Häfner H, Nowotny B, Löffler W, an der Heiden W, Maurer K
Schizophrenia Research Unit, Central Institute of Mental Health, Mannheim, Germany.
Eur Arch Psychiatry Clin Neurosci. 1995;246(1):17-28. doi: 10.1007/BF02191811.
The present study is an empirical contribution to the controversy over whether the poor social performance and lower social class of schizophrenic patients are consequences of the illness, consequences of changes in the individuals predisposed to develop schizophrenia or are due to the adverse social conditions that lead to schizophrenia. The study focuses on the socioeconomic status at onset, on the performance of social roles in the early course of schizophrenia by taking age, gender and the individual level of social development into account. In a representative sample of 232 first episodes of schizophrenia age and type of onset.type and accumulation of symptoms and social functioning in the prodromal and the psychotic prephase and at first admission were assessed and analysed for their predictive power concerning social disability 2 years after first admission. In a case-control study expected and observed social functioning from onset until first admission were compared. The subsequent course was followed up prospectively in five cross sections until 2 years after first admission. In women the age at onset was significantly higher than in men, whereas symptomatology and type of onset showed no gender differences. In 73% of the sample the prodromal phase covered 5 years on average, and the psychotic prephase (until the maximum of positive symptoms) 1.1 years. Deficits in social functioning occurred predominantly during the prodromal and the psychotic prephase. The course over 14 years showed stable group trends in social and symptom measures. By the end of the prodromal phase it was possible to predict social disability 2 years after first admission with a correct classification of 81%. The main factor determining social outcome appeared to be the acquired social status during the prodromal phase of the disorder. The unfavourable early course in men was due mainly to their significantly lower age at onset. These results raise questions concerning an earlier therapeutic and rehabilitative intervention.
本研究是对有关精神分裂症患者社会表现不佳和社会阶层较低是疾病的后果、易患精神分裂症个体变化的后果还是导致精神分裂症的不良社会条件所致这一争议的实证贡献。该研究关注发病时的社会经济状况，通过考虑年龄、性别和个体社会发展水平，考察精神分裂症早期病程中社会角色的表现。在一个包含232例首发精神分裂症的代表性样本中，评估并分析了发病年龄和类型、症状类型及累积情况以及前驱期和精神病前期及首次入院时的社会功能，以了解它们对首次入院后2年社会残疾的预测能力。在一项病例对照研究中，比较了从发病到首次入院期间预期和观察到的社会功能。随后对其病程进行前瞻性追踪，分五个阶段进行，直至首次入院后2年。女性的发病年龄显著高于男性，而症状学和发病类型没有性别差异。在73%的样本中，前驱期平均持续5年，精神病前期（直至阳性症状达到峰值）持续1.1年。社会功能缺陷主要出现在前驱期和精神病前期。14年的病程显示，社会和症状指标呈现稳定的群体趋势。在前驱期末，可以预测首次入院后2年的社会残疾情况，正确分类率为81%。决定社会结局的主要因素似乎是疾病前驱期获得的社会地位。男性早期病程不利主要是因为他们的发病年龄显著较低。这些结果引发了关于早期治疗和康复干预的问题。
