Polyvagal theory, neurodevelopment and psychiatric disorders.

Neurodevelopment is an area of psychiatry which has attracted huge interest in the last few decades. There is substantial evidence that perinatal events can contribute to later development of mental disorder. In the current perspective article we propose a novel polyvagal theory which attempts to link prenatal events with neurodevelopment and the later onset of psychiatric disorder.

Intellectual functioning and the long-term course of schizophrenia-spectrum illness.

BACKGROUND: Recent neurodevelopmental models of schizophrenia, together with substantial evidence of neurocognitive dysfunction among people with schizophrenia, have led to a widespread view that general cognitive deficits are a central aspect of schizophrenic pathology. However, the temporal relationships between intellectual functioning and schizophrenia-spectrum illness remain unclear. METHOD: Longitudinal data from the Copenhagen High-Risk Project (CHRP) were used to evaluate the importance of intellectual functioning in the prediction of diagnostic and functional outcomes associated with the schizophrenia spectrum. The effect of spectrum illness on intellectual and educational performance was also evaluated. The sample consisted of 311 Danish participants: 99 at low risk, 155 at high risk, and 57 at super-high risk for schizophrenia. Participants were given intellectual [Weschler's Intelligence Scale for Children (WISC)/Weschler's Adult Intelligence Scale (WAIS)] assessments at mean ages of 15 and 24 years, and diagnostic and functional assessments at mean ages 24 and 42 years. RESULTS: Intellectual functioning was found to have no predictive relationship to later psychosis or spectrum personality, and minimal to no direct relationship to later measures of work/independent living, psychiatric treatment, and overall severity. No decline in intellectual functioning was associated with either psychosis or spectrum personality. CONCLUSIONS: These largely negative findings are discussed in the light of strong predictive relationships existing between genetic risk, diagnosis and functional outcomes. The pattern of predictive relationships suggests that overall cognitive functioning may play less of a role in schizophrenia-spectrum pathology than is widely believed, at least among populations with an evident family history of schizophrenia.

Early maternal and paternal bonding, childhood physical abuse and adult psychopathic personality.

BACKGROUND: A significant gap in the literature on risk factors for psychopathy is the relative lack of research on parental bonding.MethodThis study examines the cross-sectional relationship between maternal and paternal bonding, childhood physical abuse and psychopathic personality at age 28 years in a community sample of 333 males and females. It also assesses prospectively whether children separated from their parents in the first 3 years of life are more likely to have a psychopathic-like personality 25 years later. RESULTS: Hierarchical regression analyses indicated that: (1) poor parental bonding (lack of maternal care and low paternal overprotection) and childhood physical abuse were both associated with a psychopathic personality; (2) parental bonding was significantly associated with psychopathic personality after taking into account sex, social adversity, ethnicity and abuse; (3) those separated from parents in the first 3 years of life were particularly characterized by low parental bonding and a psychopathic personality in adulthood; and (4) the deviant behavior factor of psychopathy was more related to lack of maternal care whereas the emotional detachment factor was related to both lack of maternal care and paternal overprotection. CONCLUSIONS: Findings draw attention to the importance of different components of early bonding in relation to adult psychopathy, and may have potential implications for early intervention and prevention of psychopathy.

High social class and suicide in persons at risk for schizophrenia.

OBJECTIVE: The relationship between suicide and social class has been equivocal. While some authors have reported that higher social class is related to higher rates of suicide, most other studies report that lower social class is associated with higher rates of suicide. Our study attempted to resolve these inconsistencies by using a High Risk for schizophrenia method. METHOD: Children of women with severe schizophrenia were assessed in 1962. In 2005, when subjects were a mean age of 58 years, we identified those who had committed suicide. RESULTS: A higher rate of suicide was associated with risk for schizophrenia in the High-Risk sample. Higher social class origin was associated with suicide in persons at risk for mental illness. CONCLUSION: Higher social class origin was associated with suicide in subjects at genetic risk for schizophrenia (but not those without risk).

Paternal alcoholism predicts the occurrence but not the remission of alcoholic drinking: a 40-year follow-up.

OBJECTIVE: To test the effects of father's alcoholism on the development and remission from alcoholic drinking by age 40. METHOD: Subjects were selected from a Danish birth cohort that included 223 sons of alcoholic fathers (high risk; HR) and 106 matched controls (low risk; LR). Clinical examinations were performed at age 40 (n = 202) by a psychiatrist using structured interviews and DSM-III-R diagnostic criteria. RESULTS: HR subjects were significantly more likely than LR subjects to develop alcohol dependence (31% vs. 16%), but not alcohol abuse (17% vs. 15%). More subjects with alcohol abuse were in remission at age 40 than subjects with alcohol dependence. Risk did not predict remission from either alcohol abuse or alcohol dependence. CONCLUSION: Familial influences may play a stronger role in the development of alcoholism than in the remission or recovery from alcoholism.

Height, weight and body mass index in early adulthood and risk of schizophrenia.

OBJECTIVE: To illuminate the possible associations between height, weight, and body mass index (BMI) during early adulthood and the development of schizophrenia. METHOD: This prospective study is based on an all-male sample of 3210 individuals from the Copenhagen Perinatal Cohort, comprising individuals born between 1959 and 1961. In 1999, cases of schizophrenia were identified in the Danish Psychiatric Central Register, and the cases were compared with the cohort pool of controls with respect to height, weight, and BMI from draft records. The effect of low BMI was adjusted for parental social status when the cohort members were 1 year old, birth weight, birth length, and maternal pre-pregnancy BMI. RESULTS: Forty-five cases of schizophrenia had a lower young adult mean body weight and BMI than controls. A significant inverse relationship between BMI and risk of later schizophrenia was found. For each unit increase in BMI, the adjusted odds ratio was 0.81 (95% CI, 0.70-0.93) and the risk of schizophrenia decreased by 19%. Excluding individuals who had been admitted to an in-patient facility before or within 5 years after appearing before the draft board, yielded virtually the same results. No significant differences between cases and controls were observed with respect to adult height. CONCLUSION: Independent of several possible confounders, an inverse relationship between young adult BMI and risk of later development of schizophrenia was demonstrated in this all-male sample.

Breastfeeding and risk of schizophrenia in the Copenhagen Perinatal Cohort.

OBJECTIVE: The aim was to study whether early weaning from breastfeeding may be associated with increased risk of schizophrenia. METHOD: The current sample comprises 6841 individuals from the Copenhagen Perinatal Cohort of whom 1671 (24%) had been breastfed for 2 weeks or less (early weaning) and 5170 (76%) had been breastfed longer. Maternal schizophrenia, parental social status, single mother status and gender were included as covariates in a multiple regression analysis of the effect of early weaning on the risk of hospitalization with schizophrenia. RESULTS: The sample comprised 93 cases of schizophrenia (1.4%). Maternal schizophrenia was the strongest risk factor and a significant association between single mother status and elevated offspring risk of schizophrenia was also observed. Early weaning was significantly related to later schizophrenia in both unadjusted and adjusted analyses (adjusted odds ratio 1.73 with 95% CI: 1.13-2.67). CONCLUSION: No or <2 weeks of breastfeeding was associated with elevated risk of schizophrenia. The hypothesis of some protective effect of breastfeeding against the risk of later schizophrenia is supported by our data.

Prediction of mortality at age 40 in Danish males at high and low risk for alcoholism.

OBJECTIVE: This prospective high-risk study examined the influence of father's alcoholism and other archival-generated measures on premature death. METHOD: Sons of alcoholic fathers (n = 223) and sons of non-alcoholic fathers (n = 106) have been studied from birth to age 40. Archival predictors of premature death included father's alcoholism, childhood developmental data, and diagnostic information obtained from the Psychiatric Register and alcoholism clinics. RESULTS: By age 40, 21 of the 329 subjects had died (6.4%), a rate that is more than two times greater than expected. Sons of alcoholic fathers were not more likely to die by age 40. Premature death was associated with physical immaturity at 1-year of age and psychiatric/alcoholism treatment. No significant interactions were found between risk and archival measures. CONCLUSION: Genetic vulnerability did not independently predict death at age 40. Death was associated with developmental immaturities and treatment for a psychiatric and/or substance abuse problem.

Male criminals with organic brain syndrome: two distinct types based on age at first arrest.

OBJECTIVE: This study examined whether criminals with organic brain syndrome could be divided into two distinct types. The authors proposed that early starters (onset of criminal activity by age 18) would display a persistent, long-lasting pattern of deviance that was largely independent of their brain disorder, whereas late starters (onset at age 19 or after) would exhibit deviant behaviors that began late in life and were more directly related to their brain disorder. METHOD: Subjects were 1,130 male criminal offenders drawn from a birth cohort of all individuals born between January 1, 1944, and December 31, 1947, in Denmark. The main study group included all men with both a history of criminal arrest and a hospitalization for organic brain syndrome (N=565). In addition, for a subset of analyses, the authors examined a randomly selected, same-size comparison group of men with a history of criminal arrest who were not hospitalized for organic brain syndrome. Data were available on all arrests and all psychiatric hospitalizations for individuals in this cohort through the age of 44. RESULTS: Among those with organic brain syndrome, early starters were significantly more likely than late starters to 1) be arrested before the onset of organic brain syndrome, 2) show a higher rate of offending before but not after the onset of organic brain syndrome, 3) be both recidivists and violent recidivists, and 4) have a diagnosis of antisocial personality disorder. CONCLUSIONS: Male criminals with organic brain syndrome can be meaningfully divided into two distinct types on the basis of age at first arrest. Early starters show a more global, persistent, and stable pattern of offending than late starters. These results have implications for treatment and risk assessment.

Early educational and health enrichment at age 3-5 years is associated with increased autonomic and central nervous system arousal and orienting at age 11 years: evidence from the Mauritius Child Health Project.

Little is known about the effects of environmental enrichment on psychophysiological measures of arousal and orienting in humans. This study tests the hypothesis that early educational and health enrichment is associated with long-term increases in psychophysiological orienting and arousal. One hundred children were experimentally assigned to a two-year enriched nursery school intervention at ages 3-5 years and matched at age 3 years on psychophysiological measures, gender, and ethnicity to 100 comparisons who received the normal educational experience. Children were retested 6-8 years later at age 11 years on skin conductance (SC) and electroencephalogram (EEG) measures of arousal and attention during pre- and postexperimental rest periods and during the continuous performance task. Nursery enrichment was associated with increased SC amplitudes, faster SC rise times, faster SC recovery times, and less slow-wave EEG during both rest and CPT conditions. This is believed to be the first study to show that early environmental enrichment is associated with long-term increases in psychophysiological orienting and arousal in humans. Results draw attention to the important influence of the early environment in shaping later psychophysiological functioning.

Three-factor model of schizotypal personality: invariance across culture, gender, religious affiliation, family adversity, and psychopathology.

Whilst the syndrome approach to schizotypy has recently demonstrated differential correlates of a three-factor model of schizotypal personality, variations in the nature of these factors question a basic assumption of this approach. This study tested competing models of the factor structure of schizotypal personality using the Schizotypal Personality Questionnaire (SPQ) in a sample of 1,201 Mauritians. Factor invariance across gender, ethnicity, family adversity, and religion and across a psychopathologically select group was also assessed. Results suggest that a three-factor model, Cognitive-Perceptual Deficits, Interpersonal Deficits, and Disorganization, underlies individual differences across widely varying groups. Other competing three-factor schizotypal personality models did not fit the data better. It is argued that the three-factor Disorganized model is a well-replicated model of DSM schizotypal personality in community samples but possibly not in some clinical samples.

Major mental disorders and criminal violence in a Danish birth cohort.

BACKGROUND: This epidemiological investigation was designed to examine the relationships between each of the major mental disorders and criminal violence. Specifically, we assessed whether a significant relationship exists between violence and hospitalization for a major mental disorder, and whether this relationship differs for schizophrenia, affective psychoses, and organic brain syndromes. METHODS: Subjects were drawn from a birth cohort of all individuals born between January 1, 1944, and December 31, 1947, in Denmark (N = 358 180). Because of the existence of accurate and complete national registers, data were available on all arrests for violence and all hospitalizations for mental illness that occurred for individuals in this cohort through the age of 44 years. RESULTS: There was a significant positive relationship between the major mental disorders that led to hospitalization and criminal violence (odds ratios 2.0-8.8 for men and 3.9-23.2 for women). Persons hospitalized for a major mental disorder were responsible for a disproportionate percentage of violence committed by the members of the birth cohort. Men with organic psychoses and both men and women with schizophrenia were significantly more likely to be arrested for criminal violence than were persons who had never been hospitalized, even when controlling for demographic factors, substance abuse, and personality disorders. CONCLUSIONS: Individuals hospitalized for schizophrenia and men hospitalized with organic psychosis have higher rates of arrests for violence than those never hospitalized. This relationship cannot be fully explained by demographic factors or comorbid substance abuse.

Prenatal teratogens and the development of adult mental illness.

Our findings in the Helsinki Influenza Study and the Danish Forty Year Study lead us to conclude that a 2nd-trimester maternal influenza infection may increase risk for adult schizophrenia or adult major affective disorder. More recently we have also reported an increase of unipolar depression among offspring who were exposed prenatally to a severe earthquake (7.8 on the Richter scale) in Tangshan, China. Among the earthquake-exposed males (but not the females), we observed a significantly greater depression response for those individuals exposed during the 2nd trimester of gestation. These findings suggest that maternal influenza infection and severe maternal stress may operate (in different ways) as teratogens, disrupting the development of the fetal brain and increasing risk for developing schizophrenia or depression in adulthood.

MMPI variables predictive of schizophrenia in the Copenhagen High-Risk Project: a 25-year follow-up.

Moldin et al. (1) have identified a cluster of Minnesota Multiphasic Personality Inventory (MMPI) scales that discriminate adolescents at risk for schizophrenia from those not at risk. The present study examines how well Moldin's scales predict schizophrenic decompensation in a sample of 207 Danish adolescents at high genetic risk for schizophrenia. Subjects were assessed using a modified, 304-item MMPI in 1962 (mean age= 15.1 years) and diagnosed in 10-year and 25-year follow-ups. Premorbidly, schizophrenic subjects (n=31) scored higher than subjects with no mental illness on the frequency (F) and psychoticism (PSY) scales. When paranoid and non-paranoid preschizophrenics were separated, three scales (F, Pz (paranoid schizophrenia) and PSY) significantly discriminated paranoid preschizophrenics. Discriminant function analyses confirmed these results. It is concluded that the MMPI may be useful for identifying schizophrenia premorbidly.

Skin-conductance orienting deficits and increased alcoholism in schizotypal criminals.

This study tested the interaction hypothesis that a subgroup of criminals with schizotypal personality would show skin-conductance orienting deficits and increased alcoholism. In a prospective, longitudinal study of alcoholism in 134 males, schizotypy was assessed during adolescence, skin-conductance orienting was assessed at ages 18-20 years, and criminal offending and alcohol abuse were assessed at ages 30-33 years. A significant interaction between schizotypy and criminality indicated that schizotypal criminals were characterized by autonomic orienting deficits. Furthermore, the rate of alcoholism in schizotypal criminals (54.8%) was significantly higher than in criminals (23.8%), schizotypal noncriminals (13.9%), and comparisons (21.7%). It is argued that schizotypal criminals are a relatively distinct group and that prefrontal dysfunction may underlie both orienting deficits and alcoholism in this group.

Maternal smoking during pregnancy and adult male criminal outcomes.

BACKGROUND: Perinatal risk factors are related to persistent and violent criminal outcomes. Prenatal maternal smoking may represent an additional perinatal risk factor for adult criminal outcomes. Our study examines maternal smoking during pregnancy as a predictor of offspring crime in the context of a prospective, longitudinal design. METHODS: Subjects were a birth cohort of 4169 males born between September 1959 and December 1961 in Copenhagen, Denmark. During the third trimester of pregnancy, mothers self-reported the number of cigarettes smoked daily. When the male offspring were 34 years of age, their arrest histories were checked in the Danish National Criminal Register. Additional data were collected concerning maternal rejection, socioeconomic status, maternal age, pregnancy and delivery complications, use of drugs during pregnancy, paternal criminal history, and parental psychiatric hospitalization. RESULTS: Results indicate a dose-response relationship between amount of maternal prenatal smoking and arrests for nonviolent and violent crimes. Maternal prenatal smoking was particularly related to persistent criminal behavior rather than to arrests confined to adolescence. These relationships remained significant after potential demographic, parental, and perinatal risk confounds were controlled for. CONCLUSIONS: Maternal prenatal smoking predicts persistent criminal outcome in male offspring. This relationship has not been accounted for by related parental characteristics or perinatal problems. Potential physiologic or central nervous system mediators between maternal smoking during pregnancy and offspring criminal outcomes need further study.

Mental illness and criminal violence.

This article examines the relationship between criminal violence and mental illness. Our data suggest that mentally ill persons tend to have an increased risk for committing violent offenses, and that the violent offending by these individuals tends to be recidivistic. Our findings suggest that parents who have both committed violent offenses and experienced a psychiatric hospitalization increase the risk of violent offending among their offspring. We propose the hypothesis that mentally ill parents transmit a biological characteristic which may genetically predispose their child towards criminal violence. Prenatal disturbances during critical periods of fetal development may provide clues regarding the etiology of criminal violence.

School teacher ratings predictive of psychiatric outcome 25 years later.

BACKGROUND: The current study examines teacher ratings as a tool for identifying students at risk of developing psychosis. Follow-up and follow-back studies have shown that teachers are capable of identifying individuals who later develop serious mental illness. METHOD: We examine the long-term outcomes for individuals at genetic risk who were identified as showing markedly deviant behaviour and those identified who did not show markedly deviant behaviour. RESULTS: Teachers were able to correctly anticipate 35% of students who developed schizophrenia. Furthermore, those identified as showing markedly deviant behaviour had poorer clinical and psychiatric outcomes 10 and 25 years later than those identified as not behaving with marked deviance. Their ratings also differentiated, within the group of people with schizophrenia, which individuals would show evidence of poorer functioning 25 years later. These results were replicated in a group of students not at genetic risk of schizophrenia. Within this low-risk group, teachers were able to predict which students would develop psychotic disorders. CONCLUSIONS: Teacher ratings were particularly useful in predicting clinical and psychiatric outcomes 10 and 25 years later. The applicability of these findings in early intervention and treatment research is discussed.

Fearlessness, stimulation-seeking, and large body size at age 3 years as early predispositions to childhood aggression at age 11 years.

BACKGROUND: Previous cross-sectional research in Western societies has linked adolescent stimulation-seeking, fearlessness, and body size to antisocial behavior. However, it is unclear how early in life these factors exert their influence, and nothing is known about their specificity to aggressive behavior per se. This study tests the hypotheses that stimulation-seeking, fearlessness, and increased body size at age 3 years predict aggression at age 11 years. METHODS: Behavioral measures of stimulation-seeking and fearlessness, together with height and weight, were measured at age 3 years and related to ratings of aggression at age 11 years in 1130 male and female Indian and Creole children from the island of Mauritius. RESULTS: Aggressive children at age 11 years were characterized by increased measures of stimulation-seeking, fearlessness, height, and weight at age 3 years. Stimulation-seeking and height were independently related to aggression, whereas the fearlessness-aggression relationship was mediated by height. Large body size at age 3 years but not 11 years was related to increased aggression at age 11 years, indicating a critical period in development for the influence of body size on aggression. CONCLUSIONS: Results (1) implicate large body size, stimulation-seeking, and fearlessness in the development of childhood aggression; (2) suggest that there may be a critical period in development in which biological processes influence later aggression; and (3) highlight the importance of early processes in the etiology of aggression.

Effects of child-rearing by schizophrenic mothers: a 25-year follow-up.

We conducted a 25-year follow-up study of 50 children of schizophrenic mothers, consisting of 25 children reared by their mothers and 25 children reared apart. The children's adult psychiatric status was evaluated in a 3-h structured interview employing a battery of syndrome check-lists and scales. A slightly higher incidence of psychopathology (including schizophrenia-spectrum disorders) was found among the reared-apart subjects. This may possibly be attributed to their greater genetic predisposition, as suggested by their mothers' more severe illnesses. Lifetime diagnoses do not provide evidence that psychopathology in offspring at genetic risk is increased by rearing by a schizophrenic mother.