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The metamorphosis of schizophrenia: from chronicity to vulnerability

  • Joseph Zubin (a1), Jay Magaziner (a1) and Stuart R. Steinhauer (a1)

On the evidence of long-term follow-up studies of cohorts of patients in Europe the outcome of schizophrenia appears to be changing from chronicity to an episodic course with a more favourable outlook. While the reasons for this change are unclear it is suggested that schizophrenia is characterized essentially by a state of vulnerability to the disorder. This vulnerability may or may not give rise to an episode of illness, depending on the incidence of triggering life event stressors and on the moderating influences of social networks, ecological factors, and premorbid personality. The traditional view of schizophrenia as an essentially chronic condition reflects not so much the natural history of the disorder as iatrogenic influences, lack of satisfactory extra-mural care, the accumulation of a relatively small proportion of truly chronic illnesses and the failure to recognize the termination of an episode of illness in patients with poor premorbid personalities. Evidence for the episodic nature of schizophrenia is presented.

Corresponding author
1Address for correspondence: Dr J. Zubin, Biometrics Research, 151R, Veterans Administration Medical Center, Highland Drive, Pittsburgh, PA 15206, USA.
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N. C. Andreasen & S. A. Olsen (1982). Negative vs. positive schizophrenia: definition and validation. Archives of General Psychiatry 39, 789794.

G. W. Brown , J. L. T. Birley & J. K. Wing (1972). The influences of family life on the course of schizophrenic disorders: a replication. British Journal of Psychiatry 121, 241258.

G. W. Brown , M. Ní Bhrolchaín & T. Harris (1975). Social class and psychiatric disturbances among women in an urban population. Sociology 9, 225254.

G. W. Brown , R. C. Preisman , M. D. Anderson , R. K. Nixon , J. L. Isbister & H. A. Price (1981). Memory performance of chemical workers exposed to polybrominated biphenyls. Science 212, 14131415.

L. Ciompi (1980). The natural history of schizophrenia in the long term. British Journal of Psychiatry 136, 413420.

T. J. Crow (1981). Riposte: positive and negative schizophrenic symptoms and the role of dopamine. British Journal of Psychiatry 139, 251254.

W. W. Eaton (1978). Life events, social supports and psychiatric symptoms: a reanalysis of the New Haven data. Journal of Health and Social Behavior 19, 230234.

E. Essen-Möller & O. Hagnell (1975). ‘Normal’ and ‘regional’ traits of personality according to Sjöbring: re-ratings and prognostic implications. Neuropsychobiology 1, 146154.

P. G. Feldman , N. L. Ricks & E. L. Baker (1980). Neuropsychological effects of industrial toxins: a review. American Journal of Industrial Medicine 1, 211227.

O. R. Galle , W. R. Gove & J. M. McPherson (1972). Population density and pathology: what are the relations for man? Science 176, 2330.

D. Gerard & L. Houston (1953). Family setting and the social ecology of schizophrenia. Psychiatric Quarterly 27, 90101.

D. Glass , J. Singer & J. Pennebaker (1977). Behavioral and physiological effects of uncontrollable environmental events. In Perspectives on Environment and Behavior (ed. D. Stokols ), pp. 131151. Plenum Press: New York.

I. I. Gottesman & J. Shields (1976). A critical review of recent adoption, twin, and family studies of schizophrenia: behavioral genetics perspectives. Schizophrenia Bulletin 2, 360401.

W. R. Gove & M. Hughes (1980). Re-examining the ecological fallacy: a study in which aggregate data are critical in investigating the pathological effects of living alone. Social Forces 58, 11571177.

M. Hammer , S. Makiesky-Barrow & L. Gutwirth (1978). Social networks and schizophrenia. Schizophrenia Bulletin 4, 525545.

E. H. Hare (1974). The changing content of psychiatric illness. Journal of Psychosomatic Research 18, 283289.

S. Henderson , D. G. Byrne , P. Duncan-Jones , R. Scott & S. Adcock (1980). Social relationships, adversity and neurosis: A study of associations in a general population sample. British Journal of Psychiatry 136, 574583.

T. H. Holmes & R. H. Rahe (1967). The Social Readjustment Rating Scale. Journal of Psychosomatic Research 11, 213218.

G. Huber , G. Gross , R. Schuttler & M. Linz (1980). Longitudinal studies of schizophrenic patients. Schizophrenia Bulletin 6,592605.

J. Leff & C. Vaughn (1981). The role of maintenance therapy and relatives' expressed emotion in relapse of schizophrenia: a two-year follow-up. British Journal of Psychiatry 139, 102104.

N. Mintz & D. Schwartz (1964). Urban ecology and psychosis. International Journal of Psychiatry 10, 101118.

W. Pollin , J. R. Stabenau , L. Mosher & J. Turpin (1966). Life history differences in identical twins discordant for schizophrenia. American Journal of Orthospychiatry 36, 492509.

J. Sokolovsky , C. Cohen , D. Berger & J. Geiger (1978). Personal networks of ex-mental patients in a Manhattan S.R.O. Hotel. Human Organization 37, 515.

V. Staudt & J. Zubin (1957). A biometric evaluation of the somatotherapies in schizophrenia. Psychological Bulletin 54, 171196.

United Nations Environment Program and the World Health Organization (1980). Environmental health criteria 12: Noise. Reviewed by Miller, A. R. In American Journal of Industrial Medicine 1, 229232.

H. Wechsler & T. F. Pugh (1967). Fit of individual and community characteristics and rates of psychiatric hospitalization. American Journal of Sociology 73(2), 331338.

D. R. Weinberger , E. F. Torrey , A. N. Neophytides & R. J. Wyatt (1979). Lateral cerebral ventricular enlargement in chronic schizophrenia. Archives of General Psychiatry 36, 735739.

J. K. Wing (1980). Social psychiatry in the United Kingdom: the approach to schizophrenia. Schizophrenia Bulletin 6, 556565.

J. Zubin & E. I. Burdock (1965). The revolution in psychopathology and its implications for public health. Acta Psychiatrica Scandinavica 41, 348359.

J. Zubin & B. Spring (1977). Vulnerability: a new view of schizophrenia. Journal of Abnormal Psychology 86, 103126.

J. Zubin & S. Steinhauer (1981). How to break the logjam in schizophrenia: A look beyond genetics. Journal of Nervous and Mental Disease 169, 477492.

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Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
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