Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-22T06:52:38.549Z Has data issue: false hasContentIssue false
  • English
  • Français

The subtyping of schizophrenia in men and women: a latent class analysis

Published online by Cambridge University Press:  09 July 2009

D. J. Castle ,
P. C. Sham ,
S. Wessely  and
R. M. Murray
D. J. Castle*
Affiliation:
Genetics Section Institute of Psychiatry, London
P. C. Sham
Affiliation:
Genetics Section Institute of Psychiatry, London
S. Wessely
Affiliation:
Genetics Section Institute of Psychiatry, London
R. M. Murray
Affiliation:
Genetics Section Institute of Psychiatry, London
*
1Address for correspondence: Dr David J. Castle, Genetics Section, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF.
Get access Rights & Permissions [Opens in a new window]

Synopsis

Latent class analysis on an epidemiologically based series of 447 first contact patients with a broad diagnosis of schizophrenia revealed evidence for two subtypes: a ‘neurodevelopmental’ type characterized by early onset, poor pre-morbid social adjustment, restricted affect and a male: female ratio of 7:3; and a ‘paranoid’ type characterized by later onset, persecutory delusions and an almost equal sex ratio. A third ‘schizoaffective’ subtype, whose existence was less clear cut, was almost entirely confined to females and characterized by dysphoria and persecutory delusions, and had negligible familial risk of schizophrenia. The aetiological, biological and clinical significance of this typology remains to be tested.

Type
Original Articles
Information
Psychological Medicine , Volume 24 , Issue 1 , February 1994 , pp. 41 - 51
Copyright
Copyright © Cambridge University Press 1994

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andreasen, N. C., Swayze, V. W. II, Flaum, M., Yates, W. R., Arndt, S. & McChesney, C. (1990). Ventricular enlargement in schizophrenia evaluated with computed tomographic scanning. Archives of General Psychiatry 47, 1008–1015.CrossRefGoogle ScholarPubMed
Angermeyer, M. C. & Kuhn, L. (1988). Gender differences in age at onset of schizophrenia: an overview. European Archives of Psychiatry and Neurological Sciences 237, 351–364.CrossRefGoogle ScholarPubMed
Angermeyer, M. C., Goldstein, J. M. & Kuhn, L. (1989). Gender differences in schizophrenia: rehospitalization and community survival. Psychological Medicine 19, 365–382.CrossRefGoogle ScholarPubMed
Angermeyer, M. C., Kuhn, L. & Goldstein, J. M. (1990). Gender and the course of schizophrenia: differences in treated outcomes. Schizophrenia Bulletin 16, 293–307.CrossRefGoogle ScholarPubMed
Aylward, E., Walker, E. & Bettes, B. (1984). Intelligence and schizophrenia: meta-analysis of the research. Schizophrenia Bulletin 10, 430–459.CrossRefGoogle ScholarPubMed
Bartholomew, D. J. (1987). Latent Variable Models and Factor Analysis. Griffin: London.Google Scholar
Bellodi, L., Bussoleni, C., Scorza-Smeraldi, R., Grassi, G., Zacchetti, G. & Smeraldi, E. (1986). Family study of schizophrenia: exploratory analysis for relevant factors. Schizophrenia Bulletin 12, 120–128.CrossRefGoogle ScholarPubMed
Bishop, Y. V. V., Fienberg, S. E. & Holland, P. W. (1975). Discrete Multivariate Analysis, pp. 123–175. MIT Press: Cambridge, Mass.Google Scholar
Bradbury, T. N. & Miller, G. A. (1985). Season of birth in schizophrenia: a review of evidence, methodology, and aetiology. Psychological Bulletin 98, 569–594.CrossRefGoogle Scholar
Castle, D. J. & Murray, R. M. (1991). The neurodevelopmental basis of sex differences in schizophrenia. Psychological Medicine 21, 565–575.CrossRefGoogle ScholarPubMed
Castle, D. J., Wessely, S., Der, G. & Murray, R. M. (1991). The incidence of operationally defined schizophrenia in Camberwell, 1965 to 1984. British Journal of Psychiatry 159, 790–794.CrossRefGoogle Scholar
Clogg, C. C. (1977). Unrestricted and Restricted Maximum Likelihood Latent Structure Analysis: A Manual for Users. Population Issues Research Office: University Park, PA.Google Scholar
Clogg, C. C. & Goodman, L. A. (1985). Simultaneous latent structure analysis in several groups. In Sociological Methodology (ed. Tuma, N. B.), pp. 81–110. Josey-Bass: San Francisco.Google Scholar
Dempster, A. P., Laird, N. M. & Rubin, D. N. (1977). Maximum likelihood from incomplete data via the EM algorithm. Journal of the Royal Statistical Society Series B 39, 1–38.Google Scholar
Done, D. J., Johnstone, E. C., Frith, C. D., Golding, J., Shepherd, P. M. & Crow, T. J. (1991). Complications of pregnancy and delivery in relation to psychosis in adult life: data from the British perinatal mortality survey sample. British Medical Journal 302, 1576–1580.CrossRefGoogle ScholarPubMed
Everitt, B. S. (1984). An Introduction to Latent Variable Models. Chapman & Hall: London.CrossRefGoogle Scholar
Everitt, B. S. (1988 a). A Monte Carlo investigation of the likelihood ratio test for number of classes in latent class analysis. Multivariate Behavioural Research 23, 531–538.CrossRefGoogle ScholarPubMed
Everitt, B. S. (1988 b). A finite mixture model for the clustering of mixed-mode data. Statistics and Probability Letters 6, 305–309.CrossRefGoogle Scholar
Farmer, A. E., McGuffin, P. & Spitznagel, E. L. (1983). Heterogeneity in schizophrenia: a cluster-analytic approach. Psychiatry Research 8, 1–12.CrossRefGoogle ScholarPubMed
Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R., Winokur, G. & Munoz, R. (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry 26, 57–000.CrossRefGoogle ScholarPubMed
Foerster, A., Lewis, S. W., Owen, M. & Murray, R. M. (1991 a). Low birth weight and a family history of schizophrenia predict poor premorbid functioning in psychosis. Schizophrenia Research 5, 13–20.CrossRefGoogle Scholar
Foerster, A., Lewis, S. W., Owen, M. & Murray, R. M. (1991 b). Premorbid personality in psychosis: effects of sex and diagnosis. British Journal of Psychiatry 158, 103–105.CrossRefGoogle ScholarPubMed
Freeman, M. F. & Tukey, J. W. (1950). Transformations related to the angular and square root. Annals of Mathematics and Statistics 21, 607–611.CrossRefGoogle Scholar
Goldstein, J. M. & Link, B. G. (1988). Gender and the expression of schizophrenia. Journal of Psychiatric Research 22, 141–155.CrossRefGoogle ScholarPubMed
Goldstein, J. M., Tsuang, M. T. & Faraone, S. V. (1989). Gender and schizophrenia: implications for understanding the heterogeneity of the illness. Psychiatry Research 28, 243–253.CrossRefGoogle ScholarPubMed
Goldstein, J. M., Santangelo, S. L., Simpson, J. C. & Tsuang, M. T. (1990). The role of gender in identifying subtypes of schizophrenia: a latent class analytic approach. Schizophrenia Bulletin 16, 263–275.CrossRefGoogle ScholarPubMed
Green, B. F. (1951). A general solution of the latent class model of latent structure analysis and latent profile analysis. Psychometrika 16, 151–166.CrossRefGoogle Scholar
Haas, G. L., Sweeney, J. A., Keilp, J. & Frances, A. J. (1990). Sex differences of neurocognition of schizophrenia.Paper presented at American Psychiatric Association Annual Meeting,San Francisco.Google Scholar
Harris, M. J. & Jeste, D. V. (1988). Late-onset schizophrenia: an overview. Schizophrenia Bulletin 14, 39–55.CrossRefGoogle ScholarPubMed
Jones, P. B. & Murray, R. M. (1991). The genetics of schizophrenia is the genetics of neurodevelopment. British Journal of Psychiatry 158, 615–623.CrossRefGoogle ScholarPubMed
Kay, S. R., Opler, L. A. & Fiszbein, A. (1986). Significance of positive and negative syndromes in chronic schizophrenia. British Journal of Psychiatry 149, 439–448.CrossRefGoogle ScholarPubMed
Klorman, R., Strauss, J. S. & Kokes, R. F. (1977). Pre-morbid adjustment in schizophrenia. III. The relationship of demographic and diagnostic factors to measures of pre-morbid adjustment in schizophrenia. Schizophrenia Bulletin 3, 214–225.CrossRefGoogle Scholar
Lazarsfeld, P. L. & Henry, N. W. (1968). Latent Structure Analysis. Houghton Mifflin: Boston, Mass.Google Scholar
Lewine, R. J. (1981). Sex differences in schizophrenia. Timing or subtypes? Psychological Bulletin 90, 432–444.CrossRefGoogle ScholarPubMed
Lewine, R. J. (1988). Gender and schizophrenia. In Handbook of Schizophrenia, Vol 3 (ed. Nasrallah, H. A.), pp. 379–397. Elsevier: Amsterdam.Google Scholar
Lewine, R. J., Strauss, J. S. & Gift, T. E. (1981). Sex differences in age at first hospital admission for schizophrenia: fact or artifact? American Journal of Psychiatry 138, 440–444.Google ScholarPubMed
Lewis, S. W. & Murray, R. M. (1987). Obstetric complications, neurodevelopmental deviance, and risk of schizophrenia. Journal of Psychiatric Research 21, 413–421.CrossRefGoogle ScholarPubMed
Loranger, A. W. (1984). Sex differences in age at onset of schizophrenia. Archives of General Psychiatry 41, 157–161.CrossRefGoogle Scholar
McCabe, M. S., Fowler, R. C., Cadoret, R. J. & Winokur, G. (1971). Familial differences in schizophrenia with good and poor prognosis. Psychological Medicine 1, 326–332.CrossRefGoogle ScholarPubMed
McGuffin, P., Farmer, A. E. & Harvey, I. (1991). A polydiagnostic application of operational criteria in psychotic illness: development and reliability of the OPCRIT system. Archives of General Psychiatry 48, 764–770.CrossRefGoogle ScholarPubMed
Murray, R. M., Lewis, S. & Reveley, A. M. (1985). Towards an aetiological classification of schizophrenia. Lancet i, 1023–1026.CrossRefGoogle Scholar
Murray, R. M., O'Callaghan, E., Castle, D. J. & Lewis, S. W. (1992). A neurodevelopmental approach to the classification of schizophrenia. Schizophrenia Bulletin 18, 319–332.CrossRefGoogle Scholar
O'Callaghan, E., Gibson, T., Colohan, H. A., Buckley, P., Walshe, D. G., Larkin, C. & Waddington, J. L. (1992). Risk of schizophrenia in adults born after obstetric complications and their association with early onset of illness: a controlled study. British Medical Journal 305, 1256–1259.CrossRefGoogle Scholar
Offord, D. R. (1974). School performance of adult schizophrenics, their siblings and age mates. British Journal of Psychiatry 125, 12–19.CrossRefGoogle ScholarPubMed
Opler, L. A., Kay, S. R., Rosado, V. & Lindenmayer, J.-P. (1984). Positive and negative syndromes in chronic schizophrenic patients. Journal of Nervous and Mental Disease 172, 317–325.CrossRefGoogle Scholar
Orel, O., Cannon, T. D., Hollister, J. M., Mednick, S. A. & Parnas, J. (1991). Ventricular enlargement and premorbid deficits in school-occupational attainment. Schizophrenia Research 4, 49–52.CrossRefGoogle Scholar
Owen, M. J., Lewis, S. W. & Murray, R. M. (1988). Obstetric complications and schizophrenia: a computed tomographic study. Psychological Medicine 18, 331–339.CrossRefGoogle ScholarPubMed
Owen, M. J., Lewis, S. W. & Murray, R. M. (1989). Family history and cerebral ventricular enlargement in schizophrenia: a case-control study. British Journal of Psychiatry 154, 629–634.CrossRefGoogle ScholarPubMed
Pearlson, G. D., Garbacz, D. J., Moberg, P. J., Ahn, H. S. & de Paulo, J. R. (1985). Symptomatic, familial, perinatal, and social correlates of computer axial tomography (CAT) changes in schizophrenia and bipolars. Journal of Nervous and Mental Disease 173, 42–50.CrossRefGoogle ScholarPubMed
Pearlson, G. D., Kim, W. S., Kubos, K. L., Moberg, P. J., Jayaram, G., Bascom, M. J., Chase, G. A., Goldfinger, A. D. & Tune, L. E. (1989). Ventricle–brain ratio, computed tomographic density, and brain area in 50 schizophrenics. Archives of General Psychiatry 46, 690–697.CrossRefGoogle ScholarPubMed
Pope, H. G. & Lipinsky, J. F. (1978). Diagnosis in schizophrenia and manic depressive illness. Archives of General Psychiatry 35, 811–828.CrossRefGoogle ScholarPubMed
Pulver, A. E., Liang, K.-Y., Brown, C. H., Wolynieck, P., McGrath, J., Adler, L., Tam, D., Carpenter, W. T. & Childs, B. (1992). Risk factors in schizophrenia: season of birth, gender and familial risk. British Journal of Psychiatry 160, 65–71.CrossRefGoogle ScholarPubMed
Riecher, A., Maurer, K., Loffler, W., Fatkenheuer, B., van der Heiden, W. & Hafner, H. (1989). Schizophrenia – a disease of young single males? European Archives of Psychiatry and Neurological Sciences 239, 210–212.CrossRefGoogle ScholarPubMed
Seeman, M. V. (1986). Current outcome in schizophrenia: women vs men. Acta Psychiatrica Scandinavica 73, 609–617.CrossRefGoogle ScholarPubMed
Shepherd, M., Watt, D., Falloon, I. & Smeeton, N. (1989). The Natural History of Schizophrenia: A 5-year Follow-up Study of Outcome and Prediction in a Representative Sample of Schizophrenics. Psychological Medicine Monograph 15. Cambridge University Press: Cambridge.Google Scholar
Shil, W. J. & Huang, W. M. (1992). Evaluating correlation with proper bounds. Biometrics 48, 1207–1213.Google Scholar
Shimizu, A., Kurachi, M., Noda, M., Yamaguchi, N., Torri, H. & Isaki, K. (1988). Influence of sex on age at onset of schizophrenia. Japanese Journal of Psychiatry and Neurology 42, 35–40.Google ScholarPubMed
Takei, N., O'Callaghan, E., Sham, P. & Murray, R. M. (1992). Winter birth excess in schizophrenia: its relationship to place of birth. Schizophrenia Research 6, 102.CrossRefGoogle Scholar
Tsuang, M. T. & Winoker, G. (1974). Criteria for subtyping schizophrenia: clinical differentiation of hebephrenic and paranoid schizophrenia. Archives of General Psychiatry 31, 43–47.CrossRefGoogle ScholarPubMed
Weinberger, D. R., Cannon-Spoor, E., Potkin, S. G. & Wyatt, R. J. (1980). Poor premorbid adjustment and CT scan abnormalities in chronic schizophrenia. American Journal of Psychiatry 137, 1410–1413.Google ScholarPubMed
Wilcox, J. A. & Nasrallah, H. A. (1987). Perinatal distress and prognosis of psychotic illness. Neuropsychobiology 17, 173–175.CrossRefGoogle ScholarPubMed
Zigler, E. & Levine, J. (1973). Pre-morbid adjustment and paranoid– nonparanoid status in schizophrenia: a further investigation. Journal of Abnormal Psychology 82, 189–199.CrossRefGoogle Scholar
Zigler, E., Levine, J. & Zigler, B. (1977). Pre-morbid social competence and paranoid–non-paranoid status in female schizophrenic patients. Journal of Nervous and Mental Disease 164, 333–339.CrossRefGoogle Scholar