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A Jablensky

Publications and source records attributed to A Jablensky.

At least 55 records · Page 3Linked to original sources
PubMed1988

Is schizophrenia universal?

The question whether schizophrenia occurs in similar forms in different populations and cultures was first raised by Kraepelin at the turn of the century. However, methodological difficulties have impeded for decades the development of comparative cross-cultural research, and it was not until the 1960s that investigations of the kind Kraepelin envisaged became feasible. A major role in launching multi-centre clinical and epidemiological studies of schizophrenia in over 20 countries in different parts of the world has been played by the World Health Organization. The WHO studies have demonstrated that: (I) syndromes of schizophrenia occur in all cultures and geographical areas investigated; (II) their rate of incidence is very similar in the different populations; (III) the course and prognosis of schizophrenia is extremely variable, but outcome is significantly better in the developing countries. These findings have fundamental implications for the conceptualization of schizophrenia and for designing strategies of new research.

Cross-Cultural Comparison↗
PubMed1987

Stressful life events preceding the acute onset of schizophrenia: a cross-national study from the World Health Organization.

This study reports on the findings from a WHO sponsored cross-national investigation of life events and schizophrenia. Data are presented from a series of 386 acutely ill schizophrenic patients selected from nine field research centers located in developing and developed countries (Aarhus, Denmark; Agra, India; Cali, Colombia; Chandigarh, India; Honolulu, USA; Ibadan, Nigeria; Nagasaki, Japan; Prague, Czechoslovakia; Rochester, USA). On a methodological level, the study demonstrates that life event methodologies originating in the developed countries can be adapted for international studies and may be used to collect reasonably reliable and comparable cross-cultural data on psychosocial factors affecting the course of schizophrenic disorders. Substantive findings replicate the results of prior studies which conclude that socioenvironmental stressors may precipitate schizophrenic attacks and such events tend to cluster in the two to three week period immediately preceding illness onset.

Adolescent↗
PubMed1986

Early manifestations and first-contact incidence of schizophrenia in different cultures. A preliminary report on the initial evaluation phase of the WHO Collaborative Study on determinants of outcome of severe mental disorders.

In a context of a WHO collaborative study, 12 research centres in 10 countries monitored geographically defined populations over 2 years to identify individuals making a first-in-lifetime contact with any type of 'helping agency' because of symptoms of psychotic illness. A total of 1379 persons who met specified inclusion criteria for schizophrenia and other related non-affective disorders were examined extensively, using standardized instruments, on entry into the study and on two consecutive follow-ups at annual intervals. Patients in different cultures, meeting the ICD and CATEGO criteria for schizophrenia, were remarkably similar in their symptom profiles and 49% of them presented the central schizophrenic conditions as defined by CATEGO class S+. However, the 2-year pattern of course was considerably more favourable in patients in developing countries compared with patients in developed countries, and the difference could not be fully explained by the higher frequency of acute onsets among the former. Age- and sex-specific incidence rates and estimates of disease expectancy were determined for a 'broad' diagnostic group of schizophrenic illness and for CATEGO S+ cases. While the former showed significant differences among the centres, the differences in the rates for S+ cases were non-significant or marginal. The results provide strong support for the notion that schizophrenic illnesses occur with comparable frequency in different populations and support earlier findings that the prognosis is better in less industrialized societies.

Adolescent↗
PubMed1986

Epidemiology of schizophrenia: a European perspective.

Since its inception, the concept of dementia praecox and, later, of schizophrenia has been one of the most disputed entities in modern medicine. Schizophrenia was, and still is, defined by its clinical symptoms and their characteristic evolution over time. No external validating criteria for the diagnosis have been established, in spite of a host of suggestive biological findings, among which the genetic data carry most weight. This absence of clear-cut substrate markers and indicators underscores the importance of the epidemiological perspective in the study of the disorder. The European contributions to the epidemiological description and understanding of schizophrenic morbidity are numerous. They range from community surveys and studies of pedigrees to case-control designs for assessment of risk factors and long-term followup investigations of course and outcome. This review focuses on epidemiological approaches to schizophrenia that have attempted to highlight the essential attributes of a disease: its incidence and prevalence, ecology, and associated features. It is difficult to generalize about European epidemiological research in schizophrenia, because of the coexistence of a variety of "schools," traditions, and approaches. It is nevertheless possible to discern several clear trends in European epidemiological investigations of schizophrenia that can, to some extent, be contrasted to North American developments.

Adolescent↗
PubMed1984

Epidemiological and clinical research as a guide in the search for risk factors and biological markers.

One of the major events in psychiatric research in the last decade has been the firm establishment of the concept of biological markers and risk factors as legitimate signposts in the search for causes and pathogenetic mechanisms in mental disorders. However, to date, no single variable and no group of variables have been unequivocally identified as markers or risk factors, as far as the functional psychoses, or personality and neurotic disorders are concerned. The reasons for this state of affairs lie in the multifactorial nature of "idiopathic" psychiatric disorders, in persisting differences between the diagnostic criteria employed by various "schools", in the low statistical power of most research designs in biological psychiatry and in the lack of a general theory of cerebral and mental functioning which can yield testable hypotheses. Epidemiological methods, which had produced spectacular results in the past, are now rarely applied to narrow down the field of investigation where disease markers are most likely to be found. There are obvious similarities between the epidemiological strategy of risk factor identification and the biological strategy of disease marker research. A combination of these two strategies is more likely to advance the field than continued use of each singly. Schizophrenia research is an example of an area presenting interesting opportunities in this respect. The following priorities are suggested: development of a research classification of schizophrenia proceeding from well-defined sub-divisions of the phenotype; studies of the schizophrenia spectrum of disorders; search for populations with extremely high or extremely low incidence; studies of large pedigrees; further attempts to clarify the phenomenon of seasonal distribution of births of schizophrenia patients; studies on the occurrence of schizophrenic syndromes in association with other, well-defined diseases; search for early developmental precursors of the disorder; and subtyping of schizophrenia according to therapeutic response.

Epidemiologic Methods↗
PubMed1981

Characteristics of depressive patients contacting psychiatric services in four cultures. A report from the who collaborative study on the assessment of depressive disorders.

The paper is a report on results obtained in the course of a multi-centre international study on depressive disorders in four countries, which was sponsored and co-ordinated by the World Health Organization. A screen form was developed and tested in order to select depressive patients among psychiatric in-patient and out-patient populations. The patients selected in this way were assessed clinically by experienced investigators using the WHO schedule for Standardized Assessment of Depressive Disorders (SADD). A total of 53 patients were evaluated in the five research centres, and the data were utilized in uni- and multivariate statistical analyses aiming to establish whether similar cases of depression could be found in different cultures, to describe their characteristics and to ascertain the extent to which diagnostic concepts and classification categories could be applied in different settings. The results point to a considerable degree of similarity in depressive symptomatology across the cultures if particular selection criteria are applied, and suggest that broad diagnostic groupings such as 'endogenous' and 'psychogenic' depressions could be used consistently by clinicians working in different cultures.

Adult↗
PubMed1980

WHO collaborative study: assessment of depressive disorders.

In the context of an ongoing WHO research programme in depression, a total of 573 patients consulting psychiatrists in Canada, Iran, Japan and Switzerland were assessed with the WHO/SADD schedule which proved to be a simple and reliable instrument for standardized recording of clinical data. The results indicated that the "average" depressive patients seeking care in culturally different settings have many clinical features in common. A screening instrument, developed in the same study, has been shown to be effective in selecting depressive patients among in- and out-patient populations.

Cross-Cultural Comparison↗
PubMed1978

Cross-cultural differences in the short-term prognosis of schizophrenic psychoses.

Results of the 2-year followup of the patients included in the International Pilot Study of Schizophrenia (World Health Organization 1973) indicate that patients diagnosed schizophrenic on the basis of standardized assessments and clearly specified criteria demonstrated very marked variations of course and outcome over a 2-year period. Schizophrenic patients in the centers in developing countries had, on the average, considerably better course and outcome than schizophrenic patients in the centers in developed countries. Part of the variation of course and outcome was related to sociodemographic (e.g., social isolation and marital status) and clinical (e.g., type of onset and precipitating factors) predictors, but another larger part remained statistically unexplained. This suggests that variables usually used to describe psychopathology, the environment, and history of psychiatric patients in European and North American cultures may not account for cross-cultural differences. Clinical diagnosis on initial evaluation appeared to be a good predictor of subsequent symptomatology, but not of the length of the episodes, the total time during which the patient would be psychotic, pattern of course, or the degree of social impairment. A 5-year followup of the IPSS patients has also been completed, and the collected data are being analyzed.

Cross-Cultural Comparison↗
PubMed1977

Two-year follow-up of the patients included in the WHO International Pilot Study of Schizophrenia.

Over 90% of the 1202 patients investigated in the 9 centres collaborating in the International Pilot Study of Schizophrenia were traced 2 years after the initial examination and on the average over 75% of them were re-examined, using standardized instruments and methods. Results indicate that patients diagnosed as schizophrenic on the basis of standardized assessments and clearly specified diagnostic criteria demonstrated very marked variations of course and outcome over a 2-year period. Schizophrenic patients in the centres in developing countries had considerably better course and outcome than schizophrenic patients in the centres in developed countries.

Adolescent↗