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Epidemiology of schizophrenia. The disease model of schizophrenia in the light of current epidemiological knowledge

Published online by Cambridge University Press:  16 April 2020

H Häfner
H Häfner*
Affiliation:
Schizophrenia Research Unit, Central Institute of Mental Health, J 5, D-68159Mannheim, Germany
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Summary

Attempting an update of the epidemiology of schizophrenia, it is pointed out that schizophrenia seems to occur with the same core symptoms and almost at the same frequency in all countries and cultures studied. Methodologically sound studies have failed to produce evidence for a secular trend of the morbid risk. The genotype of schizophrenia is expressed as psychosis, personality disorders and non-specific disorders or it goes without manifest psychopathology. Minor brain anomalies are present in most cases. The British Child Development Study showed that behavioural, cognitive, emotional and neuromotor antecedents occur in 50% of cases, thus pointing to disordered brain development, very likely not specific to schizophrenia, since found in many other mental disorders as well. A look into the hidden early course of schizophrenia revealed a significant sex difference in age of onset and a prodromal phase of some 3 to 4 years throughout the cases. A case-control study showed that it is mainly during this early course before first admission that social disadvantage in schizophrenia arises. In the prephase a disease-related lack of social ascent plays a greater role than steps of social decline. The early social course differs between the sexes mainly due to an earlier onset of the disorder in males. The actual disease variables, that is, core symptoms and type of course, do not show any essential differences between males and females. These results indicate that schizophrenia is one of the rare uniform patterns of response of the brain, capable of being triggered by a large number of causes or favoured by non-specific risk factors. In this context the protective effect of estrogens will be discussed.

Keywords

epidemiology of schizophreniaestrogen hypothesissecular trends of schizophrenia incidencegender differences in schizophreniaantecedents of schizophreniainfluenza and schizophrenia
Type
Original article
Information
European Psychiatry , Volume 10 , Issue 5 , 1995 , pp. 217 - 227
Copyright
Copyright © Elsevier, Paris 1995

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Footnotes

*

Paper presented at the Section Symposium “New Perspectives in Psychiatric Epidemiology” of the 7th Congress of the Association of European Psychiatrists “European Psychiatrists: East and West”, Copenhagen, 12-22 September 1994.

References

Alarcon J, de, Searproatt, V, Goldacre, MTrends in schizophrenia. Lancet 1990; I: 852–853Google Scholar
Angst, JIs schizophrenia disappearing?. Eur Arch Psychiatry Clin Neurosci 1991; 240: 373CrossRefGoogle Scholar
Unpublished manuscript from the National Case Register of Mental DisorderAstrup, CThe increase of mental disorders 1982 Gaustad HospitalGoogle Scholar
Babigian, HMSchizophrenia: Epidemiology. In: Freedman, AM, Kaplan, HI, Sadock, BJ eds. Comprehensive textbook of psychiatry vol II Baltimore: Williams & Wilkins, 1975; 860–866Google Scholar
Brown, GW, Birley, JLTSocial precipitants of severe psychiatric disorders. In: Hare, EH, Wing, JK eds. Psychiatric epidemiology. London: Oxford University Press, 1970; 321–325Google Scholar
Cannon, M, Cotter, D, Sham, PCet al.Schizophrenia in an Irish sample following prenatal exposure to the 1957 influenza epidemic: a case-controlled, prospective follow-up study Schizophr Res 11 1994 95Google Scholar
Crow, TJTrends in schizophrenia. Lancet 1990; I: 851CrossRefGoogle Scholar
Crow, TJ, Done, DJPrenatal exposure to influenza does not cause schizophrenia. Br J Psychiatry 1992; 161: 390–393CrossRefGoogle ScholarPubMed
Crow, TJ, Done, DJ, Sacker, ABirth cohort study of the antecedents of psychosis: ontogeney as witness to phylogenetic origins. In: Häfner, H, Gattaz, WF eds. Search for the causes of schizophreniavol III Berlin, Heidelberg: Springer, 1994; 3–20Google Scholar
Dauncey, K, Giggs, J, Baker, K, Harrison, GSchizophrenia in Nottingham: Lifelong residential mobility of a cohort. Br J Psychiatry 1993; 163: 613–619Google ScholarPubMed
Der, G, Gupta, S, Murray, RMIs schizophrenia disappearing?. Lancet 1990; I: 513–516CrossRefGoogle Scholar
Dilling, H, Weyerer, S, Lisson, HZur ambulanten psychiatrischen Versorgung durch niedergelassene Nervenärzte. Soc Psychiatry 1975; 10: 111–131CrossRefGoogle Scholar
Dohrenwend, BP, Shrout, PE, Link, BG, Skodol, AESocial and psychosocial risk factors for episodes of schizophrenia. In: Häfner, H, Gattaz, WF, Janzarik, W eds. Search for the causes of schizophrenia. Berlin, Heidelberg: Springer, 1987; 275–296Google Scholar
Dohrenwend, BP, Levav, I, Shrout, PEet al.Socioeconomic status and psychiatric disorders: The causation-selection issue Science 1992 255 946–952CrossRefGoogle ScholarPubMed
Dunham, HWCommunity and schizophrenia: an epidemiological analysis. Detroit: Wayne State University Press, 1965Google Scholar
Eagles, JM, Whalley, LJDecline in the diagnosis of schizophrenia among first admissions to Scottish mental hospitals from 1969–1978. Br J Psychiatry 1985; 146: 151–154CrossRefGoogle Scholar
Fans, RE, Dunham, WMental disorders in urban areas. An ecological study of schizophrenia and other psychoses. Chicago: University of Chicago Press, 1939Google Scholar
Folnegovic, Z, Hrabak-Zerjavic, , Folnegovic-Smalc, V, Nimica, NHospital incidence of schizophrenia in Croatia over a 25-year period. Schizophr Res 1994; 11: 99–100Google Scholar
Giel, R, Sauer, HC, Slooff, CJ, Wiersma, DEpidemiological observations on schizophrenia and disability in the Netherlands Tijdschr Psychiatrie 11–12 1980 710–722Google Scholar
Graham, PMTrends in schizophrenia Lancet I 1990 852Google Scholar
Häfner, HNew perspectives in the epidemiology of schizophreniaHäfner, H, Gattaz, WFSearch for the causes of schizophrenia vol II Berlin, Heidelberg: Springer, 1990; 408–431CrossRefGoogle Scholar
Häfner, HThe epidemiology of schizophrenia. Triangle 1992; 31: 133–154Google Scholar
Häfner, H, ander Heiden, WThe contribution of European case registers to research on schizophrenia. Schizophr Bull 1986; 12: 26–50CrossRefGoogle ScholarPubMed
Häfner, H, Gattaz, WFIs schizophrenia disappearing? (letter). Eur Arch Psychiatry Clin Neurosci 1991; 240: 374–376Google Scholar
Häfner, H, Löffler, WDie ökologische Verteilung schizophrener Ersterkrankungen in zwei deutschen Großstädten (Mannheim und Heidelberg). Fundamenta Psychiatrica 1994; 8: 103–115Google Scholar
Häfner, H, Reimann, HSpatial distribution of mental disorders in Mannheim 1965Hare, EH, Wing, JKPsychiatric epidemiology London: Oxford University Press, 1970; 341–354Google Scholar
Häfner, H, Riecher, A, Maurer, Ket al.Ein Instrument zur retrospektiven Einschätzung des Erkrankungsbeginns bei Schizophrenie (Instrument for the retrospective assessment of the onset of schizophrenia - IRAOS - Entwicklung und Ergebnisse. Z Klin Psychol 1990; 19: 230–235Google Scholar
Häfner, H, Behrens, S, Vry J, de, Gattaz, WF, Löffler, W, Maurer, K, Riecher-Rössler, AWarum erkranken Frauen später an Schizophrenie? Erhöhung der Vulnerabilitätsschwelle durch Östrogen. Nervenheilkunde 1991; 10: 154–163Google Scholar
Häfner, H, Behrens, S, de Vry, J, Gattaz, WFAn animal model for the effects of estradiol on dopamine-mediated behavior: Implications for sex differences in schizophrenia. Psychiatry Res 1992; 38: 125–134CrossRefGoogle Scholar
Häfner, H, Riecher-Rössler, A, Hambrecht, Met al.IRAOS: an instrument for the assessment of onset and early course of schizophrenia. Schizophr Res 1992; 6: 209–223CrossRefGoogle ScholarPubMed
Hambrecht, M, Riecher-Rössler, A, Fätkenheuer, B, Louza, MR, Häfner, HHigher morbidity risk for schizophrenia in males: fact or fiction?. Compr Psychiatry 1994; 35: 39–49CrossRefGoogle ScholarPubMed
Hare, EHWas insanity on the increase?. Br J Psychiatry 1983; 142: 439–455CrossRefGoogle ScholarPubMed
Helgason, LPsychiatric services and mental illness in Iceland Acta Psychiatr Scand 1977 268Google ScholarPubMed
Helgason, TExpectancy of schizophrenia in Iceland during the twentieth century Paper presented at The WPA Symposium “Changing the course and outcome of mental disorder” Groningen, the Netherlands, Sept 1–3 1993Google Scholar
Jablensky, AEpidemiology of schizophreniaBebbington, P, McGuffin, PSchizophrenia. The major issues Oxford: Heineman Professional Publishing, 1988; 19–35Google Scholar
Jablensky, A, Sartorius, N, Ernberg, G, Anker, M, Korten, A, Cooper, JE, Day, R, Bertelsen, A Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten-country study Psychol Med Monograph Suppl 20 1992 Cambridge University PressCrossRefGoogle Scholar
Krupinski, J, Alexander, LPatterns of psychiatric morbidity in Victoria, Australia, in relation to changes in diagnostic criteria 1848–1978. Soc Psychiatry 1993; 18: 61–67CrossRefGoogle Scholar
Manderscheid, RW, Locke, BZ, Pato, CN, Shore, DTrends in schizophrenia Lancet II 1990 1097CrossRefGoogle Scholar
Mednick, SA, Machon, RA, Huttunen, MOet al.Adult schizophrenia following prenatal exposure to an influenza epidemic. Arch Gen Psychiatry 1988; 45: 189–192CrossRefGoogle Scholar
Mortensen, PBIs schizophrenia disappearing?. Eur Arch Psychiatry Clin Neurosci 1991; 240: 374Google Scholar
Munk-Jørgensen, PDecreasing first admission rates of schizophrenia among males in Denmark from 1970 to 1984. Changing diagnostic patterns?. Acta Psychiatr Scand 1986; 73: 645–650CrossRefGoogle ScholarPubMed
Munk-Jørgensen, PWhy has the incidence of schizophrenia in Danish psychiatric institutions decreased since 1970?. Acta Psychiatr Scand 1987; 75: 62–68CrossRefGoogle ScholarPubMed
Murray, RM, Gupta, S, Der, GTrends in schizophrenia Lancet II 1990 1214CrossRefGoogle Scholar
Murray, RM, Gupta, S, Der, GIs schizophrenia disappearing?. Eur Arch Psychiatry Clin Neurosci 1991; 240: 377–378Google Scholar
Prince, MJ, Phelan, MCTrends in schizophrenia. Lancet 1990; 1: 851–852Google Scholar
Riecher-Rössler, A, Häfner, H, Stummbaum, M, Maurer, K, Schmidt, RCan estradiol modulate schizophrenic symptomatology?. Schizophr Bull 1994; 20: 203–214CrossRefGoogle ScholarPubMed
Sartorius, N, Jablensky, A, Korten, Aet al.Early manifestations and first-contact incidence of schizophrenia in different cultures Psychol Med 16 1986 909–928CrossRefGoogle ScholarPubMed
Torrey, EFSchizophrenia and civilisation New York: Jason Aronson, 1980Google Scholar
Weyerer, S, Häfner, HThe stability of the ecological distribution of the incidence of treated mental disorders in the city of Mannheim. Soc Psychiatry Psychiatr Epidemiol 1989; 24: 57–62CrossRefGoogle ScholarPubMed
Weyerer, S, Häfner, HThe high incidence of psychiatrically treated disorders in the inner city of Mannheim. Soc Psychiatry Psychiatr Epidemiol 1992; 27: 142–146Google ScholarPubMed
Wing, JK, Fryers, T Psychiatric services in Camberwell and Salford. Statistics from the Camberwell and Salford psychiatric registers, 1964–1974. MRC Social Psychiatry Unit, London Department of Community Medicine of Manchester 1976Google Scholar
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