Sex differences, season of birth and platelet 5-HT levels in schizophrenic patients

Summary. Similar occurrence of schizophrenia was observed in men and women independent of their season of birth. Platelet 5-HT concentration was determined in 116 healthy control subjects (61 male and 55 female) and 152 patients with schizophrenia (96 male and 56 female). Platelet 5-HT concentration was significantly higher in male than in female healthy persons and schizophrenic patients. Male and female healthy subjects born in different seasons had similar platelet 5-HT concentrations, whereas schizophrenic patients with different birth-seasons had significantly different platelet 5-HT concentrations. The highest platelet 5-HT levels were observed in both male and female schizophrenic patients born in winter when compared to matched healthy controls. Male schizophrenic patients born in winter had higher platelet 5-HT levels than schizophrenic men born in spring and summer. Female schizophrenic patients born in winter had higher platelet 5-HT than schizophrenic women born in all other seasons. These results indicated sex differences in platelet 5-HT levels in healthy persons and schizophrenic patients. The relationship between season of the birth and platelet 5-HT concentration observed only in schizophrenic patients added further support to the presumption that schizophrenia is connected with a disturbance in the central serotoninergic system. Received January 26, 1998; accepted September 18, 1998     

Do children of parents with mental illness have lower survival rate? A population-based study

Objective

The objective of this study was to investigate the incidence of mortality risk among children of parents with mental illness.

Method

The study sample comprised all women giving birth in Taiwan between 1999 and 2001; the dataset was created by linking birth certificate, death certificate, and National Health Insurance research databases. The deaths of the subjects were classified into 5 groups: stillbirths, early neonatal death, late neonatal death, postneonatal death, and early childhood death. A Cox proportional hazard regression was then performed on a pooled 3-year population-based dataset to examine the relationship between parental mental status and survival rates for children younger than 3 years, with the crude and adjusted hazard ratios (HRs) being calculated.

Results

Around 2316 affected children were compared with a general population of 605?107. No stillbirths were observed among any children of parents with schizophrenia or affective disorder. Mothers with affective disorder are prone to higher risk of child death, with a crude HR of 4.86 (95% confidence interval, 3.06-7.73), and a reduced adjusted HR of 3.51 (95% confidence interval, 2.22-5.57). However, fathers with affective disorder played no role. Children born to schizophrenic women have a significant higher risk of child death with a crude HR of 2.47, whereas those born to schizophrenic fathers have a similarly high risk with a crude HR of 2.69.

Conclusion

A focus needs to be placed on the identification and treatment of parental schizophrenia and affective disorder through antenatal and postnatal intervention, so as to reduce mortality risks for children exposed to risk during their first 3 years of life.     

Early indicators of developmental risk: Rochester Longitudinal Study

Early indicators of schizophrenic outcomes were sought in a group of children of chronically ill schizophrenic women. A sample of pregnant women with varying degrees of mental illness were examined during the perinatal period and recruited into a 4-year longitudinal evaluation, which included cognitive, psychomotor, social, and emotional assessments at birth, 4, 12, 30, and 48 months of age. The mothers varied on mental health dimensions of diagnosis, severity of symptomatology, and chronicity of illness. Other factors included in the analyses were socioeconomic status (SES), race, sex of child, and family size. Hypotheses were tested to determine the relative impact of three sets of variables on the child's behavior: (1) specific maternal psychiatric diagnosis, (2) severity and chronicity of disturbance independent of diagnosis, and (3) general social status. We found that a specific maternal diagnosis of schizophrenia had the least impact. Neurotic-depressive mothers produced worse development in their children than schizophrenic or personality-disordered mothers. Both social status and severity/chronicity of illness showed a greater impact on development. Children of more severely or chronically ill mothers and lower-SES black children performed most poorly. These results do not support etiological models based on simple biological or environmental transmission of schizophrenia. The role of social and family environmental factors in predicting child cognitive and social-emotional competence was further evaluated using a multiple risk index. Children with high multiple environmental risk scores had much worse outcomes than children with low multiple risk scores.     

Platelet monoamine-oxidase activity in schizophrenia. Relation to genetic load of the illness and treatment with antipsychotic drugs

A significant decrease of mean platelet monoamine-oxidase (MAO) activity was observed in a sample of haloperidol-treated schizophrenic patients as compared with normal control subjects. The enzyme activity was not significantly reduced in drug-free schizophrenics. No significant difference was found between drug-free schizophrenics with and without a family history of the illness and between healthy relatives of schizophrenics and normal subjects without a family history of schizophrenia. MAO activity was significantly reduced after 14 and 21 days of treatment with haloperidol, in comparison with baseline values. It is suggested that neuroleptic intake may at least in part explain low MAO values repeatedly reported in schizophrenics.     

Winter birth and biological family history in adopted schizophrenics

To investigate relationships between birth season and biological family history in schizophrenia, this study used a sample of schizophrenics that had the advantages of (a) particularly thorough diagnostic assessments of schizophrenics' relatives, including information from direct interviews as well as chart reviews, and (b) schizophrenic probands who were adopted at early age, mitigating the usual confounding of genetic and postnatal environmental influences of the family. Adopted schizophrenics with no biological family history of schizophrenia-spectrum disorders were significantly more likely to be born in winter months than were either (a) their own biological relatives, including their sibs and half-sibs, (b) schizophrenics with a positive family history for schizophrenia-spectrum disorders, or (c) people in the general population. Family-history-positive schizophrenics and their schizophrenic relatives were, in turn, significantly less likely than their own non-schizophrenic biological relatives to be born in the winter; schizophrenics in these families tended to be born in the milder-weather seasons, particularly the spring and fall. Results suggest that environmental factors associated with winter birth may be etiologically important in schizophrenia, particularly for cases in which familial liability factors are weak. By contrast, a familial, probably genetic, liability factor may be especially important in schizophrenics born in mild weather.     

P300 abnormality in schizophrenic subtypes

P300 and other long latency event-related potentials were recorded in 65 schizophrenic subjects and results were compared to findings in 119 healthy controls. Highly significant differences in P300 latency and amplitude were found between the two groups. Forty six per cent of schizophrenics had P300 latency more than two standard deviations longer than the mean for controls, 35% had a P300 amplitude smaller than the mean for controls by the same amount, and 24% were more than two standard deviations outside the mean for controls on both measures. These differences were independent of chronicity of illness, clinical subtype, family psychiatric history or the effects of neuroleptic medication. They confirm that P300 abnormality is present as a stable trait in a high proportion of schizophrenics. The status of abnormal P300 as a biological vulnerability factor for major mental illness is discussed.     

Season of birth among siblings of schizophrenics

Many studies have shown schizophrenics to be born with unusual frequency in the period January-April, and one interpretation of this seasonality of birth is that the parents of schizophrenics have an unusually strong general tendency to conceive offspring who will be born in January-April. This parental conception habits interpretation may be tested by studying whether the siblings of schizophrenics are also born with increased frequency in January- April. The present study investigated the season of birth of 288 full siblings and 44 half-siblings in 91 families of male schizophrenics. Approximately 5 % of the siblings were known to be schizophrenic; with the schizophrenic siblings excluded from the analyses, the full siblings showed a birth pattern much closer (nonsignificant) to that of the schizophrenics than to that of the general population. Half siblings showed January-April birth rates at or below the population level. Although the mechanisms responsible for the current results still remain unclear, the study suggests that seasonality of births of schizophrenics may be related to the parents' conception habits as well as to an etiological or triggering effect on the development of schizophenia in the offspring.     

Seasons of birth and psychiatry. A retrospective inpatients study

Births of schizophrenics tend to occur more often than expected during the first months of the year. This phenomenon has been repeatedly demonstrated in large samples of patients, but data from France are not yet available. METHOD. Medical records of 2,215 inpatients born in France, have been studied with DSM III-R. Admissions were unduplicated. Inpatient population is described table I. The 230 schizophrenic patients were also classified into three groups according with family history for psychotic diseases (Positive, Negative and Unknown). The year was divided in quarters, but also in two climatic half-years (Cold and Warm). Two different populations were used as controls: first, the live births data in France collected by the INSEE; and second, the 1726 non psychotic inpatients hospitalised in the same unit as the psychotics, during the same period. RESULTS. The season of birth effect can be demonstrated from our sample. When the whole schizophrenic group is compared to the INSEE data, a significant excess of births is found for the winter quarter (p less than .04) and for the cold half-year (p less than .01). In the DSM III-R disorganized patients the seasonal variation becomes significant at a level of p less than .001. The other subtypes of schizophrenia do not show significant seasonal variations (table II). The pattern of birth of the other DSM III-R diagnoses, does not significantly differ from INSEE control data (table III). Schizophrenic patients without psychiatrically ill relatives show a slight, non significant excess of births in winter which become significant for the cold half-year (p less than .03). Subjects with possible family history do not show any trend suggesting a seasonal effect (table IV). DISCUSSION. Few reports include an entire inpatient population as we have done. Such data in our study offers an element of useful comparison with the schizophrenics. Clinic data: Most of seasonal studies have used ICD-8, ICD-9 or Tsuang and Winokur criteria, to compare only paranoid and non paranoid subjects, and some of them found a very small excess of paranoid births in winter. The discrepancies between these studies and ours, can reflect both variability among environmental factors and variability in the diagnostic criteria. Control data: Most of the subjects were born between 1920 and 1960. All live births in France for the same years could be used as controls, but unfortunately INSEE data were not available by months or quarters before 1949. But since in western and southern European general population, the season of birth appears to be relatively uniform and stable over time, it seemed possible to use the posterior INSEE data to compare with our anterior inpatients data. Familial data: We found a birth excess in the cold season, only for schizophrenics without any family history. This finding is consistent with various other reports. CONCLUSION. In conclusion, our findings are consistent with the suggestion that the season of birth is important in the aetiology of the disorganized subgroup of schizophrenic aetiology of the disorganized subgroups of schizophrenic patients. Moreover, the excess of winter births is only observed in the "negative family history" group.     

A brief test for measuring malingering in schizophrenic individuals

The M Test, a brief test for measuring malingering of schizophrenic illness, contains true-false items describing actual symptoms of schizophrenia, bizarre attitudes and beliefs, and fake symptoms. Normal subjects rarely endorsed any of the items. The responses of genuinely ill schizophrenic inpatients were compared with those of normal subjects who had been asked to fake malingering after being educated about the symptoms of schizophrenia and forewarned about the purpose of the test. The test significantly discriminated between genuinely ill patients and malingerers. The test correctly identified 87.3% of the schizophrenic subjects and 78.2% of the malingering normal subjects.     

The sequestration of [3H]spiperone by lymphocytes in schizophrenics and their first-degree relatives: a limited vulnerability marker?

The sequestration of [3H]spiperone by lymphocytes was studied in preserved cells obtained from 22 schizophrenic subjects and 40 of their relatives, and the results were compared with those obtained from 25 healthy control subjects. Mean displaceable sequestration values, obtained from measurements made at a single radioligand concentration (1nM) which optimised the relative contribution of "high affinity" sequestration, were found to be similar for all groups of subjects. Furthermore, displaceable spiperone sequestration was abnormally high in only a small proportion of the schizophrenics (13.6%) and their relatives (5%). There was no evidence that either exposure to neuroleptic medication or duration of illness had an effect on sequestration values. The results suggest that, at least until the required experimental conditions are better established, [3H]spiperone sequestration by lymphocytes does not offer a useful vulnerability marker for schizophrenia.     

A new look at delusions of grandeur

Delusions of grandeur were explored by chart review. Seventy-six percent of manics and 40% of schizophrenics studied demonstrated these delusions. Male patients with schizophrenia and delusions of grandeur were ill an average of 0.86 years longer than patients without grandiose delusions. The author suggests that in male schizophrenics these delusions may indicate advanced illness. The author proposes a subtyping of delusions of grandeur into ability. role, and identity. Grandiose ability was the most common, found in all manics and 74% of schizophrenics. The author explores the relation of subtypes to duration of illness, birth order, and sex in mania and schizophrenia.     

Antenatal and delivery risk factors and prevalence of cerebral palsy in Duzce (Turkey)

This cross-sectional study aimed at investigating the prevalence and the etiological factors of cerebral palsy (CP) and comparing them with normal population within the rural and urban areas of Duzce province. Of the 102 children with cerebral palsy, 98 were associated with antenatal and delivery risk factors. The mean crude prevalence of cerebral palsy was 1.1 per 1000 live births. The children with CP were compared with 530 control subjects. The mothers of the children with cerebral palsy were significantly younger than the mothers of children in control group, and they had less parity and abortion. Preeclampsia, premature rupture of membranes, home births, prolonged labor, and twin pregnancies were significantly more common in the mothers of children with cerebral palsy, where no significant differences were found between the groups in terms of breech delivery, rate of cesarean births, gestational diabetes, and hemorrhage in late pregnancy. Birth asphyxia, liqueur with meconium stained, prolonged jaundice and neonatal seizure were also significantly more common in the group with cerebral palsy. Of the children with cerebral palsy, 78% were born at term, 20% were born with gestational ages of 32-36 weeks, 2% were born with gestational ages of 30-31 weeks. Nine percent of those children had a birth weight of >or= 3000 g, 12.2% had a birth weight of 2500-2999 g, 33.7% had a birth weight of 1500-2499 g, and 5.1% had a birth weight of 相似文献   

Seasonality of birth and ventricular enlargement in chronic schizophrenia

Many studies have established that birth dates during the winter and early spring months are more common in schizophrenic patients than in the general population. It has been hypothesized that children born in winter are more likely to be exposed to environmental factors which could lead to the development of schizophrenia later in life. Another finding of interest has been the demonstration in brain-imaging studies that mild ventricular enlargement is more often found in schizophrenic patients than in healthy control subjects. In the present report, an increased incidence of ventricular enlargement was found in schizophrenic patients born in the winter months. Although the relationship between seasonality of birth and brain abnormalities is unclear, these phenomena could be partly linked.     

Familial aspects of CT scan abnormalities in chronic schizophrenic patients

To investigate the possibility that lateral cerebral ventricular size may be under genetic control, we compared the computed tomography (CT) scans of 17 healthy siblings from 7 normal sibships. The CT scans of 10 chronic schizophrenic patients and 12 of their nonschizophrenic siblings were also compared. A trend was found for a correlation of ventricular size between siblings in the healthy sibships (ICC = 0.25, p = 0.1) but not in the schizophrenic sibships (ICC = -0.05). In each sibship the schizophrenic patient had the largest ventricles; in seven cases they exceeded the normal range. Although the discordant siblings were all well within the normal range, their ventricles were larger (p = 0.001) than those of the controls. The findings suggest a genetic component to ventricular size in healthy individuals and that CT findings in schizophrenics are not coincidental familial traits but markers of the illness. The implications of the findings in the discordant siblings are discussed.     

The lifetime risk of suicide in schizophrenia: a reexamination

BACKGROUND: The psychiatry literature routinely quotes a lifetime schizophrenia suicide prevalence of 10% based on 1 meta-analysis and 2 studies of chronic schizophrenics. OBJECTIVES: To build a methodology for extrapolating lifetime suicide prevalence estimates from published cohorts and to apply this approach to studies that meet inclusion criteria. DATA SOURCES: We began with a MEDLINE search (1966-present) for articles that observed cohorts of schizophrenic patients. Exhaustive bibliography searching of each identified article brought the total number of articles reviewed to 632. STUDY SELECTION: Studies included in the meta-analysis observed a cohort of schizophrenic patients for at least 2 years, with at least 90% follow-up, and reported suicides. Articles are excluded for systematic age bias (ie, adolescents). DATA EXTRACTION: Extracted data included sample size, number of deaths, number of suicides, percentage of follow-up, and diagnostic system used. Data were extracted independently by 2 of us, and differences were resolved by consensus after re-review. DATA SYNTHESIS: Studies were divided into 2 groups: 32 studies of schizophrenics enrolled at various illness points (25 578 subjects) and 29 studies of schizophrenics identified at either illness onset or first admission (22 598 subjects). Regression models of the intersection of proportionate mortality (the percentage of the dead who died by suicide) and case fatality (the percentage of the total sample who died by suicide) were used to calculate suicide risk in each group. The estimate of lifetime suicide prevalence in those observed from first admission or illness onset was 5.6% (95% confidence interval, 3.7%-8.5%). Mixed samples showed a rate of 1.8% (95% confidence interval, 1.4%-2.3%). Case fatality rates showed no significant differences when studies of patients diagnosed with the use of newer systems were compared with studies of patients diagnosed under older criteria. CONCLUSION: This study estimates that 4.9% of schizophrenics will commit suicide during their lifetimes, usually near illness onset.     

Facial affect recognition in the course of schizophrenia

Deficits in facial affect recognition have been shown repeatedly in schizophrenia. However, the stability of this deficit over time remains to be clarified. A total of 36 remitted, 32 acutely ill schizophrenic patients and 21 healthy volunteers participated in a cross-sectional and longitudinal study. All subjects were assessed twice within 4 weeks (acute schizophrenics and normal controls), or 12 weeks, respectively (remitted schizophrenics). Subjects had to identify six basic emotions from corresponding facial expressions shown as photographs on a video screen. Both acute and remitted schizophrenics demonstrated a stable deficit over time in facial affect recognition unrelated to psychopathology and medication. This suggests that deficits in facial affect recognition in schizophrenia reflect a trait-like, rather than a state-dependent, characteristic.     

A comparison of plasma homovanillic acid concentrations in schizophrenic patients and normal controls

Plasma homovanillic acid concentrations, a potential index of central dopamine turnover, were examined in normal control subjects and chronic schizophrenic patients over a 12-hour period, including the period of sleep. Plasma homovanillic acid concentrations were lower in schizophrenic patients compared with normal controls at all times; however, within the group of schizophrenics, the more symptomatic patients had higher plasma homovanillic acid concentrations than the less severely ill patients. These data are consistent with a more complex role of dopamine in schizophrenia than was previously conceptualized.     

Month of birth and schizophrenia in Alberta

Numerous studies have demonstrated that a greater than expected number of schizophrenics are born during the winter months. The present investigation examined this phenomenon in Alberta. The study population consisted of 1,101 schizophrenic patients admitted to either of the two provincial mental hospitals during 1976-1983 and who were born in Canada. After controlling for year of birth, no seasonality effect was found.     

Vitamin C status in chronic schizophrenia

Schizophrenic patients on the same hospital diet as control group subjects had significantly lower levels of fasting plasma vitamin C (p less than 0.05) and 6-hr urinary vitamin C excretion after an ascorbic acid load test (p less than 0.01). After administration of 70 mg of ascorbic acid for 4 weeks there was no longer any difference in plasma vitamin C levels between schizophrenics and control group subjects, but the urinary vitamin C excretion after the vitamin C loading test remained significantly lower in schizophrenics (p less than 0.05). The administration of 1 g ascorbic acid for 4 weeks, in addition to eliminating differences in the plasma vitamin C level, also increased the urinary vitamin C excretion of schizophrenic patients to the level of the control group subjects. The results of this study are in agreement with the hypothesis that schizophrenic patients require higher levels of vitamin C than the suggested optimal ascorbic acid requirement for healthy humans.     

Season of birth and obstetrical complications in schizophrenics

Many studies indicate that both obstetrical complications (OCs) and birth in winter or early spring are risk factors for schizophrenia, but few studies have examined how these risk factors covary in the same subjects. We assessed pre- and perinatal OCs, while blind to diagnosis, using medical data recorded at the time of subjects' births, in 29 probands with DSM-III schizophrenia or schizoaffective disorder and 39 of their unaffected adult sibs. Pre- and perinatal OCs were both significantly more common in probands than sibs. Schizophrenics not born during the winter or early spring had significantly more total and perinatal OCs than schizophrenics born in other months, but did not differ for prenatal OCs. Results indicate that OCs increase risk for schizophrenia, but also suggest the possibility that the impact of OCs on this risk may be affected by season of birth.