University of Oulu

Miettunen J., Immonen J., McGrath J.J., Isohanni M., Jääskeläinen E. (2019) The Age of Onset of Schizophrenia Spectrum Disorders. In: de Girolamo G., McGorry P., Sartorius N. (eds) Age of Onset of Mental Disorders. Springer, Cham.

The age of onset of schizophrenia spectrum disorders

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Author: Miettunen, Jouko1,2; Immonen, Johanna1,2; McGrath, John J.3,4;
Organizations: 1Center for Life Course Health Research, University of Oulu, PO Box 5000, 90014 Oulu, Finland
2Medical Research Center Oulu, Oulu University Hospital and University of Oulu, P.O. Box 5000, FIN-90014 Oulu, Finland
3Queensland Centre for Mental Health Research, a Queensland Brain Institute, University of Queensland, St Lucia, QLD 4072, Australia
4National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
5Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, P.O. Box 5000, FIN-90014 Oulu, Finland
6Department of Psychiatry, Oulu University Hospital, P.O. Box 26, FIN-90029 Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
Persistent link:
Language: English
Published: Springer, 2019
Publish Date: 2020-12-14


This chapter characterises the age of onset (AOO) of schizophrenia spectrum disorders and summarises findings regarding a range of clinical and social outcomes, cognition, brain structure and mortality. The peak AOO for schizophrenia spectrum disorders is between 20 and 29 years, during which the estimated incidence among males and females was 4.15 and 1.71 per 10,000 person-years, respectively. Male gender has been linked with earlier onset age, although corresponding gender differences do not exist among those with family history and cannabis use. Early-onset schizophrenia has been linked with, for example, higher familial risk, poor premorbid social adjustment and cannabis use. In adult samples, earlier AOO was associated with worse outcome regarding hospitalisations, negative symptoms, relapses, social and occupational functioning, and global outcome. Earlier onset has also been linked with more severe outcomes in childhood and adolescence schizophrenia. In addition, early AOO has been linked with larger cognitive deficits and brain alterations. In the few existing studies, later AOO has been linked with a higher suicide rate. In all, the current study found a number of differences between patients with a different AOO. However, the studies on AOO are relative heterogeneous in methodology and have provided varying results. More good-quality studies are needed that include patients without restriction on the onset age. AOO is an important characteristic of schizophrenia that could help when examining the origin, genetic mechanism and care of schizophrenia. Understanding factors that influence AOO in schizophrenia may offer clues to aid prevention of or delaying the onset of this debilitating group of disorders.

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ISBN: 978-3-319-72619-9
ISBN Print: 978-3-319-72618-2
Pages: 55 - 73
DOI: 10.1007/978-3-319-72619-9_4
Host publication: Age of onset of mental disorders : etiopathogenetic and treatment implications
Host publication editor: de Girolamo, Giovanni
McGorry, Patrick D.
Sartorius, Norman
Type of Publication: A3 Book chapter
Field of Science: 3124 Neurology and psychiatry
Funding: This work was supported by grants from the NARSAD: Brain and Behavior Research Fund and the Academy of Finland (#268 336, #278 286). The funders had no role in the manuscript.
Academy of Finland Grant Number: 268336
Detailed Information: 268336 (Academy of Finland Funding decision)
278286 (Academy of Finland Funding decision)
Copyright information: © Springer International Publishing AG, part of Springer Nature 2019. This is a post-peer-review, pre-copyedit version of an article published in Age of Onset of Mental Disorders. The final authenticated version is available online at