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Incidence of schizophrenia in Nottingham: A comparison of two cohorts, 1978–80 and 1992–94

  • J. Brewin (a1), R. Cantwell (a1), T. Dalkin (a1), R. Fox (a1), I. Medley (a1), C. Glazebrook (a1), R. Kwiecinski (a1) and G. Harrison (a1)...

Several studies have reported a decline of up to 50% in the incidence of schizophrenia over recent decades. We aimed to measure changes in the incidence and diagnostic patterns of first-episode psychosis by comparing two Nottingham cohorts, identified in two equal periods separated by 14 years.


Two prospectively ascertained cohorts of first-episode psychotic disorder were identified over the time periods 1978–80 and 1992–94. The earlier cohort was of the World Health Organization Determinants of Outcome of Severe Mental Disorder (DOSMD) ten-country study. The later cohort was obtained using similar methodology. Both groups were diagnosed using ICD-10 diagnostic criteria and age-standardised incidence rates were compared.


The standardised incidence rate for all psychotic disorders rose slightly from 2.49 to 2.87 per 10 000 population per year, but the F20 classification fell significantly by over a third (1.41 to 0.87 per 10 000 per year). The second study group (1992–1994) included a greater diversity of psychotic diagnoses compared with the first, in particular an increased proportion of acute and drug-related psychoses.


Methodological considerations call for caution in interpreting such data, but we conclude that the significant fall in the narrowly defined diagnostic category of schizophrenia reflects a real change in the syndromal presentation of psychotic disorders.

Corresponding author
Dr J. Brewin, Psychiatry Department, B Floor, South Block, Queen's Medical Centre, University Hospital, Nottingham NG7 2UH
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American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn. revised) (DSM–III–R). Washington. DC: APA.
Andreasen, N. C. (1982) Negative symptoms in schizophrenia. Archives of General Psychiatry, 39, 784788.
Bamrah, J. S., Freeman, H. L. & Goldberg, D. P. (1991) Epidemiology of schizophrenia in Salford, 1974–84. Changes in an urban community over 10 years. British Journal of Psychiatry, 159, 802810.
Castle, D., Wessely, S., Der, G., et al (1991) The incidence of operationally defined schizophrenia in Camberwell, 1965–84. British Journal of Psychiatry, 159, 790794.
Cooper, J. E., Goodhead, D., Craig, T., et al (1987) The incidence of schizophrenia in Nottingham. British Journal of Psychiatry, 151, 619626.
de Alarcon, J., Seagroatt, V. & Goldacre, M. (1990) Trends in schizophrenia. Lancet, 335, 852853.
Eagles, J. M. & Whalley, L. J. (1985) Decline in the diagnosis of schizophrenia among first admissions to Scottish mental hospitals from 1969–78. British Journal of Psychiatry, 146, 151154.
Eagles, J., Hunter, D. & McCance, C. (1988) Decline in the diagnosis of schizophrenia among first contacts with psychiatric services in north-east Scotland. 1969–1984. British Journal of Psychiatry, 152, 793798.
Gaddas, J. R., Black, R. J., Whalley, L. J., et al (1993) Persistence in the decline of diagnosis of schizophrenia among first admissions to Scottish hospitals from 1969 to 1988. British Journal of Psychiatry, 163, 620626.
Haffner, H. & an der Heiden, W. (1986) The contribution of European case registers to research on schizophrenia. Schizophrenia Bulletin, 12, 2651.
Harrison, G. (1993) Disappearing schizophrenia ? Schizophrenia Monitor, 3, 15.
Harrison, G., Cooper, J. E. & Gancarczyk, R. (1991) Changes in the administrative incidence of schizophrenia. British Journal of Psychiatry, 159, 811816.
Jablensky, A., Sartorius, N., Ernberg, G., et al (1992) Schizophrenia: manifestations, incidence and course in different cultures. A World Health Organization ten country study. Psychological Medicine monograph supplement 20.
Joyce, P. R. (1987) Changing trends in first admissions and readmissions for mania and schizophrenia in New Zealand 1974 to 1984. Australian and New Zealand Journal of Psychiatry, 21, 8286.
Kendall, R. E., Malcolm, D E. & Adams, W. (1993) The problem of detectng changes in the incidence of schizophrenia. British Journal of Psychiatry, 162, 212218.
Munk-Jorgensen, P. (1986) Decreasing first admission rates of schizophrenia among males in Denmark from 1970 to 1984. Acta Psychiatrica Scandinavica, 73, 645650.
Munk-Jorgensen, P. (1995) Decreasing rates of incident schizophrenia cases in psychiatric service: a review of the literature. European Psychiatry, 10, 129141.
Munk-Jorgensen, P. & Mortensen, P. R. (1992) Incidence and other aspects of the epidemiology of schizophrenia in Denmark, 1971–87. British Journal of Psychiatry, 161, 489495.
Office of Population Censuses and Surveys (1992) Census 1991. London: HMSO.
Parker, G., O'Donnell, M. & Walter, S. (1985) Changes in the diagnoses of the functional psychoses associated with the introduction of lithium. British Journal of Psychiatry, 146, 377382.
World Health Organization (1993) The Tenth Revision of the International Classification of Diseases and Related Health Problems (ICD–10): Diagnostic Criteria for Research. Geneva: WHO.
World Health Organization (1994) Schedules for Clinical Assessment in Neuropsychiatry, version 2. Geneva: WHO.
Zubin, J., Magaziner, J. & Steinhauser, S. R. (1983) The metamorphosis of schizophrenia: from chronicity to vulnerability. Psychological Medicine, 13, 551571.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
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Incidence of schizophrenia in Nottingham: A comparison of two cohorts, 1978–80 and 1992–94

  • J. Brewin (a1), R. Cantwell (a1), T. Dalkin (a1), R. Fox (a1), I. Medley (a1), C. Glazebrook (a1), R. Kwiecinski (a1) and G. Harrison (a1)...
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