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Second-trimester exposure to maternal stress is a possible risk factor for psychotic illness in the child
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n=9.564). The government provided monthly numbers of livebirths. We used time series analysis. Results: In the general population there was a 4-5% excess of births in spring (Febr-May) and a 4-7% deficit in autumn (Oct-Dec). In patients, as compared to the general population, there was no marked winter-spring excess. The risk of schizophrenia was highly significantly(about 10%)decreased for men and women born in autumn (Aug-Nov). The same was true for the risk of affectiveillness in women born in autumn. There was no clear seasonality in the risk of affective illness for men. All results remained essentially unchanged after correction for 'age incidence'. Discussion: Parents of patients might be more vulnerable to winter depressions than the general population. If winter depressions in these parents occur somewhat earlier than in the general population, seasonal fluctuations in their sexual behaviour might explain some of these findings.
1'3(, SECOND-TRIMESTER EXPOSURE TO MATERNAL STRESS IS A POSSIBLE RISK FACTOR FOR PSYCHOTIC ILLNESS IN THE CHILD J.P. Selten, R. van Duursen, Y. van der Graaf, C. Gispen-de Wied, R.S. Kahn
Identifying effective treatments for schizophrenia requires understanding the relative importance of the disorder's multiple outcomes. Medical decision analysts have developed various methods for measuring health state preferences. However, measuring preferences for schizophrenia outcomes poses special challenges. First, several stakeholder groups are involvedpatients, patient's families, clinicians, and the general public. Second, patients-whose preferences are central-often have symptoms which limit their ability to express their preferences. Three studies evaluated the suitability of 4 preference assessment methods (Category Rating, Time Trade-off, Paired Comparison, Direct Importance Rating) for studying schizophrenia outcomes. In the first study, 21 clinicians evaluated all 4 methods. The second study examined effects of presentation format and time frame on clinician's Time Trade-off ratings. In the third study, 20 persons with schizophrenia evaluated the Category Rating, Paired Comparison and Direct Importance methods. Results suggest that standard assessment methods were more difficult than anticipated. The Time Trade-off method appears least suitable, possibly due to the chronic, but variable, course of schizophrenic illness. The Paired Comparison method was well understood. but fatiguing because it requires subjects to evaluate more health states. The Category Rating and Direct Importance methods appear feasible and appropriate for use in schizophrenia research.
Univ. Hosp. Utrecht, The Netherlands Introduction: On February lst 1953 a gale caused a flood in the South-west of The Netherlands. 1835 people perished. We tested the hypothesis that second-trimester exposure to maternal stress is a risk factor for psychosis in the child. Method: The national registry provided data on all patients who had been discharged from a Dutch psychiatric institute with an ICD-diagnosis of schizophrenia (ICD: 295), paranoid state (ICD: 297) or other non-organic psychosis (ICD: 298) in the period 1970-1994. Next, we selected data on patients who had been born in the 15 villages where mortality due to the gale was over 1% (range: 1.3-16.1%). We compared the risk for persons born in each trimester after the disaster (Febr-Apr, May-July, Aug-Oct 1953) to the risk for persons born in the corresponding trimesters of the previous two and next two years. There were monthly numbers of livebirths for each village in the period 1951-55. Results: The relative risk (RR) of psychotic illness (lCD: 295297298) for persons born in the period May-July 1953was 3.4 (95% CI: 1.2-9.7). The RR of schizophrenia was 3.7 (0.9-14.8). Conclusion: Second-trimester exposure to maternal stress is a possible risk factor for psychotic illness in the child. We suggest that maternal glucocorticoids cross the placenta and disturb the child's brain development.
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STAKEHOLDER PREFERENCES FOR SCHIZOPHRENIA OUTCOMES: AN EVALUATION OF ASSESSMENT METHODS Martha Shumway, Tandy Chouljian, Cynthia Battle DepartmentofPsychiatry, University of California, 1001 Potrero Ave, Rm. 7M-W21, San Francisco, CA 94110 USA
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SEASONAL ADMISSION PAlTERNS IN FIRST EPISODE SCHIZOPHRENIA Rael D. Strous, Michael Rokhsar, Delbert Robinson, MargaretG. Woerner DepartmentofPsychiatryResearch. Hillside Hospital. P.O. Box 38 GlenOaks, New York 11004 Analysis of seasonal and monthly variations in hospital admissions of chronic schizophrenic patients have yielded inconsistent findings. However it is unknown to what extent there may be patterns of admission in first episode (FE) schizophrenics, who may be relatively unaffected by chronic disease, treatment and advanced age. We analyzed quarterly admissions of FE schizophrenics over a 10 year period at Hillside Hospital and compared the patterns of these 369 admissions to patterns of total admissions of chronic schizophrenic (n=673) and psychotic patients (n= 1048) over a period of the previous year. Results indicated a significant pattern of increased FE admissions in the first and third quarters (p=O.OI), with no similar pattern in either the chronic schizophrenic or total psychotic patient group. The pattern of FE admissions was significantly different from the other 2 groups (p=O.OO8; p=O.04). Furthermore, there was no difference between admission patterns of chronic schizophrenic and total psychotic patients. Our results suggest a contribution of seasonal variation to FE admissions, perhaps related to certain unique stressors particular to the first and third quarters of the year. Further studies are clearly warranted to elucidate the precise nature of these factors.
n=9.564). The government provided monthly numbers of livebirths. We used time series analysis. Results: In the general population there was a 4-5% excess of births in spring (Febr-May) and a 4-7% deficit in autumn (Oct-Dec). In patients, as compared to the general population, there was no marked winter-spring excess. The risk of schizophrenia was highly significantly(about 10%)decreased for men and women born in autumn (Aug-Nov). The same was true for the risk of affectiveillness in women born in autumn. There was no clear seasonality in the risk of affective illness for men. All results remained essentially unchanged after correction for 'age incidence'. Discussion: Parents of patients might be more vulnerable to winter depressions than the general population. If winter depressions in these parents occur somewhat earlier than in the general population, seasonal fluctuations in their sexual behaviour might explain some of these findings.
1'3(, SECOND-TRIMESTER EXPOSURE TO MATERNAL STRESS IS A POSSIBLE RISK FACTOR FOR PSYCHOTIC ILLNESS IN THE CHILD J.P. Selten, R. van Duursen, Y. van der Graaf, C. Gispen-de Wied, R.S. Kahn
Identifying effective treatments for schizophrenia requires understanding the relative importance of the disorder's multiple outcomes. Medical decision analysts have developed various methods for measuring health state preferences. However, measuring preferences for schizophrenia outcomes poses special challenges. First, several stakeholder groups are involvedpatients, patient's families, clinicians, and the general public. Second, patients-whose preferences are central-often have symptoms which limit their ability to express their preferences. Three studies evaluated the suitability of 4 preference assessment methods (Category Rating, Time Trade-off, Paired Comparison, Direct Importance Rating) for studying schizophrenia outcomes. In the first study, 21 clinicians evaluated all 4 methods. The second study examined effects of presentation format and time frame on clinician's Time Trade-off ratings. In the third study, 20 persons with schizophrenia evaluated the Category Rating, Paired Comparison and Direct Importance methods. Results suggest that standard assessment methods were more difficult than anticipated. The Time Trade-off method appears least suitable, possibly due to the chronic, but variable, course of schizophrenic illness. The Paired Comparison method was well understood. but fatiguing because it requires subjects to evaluate more health states. The Category Rating and Direct Importance methods appear feasible and appropriate for use in schizophrenia research.
Univ. Hosp. Utrecht, The Netherlands Introduction: On February lst 1953 a gale caused a flood in the South-west of The Netherlands. 1835 people perished. We tested the hypothesis that second-trimester exposure to maternal stress is a risk factor for psychosis in the child. Method: The national registry provided data on all patients who had been discharged from a Dutch psychiatric institute with an ICD-diagnosis of schizophrenia (ICD: 295), paranoid state (ICD: 297) or other non-organic psychosis (ICD: 298) in the period 1970-1994. Next, we selected data on patients who had been born in the 15 villages where mortality due to the gale was over 1% (range: 1.3-16.1%). We compared the risk for persons born in each trimester after the disaster (Febr-Apr, May-July, Aug-Oct 1953) to the risk for persons born in the corresponding trimesters of the previous two and next two years. There were monthly numbers of livebirths for each village in the period 1951-55. Results: The relative risk (RR) of psychotic illness (lCD: 295297298) for persons born in the period May-July 1953was 3.4 (95% CI: 1.2-9.7). The RR of schizophrenia was 3.7 (0.9-14.8). Conclusion: Second-trimester exposure to maternal stress is a possible risk factor for psychotic illness in the child. We suggest that maternal glucocorticoids cross the placenta and disturb the child's brain development.
-m
STAKEHOLDER PREFERENCES FOR SCHIZOPHRENIA OUTCOMES: AN EVALUATION OF ASSESSMENT METHODS Martha Shumway, Tandy Chouljian, Cynthia Battle DepartmentofPsychiatry, University of California, 1001 Potrero Ave, Rm. 7M-W21, San Francisco, CA 94110 USA
7~
SEASONAL ADMISSION PAlTERNS IN FIRST EPISODE SCHIZOPHRENIA Rael D. Strous, Michael Rokhsar, Delbert Robinson, MargaretG. Woerner DepartmentofPsychiatryResearch. Hillside Hospital. P.O. Box 38 GlenOaks, New York 11004 Analysis of seasonal and monthly variations in hospital admissions of chronic schizophrenic patients have yielded inconsistent findings. However it is unknown to what extent there may be patterns of admission in first episode (FE) schizophrenics, who may be relatively unaffected by chronic disease, treatment and advanced age. We analyzed quarterly admissions of FE schizophrenics over a 10 year period at Hillside Hospital and compared the patterns of these 369 admissions to patterns of total admissions of chronic schizophrenic (n=673) and psychotic patients (n= 1048) over a period of the previous year. Results indicated a significant pattern of increased FE admissions in the first and third quarters (p=O.OI), with no similar pattern in either the chronic schizophrenic or total psychotic patient group. The pattern of FE admissions was significantly different from the other 2 groups (p=O.OO8; p=O.04). Furthermore, there was no difference between admission patterns of chronic schizophrenic and total psychotic patients. Our results suggest a contribution of seasonal variation to FE admissions, perhaps related to certain unique stressors particular to the first and third quarters of the year. Further studies are clearly warranted to elucidate the precise nature of these factors.