Incidence and Cumulative Risk of Treated Schizophrenia in the Prenatal Determinants of Schizophrenia Study (original) (raw)
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The Design of the Prenatal Determinants of Schizophrenia Study
Schizophrenia Bulletin, 2000
This paper describes the Prenatal Determinants of Schizophrenia (PDS) Study; three companion papers report the first results. The PDS Study was designed to study early antecedents of schizophrenia in a birth cohort of 1959-1967 for whom a wealth of archived prenatal data-including maternal sera-was available. Making use of the registries of a health plan into which the cohort was born, we ascertained and then diagnosed 71 cases of schizophrenia and spectrum disorders in the cohort We describe herein the available prenatal data, the process of case diagnosis, and the strategies used to analyze prenatal determinants of schizophrenia in this cohort. Data are presented that bear on the main sources of potential bias and are important to understanding the strengths and limitations of this unique data set.
Age, sex and first treatment of schizophrenia in a population cohort
Journal of Psychiatric Research, 2011
Objective-Schizophrenia affects men more than women, but this may not be true at all ages. This study examines the incidence of first hospitalization for treatment of schizophrenia in each sex over different ages. Methods-We compared the incidence of first admission for treatment in a cohort a cohort of 46,388 males and 43,680 females followed from birth until ages 29-41, using life tables and proportional hazards methods. Results-Life table estimates of cumulative incidence by age 40 were 1.44% in males) and .86% in females. Over all ages the relative risk (RR) in males was 1.6 (95% confidence limits=1.4-1.8) compared with females. Before age 17 there was no significant difference between the sexes (RR=.86, .56-1.3). Excess risk in males was observed only from age 17 (RR=1.7, 1.4-1.9). There was no evidence of the incidence in females catching up with that in males, during the 30s. Conclusion-In this population, there was a significant change, over age, in the relative incidence of first hospitalization for schizophrenia between the sexes; the excess incidence in males first developed at age 17.
A population based elaboration of the role of age of onset on the course of schizophrenia
Schizophrenia Research, 2006
Despite suggestions that an earlier age of onset and being male confer to a poorer course of schizophrenia, evidence regarding when these effects are most salient appears to be ambiguous.To examine the relationship of age of first hospitalization and sex with the course of hospitalization in a population based cohort.All first admissions for schizophrenia in a national population based cohort in Israel from 1978 to 1992 were followed through 1996 (n = 12,071) using data from the National Psychiatric Hospitalization Case Registry of the State of Israel, a complete national registry of psychiatric admissions. Recursive partitioning was conducted to empirically determine cut-off points for age groups showing the greatest difference on the variables of interest.A younger age of first hospital admission was associated with a greater likelihood of having more than one hospital admission, longer first admissions, more hospital admissions and more inpatient days per year. Of patients with age of first admission below 17, 82.5% had more than one admission which decreased for subsequent age groups to 73.54% (18–28), 69.36% (29–31), 62.88% (32–45), and 50.77% (over 45). Men had an earlier first admission than women, and had slightly more cut-off values. Irrespective of sex, the relationship between age at first admission and later hospitalization conformed to a linear trend.An earlier onset corresponds linearly with the severity of the course of illness and appears to have prognostic value.
Schizophrenia research, 2015
Different case definitions of schizophrenia have been used in register based research. However, no previous study has externally validated two different case definitions of schizophrenia against a wide range of risk factors for schizophrenia. We investigated hazard ratios (HRs) for a wide range of risk factors for ICD-10 DCR schizophrenia using a nationwide Danish sample of 2,772,144 residents born in 1955-1997. We compared one contact only (OCO) (the case definition of schizophrenia used in Danish register based studies) with two or more contacts (TMC) (a case definition of at least 2 inpatient contacts with schizophrenia). During the follow-up, the OCO definition included 15,074 and the TMC 7562 cases; i.e. half as many. The TMC case definition appeared to select for a worse illness course. A wide range of risk factors were uniformly associated with both case definitions and only slightly higher risk estimates were found for the TMC definition. Choosing at least 2 inpatient contac...
The epidemiology of schizophrenia: replacing dogma with knowledge
Dialogues in clinical neuroscience, 2010
Major advances have been made in our understanding of the epidemiology of schizophrenia. We now know that the disorder is more common and severe in young men, and that the incidence varies geographically and temporally. Risk factors have been elucidated; biological risks include a family history of the disorder, advanced paternal age, obstetric complications, and abuse of drugs such as stimulants and cannabis. In addition, recent research has also identified social risk factors such as being born and brought up in a city, migration, and certain types of childhood adversity such as physical abuse and bullying, as well as social isolation and adverse events in adult life. Current research is focussing on the significance of minor psychotic symptoms in the general population, gene-environmental interaction, and how risk factors impact on pathogenesis; perhaps all risk factors ultimately impact on striatal dopamine as the final common pathway.
The Epidemiology of Schizophrenia: A Concise Overview of Incidence, Prevalence, and Mortality
2008
Recent systematic reviews have encouraged the psychiatric research community to reevaluate the contours of schizophrenia epidemiology. This paper provides a concise overview of three related systematic reviews on the incidence, prevalence, and mortality associated with schizophrenia. The reviews shared key methodological features regarding search strategies, analysis of the distribution of the frequency estimates, and exploration of the influence of key variables (sex, migrant status, urbanicity, secular trend, economic status, and latitude). Contrary to previous interpretations, the incidence of schizophrenia shows prominent variation between sites. The median incidence of schizophrenia was 15.2/100,000 persons, and the central 80% of estimates varied over a fivefold range (7.7-43.0/100,000). The rate ratio for males:females was 1.4:1. Prevalence estimates also show prominent variation. The median lifetime morbid risk for schizophrenia was 7.2/1,000 persons. On the basis of the standardized mortality ratio, people with schizophrenia have a two-to threefold increased risk of dying (median standardized mortality ratio 5 2.6 for all-cause mortality), and this differential gap in mortality has increased over recent decades. Compared with native-born individuals, migrants have an increased incidence and prevalence of schizophrenia. Exposures related to urbanicity, economic status, and latitude are also associated with various frequency measures. In conclusion, the epidemiology of schizophrenia is characterized by prominent variability and gradients that can help guide future research.
Psychiatry research, 2009
This article examines how premorbid years of education and age of onset relate to the course of schizophrenia in a population-based cohort. All first and subsequent cases who were hospitalized with schizophrenia (1988-92, followed up until 1996) and completed their formal education at least 1 year before hospitalization (n=2135) were extracted from the Israeli National Psychiatric Hospitalization Registry. Results, based on hierarchical moderated regression models showed that age of onset predicted the course with greater consistency and magnitude than years of education. Years of education predicted the age of first hospitalization among males. Years of education and age of first hospitalization significantly interacted to predict the length of first stay and average number of days hospitalized over the course for males. The interaction showed that for males less education predicted poorer hospitalization outcomes if an earlier onset occurred. Together, the results suggest that les...
An Update on the Epidemiology of Schizophrenia*
The Canadian Journal of Psychiatry, 1990
This report summarizes research in epidemiology and related areas which addresses as yet unresolved issues in schizophrenia. These include the nature of the disorder, environmental and psychosocial risk/actors and differences in the course ofillness. Unravelling the complexities ofetiology, course and appropriate treatment calls for an integration of biological and psychosocial paradigms. The review also illustrates that a broad-based view can generate fruitful hypotheses as well as important alternative explanations for research findings.