ABSTRACT
It has long been known that, in the vast majority of cases, schizophrenia is not a sudden event. In the Mannheim Age, Beginning, Course (ABC) study of 232 first admissions for first episode schizophrenia,1 it was found that first hospitalization was preceded by a psychotic prephase in which psychotic symptoms had been present already for about 1 year and by an additional phase of an average of 5 years in which first negative or nonspecific signs of a mental disorder had been present. This was true for about threequarters of all patients. Furthermore, at the time of the first sign of mental illness, only insignificant differences were found between people who later developed schizophrenia (n = 57) and age, sex and place of residence matched controls (n = 57) with regard to different key roles for social role performance. However, at the time of first admission to hospital, this picture had changed and significant differences in social role performance were shown especially with regard to employment (t-test, P < 0.10), own income (t-test, P < 0.01) and stable partnership or marriage (t-test, P < 0.001). The onset of social disabilities that were assessed according to the Disability Assessment Schedule2 on average clearly pre-dated the first admission and-by more than a year-even the onset of the first positive symptoms (Figure 10.1). Thus, social deficits that are often hard to treat after the first episode of schizophrenia seem to have developed already in the initial prodromal phase.
