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Infant feeding and tile development of schizophrenia
2SS
77-' In utero exposure to influenza has been implicated as a risk factor for developmental CNS damage. This study hypothesises that in utero exposure to influenza (I) in the second gestational trimester is associated with an increased risk of schizophrenia and affective psychoses, (2) in the first gestational trimester is associated with an increased risk of intellectual handicap, and (3) in any gestational trimester is not be associated with an increased risk of neurotic depression. Analysis was confined to cases on the WA Mental Health Information System with an lCD-9 diagnosis of schizophrenia (N = 1186), affective psychoses (N = 1344) or neurot ic depression (N = 1402), and to cases on the Intellectual Handicap Register with selected Heber diagnoses (N=1233). All cases were born in WA between 1~50 and 1960. The number of births in WA for the same penod was 177529. Our results provide qualified support for the hypotheses. Second trimester exposure increased the .risk .of schizophrenia and affectivepsychosesfor some of the epidemics studied. Risk of intellectual handicap was increased for males following exposure to some epidemics, an effect which was not restricted to first trimester exposure. Our results suggest that in utero exposure to influenza may involve a neurodevelopmental insult increasing the risk of CNS disorders.
"')i" WHAT CAN WE LEARN FROM THE EPJDEMIC OF SCHIZOPHRENIA IN AFRICAN-CARIBBEANS IN THE UK?
A PROSPECTIVE STUDY OF SUBSTANCE USE DISORDERS IN A SAMPLE OF PATIENTS WITH SCHIZOPHRENIA R. Mark Newman, Peg Nopoulos, Sue Oliver, Nancy C . Andreasen Mental Health Clinical Research Center. The University of Iowa Hospital and Clinics 191/ J P P, College of Medicine, Department of Psychiatry, Iowa City, IA 51241, USA
Numerous studies have revealed that substance use disorders occur frequently in schizophrenic patients . However, fewstudies have prospectively examined the course of substance use disorders in this population. We studied a group of 6S patients who were first episode or recent onset psychosis. We examined the rate and stability of comorbid substance use disorders in these patients over fiveyears. Weassessed two categor ies of substance use disorders: substance abuse and substance dependence. At intake 32.3% had a lifetime history of a substance use disorder . In contrast, there were only 7.7"1" with a current substance use disorder. At 24 months. the rate of current substance use disorder was 1.5%, and at 60 months the rate was I.S%. These findings suggest that, in this rural Iowa sample, despite a significant past history of substance use disorders, the rates of substance use disorders over time in first episode and recent onset patients were low. The data also suggest a pattern of substance disorder that is associated with the early phase of the illness or antedates it. but that remits as the psychotic illness becomes more chronic.
Robin M . Murray, Gerard Hutchinson, Kwame McKenzie, Jim van Os Department of Psychological Medicine, Institute of Psychiatry, London SE58AF, UK
Twelve epidemiological studies, including two of our own, have shown that African-Caribbeans living in Britain have ares of schizophrenia 4-8 times that of the rest of the popula~ion. We found that schizomanicpresentations were particularly common, and, over a four year follow-up, African-Caribbean psychotic patients were less likely than white patients to have a chronic illness. Rates of schizophrenia are not elevated in the Caribbean, and the parents of African-Caribbean schizophrenics in the UK have similar risks to their white counterparts. However. the siblings of second generation African-Caribbean schizohrenics in the UK have risks 6 times higher than those of the ~blings of white schizophrenics. These findings suggest an environmental factor operating, particularly on the second generation, We have found that African-Caribbean schizophrenics show fewer neurological signs or childhood problems than white patients, and fewer h~ve a his.tory of obstet~c c~mplications. However, like the Afncan-Canbbean population 10 the UK as a whole. they show much evidence of social disadvantage. Perhaps this plays a precipitating role in susceptible families.
"2f' INFANT FEEDING AND TIlE DEVELOPMENT OF SCHIZOPHRENIA • Malcolm Peet, Jacqui Poole, Jon Laugharne Department of Psychiatry, University of Sht!jJie/d. Northern General Hospital, Sheffield S5 7A U, UK
There arc data to suggest that long chain polyunsaturated fatty acids which are present in breast milk but not in most formula milks may play an important role in early brain development. We have conducted a case control study of breast feeding versus formula feeding in schizophrenic patients, !is patients (47 M, 8 F; mean - 34 yrs) meeting DSM IV diagnostic criteria for schizophrenia were matched for age, sex and socioeconomic group to 55 non psychiatric controls. The mother of each patient and control subject was interviewed in regard to the way the individual had been fed as an infant . In the patient group 33 (60%) were breast fed compared to 43 (78%) in the control group (p - 0.033). Further analysis of which individuals were breast fed for more than four weeks gave 24 (44%) in the schizophrenic group and 37 (67%) in the control group (p_ 0.020). The possibility arises from these data that breast feeding
256
is a protective factor against the future development of schizophrenia.
7l~ COMORBID SUBSTANCE MISUSE AMONG PEOPLE WITH SCHIZOPHRENIA IN THE COMMUNITY: AN EPIDEMIOLOGICAL STUDY IN CENTRAL LONDON Mike A. McPhillips, Peter Duke, Christos Pantelis, Thomas R.E. Barnes Department of Psychiatry, Charing Cross and Westminster Medical School, St Dunstan's Road. London W68RF. UK
Despite the reported association between illegal drug use and worse clinical and social outcomes in patients with schizophrenia, only scant data are available regarding the extent of comorbid drug and alcohol use among community patients with this condition in the UK. Similarly, little is known about the patterns of drug use and risk factors for a dual diagnosis of substance use in such individuals. Further, the nature of the relationship between substance use, the symptoms of schizophrenia, the side-effects of antipsychotic medication and treatment compliance is poorly understood. Three hundred and fifty-two individuals with schizophrenia, schizoaffective psychosis or paranoid psychosis were identified in a census survey of the South Westminster area of inner London. The assessment of each patient included ratings of mental state, movement disorder and social behaviour, and questioning about drug and alcohol use. Fifty-two (15%) subjects reported a lifetime history of substance use, excluding alcohol. Statistically significant and interacting predictors of increased self-report of substance misuse were being under 36 years old, male gender and African or Afro-Caribbean ethnic origin. The findings also provided some limited support for the self-medication hypothesis in that there was a significant association between parkinsonism and reported substance use in young males.
71() SUICIDAL BEHAVIOR BEFORE THE FIRST HOSPITALIZATION IN PSYCHOTIC DISORDERS Elizabeth D. Radomsky, Gretchen L. Haas, Matcheri S. Keshavan, John A. Sweeney Department of Psychiatry, University ofPittsburgh Medical Center, Pittsburgh. PA /52/7
Among individuals with schizophrenia, approximately 10% die by suicide. Previous work by our group has shown that 60% of psychotic patients endorsed one or more episodes of significant suicidal ideation and/or a suicide attempt at some point in their lifetime. Among these, half(30%) reported having made a suicide attempt. Previous studies of suicidal behavior among psychotic patients have been confounded by the failure
to identify a patient cohort that is homogeneous with respect to stage of illness and/or treatment. 105 consecutive psychotic inpatient admissions to the Western Psychiatric Institute and Clinic who were experiencing their first psychiatric hospitalization were evaluated using the SCID, BPRS, SAPS, SANS, and HAMD. The sample included 21 subjects (20%) with DSMIII-R affective psychoses, 56 (53%) with a Schizophrenia or Schizophreniform Disorder, 14 (l3%) with SchizoatTective Disorder, and 14 (13%) with another non-affective psychotic disorder (Delusional Disorder or Psychotic Disorder NOS). Twenty (19%) subjects had a history of a suicide attempt prior to their first admission (7 of these attempts were within one month of their admission), and 17 (16%) reported suicidal ideation at the time of admission. The highest rates of both suicidal ideation and attempts were among patients with a diagnosis of Schizoaffective Disorder or Delusional Disorder and Psychotic Disorder NOS combined (,X2 = 13.12, dJ. = 6, p < .05). Patients with a history of a suicide attempt were approximately 15.68 times more likely to have experienced an episode of major depression over their lifetime (O.R. = 15.68, ,X2= 16.11, d.f, = 1. p< .00(1) than were those without a history of attempts. Suicide attempters were younger (p < .(5) and more severely depressed on admission as rated on the HAM-D (p<.OOOI); non-attempters received higher ratings for delusions and bizarre behavior (p < .(5). Results suggest a high prevalence of suicidal thoughts and behaviors independent of the stage of psychotic illness.
711 SCHIZOPHRENIA, ALCOHOL ABUSE AND VIOLENT BEHAVIOUR
A 26-yearfollow-up study of an unselected birth cohort Pirkko Rasanen, Jari Tiihonen, Matti Isohanni, Paula Rantakallio, Jari Lehtonen, Juha Moring Department ofForensic Psychiatry, University ofKuopio, ' Niuvanniemi Hospital
It has been suggested that schizophrenia and alcoholism are associated with violent behavior, but so far there are no published qualitative data from unselected cohorts quantifying the actual risk associated with schizophrenia with and without co-morbid alcoholism. In this study, an unselected birth cohort (n = 11(17) was prospectively followed up to the age of 26 years and data on psychiatric disorders and crimes were collected from national registers. The odd ratios for violent offences and recidivism were calculated for each diagnostic group. Men with alcohol abuse and schizophren!a were .25.2 (95% CI 6.1-97.5) times more likely to commit vlole~t ~es than mentally healthy men. The risks for non-alcoholic sc~o phrenics were 3.6% (95% CI 0.9-12.3). None of the ~'hizO phrenics without alcohol abuse were recidivists. The risk for recidive crimes among alcoholic schizophrenics was 9.S-fold (95% CI 2.7-30.0).
77-' In utero exposure to influenza has been implicated as a risk factor for developmental CNS damage. This study hypothesises that in utero exposure to influenza (I) in the second gestational trimester is associated with an increased risk of schizophrenia and affective psychoses, (2) in the first gestational trimester is associated with an increased risk of intellectual handicap, and (3) in any gestational trimester is not be associated with an increased risk of neurotic depression. Analysis was confined to cases on the WA Mental Health Information System with an lCD-9 diagnosis of schizophrenia (N = 1186), affective psychoses (N = 1344) or neurot ic depression (N = 1402), and to cases on the Intellectual Handicap Register with selected Heber diagnoses (N=1233). All cases were born in WA between 1~50 and 1960. The number of births in WA for the same penod was 177529. Our results provide qualified support for the hypotheses. Second trimester exposure increased the .risk .of schizophrenia and affectivepsychosesfor some of the epidemics studied. Risk of intellectual handicap was increased for males following exposure to some epidemics, an effect which was not restricted to first trimester exposure. Our results suggest that in utero exposure to influenza may involve a neurodevelopmental insult increasing the risk of CNS disorders.
"')i" WHAT CAN WE LEARN FROM THE EPJDEMIC OF SCHIZOPHRENIA IN AFRICAN-CARIBBEANS IN THE UK?
A PROSPECTIVE STUDY OF SUBSTANCE USE DISORDERS IN A SAMPLE OF PATIENTS WITH SCHIZOPHRENIA R. Mark Newman, Peg Nopoulos, Sue Oliver, Nancy C . Andreasen Mental Health Clinical Research Center. The University of Iowa Hospital and Clinics 191/ J P P, College of Medicine, Department of Psychiatry, Iowa City, IA 51241, USA
Numerous studies have revealed that substance use disorders occur frequently in schizophrenic patients . However, fewstudies have prospectively examined the course of substance use disorders in this population. We studied a group of 6S patients who were first episode or recent onset psychosis. We examined the rate and stability of comorbid substance use disorders in these patients over fiveyears. Weassessed two categor ies of substance use disorders: substance abuse and substance dependence. At intake 32.3% had a lifetime history of a substance use disorder . In contrast, there were only 7.7"1" with a current substance use disorder. At 24 months. the rate of current substance use disorder was 1.5%, and at 60 months the rate was I.S%. These findings suggest that, in this rural Iowa sample, despite a significant past history of substance use disorders, the rates of substance use disorders over time in first episode and recent onset patients were low. The data also suggest a pattern of substance disorder that is associated with the early phase of the illness or antedates it. but that remits as the psychotic illness becomes more chronic.
Robin M . Murray, Gerard Hutchinson, Kwame McKenzie, Jim van Os Department of Psychological Medicine, Institute of Psychiatry, London SE58AF, UK
Twelve epidemiological studies, including two of our own, have shown that African-Caribbeans living in Britain have ares of schizophrenia 4-8 times that of the rest of the popula~ion. We found that schizomanicpresentations were particularly common, and, over a four year follow-up, African-Caribbean psychotic patients were less likely than white patients to have a chronic illness. Rates of schizophrenia are not elevated in the Caribbean, and the parents of African-Caribbean schizophrenics in the UK have similar risks to their white counterparts. However. the siblings of second generation African-Caribbean schizohrenics in the UK have risks 6 times higher than those of the ~blings of white schizophrenics. These findings suggest an environmental factor operating, particularly on the second generation, We have found that African-Caribbean schizophrenics show fewer neurological signs or childhood problems than white patients, and fewer h~ve a his.tory of obstet~c c~mplications. However, like the Afncan-Canbbean population 10 the UK as a whole. they show much evidence of social disadvantage. Perhaps this plays a precipitating role in susceptible families.
"2f' INFANT FEEDING AND TIlE DEVELOPMENT OF SCHIZOPHRENIA • Malcolm Peet, Jacqui Poole, Jon Laugharne Department of Psychiatry, University of Sht!jJie/d. Northern General Hospital, Sheffield S5 7A U, UK
There arc data to suggest that long chain polyunsaturated fatty acids which are present in breast milk but not in most formula milks may play an important role in early brain development. We have conducted a case control study of breast feeding versus formula feeding in schizophrenic patients, !is patients (47 M, 8 F; mean - 34 yrs) meeting DSM IV diagnostic criteria for schizophrenia were matched for age, sex and socioeconomic group to 55 non psychiatric controls. The mother of each patient and control subject was interviewed in regard to the way the individual had been fed as an infant . In the patient group 33 (60%) were breast fed compared to 43 (78%) in the control group (p - 0.033). Further analysis of which individuals were breast fed for more than four weeks gave 24 (44%) in the schizophrenic group and 37 (67%) in the control group (p_ 0.020). The possibility arises from these data that breast feeding
256
is a protective factor against the future development of schizophrenia.
7l~ COMORBID SUBSTANCE MISUSE AMONG PEOPLE WITH SCHIZOPHRENIA IN THE COMMUNITY: AN EPIDEMIOLOGICAL STUDY IN CENTRAL LONDON Mike A. McPhillips, Peter Duke, Christos Pantelis, Thomas R.E. Barnes Department of Psychiatry, Charing Cross and Westminster Medical School, St Dunstan's Road. London W68RF. UK
Despite the reported association between illegal drug use and worse clinical and social outcomes in patients with schizophrenia, only scant data are available regarding the extent of comorbid drug and alcohol use among community patients with this condition in the UK. Similarly, little is known about the patterns of drug use and risk factors for a dual diagnosis of substance use in such individuals. Further, the nature of the relationship between substance use, the symptoms of schizophrenia, the side-effects of antipsychotic medication and treatment compliance is poorly understood. Three hundred and fifty-two individuals with schizophrenia, schizoaffective psychosis or paranoid psychosis were identified in a census survey of the South Westminster area of inner London. The assessment of each patient included ratings of mental state, movement disorder and social behaviour, and questioning about drug and alcohol use. Fifty-two (15%) subjects reported a lifetime history of substance use, excluding alcohol. Statistically significant and interacting predictors of increased self-report of substance misuse were being under 36 years old, male gender and African or Afro-Caribbean ethnic origin. The findings also provided some limited support for the self-medication hypothesis in that there was a significant association between parkinsonism and reported substance use in young males.
71() SUICIDAL BEHAVIOR BEFORE THE FIRST HOSPITALIZATION IN PSYCHOTIC DISORDERS Elizabeth D. Radomsky, Gretchen L. Haas, Matcheri S. Keshavan, John A. Sweeney Department of Psychiatry, University ofPittsburgh Medical Center, Pittsburgh. PA /52/7
Among individuals with schizophrenia, approximately 10% die by suicide. Previous work by our group has shown that 60% of psychotic patients endorsed one or more episodes of significant suicidal ideation and/or a suicide attempt at some point in their lifetime. Among these, half(30%) reported having made a suicide attempt. Previous studies of suicidal behavior among psychotic patients have been confounded by the failure
to identify a patient cohort that is homogeneous with respect to stage of illness and/or treatment. 105 consecutive psychotic inpatient admissions to the Western Psychiatric Institute and Clinic who were experiencing their first psychiatric hospitalization were evaluated using the SCID, BPRS, SAPS, SANS, and HAMD. The sample included 21 subjects (20%) with DSMIII-R affective psychoses, 56 (53%) with a Schizophrenia or Schizophreniform Disorder, 14 (l3%) with SchizoatTective Disorder, and 14 (13%) with another non-affective psychotic disorder (Delusional Disorder or Psychotic Disorder NOS). Twenty (19%) subjects had a history of a suicide attempt prior to their first admission (7 of these attempts were within one month of their admission), and 17 (16%) reported suicidal ideation at the time of admission. The highest rates of both suicidal ideation and attempts were among patients with a diagnosis of Schizoaffective Disorder or Delusional Disorder and Psychotic Disorder NOS combined (,X2 = 13.12, dJ. = 6, p < .05). Patients with a history of a suicide attempt were approximately 15.68 times more likely to have experienced an episode of major depression over their lifetime (O.R. = 15.68, ,X2= 16.11, d.f, = 1. p< .00(1) than were those without a history of attempts. Suicide attempters were younger (p < .(5) and more severely depressed on admission as rated on the HAM-D (p<.OOOI); non-attempters received higher ratings for delusions and bizarre behavior (p < .(5). Results suggest a high prevalence of suicidal thoughts and behaviors independent of the stage of psychotic illness.
711 SCHIZOPHRENIA, ALCOHOL ABUSE AND VIOLENT BEHAVIOUR
A 26-yearfollow-up study of an unselected birth cohort Pirkko Rasanen, Jari Tiihonen, Matti Isohanni, Paula Rantakallio, Jari Lehtonen, Juha Moring Department ofForensic Psychiatry, University ofKuopio, ' Niuvanniemi Hospital
It has been suggested that schizophrenia and alcoholism are associated with violent behavior, but so far there are no published qualitative data from unselected cohorts quantifying the actual risk associated with schizophrenia with and without co-morbid alcoholism. In this study, an unselected birth cohort (n = 11(17) was prospectively followed up to the age of 26 years and data on psychiatric disorders and crimes were collected from national registers. The odd ratios for violent offences and recidivism were calculated for each diagnostic group. Men with alcohol abuse and schizophren!a were .25.2 (95% CI 6.1-97.5) times more likely to commit vlole~t ~es than mentally healthy men. The risks for non-alcoholic sc~o phrenics were 3.6% (95% CI 0.9-12.3). None of the ~'hizO phrenics without alcohol abuse were recidivists. The risk for recidive crimes among alcoholic schizophrenics was 9.S-fold (95% CI 2.7-30.0).