Differential propensity in recognition of prepsychotic phenomena among psychiatrists, clinical psychologists and school counsellors

Aim: The prodromal symptoms of schizophrenia are difficult to differentiate from other common psychiatric illnesses or stress reactions. Despite the development of new diagnostic instruments, non-specificity and poor awareness of this clinical entity are still major barriers to early identification of individuals at risk for schizophrenia. This study was conducted to assess differences among three types of mental health professionals in the recognition of prepsychotic phenomena.Methods: A questionnaire was developed that presented 11 case vignettes. The vignettes represented a hypothetical gradient of clinical severity, including stress reactions; very early stage, intermediate-risk stage and very high-risk stage of the schizophrenia prodrome; and full-blown psychosis. The questionnaire was completed by 57 psychiatrists, 44 clinical psychologists and 50 school counsellors. For each vignette, respondents indicated their top three choices among nine different diagnostic considerations.Results: As a group, psychiatrists were most likely to consider schizophrenia for all stages of clinical severity, whereas school counsellors were least likely to. Still, only about half of psychiatrists selected schizophrenia as their first choice for very high-risk cases, and even fewer psychologists and counsellors did so. A proportion of school counsellors failed to recognize full-blown psychosis. Despite the differential propensity in recognition of prepsychotic phenomena, a gradient in considering schizophrenia as a possible diagnosis across the stages of clinical severity was obvious.Conclusions: Psychiatrists, clinical psychologists and school counsellors all need further education, targeting their group-specific proclivities, to improve their sensitivity and specificity in early identification of individuals at risk for schizophrenia.