The ABC Schizophrenia Study, a large-scale epidemiological and neurobiological research project commenced in 1987, initially pursued two aims: (1) to elucidate the possible causes of the sex difference in age at first admission for schizophrenia and (2) to analyse the early course of the disorder from onset until first contact and its implications for further course and outcome. First, transnational case-register data (for Denmark and Germany) were compared, second, a population-based sample of first-episode cases of schizophrenia (n = 232) were selected and third, the results obtained were compared with data from the WHO Determinants of Outcome Study by using a systematic methodology. A consistent result was a 3-4 years higher age of onset for women by any definition of onset, which was not explainable by social variables, such as differences in the male-female societal roles. A sensitivity-reducing effect of oestrogen on central D2 receptors was identified as the underlying neurobiological mechanism in animal experiments. Applicability to humans with schizophrenia was established in a controlled clinical study. A comparison of familial and sporadic cases showed that in cases with a high genetic load, the sex difference in age of onset disappeared due to a clearly reduced age of onset in women, whereas in sporadic cases it increased. To analyse early course retrospectively, a semistructured interview, IRAOS, was developed. The early stages of the disorder were reconstructed in comparison with age- and sex-matched controls from the same population of origin. The initial signs consisted mainly of negative and affective symptoms, which accumulated exponentially until the first episode, as did the later emerging positive symptoms. Social disability appeared 2-4 years before first admission on average. In early-onset cases, social course and outcome, studied prospectively over 5 years, was determined by the level of social development at onset through social stagnation. In late-onset cases, decline from initially high social statuses occurred. Socially negative illness behaviour contributed to the poor social outcome of young men. Symptomatology and other proxy variables of the disorder showed stable courses and no sex differences. Further aspects tested were the sequence of onset and the influence of substance abuse on the course of schizophrenia, primary and secondary negative symptoms, structural models and symptom clusters from onset until 5 years after first admission.
OBJECTIVE: The aim of this study was to determine the treatment incidence, diagnostic stability and clinical and social outcome of affective disorders in the Greenlandic population. METHODS: A cohort of Greenlanders first hospitalized in 1980-1983 and diagnosed with an affective disorder at least once during the period 7 to 12 years after first admission formed the study population. The manic-depressive patients who were still alive at follow-up were invited for a Present State Examination, and information about clinical and social condition was obtained for the total cohort. RESULTS: The rates of manic-depressive psychoses diagnosed at first admission or later were 6.6 for men and 20.4 for women per 100,000 individuals of over 15 years of age. The unipolar:bipolar ratio was very low, namely 1:3 for men and 1:2 for women. Outcome was relatively poor. CONCLUSION: Manic-depression is a recognizable diagnostic category in Greenland. Extremely low rates of unipolar disorders in both sexes and high rates of bipolar disorders among women were the most marked findings.
OBJECTIVE: Energy restriction reduces the incidence of malignant tumors in experimental animals, but evidence for a similar effect in humans is lacking. To test the hypothesis in humans, we investigated cancer incidence among patients with anorexia nervosa, who have had an extremely low intake of calories for prolonged periods of their lives. METHODS: Patients with anorexia nervosa (2151 women and 186 men) during 1970-1993 were identified in the population-based Danish Psychiatric Case Register and the National Registry of Patients. The cohort was linked to the Danish Cancer Registry, and cancer incidence among cohort members was compared with that of the general population. RESULTS: The overall cancer incidence among women with anorexia nervosa was reduced by a factor of 0.80 (95% confidence interval 0.52-1.18) below that of the general population on the basis of 25 observed and 31.4 expected cases. Among men, two cases of cancer were observed, both confined to the brain, whereas 0.2 cases were expected. CONCLUSIONS: The finding of a slight reduction in cancer risk among women with anorexia nervosa may support the theory that a low-energy diet may decrease tumor development in humans. However, longer follow-up and control for confounding factors are needed to obtain more convincing evidence.
The present register-based investigation includes all hospitalized schizophrenic patients in Denmark on census days in September 1977 and September 1982. In 1977 the rates were 107.8 and 88.1 per 100,000 inhabitants aged 15 years or more for males and females, respectively, and correspondingly 99.2 and 71.5 in 1982. The prevalence rates of first admitted on the census days had decreased slightly in the older age groups from 1977 to 1982 but were unchanged in the age groups 15-44 years. The long-stay groups were smaller but at the same time the rates of re-admitted younger males had increased. Only a few changes between the distribution of the two groups' marital status occurred and there was still a considerable excess of single and divorced among the schizophrenic patients. More patients were in day-patient care and in nursing homes and fewer were admitted as in-patients, although in 1982 56% of the males and 52% of the females were in the latter type of care. The percentage of committed patients decreased from 12.6 to 9.1 for the males and from 8.9 to 7.0 for the females. This decrease was most pronounced in the group of patients admitted because of dangerous behaviour. The results are discussed especially in relation to reductions in available beds in psychiatric institutions.
A dataset of psychiatric ICD-10 diagnoses from the Danish case register concerning psychiatric hospitals was compared with a sample of psychiatric diagnoses from 27 psychiatric hospitals in Germany. The comparison shows a higher proportion of F1 diagnoses in the German dataset and a difference in the coding of alcohol dependence and harmful use. Some further differences in the groups F0-F6 are demonstrated and some of them are discussed. The most frequent diagnoses found in both datasets but in different sequence are alcohol dependence syndrome and paranoid schizophrenia and, in third place, adjustment disorder. Various aspects of the problem of rarely used diagnoses are discussed.