ABSTRACT
Our recent clinical and epidemiological studies show that the more strictly schizophrenia is defined, the fewer females qualify for the diagnosis. In particular, there is a huge excess of DSM-3 schizophrenia in young men while later onset schizophreniform disorders are much commoner in woman. The later onset female cases show normal premorbid functioning, more affective and fewer negative symptoms, a better outcome, and less structural brain abnormalities. The evidence that their relatives have an increased risk of affective disorder, and that they show the same summer peak of admissions as manic patients, suggests that they have much in common with affective disorder. On the other hand, evidence will be presented that early onset, predominantly male schizophrenia is associated with premorbid personality, social under achievement and structural brain abnormalities. Adult schizophrenics seen previously at the Maudsley Children’s Department had low IQ as children. In addition, mentally handicapped individuals who develop schizophrenia have an earlier onset of psychosis than schizophrenics without mental handicap; they also show an excess of males. It is suggested that neurodevelopmental schizophrenia has its origins in abnormal brain development during foetal or neonatal life. Aberrant genetic control of brain development and early environmental hazards are both implicated.
