Malmberg A, Lewis G, David A, Allebeck P
University Department of Psychiatry, Warneford Hospital, Oxford.
Br J Psychiatry. 1998 Apr;172:308-13; discussion 314-5. doi: 10.1192/bjp.172.4.308.
Schizoid personality and poor social adjustment have been thought of as common antecedents of schizophrenia but the existing literature is inconclusive. We have carried out a large cohort study with improved methodology.
The premorbid personality and adjustment of 50,054 Swedish men were assessed on entry into the army at the age of 18. Individuals who developed schizophrenia or another psychosis after 15-year follow-up were identified. Odds ratios for variables independently associated with the later development of schizophrenia were calculated, adjusting for potential confounders.
Four variables reflecting early problems with interpersonal relationships were strongly associated with later schizophrenia and, to a lesser extent, non-schizophrenic psychoses, but also occurred commonly in the cohort as a whole. These associations with schizophrenia persisted after early-onset cases were excluded, though their predictive value was low (3.0%, 95% CI 1.5-4.5).
Some aspects of premorbid personality and adjustment may act as risk factors for schizophrenia. The results appear to be most consistent with a multi-factorial aetiology for schizophrenia and offer tentative support for a psychological disturbance mediating genetic and environmental effects on the causal pathway to the illness.
分裂样人格和社会适应不良一直被认为是精神分裂症常见的前驱因素，但现有文献尚无定论。我们采用了改进的方法进行了一项大型队列研究。
对50054名18岁入伍的瑞典男性的病前人格和适应情况进行评估。在15年随访后确定发生精神分裂症或其他精神病的个体。计算与精神分裂症后期发展独立相关变量的比值比，并对潜在混杂因素进行校正。
反映人际关系早期问题的四个变量与后期精神分裂症密切相关，在较小程度上与非精神分裂症性精神病相关，但在整个队列中也很常见。排除早发病例后，这些与精神分裂症的关联依然存在，尽管其预测价值较低（3.0%，95%可信区间1.5 - 4.5）。
病前人格和适应的某些方面可能是精神分裂症的危险因素。结果似乎最符合精神分裂症的多因素病因学，并为心理障碍在疾病因果途径中介导遗传和环境影响提供了初步支持。
