The early symptoms of schizophrenia

Since Bleuler introduced his concept of schizophrenia in 1911, there has been a steady growth of clinical and experimental data relating to this disease. However, the literature dealing with early diagnosis is sparse and as yet there is no general agreement as to what symptomatology constitutes the early clinical picture. Older texts (Kraepelin, 1919; Bleuler, 1911) do not elaborate early diagnosis, dwelling more on distinguishing schizophrenia from other disease entities. Likewise, more recent texts tend to refer to the early stages very briefly in rather vague terms, signifying the development of the disease over the first few years from its onset. Although practice varies, the diagnosis of schizophrenia is often reserved until Bleuler's primary symptoms of disordered volition, thinking and affect appear overtly, by which time there may be also some evidence of deterioration. It is recognized, however, that these symptoms may take years to appear (Gillies, 1949) so that early diagnosis cannot readily be made by using these criteria.