Knowledge of the similarities and differences between early- and late-onset schizophrenia and between late-onset schizophrenia and paranoid disorder of old age and very old age is fragmentary. We compared diagnosis, subtypes, syndromes and symptoms between first-episode schizophrenia (ICD-9: 295) and paranoid disorder (ICD-9: 297, 298.3/4.) over the life cycle in a population-based (N = 232) and a clinical first-admission sample (N = 1109). Apart from different age patterns of the sexes only two symptom groups were significantly different between early- and late-onset illness: paranoid and systematic delusions showed a linear increase, symptoms of disorganisation a linear decrease over the life cycle. Clearly different between early- and late-onset illness were the neurobiological and psychological risk factors, suggesting that both neurodevelopmental and neurodegenerative disorder causes psychopathology typical of schizophrenia. Late- (40 to 60) and very-late-onset (over 60) cases of both groups of illness showed the same symptom profiles, merely the number of symptoms being higher in the group diagnosed with schizophrenia. Age was the only factor significantly contributing to a clinico-diagnostic differentiation of schizophrenia from paranoid disorder beyond age 40.
Ecologically oriented research of psychiatric service utilization has almost exclusively dealt with regular in- and out-patient services. There are hardly any results on the ecological distribution of utilization rates of psychiatric emergency services. This study aims at investigating the topographic distribution of utilization rates of the psychiatric emergency service out of office hours at the Central Institute of Mental Health (CIMH, Mannheim) from 1982 to 1993. Within this period of time 6463 patients with a total of 14,628 contacts were registered at the CIMH. In order to explain topographic differences in the utilization rates, ecological variables, the distance between patients' residence and service location, and diagnosis were taken into account. The study shows that ecological, distance-related and diagnostic factors all influence the utilization of the psychiatric emergency service in Mannheim. First contact and contact rates decrease from the city centre toward the outskirts. There was a strong general effect of ecological variables: the utilization rates were higher for districts with worse ecological conditions and specific for some diagnostic groups. The greatest difference in utilization rates between the city centre and the outskirts was found for schizophrenia and psychoactive substance use disorders, whereas there was no difference with regard to organic and symptomatic mental disorders. With increasing spatial and time-related distance between residence and service location, the utilization rate decreases. No relation was found between diagnosis and distance. The study also shows an interaction between time-related distance and the ecological variables. The influence of the ecological factors on service utilization is amplified with decreasing distance.
Up to now all investigations about the topographic distribution of psychiatric utilization rates ignore whether or not the patients really require care (need for care) respectively express that need by themselves (demand for care). To analyze utilization rates of the psychiatric emergency service of the Central Institute of Mental Health in Mannheim (CIMH), variables differentiating between need and demand for emergency care were included. The investigation is based on contacts in the psychiatric emergency service between 1982 and 1993 and comprises 6463 patients with 14,628 contacts. To operationalize the concepts of need and demand the items "instance of consultation", "reasons for consultation", "inpatient admission" and "rated urgency" from the standardized record system of the psychiatric emergency service were used. The association between need, demand and ecological, socio-demographic and distance-related factors were analyzed. The results show that demand for psychiatric emergency care is an important factor for explaining topographic differences in service utilization. Demand correlates with ecological, socio-demographic and distance related factors; need only correlates with age. The amount of demand also varies with specific mental disorders.
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