Life events, familial stress, and coping in the developmental course of schizophrenia.

Recent studies have isolated some socioenvironmental factors that seem to predict the onset of schizophrenic episodes in vulnerable persons. In particular, stressful life events have been found to cluster in the 3- to 4- week period preceding a schizophrenic episode in some patients. Many persons with a schizophrenic disorder also seem to contribute to additional stressful life change events--for example, by high geographic mobility--thereby playing an active role in precipitating the onset of illness episodes. Within the family environment, hostile, critical, and emotionally overinvolved attitudes toward the patient by relatives have been found to be related to relapses. Irregularities in the communication style of parents also predict the subsequent development of schizophrenia spectrum disorders among disturbed adolescents. Many schizophrenic patients also seem to be deficient in the coping skills required to remediate the losses brought on by life events or to deal effectively with stressful relatives. Thus, they may experience greater and more prolonged stress than most others due partially to inadequate social and problem-solving skills and less supportive social networks. These findings have important implications for the design of clinical interventions as well as the development of a comprehensive vulnerability/stress model for the course of schizophrenic disorders.