WHEN AND HOW DOES SCHIZOPHRENIA PRODUCE SOCIAL DEFICITS

The present study is an empirical contribution to the controversy over whether the poor social performance and lower social class of schizop hrenic patients are consequences of the illness, consequences of chang es 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 s ocial roles in the early course of schizophrenia by taking age, gender and the individual level of social development into account. In a rep resentative 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 dis ability 2 years after first admission. In a case-control study expecte d and observed social functioning from onset until first admission wer e compared. The subsequent course was followed up prospectively in fiv e 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 prep hase (until the maximum of positive symptoms) 1.1 years. Deficits in s ocial functioning occurred predominantly during the prodromal and the psychotic prephase. The course over 14 years showed stable group trend s in social and symptom measures. By the end of the prodromal phase it was possible to predict social disability 2 years after first admissi on with a correct classification of 81%. The main factor determining s ocial outcome appeared to be the acquired social status during the pro dromal phase of the disorder. The unfavourable early course in men was due mainly to their significantly lower age at onset. These results r aise questions concerning an earlier therapeutic and rehabilitative in tervention.