Antecedents of schizophrenia and affective illness. Obstetric complications.

This exploratory study seeks to generate new hypotheses about the relationship between obstetric complications and schizophrenia. The British Perinatal Mortality Survey represents 98% of all births during one week in March 1958 in Great Britain. Present State Examination (PSE), Catego diagnoses of narrowly defined schizophrenia (n = 49), broadly defined schizophrenia (n = 79), affective psychosis (n = 44) and neurosis (n = 93) were derived from case notes for all cohort members. The remainder of the cohort, surviving the perinatal period, acted as controls (n = 16 812). Variables in the British Perinatal Mortality Survey were grouped into five categories: the physique/lifestyle of the mother (including demographic characteristics), her obstetric history, the current pregnancy, the delivery and the condition of the baby. There were 7/17 significant differences in maternal physique/lifestyle and obstetric history between the births of schizophrenics and controls, compared to 4/40 comparisons of somatic variables relating to pregnancy, birth and the condition of the baby. This compares with 4/17 and 7/40 for affective psychotics and a total of 4/57 differences for all categories of variables when neurotics were contrasted with controls. The purported increased risk of obstetric complications in schizophrenics may result from the physique/lifestyle of their mothers.

Sacker A ，Done DJ ，Crow TJ ，Golding J ... -  《BRITISH JOURNAL OF PSYCHIATRY》

Obstetric complications in children born to parents with schizophrenia: a meta-analysis of case-control studies.

On the basis of previous findings, we used meta-analyses to consider whether births to parents with schizophrenia have an increased risk of obstetric complications. Meta-analyses were based on published studies satisfying the following selection criteria. The schizophrenic diagnosis could apply to either parent: parents with non-schizophrenic psychoses were not included: only normal controls were accepted. In all, 14 studies provided effect sizes or data from which these could be derived. Studies were identified by data searches through MEDLINE, PSYCLIT and through references of papers relating to the subject. Births to individuals with schizophrenia incur an increased risk of pregnancy and birth complications, low birthweight and poor neonatal condition. However, in each case the effect size is small (mean r = 0.155; 95% CI = 0.057). The risk is greater for mothers with schizophrenia and is not confined to mothers with onset pre-delivery or to the births of the children who become schizophrenic themselves.

Sacker A ，Done DJ ，Crow TJ 《PSYCHOLOGICAL MEDICINE》

Obstetric complications and schizophrenia: a case control study based on standardised obstetric records.

There have been many reports of a higher incidence of 'obstetric complications' in the histories of schizophrenics than of controls, but because of the methodological shortcomings of most of these comparisons the relationship remains controversial. Comprehensive records covering all psychiatric hospital admissions and all hospital deliveries in Scotland since 1971 made it possible to identify the obstetric records of people born in 1971-74 who were subsequently admitted to hospital with a diagnosis of schizophrenia, and then to compare their standardised obstetric records with those of closely matched controls. One hundred and fifteen schizophrenic/control pairs were compared. The former showed a highly significant (P < 0.001) excess of complications of both pregnancy and delivery. In particular, there was a significant excess of pre-eclampsia (10 v. 2) and of infants detained in hospital for neonatal care (18 v. 6). The raised incidence of obstetric complications often reported in people with schizophrenia is genuine and probably contributes to the aetiology of the condition.

Kendell RE ，Juszczak E ，Cole SK 《BRITISH JOURNAL OF PSYCHIATRY》

Minor physical anomalies in schizophrenia and mood disorders.

The Waldrop Physical Anomaly Scale was used to assess the prevalence of minor physical anomalies in three groups: schizophrenia patients (n = 118), patients with mood disorders (n = 33), and normal controls (n = 31). Patients with schizophrenia had significantly more anomalies than controls. Patients with mood disorders did not have significantly different anomaly scores than schizophrenia patients or controls. Patients with tardive dyskinesia (TD) had significantly more anomalies than those without TD. Physical anomalies in the schizophrenia group were not found to be related to severity of psychopathology, age of onset, positive or negative schizophrenic symptoms, or socioeconomic status.

Lohr JB ，Flynn K 《SCHIZOPHRENIA BULLETIN》

Obstetric complications, treatment response and brain morphology in adult-onset and early-onset males with schizophrenia.

Substantial variability in age at onset of illness and course of illness exists between patients with schizophrenia. Recent studies suggest that age at illness onset may be useful in defining biologically and clinically distinct subgroups of patients. Two hundred and ten males with schizophrenia were classified as early-onset or adult-onset according to their age at first hospitalization. Birth history, clinical functioning and treatment response was assessed in a subgroup of patients. Brain anatomy was assessed from CT scans in all patients and in 32 non-psychiatric control subjects. Patients with an early-onset were likely to have a history of obstetric complications, a poor response to neuroleptic treatment, and showed no relationship between ventricle size and duration of illness. Adult-onset patients were less likely to have obstetric complications, more likely to respond to treatment in the first years of illness, and showed an association between brain structure and duration of illness. The distinction between early- and adult-onset patients may have important aetiological and treatment implications.

Smith GN ，Kopala LC ，Lapointe JS ，MacEwan GW ，Altman S ，Flynn SW ，Schneider T ，Falkai P ，Honer WG ... -  《PSYCHOLOGICAL MEDICINE》