Crises and Life Changes preceding the Onset or Relapse of Acute Schizophrenia: Clinical Aspects

¹ M.R.C. Social Psychiatry Research Unit, Institute of Psychiatry. Consultant Psychiatrist, Bethlem Royal Hospital and Maudsley Hospital, London, S.E.5
² Reader in Sociology, Bedford College, Regent's Park, London, N.W.1

From a consecutive series of 123 patients diagnosed as suffering from schizophrenia, the first 50 were selected who had experienced an acute onset or relapse within three months of admission. They and their relatives were interviewed concerning the occurrence, during the 12 weeks prior to onset, of certain previously defined events which might, on commonsense grounds, be considered as potentially disturbing. Sixty per cent of the patients had experienced at least one such an event during the three weeks prior to onset compared to an average of 23 per cent during the three earlier three-weeks periods.

Diagnostically, the patients were divided into two groups—'definite' and 'probable' schizophrenia. In addition, the frequency of 21 different symptoms were looked at. Onsets were classified into (1) 'normal to schizophrenic', (2) `non-specific to schizophrenic' and (3) `exacerbations from mild to severe schizophrenia'.

There were no significant differences by age, sex and diagnostic category between the 50 included and the 73 excluded patients. Within the acute onset group, there were no differences by age, sex and diagnostic category or symptomatology between those who had and those who had not experienced any event in the final three weeks, except that certain depressive pre-occupations were commoner in the former. Thirteen patients gave a history of stopping or considerably reducing their phenothiazines medication. The proportion of these experiencing any event in the final three weeks (31 per cent) was significantly lower than for the rest of the patients (72 per cent) and not different from the `average rate' (23 per cent) for all patients in the earlier three weeks periods.

We conclude firstly that both life events and reducing or stopping phenothiazines contribute as precipitants of acute schizophrenia, and secondly that the symptomatology of acute schizophrenia is largely unrelated to its precipitants.

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