Neuropsychological impairment and psychopathology in first-episode schizophrenic patients related to the early course of illness

The objective of the present study was to explore whether the early course of illness including first onset of psychotic symptoms influences neuropsychological functioning and psychopathology in first-episode schizophrenics. Patients with a short prodromal period (n = 20) and patients with a long prodromal period (n = 20) and controls matched with regard to age, gender and education (n = 40) were administered a battery of standardized neuropsychological tests and psychopathological rating scales. The results indicate an overall difference in neuropsychological performance with the schizophrenic patients scoring lower than controls. Schizophrenic patients scored significantly lower in all subtests except in visual memory and abstraction/flexibility than controls. No significant difference between neuropsychological performance between patient samples was found. Psychopathology was more pronounced in the long prodromal period group rating higher on negative and affective symptoms compared with the short prodromal period group. The data suggests that neuropsychological deficits in first-episode schizophrenia are independent of the early course of schizophrenia, and although negative symptoms are associated with the length of the prodromal period, they do not imply greater neuropsychological impairment. Received: 30 May 1997 / Accepted: 10 October 1997     

The prevalence of DSM-III-R "prodromal" symptoms of schizophrenia in non-psychotic psychiatric outpatients

A cross-sectional point prevalence study of the DSM-III-R prodromal symptoms in non-psychotic ( n = 501) consecutive outpatients from a catchment area with 260,000 inhabitants is presented. The relationship between the three most psychosis-specific prodromal symptoms and the development of psychosis during the following 6 months was also explored. The prevalence of any prodromal symptom was 25%, the most prevalent being impairment of role functioning (14%), isolation and withdrawal (11%) and lack of initiative (8%). The most prevalent symptom in affective disorders was lack of initiative (14%); in personality disorders, it was impairment of role functioning (21%). The prevalences of the most psychosis-specific symptoms "peculiar behaviour", "magical thinking" and "unusual perceptual experiences" was 1-2%. At re-evaluation 6 months later, three of 20 patients (15%) with one or more such symptoms had become psychotic, two with schizoaffective disorder, one with affective psychosis. It was concluded that DSM-III prodromal symptoms are common among non-psychotic outpatients, but most such symptoms are non-specific for psychosis. Persistent peculiar behaviour, magical thinking and unusual perceptual experiences have a very low prevalence but may indicate an increased risk for psychosis. Such patients should be followed with that risk in mind.     

The prevalence of DSM-III-R "prodromal" symptoms of schizophrenia in non-psychotic psychiatric outpatients

A cross-sectional point prevalence study of the DSM-III-R prodromal symptoms in non-psychotic (n = 501) consecutive outpatients from a catchment area with 260000 inhabitants is presented. The relationship between the three most psychosis-specific prodromal symptoms and the development of psychosis during the following 6 months was also explored. The prevalence of any prodromal symptom was 25%, the most prevalent being impairment of role functioning (14%), isolation and withdrawal (11%) and lack of initiative (8%). The most prevalent symptom in affective disorders was lack of initiative (14%); in personality disorders, it was impairment of role functioning (21%). The prevalences of the most psychosis-specific symptoms "peculiar behaviour", "magical thinking" and "unusual perceptual experiences" was 1-2%. At re-evaluation 6 months later, three of 20 patients (15%) with one or more such symptoms had become psychotic, two with schizoaffective disorder, one with affective psychosis. It was concluded that DSM-III prodromal symptoms are common among non-psychotic outpatients, but most such symptoms are non-specific for psychosis. Persistent peculiar behaviour, magical thinking and unusual perceptual experiences have a very low prevalence but may indicate an increased risk for psychosis. Such patients should be followed with that risk in mind.     

Prodromal psychotic symptoms and psychological distress among secondary school students in Abeokuta,Nigeria

Objective: This study aimed to investigate the relationship between prodromal psychotic symptoms and psychological distress among Nigerian adolescents.

Method: Students (n=508) were randomly selected from secondary schools in Abeokuta, Nigeria. A socio-demographic questionnaire, the Prodromal Questionnaire-Brief Version (PQ-B) and the Strengths and Difficulties Questionnaire (SDQ) were administered to each student.

Results: The mean age of the students was 15.4 years (SD 1.3), with most (63%) being female. More than half (55.3%) reported having had a lifetime experience of major life event (20.9% in the preceding 6 months) while 13.9% had experienced bullying or abuse (5.1% in the preceding 6 months). The prevalence of prodromal symptoms was 20.9% (95% CI 0.174–0.244). Abnormal scores in emotional and conduct problems were seen in 11.8% and 6% respectively, while 7.3% had abnormal scores in each of the hyperactivity and peer problems subscales of the SDQ. Abnormality in prosocial behaviour was found in 1.8% of students, with overall abnormality in 4.9%. Regression analysis showed that prodromal symptoms were predicted by female sex, lifetime and 6 month history of major life event, and lifetime and 6 month history of bullying or abuse. Prodromal symptoms were also predicted by higher total SDQ scores and higher scores in all domains of psychological distress except the prosocial domain.

Conclusion: The study showed a relationship between reported prodromal symptoms and the occurrence of psychological distress. It also showed that early childhood trauma may be a predisposing factor to the early stages of development of psychosis, with female children being especially prone in the years of adolescence.     

Is there a primary prevention of schizophrenic psychiasis?

At first, this article comprises the innovative programme of the international "Early Detection and Intervention" research and then shows results of the "Cologne/Bonn Early Recognition - CER" project on schizophrenia, the first longterm prospective study on patients in potentially initial prodromal stages prior to the first psychotic manifestation. At re-examination at an average of 9.6 years later, 79 of 160 patients had subsequently developed a schizophrenic psychosis according to DSM-IV criteria. Prediction values for the complete range of prodromal symptoms, for 5 subsyndromes and for individual symptoms were assessed. Best prediction values with a high positive predictive power (71 - 91 %) and a low rate of false-positive predictions (7.5 - 1.9 %) were achieved for 10 symptoms and symptom complexes mainly out of the group of thought, speech and perception disturbances. As only unsatisfactory prediction values for other prodromal symptom definitions were reported, e.g. the commonly used DSM-III-R definition, empirical evidence for the possibility of diagnosing schizophrenia as early as in the initial prodromal stage, has been found for the first time. In the following, this article considers essential initiatives for the development, performance and evaluation of a promising early intervention programme based on the results found. In Germany, within the project unit "Early Recognition and Intervention" of the competence network "Schizophrenia", such a programme has been initiated. Late prodromal stages are defined by attenuated or transient psychotic symptoms and early prodromal stages by the presence of at least one of the highly predictive prodromal symptoms from the CER-study or decline in psychic functions in combination with other risk factors. Intervention strategies are a multimodal psychological programme for the intervention in early prodromal stages and a combination of psychotherapy with atypical neuroleptic drugs in the late prodromal stages. If such strategies were able to suppress the progress to first psychotic episodes, this prevention could be classified as a primary prevention, not with regard to the prodromal symptoms but to frank/manifest schizophrenia.     

Gender differences in first onset Schizophrenia spectrum psychoses

Background: Mental health profiles differ between boys and girls from puberty onwards. It is not known whether differences also extend to symptom presentation in schizophrenia spectrum disorders. It may be that girls and boys are not treated entirely equally by the professionals.

Aims: To study gender differences in symptom profiles, family adversities, pathway to care, and characteristics of inpatient treatment at the first episode of diagnosed schizophrenia spectrum disorder (F20–29) among adolescents aged 13–17.

Methods: A retrospective chart review of all (n?=?106) consecutive adolescents diagnosed for the first time with schizophrenia spectrum disorder (F20–29) in a specified catchment area. Girls and boys were compared with regard to sociodemographics, pathways to care, living arrangements, symptom profiles, and treatment received.

Results: During the study period more adolescent girls (n?=?70, 66%) than boys (n?=?36, 34%) were diagnosed with schizophrenia spectrum (F20–29) psychoses, most commonly F29. Girls were moreover younger (mean age?=?15.46) than boys (mean age?=?16.62) at admission. Girls more often displayed mood symptoms and boys aggressive behaviours, alcohol abuse problems, and isolation. Family adversities recorded as current stressors were more numerous among girls. Girls were more likely to be referred to specialized after-care than boys.

Conclusions: The gender differences observed in symptoms presentation are reminiscent of differences encountered in the general adolescent population. Prior to transition to psychosis, girls and boys are equally in contact with psychiatric services due to other (possibly prodromal) symptoms/disorders. Family adversities may be more stressful for girls vulnerable to psychosis than to boys.     

The early course of schizophrenia and depression*

OBJECTIVE: Risk factors, emergence and accumulation of symptoms in the untreated early course were studied as a basis for understanding the relationship between schizophrenia and depression. MATERIALS AND METHODS: 130 representative first admissions for schizophrenia were compared retrospectively with 130 individually matched first admissions for depressive episodes and with 130 healthy controls. RESULTS: Onsets of schizophrenia and severe depression were marked by depressive symptoms, followed by negative symptoms and functional impairment. This prodromal core syndrome became more prevalent as the disorders progressed, and it reappeared in psychotic relapses. Psychotic symptoms emerged late, indicating a different and more severe "disease pattern". CONCLUSION: The prevalence of depressive symptoms in the general population and at the prodromal stage of numerous mental disorders precipitated by various psychological and biological factors suggests that depression might be an expression of an inborn mild reaction pattern of the human brain. With progressing brain dysfunction more severe patterns like psychosis are expressed.     

Risk of suicide and suicidal ideation in psychosis: Results from an Italian multi-modal pilot program on early intervention in psychosis

Suicidality is high in schizophrenia, particularly in first-episode patients. Little is known about patients with prodromal symptoms of psychosis or otherwise high-risk persons.In a sample enrolled in an early intervention program implemented in Milan (Italy), a history of attempted suicide before enrollment was found in 6 first-episode schizophrenia (out of 87, 6.9%), and 7 high-risk of psychosis (out of 81, 8.6%) patients.In the first-episode group, a history of suicide attempts was related to a shorter duration of untreated psychosis. In the high-risk group, a family psychiatric history in first/second degree relatives of patients and a personal history of substance abuse were both associated with an enhanced risk of attempted suicide before enrollment.During the first year of treatment, 3 new attempted suicides were recorded among 57 (5.3%) high-risk patients, and none among first-episode patients (n = 58) (no dropout in the sample). The levels of suicide ideation on the BPRS did not differ by group at assessment, and significantly declined from assessment at entry to 1-year follow-up, except in seven HRP patients who become positive for core symptoms of schizophrenia, as measured on the BPRS.At enrollment, patients at high risk of psychosis had the same prevalence of past suicide attempts than first-episode schizophrenia patients: since suicide attempt is the most important predictor of a future suicidal attempt, the assessment of suicide risk should be given a privileged role in patients at high risk of psychosis as well.     

Anomalous self-experiences are strongly associated with negative symptoms in a clinical high-risk for psychosis sample

ObjectiveAnomalous self-experiences (ASE) are considered as central features of the schizophrenia spectrum disorders and prodromal schizophrenia. We investigated total and single-item prevalence of these phenomena in a clinical high-risk (CHR) for psychosis sample, and associations with conventional psychosis-risk symptoms, present and childhood global/psychosocial functioning, and childhood trauma.MethodsThe sample (n = 38) included 31 CHR, according to ultra-high risk or cognitive basic symptoms (COGDIS) criteria, and seven with non-progressive attenuated positive symptoms. Psychopathological evaluations included the Examination of Anomalous Self-Experience (EASE), Structured Clinical Interview for Prodromal Syndromes (SIPS), Schizophrenia Proneness Instrument – Adult (SPI-A) (only the COGDIS-criteria), a diagnostic interview (SCID-I), Global Assessment of Functioning – Split version (S-GAF), Premorbid Adjustment Scale (PAS) and Childhood Trauma Questionnaire (CTQ).ResultsThe mean total EASE score was in line with reports from other CHR samples, and was particularly enhanced in schizotypal personality disorder and in subjects fulfilling COGDIS-criteria. The four most frequent EASE-items were present in two-thirds or more of the participants. EASE total was significantly associated with negative and disorganization symptoms. A multiple regression analysis revealed that the level of negative symptoms explained most of the variance in EASE total.ConclusionsThese results corroborates other findings that anomalous self-experiences are frequent and important features in CHR conditions and in the schizophrenia spectrum. The strong associations with negative symptoms and cognitive disturbances (COGDIS) should be investigated in longitudinal studies to address causality, psychopathological pathways and schizophrenia spectrum specificity. The weaker correlation between EASE total and positive symptoms may partly be related to a restricted range of positive symptoms.     

Diagnosing schizophrenia in the initial prodromal phase

BACKGROUND: In schizophrenia research, early detection in the initial prodrome before first psychotic episodes is a major topic. Therefore, the prognostic accuracy of initial prodromal symptoms was examined prospectively. METHODS: The study sample was composed of patients referred to outpatient departments of German psychiatric university departments, because of diagnostic problems, between 1987 and 1991. They were examined with the Bonn Scale for the Assessment of Basic Symptoms and the Ninth Version of the Present State Examination to detect an incipient schizophrenic disorder. Of 385 patients showing no schizophrenia-characteristic symptoms, between 1995 and 1998, 110 with and 50 without initial prodromal symptoms were followed up and reexamined with the same instruments for a transition to schizophrenia. RESULTS: During a mean follow-up period of 9.6 years, 79 (49.4%) of the 160 patients had transited to schizophrenia. The absence of prodromal symptoms excluded a subsequent schizophrenia with a probability of 96% (sensitivity: 0.98; false-negative predictions: 1.3%), whereas their presence predicted schizophrenia with a probability of 70% (specificity: 0.59; false-positive predictions: 20%). Certain disturbances, such as thought interference, disturbances of receptive language, or visual distortions, predicted schizophrenia, even with a probability up to 91% (specificity: 0.85-0.91; false-positive predictions: 1.9%-7.5%). CONCLUSIONS: The Bonn Scale for the Assessment of Basic Symptoms operationalization of prodromal symptoms performed well in the early detection of schizophrenia. It therefore might be useful for the prediction of the disorder, especially if it is further refined to select those items with particularly high prognostic accuracy.     

Suicidality in the "prodromal" phase of schizophrenia

Objectives

Patients with schizophrenia are at high risk for suicide ideation, attempts, and completed suicide. However, suicidal behavior during the prodromal phase of schizophrenia and a possible association between prodromal suicidal behavior and suicidality after the onset of overt psychosis are not studied.

Methods

One hundred six consecutively admitted schizophrenia patients with recent onset were evaluated retrospectively for prodromal symptoms and suicidality during the prodromal phase and after the onset of frank psychosis. In addition, 106 matched control subjects from the general population were evaluated for suicidality during the same age period of the prodromal phase of the corresponding patient.

Results

Suicide ideation and attempt during the prodromal period were reported in 25.5% and 7.5% of the patients, which are 3.8- and 8-fold greater than in the controls, respectively. Patients with suicidal behavior experienced a greater number of prodromal symptoms than those without. Prodromal depressive mood, marked impairment in role functioning, and tobacco smoking exerted an independent effect on suicide ideation, whereas depressive mood was the symptom significantly more frequent in patients with suicide attempt. Suicide attempts were associated with an earlier onset of prodromal symptoms and frank psychosis. All patients with prodromal suicide attempts were cigarette smokers. Suicide ideation during the prodromal phase was strongly associated with lifetime suicidality after the onset of frank psychosis.

Conclusions

Suicidal behavior is quite common during the prodromal period. The association of smoking, depressive mood, impaired functioning, and a large number of prodromal symptoms, particularly in patients with an early onset of symptomatology, carries a substantially increased risk for suicide ideation. Particular care is needed in patients with prodromal suicide ideation after the onset of frank psychosis because the risk to attempt suicide is high.     

Clinical features of childhood-onset schizophrenia with obsessive-compulsive symptoms during the prodromal phase

Abstract Thirty-nine patients with schizophrenia, diagnosed according to DSM-III-R, who were under 15 years of age, were studied in two groups; 16 subjects with obsessive-compulsive symptoms during the prodromal phase, and 23 with no obsessive-compulsive disorders. The group with obsessive-compulsive symptoms during the prodromal phase was characterized by a higher ratio of males, higher incidences of perinatal and brain computed tomography (CT) abnormalities, fewer hereditary factors, longer duration of the prodromal phase, and a higher incidence of insidious onset and negative symptoms compared with the group without such prodromal symptoms. Schizophrenic patients with obsessive-compulsive symptoms during the prodromal phase were clinically distinct from those without, which suggests the possibility of subtype categorization.     

Plasma homovanillic acid in the prodromal phase of schizophrenia.

BACKGROUND: Plasma levels of homovanillic acid (pHVA) have been used as a peripheral measure of central dopaminergic activity. Despite a large body of studies investigating pHVA in schizophrenia, little is known about pHVA in patients in the prodromal phase of the illness. METHODS: Plasma HVA levels of 12 male outpatients meeting DSM-III-R criteria for the prodromal phase of schizophrenia at the time of blood sampling (who later developed psychotic symptoms) were compared with those of 12 normal male healthy volunteers. Task amounts in the Kraepelin arithmetic test at the time of blood sampling were compared between the prodromal patients and normal controls and were correlated with pHVA levels. RESULTS: The prodromal patients had significantly higher pHVA levels compared with normal control subjects. The mean amount of the arithmetic task for the prodromal patients was significantly less than that for controls. In the patient group, a significant negative correlation was observed between pHVA levels and the task amounts. CONCLUSIONS: Data from the present study indicate the presence of dopaminergic dysfunction in the prodromal stage of schizophrenia that is associated with neuropsychological impairment. Increased pHVA levels in the prodromal patients may have implications for early detection of schizophrenia.     

Bizarre delusions and first-rank symptoms in a first-admission sample: A preliminary analysis of prevalence and correlates

This report examines the prevalence and correlates of bizarre delusions and Schneider's first-rank symptoms (FRS) in a first-admission sample with psychosis. A total of 196 patients were assessed with the Structured Clinical Interview for DSM-III-R (SCID) and given a consensus diagnosis. Project psychiatrists blind to the consensus diagnoses coded each delusion and hallucination in the sample for both FRS and DSM-III-R bizarreness. Interrater reliability of bizarreness was lower than that of FRS (κ = .681 v 861). The majority of symptoms (72%) were neither bizarre nor FRS, and of the remainder, bizarre delusions that were not also FRS were extremely uncommon. The prevalence of FRS was 70% in schizophrenia, 29% in psychotic bipolar disorder, and 18% in psychotic depression. For seven schizophrenic patients (7.45%), diagnosis of that disorder depended on the presence of a DSM-III-R bizarre delusion to meet criteria. There was a trend for FRS to be associated with poorer prognostic features in the schizophrenic sample. We concluded that although the constructs of bizarre delusions and FRS overlap, FRS were a more important feature in schizophrenia than bizarreness. The rarity of bizarre delusions that were not FRS, combined with the lower reliability of their assessment as compared with that of FRS, raises questions about the continued emphasis on this phenomenon in the definition of schizophrenia.     

Young people at risk for psychosis: case finding and sample characteristics of the Oulu Brain and Mind Study

Aim: Set within the general population‐based Northern Finland Birth Cohort 1986, the Oulu Brain and Mind Study aims to explore the causes and pathogenesis of psychotic illness by following young people at risk for psychosis due to having a first‐degree relative with psychotic illness or due to having experienced psychotic‐like symptoms themselves. We report the study methods and explore the relationship between these definitions of high risk for psychosis and operational criteria for a prodromal psychosis syndrome based on interview. Methods: Prospectively collected data from earlier follow‐ups of this cohort were combined with health register data to categorize subjects as those with familial risk (n = 272), symptomatic risk (n = 117), psychosis (n = 78), attention deficit hyperactivity disorder (ADHD) (n = 103) and a sample of controls (n = 193) drawn randomly from the remaining cohort. The Structured Interview for Prodromal Syndromes (SIPS) was applied to all, 295 participants together with questionnaires measuring psychosis vulnerability and schizotypal traits. Results: There were 29 (10%) current prodromal cases. Criteria for the current prodromal syndrome were fulfilled by 12% of the familial risk group and 19% of the symptomatic risk group, compared with 5% of the ADHD group and 4% of controls. Conclusion: We successfully detected young people with a prodromal psychosis syndrome although relatively few subjects deemed to be at high risk met the full operational criteria according to the SIPS interview. Combining methods from familial, clinical and psychometric high‐risk approaches provides a tractable method for studying risk of psychosis in the general population.     

Prevalence and diagnosis of schizophrenia based on register, case record and interview data in an isolated Finnish birth cohort born 1940–1969

Introduction Schizophrenia occurs worldwide but the prevalence varies markedly. In Finland, schizophrenia is most prevalent in the northeastern region. Our aims were to reassess the register-, case record- and interview-based lifetime prevalence in a genetically homogeneous birth cohort from an isolate population with earlier reported high prevalence of schizophrenia and a chromosome linkage to chromosome 1q. Methods We identified all patients with a diagnosis of schizophrenia [International Classification of Diseases (ICD)-8, ICD-9 or ICD-10 codes], born 1940–1969 in the isolate (n=282) and alive (n=237) in 1998 using the Hospital Discharge, Disability Pension and Free Medicine Registers. The corresponding birth cohort of 14,817 persons and 12,368 alive in 1998 was identified from the National Population Register. We validated 69% of the register diagnosis by making DSM-IV consensus diagnoses, and interviewed 131 (55%) of the 237 patients with SCID-I and SCID-II. Results The register-based lifetime prevalence was 1.5% for schizophrenia and 1.9% for schizophrenia spectrum psychotic disorders: in birth cohorts born 1945 to 1959, the latter prevalence was especially high (2.4%). Of those with a register diagnosis of schizophrenia spectrum psychotic disorder, 69% or 63% also received a record-based consensus diagnosis or SCID interview diagnosis of schizophrenia, and the prevalence was 0.9–1.3 and 0.7–1.2%, respectively, when we reassessed most of the register-based cases. The cumulative incidence of schizophrenia spectrum psychotic disorders in the total birth cohort was 1.9%. Conclusion In this isolate, the register, DSM-IV consensus and SCID interview-based lifetime prevalence of schizophrenia was internationally high. For genetic research work, the register diagnosis should be reassessed using either structured interview or the best estimate consensus diagnosis.     

A comparison of clinical and research DSM-III-R diagnoses of schizophrenia in a Finnish national birth cohort

As a prerequisite to the use of the Finnish National Hospital Discharge Register in psychiatric epidemiological research, we studied the diagnostic reliability of the register in terms of the psychiatric morbidity experienced by a national birth cohort. We investigated all entries to the register for a sample based upon the Northern Finland 1966 birth cohort at the age of 16 years (n=11017). Until the end of 1993 (age 27 years), a total of 563 subjects had a register diagnosis indicating a psychiatric illness, 37 of them being schizophrenia. When operational criteria (DSM-III-R) were applied to clinical information in the available original hospital records for cases of psychosis, personality disorder and substance abuse (n=249), 71 fulfilled criteria for schizophrenia, including all of the 37 cases in the register and an additional 34 (48% false-negatives), most frequently diagnosed in the register as schizophreniform or other psychosis. Despite the official use of DSM-III-R nomenclature, it appears that the clinical concept of schizophrenia in Finland, manifest within the register, remains very restrictive. The application of operational criteria is a necessary prerequisite for scientific research on schizophrenia.     

Fertility in schizophrenia: results from a contemporary US cohort

To investigate procreation in schizophrenia, as well as gender-related differences, female patients with schizophrenia (n= 79, DSM-III-R criteria) were compared with screened female controls (n= 124) and subsequently with male patients (n=86). Two outcomes were investigated: (i) the proportion of subjects with one or more children (an index of fertility) and (ii) the number of children per subject among those with one or more children (an index of fecundity). Multivariate analysis was used to control for confounding variables. No significant differences in fertility between female patients and controls were detected, but reduced fecundity was noted among female patients past the reproductive period. Male patients showed a significant reduction in both fertility and fecundity compared to female patients. These results suggest that there is a relatively small impairment of fecundity among female patients compared with controls, but that there are more significant gender-related differences in both fertility and fecundity. The latter have important implications for the genetics of schizophrenia.     

A program for relapse prevention in schizophrenia: a controlled study

BACKGROUND: This study examined whether a program for relapse prevention (PRP) is more effective than treatment as usual (TAU) in reducing relapse and rehospitalization rates among outpatients with schizophrenia. METHODS: Eighty-two outpatients with DSM-III-R schizophrenia or schizoaffective disorder were randomly assigned to receive either PRP (experimental group, n = 41) or TAU (control group, n = 41) and were followed up for an 18-month prospective controlled study. Patients in both groups were prescribed standard doses of maintenance antipsychotic medication. Treatment with PRP consisted of a combination of psychoeducation, active monitoring for prodromal symptoms with clinical intervention when such symptoms occurred, weekly group therapy for patients, and multifamily groups. The TAU consisted of biweekly individual supportive therapy and medication management. RESULTS: Outcome rates over 18 months were 17% for relapse (7 patients) and 22% for rehospitalization (9 patients) in the PRP group, compared with 34% for relapse (14 patients) and 39% for rehospitalization (16 patients) in the TAU group (P = .01 and P = .03, respectively). Addition of age, sex, baseline Global Assessment Scale score, Positive and Negative Syndrome Scale scores (3 measures), and substance abuse to the proportional hazards regression models all yielded nonsignificant effects. The PRP teams were much more likely than the TAU psychiatrists to identify prodromal episodes before patients met objective relapse criteria or needed hospitalization. CONCLUSIONS: The PRP was effective in detecting prodromal symptoms of relapse early in an episode. Crisis intervention including increased antipsychotic medication use during the prodromal phase reduced relapse and rehospitalization rates.     

Characteristics of hospital-treated schizophrenia in São Paulo,Brazil

Summary This paper reports a study on the prevalence of hospital-treated schizophrenia in a large urban centre in Brazil. A sample of 124 individuals from a defined catchment area of São Paulo consecutively admitted to psychiatric hospitals due to acute episodes of non-affective psychoses were assessed by standardized instruments for mental state and social adjustment. The sample was predominantly white (72.6%), single (65.2%), Catholic (61.3%) and not born in that city (58.9%). Eighty-six subjects fulfilled DSM-III-R criteria for schizophrenia (69.3%), 15 were classified as schizophreniform psychosis (12.1%), and 7 as schizoaffective (5.6%). Almost twothirds showed Schneider's first rank symptoms. Social adjustment before admission was poor or very poor in nearly half the sample. Mean age at onset was 3.2 years earlier in men than in women (P=0.007). No gender differences in mental state or social adjustment were observed. Individuals born outside São Paulo State had significantly more florid symptoms than those born in that state. These findings suggest that the features of schizophrenia in a large urban centre of Brazil are consistent with the patterns of schizophrenia described in Western developed countries.