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The British Journal of Psychiatry (2005) 186: 386-393
© 2005 The Royal College of Psychiatrists

Pathogenesis of schizophrenia: a psychopathological perspective

D.G. Cunningham Owens, FRCPsych, Patrick Miller, PhD, Stephen M. Lawrie, MRCPsych and Eve C. Johnstone, FRCPsych

Division of Psychiatry, University of Edinburgh

Correspondence: D.G.Cunningham Owens, University of Edinburgh, Division of Psychiatry, Kennedy Tower, Royal Edinburgh Hospital, Morningside Terrace, Edinburgh EH10 5HF, UK.Tel: 0131 537 6267; fax: 0131 537 6291; e-mail: david.owens{at}ed.ac.uk

Declaration of interest None. Funding detailed in Acknowlegements.

Background Despite interest in early treatment of schizophrenia, premorbid and prodromal symptomatology remain poorly delineated.

Aims To compare pre-illness symptomatology in patients at high risk of schizophrenia who progress to illness with that of high-risk subjects who remain well and with normal controls.

Method Using Present State Examination (PSE) data, symptomatic scales were devised from participants of the Northwick Park Study of first-episode schizophrenia and scores were compared on the first and last PSEs of participants of the Edinburgh High Risk Study.

Results At entry, when still well, high-risk individuals who subsequently became ill (mean time to diagnosis 929 days; s.e.=138 days) scored significantly higher on‘situational anxiety’, ‘nervous tension’, ‘depression’, ‘changed perception’and ‘hallucinations’than those remaining well and normal controls, who did not differ. With illness onset, affective symptomatology remained high but essentially stable.

Conclusions In genetically predisposed individuals, affective and perceptual disorders are prominent before any behavioural or subjective change that usually characterises the shift to schizophrenic prodrome or active illness.




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