Epidemiology of Schizophrenia: A European Perspective

Abstract

Since its inception, the concept of dementia praecox and, later, of schizophrenia has been one of the most disputed entities in modern medicine. Schizophrenia was, and still is, defined by its clinical symptoms and their characteristic evolution over time. No external validating criteria for the diagnosis have been established, in spite of a host of suggestive biological findings, among which the genetic data carry most weight. This absence of clear-cut substrate markers and indicators underscores the importance of the epidemiological perspective in the study of the disorder. The European contributions to the epidemiological description and understanding of schizophrenic morbidity are numerous. They range from community surveys and studies of pedigrees to case-control designs for assessment of risk factors and long-term followup investigations of course and outcome. This review focuses on epidemiological approaches to schizophrenia that have attempted to highlight the essential attributes of a disease: its incidence and prevalence, ecology, and associated features. It is difficult to generalize about European epidemiological research in schizophrenia, because of the coexistence of a variety of "schools," traditions, and approaches. It is nevertheless possible to discern several clear trends in European epidemiological investigations of schizophrenia that can, to some extent, be contrasted to North American developments.

The ‘Diagnostic History’ of Schizophrenia

“…One possible explanation underlying the long diagnostic and onset diagnosis latency described in this study is that the Swedish tradition is still bound to the seminal concept of Kraepelin [18], which emphasizes the course of the dis ease. This explanation is in accordance with the opinion of Jablenski [19], who described that Scandinavian psychiatry has tradition ally adhered to a 'narrow' concept of schizo phrenia, which is more restrictive than the German one, excluding from its shape not only cases with an admixture of affective fea tures and acute onset (which according to Langfeldt [20] could be classified as schizo phreniform), but also cases of unequivocal paranoid manifestation in which a link could be inferred between the onset and the content of symptoms and a psychotraumatic experi ence. Such cases are classified as reactive psy choses [21][22][23].…”

Symptom Assessment in Casenotes and the Clinical Diagnosis of Schizophrenia

“…psychopathological symptoms [1], As different psychiatric traditions use divergent symptom Until now, the lack of an etiological defini-sets [2], completed by specific criteria, transna tion of schizophrenia leads to the necessity of tional comparisons lead only to limited concorbasing the schizophrenia diagnosis mainly on dance [3], One important transnational study, the U S-U K study [4], revealed important dif ferences in the usage of the clinical diagnosis of schizophrenia in the United Kingdom and the United States. This study showed that differ ences in incidence between the two countries were largely artifacts of different diagnostic habits and not of different morbidity.…”

Management of people with schizophrenia in primary care

“…Vocational training has improved the situation, but even among newly trained principals in the 1990s, only 40% have completed a postgraduate psychiatry senior house job (Styles, 1991). Each GP will have on their books, on average, around seven people with chronic schizophrenia (Jablensky, 1986), which means that they do not have frequent opportunities to learn about the condition through experience with their own patients. Therefore, GPs need up-to-date information and practical advice on the management of schizo phrenia.…”