Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes - Findings from the 3-center AESOP study
Heterogeneity in incidence rates of schizophrenia and other psychotic syndromes - Findings from the 3-center AESOP study
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DOI：
10.1001/archpsyc.63.3.250
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发表时间：
2006-03-01
影响因子：
--
通讯作者：
Jones, PB
中科院分区：
文献类型：
--
作者：
Kirkbride, JB;Fearon, P;Jones, PB
背景：惯例表明精神分裂症和其他精神病的发病率是一致的；变异可能会对它们的病因和生物学特征产生影响。目的：调查精神病综合征发病率在地点、种族、年龄和性别方面的变异性。设计：对两年(1997-1999年)临床相关的首发精神病综合征进行三中心前瞻性全面调查。地点：伦敦东南部、诺丁汉和英国布里斯托尔。参与者：160万人年共产生568名16岁至岁的临床相关精神病综合征患者。主要观察指标：世界卫生组织精神病筛查和神经精神病学临床评估表对所有DSM-IV精神病综合征及其亚类、精神分裂症、其他非情感性障碍、情感性障碍和物质诱导性精神病进行分类。结果：所有症状都具有典型的年龄分布。精神分裂症在男性中明显更常见(发病率比[IRR]，2.3[95%可信区间(CI)，1.7-3.1])；情感性障碍在男性和女性中同等发生(IRR，1.0[95%CI，0.7-1.3])。所有精神病在黑人和少数民族中更常见(粗略的IRR，3.6[95%CI，3.0-4.2])。年龄、性别和研究中心的差异约占每个精神病结果的四分之一(调整后的IRR，2.9[95%CI，2.4-3.5])。伦敦东南部所有精神病患者的年龄性别标化发病率(IRR，49.4[95%CI，43.6-55.3])高于诺丁汉(IRR，23.9[95%CI，20.6-27.2])或布里斯托尔(IRR，20.4[95%CI，15.1-25.7])。在伦敦东南部，当模型扩展到种族控制时，除情感障碍外的所有结局的发生率仍然显著高于其他地区。结论：精神分裂症和其他精神病的发病率在性别、年龄、种族和地点方面存在显著而独立的差异。这证实了环境对个体的影响，也许还有邻里层面的影响，可能共同作用，并与精神病病因中的遗传因素相互作用。
Context: Convention suggests uniformity of incidence of schizophrenia and other psychoses; variation would have implications for their causes and biological characteristics.Objective: To investigate variability in the incidence of psychotic syndromes in terms of place, ethnicity, age, and sex.Design: Three-center, prospective, comprehensive survey of clinically relevant first-onset psychotic syndromes over a 2-year period (1997-1999). Census data provided the denominator.Setting: Southeast London, Nottingham, and Bristol, England.Participants: One million six hundred thousand person-years yielded 568 subjects aged 16 to 64 years with clinically relevant psychotic syndromes.Main Outcome Measures: The World Health Organization Psychosis Screen and the Schedules for Clinical Assessment in Neuropsychiatry to classify, blind to ethnicity, all DSM-IV psychotic syndromes and the subclasses of schizophrenia, other nonaffective disorders, affective disorders, and substance-induced psychosis.Results: All syndromes showed a characteristic age distribution. Schizophrenia was significantly more common in men (incidence rate ratio [IRR], 2.3 [95% confidence interval (CI), 1.7-3.1]); affective disorders occurred equally in men and women (IRR, 1.0 [95% CI, 0.7-1.3]). All psychoses were more common in the black and minority ethnic group (crude IRR, 3.6 [95% CI, 3.0-4.2]). Differences in age, sex, and study center accounted for approximately a quarter of this effect (adjusted IRR, 2.9[95% CI, 2.4-3.5]) in each psychosis outcome. The age-sex standardized incidence rate for all psychoses was higher in Southeast London(IRR, 49.4[95% CI, 43.6-55.3]) than Nottingham(IRR, 23.9 [95% CI, 20.6-27.2]) or Bristol (IRR, 20.4 [95% CI, 15.1-25.7]). Rates of all outcomes except affective disorders remained significantly higher in Southeast London when the model was expanded to control for ethnicity.Conclusions: There is significant and independent variation of incidence of schizophrenia and other psychoses in terms of sex, age, ethnicity, and place. This confirms that environmental effects at the individual, and perhaps neighborhood level, may interact together and with genetic factors in the etiology of psychosis.