WHEN AND HOW DOES SCHIZOPHRENIA PRODUCE SOCIAL DEFICITS
WHEN AND HOW DOES SCHIZOPHRENIA PRODUCE SOCIAL DEFICITS
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DOI：
10.1007/bf02191811
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发表时间：
1995-12-01
影响因子：
4.7
通讯作者：
MAURER, K
中科院分区：
文献类型：
--
作者：
HAFNER, H;NOWOTNY, B;MAURER, K
对于精神分裂症患者社会表现不佳和社会阶层低下究竟是精神分裂症本身的结果，还是精神分裂症易发个体自身变化的结果，抑或是不良社会条件导致精神分裂症的结果，本研究是一项实证研究。该研究将年龄、性别和个人社会发展水平考虑在内，重点关注精神分裂症发病时的社会经济地位，以及精神分裂症早期病程中社会角色的表现。在232例精神分裂症首次发作的代表性样本中，评估和分析了年龄和发病类型、前驱和精神病前期以及首次入院时症状的类型和积累以及社会功能，以预测首次入院后2年的社会残疾。在一项病例对照研究中，比较了从发病到首次入院的预期和观察到的社会功能。随后的课程在5个横截面进行前瞻性随访，直到首次入院后2年。女性发病年龄明显高于男性，而症状和发病类型没有性别差异。在73%的样本中，前驱期平均持续5年，精神病前期（直到阳性症状达到最大值）平均持续1.1年。社会功能缺陷主要发生在前驱和精神病前期。在14年的病程中，社会和症状测量显示出稳定的群体趋势。在前驱期结束时，可以预测首次入院后2年的社会残疾，准确率为81%。决定社会结果的主要因素似乎是在障碍的前驱期获得的社会地位。男性的早期病程不利主要是由于他们的发病年龄明显较低。这些结果提出了关于早期治疗和康复干预的问题。
The present study is an empirical contribution to the controversy over whether the poor social performance and lower social class of schizophrenic patients are consequences of the illness, consequences of changes in the individuals predisposed to develop schizophrenia or are due to the adverse social conditions that lead to schizophrenia. The study focuses on the socioeconomic status at onset, on the performance of social roles in the early course of schizophrenia by taking age, gender and the individual level of social development into account. In a representative sample of 232 first episodes of schizophrenia age and type of onset, type and accumulation of symptoms and social functioning in the prodromal and the psychotic prephase and at first admission were assessed and analysed for their predictive power concerning social disability 2 years after first admission. In a case-control study expected and observed social functioning from onset until first admission were compared. The subsequent course was followed up prospectively in five cross sections until 2 years after first admission. In women the age at onset was significantly higher than in men, whereas symptomatology and type of onset showed no gender differences. In 73% of the sample the prodromal phase covered 5 years on average, and the psychotic prephase (until the maximum of positive symptoms) 1.1 years. Deficits in social functioning occurred predominantly during the prodromal and the psychotic prephase. The course over 14 years showed stable group trends in social and symptom measures. By the end of the prodromal phase it was possible to predict social disability 2 years after first admission with a correct classification of 81%. The main factor determining social outcome appeared to be the acquired social status during the prodromal phase of the disorder. The unfavourable early course in men was due mainly to their significantly lower age at onset. These results raise questions concerning an earlier therapeutic and rehabilitative intervention.