The Epidemiology of Schizophrenia by Robin M. Murray, Peter B. Jones, Ezra Susser, Jim Van Os,

By Robin M. Murray, Peter B. Jones, Ezra Susser, Jim Van Os, Mary Cannon

A world crew of best researchers and clinicians offers the 1st finished, epidemiological evaluation of this multi-faceted and still-perplexing disease. arguable concerns akin to the validity of discrete or dimensional classifications of schizophrenia and the continuum among psychosis and 'normality' are explored intensive. Separate chapters are dedicated to issues of specific relevance to schizophrenia corresponding to suicide, violence and substance abuse. eventually, new customers for remedy and prevention are thought of.

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Time trends in incidence The 19th century: the growth of asylums In the historical epidemiology of schizophrenia, the fulcrum of interest resides in the 19th century. The pace and scope of change in the social environment was 34 35 Temporal variation in schizophrenia unprecedented in human history, with dramatic increases in population and the industrialization of many western countries. A heated debate developed in both Europe and North America, not only among psychiatrists but also among the general public, over whether insanity was increasing.

Analysing trends by generation, however, revealed that in each generation the peak in rates occurred between 20 and 30 years of age, and that over each succeeding generation rates were declining in an orderly fashion. The disease had not undergone a metamorphosis, nor had the elderly developed a peculiar susceptibility to the disease; instead, experience had changed over successive generations. Understanding this also pointed to early life experience as crucial to risk for the disease. Graphical display analysis is useful in visually discriminating period and age, or chort and age effects.

Period trends reflecting something other than changes in underlying incidence can also emerge from ascertainment varying with changing treatment systems or diagnostic practices. The observed decline in incidence in recent decades corresponds to a time of great service change in developed countries. Treatment systems were increasingly emphasizing community-based care. , 1991). , 1997). There has been no indication that the proportion of nevertreated cases has increased over this period, ruling out a final effect of service change in accounting for the decline.

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