A 26-year-old man has experienced auditory hallucinations, disorganised speech, and flat affect for 8 months. Two months before the psychotic break, he had a period of marked social withdrawal and declining academic performance. According to DSM-5, which prodromal phase duration criterion does this presentation satisfy for a schizophrenia diagnosis?

• A The 2-month prodrome qualifies as the required attenuated positive symptom phase
• B The DSM-5 requires negative or attenuated symptoms for at least 1 month before full psychosis, making this 2-month period part of the 6-month total duration criterion ✓
• C Prodrome duration must be at least 3 months to count toward the 6-month criterion
• D The prodromal phase is not counted in the 6-month duration criterion; only active-phase symptoms count

Explanation

DSM-5 requires that signs of schizophrenia (including prodromal, active, and residual phases) be continuously present for at least 6 months. The 2-month period of social withdrawal and declining function qualifies as a prodromal phase, and when added to the 8 months of active psychosis it well exceeds the 6-month minimum. There is no minimum duration specified for the prodrome itself in DSM-5, so option C is incorrect. The prodrome does count toward the 6-month criterion, refuting option D.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.