Onset of functional psychoses in later middle age. Social-psychiatric considerations

The onset of functional psychosis occurring in later middle age (45-64 years) was studied by comparing the life situation and personal history of 74 Turku patients admitted to the mental hospital for the first time with the corresponding information obtained for randomly selected controls of the same age and of the same sex. The annual first admission rate of functional psychoses was 81 per 100,000; there was no difference between men and women. The rate was highest in unmarried individuals and lowest in married individuals (167 vs. 56 per 100,000). Measured by many different indicators, the patients' prepsychotic social development had been clearly poorer than that of the controls during the corresponding period. Almost all patients had had a precipitating life change during the last 5 years preceding the onset of psychosis. Objective losses had occurred more often in the group of affective psychoses than in the other diagnostic groups. In the case of childhood losses, on the other hand, there were no difference between patients and controls or between the diagnostic groups.