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.

Breast-feeding and alcoholism: the Trotter hypothesis.

OBJECTIVE: The authors' goal was to determine whether early termination of breast-feeding contributes to later alcohol dependence, as proposed more than 200 years ago by the British physician Thomas Trotter. METHOD: In 1959-1961, a multiple-specialty group of physicians studied 9, 182 consecutive deliveries in a Danish hospital, obtaining data about prepartum and postpartum variables. The present study concentrates on perinatal variables obtained from 200 of the original babies who participated in a 30-year high-risk follow-up study of the antecedents of alcoholism. RESULTS: Of the 27 men who were diagnosed as alcohol dependent at age 30, 13 (48%) came from the group weaned from the breast before the age of 3 weeks; only 33 (19%) of the 173 non-alcohol-dependent subjects came from the early weaning group. When challenged by other perinatal variables in a multiple regression analysis, early weaning significantly contributed to the prediction of the severity of alcoholism at age 30. CONCLUSIONS: The data support the hypothesis that early weaning may be associated with a greater risk of alcohol dependence later in life.

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.

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.

Psychophysiological protective factors for male subjects at high risk for criminal behavior.

OBJECTIVE: This study examines the role of elevated autonomic nervous system reactivity in protecting individuals at high risk for criminal behavior from antisocial outcomes. The authors hypothesized that subjects with criminal fathers who did not become criminals themselves were biologically protected from such an outcome because of, in part, heightened responsiveness of the autonomic nervous system. METHOD: Ninety-four male subjects were placed into one of four study groups: criminal with criminal father (N = 26), noncriminal with criminal father (N = 24), criminal with noncriminal father (N = 20), and noncriminal with noncriminal father (N = 24). Skin conductance and heart rate data were gathered in an orienting paradigm. RESULTS: Skin conductance and heart rate orienting reactivity were found to be significantly higher in the group of noncriminal subjects with criminal fathers than in the other three groups. CONCLUSIONS: For subjects at high risk for criminal behavior, heightened autonomic nervous system responsiveness appears to be associated with lower likelihood of criminal outcome.

Childhood behavior precursors of schizotypal personality disorder.

No study has yet reported specifically on the early behavior of individuals later diagnosed with schizotypal personality disorder (SPD). This study examines prospectively collected teacher reports on school behavior as a means of assessing childhood precursors of SPD. Thirty-six DSM-III-R diagnosed schizotypal subjects were compared with four other groups: 31 schizophrenia patients, 37 diagnosed as nonpsychotic mentally ill, 68 who were not mentally ill but had mothers with schizophrenia, and 60 who were not mentally ill and had normal parents. These individuals were compared on a teachers' school report questionnaire obtained when the subjects averaged 15.1 years old. Those who later developed SPD were found to be more passive and unengaged and more hypersensitive to criticisms compared with the nonschizophrenia groups. Similar results were found when males and females were examined separately, except that males who developed SPD were found to be less disruptive and hyperexcitable compared with males with schizophrenia; females with SPD did not differ from females with schizophrenia. A receiver operating characteristic analysis found these factors to predict 73.5 percent of future SPDs; the ability of these factors to predict future SPDs is comparable for males and females. These findings suggest that preschizotypal traits may be identified in late childhood or adolescence.

Structural brain abnormalities in schizophrenia: a family study.

Structural brain abnormalities such as ventricular enlargement are robust correlates of schizophrenia, but the degree of difference compared with unrelated normal controls is only moderate (< 1 standard deviation), and only 40% of patients have values on these measures that fall outside of the normal distribution. Family studies can help to clarify the meaning of this overlap by controlling for some of the non-schizophrenia-related genetic variation in neuroanatomical traits. Computerized tomographic scans of the brain were used to measure ventricular and sulcal cerebrospinal fluid (CSF) to brain ratios (VBR and SBR) for each hemisphere in 16 pairs of discordant siblings from the Copenhagen Schizophrenia High-Risk Project. Schizophrenics' values for VBR and SBR exceeded those of their nonschizophrenic siblings in 75% of the pairs; on average, patients' values on these measures were 1 and 5 standard deviations larger, respectively, than those of their nonschizophrenic siblings. Sulcal and left hemisphere effects were significantly more pronounced than ventricular and right hemisphere effects. After controlling for between-family variation, structural brain abnormalities appear to be more prevalent and more pronounced in schizophrenia than has previously been assumed, with relatively greater deviation observed for cortical and left hemisphere measures of CSF space enlargement.

Mental disorder and crime. Evidence from a Danish birth cohort.

BACKGROUND: Evidence has accumulated since the mid 1960s from a number of different countries indicating an association between mental disorder and crime and particularly between the major mental disorders and violence. Registries in Denmark were used to identify a birth cohort and to document all psychiatric admissions and all criminal proceedings of the 324401 members of this cohort up to the age of 43 years. METHODS: Persons who had been admitted to a psychiatric ward were assigned to a diagnostic category according to a hierarchy of principal discharge diagnoses. They were compared with persons never admitted to a psychiatric ward as to the prevalence, type, and frequency of criminal convictions. RESULTS: Women and men who had been hospitalized in psychiatric wards were more likely to have been convicted of a criminal offense than persons with no history of psychiatric hospitalization. The offenders who were hospitalized committed all types and, on average, as many offenses as did the never-hospitalized group of the same sex. CONCLUSIONS: These findings confirm those from 2 other post-World War II Scandinavian birth cohorts that have found an association between psychiatric hospitalization and criminal convictions. They also concur with findings that patients discharged from psychiatric wards are more likely than other persons living in the same community to commit crimes and with results from North America showing elevated rates of major mental disorders among incarcerated offenders. Generalization of these findings is limited to nations with similar criminal justice, mental health, and social welfare systems.

The latent structure of schizotypy: I. Premorbid indicators of a taxon of individuals at risk for schizophrenia-spectrum disorders.

A taxometric analysis (R. R. Golden & P. E. Meehl, 1979) was conducted to test the hypotheses that liability for schizophrenia-spectrum disorders is dichotomously distributed and that this liability can be detected premorbidly with behavioral indicators analogous to many of the criteria for schizotypal personality disorder. Behaviors were assessed in 207 offspring of schizophrenic mothers and 104 matched offspring of normal parents in 1962, when participants' mean age was 15 years. Diagnoses on the basis of the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) were made in 1986-1989, when participants were nearly through the risk period for developing schizophrenia. The aggregation of indicators was consistent with a bimodal latent liability distribution. Membership in the schizotypal class was a sensitive and specific predictor of the emergence of schizophrenia-spectrum disorders in adulthood.

Developmental brain abnormalities in the offspring of schizophrenic mothers. II. Structural brain characteristics of schizophrenia and schizotypal personality disorder.

BACKGROUND: We examined differences in ventricular and sulcal cerebrospinal fluid-to-brain ratios as a function of lifetime psychiatric diagnosis in the offspring of schizophrenic mothers (high-risk sample) and in the offspring of normal parents (low-risk sample). METHODS: We used a cohort analytic study of 17 high-risk individuals with schizophrenia, 31 high-risk individuals with schizotypal personality disorder, 33 high-risk individuals with nonschizophrenia-spectrum psychiatric disorders, 45 high-risk individuals with no disorders, 31 low-risk individuals with psychiatric disorders of all types, and 46 low-risk individuals with no disorders, evaluated initially in 1962 when they were a mean age of 15 years, and reexamined from 1986 through 1989 with psychiatric interviews and computed tomographic scans of the brain. RESULTS: High-risk individuals with schizophrenia and schizotypal personality disorder evidenced an equivalent degree of cortical sulcal enlargement, and both groups evidenced significantly greater sulcal enlargement than did high-risk individuals with nonschizophrenia-spectrum disorders and no disorders and low-risk individuals with psychiatric disorders and no disorders. High-risk individuals with schizophrenia evidenced significantly greater ventricular enlargement than did high-risk and low-risk subjects with other disorders and no disorders, including those with schizotypal personality disorder. These differences were independent of age, gender, history of substance dependence, and history of organic brain syndromes and head injuries. CONCLUSIONS: Among the offspring of schizophrenic parents, cortical abnormalities are expressed equally across the range of syndromes in the schizophrenia spectrum. Subcortical abnormalities (ie, ventricular enlargement) are more pronounced in the more severe syndrome (ie, schizophrenia).

The influence of parental socioeconomic status on CT studies of schizophrenia.

A sample of 19 DSM-III-R schizophrenics and 94 controls with no mental illness from the Copenhagen high-risk project was used to test the hypothesis that social class of origin is related to adult CT measures of ventricular, sulcal, Sylvian fissure and anterior interhemispheric fissure enlargement, cerebellar pathology, and brain volume. The schizophrenics and controls were divided into high and low SES-of-origin. No significant differences emerged between the high and low SES-of-origin subjects within the schizophrenic and control groups on any of the six CT measures.

Lifetime DSM-III-R diagnostic outcomes in the offspring of schizophrenic mothers. Results from the Copenhagen High-Risk Study.

OBJECTIVES: To perform a long-term prospective follow-up of children at high risk for schizophrenia to identify risk factors for the development of this disorder. DESIGN: Prospective follow-up population study of children of schizophrenic mothers and their matched controls from age 15 years to age 42 years, with multiple diagnostic assessments performed by senior clinicians using structured interviews blindly with respect to the group membership of the subject. PARTICIPANTS: Two hundred seven offspring of schizophrenic mothers and 104 control children without schizophrenic parents matched to the index group on age, sex, paternal socioeconomic status, urban/rural residence, and the amount of time spent during childhood in institutional rearing. MAIN OUTCOME MEASURE: The prevalence of the DSM-III-R disorders during the subjects lifetime. RESULTS: A significant aggregation of schizophrenia (16.2%) and other nonaffective, nonorganic psychosis (4.6%), and Cluster A personality disorders (21.3%) occurred among the offspring of schizophrenic mothers compared with the controls (1.9%, 0.9%, and 5%, respectively). No evidence of increased aggregation of (psychotic and nonpsychotic) affective disorders was noted among the offspring of schizophrenics. CONCLUSION: These results coincide with the results of other family studies in demonstrating a significant and specific familial aggregation of schizophrenia and nonpsychotic schizophrenia spectrum disorders among the biological relatives of schizophrenics.

Developmental brain abnormalities in the offspring of schizophrenic mothers. I. Contributions of genetic and perinatal factors.

OBJECTIVE: We examined the contributions of genetic risk for schizophrenia and obstetric complications to brain morphological abnormalities in the offspring of schizophrenic and normal patents. METHODS: We used a cohort analytic study of 60, 72, and 25 individuals with neither, one, or two parents, respectively, who were affected with schizophrenia spectrum disorders, evaluated initially in 1962 when they were on average 15 years old, and reexamined from 1986 through 1989 with psychiatric interviews and computed tomographic scans of the brain. RESULTS: After controlling for the effects of age, gender, substance abuse, and history of organic brain syndromes and head injuries, there were significant stepwise, linear increases in cortical and ventricular cerebrospinal fluid-brain ratios with increasing level of genetic risk for schizophrenia. Genetic risk for schizophrenia also interacted with prospectively assessed birth complications in predicting selectively to enlargement of the ventricular system; ie, the effect of birth complications on ventricular enlargement was greater among those with two affected parents compared with those with one affected parent, and greater among those with one affected parent compared with those with normal parents. Perinatal exposure to ether anesthesia was associated with a generalized increase in brain abnormality, which varied in severity according to level of genetic risk for schizophrenia. CONCLUSIONS: The type and degree of brain abnormalities shown by adult offspring of schizophrenic and normal parents are strongly predicted by the independent and interacting influences of genetic risk for schizophrenia and obstetric complications. The findings further substantiate the hypothesis that structural brain abnormalities in schizophrenia are at least in part neurodevelopmental in origin.

Housing conditions and residential needs of psychiatric patients in Copenhagen.

A study of the extent of homelessness among 1581 psychiatric patients in Copenhagen found that 342 patients (22%) in contact with the psychiatric services had serious housing problems. A total of 112 (7%) were long-stay patients without a home address, 134 (8%) were in an unstable housing situation and 96 (6%) were actually homeless. The homeless among the psychiatric patients were characteristically single, on disability pension or general public assistance, most often under 45 years of age, often schizophrenic and, among the men, almost one third were alcohol abusers. The majority of the homeless preferred separate apartments, and the psychiatrists also considered this form of housing to be the most appropriate for them. Approximately one fifth were estimated to need staff-supported housing, and the number of places in psychiatric group homes or halfway houses should therefore be increased.

Third ventricle enlargement and lower heart rate levels in a high-risk sample.

Heart rate activity and computed tomographic measures of structural brain abnormalities were evaluated in 32 individuals with a genetic risk for schizophrenia (offspring of schizophrenic mothers). Heart rate activity was assessed in 1962 when the subjects were a mean age of 15.1 years. Diagnostic and computed tomography assessments were conducted in 1980. Compared to individuals with normal third ventricles, individuals with enlarged third ventricles evidenced significantly lower heart rate levels overall and significantly lower heart rate during rest and during the periods preceding conditioning and test for conditioning stimulus trials. These effects were independent of age, psychiatric diagnosis, and abnormalities in other brain regions. Difficulties in interpretation posed by the index of brain abnormality employed and by the 18-year time interval between the heart rate and computed tomography assessments are discussed. Together with prior evidence of a relationship between third ventricle enlargement and reduced electrodermal responsiveness in the same subjects, these findings provide a preliminary indication that enlargement of the third ventricle may involve damage to diencephalic structures involved in autonomic nervous system activity.

The national mental health programme in the United Republic of Tanzania. A report from WHO and DANIDA.

This is the terminal report on the pilot implementation phase of the national mental health programme in the United Republic of Tanzania which was carried out as a cooperative venture between the Government of Tanzania, the Danish International Development Agency (DANIDA), and the World Health Organization (WHO). Although Tanzania had already achieved wide coverage of its population through a decentralized and easily accessible system of primary health care facilities providing the most essential services, its mental health services were poorly staffed and concentrated in a few custodial-type institutions and out-patient departments hardly capable of ensuring even one contact per year to about one-fifth of the estimated 100,000 severely mentally ill adults and 37,000 children in need of care at any given point in time. The programme design, developed jointly by the three parties involved, aimed to take full advantage of Tanzania's existing primary health care infrastructure by integrating mental health into the general health services of the country, including the 'grassroot' level of the services in the village and the district. The objectives guiding the new programme were: (i) to create an infrastructure for mental health care provision which should meet the requirements of both adequate population coverage and quality of service; (ii) to raise the community's awareness of mental health issues (including informing the community on the availability of effective means to deal with specific problems) and thus enlist its support and participation. The essential features of the adopted strategy were as follows. 1. Mental health care provision was conceived as a sub-system within the health care system, extending from rural health posts and dispensaries through rural health centres to district and regional hospitals. While full integration of mental health care within the general functions of the health workers was sought at the village and dispensary level (first echelon of care), relative differentiation and identity of mental health services were considered necessary at the district and regional levels (the second echelon). Tasks appropriate to each level of care were defined in operational terms and referral pathways were designated to enable the unobstructed access of the patient to more specialized diagnostic or therapeutic services if the problem was not within the competence of the more peripheral level. These pathways were also used in reverse when, following assessment or treatment, a patient was discharged back to the rural service with appropriate instructions about maintenance treatment and aftercare.(ABSTRACT TRUNCATED AT 400 WORDS)

Genetics of obesity in adult adoptees and their biological siblings.

An adoption study of genetic effects on obesity in adulthood was carried out in which adoptees separated from their natural parents very early in life were compared with their biological full and half siblings reared by their natural parents. The adoptees represented four groups who by sampling from a larger population were categorised as either thin, medium weight, overweight, or obese. Weight and height were obtained for 115 full siblings of 57 adoptees and for 850 half siblings of 341 adoptees. In full siblings body mass index (kg/m2) significantly increased with weight of the adoptees. Body mass index of the half siblings showed a steady but weaker increase across the four weight groups of adoptees. There were no significant interactions with sex of the adoptees, sex of the siblings, or (for the half siblings) sex of the common parent. In contrast with the findings in half siblings and (previously) the natural parents there was a striking, significant increase in body mass index between full siblings of overweight and obese adoptees. The degree of fatness in adults living in the same environment appears to be influenced by genetic factors independent of sex, which may include polygenic as well as major gene effects on obesity.