Onset and Course of the First Schizophrenic Episode

精神分裂病第一次病發與病程

Heinz Hafner

《The Kaohsiung Journal of Medical Sciences》 14卷7期 (1998/07) Pp. 413-431

https://doi.org/10.6452/KJMS.199807.0413

摘要

精神分裂病在世界各國的發生率是相近的。有關社會及環境生態肇因與精神分裂病發病率差距，其實與社會因素無關，而與社會「適者生存」淘汰論有關。其病程中，患者不知何時產生社會不適應現象，實際發生機轉與理論，有待釐清。
在一代表性232名第一次發病之精神分裂病患研究中，以結構性會談(IRAOS)評估時發現，女性的病發年齡要比男性晚3至4年，上述發現叼一控制研究與動物實驗證明，由女性激素(estrogen)影響所致。尤以甚之，其相關性可由女性在青春期間的低發生率及更年期的較高發生率可印證。
約四分之三之精神分裂病之病發年齡在15-30歲間，此期間正是個人處於社會生活的顛峰期。應用社會生活過程(social biography)的研究發現，男性的精神分裂病患比女性早3-4年有上述社會障，顯示疾病在初期時就影響個人之社會生活。將近75%的個案有約5年的前驅期，而精社病之前期維持在1.1年，其中負向的前驅病狀往往在此期與社會及認知障礙有關。
在另一個案對照研究中發現，社會遲緩發展或社會行為退步現象在病發前驅期時已發生。在第一次病發後，社會障礙及客觀的社經地位評估示平穩，其間至少維持3年之久。至目前為止，精神分裂病之治療與復健均在個案第一次住院後開始，但個案之社會障礙早已在病發前幾年已進行。

並列摘要

Schizophrenia seems to occur with equal frequency in all countries and cultures. The ecological and social disparity of prevalence rates in open societies is not due to social causes, but to selection processes. At what point in the course of the disease social disadvantage begins and on account of which mechanisms is a question of both theoretical and practical importance.
In a representative sample of 232first episodes the true onset of schizophrenia is assessed by means of a standardized interview (IRAOS). The onset is 3 to 4 years later in women than in men, which is a result of the protective effect of estrogens as confirmed by animal experiments and by a controlled clinical study. For women the distribution of disease onset across the entire age range shows a delayed increase in adolescence and a second peak in the age group 40-45, presumably due to the fading effect of estrogen around menopause.
For three quarters of all schizophrenias the onset lies between 15 and 30 years of age, the period of steepest social development. The distribution of the social biography through the psychosis, which occurs on average 3-4 years earlier in males than in females, determines the social starting conditions of the disorder and affects the early social course. Nearly 75% of the total cases begin with a prodromal phase of 5 years on average. The psychotic prophase lasts 1.1 years. The mainly negative prodromal symptoms are often associated with social and cognitive deficits already at this stage.
In a case control study social stagnation or decline occur already during the prodromal phase. After the end of the first episode the mean values of social disability and the objective social status remain fairly stable over a period of at least three years.
So far treatment and rehabilitation measures are not started until after first admission, which means after several years’ duration of the disease when the majority of social deficits have already become manifest.

並列關鍵字

schizophrenia ； first episode ； course