Skip to main content

Advertisement

SpringerLink
Log in

ABC Schizophrenia study: an overview of results since 1996

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

The ABC Schizophrenia study, led by a single research team, investigated a schizophrenia sample systematically over quarter of a century. This paper summarises results from 1996 onwards. The initial goals were to explain the considerably higher age at first admission in women, and to obtain precise information on the onset and early course of schizophrenia as a prerequisite for early intervention.

Method

The study was hypothesis-driven. People with schizophrenia were compared in the prodrome and at first admission to those with unipolar depression and to healthy controls. We analysed the medium-term (5-year) and the long-term (12-year) course of schizophrenia, its symptom dimensions, social parameters and predictors. Samples: (1) 276 population-based first admissions (232 first episodes) of schizophrenia (age range 12–59 years); (2) a subsample of 130 first admissions for schizophrenia; (3) 130 first admissions for unipolar depression; (4) 130 healthy population controls and (5) 1,109 consecutive first admissions for schizophrenia spectrum disorder without an age limit.

Results

The prodromal stages of schizophrenia and depression were very similar until positive symptoms appeared. The most frequent symptom in schizophrenia was depressed mood. The course of psychosis from prodrome to 12 years following first admission was very variable. From 5 to 12 years after first admission the course was characterised by irregular exacerbations of the main symptom dimensions, with no overall deterioration or improvement.

Conclusions

Schizophrenic psychosis and severe affective disorder, rather than representing discrete illnesses, probably mark different stages in the manifestation of psychopathology produced by various degrees of brain dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Häfner H, Maurer K, Löffler W, an der Heiden W, Munk-Jφrgensen P, Hambrecht M, Riecher-Rössler A (1998) The ABC schizophrenia study: a preliminary overview of the results. Soc Psychiatry Psychiatr Epidem 33:380–386

    Article  Google Scholar 

  2. Kraepelin E (1909–1915) Psychiatrie, 8. Aufl. (Bd 1-4). Barth, Leipzig

  3. Kraepelin E (1896) Psychiatrie, 5. Aufl. Barth, Leipzig

    Google Scholar 

  4. Siris SG, Bench C (2003) Depression and schizophrenia. In: Hirsch SR, Weinberger DR (eds) Schizophrenia, 2nd edn. Blackwell Publishing, Oxford, pp 142–167

    Chapter  Google Scholar 

  5. Buckley PF, Miller BJ, Lehrer DS, Castle DJ (2009) Psychiatric comorbidities and schizophrenia. Schizophr Bull 35:383–402

    Article  PubMed  Google Scholar 

  6. Cotton SM, Lambert M, Schimmelmann BG, Mackinnon A, Gleeson JF, Berk M, Hides L, Chanen A, McGorry PD, Conus P (2012) Depressive symptoms in first episode schizophrenia spectrum disorder. Schizophr Res 134:20–26

    Article  PubMed  CAS  Google Scholar 

  7. Häfner H, Maurer K, Trendler G, an der Heiden W, Schmidt M, Könnecke R (2005) Schizophrenia and depression: challenging the paradigm of two separate diseases—a controlled study of schizophrenia, depression and healthy controls. Schizophr Res 77:11–24

    Article  PubMed  Google Scholar 

  8. Häfner H, Löffler W, Maurer K, Hambrecht M, an der Heiden W (1999) Depression, negative symptoms, social stagnation and social decline in the early course of schizophrenia. Acta Psychiatr Scand 100:105–118

    Article  PubMed  Google Scholar 

  9. Maurer K, Trendler G, Schmidt M, an der Heiden W, Könnecke R, Häfner H (2006) Schizophrenie und depression. Nervenarzt 77:809–822

    Article  PubMed  CAS  Google Scholar 

  10. Häfner H (1996) The epidemiology of onset and early course of schizophrenia. In: Häfner H, Wolpert EM (eds) New research in psychiatry. Hogrefe & Huber, Seatle, pp 33–61

    Google Scholar 

  11. Loebel AD, Lieberman JA, Alvir JMJ, Mayerhoff DI, Geisler SH, Szymanski SR (1992) Duration of psychosis and outcome in first-episode schizophrenia. Am J Psychiatry 149:1183–1188

    PubMed  CAS  Google Scholar 

  12. Birchwood M, McMillan JF (1993) Early intervention in schizophrenia. Aust N Z J Psychiatry 27:374–378

    Article  PubMed  CAS  Google Scholar 

  13. McGorry PD, Edwards J, Mihalopoulos C, Harrigan SM, Jackson JH (1996) EPPIC: an evolving system of early detection and optimal management. Schizophr Bull 22:305–326

    Article  PubMed  CAS  Google Scholar 

  14. Linszen D, Lenior M, de Haan L, Dingemans P, Gersons B (1998) Early intervention, untreated psychosis and the course of early schizophrenia. Br J Psychiatry 172(Suppl):84–89

    CAS  Google Scholar 

  15. Norman RM, Malla AK (2001) Duration of untreated psychosis: a critical examination of the concept and its importance. Psychol Med 31:381–400

    Article  PubMed  CAS  Google Scholar 

  16. Häfner H, Maurer K (2006) Early detection of schizophrenia: current evidence and future perspectives. World Psychiatry 5:130–138

    PubMed  Google Scholar 

  17. Löffler W, Häfner H (1999) Dimensionen der schizophrenen Symptomatik. Nervenarzt 70:416–429

    Article  PubMed  Google Scholar 

  18. Häfner H, Maurer K, Löffler W, an der Heiden W, Könnecke R, Hambrecht M (1999) Onset and prodromal phase as determinants of the course. In: Gattaz WF, Häfner H (eds) Search for the causes of schizophrenia, vol IV: balance of the century. Steinkopff-Verlag/Springer, Darmstadt/Berlin, pp 1–24

    Google Scholar 

  19. van Os J, Howard R, Takei N, Murray R (1995) Increasing age is a risk factor for psychosis in the elderly. Soc Psychiatry Psychiatr Epidemiol 30:161–164

    Article  PubMed  Google Scholar 

  20. Castle DJ, Wessely S, van Os J, Murray RM (1998) Psychosis in the inner city. Psychology Press, East Sussex

    Google Scholar 

  21. Häfner H, Hambrecht M, Löffler W, Munk-Jørgensen P, Riecher-Rössler A (1998) Is schizophrenia a disorder of all ages? A comparison of first episodes and early course across the life-cycle. Psychol Med 28:351–365

    Article  PubMed  Google Scholar 

  22. Häfner H, Löffler W, Riecher-Rössler A, Häfner-Ranabauer W (2001) Schizophrenie und Wahn im höheren und hohen Lebensalter. Nervenarzt 72:347–357

    Article  PubMed  Google Scholar 

  23. Könnecke R, Häfner H, Maurer K, Löffler W, an der Heiden W (2000) Main risk factors for schizophrenia: increased familial loading and pre- and peri-natal complications antagonize the protective effect of oestrogen in women. Schizophr Res 44:81–93

    Article  PubMed  Google Scholar 

  24. Eggers C (2011) Schizophrenie des Kindes- und Jugendalters. MWV Medizinisch Wissenschaftliche Verlagsgesellschaft, Stuttgart

    Google Scholar 

  25. Remschmidt H, Martin M, Schultz E, Trott G-E (1994) Etiology of schizophrenia: perspectives from childhood psychoses. In: Marneros A, Andreasen NC, Tsuang MT (eds) Psychotic continuum. Springer, Berlin, pp 67–85

    Google Scholar 

  26. Remschmidt H (2004). Schizophrene Erkrankungen im Kindes- und Jugendalter. Klinik, Ätiologie, Therapie und Rehabilitation. Schattauer, Stuttgart

  27. Lewine RRJ (1988) Gender and schizophrenia. In: Nasrallah HA (ed) Handbook of schizophrenia, vol 3. Elsevier, Amsterdam, pp 379–397

    Google Scholar 

  28. McGrath J, Saha S, Welham J, El Saadi O, MacCauley C, Chant D (2004) A systematic review of the incidence of schizophrenia: the distribution of rates and the influence of sex, urbanicity, migrant status and methodology. BMC Med 28:13

    Article  Google Scholar 

  29. Salokangas RKR (1983) Prognostic implications of the sex of schizophrenic patients. Br J Psychiatry 142:145–151

    Article  PubMed  CAS  Google Scholar 

  30. Shepherd M, Watt D, Falloon I, Smeeton N (1989) The natural history of schizophrenia: a five-year follow-up study of outcome and prediction in a representative sample of schizophrenics (Psychol Med Monograph Suppl 15). Cambridge University Press, Cambridge

    Google Scholar 

  31. Häfner H, an der Heiden W, Behrens S, Gattaz WF, Hambrecht M, Löffler W, Maurer K, Munk-Jørgensen P, Nowotny B, Riecher-Rössler A, Stein A (1998) Causes and consequences of the gender difference in age at onset of schizophrenia. Schizophr Bull 24:99–113

    Article  PubMed  Google Scholar 

  32. Choquet M, Ledoux S (1994) Epidémiologie et adolescence. Confront Psychiatr 35:287–309

    Google Scholar 

  33. Döpfner M, Pluck J, Berner W, Fegert JM, Huss M, Lenz K, Schmeck K, Lehmkuhl U, Poustka F, Lehmkuhl G (1997) Psychische Auffälligkeiten von Kindern und Jugendlichen in Deutschland—Ergebnisse einer repräsentativen Studie: Methodik, Alters-, Geschlechts- und Beurteilereffekte (Mental disturbances in children and adolescents in Germany. Results of a representative study: age, gender and rater effects). Zeitschrift für Kinder- und Jugendpsychiatrie Psychotherapie 25:218–233

    Google Scholar 

  34. Häfner H (2000) Ist es alles nur die Krankheit? (Schriften der Mathematisch-naturwissenschaftlichen Klasse der Heidelberger Akademie der Wissenschaften Nr 7). Springer, Berlin

    Google Scholar 

  35. Häfner H, Maurer K, Löffler W, an der Heiden W, Hambrecht M, Schultze-Lutter F (2003) Modeling the early course of schizophrenia. Schizophr Bull 29:325–340

    Article  PubMed  Google Scholar 

  36. Häfner H, Maurer K, Löffler W, an der Heiden W, Könnecke R, Hambrecht M (2001) Onset and early course of schizophrenia—a challenge for early intervention. Psychiatr Fenn 32(Suppl 2):81–108

    Google Scholar 

  37. Häfner H (1998) Ist es einzig die Krankheit? In: Möller H-J, Müller N (eds) Schizophrenie—Moderne Konzepte zu Diagnostik, Pathogenese und Therapie. Springer, Wien, pp 37–60

    Chapter  Google Scholar 

  38. Zubin J, Spring B (1977) Vulnerability—a new view of schizophrenia. J Abnorm Psychol 86:103–126

    Article  PubMed  CAS  Google Scholar 

  39. Nuechterlein KH, Dawson ME (1984) A heuristic vulnerability/stress model of schizophrenic episodes. Schizophr Bull 2:300–312

    Article  Google Scholar 

  40. Thurm-Mussgay I, Galle K, Häfner H (1987) Interview zur Krankheitsbewältigung (IKB). CIMH, Mannheim (unpublished)

  41. Maurer K, Häfner H (1999) The impact of coping abilities on the development of schizophrenia. In: Lopez-Ibor JJ, Lieh-Mak F, Visotsky HM, Maj M (eds) One world, one language—paving the way to better perspectives for mental health. Hogrefe & Huber, Seattle, pp 228–239

    Google Scholar 

  42. Löffler W, Häfner H (1999) Ecological pattern of first admitted schizophrenics in two German cities over 25 years. Soc Sci Med 49:93–108

    Article  PubMed  Google Scholar 

  43. Löffler W, Häfner H (2002) Umwelt oder Krankheit: Wann und wie entsteht die ökologische Ungleichverteilung Schizophrener? In: Konrad P (ed) Fortschritte in Psychiatrie und Psychotherapie, Interdisziplinäre und integrative Aspekte. Springer, Wien, pp 9–26

    Chapter  Google Scholar 

  44. Häfner H, Riecher-Rössler A, Maurer K, Fätkenheuer B, Löffler W (1992) First onset and early symptomatology of schizophrenia: a chapter of epidemiological and neurobiological research into age and sex differences. Eur Arch Psychiatr Clin Neurosci 242:109–118

    Article  Google Scholar 

  45. Bühler B, Hambrecht M, Löffler W, an der Heiden W, Häfner H (2002) Precipitation and determination of the onset and course of schizophrenia by substance abuse—a retrospective and prospective study of 232 population-based first illness episodes. Schizophr Res 54:243–251

    Article  PubMed  Google Scholar 

  46. Häfner H, Bühler B, Hambrecht M, Löffler W, Maurer K, an der Heiden W (2002) Vorzeitige Auslösung der Psychose durch Substanzmissbrauch und Folgen für den weiteren Verlauf. Nervenheilkunde 21:198–207

    Google Scholar 

  47. Zammit S, Allebeck P, Andreasson S, Lundberg I, Lewis G (2002) Self reported cannabis use as a risk factor for schizophrenia in Swedish conscripts of 1969: historical cohort study. BMJ 325:1199–1201

    Article  PubMed  Google Scholar 

  48. Van Os J, Bak M, Hanssen M, Bijl RV, de Graaf R, Verdoux H (2002) Cannabis use and psychosis: a longitudinal population-based study. Am J Epidemiol 156:319–327

    Article  PubMed  Google Scholar 

  49. Arseneault L, Cannon M, Witton J, Murray RM (2004) Causal association between cannabis and psychosis: examination of the evidence. Br J Psychiatry 184:110–117

    Article  PubMed  Google Scholar 

  50. Jablensky A (2003) The epidemiological horizon. In: Hirsch SR, Weinberger D (eds) Schizophrenia, 2nd edn. Blackwell Publishing, Oxford, pp 203–231

    Chapter  Google Scholar 

  51. Häfner H, an der Heiden W (2003) Course and outcome of schizophrenia. In: Hirsch SR, Weinberger DR (eds) Schizophrenia, 2nd edn. Blackwell Publishing, Oxford, pp 101–141

    Chapter  Google Scholar 

  52. an der Heiden W, Könnecke R, Maurer K, Ropeter D, Häfner H (2005) Depression in the long-term course of schizophrenia. Eur Arch Psychiatry Clin Neurosci 255:174–184

    Article  Google Scholar 

  53. Häfner H (2010) Psychose, depression und manische Symptomatik—Leitsyndrome eigener Krankheiten oder Kontinuum? In: Möller H-J, Müller N (eds) Schizophrenie—Zukunftsperspektiven in Klinik und Forschung. Springer, Wien, pp 3–30

    Chapter  Google Scholar 

  54. Häfner H (2010) The early Kraepelin’s dichotomy of schizophrenia and affective disorder—evidence for separate diseases? Eur J Psychiatry 24:98–113

    Google Scholar 

  55. Häfner H, an der Heiden W, Maurer K (2008) Evidence for separate diseases? Stages of one disease or different combinations of symptom dimensions? Eur Arch Psychiatry Clin Neurosci 258(Suppl 2):85–96

    Article  PubMed  Google Scholar 

  56. Bressan RA, Chaves AC, Pilowsky LS, Shirakawa I, Mari JJ (2003) Depressive episodes in stable schizophrenia: critical evaluation of the DSM-IV and ICD-10 diagnostic criteria. Psychiatry Res 117:47–56

    Article  PubMed  Google Scholar 

  57. Häfner H (2005) Das Rätsel Schizophrenie—Eine Krankheit wird entschlüsselt, 3. vollständig überarbeitete Aufl. CH Beck, München

  58. Arndt S, Andreasen NC, Flaum M, Miller D, Nopoulos P (1995) A longitudinal study of symptom dimensions in schizophrenia—prediction and patterns of change. Arch Gen Psychiatry 52:352–360

    Article  PubMed  CAS  Google Scholar 

  59. Liddle PF (1987) The symptoms of chronic schizophrenia: a re-examination of the positive-negative dichotomy. Br J Psychiatry 151:145–151

    Article  PubMed  CAS  Google Scholar 

  60. Liddle PF (1987) Schizophrenic syndromes, cognitive performance and neurological dysfunction. Psychol Med 17:49–57

    Article  PubMed  CAS  Google Scholar 

  61. Liddle PF, Barnes TRE (1990) Syndromes of chronic schizophrenia. Br J Psychiatry 157:558–561

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The ABC Schizophrenia study was funded by the German Research Foundation (DFG) as part of the Special Research Branch (Sonderforschungsbereich) 258 at the Central Institute of Mental Health from January 1, 1987 to December 30, 1998 and from January 1, 1999 to May 31, 2012 as an independent project. The authors wish to thank all those researchers who in the 25 years have contributed to the ambitious ABC Schizophrenia research project and the accompanying studies, which provide the basis for this publication.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. The Schizophrenia Research Group, Central Institute of Mental Health, Mannheim Faculty of Medicine/University of Heidelberg, J5, 68159, Mannheim, Germany

    H. Häfner, K. Maurer & W. an der Heiden

Authors
  1. H. Häfner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Maurer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. an der Heiden
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Häfner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Häfner, H., Maurer, K. & an der Heiden, W. ABC Schizophrenia study: an overview of results since 1996. Soc Psychiatry Psychiatr Epidemiol 48, 1021–1031 (2013). https://doi.org/10.1007/s00127-013-0700-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-013-0700-4

Keywords

Search

Navigation