M, Assion HJ, Juckel G | title = Early mood swings as symptoms of the bipolar prodrome: preliminary results of a retrospective analysis | journal = Psychopathology | volume = 42 | issue = 5 | pages = 337–42 | date = 2009 | pmid = 19672137 | doi = 10.1159/000232977 | s2cid = 15290117 | url = http://tud.qucosa.de/id/qucosa%3A27567 }}</ref> and [[Symptom Checklists "O" and "S"|symptom checklists]] like the [[Young Mania Rating Scale|Young Mania Rating Scale (YMRS)]]<ref>{{cite journal | vauthors = Young RC, Biggs JT, Ziegler VE, Meyer DA |title=Young Mania Rating Scale |doi = 10.1037/t20936-000|year=2013 }}</ref> and the [[Hamilton Rating Scale for Depression|Hamilton Depression Scale (HAM-D)]].<ref>{{cite journal | vauthors = Hamilton M | title = A rating scale for depression | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 23 | issue = 1 | pages = 56–62 | date = February 1960 | pmid = 14399272 | pmc = 495331 | doi = 10.1136/jnnp.23.1.56 }}</ref><ref name=":4" /><ref name=":3" />
==== Interventions ====
Early intervention is associated with better outcomes for people with prodromal symptoms of BD. Interventions with some evidence of efficacy include medication (e.g. [[mood stabilizer]]s, [[atypical antipsychotic]]s) and psychotherapy. Specifically, [[Family therapy|family-focused therapy]] improves [[emotion regulation]] and enhances functioning in both adults and adolescents.<ref>{{cite journal | vauthors = Miklowitz DJ, Schneck CD, Walshaw PD, Garrett AS, Singh MK, Sugar CA, Chang KD | title = Early intervention for youth at high risk for bipolar disorder: A multisite randomized trial of family-focused treatment | journal = Early Intervention in Psychiatry | volume = 13 | issue = 2 | pages = 208–216 | date = April 2019 | pmid = 28776930 | pmc = 5797511 | doi = 10.1111/eip.12463 }}</ref> [[Interpersonal and social rhythm therapy|Interpersonal and Social Rhythm Therapy (IPSRT)]] may be beneficial for youth at risk of developing BD by helping to stabilize their sleep and [[Circadian rhythm|circadian]] patterns.<ref>{{cite journal | vauthors = Goldstein TR, Fersch-Podrat R, Axelson DA, Gilbert A, Hlastala SA, Birmaher B, Frank E | title = Early intervention for adolescents at high risk for the development of bipolar disorder: pilot study of Interpersonal and Social Rhythm Therapy (IPSRT) | journal = Psychotherapy | volume = 51 | issue = 1 | pages = 180–9 | date = March 2014 | pmid = 24377402 | doi = 10.1037/a0034396 }}</ref> [[Psychoeducation|Psychoeducational Psychotherapy]] (PEP) may be protective in individuals at risk of developing bipolar disorder and are associated with a four-fold reduction in risk for conversion to BD.<ref name=":5">{{cite journal | vauthors = Nadkarni RB, Fristad MA | title = Clinical course of children with a depressive spectrum disorder and transient manic symptoms | journal = Bipolar Disorders | volume = 12 | issue = 5 | pages = 494–503 | date = August 2010 | pmid = 20712750 | pmc = 2924759 | doi = 10.1111/j.1399-5618.2010.00847.x }}</ref> This research needs to be explored further, however, it is currently thought to produce improvements in decreased stress due to [[social support]] and improved functioning through the skills developed in PEP. PEP can prove especially beneficial for individuals presenting transitional mania symptoms as it can assist caregivers in recognizing prodromal mania symptoms and knowing the next steps towards early intervention.<ref name=":5" /> The key goals of this type of therapy are to provide psychoeducation about [[mood disorder]]s and treatments, social support, and to build skills in symptom management, emotion regulation, and problem-solving and communication. This research is in its infancy, further investigations will be necessary to determine which methods lead to the best outcomes and for whom.<ref>{{cite journal | vauthors = Fristad MA, Young AS, Vesco AT, Nader ES, Healy KZ, Gardner W, Wolfson HL, Arnold LE | display-authors = 6 | title = A Randomized Controlled Trial of Individual Family Psychoeducational Psychotherapy and Omega-3 Fatty Acids in Youth with Subsyndromal Bipolar Disorder | journal = Journal of Child and Adolescent Psychopharmacology | volume = 25 | issue = 10 | pages = 764–74 | date = December 2015 | pmid = 26682997 | pmc = 4691654 | doi = 10.1089/cap.2015.0132 }}</ref>
==In neurological conditions==
===Neurodegenerative diseases===
Several [[Neurodegeneration|neurodegenerative]] diseases have a prodromal phase. Early impairments in behavior, personality and language may be detected in [[Alzheimer's disease]].<ref>{{cite journal | vauthors = Welsh-Bohmer KA | title = Defining "prodromal" Alzheimer's disease, frontotemporal dementia, and Lewy body dementia: are we there yet? | journal = Neuropsychology Review | volume = 18 | issue = 1 | pages = 70–2 | date = March 2008 | pmid = 18327642 | pmc = 2881320 | doi = 10.1007/s11065-008-9057-y }}</ref> In [[dementia with Lewy bodies]], there is an identifiable set of early signs and symptoms that can appear 15 years or more before [[dementia]] develops.<ref>{{cite journal |vauthors=McKeith IG, Ferman TJ, Thomas AJ, Blanc F |display-authors=3 |title=Research criteria for the diagnosis of prodromal dementia with Lewy bodies |journal=Neurology |volume=94 |issue=17 |pages=743–55 |date=April 2020 |pmid=32241955 |pmc=7274845 |doi=10.1212/WNL.0000000000009323|type= Review}}</ref> The earliest symptoms are [[constipation]] and [[dizziness]] from [[dysautonomia|autonomic dysfunction]], [[hyposmia]] (reduced ability to smell), visual hallucinations, and [[rapid eye movement sleep behavior disorder]] (RBD).<ref>{{cite journal | vauthors = Donaghy PC, O'Brien JT, Thomas AJ | s2cid = 21628548 | title = Prodromal dementia with Lewy bodies | journal = Psychol Med | volume = 45 | issue = 2 | pages = 259–68 | date = January 2015 | pmid = 25066469 | doi = 10.1017/S0033291714000816 | url = https://eprint.ncl.ac.uk/fulltext.aspx?url=198203/A160C698-A6FD-443C-8FF7-137584B1D6DE.pdf&pub_id=198203 | type = Review | access-date = July 20, 2021 | archive-date = July 20, 2021 | archive-url = https://web.archive.org/web/20210720105457/https://eprint.ncl.ac.uk/file_store/production/198203/A160C698-A6FD-443C-8FF7-137584B1D6DE.pdf | url-status = live }}</ref> RBD may appear years or decades before other symptoms.<ref>{{cite journal |vauthors=Taylor JP, McKeith IG, Burn DJ, Boeve BF |display-authors=3 |title=New evidence on the management of Lewy body dementia |journal=Lancet Neurol |volume=19 |issue=2 |pages=157–69 |date=February 2020 |pmid=31519472 |doi=10.1016/S1474-4422(19)30153-X |pmc=7017451 |type= Review}}</ref> In [[Parkinson's disease]] the [[Anosmia|loss of sense of smell]] may aid in earlier diagnosis.<ref>{{cite journal |vauthors=Heinzel S, Berg D, Gasser T, Chen H, Yao C, Postuma RB |title=Update of the MDS research criteria for prodromal Parkinson's disease |journal=Mov Disord |volume=34 |issue=10 |pages=1464–1470 |date=October 2019 |pmid=31412427 |doi=10.1002/mds.27802 |s2cid=199663713 |url=|doi-access=free }}</ref> [[Multiple sclerosis]] may have a prodromal phase.<ref name="Makhani2021Prodrome">{{cite journal | vauthors = Makhani N, Tremlett H | title = The multiple sclerosis prodrome | journal = Nature Reviews. Neurology | volume = 17 | issue = 8 | pages = 515–521 | date = August 2021 | pmid = 34155379 | pmc = 8324569 | doi = 10.1038/s41582-021-00519-3 }}</ref><ref name="Marrie2019_Prodrome">{{cite journal | vauthors = Marrie RA | title = Mounting evidence for a multiple sclerosis prodrome | journal = Nature Reviews. Neurology | volume = 15 | issue = 12 | pages = 689–690 | date = December 2019 | pmid = 31654040 | doi = 10.1038/s41582-019-0283-0 | s2cid = 204887642 }}</ref>
=== Migraine ===
The [[Migraine#Prodrome phase|prodromal phase of migraine]] is not always present, and varies from individual to individual, but can include ocular disturbances such as shimmering lights with reduced vision, altered mood, irritability, [[clinical depression|depression]] or [[Euphoria (emotion)|euphoria]], [[fatigue (physical)|fatigue]], [[yawning]], excessive sleepiness, craving for certain food (e.g. [[chocolate]]), stiff muscles (especially in the neck), hot ears, constipation or diarrhea, increased urination, and other visceral symptoms.<ref name="pmid15447695">{{cite journal | vauthors = Kelman L | title = The premonitory symptoms (prodrome): a tertiary care study of 893 migraineurs | journal = Headache | volume = 44 | issue = 9 | pages = 865–72 | date = October 2004 | pmid = 15447695 | doi = 10.1111/j.1526-4610.2004.04168.x | s2cid = 43574578 }}</ref>
== See also ==
* [[Apophenia]]
* [[Postdrome]]
== References ==
{{reflist|2}}
== External links ==
* {{wikiversity inline|Evidence based assessment/Schizophrenia (disorder portfolio)}}
* {{wikiversity inline|Evidence based assessment/Bipolar disorder in youth (assessment portfolio)}}
* {{wikiversity inline|Evidence based assessment/Bipolar disorder in adults (assessment portfolio)}}
{{Psychiatry}}
{{Bipolar disorder}}
[[Category:Early psychosis]]
[[Category:Symptoms]]