Heart rate and skin conductance in behaviorally inhibited Mauritian children

This study tested predictions that inhibited versus uninhibited children exhibit higher heart rate (HR) and skin conductance (SC) arousal. Mauritian children (N = 1,795) were tested at age 3 and classified as inhibited, middle, or uninhibited on the basis of social behavior. HR level and several SC measures were obtained immediately before or during a tone task. Inhibited children displayed significantly higher HR and SC levels and longer SC latency relative to uninhibited children. Results remained regardless of ethnicity, gender, height, weight, respiratory complaints, or crying behavior. Findings suggest that HR and SC levels may be early indicators of inhibited or uninhibited behavior at age 3 and support the notion of heightened sympathetic reactivity due to limbic arousal in inhibited children.

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.

Heart rate and skin conductance in behaviorally inhibited Mauritian children

This study tested predictions that inhibited versus uninhibited children exhibit higher heart rate (HR) and skin conductance (SC) arousal. Mauritian children (N = 1,795) were tested at age 3 and classified as inhibited, middle, or uninhibited on the basis of social behavior. HR level and several SC measures were obtained immediately before or during a tone task. Inhibited children displayed significantly higher HR and SC levels and longer SC latency relative to uninhibited children. Results remained regardless of ethnicity, gender, height, weight, respiratory complaints, or crying behavior. Findings suggest that HR and SC levels may be early indicators of inhibited or uninhibited behavior at age 3 and support the notion of heightened sympathetic reactivity due to limbic arousal in inhibited children.

Adult major affective disorder after prenatal exposure to an influenza epidemic

BACKGROUND

We have previously reported an increase in schizophrenia diagnoses in a population exposed during the second trimester to the 1957 influenza epidemic. These basic findings together with a fair number of replications have been interpreted as supporting a neurodevelopmental contribution to the origins of schizophrenia. Recent neuroimaging findings suggest that affective illness may also have a neurodevelopmental origin. We examined the hypothesis that exposure to an influenza epidemic during the second trimester would increase the risk for adult major affective disorder.

METHODS

The subjects had been exposed as fetuses to the type A2/Singapore influenza epidemic in greater Helsinki, Finland. Control subjects were born in the 6 years before the epidemic.

RESULTS

We found a significant (P < .001) increase in the proportion of hospital diagnoses for major affective disorder for individuals exposed to the influenza epidemic during their second trimester of fetal development compared with control subjects (13% vs 2%). This second-trimester effect seems somewhat stronger in men (16% vs 2%) (P < .001), although the rates of major affective disorder in women (8% vs 3%) (P > .05) were similar. The second-trimester effect remained when we estimated population-based rates (2.1 vs 0.6 per 1000) (P < .05) of major affective disorder. Additional analyses revealed that the increase of major affective disorder among subjects in the index group who were exposed during the second trimester was due to a significant (P < .002) elevation of unipolar forms, although a similar though not significant (P > .05) elevation was observed for the bipolar forms of major affective disorder.

CONCLUSIONS

These data are consistent with the hypothesis concerning the possible neurodevelopmental contribution to the origins of some forms of major affective disorder, especially unipolar depressive disorder. These encouraging findings, if replicated, may suggest that some mental disorders may stem, in part, from a disturbance in the development of the fetal brain during the second trimester.

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.

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.

High rates of violence, crime, academic problems, and behavioral problems in males with both early neuromotor deficits and unstable family environments

BACKGROUND

It is commonly assumed that individuals with both biological and psychosocial deficits are more likely to become criminal, but there is surprisingly little empirical support for this assumption. We test the hypothesis that a group with biosocial risk factors are more likely to develop behavioral and academic problems in adolescence and violent criminal offending in adult-hood compared with groups with only biological or only social risk factors.

METHODS

Hypotheses were tested on a sample of 397 male subjects, using obstetric and early neuromotor measures collected in the first year of life; family, social, demographic, and behavioral measures at age 17 to 19 years; and criminal data at 20 to 22 years of age.

RESULTS

Cluster analysis of the risk factors indicated a group with obstetric risk factors only, a group with poverty risk factors only, and a biosocial group with both early neuromotor deficits and unstable family environments. The biosocial group had more than double the adult violence, theft, and total crime rates of the other 2 groups and had significantly more behavioral and academic problems in adolescence.

CONCLUSIONS

When early neuromotor deficits and negative family factors cluster together, individuals are particularly likely to become criminal and violent compared with those with only poverty or only obstetric risk factors. Because this biosocial group accounted for 70.2% of all crimes committed in the entire sample, early interventions that tackle these deficits might significantly reduce violence.

The electroencephalogram after alcohol administration in high-risk men and the development of alcohol use disorders 10 years later

BACKGROUND

In 1979 through 1980, electroencephalographic (EEG) responses to an alcohol challenge in 19 year-old sons of alcoholics as well as in sons of nonalcoholic control subjects were examined. The familial risk status of the subjects and greater EEG sensitivity to alcohol were hypothesized to predict the development of alcoholism 10 years later.

METHODS

In 1990 through 1992, diagnostic interviews were completed to ascertain alcohol and other substance use disorders in these subjects and to update their family history.

RESULTS

Updated family history of alcoholism predicted the development of substance dependence. Density of alcoholic relatives (the number of alcoholic relatives divided by the number of known relatives) was positively related to the severity of alcohol use disorders in the probands. Contrary to expectation, a greater EEG response at age 19 years was not related to the later development of alcohol dependence. Instead, the opposite was observed: a smaller EEG alpha frequency response to alcohol at age 19 years was related to the development of alcohol dependence and high quantity and frequency of alcohol consumption 10 years later.

CONCLUSIONS

Lower EEG response to a small dose of alcohol may be associated with the later development of alcohol dependence. This result is based on a small number of subjects and should be interpreted with caution. Although this result is opposite to our 1980 hypothesis, it is consistent with much of the recent literature.

Risk factors of psychosis: identifying vulnerable populations premorbidly

This article reviews premorbid indicators of psychosis that may be relevant to primary intervention. These risk markers are divided into two categories: (1) precursors related to early etiological factors (family psychiatric history, perinatal and obstetric complications, neurobehavior deficits, early parental separation, institutionalization, and poor family function) and (2) precursors signaling latent mental illness (personality measurements indicating proneness to psychosis, and teacher ratings indicating emotional lability, social anxiety, social withdrawal, passivity, poor peer relations, and disruptive and aggressive behavior). Because teacher ratings have been shown to be powerful predictors of adult mental breakdown, part of this article focuses on a specific study that assesses such ratings as predictors of psychosis in a high-risk population. Risk indicators may also provide clues about protective factors relevant for primary prevention.

Rhesus incompatibility as a risk factor for schizophrenia in male adults

BACKGROUND

Rhesus (Rh) incompatibility is a cause of hemolytic disease of the fetus and newborn. Hemolytic disease results from the transplacentally transmitted maternal antibodies against Rh factor D and can cause permanent neurological damage in the affected newborn. This study examines the hypothesis that Rh incompatibility may be a risk factor for schizophrenia.

METHODS

A sample of 1867 male subjects was divided into two groups, 535 Rh incompatible and 1332 Rh compatible, and compared on rate of schizophrenia.

RESULTS

The rate of schizophrenia was significantly higher in the Rh-incompatible group (2.1%) compared with the Rh-compatible group (0.8%) (P < .03). In addition, since the risk for Rh hemolytic disease increases with second and later Rh incompatible pregnancies, it is noteworthy that the second- and later-born incompatible offspring exhibited a significantly higher rate of schizophrenia than second- and later-born compatible offspring (P < .05). Also, as predicted, the rate of schizophrenia among firstborn incompatible subjects was not significantly different from that of firstborn compatible subjects (1.1% vs 0.7%).

CONCLUSION

Rh incompatibility may be a risk factor for schizophrenia.

The stability of inhibited/uninhibited temperament from ages 3 to 11 years in Mauritian children

Stability of inhibited/uninhibited temperament was assessed using 1,795 Mauritian children tested at ages 3, 8, and 11 years. Children were divided into uninhibited, middle, and inhibited groups at each age based on social behavior. Results indicated that, relative to uninhibited children (1) those inhibited at age 3 obtained larger inhibition scores at age 8 (p < .0001), (2) those inhibited at age 8 obtained larger inhibition scores at age 11 (p < .002), and (3) those remaining inhibited from ages 3 to 8 obtained larger inhibition scores at age 11 (p < .002). Relative to children who changed classification from ages 3 to 8, those remaining inhibited obtained larger inhibition scores (p < .05) and those remaining uninhibited obtained smaller inhibition scores (p < .015) at age 11. Inhibition scores tended to be higher in females by age 11. Results remained regardless of ethnicity. The results provide some support that inhibited/uninhibited temperament remains stable from ages 3 to 8 and may continue to age 11. The results suggest cross-cultural generalizability of these findings with implications regarding the development of anxiety disorders in the Mauritian population.

Assessing the predictive value of teacher reports in a high risk sample for schizophrenia: a ROC analysis

We examined teachers' reports to determine early patterns of school behavior that identify children who were diagnosed schizophrenic in adulthood. High risk subjects (n = 207) in the Copenhagen High Risk for schizophrenia project were examined on a 25-item questionnaire completed by teachers. A likelihood ratio approach was used to create a classification index relating school report to DSM-IIIR diagnoses made 31 years later. A standard receiver operating characteristic (ROC) analysis was used to evaluate the efficacy of the classification indices for distinguishing preschizophrenics from children who later developed schizotypal disorder, other nonpsychotic disorders, and no mental illness. Different items predicted schizophrenia in males and females. To a significantly greater degree than their controls, preschizophrenic males were lonely and rejected, behaved inappropriately, were disciplinary problems, emotionally high strung, and were more likely to have repeated a grade; preschizophrenic females were nervous and passive. Both preschizophrenic males and females were judged by teachers to be vulnerable to future psychotic problems. These findings are consistent with our preliminary findings, as well as with other research. They highlight the ability of teachers to identify school behaviors that may be used to select future schizophrenics for early intervention.

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.

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).

Birth complications combined with early maternal rejection at age 1 year predispose to violent crime at age 18 years

BACKGROUND

This study tests the bisocial interaction hypothesis that birth complications when combined with early maternal rejection of the infant predispose to adult violent crime.

METHODS

This hypothesis was tested using a cohort of 4269 consecutive live male births on whom measures of birth complications (age 0), early maternal rejection (age 1 year), and violent crime (age 18 years) were collected.

RESULTS

A significant interaction (P < .0001) between birth complications and early maternal rejection indicated that those who suffered both birth complications and early child rejection were most likely to become violent offenders in adulthood. While only 4.5% of the subjects had both risk factors, this small group accounted for 18% of all violent crimes. The effect was specific to violence and was not observed for nonviolent criminal offending.

CONCLUSIONS

To our knowledge, this is the first study to show that birth complications in combination with early child rejection predispose to violent crime. The findings illustrate the critical importance of integrating biological with social measures to fully understand how violence develops and also suggest that prenatal, perinatal, and early postnatal health care interventions could significantly reduce violence.

Learning theory approach to the deterrence of criminal recidivism

Data on punishment and criminal arrests in a total birth cohort of men in Denmark (N = 28,879) was used to test the following hypotheses derived from learning theory: (a) the imposition of sanctions reduces rates of subsequent criminal arrest; (b) the more severe the sanction received for an arrest, the lower the rate of recidivism; (c) different types of sanctions have similar effects on recidivism; (d) the higher the proportion of sanctions received for past arrests, the lower the rates of future arrest; (e) continuous sanctions reduce arrest rates more than intermittent sanctions; and (f) discontinuation of punishment results in recovery of criminal arrests. Results support the above hypotheses, except Hypothesis b; our results suggest that sanctions have similar effects on recidivism regardless of their severity.

Impaired autonomic nervous system-habituation in those at genetic risk for schizophrenia

BACKGROUND

Schizophrenia has been associated with habituation of skin conductance activity. Skin conductance data from the Copenhagen High Risk Project were analyzed. We hypothesized that genetic risk for schizophrenia and development of schizophrenia later in life are related to impaired habituation of autonomic nervous system activity.

METHODS

Data were collected in 1962, when subjects averaged 15 years of age and had not yet qualified for a psychiatric diagnosis. Nonspecific fluctuations in electrodermal activity were monitored during a rest period free of sensory stimulation.

RESULTS

We found that an increasing level of genetic risk for schizophrenia was related to impaired habituation of autonomic nervous system activity over time. Individuals with two schizophrenia-spectrum parent evidenced no habituation, those with one spectrum parent evidence some habituation, and those with normal parents evidenced rapid habituation. Subjects who developed schizophrenia in adulthood evidenced significant deficits in habitation in adolescence.

CONCLUSIONS

These results suggest that impaired habituation of spontaneous autonomic nervous system activity may represent a behavioral marker of the genetic predisposition to schizophrenia.

Prenatal factors in the pathogenesis of schizophrenia

The excess of winter-spring births among individuals suffering from schizophrenia provides strong evidence for the existence of some prenatally occurring factors in the pathogenesis of schizophrenia. Recent epidemiological findings suggest that maternal viral infections during the second trimester of pregnancy may play a crucial role in the aetiology of adult schizophrenia. A 'two-hit window' hypothesis of the mechanism of action of prenatal factors in the pathogenesis of schizophrenia suggests at least two time-specific prenatal aetiological events. The observed association between prenatal viral infection and increased incidence of adult schizophrenia need not be a direct cytotoxic result of the viral infection, but may be caused indirectly, for example from foetal minor cerebral haemorrhages produced by the anticoagulant effects of aspirin.

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.

Prenatal influenza infections and adult schizophrenia

We reported previously that residents of Greater Helsinki, Finland, whose mothers were exposed to the 1957 influenza epidemic during their second trimester of gestation had a significantly elevated risk of developing adult schizophrenia. The majority of the replication studies to date have not determined whether the mothers actually contracted an infection or the stage of gestation based on mother's last menstruation. We read prenatal clinic records of the mothers of the Helsinki-born schizophrenia subjects to determine timing of infection, as noted by the prenatal clinic obstetric nurse at a time close to the actual infection. Schizophrenia subjects who were exposed in the second trimester had a significantly higher rate of definite influenza infection (86.7%) in that period compared to those who were exposed during the first and third trimesters (20.0%). These results are interpreted with caution because of the small number of cases.

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.

Research experiences with Fini Schulsinger

For the past 31 years (1961-1992) Fini Schulsinger and I have been exploring the origins of schizophrenia. We have started a number of longitudinal projects that are still keeping us rather busy; after all, retirement just means more time for research. Through our students and these projects, our collaboration may never end.

The schizophrenia high-risk project in Copenhagen: three decades of progress

We describe the design, theoretical approach and major recent findings of a prospective longitudinal study of the offspring of schizophrenic mothers and controls, initiated in 1962 by Sarnoff Mednick and Fini Schulsinger in Copenhagen, Denmark. Over 90% of the original 207 high-risk and 104 low-risk subjects have been successfully followed up since the initial assessment. At the time of the most recent assessment (1989), the subjects averaged 42 years of age and were nearly completely through the risk period for developing schizophrenia. By relating the lifetime psychiatric diagnoses of the subjects back to information on their premorbid experiences and functioning, we have identified several precursors of schizophrenia. This paper reviews our recent findings concerning whether outcomes of schizophrenia that differ in the relative prominence of negative versus positive symptoms represent discrete longitudinal syndromes. Predominantly negative and predominantly positive symptom schizophrenia were found to follow different patterns of symptom development from adolescence through the adult course of illness and were predicted by different combinations of genetic and environmental influences. Taken together, the findings suggest that the pathological processes underlying these two forms of schizophrenia are 1) partly independent of each other, 2) at least partly active during the premorbid state and 3) to some degree stable in the adult course of illness.