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Age at Onset, Sex, and Familial Psychiatric Morbidity in Schizophrenia

Camberwell Collaborative Psychosis Study

Published online by Cambridge University Press:  02 January 2018

Pak Chung Sham ,
Peter Jones ,
Ailsa Russell ,
Karyna Gilvarry ,
Paul Bebbington ,
Shôn Lewis ,
Brian Toone  and
Robin Murray
Pak Chung Sham*
Affiliation:
Departments of Psychological Medicine and Biostatistics
Peter Jones
Affiliation:
Department of Psychological Medicine
Ailsa Russell
Affiliation:
Genetics Section
Karyna Gilvarry
Affiliation:
Genetics Section
Paul Bebbington
Affiliation:
MRC Social and Community Psychiatry Unit, Institute of Psychiatry, De Crespigny Park, London SE5 8AF
Shôn Lewis
Affiliation:
Academic Department of Psychiatry, Charing Cross and Westminster Medical School, London W6 8RP
Brian Toone
Affiliation:
King's College and Maudsley Hospitals, Denmark Hill, London SE5 9RS
Robin Murray
Affiliation:
Institute of Psychiatry and King's College Hospital, De Crespigny Park, London SE5 8AF
*
Dr P. C. Sham, Institute of Psychiatry
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Abstract

Background

Although a genetic component in schizophrenia is well established, it is likely that the contribution of genetic factors is not constant for all cases. Several recent studies have found that the relatives of female or early onset schizophrenic patients have an increased risk of schizophrenia, compared to relatives of male or late onset cases. These hypotheses are tested in the current study.

Method

A family study design was employed; the probands were 195 patients with functional psychosis admitted to three south London hospitals, diagnosed using Research Diagnostic Criteria (RDC), and assessed using the Present State Examination (PSE). Information on their relatives was obtained by personal interview of the mother of the proband, and from medical records. Psychiatric diagnoses were made using Family History – Research Diagnostic Criteria (FH-RDC), blind to proband information.

Results

There was a tendency for homotypia in the form of psychosis within families. The lifetime risk of schizophrenia in the first degree relatives of schizophrenic probands, and the risk of bipolar disorder in the first degree relatives of bipolar probands, were 5–10 times higher than reported population risks. Relatives of female and early onset (<22 years) schizophrenic probands had higher risk of schizophrenia than relatives of male and late onset schizophrenic probands. However, this effect was compensated in part by an excess of non-schizophrenic psychoses in the relatives of male probands.

Conclusions

These results suggest a high familial, possibly genetic, loading in female and early onset schizophrenia, but do not resolve the question of heterogeneity within schizophrenia.

Type
Papers
Information
The British Journal of Psychiatry , Volume 165 , Issue 4 , October 1994 , pp. 466 - 473
Copyright
Copyright © Royal College of Psychiatrists, 1994 

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References

Abe, K. (1969) The morbidity rate and environmental influence in monozygotic co-twins of schizophrenics. British Journal of Psychiatry, 115, 519–531.Google Scholar
Andreasen, N. C., Rice, J. P., Endicott, J., et al (1986) The family history approach to diagnosis. How useful is it? Archives of General Psychiatry, 43, 421–429.Google Scholar
Angermeyer, M. C., Kuhn, L. & Goldstein, J.M. (1990) Gender and the course of schizophrenia: differences in treated outcomes. Schizophrenia Bulletin, 16, 293–307.Google Scholar
Baron, M. (1986) Genetics of Schizophrenia, 1. Familial patterns and mode of inheritance. Biological Psychiatry, 21, 1051–1066.CrossRefGoogle Scholar
Bebbington, P., Wilkins, S., Jones, P., et al (1993) Life events and psychosis: Initial results from the Camberwell Collaborative Psychosis Study. British Journal of Psychiatry, 162, 72–79.CrossRefGoogle ScholarPubMed
Bland, R. C. (1984) Long-term mental illness in Canada: an epidemiological perspective on schizophrenia and affective disorders. Canadian Journal of Psychiatry, 29, 242–246.Google Scholar
Castle, D. J. & Murray, R. M. (1991) The neurodevelopmental basis of sex differences in schizophrenia. Psychological Medicine, 31, 565–575.Google Scholar
Castle, D. J., Wessely, S., Der, G., et al (1991) The incidence of operationally defined schizophrenia in Camberwell, 1965–84. British Journal of Psychiatry, 159, 790–794.CrossRefGoogle ScholarPubMed
Castle, D. J., Wessely, , & Murray, R. M. (1993) Sex and schizophrenia: effects of diagnostic stringency, and premorbid variables. British Journal of Psychiatry, 162, 658–664.Google Scholar
Childs, B. & Scriver, C. (1986) Age at onset and causes of disease. Perspectives in Biology and Medicine, 29, 437–460.Google Scholar
Crow, T. J. (1986) The continuum of psychosis and its implication for the structure of the gene. British Journal of Psychiatry, 149, 419–429.Google Scholar
Efron, B. (1979) Bootstrap methods: another look at the Jackknife. Annals of Statistics, 7, 1–26.Google Scholar
Essen-Moller, E. (1955) The calculation of morbid risk in parents of index cases, as applied to a family sample of schizophrenics. Acta Genetica, 5, 334–342.Google Scholar
Foerster, A., Lewis, S., Owen, M., et al (1991) Premorbid adjustment and personality in psychosis: Effects of sex and diagnosis. British Journal of Psychiatry, 158, 171–176.Google Scholar
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.Google Scholar
Goldstein, J. M., Faraone, S. V., Chen, W. J., et al (1990) Sex differences in the familial transmission of schizophrenia. British Journal of Psychiatry, 156, 819–826.Google Scholar
Gottesman, I. I. & Shields, J. (1982) Schizophrenia: The Epigenetic Puzzle. Cambridge: Cambridge University Press.Google Scholar
Iacono, W. G. & Beiser, M. (1992) Are males more likely than females to develop schizophrenia? American Journal of Psychiatry, 149, 1070–1074.Google Scholar
Jones, P. B. & Murray, R. M. (1991) The genetics of schizophrenia is the genetics of neurodevelopment. British Journal of Psychiatry, 158, 615–623.Google Scholar
Jones, P. B., Bebbington, P., Foerster, A., et al (1993) Poor scholastic achievement and pre-psychotic social decline are specific to schizophrenia: Results from the Camberwell Collaborative Psychosis Study. British Journal of Psychiatry, 162, 65–71.Google Scholar
Kendler, K. S. (1988) The Genetics of Schizophrenia: An Overview. In The Handbook of Schizophrenia, Vol. 3 (eds Tsuang, M. T. & Simpson, J. C.). Amsterdam: Elsevier.Google Scholar
Kendler, K. S., Tsuang, M. T. & Hays, P. (1987) Age at onset in schizophrenia: a familial perspective. Archives in General Psychiatry, 44, 881–890.Google Scholar
Kendler, K. S. & MacLean, C. J. (1990) Estimating familial effects on age at onset and liability to schizophrenia. I. Results of a large family study. Genetic Epidemiology, 7, 409–417.Google Scholar
Kraepelin, E. (1896) Dementia Praecox and Paraphrenia. Translation by Barclay, R. M., Huntington, New York: Krieger, 1971. (Originally published by Livingstone, Edinburgh, 1919.) Google Scholar
Lee, C. K., Kwak, Y. S., Yamamoto, J., et al (1990) Psychiatric epidemiology in Korea, part 1: gender and age differences in Seoul. Journal of Nervous and Mental Disease, 178, 242–246.CrossRefGoogle ScholarPubMed
Lewine, R. J. (1981) Sex differences in schizophrenia: timing or subtypes? Psychological Bulletin, 90, 432–444.Google Scholar
Lewine, R. J. (1988) Gender and schizophrenia. In The Handbook of Schizophrenia, Vol. 3 (eds Tsuang, M. T. & Simpson, J. C.). Amsterdam: Elsevier.Google Scholar
Lewis, S. W. & Murray, R. M. (1987) Obstetric complications, neurodevelopmental deviance, and risk of schizophrenia. Journal of Psychiatric Research, 21, 413–421.Google Scholar
Lewis, S. (1992) Sex and schizophrenia: vive la difference. British Journal of Psychiatry, 161, 445–450.Google Scholar
McGlashan, T. H. & Fenton, W. S. (1991) Classical subtypes for schizophrenia: Literature review for DSM-IV. Schizophrenia Bulletin, 17, 609–623.Google Scholar
McGue, M. & Gottesman, I. I. (1989) Genetic linkage in schizophrenia: perspectives from genetic epidemiology. Schizophrenia Bulletin, 15, 453–464.Google Scholar
McGuffin, P. & Katz, R. (1986) Nature, Nurture, and Affective Disorder. In The Biology of Depression (ed. Deakin, J. W. K.). London: Gaskell.Google Scholar
McNeil, T. F. & Kaji, L. (1978) Obstetric factors in the development of schizophrenia: Complications in the births of preschizophrenics and in reproduction by schizophrenic parents. In The Nature of Schizophrenia: New Approaches to Research and Treatment (eds Wynne, L. C., Cromwell, R. L. & Mathysse, S.). New York: Wiley.Google Scholar
Munk-Jorgensen, P. (1986) Schizophrenia in Denmark: incidence and utilization of psychiatric institutions. Acta Psychiatrica Scandinavica, 73, 172–180.CrossRefGoogle ScholarPubMed
Murray, R. M., O'Callaghan, E., Castle, D. J., et al (1992) A neurodevelopmental approach to the classification of schizophrenia. Schizophrenia Bulletin, 18, 319–332.Google Scholar
NiNullain, M., O'Hare, A. & Walsh, D. (1987) Incidence of schizophrenia in Ireland. Psychological Medicine, 17, 943–948.Google Scholar
Numerical Algorithms Group (1985) The GLIM System Release 3.77 Manual (ed. Payne, C. D.). Oxford: NAG.Google Scholar
O'Callaghan, E., Gibson, T., Colohan, H. A., et al (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.Google Scholar
Pearlson, G. D., Kim, W. S., Kubos, K. L., et al (1989) Ventricular-brain ratio, computed tomographic density, and brain area in 50 schizophrenics. Archives of General Psychiatry, 46, 690–697.Google Scholar
Pulver, A. E., Brown, C. H., Wolyniec, P. S., et al (1990) Schizophrenia, age at onset, gender and familial risk. Acta Psychiatrica Scandinavica, 81, 344–351.Google Scholar
Pulver, A. E., Brown, C. H., Wolyniec, P. S., & Liang, K. Y. (1991) Estimating effects of proband characteristics on familial risk: II. The association between age at onset and familial risk in the Maryland Schizophrenia Sample. Genetic Epidemiology, 8, 339–350.Google Scholar
Risch, N. (1983) Estimating morbidity risks with variable age of onset: Review of methods and a maximum likelihood approach. Biometrics, 39, 929–939.Google Scholar
Rudin, E. (1916) Zur Vererbung und Neuentstehung der Dementia Praecox. Berlin: Springer.Google Scholar
Shimizu, A., Kurachi, M., Noda, M., et al (1987) Morbidity risk of schizophrenia to parents and siblings of schizophrenia patients. Japanese Journal of Psychiatry and Neurology, 41, 65–70.Google Scholar
Slater, E. (1936) The inheritance of manic-depressive insanity. Proceedings of the Royal Society of Medicine, 29, 981–990.Google Scholar
Slater, E. & Cowie, V. (1971) The Genetics of Mental Disorders. London: Oxford University Press.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1978) Research Diagnostic Criteria (RDC) for a Selected Group of Functional Disorders, 3rd Edition. New York: Biometrics Research Division, New York State Psychiatric Institute.Google Scholar
Stromgren, E. (1935) Zum ersatz des Weinbergschen “abgekurzten verfahrens” zugleich ein beitrag zur Frage von der Erblichkeit des Erkrankungsalters bei der Schizophrenic Zeitschrift für die gesamte Neurologie und Psychiatrie, 153, 784–797.Google Scholar
Takei, N., O'Callaghan, E., Sham, P. C., et al (1992) Winter birth excess in schizophrenia: its relationship to place of birth. Schizophrenia Research, 6, 102.Google Scholar
Taylor, M. A. (1992) Are schizophrenia and affective disorder related? A selective literature review. American Journal of Psychiatry, 149, 22–32.Google Scholar
Tsuang, M. T. & Faraone, S. V. (1990) The Genetics of Mood Disorders. Baltimore: The Johns Hopkins University Press.Google Scholar
Wilcox, J. A. & Nasrallah, H. A. (1987) Perinatal distress and prognosis of psychotic illness. Neuropsychobiology, 17, 173–175.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) Measurement and Classification of Psychiatric Symptoms. Cambridge: Cambridge University Press.Google Scholar
Wyatt, R. J., Alexander, R. C., Egan, M. F., et al (1988) Schizophrenia, just the facts: what do we know, how well do we know it? Schizophrenia Research, 1, 3–18.Google Scholar
Zimmerman, M., Coryell, W., Pfohl, B., et al (1988) The reliability of the family history method for psychiatric diagnoses. Archives of General Psychiatry, 45, 320–322.Google Scholar
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