Main risk factors for schizophrenia: increased familial loading and pre- and peri-natal complications antagonize the protective effect of oestrogen in women.

Women fall ill with schizophrenia 3 to 4 years later than men. The neurobiological mechanism, explaining the delay of onset in women until menopause, is presumably due to a sensitivity reducing effect of oestrogen on central d(2) receptors, as we have previously shown in animal experiments and in a controlled clinical study. The gender difference in age at onset seems to disappear in familial cases with schizophrenia, but it increases to highly significant values of 5 years or more in isolated cases according to a recent study by Albus and Maier (Schizophrenia Research 18:51-57, 1995). We tried to replicate these findings and to test the hypothesis of a functional antagonism between genetic predisposition to illness and the protective effect of oestrogen in a population-based sample of 232 first illness episodes of schizophrenia. In women with at least one first-degree relative suffering from schizophrenia, age at onset defined by first psychotic symptom was significantly reduced by several years and the difference with men disappeared. In sporadic female cases (no mental disorder in first-degree relatives) the age at onset was slightly increased compared with the total sample, which was in accordance with our hypothesis. In men with familial schizophrenia, but without a protective agent like oestrogen, the age at onset was only slightly and non-significantly reduced compared with the total group and with sporadic cases. This was in line with Albus and Maier and with our hypothesis that only the protective effect of oestrogen could be antagonized by a strong genetic disposition. The second main risk factor for schizophrenia is pre- and peri-natal complications. We compared men and women from our sample of first illness episodes with a history of pre- and peri-natal complications with those without a history of obstetric complications. In women the age at first psychotic symptom was markedly reduced, but due to small case numbers not significantly, compared with women without the risk factor and with the total group. Again, schizophrenic men with a history of pre- and peri-natal complications showed only a small, non-significant reduction of age at onset compared with the total and the group without the risk factor. Therefore, we concluded that the degree of genetically determined vulnerability and, presumably to a slightly lesser extent, the degree of pre- and peri-natal brain injury antagonizes the onset delaying effect of oestrogen in schizophrenia.

Coherent-pulse 2D crystallography using a free-electron laser x-ray source.

Coherent diffractive imaging for the reconstruction of a two-dimensional (2D) finite crystal structure with a single pulse train of free-electron laser radiation at 7.97 nm wavelength is demonstrated. This measurement shows an advance on traditional coherent imaging techniques by applying it to a periodic structure. It is also significant that this approach paves the way for the imaging of the class of specimens which readily form 2D, but not three-dimensional crystals. We show that the structure is reconstructed to the detected resolution, given an adequate signal-to-noise ratio.

[Schizophrenia and depression]. / Schizophrenie und Depression.

BACKGROUND: Comparison of symptom-related and social role development between patients with schizophrenia, major depression and healthy controls provided insights into the untreated early course of the two disorders. SAMPLES AND METHODS: Symptoms, functional impairment and social disability were assessed and compared using the IRAOS and several other cross-sectional instruments in three samples. RESULTS: At the early illness stages there was considerable overlap in the symptom patterns and impairments presented by persons with schizophrenia and severe depression. The two disorders did not diverge until later in the early illness course with the onset of psychotic symptoms. Depressive symptoms showed a maximum in the first psychotic episode and relapse episodes and decreased with the remitting episode. Due to differences in cognitive appraisal depressed patients reported more functional impairment and social disability than patients with schizophrenia did. CONCLUSION: The early course of symptoms and social impairment in schizophrenia and depression seems to offer an opportunity to distinguish these disorders from variants of normal development fairly early. However, early diagnostic distinction and prediction of psychosis versus depression risk at the pre-psychotic prodromal stage do not seem promising due to the broad overlap in symptoms and impairment.

[Coping with involuntary childlessness in men]. / Zur Verarbeitung ungewollter Kinderlosigkeit von Männern im Verlauf.

Somatic causes are equally distributed between the sexes, as are challenges in coping with infertility. The present paper is concerned with the hypothesis that coping mechanisms are influenced by personal motives for parenting and by the narcissistic demands of the personality. In the Heidelberg project on male infertility, 136 (80) male patients seeking andrological treatment were assessed before the onset of andrological diagnosis and one year later. Questionnaires on the motivation for parenting, narcissistic self-regulation, and coping mechanisms were submitted. Among the results, two correlational patterns that were stable over time are especially important: 1. "fragile self" pattern consisting of correlations between an endangered self image, depressive coping, and the wish to be emotionally stabilized by a child. 2. "symbiotic" pattern characterized by self-stabilization through symbiotic wishes expressed regarding the partner or the desired child, or by commitment to religion. The relevance of these patterns for men coping with infertility is discussed.

[Unfulfilled desire for children in the man: coping and pain. Results of a psychosomatic-andrologic cooperative study]. / Der unerfüllte Kinderwunsch beim Mann: Bewältigung und Erleiden. Ergebnisse einer psychosomatisch-andrologischen Kooperationsstudie.

115 andrological patients were studied with psychological self-assessment tests to assess both their motivation concerning parenthood, and their own explanations for the causes. Additionally self-esteem was evaluated in 51 patients. The main results were: Motivation concerning parenthood is of greater importance in coping with involuntary childlessness than objective andrological data. Patients assess their situation quite realistically; no tendency to misinterpret the medical data in order to defend negative feelings and to protect self-esteem could be found. Most patients with reduced fertility consider this situation a challenge and are willing to mobilize resources and the help of others in order to cope. Self-esteem was only threatened in those patients with longlasting unvoluntary childlessness and little acceptance of medical infertility treatment and parenting substitutes, e.g. adopting a child.

[Evaluation of infertile men after 1 year of andrological therapy. Results of treatment and its effect on desire for children and self-esteem]. / Ungewollt kinderlose Männer nach einem Jahr andrologischer Therapie. Der Behandlungserfolg und seine Auswirkungen auf Kinderwunsch und Selbstwerterleben.

BACKGROUND AND OBJECTIVE: Many couples have to cope with periods of involuntary childlessness and they often ask for medical help. In the Heidelberg Project of involuntary childlessness in men, andrological patients were surveyed from the time before diagnosis till the end of 1 year's andrological treatment. PATIENTS/METHODS: 145 andrological patients were interviewed and filled out questionnaires to assess their wishes for parenting and their self-esteem. RESULTS: As expected men with a normal spermiographic finding had an increased chance to father a child--even more so, when no andrological treatment was performed. For those who remained childless, the wish for parenting had a higher importance than for the eventual fathers. There was little change in self-esteem, either at the beginning of treatment or one year later--with one exception: men who became fathers and had been treated suffered from more social isolation than those who became fathers and had not been treated. CONCLUSIONS: Beyond the desired effects of medical treatment, psychological and social effects have to be considered in men with involuntary childlessness, especially with those patients whose spermiogram is not severely reduced.