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Maternal long labor and schizohrenia
192
teristics, and relationship of schizophrenia to pregnancy/birth complications.
STRINGENT CLOZAPINE ELIGIBILITY CRITERIA: IMPACT ON ETHNIC, GENDER, A N D AGAE SUBGROUPS OF SCHIZOPHRENIC PATIENTS Maria Juarez-Reyes*, Martha Shumway, Peter Bacchetti, Cynthia Battle, Mary Susan Hansen, William Hargreaves UCSF/SFGH, 1001 Potrero Ave, Room 7M36, San Francisco,
to diminish in recent decades. These patterns would be expected if stresses associated with cold weather increase risk for schizophrenia, but higher living standards protect against weatherrelated stresses. In the present study, we hypothesized that geographic regions with cold weather would have higher overall schizophrenia prevalence rates, but only for groups of low socioeconomic status. To test this, we compared published data on mean low temperature in different regions with age-corrected schizophrenia prevalence rates for all 50 samples reported in Torrey's (1987) review of all large schizophrenia prevalence studies around the world published over a forty-year period. As hypothesized, greater severity of winter weather was significantly correlated with higher schizophrenia prevalence for economically disadvantaged populations (p < 0.01 ), but not for advantaged ones.
CA 94110, USA
Despite clozapine's effectiveness, use has been restricted because of side effects and costs. Mental health agencies have used more stringent criteria than prescribed by the package insert to control treatment costs. Previously, we estimated clozapine eligibility among schizophrenic patients to be 43% using a broad interpretation of the package insert and 13% using more stringent criteria. This retrospective chart review study determined whether stringent eligibility criteria differentially affected ethnic, gender and age subgroups. Data were collected on 505 schizophrenic patients in an urban mental health agency. With broad criteria, Asian patients were 50% less likely to be eligible than Whites (OR 0.52, p = 0.06). Differential exclusion was observed with 2 stringent criteria. Older patients were more likely to be excluded if automatic eligibility due to TD was eliminated ( O R = 1.99, p < 0.01 ) and less likely to be excluded if more medication trials were required (OR = 0.66, p < 0.01 ). While nonsignificant, odds ratios suggest that Asians (OR=0.36, p=0.06) and Hispanics (OR=0.47, p=0.14) were less likely to be excluded if schizoaffective disorder was not an eligible diagnoses and more likely to be excluded if more medication trials were required (OR = 1.61, p=0.34; OR = 1.61, p=0.33).
TEMPERATURE ASSOCIATED WITH REGIONAL DIFFERENCES IN SCHIZOPHRENIA PREVALENCE RATES Dennis Kinney*, William H y m a n , Aliette Vernooy, Sharon Tramer
Laboratories for Psychiatric Research, NBG-28, McLean Hospital, Belmont, MA 02178, USA Previous analyses of data on over 50 000 schizophrenics in 19 US states found a significant overall excess of schizophrenics born in months with cold weather; across states, moreover, the excess of schizophrenic births in cold months increased significantly as severity of cold weather increased (Kinney et al., 1993). Complementary studies report (a) larger excesses of schizophrenic births in cold months among economically disadvantaged groups, and (b) secular trends for birth-season effects
MATERNAL LONG LABOR A N D SCHIZOHRENIA H. Kunugi*, S. Nanko, N. Takei, K. Saito, R.M. Murray, H. Kazamatsuri Genetics Section, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK There is substantial evidence for an etiological role of obstetric complications (OCs) in schizophrenia. Among OCs, long labor has been considered to be important. However, few studies have reported a significant excess of long labor in schizophrenia. This may be due to the imprecise definition of "long labor" used in psychiatric research. For example, the average labor for the first child (12-15 h) is twice as long as that for the second or later child (5-8 h); however most investigators have not used different cut off points for the first child and the others. We obtained birth records and data on labor for 31 DSM-III-R schizophrenics and 20 healthy controls aged 14-28 in Japan. When labor for the first born schizophrenics (17 h on average, n = 17) was compared with that for the controls (15 h, n = 6) by Mann-Whitney U-tests, there was no significant difference ( Z = - 0 . 7 4 ; p=0.46). However, when comparison was made among the second or later children, labor for the schizophrenics (10h, n = 1 4 ) was significantly longer than that for the controls (6 h, n = 14) ( Z = - 2 . 7 ; p = 0.007). This suggests that schizophrenia is associated with long labor. However, if a particular cut off point, 24 h, for example, was used, we could not find any single individual in the schizophrenics or the controls among second or later born children. The reevaluation of the definition of "long labor" in schizophrenic birth is warranted.
SMALL HEAD CIRCUMFERENCE AT BIRTH IN SCHIZOPHRENIA H. Kunugi*, S. N a n k o , N. Takei, K. Saito, R.M. M u r r a y , H. K a z a m a t s u r i
Genetics Section, Institute of P~ychiatry, De Crespigny Park, London SE5 8AF, UK
teristics, and relationship of schizophrenia to pregnancy/birth complications.
STRINGENT CLOZAPINE ELIGIBILITY CRITERIA: IMPACT ON ETHNIC, GENDER, A N D AGAE SUBGROUPS OF SCHIZOPHRENIC PATIENTS Maria Juarez-Reyes*, Martha Shumway, Peter Bacchetti, Cynthia Battle, Mary Susan Hansen, William Hargreaves UCSF/SFGH, 1001 Potrero Ave, Room 7M36, San Francisco,
to diminish in recent decades. These patterns would be expected if stresses associated with cold weather increase risk for schizophrenia, but higher living standards protect against weatherrelated stresses. In the present study, we hypothesized that geographic regions with cold weather would have higher overall schizophrenia prevalence rates, but only for groups of low socioeconomic status. To test this, we compared published data on mean low temperature in different regions with age-corrected schizophrenia prevalence rates for all 50 samples reported in Torrey's (1987) review of all large schizophrenia prevalence studies around the world published over a forty-year period. As hypothesized, greater severity of winter weather was significantly correlated with higher schizophrenia prevalence for economically disadvantaged populations (p < 0.01 ), but not for advantaged ones.
CA 94110, USA
Despite clozapine's effectiveness, use has been restricted because of side effects and costs. Mental health agencies have used more stringent criteria than prescribed by the package insert to control treatment costs. Previously, we estimated clozapine eligibility among schizophrenic patients to be 43% using a broad interpretation of the package insert and 13% using more stringent criteria. This retrospective chart review study determined whether stringent eligibility criteria differentially affected ethnic, gender and age subgroups. Data were collected on 505 schizophrenic patients in an urban mental health agency. With broad criteria, Asian patients were 50% less likely to be eligible than Whites (OR 0.52, p = 0.06). Differential exclusion was observed with 2 stringent criteria. Older patients were more likely to be excluded if automatic eligibility due to TD was eliminated ( O R = 1.99, p < 0.01 ) and less likely to be excluded if more medication trials were required (OR = 0.66, p < 0.01 ). While nonsignificant, odds ratios suggest that Asians (OR=0.36, p=0.06) and Hispanics (OR=0.47, p=0.14) were less likely to be excluded if schizoaffective disorder was not an eligible diagnoses and more likely to be excluded if more medication trials were required (OR = 1.61, p=0.34; OR = 1.61, p=0.33).
TEMPERATURE ASSOCIATED WITH REGIONAL DIFFERENCES IN SCHIZOPHRENIA PREVALENCE RATES Dennis Kinney*, William H y m a n , Aliette Vernooy, Sharon Tramer
Laboratories for Psychiatric Research, NBG-28, McLean Hospital, Belmont, MA 02178, USA Previous analyses of data on over 50 000 schizophrenics in 19 US states found a significant overall excess of schizophrenics born in months with cold weather; across states, moreover, the excess of schizophrenic births in cold months increased significantly as severity of cold weather increased (Kinney et al., 1993). Complementary studies report (a) larger excesses of schizophrenic births in cold months among economically disadvantaged groups, and (b) secular trends for birth-season effects
MATERNAL LONG LABOR A N D SCHIZOHRENIA H. Kunugi*, S. Nanko, N. Takei, K. Saito, R.M. Murray, H. Kazamatsuri Genetics Section, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK There is substantial evidence for an etiological role of obstetric complications (OCs) in schizophrenia. Among OCs, long labor has been considered to be important. However, few studies have reported a significant excess of long labor in schizophrenia. This may be due to the imprecise definition of "long labor" used in psychiatric research. For example, the average labor for the first child (12-15 h) is twice as long as that for the second or later child (5-8 h); however most investigators have not used different cut off points for the first child and the others. We obtained birth records and data on labor for 31 DSM-III-R schizophrenics and 20 healthy controls aged 14-28 in Japan. When labor for the first born schizophrenics (17 h on average, n = 17) was compared with that for the controls (15 h, n = 6) by Mann-Whitney U-tests, there was no significant difference ( Z = - 0 . 7 4 ; p=0.46). However, when comparison was made among the second or later children, labor for the schizophrenics (10h, n = 1 4 ) was significantly longer than that for the controls (6 h, n = 14) ( Z = - 2 . 7 ; p = 0.007). This suggests that schizophrenia is associated with long labor. However, if a particular cut off point, 24 h, for example, was used, we could not find any single individual in the schizophrenics or the controls among second or later born children. The reevaluation of the definition of "long labor" in schizophrenic birth is warranted.
SMALL HEAD CIRCUMFERENCE AT BIRTH IN SCHIZOPHRENIA H. Kunugi*, S. N a n k o , N. Takei, K. Saito, R.M. M u r r a y , H. K a z a m a t s u r i
Genetics Section, Institute of P~ychiatry, De Crespigny Park, London SE5 8AF, UK