The influence of age and sex on the onset and early course of schizophrenia. Br J Psychiatry 162: 80-86

Central Institute of Mental Health, Mannheim, Germany.
The British Journal of Psychiatry (Impact Factor: 7.99). 02/1993; 162(1):80-6. DOI: 10.1192/bjp.162.1.80
Source: PubMed


A new standardised interview for the retrospective assessment of onset and early course of schizophrenia (IRAOS) was used to study the influence of age and sex on time of onset and psychopathology before first admission in 267 schizophrenic patients admitted for the first time. Mean age at onset, according to various operationalised definitions, differed by three to four years between the sexes. The age distribution at the earliest sign of mental disorder showed an early and steep increase until the age of 25 in males, and a delayed and smaller increase in females, with a second peak in women aged 45-79. Schizophrenia began with negative symptoms in 70% of cases, appearing two to six years before admission, and all positive symptoms appearing up to two years before. Both positive and negative symptoms accumulated exponentially. The early course of the disease was similar across age groups, except there was a longer period of negative symptoms before first admission in late-onset schizophrenia in women. The few significant age differences in symptoms were presumably due to general age-dependent reaction patterns like anxiety and depression or the cognitive development of personality, as indicated by an increase in fully elaborated positive symptoms, especially systematised paranoid delusions, with age.


Available from: Heinz Häfner
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    • "The lifetime prevalence of psychoses is estimated between 0.2 and 3.5% [83] [125], their annual incidence between 0.01 and 0.035%, with growing numbers reported in Europe where, within 12 months, approximately 3.7 million adults (0.8%) had been affected in 2005 and as much as 5 million (1.2%) in 2011 [46] [125]. The gender related incidence of affective and non-affective psychotic disorders depends on type of psychosis and age with a higher incidence of schizophrenia in men and a similar cumulative incidence of all psychoses at age 60 [19] [34] [35] [38] [47] [65] [114]. Approximately 10–15% of all psychoses are early-onset psychoses (EOP) manifesting before the age of 18, and approximately 1–3% are very-early-onset psychoses (VEOP) with an onset before the age of 13 [98] [125]. "
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    ABSTRACT: The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion 'cognitive disturbances' (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The 'genetic risk and functional decline' UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
    European Psychiatry 03/2015; 30:405-416. DOI:10.1016/j.eurpsy.2015.01.010 · 3.44 Impact Factor
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    • "Symptoms of schizophrenia are delineated into positive and negative symptoms; the former include hallucinations, paranoia and delusions, and examples of the latter are reduced motivation, impoverished speech, blunted affect and social withdrawal; in addition this over-arching label can be further sub-grouped based on symptom profile [2]. These symptoms generally emerge in early adulthood and often persist in approximately three-quarters to two-thirds of individuals despite optimal treatment [3–5]. This enduring and/or fluctuating course of illness leads not only to personal distress and disability but also engenders a high societal burden with the estimated total financial cost of £11.8 billion per annum in England alone [6]. "
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    ABSTRACT: Schizophrenia is a chronic condition that impacts significantly not only on the individual and family, but the disorder also has wider consequences for society in terms of significant costs to the economy. This highly prevalent condition affects approximately 1% of the worldwide population, yet there are few therapeutic options. The predominant treatment strategy for schizophrenia is anti-psychotic medication (with or without additional talking therapy) even though this approach lacks efficacy in managing the negative symptoms of the condition, is not effective in one-third of the patient group and the side effects of the medication can be severe and debilitating. In recent years, a number of pathophysiological processes have been identified in groups of people with schizophrenia including oxidative stress, one-carbon metabolism and immune-mediated responses. A number of studies have shown that these altered physiological mechanisms can be ameliorated by nutritional interventions in some individuals with schizophrenia. This review briefly describes the aforementioned processes and outlines research that has investigated the utility of nutritional approaches as an adjunct to anti-psychotic medication including antioxidant and vitamin B supplementation, neuroprotective and anti-inflammatory nutrients and exclusion diets. Whilst none of these interventions provides a ‘one-size-fits-all’ therapeutic solution, we suggest that a personalised approach warrants research attention as there is growing agreement that schizophrenia is a spectrum disorder that develops from the interplay between environmental and genetic factors. Electronic supplementary material The online version of this article (doi:10.1186/1475-2891-13-91) contains supplementary material, which is available to authorized users.
    Nutrition Journal 09/2014; 13(1):91. DOI:10.1186/1475-2891-13-91 · 2.60 Impact Factor
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    • "(2014), symptoms that may suggest a possible prodrome to, or more conservatively " clinical high risk " (CHR) for, a psychotic disorder. Most primary psychotic disorders onset in late adolescence and early adulthood, with peak onset between ages 15 to 25 in males and 20 to 29 in females (Castle et al., 1993; Häfner et al., 1993). Since the prodromal period is thought to precede illness onset by 1 to 6 years (Yung and McGorry, 1996; Häfner et al., 1998; Köhn et al., 2004), screening measures for identification of prodromal symptoms have been developed primarily for adolescents and young adults. "
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    ABSTRACT: Background Psychosis prevention and early intervention efforts in schizophrenia have focused increasingly on sub-threshold psychotic symptoms in adolescents and young adults. Although many youth report symptom onset prior to adolescence, the childhood incidence of prodromal-level symptoms in those with schizophrenia or related psychoses is largely unknown. Methods This study reports on the retrospective recall of prodromal-level symptoms from 40 participants in a first-episode of schizophrenia (FES) and 40 participants at “clinical high risk” (CHR) for psychosis. Onset of positive and non-specific symptoms was captured using the Structured Interview for Prodromal Syndromes. Frequencies are reported according to onset during childhood (prior to age 13), adolescence (13–17), or adulthood (18 +). Results Childhood-onset of attenuated psychotic symptoms was not rare. At least 11% of FES and 23% of CHR reported specific recall of childhood-onset of unusual or delusional ideas, suspiciousness, or perceptual abnormalities. Most recalled experiencing non-specific symptoms prior to positive symptoms. CHR and FES did not differ significantly in the timing of positive and non-specific symptom onset. Other than being younger at assessment, those with childhood onset did not differ demographically from those with later onset. Conclusion Childhood-onset of initial psychotic-like symptoms may be more common than previous research has suggested. Improved characterization of these symptoms and a focus on their predictive value for subsequent schizophrenia and other major psychoses are needed to facilitate screening of children presenting with attenuated psychotic symptoms. Accurate detection of prodromal symptoms in children might facilitate even earlier intervention and the potential to alter pre-illness trajectories.
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