Häfner H
Zentralinstitut für Seelische Gesundheit, Mannheim, Germany.
Acta Psychiatr Scand Suppl. 2000(407):44-8.
First treatment contact is preceded by a lengthy prodromal and psychotic prephase. We analysed the occurrence of symptoms and disabilities prior to first contact and their consequences for medium-term illness course.
A population-based sample of 232 first episodes of schizophrenia was studied retrospectively using the IRAOS and compared with matched peers from the population of origin. Further illness course was studied prospectively at six cross-sections over 5 years from first admission onwards.
Three quarters showed a prodromal phase of 5 years (mean) and a 1-year accumulation of psychotic symptoms. First to appear were depressive and negative symptoms and early signs of cognitive and social impairment. Social disability emerged 4 to 2 years before first contact. Further illness course was determined by stage of social development at psychosis onset with the consequence of a significantly poorer course for men than women because of men's earlier illness onset. Symptomatology, type of onset, age and gender influenced social course via stage of social development and, additionally, via young men's socially adverse illness behaviour.
Social course is determined by individual stage of social development at illness onset and by early illness course. Therefore, early detection and intervention are needed.
首次治疗接触之前存在漫长的前驱期和精神病前期。我们分析了首次接触之前症状和残疾的发生情况及其对中期病程的影响。
使用IRAOS对232例首次发作的精神分裂症患者进行基于人群的回顾性研究，并与来自原人群的匹配同龄人进行比较。从首次入院起，在5年的6个时间点对进一步的病程进行前瞻性研究。
四分之三的患者有5年（平均）的前驱期和1年的精神病症状累积。首先出现的是抑郁和阴性症状以及认知和社会功能损害的早期迹象。社会残疾在首次接触前4至2年出现。进一步的病程由精神病发作时的社会发展阶段决定，结果是男性的病程明显比女性差，因为男性发病更早。症状学、起病类型、年龄和性别通过社会发展阶段，此外还通过年轻男性的社会不良疾病行为影响社会病程。
社会病程由发病时的个体社会发展阶段和早期病程决定。因此，需要早期发现和干预。
