EPIDEMIOLOGY OF EARLY-ONSET SCHIZOPHRENIA

A total of 232 (84%) first episodes of schizophrenia from our epidemio logically defined ABC sample (Age, Beginning and Course) were retrospe ctively asb sessed with regard to the onset and early course of the di sorder. In a follow-up study a representative subgroup (n = 133) was p rospectively examined in five cross sections over 3 years from first a dmission on. Population-based incidence rates for 5-year age groups co mprising a range of < 10-< 60 years were calculated on the basis of tw o definitions of onset: first sign of disorder and first psychotic sym ptom. In 40% of adult patients who had been admitted with a first schi zophrenic episode after age 20 years the prodromal phase, in 11% the p sychotic prephase, began before that age. This demonstrates that schiz ophrenia often begins in an age period in which the social and cogniti ve development and brain maturation are still unfinished. Early-onset schizophrenias (less than or equal to 20 years) were compared with a m edium-onset group (21-<35 years) and a late-onset group (35-<60 years) with regard to age and type of onset, early symptom-related course, s ocial development and social course. The number of schizophrenia-speci fic positive and negative syndromes in early-onset schizophrenia is co mparable to that of higher age groups. However, neurotic syndromes, em otional disorders and conduct disorders are most frequent in younger p atients, especially in young men. Paranoid syndromes seem to prevail i n late-onset schizophrenia, whereas less differentiated positive syndr omes, such as delusional mood, are more frequent in the youngest age g roup. An earlier onset of schizophrenia has more severe social consequ ences than onset in adults, because it interrupts the cognitive and so cial development at an earlier stage. The worse social course of schiz ophrenia in men compared with women cannot be related to a more severe symtomatology, but to the earlier age at onset and the impairment or stagnation of social ascent at an earlier stage of social and cognitiv e development. Social disability in the sense of an adaptation to the expectations of the social environment, as well as symtomatology durin g the further course of schizophrenia, show no major differences betwe en the genders nor between the age groups.