The Epidemiology of Early Schizophrenia

Abstract

For the investigation of the early course of schizophrenia starting from onset, the standardised Interview for the Retrospective Assessment of the Onset of Schizophrenia was developed and validated. In a representative sample of 267 first-admitted German schizophrenics of a broad diagnosis from a population of 1.5 million, the age at which different diagnostic and onset definitions were satisfied, the symptoms at the time of the interview, and the accumulation of positive and negative symptoms until first admission were assessed. Comparison between the two sexes and three age groups yielded hardly any differences in the accumulation of symptoms and their course until first admission, except for a slightly shorter period of negative symptoms in young males and a slightly longer one in older women – which contradicts prevailing opinion. At the time of the interview, no significant sex differences were found with respect to the core symptoms of schizophrenia (negative and first-rank symptoms), but clear and substantial differences emerged in disease behaviour. The significantly higher age at first onset in women is explained, on the basis of animal experiments and a clinical study, by the neuromodulatory effect of oestrogen on D2 receptors and by a higher vulnerability threshold in women.

Real-life assessment of aripiprazole monthly (Abilify Maintena) in schizophrenia: a Canadian naturalistic non-interventional prospective cohort study

“…The former provides, at best, an indication that younger patients may have responded better and it is implied that they would be in an earlier phase of the illness. However, many patients who were 35 years old or younger would have been much past 10 years since diagnosis given that the mean age of onset of psychosis is around 22 and 25 years for men and women, respectively [32, 33]. In our study, the classification is more closely aligned to definition of early phase, often referred to as ‘critical phase’ of the first 5 years [34] and does not rely on age as the means for classification.…”

Mental Illness and Youth-Onset Homelessness: A Retrospective Study among Adults Experiencing Homelessness

“…The results are consistent with previous studies [48][49][50][51] and expands upon prior literature by assessing relations with history of severe mental illness and its comorbidities, and examined these associations retrospectively among a large sample of homeless adults. Given that both bipolar and schizophrenia/schizoaffective disorder have been shown to typically emerge during youth (~22-24 years of age) [13,18,19,52], results linking a history of these disorders with the reason for current adult homelessness and youth-onset homelessness suggest that youths with mental illness may face compounding stressors and barriers in the access and delivery of mental health care which could result in youth-onset homelessness that perpetuates homelessness as an adult [5,33].…”

“…We also do not have information on the timing of mental health diagnoses; thus, we do not truly know if mental illness or mental illness comorbidities preceded first homelessness. However, some of the diagnoses assessed are known to first emerge prior to age 25 (e.g., schizophrenia) [52].…”

Psychiatric rehabilitation: general issues

“…The onset of schizophrenia is predominantly very early and leads to functional impairments and social status deficits already in the prodromal phase prior to first admission (Hafner et al, 1994). During the long-term course there are irregularly occurring psychotic episodes and wide variations in the unspecific and negative symptomatology accompanied by functional impairments and social disabilities.…”