title: Early psychosis symptoms.
abstract: OBJECTIVE
  To determine the prodromal symptoms of schizophrenia in the pathways to help-seeking.
  
  
  METHODS
  A cross-sectional study.
  
  
  METHODS
  The Department of Psychiatry, the Aga Khan University, Karachi, from 2008 to 2009.
  
  
  METHODS
  A total of 93 patients were interviewed in the pathways to care of schizophrenia. The diagnosis was based on ICD-10 criteria. The pathways to care were assessed through a semi-structured questionnaire. The onset, course and symptoms of psychosis were assessed through Interview for Retrospective Assessment at Age at Onset of Psychosis (IROAS).
  
  
  RESULTS
  Fifty five (59%) participants were male while 41% (n=38%) were female. Using IROAS, 108 symptoms were identified as concerning behaviour. Alternatively, 60 (55%) concerning behaviours were reported in the open-ended inquiry of the reasons for help seeking as assessed by the pathways to care questionnaire with a statistically significant difference between most symptoms category. The difference was most pronounced (p < 0.001) for depressed mood (66%), worries (65%), tension (63%), withdrawal/mistrust (54%) and loss of self-confidence (53%). Thought withdrawal (22%) and passivity (15%) were elicited only through structured interview (IROAS). When symptoms were categorized together, about 83% of the subjects presented with affective and non-specific prodromal symptoms. Roughly, 10% of the subjects presented with positive symptoms and 3% presented with the negative symptoms of psychosis. The non-specific, affective symptoms appear to predominate the prodromal phase of the illness.
  
  
  CONCLUSIONS
  Prodromal symptoms of schizophrenia include non-specific, affective symptoms. Attention needs to be paid on identifying the prodromal symptoms and change in social functioning in order to identify those who are at risk of longterm psychosis.
authors.affiliation: Department of Psychiatry, The Aga Khan University Hospital, Karachi.
authors.forename: Haider A
authors.initials: HA
authors.lastname: Naqvi
authors.affiliation: Department of Psychiatry, The Aga Khan University Hospital, Karachi.
authors.forename: Sajjad
authors.initials: S
authors.lastname: Hussain
authors.affiliation: Department of Community Health Sciences, The Aga Khan University Hospital, Karachi.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Islam
authors.affiliation: Department of Psychiatry, The Aga Khan University Hospital, Karachi.
authors.forename: Shafqat
authors.initials: S
authors.lastname: Huma
mesh_terms: D000328:Adult; D017668:Age of Onset; D003156:Community Mental Health Services; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000523:psychology; D012189:Retrospective Studies; D012559:Schizophrenia / Q000175:diagnosis*; D012565:Schizophrenic Psychology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors