The Epidemiology of Schizophrenia

Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 10
Preface......Page 15
Foreword......Page 17
Part I The social epidemiology of schizophrenia......Page 19
Introduction......Page 21
REFERENCE......Page 22
1 Investigating socioenvironmental influences in schizophrenia: conceptual and design issues......Page 23
Effects at the level of the individual......Page 26
Effects at the societal level......Page 27
Period effects......Page 29
Discriminating age–period–cohort effects......Page 30
Life-course effects......Page 33
REFERENCES......Page 34
Incidence......Page 36
The Ten Country Study......Page 37
Nonaffective acute remitting psychosis......Page 40
Course and outcome......Page 41
International Pilot Study of Schizophrenia......Page 45
International Study of Schizophrenia......Page 46
Community cohesion......Page 47
REFERENCES......Page 48
The 19th century: the growth of asylums......Page 52
Declining incidence: period effects?......Page 54
Declining incidence: birth cohort effects?......Page 58
Time trends in course and outcome......Page 59
REFERENCES......Page 62
Historical context......Page 67
Recent studies......Page 68
Timing of exposure: urban birth, upbringing or residence......Page 70
Infectious disease......Page 71
Social isolation......Page 72
Influence of season of birth on the incidence of schizophrenia......Page 73
Maternal exposure to influenza......Page 74
Differences between people with schizophrenia according to their season of birth......Page 75
Historical context......Page 76
Estimating the denominator......Page 77
A different illness?......Page 78
Social causation......Page 79
Summary......Page 80
REFERENCES......Page 81
Part II The developmental epidemiology of schizophrenia......Page 87
Introduction......Page 89
REFERENCES......Page 90
A neurodevelopmental model of schizophrenia......Page 92
Prenatal influenza......Page 93
Prenatal rubella......Page 95
Prenatal infection: possible mechanisms and future directions......Page 96
Rhesus incompatibility......Page 97
Prenatal stress......Page 98
Case-control studies......Page 99
Methodological issues......Page 100
Timing of exposure......Page 101
Conclusions and speculations on the study of pre- and perinatal risk factors for schizophrenia......Page 104
Programming......Page 105
Longitudinal or life-course approach......Page 107
Collaborative ventures......Page 108
REFERENCES......Page 109
Historical context......Page 118
Genetic high-risk cohorts......Page 119
New York Infant Development Study......Page 120
Neurobehavioural assessments......Page 121
Israeli High Risk Study......Page 122
Protective factors......Page 123
Neuropsychological predictors......Page 124
Cognitive predictors: intelligence......Page 125
Copenhagen High Risk Study......Page 126
Finnish Adoptive Family Study of Schizophrenia......Page 127
Summary of the data on childhood development from the high-risk studies......Page 128
Medical Research Council National Survey of Health and Development (1946 British birth cohort)......Page 129
The National Child Development Study (1958 British birth cohort)......Page 130
Helsinki 1951–1960 Birth Cohort......Page 131
The National Collaborative Perinatal Project: the Philadelphia cohort......Page 132
Language abnormalities......Page 133
The Dunedin Multidisciplinary Health and Developmental Survey......Page 134
Summary of information on developmental markers in schizophrenia from birth cohort studies......Page 135
What is the nature of the relationship?......Page 136
REFERENCES......Page 137
Historical context......Page 142
Assessment of prodromal signs and symptoms......Page 143
Phase models of early illness course......Page 146
Prospective validation of prodromal and attenuated psychotic symptoms......Page 147
Defining onset and early course......Page 149
Assessment of onset......Page 150
Systematic retrospective analysis of onset and early course: the ABC Study......Page 151
Stages of illness onset......Page 152
Gender differences......Page 153
What symptoms mark the onset of schizophrenia?......Page 155
Early illness course as a prognostic indicator of later course......Page 157
Comorbidity of schizophrenia and alcohol and drug abuse......Page 159
Conclusions......Page 160
REFERENCES......Page 161
8 The value of first-episode studies in schizophrenia......Page 166
Time trends in incidence......Page 167
Gender effects......Page 168
Course and outcome......Page 169
Abnormalities in cerebral structure and function at the time of first presentation......Page 171
Static versus progressive change?......Page 172
Definition of the first episode......Page 173
Study population......Page 174
Conclusions and future directions......Page 175
REFERENCES......Page 176
Methodological concerns......Page 185
Early-onset schizophrenia......Page 186
Gender differences......Page 188
Early-onset schizophrenia......Page 189
Very-late-onset schizophrenia......Page 190
Genetic......Page 191
Pregnancy and birth complications......Page 192
Premorbid social adjustment and personality......Page 193
Social isolation......Page 194
Early-onset schizophrenia......Page 195
Early-onset schizophrenia......Page 196
Very-late-onset schizophrenia......Page 197
Early-onset schizophrenia......Page 198
Early-onset schizophrenia......Page 199
Late-onset schizophrenia......Page 200
Conclusions......Page 201
REFERENCES......Page 202
Part III The genetic epidemiology of schizophrenia......Page 209
Introduction......Page 211
REFERENCE......Page 212
Family studies......Page 213
Results......Page 214
The equal environments assumption......Page 215
The risk of receiving the diagnosis is the same in twins and singletons......Page 216
Results......Page 217
Adoption studies......Page 218
The liability-threshold model......Page 219
Biometrical model fitting......Page 220
Results......Page 222
Is the genetic liability to schizophrenia specific?......Page 223
The ‘schizophrenia spectrum’......Page 224
Symptom dimensions......Page 225
Studies of discordant twin pairs......Page 226
Phenotypic abnormalities in relatives......Page 227
Gene–environment interaction......Page 228
Conclusions and implications......Page 229
REFERENCES......Page 230
11 Molecular genetics and epidemiology in schizophrenia: a necessary partnership......Page 238
The nature of the genetic effect......Page 239
Gene mapping strategies......Page 240
Linkage studies......Page 241
Association studies......Page 242
Family-based association studies......Page 243
Methodological problems......Page 244
Refining phenotypes......Page 245
Genome-wide association studies......Page 246
Nosology......Page 247
Genetic testing......Page 248
REFERENCES......Page 249
The interplay of genes and environment......Page 253
Models describing gene–environment synergism......Page 254
Multiplicative: genes and environment multiply each other’s effects......Page 257
Gene–environment correlation......Page 258
Consequences for risk studies......Page 259
Consequences for twin studies......Page 263
Consequences for gene-mapping studies......Page 267
REFERENCES......Page 269
Investigating gene–environment interaction in schizophrenia......Page 272
Obstetric complications......Page 273
Detecting causes of brain morphological changes in schizophrenia......Page 274
Danish High-Risk Project: pilot study......Page 275
Results......Page 276
Danish High-Risk Project: follow-up study......Page 277
Helsinki Cohort Study......Page 279
Brain changes......Page 280
Perinatal hypoxia......Page 281
Genotype–perinatal hypoxia interaction......Page 282
Conclusions and future directions......Page 283
REFERENCES......Page 284
Part IV Special issues in the epidemiology of schizophrenia......Page 289
Introduction......Page 291
Death from natural causes......Page 293
Physical illness......Page 295
Cancer......Page 296
Rheumatoid arthritis......Page 298
Epilepsy......Page 299
Conclusions and suggestions for future studies......Page 300
REFERENCES......Page 301
Classification of suicide......Page 306
Psychological autopsy......Page 307
Prevalence of schizophrenia among general population suicides......Page 308
Suicide rate in follow-up studies of people with schizophrenia......Page 310
Cultural factors......Page 316
Duration of schizophrenia, illness course and illness phase......Page 317
Comorbidity and suicide risk......Page 320
Adverse life events and suicide......Page 321
Treatment-related factors......Page 322
Drug treatment......Page 323
Limitations of current studies and future implications for research......Page 324
Conclusions......Page 325
REFERENCES......Page 326
16 What is the relationship between substance abuse and schizophrenia?......Page 335
UK......Page 336
Temporal and geographic variations......Page 337
Alcohol abuse......Page 338
Cannabis......Page 339
Nicotine......Page 340
Can substance abuse cause schizophrenia?......Page 341
Can stimulant use cause psychosis?......Page 342
Can cannabis use cause psychosis?......Page 343
Can nicotine use cause psychosis?......Page 345
An explanatory model......Page 346
The self-medication hypothesis......Page 347
Effects of the social milieu......Page 348
Is there a common factor underlying both schizophrenia and substance misuse?......Page 349
Premorbid personality......Page 350
Use of services......Page 351
Other outcomes......Page 353
Future studies......Page 354
REFERENCES......Page 355
Studies estimating the prevalence of violent acts among those with schizophrenia......Page 361
Following discharge......Page 362
Retrospective cohorts using case linkage......Page 363
Unselected birth cohort studies......Page 365
Studies estimating the prevalence of schizophrenia in individuals who have committed violent acts......Page 366
Community prevalence studies......Page 367
Definition and measurement of exposure (schizophrenia)......Page 368
Definition and measurement of outcome (violence)......Page 369
Selection bias......Page 370
Confounding......Page 371
Predictors of violent behaviour in schizophrenia......Page 372
Risk of violence in society attributable to schizophrenia......Page 373
REFERENCES......Page 375
Part V Future directions and emerging issues......Page 379
Introduction......Page 381
Introduction......Page 382
Levels of care......Page 383
The continuity hypothesis: diseases or distributions?......Page 384
Causal risk factors and distribution......Page 385
Prevalence of symptoms of psychosis......Page 387
Hallucinations......Page 388
Delusions......Page 389
Cooccurrence of delusions and hallucinations......Page 390
Similarity in underlying dimensional representation......Page 391
Familial clustering and longitudinal associations......Page 392
Psychosis ‘transitions’......Page 393
Grouping symptoms......Page 395
Grouping individuals......Page 396
Validity of dimensional and categorical representations......Page 397
Discontinuity......Page 398
Psychopathological contrast......Page 399
Contrast in aetiology......Page 401
Psychopathological contrast......Page 404
Contrast in aetiology, treatment and outcome......Page 405
Psychopathological contrast......Page 408
Contrast in aetiology and familial morbid risk......Page 410
Contrast in course and outcome......Page 411
Contrast in neuropsychology......Page 414
Conclusions......Page 416
REFERENCES......Page 417
Introduction: the uses of epidemiological data......Page 429
An evidence-based approach to service planning......Page 430
Genetic risk......Page 432
Symptom severity and social function are inversely correlated......Page 433
Onset in early adulthood......Page 434
Delay of treatment is associated with poorer course......Page 435
High-risk groups: ethnic minorities, prisoners, dual diagnosis......Page 436
Increased mortality and physical morbidity rates......Page 437
High unemployment rates......Page 438
Conclusions......Page 439
REFERENCES......Page 440
The science of prevention......Page 445
Risk factors and causes......Page 446
Barriers to the primary prevention of schizophrenia......Page 447
Indicated prevention......Page 448
Genetic factors......Page 449
Pregnancy and birth complications......Page 450
Nutritional factors......Page 451
Developmental risk factors:from infancy to onset......Page 452
Future directions: what type of research do we need?......Page 453
REFERENCES......Page 455
Glossary of epidemiological terms......Page 459
REFERENCES......Page 463
Index......Page 465