Depression, negative symptoms, social stagnation and social decline in theearly course of schizophrenia

Objective: The aim of this study was to investigate when social consequence s in schizophrenia emerge, and what conditions give rise to the social disa dvantage evident in people suffering from schizophrenia. Method: Early course in schizophrenia was studied in a population-based sam ple of 232 first illness-episode cases retrospectively from onset to first admission, and in a representative subsample of 115 patients prospectively at six cross-sections over a period of 5 years. Data on non-specific and ne gative symptomatology and social development was compared with data from an age- and sex-matched control group drawn from the normal population. Results: In total, 73% of the patients showed a prodromal phase of several years. First signs were depressive and negative symptoms. In 57% of cases s ocial disability emerged 2 to 4 years before first admission. Social conseq uences depended on the level of social development at onset. An early onset involved social stagnation, and a late onset was associated with social de cline. Men's poorer social outcome was determined by their lower level of s ocial development at onset and socially adverse illness behaviour. The 5-ye ar symptom-related course showed no gender difference. At 81% the lifetime prevalence of depressive mood until first admission was several times highe r in schizophrenics than in healthy controls. Early depression predicted a lower subsequent score for affective flattening. Suicide indicators were pr edicted by lack of self-confidence and feelings of guilt early in the illne ss. Conclusion: Taking into account a prodromal phase of several years on avera ge before first hospital admission, early detection, case identification an d intervention are urgently needed. The intervention must be targeted at sy ndromes such as early depression, negative symptoms and certain forms of co gnitive and social impairment.