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Epidemiología de la esquizofrenia. El modelo de enfermedad de la esquizofrenia a la luz del conocimiento epidemiológico actual

Published online by Cambridge University Press:  12 May 2020

H. Häfner
H. Häfner*
Affiliation:
Unidad de Investigación de la Esquizofrenia, Instituto Central de Salud Mental, J 5, D-68159Mannheim, Alemania
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Resumen

En un intento de actualizar la epidemiología de la esquizofrenia, se señala que la esquizofrenia parece producirse con los mismos síntomas nucleares y casi con la misma frecuencia en todos los países y culturas estudiados. Estudios metodológicamente sólidos no han producido datos en favor de una tendencia secular de riesgo mórbido. El genotipo de esquizofrenia se expresa como psicosis, trastornos de la personalidad y trastornos no específicos o prescinde de manifestaciones psicopatológicas. En la mayoría de los casos, están presentes anomalías cerebrales menores. El Estudio Británico del Desarrollo Infantil mostró que se producen antecedentes conductuales, cognitivos, emocionales y neuromotores en 50% dedos casos, lo que de este modo apunta a un trastorno del desarrollo del cerebro, muy probablemente no específico a la esquizofrenia, ya que se encuentra también en muchos otros trastornos mentales. Un examen del curso temprano oculto de la esquizofrenia reveló una diferencia sexual significativa en la edad de comienzo y una fase prodrómica de unos 3 a 4 años en todos los casos. Un estudio con control de casos mostró que es sobre todo durante este curso temprano antes de la primera admisión cuando surge la desventaja social en la esquizofrenia. En la prefase, una falta de ascenso social relacionada con la enfermedad desempeña un papel mayor que los pasos de descenso social. El curso social temprano difiere entre los sexos sobre todo debido a un comienzo más temprano del trastorno en los varones. Las variables de enfermedad verdadera, es decir, los síntomas nucleares y el tipo de curso, no muestran diferencias esenciales entre varones y mujeres. Estos resultados indican que la esquizofrenia es uno de los infrecuentes patrones uniformes de respuesta del cerebro, que pueden ser desencadenados por un gran número de causas o favorecidos por factores de riesgo no específicos. Se discutirá en este contexto el efecto protector de los estrógenos.

Keywords

epidemiología de la esquizofreniahipótesis de los estrógenostendencias seculares de incidencia de la esquizofreniadiferencias de género en esquizofreniaantecedentes de la esquizofreniagripe y esquizofrenia
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 2 , Issue 6 , December 1995 , pp. 370 - 382
Copyright
Copyright © European Psychiatric Association 1995

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References

Bibliografia

Alarcon, J deSearproatt, VGoldacre, MTrends in schizophrenia. Lancet 1990; I: 852–3.Google Scholar
Angst, JIs schizophrenia disappearing? Eur Arch Psychiatry Clin Neurosci 1991; 240: 373.CrossRefGoogle Scholar
Astrup, CThe increase of mental disorders. Unpublished manuscript from the National Case Register of Mental Disorder, Gaustad Hospital, Oslo, 1982.Google Scholar
Babigian, HMSchizophrenia: Epidemiology. In: Freedman, AMKaplan, HISadock, BJ, eds. Comprehensive textbook of psychiatry, vol II. Baltimore: Williams & Wilkins, 1975; 860–6.Google Scholar
Brown, GWBirley, JLTSocial precipitants of severe psychiatric disorders. In: Hare, EHHare, EH, eds. Psychiatric epidemiology. London: Oxford University Press, 1970; 321–5.Google Scholar
Cannon, MCotter, DSham, PC et al. . Schizophrenia in an Irish sample following prenatal exposure to the 1957 influenza epidemic: a case-controlled, prospective follow-up study. Schizophr Res 1994; 11: 95.Google Scholar
Crow, TJTrends in schizophrenia. Lancet 1990; I: 851.CrossRefGoogle Scholar
Crow, TJDone, DJPrenatal exposure to influenza does not cause schizophrenia. Br J Psychiatry 1992; 161: 390–3.CrossRefGoogle ScholarPubMed
Crow, TJDone, DJSacker, ABirth cohort study of the antecedents of psychosis: ontogeney as witness to phylogenetic origins. In: Häfner, HGattaz, WF, eds. Search for the causes o f schizophrenia, vol III. Berlin, Heidelberg: Springer, 1994; 3–20.Google Scholar
Dauncy, KGiggs, JBaker, KHarrison, GSchizophrenia in Nottingham: Lifelong residential mobility o fa cohort. Br J Psychiatry 1993; 163: 613–19.CrossRefGoogle Scholar
Der, GGupta, SMurray, RMIs schizophrenia disappearing? Lancet 1990; I: 513–6.CrossRefGoogle Scholar
Dilling, HWeyerer, SLisson, HZur ambulanten psychiatrischen Versorgung durch niedergelassene Nervenärzte. Soc Psychiatry 1975; 10: 111–31.CrossRefGoogle Scholar
Dohrenwend, BPShrout, PELink, BGSkodol, AESocial and psychosocial risk factors for episodes of schizophrenia. In: Häfner, HGattaz, WFJanzarik, W, eds. Search for the causes of schizophrenia. Berlin, Heidelberg: Springer, 1987; 275–96.CrossRefGoogle Scholar
Dohrenwend, BPLevav, IShrout, PE et al. . Socioeconomic status and psychiatric disorders: The causation- selection issue. Science 1992; 255: 946–52.CrossRefGoogle ScholarPubMed
Dunham, HWCommunity and schizophrenia: an epidemiological analysis. Detroit: Wayne State University Press, 1965.Google Scholar
Eagles, JMWhalley, LJDecline in the diagnosis of schizophrenia among first admissions to Scottish mental hospitals from 1969-1978. Br J Psychiatry 1985; 146: 151–4.CrossRefGoogle Scholar
Faris, REDunham, WMental disorders in urban areas. An ecological study of schizophrenia and other psychoses. Chicago: University of Chicago Press, 1939.Google Scholar
Folnegovic, Z, Hrabak-Zerjavic, Folnegovic-Smalc V, Nimica, NHospital incidence of schizophrenia in Croatia over a 25-year period. Schizophr Res 1994; 11: 99–100.Google Scholar
Giel, RSauer, HCSlooff, CJWiersma, DEpidemiological observations on schizophrenia and disability in the Netherlands. Tijdschr Psychiatrie 1980; 11-12: 710–22.Google Scholar
Graham, PMTrends in schizophrenia. Lancet 1990; I: 852.Google Scholar
Häfner, HNew perspectives in the epidemiology of schizophrenia. In: Häfner, HGattaz, WF, eds. Search of the causes of schizophrenia, vol II. Berlin, Heidelberg: Springer, 1990; 408–31.CrossRefGoogle Scholar
Häfner, HThe epidemiology of schizophrenia. Triangle 1992; 32: 133–54.Google Scholar
Häfner, Hander Heiden, WThe contribution of European case registers to research on schizophrenia. Schizophr Bull 1986; 12: 26–50.CrossRefGoogle ScholarPubMed
Häfner, HGattaz, WFIs schizophrenia disappearing? (letter). Eur Arch Psychiatry Clin Neurosci 1991; 240: 374–6.Google Scholar
Häfner, HLoffler, WDie okologische Verteilung schizophrener Ersterkrankungen in zwei deutschen GroBstadten (Mannheim und Heidelberg). Fundamenta Psychiatrica 1994; 8: 103–15.Google Scholar
Häfner, HReimann, HSpatial distribution of mental disorders in Mannheim 1965. In: Hare, EHHare, EH, eds. Psychiatric epidemiology. London: Oxford University Press, 1970; 341–54.Google Scholar
Häfner, HRiecher, AMaurer, K et al. . Ein Instrument zur retrospektiven Einschatzung des Erkrankungsbeginns bei Schizophrenia (Instrument for the retrospective assessment of the onset of schizophrenia - IRAOS - Entwicklung und Ergebnisse Z Klin Psychol 1990; 19: 230–55.Google Scholar
Häfner, HBehrens, SVry, J deGattaz, WFLofiler, WMaurer, KRiecher-Rossler, AWarum erkranken Frauen spater and Schizophrenie? Erhohung der Vulnerabilitatsschwelle durch Ostrogen. Nervenheilkunde 1991; 10: 154–63.Google Scholar
Häfner, HBehrens, Sde Vry, JGattaz, WFAn animal model for the effects of estradiol on dopaminemediated behavior: Implications for sex differences in schizophrenia. Psychiatry Res 1992a; 38: 125–34.CrossRefGoogle Scholar
Häfner, HRiecher-Rossler, AHambrecht, M et al. . IRAOS: an instrument for the assessment of onset and early course of schizophrenia. Schizophr Res 1992b; 6: 209–23.CrossRefGoogle Scholar
Hambrecht, MRiecher-Rossler, AFatkenheuer, BLouza, MRHäfner, HHigher morbidity risk for schizoprhenia in males: fact or fiction? Compr Psychiatry 1994; 35: 39–49.CrossRefGoogle ScholarPubMed
Hare, EHWas insanity on the increase? Br J Psychiatry 1983; 142: 439–55.CrossRefGoogle ScholarPubMed
Helgason, L Psychiatric Services and mental illness in Iceland. Acta Psychiatr Scand 1977; (suppl): 268.Google Scholar
Helgason, TExpectancy of schizophrenia in Iceland during the twentieth century. Paper presented at the WPA Symposium “Changing the course and outcome of mental disorder”, Groningen, the Netherlands, Sept 1-3, 1993.Google Scholar
Jablensky, AEpidemiology of schizophrenia. In: Bebbington, PBebbington, P, eds. Schizophrenia. The major issues. Oxford: Heineman Professional Publishing, 1988; 19–35.Google Scholar
Jablensky, ASartorius, NEmberg, GAnker, MKorten, ACooper, JEDay, RBertelsen, ASchizophrenia: manifestations, incidence and course in different cultures. A World Health Organization tencountry study. Psychol Med Monograph Suppl 20. Cambridge University Press, Cambridge 1992.Google Scholar
Krupinski, JAlexander, LPatterns of psychiatric morbidity in Victoria, Australia, in relation to changes in diagnostic criteria 1848-1978. Soc Psychiatry 1993; 18: 61–7.CrossRefGoogle Scholar
Manderscheid, RWLocke, BZPato, CNShore, DTrends in schizophrenia. Lancet 1990; II: 1097.CrossRefGoogle Scholar
Mednick, SAMachon, RAHuttunen, MOet al. Adult schizophrenia following prenatal exposure to an influenza epidemic. Arch Gen Psychiatry 1988; 45: 189–92.CrossRefGoogle Scholar
Mortensen, PBIs schizophrenia disappearing? Eur Arch Psychiatry Clin Neurosci 1991; 240: 374.Google Scholar
Munk-Jorgenscn, PDecreasing first admission rates o f schizophrenia among males in Denmark from 1970 to 1984. Changing diagnostic patterns? Acta Psychiatr Scand 1986; 73: 645–50.CrossRefGoogle Scholar
Munk-Jorgensen, PWhy has the incidence of schizophrenia in Danish psychiatric institutions decreased since 1970? Acta Psychiatr Scand 1987; 75: 62–8.CrossRefGoogle ScholarPubMed
Murray, RMGupta, SDer, GTrends in schizophrenia. Lancet 1990; II: 1214.CrossRefGoogle Scholar
Murray, RMGupta, SDer, GIs schizophrenia disappearing? Eur Arch Psychiatry Clin Neurosci 1991; 240: 377–8.Google Scholar
Prince, MJPhelan, MCTrends in schizophrenia. Lancet 1990; 1:851–2.Google Scholar
Riecher-Rössler, AHäfner, HStummbaum, MMaurer, KSchmidt, RCan estradiol modulate schizophrenic symptomatology? Schizophr Bull 1994; 20: 203–14.CrossRefGoogle ScholarPubMed
Sartorius, NJablensky, AKorten, Aet al. Early manifestations and first-contact incidence of schizophrenia in different cultures. Psychol Med 1986; 16: 909–28.CrossRefGoogle ScholarPubMed
Torrey, EFSchizophrenia and civilisation. New York: Jason Aronson, 1980.Google Scholar
Weyerer, SHäfner, HThe stability o f the ecological distribution of the incidence of treated mental disorders in the city of Mannheim. Soc Psychiatry Psychiatr Epidemiol 1989; 24: 57–62.CrossRefGoogle Scholar
Weyerer, SHäfner, HThe high incidence of psychiatrically treated disorders in the inner city of Mannheim. Soc Psychiatry Psychiatr Epidemiol 1992; 27: 142–6.Google ScholarPubMed
Wing, JKFryers, T (eds.). Psychiatric Services in Cambewell and Salford. Statistics from the Camberwell and Salford psychiatric registers, 1964-1974. MRC Social Psychiatry Unit, London Department of Community Medicine of Manchester 1976.Google Scholar