- Email: [email protected]
Season of birth in schizophrenia, seasonal fertility and prematurity
28
Method. Patients admitted to Irish psychiatric inpatient facilities between 1989 94 with an ICD9/10 diagnosis of schizophrenia or bipolar disorder were identified from the National Psychiatric Inpatient Reporting System. Seasonality of admission was examined in first and readmissions using the chi square test, a Kolgomorov-Smirnov type statistic (KS), and then by applying the method described by Walter and Elwood to significant results. Results. For first admissions, significant seasonal variation existed in the monthly admission patterns of schizophrenia ( 2 = 18.28, 4/=2, p<0.001) and bipolar disorder (2=49.43, d[= 2. p < 0.001 ), ( Walter and Elwood). The magnitude of the July excess was 12% in schizophrenia and 17% in bipolar disorder. Bipolar readmissions showed a similar seasonality (2=37.33, 4[=2, p<0.001), but readmissions with schizophrenia did not (2=6.12, 4/= l l, p>0.1; KS=0.57, p>0.1 ). Conclusions. Although individuals with bipolar disorder show seasonality in both first and readmissions, seasonal influences may be more important in onset than relapse in schizophrenia.
SEASON OF BIRTH IN S C H I Z O P H R E N I A , S E A S O N A L FERTILITY A N D PREMATURITY R. Miller, K. Winders D~7~artment o/'Anaton O"and Structural Bh)h),g3', Universio' o/ Otago 5ledical School. P.O. Bo.v 913 Dunedin NZ Many epidemiological studies show that for subjects born in winter months incidence of schizophrenia is slightly higher than expected. It has recently been suggested (Mueller and Kleider, 1990) that this may be due to a combination of two effects: (i) There is a summer increase in conception rate in many countries, associated with a spring excess in total births: (ii) Premature birth is hypothesised as a risk factor for schizophrenia. The excess of schizophreqia births related to the summer increase in conception rate would then occur I 3 months before the spring excess in total births, that is in winter. If this hypothesis is correct, monthly total birth rate should correlate positively with schizophrenia births 1 3 months earlier. In this study we sought such correlations in previously published reports giving monthly total birth rates and schizophrenia birth rates. Correlation coefficients for zero. one, two and three month delays of total births with respect to schizophrenia births were computed. In 51 such data sets correlation coefficients were distributed rather symmetrically around zero (i.e. there were similar numbers of negative as of positive correlations), and there was no tendency for positive correlations to cluster at any of the delay intervals. Thus, no support is provided for the suggestion that premature birth is a risk factor for schizophrenia big enough to contribute to the season of birth effect.
K. Suicide THE I N F L U E N C E OF P H A R M A C O T H E R A P Y O N SELFDIRECTED AND EXTERNALLY-DIRECTED A G G R E S S I O N IN S C H I Z O P H R E N I A C.M. Beasley, M.E. Sayler, G.M. Kiesler, J.H. Potvin, T.M. Sanger, G.D. Tollefson Eli Lilly and Company, Indianapolis, LLlly Corporate Center lndiana, 46285, USA The potential association of violence, aggression, and hostility with psychiatric disorders has been an issue of considerable academic and social interest. A comprehensive analysis of clinical trial data was performed to evaluate the incidence of externally-directed aggression and self-directed aggression in patients with schizophrenia and related psychoses treated with an antipsychotic agent or placebo. Spontaneously reported adverse event data and clinicianassessed rating scale items (BPRS, MADRS) were evaluated to determine the incidence of aggression in patients with DSMIII-R schizophrenia, schizophreniform disorder, or schizoaffectire disorder treated with olanzapine (n=2284), haloperidol In=810), or placebo ( n = l l 8 ) . Data from the double-blind acute and the long-term phases as well as open-label extensions of 4 multicenter, controlled clinical studies were evaluated, Categorized treatment-emergent adverse events and rating scale scores were compared using Cochran-ManteI-Haenszel and Fisher's Exact tests. Based on assessment of categorized adverse events, no excess incidence of externally-directed or self-directed aggression was associated with olanzapine treatment compared with either placebo or haloperidol treatment. Analyses of the BPRS hostility item indicated that olanzapine-treated patients had statistically significantly decreased mean hostility scores compared with placebo-treated patients and comparable hostility scores compared with haloperidol-treated patients. Analyses of the MADRS suicidal thoughts item indicated statistically significantly greater improvement in suicidal thoughts in olanzapinetreated patients than in haloperidol-treated patients. Categorized treatment-emergent adverse event data and objective rating scale items, in combination, suggested a decreased incidence of both externally-directed and self-directed aggression of either an ideational or overt nature to be associated with olanzapine compared with placebo and haloperidol.
T H E E F F E C T OF A N E D U C A T I O N A L I N T E R V E N T I O N ON I N S I G H T A N D S U I C I D A L I D E A T I O N IN S C H I Z O P H R E N I A A. Carroll, Z. Clyde, S. F a t t a h , I. Coffey, E.C. J o h n s t o n e , D.C. O w e n s
Department o/'P,~3'elliato,, UniversiO" qf Edinburgh, Rco'al Edinburgh How#a/, Edinburgh, EHIO 5HF. UK Psychoeducational interventions in schizophrenia have been shown to improve both compliance (1) and insight (2).
Method. Patients admitted to Irish psychiatric inpatient facilities between 1989 94 with an ICD9/10 diagnosis of schizophrenia or bipolar disorder were identified from the National Psychiatric Inpatient Reporting System. Seasonality of admission was examined in first and readmissions using the chi square test, a Kolgomorov-Smirnov type statistic (KS), and then by applying the method described by Walter and Elwood to significant results. Results. For first admissions, significant seasonal variation existed in the monthly admission patterns of schizophrenia ( 2 = 18.28, 4/=2, p<0.001) and bipolar disorder (2=49.43, d[= 2. p < 0.001 ), ( Walter and Elwood). The magnitude of the July excess was 12% in schizophrenia and 17% in bipolar disorder. Bipolar readmissions showed a similar seasonality (2=37.33, 4[=2, p<0.001), but readmissions with schizophrenia did not (2=6.12, 4/= l l, p>0.1; KS=0.57, p>0.1 ). Conclusions. Although individuals with bipolar disorder show seasonality in both first and readmissions, seasonal influences may be more important in onset than relapse in schizophrenia.
SEASON OF BIRTH IN S C H I Z O P H R E N I A , S E A S O N A L FERTILITY A N D PREMATURITY R. Miller, K. Winders D~7~artment o/'Anaton O"and Structural Bh)h),g3', Universio' o/ Otago 5ledical School. P.O. Bo.v 913 Dunedin NZ Many epidemiological studies show that for subjects born in winter months incidence of schizophrenia is slightly higher than expected. It has recently been suggested (Mueller and Kleider, 1990) that this may be due to a combination of two effects: (i) There is a summer increase in conception rate in many countries, associated with a spring excess in total births: (ii) Premature birth is hypothesised as a risk factor for schizophrenia. The excess of schizophreqia births related to the summer increase in conception rate would then occur I 3 months before the spring excess in total births, that is in winter. If this hypothesis is correct, monthly total birth rate should correlate positively with schizophrenia births 1 3 months earlier. In this study we sought such correlations in previously published reports giving monthly total birth rates and schizophrenia birth rates. Correlation coefficients for zero. one, two and three month delays of total births with respect to schizophrenia births were computed. In 51 such data sets correlation coefficients were distributed rather symmetrically around zero (i.e. there were similar numbers of negative as of positive correlations), and there was no tendency for positive correlations to cluster at any of the delay intervals. Thus, no support is provided for the suggestion that premature birth is a risk factor for schizophrenia big enough to contribute to the season of birth effect.
K. Suicide THE I N F L U E N C E OF P H A R M A C O T H E R A P Y O N SELFDIRECTED AND EXTERNALLY-DIRECTED A G G R E S S I O N IN S C H I Z O P H R E N I A C.M. Beasley, M.E. Sayler, G.M. Kiesler, J.H. Potvin, T.M. Sanger, G.D. Tollefson Eli Lilly and Company, Indianapolis, LLlly Corporate Center lndiana, 46285, USA The potential association of violence, aggression, and hostility with psychiatric disorders has been an issue of considerable academic and social interest. A comprehensive analysis of clinical trial data was performed to evaluate the incidence of externally-directed aggression and self-directed aggression in patients with schizophrenia and related psychoses treated with an antipsychotic agent or placebo. Spontaneously reported adverse event data and clinicianassessed rating scale items (BPRS, MADRS) were evaluated to determine the incidence of aggression in patients with DSMIII-R schizophrenia, schizophreniform disorder, or schizoaffectire disorder treated with olanzapine (n=2284), haloperidol In=810), or placebo ( n = l l 8 ) . Data from the double-blind acute and the long-term phases as well as open-label extensions of 4 multicenter, controlled clinical studies were evaluated, Categorized treatment-emergent adverse events and rating scale scores were compared using Cochran-ManteI-Haenszel and Fisher's Exact tests. Based on assessment of categorized adverse events, no excess incidence of externally-directed or self-directed aggression was associated with olanzapine treatment compared with either placebo or haloperidol treatment. Analyses of the BPRS hostility item indicated that olanzapine-treated patients had statistically significantly decreased mean hostility scores compared with placebo-treated patients and comparable hostility scores compared with haloperidol-treated patients. Analyses of the MADRS suicidal thoughts item indicated statistically significantly greater improvement in suicidal thoughts in olanzapinetreated patients than in haloperidol-treated patients. Categorized treatment-emergent adverse event data and objective rating scale items, in combination, suggested a decreased incidence of both externally-directed and self-directed aggression of either an ideational or overt nature to be associated with olanzapine compared with placebo and haloperidol.
T H E E F F E C T OF A N E D U C A T I O N A L I N T E R V E N T I O N ON I N S I G H T A N D S U I C I D A L I D E A T I O N IN S C H I Z O P H R E N I A A. Carroll, Z. Clyde, S. F a t t a h , I. Coffey, E.C. J o h n s t o n e , D.C. O w e n s
Department o/'P,~3'elliato,, UniversiO" qf Edinburgh, Rco'al Edinburgh How#a/, Edinburgh, EHIO 5HF. UK Psychoeducational interventions in schizophrenia have been shown to improve both compliance (1) and insight (2).