چگونگی تاثیر جنسیت، سن و سایر عوامل خطرزا بر بروز و روند بیماری اسکیزوفرنی
Abstract
1- Introduction
2- Materials, Methods, and Results
3- Conclusions
References
Abstract
The core symptoms of psychosis—delusions, hallucinations, and thought disorders—are not unique to the disorder traditionally called schizophrenia. They occur at the early stages of various brain diseases, too. Psychosis seems to be a preformed pattern of response of the human brain. Most schizophrenia onsets are marked by a prodromal stage extending over several years and producing the maximum of social consequences. Schizophrenia incidence shows a steep increase culminating at age 15 to 25 years in males. In females it reaches a first peak at age 15 to 30 years and a second, flatter peak at menopausal age (44-49 years). Thereafter, incidence declines to a plateau at later ages. Unlike what the findings of most large-scale epidemiological studies applying an upper age limit of 45 to 55 years suggest, schizophrenia is a disorder of all ages. The lifetime risk seems to be the same for both sexes. The lower incidence in premenopausal women is accounted for by the downregulating effect of oestrogen on dopamine receptors. This hormonal protective effect is antagonised by the genetic effect of a high familial load. In the long-term illness course, right-censored to 11.2 years following first admission, the number of psychotic relapse episodes ranges from 0 to 29 with a mean of 3. The positive symptom dimension produces the highest number of relapses and the shortest duration of exacerbations with a mean length of two months. The depressive and negative symptom dimensions show exacerbations extending over nearly six months on average. Following the first illness episode symptom scores decline sharply, reaching a plateau five years after first admission. Negative symptoms come to a plateau after 2 to 3 years in females and after 5 years in males. Depression is the most frequent type of symptom in the long-term course. In the light of these results urgent treatment issues will be discussed.
Introduction
Schizophrenia, defned as a disorder, is characterised by symptoms that distort or in part block some basic functions of the human mind, such as outer and inner perception and memory. In that respect schizophrenia is a disorder that hampers or distorts reality control during episodes of acute symptomatology and in a few cases also permanently. Mental disorders involving loss of reality control can have serious consequences for both the afected individual and the community. For this reason, elucidating their causes has long been one of the main issues in psychiatric research. Since Emil Kraepelin’s [1] frst attempt to defne schizophrenia as a unitary disorder by applying to it the diagnosis of “dementia praecox” we have seen over a hundred years of schizophrenia research. Given all these eforts we should actually know by now the underlying causes of the disorder and how to successfully treat it and the consequences it produces. But the truth is that as far as the symptoms leading to pronounced social disability and loss of quality of life, i.e., negative symptoms and cognitive impairment, are concerned, only modest progress has been achieved. Defning the diagnosis Emil Kraepelin proceeded both from the main age of onset (praecox) and from the outcome (dementia) of the disease construct he called dementia praecox. Te diagnostic features of a young age of onset, up to 45 years, and an unfavourable outcome frequently resembling dementia were eagerly accepted in those days and continued to be used in clinical practice.