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Am J Psychiatry 1993; 150:1349-1354
Copyright © 1993 by American Psychiatric Association
Establishing the onset of psychotic illness
M Beiser, D Erickson, JA Fleming and WG Iacono
Clarke Institute of Psychiatry, Toronto, Ont., Canada.
OBJECTIVE: To date, the literature has provided no standardized, replicable
method for establishing illness onset. The authors describe a method for
dating the first appearance of prodromal signs of psychotic illness, the
emergence of an acute episode, and the initiation of treatment seeking.
METHOD: Using reports by family and friends about a sample of 141 subjects
with first-episode psychosis, the investigators derived a checklist of
behaviors describing the evolution of various phases of illness. Supplied
with the checklist, clinician pairs independently rated the critical phases
in the evolution of illness: first appearance of noticeable symptoms, first
appearance of prominent psychotic symptoms, and initiation of treatment
seeking. RESULTS: The judges achieved good reliability in assigning age at
the first appearance of psychotic symptoms and at initiation of treatment
seeking. Judging the beginning of the prodrome proved more difficult.
Insidious onset proved as characteristic of affective psychosis as of
schizophrenia, while treatment lag--the interval between emergence of acute
psychotic symptoms and initiation of treatment seeking--was longer for
schizophrenia than for affective psychosis. Onset of schizophrenia occurred
earlier in women than in men. Depression with psychotic features appeared
earlier in men than women. CONCLUSIONS: Although dating the onset of
illness phases is probably feasible, efforts to improve reliability must
continue. The study results challenge beliefs about gender differences in
age at onset.
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