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The concept of a prodrome, or the very earliest signs of the onset of a mental disorder, is well known in clinical psychiatry, and refers to disturbances of ordinary behaviour that may precede the behaviour and experiences that constitute recognised psychiatric symptoms and signs. In the literature, however, prodromes are described simply by means of lists of behaviours, such as avoidance of meeting other people, irritability, polite greetings absent or minimal, poor table manners, conversation avoided or kept to a minimum, and lowering of standards of personal appearance and hygiene.
To examine a relationship between social rituals and onset of mental disorders, we decided to develop an instrument to measure changes in ritualistic behaviour during the prediagnostic stages of mental illness, and explore whether it could be used as a tool for early detection of individuals who are in, or at risk of soon developing poor mental health. The result is the Social Ritual Interview which consists of ten distinct domains which are based upon universal social rituals identified via extensive cross-cultural investigation.
Once the draft instrument was finalised, mental health professionals administered it upon 30 patients with a variety of mental disorders. The interview was then conducted with a close relative or other carer nominated by the patient, and the questions were asked in relation to the patient's appearance and behaviour. Data analysis found moderate to severe changes in most of the ten social ritual domains, meaning there is often an observable disrespect of such rituals during the prediagnostic stages of mental illness.