Institutional rearing and diagnostic outcome in children of schizophrenic mothers. A prospective high-risk study.

Within a prospective, longitudinal study of offspring of schizophrenic mothers (so-called high-risk children), diagnostic outcome (schizophrenia, "schizotypal" personality disorder, other diagnoses, and no mental illness) was predicted by the mother's age at first hospitalization and by institutionalization during the first five years of life. Institutionalization was unrelated to adult psychopathology in a low-risk control group. These results are interpreted as supporting a diathesis-stress model of schizophrenic origin.

A prospective study of young men at high risk for alcoholism. Social and psychological characteristics.

In a prospective longitudinal study of alcoholism, we applied the high-risk method using a Danish birth cohort (9125 consecutive deliveries, 1959 to 1961). From the cohort, 134 sons of alcoholic fathers (high-risk group) and 70 matched controls without parental alcoholism were selected for study. Extensive data were collected in a multidisciplinary etiologic approach. We report the social and psychological characteristics from a "premorbid" assessment when the subjects were 19 to 20 years old. The high-risk group reported more disrupted familial conditions during childhood than the control group. Both groups had a drinking pattern similar to that of the general Danish population at the same age. No alcoholic subjects were found. The high-risk group was characterized by poor verbal ability and impulsive behavior. We plan a follow-up examination of the sample.

Behavioral precursors of schizophrenia spectrum. A prospective study.

In a prospective longitudinal study of children of severely schizophrenic mothers, premorbid behavioral data on individuals diagnosed as suffering from schizophrenia spectrum disorder were compared with the same data on individuals diagnosed as not suffering from any mental disorder. Future schizophrenia spectrum individuals were passive babies who exhibited short attention spans. In school, they experienced interpersonal difficulties and displayed disturbing behavior, reflecting poor affective control. From clinical assessments at a mean of 15 years of age, formal cognitive disturbance and defective emotional rapport emerged as premorbid characteristics of schizophrenia spectrum disorder. These results seem to indicate that signs of defective emotional contact and formal thought disorder are important for the psychopathology of schizophrenia. Furthermore, the premorbid similarity of borderline schizophrenia and schizophrenia suggests a basic relationship between these two disorders.

Cerebral ventricular size in the offspring of schizophrenic mothers. A preliminary study.

Within a prospective, longitudinal study of offspring of schizophrenic mothers, computed tomographic scan-derived measurements of ventricular size were evaluated for a subsample consisting of schizophrenics, borderline schizophrenics (DSM-III schizotypal), and mentally healthy individuals. Schizophrenics exhibited larger ventricular sizes and borderline schizophrenics smaller ventricular sizes than mentally healthy individuals. Ventricular size correlated with premorbidly obtained obstetric data. These results are interpreted as being consistent with the hypothesis that neurological insult may decompensate schizotypal individuals toward florid schizophrenia.

Cognitive abilities in left-handers: writing posture revisited.

Among 1848 young men appearing before the Danish draft board, 232 (13%) were left-handed. Of these, 118 (51%) used an inverted, or hook-like, writing posture, 49 (21%) used a non-inverted posture and the remaining 65 (28%) could not be categorized. There were no differences between left- and right-handers on a battery of four cognitive tests. However, inverted left-handers performed significantly or near-significantly better than the non-inverted left-handers on two of the four tests and significantly better on the total score for the test battery. These results support the contention that the inverted posture is adaptive for left-handers and suggest that it may be more likely to be adopted by those with better cognitive abilities. Our findings conflict with earlier reports from two decades ago, however, and the association may therefore be socially and culturally dependent.

Heredity-environment interaction and schizophrenia.

The longitudinal prospective study of populations at risk is considered a powerful strategy towards disentangling hereditary and environmental factors. Data from Mednick and Schulsinger's 1962 study in Copenhagen, on children at high-risk for schizophrenia are used as an illustration. Pregnancy and birth complications, as well as institutional rearing in early childhood contributes towards schizophrenia in the risk children, but not in the low-risk controls. Risk children with an outcome of schizotypal personality disorder were hardly exposed to perinatal complications. To some extent, schizophrenia may be considered as a complicated form of schizotypal personality disorder, which again may be a genetically transmitted condition.

Suicide after a stroke: a population study.

STUDY OBJECTIVE: To establish whether there are increased rates of suicide after a stroke and the degree to which any increase is related to gender, age at stroke, diagnosis, duration of hospitalisation, and time since stroke. DESIGN: Cross linkage of national registers for hospitalisations and causes of death. SETTING: The population of Denmark, 1979-1993. PATIENTS: A study cohort was defined comprising all 114 098 stroke patients discharged alive from hospital during the period 1979-1993. These patients were then screened in a register of causes of death over the same time period, and 359 cases of suicide were identified. MAIN RESULTS: Annual incidence rates, both observed and expected, together with standardised mortality ratios (SMR) were computed based on annual population and suicide statistics, stratified by age and gender. The overall annual incidence rate of suicide in the cohort was 83 per 100 000 per year compared with an expected figure of 45 (difference = 38, 95% CI = 27, 49). Correspondingly, SMR were increased for stroke patients. Across all age bands the SMR for mens was 1.88 (95%CI 1.66, 2.13) and for women 1.78 (1.48, 2.14). SMR were greatest (2.85; 2.17, 3.76) for patients under 50 years of age group and were least for patients 80 years or older (1.3; 0.95, 1.79). There was no clear relation to stroke diagnosis. Suicides were negatively related to duration of hospitalisation, being lowest for those hospitalised for more than three months (0.88; 0.65, 1.19) and highest for those hospitalised for less than two weeks (2.32; 1.92, 2.80). Survival analysis suggested that the risk for suicide is greatest up to about five years after a stroke. CONCLUSIONS: Stroke patients are at an approximately doubled risk for suicide. This risk is greater among younger patients and among patients hospitalised for a relatively shorter time. The risk appears to decline with time after a stroke, being greatest within the first five years.

Subjective and objective measures of response to alcohol among young men at risk for alcoholism.

Biological sons of alcoholic men constitute one group at high risk (HR) for the development of alcoholism. A low dose of alcohol (0.5 g/kg) was administered to HR and control subjects. Measures based on self-ratings, an observer's assessment and visuomotor performance were used to compare the HR and control subjects before and after alcohol administration. Results showed HR subjects' self-ratings of intoxication and somatic symptoms were significantly lower than those of control subjects after alcohol administration. Measures based on an observer's assessment of the two groups did not distinguish them, but one measure of visuomotor performance did. Because the HR and control subjects did not differ in self-reported alcohol consumption or blood alcohol levels acquired in this study, it appears unlikely these factors could account for the differential responses to alcohol administration in HR and control subjects.

A prospective study of young men at high risk for alcoholism: school behavior and achievement.

From a large consecutive birth cohort in Denmark, 134 sons of alcoholic fathers (high-risk group) and 70 matched controls were selected for a prospective longitudinal study of alcoholism. A premorbid multidisciplinary assessment was conducted at age 19-20. Data were derived from three sources: a social worker interview, a psychopathological interview that also collected information about current drinking pattern, and a questionnaire sent to teachers. The high-risk group reported having experienced a more disturbed school career, and were rated by their teachers as having been more impulsive and as having had poorer verbal proficiency. These factors may be predictive of future alcoholism.

School health screening of a birth cohort: a prospective longitudinal study.

School age illnesses, coded according to the International Classification of Diseases (ICD) from information in 4 327 school health records, are reported for a perinatal cohort (The Copenhagen Perinatal Cohort 1959-61) comprising 9 125 successive live births. Although characteristic somatic disorders continue to arise, the medical picture is dominated by problems of a psycho-social nature. This finding suggests that the school health service should be adapted towards this changing pattern of child health.

Duration of cognitive dysfunction after concussion, and cognitive dysfunction as a risk factor: a population study of young men.

OBJECTIVES: To establish how long cognitive dysfunction lasts after concussion, and the extent to which it may be a predisposing risk factor for concussion, by examining the prevalence of cognitive dysfunction among young men who have sustained concussion. DESIGN: Observational study. SETTING: Denmark. SUBJECTS: 1220 young men who had been admitted to hospital for concussion between the ages of 16 and 24 (identified in a national register of admissions) and who had also been cognitively tested by the Danish conscription draft board. MAIN OUTCOME MEASURE: Score on the draft board's cognitive screening test, dichotomised as dysfunctional or non-dysfunctional (20.4% of the general population of Danish men appearing before the draft board had a dysfunctional score). RESULTS: 700 of the 1220 men had been tested after sustaining concussion; 520 had been tested before concussion. Four (50%) of the eight men who were tested less than seven days after the injury had a dysfunctional score. Among groups of the remaining 692 men who were tested at later time points after injury, the rates were only marginally raised (range 21.4% to 26.5%) above the population level. Among men tested before injury, the rate of dysfunctional scores was higher (30.4% (158/520)). Apart from suggesting cognitive dysfunction as a risk factor for concussion, this higher proportion seems to relate to the fact that they were typically injured as young adults, whereas those men who were tested after concussion had more often been injured as adolescents. The relative risk for concussion in the presence of cognitive dysfunction is estimated to be 1.57 (95% confidence interval 1.32 to 1.86). CONCLUSIONS: Cognitive dysfunction is not only a short term consequence of concussion but also a predisposing risk factor for concussion, more so for young adults than for adolescents.

Genetic and early environmental components in sociodemographic influences on adult body fatness.

OBJECTIVE: To explore genetic and environmental contributions to the influence of parental social class and region of upbringing on adult human fatness. DESIGN: Survey of sample of adults who had been adopted in childhood to relate their body mass index to sociodemographic variables in a series of multiple linear regression analyses. SUBJECTS: 4643 Subjects traced from a register of 5455 non-familial adoptees registered in 1924-47, of whom 3651 gave details of current height, weight, and occupation. The final sample totalled 2015 adoptees for whom there was also information on their region of upbringing and on the social class of their adoptive and biological fathers. MAIN OUTCOME MEASURES: Age, sex, body mass index, social class (of adoptee and adoptive and biological father), and geographical region. RESULTS: There was a significant inverse relation of adoptees' body mass index with their own social class and that of both their biological and adoptive fathers. Adoptees raised in provincial areas had a significantly greater body mass index than did those raised in Copenhagen. A multivariate regression model, including age, sex, and social class of the adoptee, confirmed the significant independent influence of the social class of both adoptive and biological fathers and of region of rearing on adoptees' body mass index. CONCLUSION: Both familial environmental and genetic factors contribute to the relation of parental social class to adult fatness, and they are partly independent of the effect of an individual's own social class. The influence of region of upbringing on adult fatness is of environmental origin and is independent of social class characteristics.

Prenatal exposure to alcohol, and gender differences on child mental health at age seven years.

BACKGROUND: It remains uncertain whether exposure to lower doses of alcohol is damaging to the developing fetus. The present study aimed to investigate associations for boys and girls between prenatal exposure to binge drinking and lower doses of alcohol in pregnancy, and parent-reported behavioural and emotional development at age seven. METHODS: This study used data from the Danish National Birth Cohort. Associations between cumulated alcohol exposure and binge drinking from full pregnancy and parent scores on the Strengths and Difficulties Questionnaire (SDQ) measured at age seven were investigated. The SDQ was used as continuous externalising/internalising scores, and as above/below cut-off for the specific scales of hyperactivity/inattention, conduct, emotional and peer problems. Inclusion criteria were information on alcohol exposure from three interviews, SDQ scores at age seven and being born full term (n=37 152). RESULTS: Controlling for relevant confounders, small positive associations were observed between binge drinking and internalising (relative change in mean: 1.04-1.06), externalising scores (relative change in mean: 1.01-1.07), and conduct scores (OR 1.12 to 1.23) for boys. No associations were observed with lower doses of alcohol. CONCLUSIONS: Exposure to binge drinking is weakly associated with impaired behavioural and emotional development measured at age seven. Large differences in background characteristics were observed between the groups defined by cumulated alcohol exposure, leaving the interpretations of findings uncertain.

Parental stress and marital relationships among patients with brain injury and their spouses.

INTRODUCTION/OBJECTIVES: This study examines parental stress and marital relationship among patients with acquired brain injury and their spouses. PARTICIPANTS, MATERIALS/METHODS: The participants were 35 patients diagnosed with acquired brain injury and having school-aged children, together with their spouses recruited from out-patients from brain injury rehabilitation units across Denmark. The parents self-reported parental stress using the Parental Stress Index (PSI), marital adjustment using the Dyadic Adjustment Scale (DAS), family functioning using the Family Environment Scale (FES). Additionally, the healthy parents completed the Symptom Checklist 90 (SCL-90) measuring psychological symptoms. A matched control group consisted of parents suffering from diabetes and their spouses, being recruited from the National Danish Diabetes Register. RESULTS: Significantly more symptoms of parental stress were reported by the brain-injured parents when compared to the diabetic parents (p < 0.05); the brain injured parents also reported significant more family dysfunction (p < 0.05). The healthy parents in the brain injury group rated their marital satisfaction and current relationship happiness significantly lower (p < 0.05) than the healthy control group. The spouses to the brain-injured patients were also significantly more depressed (p < 0.01). CONCLUSIONS: When parents have acquired brain injury, they experience more parental stress and family dysfunction. Their spouses are less satisfied in their marital relationship and feel more depressed. These results indicate the need of a family centred supportive service to focus on the relational changes and dysfunctional family processes in families with a brain-injured parent and dependent children.

The European Brain Injury Questionnaire (EBIQ) as a reliable outcome measure for use with people with brain injury.

PRIMARY PURPOSE: There is a need to develop reliable outcome measures to determine well-being after brain injury. In 1997, Teasdale et al. published the European Brain Injury Questionnaire (EBIQ), a self-report and relative-report measure of the subjective experience of cognitive, emotional and social difficulties experienced by people with brain injury. It is now used in several rehabilitation centres as an outcome measure, but its test-re-test reliability has yet not been determined. The primary purpose of the present study is to establish this degree of reliability. RESEARCH DESIGN: The EBIQ was administered twice within an approximately 1-month period to 50 people with brain injury, to 20 relatives of people with brain injury and to 51 normal controls. RESULTS: The results showed significant and satisfactory test-re-test reliabilities for all three groups across all nine EBIQ scales (r = 0.55-0.90). CONCLUSION: It is concluded that the EBIQ is a clinically reliable measure to determine the subjective well-being of people with brain injury and to assess change of subjective concerns over time.

Subjective well-being and quality of life following traumatic brain injury in adults: a long-term population-based follow-up.

PRIMARY OBJECTIVE: To assess subjective well-being and quality-of-life in nationally representative samples of patients at long intervals following traumatic brain injuries. METHODS AND PROCEDURES: Patients with either cranial fractures or cerebral lesions were identified in a national computer-based register of hospital admissions and random samples were selected among those who had suffered the injury at 5, 10 or 15 years prior to the follow-up. Postal questionnaires were sent to them covering quality of life, e.g. return to employment, family relations and current subjective well-being in terms of symptomatology, e.g. somatic complaints, cognitive dysfunction. A response rate of 76% was obtained, comprising 114 patients with cranial fracture and 126 with cerebral lesions. MAIN OUTCOMES AND RESULTS: The group with cerebral lesions had markedly poorer quality of life and subjective well-being than the group with cranial fractures and this did not vary across time. In both groups, the most common symptoms concerned cognition. Among the cerebral lesion group, quality of life outcome was fairly well predicted by severity of injury, but subjective well-being was less well predicted. CONCLUSIONS: The negative consequences of traumatic cerebral lesions are marked and do not vary at long periods following injury.

Psychosocial consequences of stroke: a long-term population-based follow-up.

PRIMARY OBJECTIVE: To investigate psychosocial status among nationally representative groups of stroke patients at long intervals post-stroke. METHODS AND PROCEDURES: From a Danish national register of hospitalizations, three representative groups of surviving patients were selected who had suffered a stroke 5, 10 and 15 years previously. A follow-up postal questionnaire was sent to them comprising items concerning symptomatology, functioning and social conditions, together with the Nottingham Health Profile (NHP). MAIN OUTCOMES AND RESULTS: Longer follow-up intervals were associated with younger age at stroke and better functioning at discharge. At follow-up, the majority of patients reported difficulties with attention, memory and emotional control, irrespective of follow-up interval. Return to employment, social relations and leisure activities were affected, but were comparatively better at longer follow-up intervals, as was self-rated functioning and several NHP symptom scales. However, multi-variate analyses suggest that these positive changes with time appear to be mediated by attrition related to age at stroke and discharge functioning rather than time since stroke itself. CONCLUSIONS: Symptomatology, functioning and social conditions remain affected and perhaps stagnant in long-term survivors of stroke.