Häfner H, Riecher-Rössler A, Maurer K, Fätkenheuer B, Löffler W
Central Institute of Mental Health, W-Mannheim, Federal Republic of Germany.
Eur Arch Psychiatry Clin Neurosci. 1992;242(2-3):109-18. doi: 10.1007/BF02191557.
In the frame of the ABC (Age, Beginning and Course) Schizophrenia Project we studied the influence of age and sex on first-ever onset, symptom manifestation and early course up to first admission in schizophrenia by using a large, representative sample of first-admitted schizophrenic patients. The results showed that the two variables had surprisingly little bearing upon the core symptoms, particularly on negative and other most frequent symptoms and on first-rank symptoms. In 70% of the cases schizophrenia started solely with negative symptoms, in 20% with negative and positive and in 10% with positive symptoms only. In most of the cases symptoms accumulated exponentially up to the first acute episode with positive symptoms appearing considerably later. The age differences observed concerned secondary phenomena associated with developmental factors. Such phenomena, i.e. anxiety, depression and the cognitive formation of delusions, can be interpreted as responses to the psychosis. Also the sex differences, which culminated in far more frequent socially negative disease behaviour in males, were limited to secondary phenomena. This positive and negative core symptomatology of schizophrenia seems to be astonishingly uniform and fairly independent of age and sex at this early stage of the disease. The only remarkable difference was a three to four years higher mean age of onset in females. We were able to show in animal experiments and to confirm in a clinical study that this finding is attributable to a neuromodulatory effect of estrogens on the sensitivity of D2 receptors in the brain. Apparently, estrogens raise the vulnerability threshold until menopause and have a slight neuroleptic-like effect on the symptomatology in acute schizophrenic episodes.
在ABC（年龄、起病与病程）精神分裂症项目框架内，我们通过使用首次入院的精神分裂症患者的大型代表性样本，研究了年龄和性别对精神分裂症首次发病、症状表现以及首次入院前的早期病程的影响。结果表明，这两个变量对核心症状的影响出奇地小，尤其是对阴性症状及其他最常见症状和一级症状。在70%的病例中，精神分裂症仅以阴性症状起病，20%以阴性和阳性症状起病，10%仅以阳性症状起病。在大多数病例中，症状呈指数级累积直至首次急性发作，阳性症状出现得相当晚。观察到的年龄差异涉及与发育因素相关的继发现象。这些现象，即焦虑、抑郁和妄想的认知形成，可被解释为对精神病的反应。同样，性别差异虽在男性中导致更为频繁的社会负面疾病行为，但也仅限于继发现象。在疾病的这个早期阶段，精神分裂症的这种阳性和阴性核心症状学似乎惊人地一致，且相当独立于年龄和性别。唯一显著的差异是女性的平均起病年龄比男性高3至4岁。我们能够在动物实验中证明并在一项临床研究中证实，这一发现归因于雌激素对大脑中D2受体敏感性的神经调节作用。显然，雌激素会提高易感性阈值直至绝经，并在急性精神分裂症发作时对症状学产生轻微的抗精神病样作用。
