The anthropometric assessment of dysmorphic features in schizophrenia as an index of its developmental origins

BACKGROUND

Evidence suggests that schizophrenia may be a disorder with origins in early intrauterine mal-development. We have constructed a comprehensive anthropometric scale for the evaluation of dysmorphic features as an index of the nature and timing of developmental disturbance.

METHOD

A detailed set of craniofacial and bodily measures was compiled and applied to 174 patients with schizophrenia and 80 matched control subjects.

RESULTS

Patients had significantly higher scores on this scale and displayed multiple anomalies of the craniofacial region with an overall narrowing and elongation of the mid-face and lower face. Twelve craniofacial anomalies independently distinguished patients from controls and these variables correctly classified 95% of patients and 80% of control subjects.

CONCLUSIONS

This new scale, while procedurally more exacting than the Waldrop scale, more clearly defines the topography of anomalies previously suspected in individuals with schizophrenia. These findings constitute direct evidence for disturbed craniofacial development in schizophrenia and indicate origins in the foetal period during which the characteristic human facial pattern evolves in close association with brain differentiation.

Executive (frontal) dysfunction and negative symptoms in schizophrenia: apparent gender differences in 'static' v. 'progressive' profiles

BACKGROUND

While executive (frontal lobe) dysfunction appears to be a core feature of schizophrenia, its relationship to psychopathology, age and duration of illness has yet to be explored systematically between the genders.

METHOD

Executive dysfunction, positive and negative symptoms were evaluated in 27 male and 21 female in-patients who were unusually well-matched on numerous demographic and clinical measures.

RESULTS

Measures of executive dyscontrol and negative symptoms were highly associated in both genders. However, while both executive dyscontrol and negative symptoms increased prominently with age/ duration of illness among women, no such relationship was evident among men.

CONCLUSIONS

The similarly prominent levels of current executive dyscontrol and negative symptoms in male and female patients appear to have emerged via processes that differ fundamentally between the genders; among males these deficits appear to emerge and become 'locked in' earlier in the course of illness and to show little subsequent increase, while among females these same deficits appear to be less evident early in the course but to increase in prominence thereafter.

Do D2-like dopamine receptors mediate neuronal excitation or inhibition: some functional-behavioural implications

Few controversies in contemporary neuroscience have endured as long as that concerning the immediate neurophysiological effect(s) of 'D2-like' dopamine receptor activation. While the issue is of fundamental importance, it could be argued that the matter is more abstract and of less consequence than clarifying receptor-mediated actions at other, more functional levels from second messenger through neurochemistry to behaviour. Yet it is not possible to define fully these processes without insight into the immediate neurophysiological action. This necessity has been accentuated by a number of recent developments, including (i) recognition of multiple, complex forms of functional interactions between 'D2-like' and 'D1-like' receptor families which ultimately regulate so many forms of behaviour and (ii) the ongoing debate as to the extent to which members of 'D1-like' and 'D2-like' receptor families might be co-localised on the same neuronal membrane to subserve such interactions. Full specification of these phenomena requires a clear understanding of the relevant neurophysiological events.

Developmental trajectory and disease progression in schizophrenia: the conundrum, and insights from a 12-year prospective study in the Monaghan 101

Though conceptualised originally as a deteriorating disorder, some contemporary studies have been interpreted as challenging these foundations; more radically, it has been proposed that schizophrenia may be a 'static encephalopathy' of neurodevelopmental origin. The argument offered here is that schizophrenia is indeed a neurodevelopmental disorder, but that this is not in itself antithetical to later disease progression. Rather, the onset of psychosis may reflect the maturationally-mediated triggering of an active disease process that is associated with progressive deterioration unless attenuated by antipsychotic drugs. A developmental trajectory is proposed to link first or early second trimester dysplasia to the chronic course of the illness; from this, it is argued that schizophrenia is inherently a progressive disorder but that antipsychotic drugs may act to ameliorate this progressive component and thus confer on the disease course some of the characteristics of a 'static encephalopathy'. The 'true' natural history of an illness cannot be determined from studies in treated populations.

Evidence for dopamine 'D1-like' receptor subtypes in the behavioural effects of two new selective antagonists, LY 270411 and BW 737C

A new, chemically distinct antagonist at dopamine 'D1-like' receptors, the thienoazepine LY 270411, ([+]-2(3-chloro-6-methyl-8-phenyl-5,6,7,8 -tetrahydro-4H-thieno[2,3d]azepin-2-yl)propan-2-ol) was compared with the isoquinoline BW 737C ([S]-6-chloro-1-[2,5-dimethoxy-4- propylbenzyl]-7-hydroxy-2-methyl-1,2,3,4-tetrahydroisoquinoline) and the benzazepine SCH 23390 ([R]-7-chloro-8-hydroxy-2,3,4,5-tetrahydro-3-methyl-1-phenyl-1 H-3-benzazepine) for effects on behavioural responses to the isochroman full efficacy dopamine 'D1-like' receptor agonist A 68930 ([1R,3S]-1-aminomethyl-5, 6-dihydroxy-3-phenylisochroman) vs. the dopamine 'D2-like' receptor agonist RU 24213 (N-n-propyl-N-phenylethyl-p-3-hydroxyphenylethylamine). Grooming responses to A 68930 were readily blocked by each of LY 270411, BW 737C and SCH 23390; however, the vacuous chewing response was blocked only by BW 737C. Sniffing and locomotor responses to RU 24213 were attenuated by BW 737C and SCH 23390 but not by LY 270411; furthermore, myoclonic jerking to RU 24213 was released by BW 737C and SCH 23390 but not by LY 270411. These findings indicate that grooming induced by dopamine 'D1-like' receptor agonism is blocked by all chemical classes of dopamine 'D1-like' receptor antagonist while vacuous chewing is blocked only by isoquinoline dopamine 'D1-like' receptor antagonism; this suggests that these behaviours may be mediated via functionally and pharmacologically distinct subtypes of dopamine 'D1-like' receptor. Furthermore, LY 270411 appears unique in its activity to readily block 'D1-like' receptor agonist-induced grooming without influencing behavioural responses to dopamine 'D2-like' receptor agonism; thus, the site mediating prototypical dopamine 'D1-like' receptor agonist-induced behaviours may be dissociable pharmacologically from dopamine 'D1-like' site(s) participating in functional interactions with dopamine 'D2-like' receptors.

Schizophrenia and neurological soft signs: gender differences in clinical correlates and antecedent factors

Although it is recognized that patients with schizophrenia demonstrate more neurological soft signs (NSS) than control subjects, the significance and clinical correlates of these signs remain poorly defined. The present study examined 48 patients with DSM-III-R schizophrenia for evidence of NSS. The majority (98%) of patients demonstrated at least one NSS, although the range of scores was wide. There was no relationship between current dosage of neuroleptic medication and NSS score. Among males, there was a significant relationship between NSS and duration of illness. Males whose mothers experienced obstetric complications had higher NSS scores, while females with a family history of schizophrenia exhibited higher scores. These relationships in schizophrenia between NSS and factors of etiological importance wuch as obstetric complications and family history require further evaluation. The present findings are in accord with a body of evidence which suggests that gender may influence the impact of genetic and environmental factors on the neurology of the disorder.

Cognitive dysfunction in chronic schizophrenia followed prospectively over 10 years and its longitudinal relationship to the emergence of tardive dyskinesia

Basic cognitive function was assessed at initial and at 5- and 10-year follow-up assessments among 41 primarily middle-aged in-patients manifesting the severest form of schizophrenia; additionally, the presence and severity of tardive dyskinesia was evaluated on each occasion. Overall, there was a modest but significant deterioration in cognitive function over the decade, particularly among older men. Longitudinally, patients with persistent tardive (orofacial) dyskinesia continued to show poorer cognitive function than those consistently without such movement disorder, though within neither group did cognitive function change over the decade. Those patients demonstrating prospectively the emergence of orofacial dyskinesia showed a marked deterioration in their cognitive function over the same time-frame within which their movement disorder emerged, but this decline did not progress further thereafter. There appears to exist some modes, progressive deterioration in cognitive function even late in the chronic phase of severe schizophrenic illness which appears to derive primarily from patients showing de novo emergence of tardive orofacial dyskinesia.

Comparison of the new atypical antipsychotics olanzapine and ICI 204,636 with clozapine on behavioural responses to the selective "D1-like" dopamine receptor agonist A 68930 and selective "D2-like" agonist RU 24213

The effects of the putative atypical antipsychotics olanzapine and ICI 204,636 on behavioural responses to the selective "D2-like" dopamine receptor agonist RU 24213 and to the selective "D1-like" agonist A 68930 were compared with those of the prototype atypical antipsychotic clozapine, the selective D1-like antagonist SCH 23390 and the selective D2-like antagonist YM 09151-2. Olanzapine (0.4-2.0 mg/kg) and ICI 204,636 (4.0-36.0 mg/kg), like clozapine (4.0-36.0 mg/kg) and SCH 23390 (0.01-1.0 mg/kg), effected at best modest reduction in typical sniffing and locomotor responses and, with the exception of ICI 204,636, released episodes of atypical myoclonic jerking to RU 24213 (12.5 mg/kg); a high dose of olanzapine (10.0 mg/kg), like YM 09151-2 (0.005-0.5 mg/kg), blocked all responsivity to RU 24213. Conversely, olanzapine (0.4-2.0 mg/kg) and ICI 204,636 (4.0-36.0 mg/kg), like clozapine (4.0-12.0 mg/kg) and SCH 23390 (0.01-0.1 mg/kg), readily blocked typical grooming responses to A 68930 (0.5 mg/kg); YM 09151-2 failed to block grooming and exerted more variable effects. Olanzapine and, to a lesser extent, ICI 204,636 share with clozapine a preferential action to attenuate D1-mediated function; given their lack of selective affinity for D1-like receptors, this common effect may be exerted at an alternative level of synaptic function. The action of olanzapine and particularly ICI 204,636 to release additional episodes of atypical vacuous chewing to A 68930 indicates some deviation from a wholly clozapine-like profile, the clinical significance of which remains to be specified.

Familial-genetic and reproductive epidemiology of schizophrenia in rural Ireland: age at onset, familial morbid risk and parental fertility

Among all ascertainable cases of DSM IIIR schizophrenia within an unusually homogeneous region of rural Ireland, family history information was sought from multiple sources. Morbid risk for schizophrenia among probands' first degree relatives was 6.1% and did not differ between male (6.5%) and female (5.5%) probands; risk among probands' siblings (8.3%) exceeded that among their parents (1.4%), with only 2% of male and 31% of female probands being themselves married. Both age at onset <25 and having >7 siblings were associated with elevated morbid risk, particularly among relatives of male probands (11.9% vs. 2.2% and 11.8% vs. 3.7%, respectively). Increased fertility particularly among parents of male patients with high familial-genetic loading may contribute to perpetuation of the disorder in the face of those patients' own extremely low fecundity.

Initial 'schizophrenia-like' psychosis in Pick's disease: case study with neuroimaging and neuropathology, and implications for frontotemporal dysfunction in schizophrenia

'Schizophrenia-like' psychosis has not been reported previously as a prodrome of Pick's disease, a dementia of frontotemporal pathology. A woman having a consistent clinical diagnosis of typical schizophrenia who developed increasing affectivity and cognitive deficits was examined by computed tomography and brain biopsy. This presentation was found to be associated with left frontotemporal atrophy, left sylvian fissure abnormalities and enlargement of the anterior and temporal horns of the left lateral ventricle. On biopsy, all the neuropathological hallmarks of Pick's disease were present. Unusually, some specific aspect of Pick's disease in this patient appears initially to have disturbed brain function in a manner reproducing some fundamental aspect(s) of schizophrenia itself; left frontotemporal dysfunction would appear to be a relevant common denominator.

The relationship of minor physical anomalies and other putative indices of developmental disturbance in schizophrenia to abnormalities of cerebral structure on magnetic resonance imaging

Minor physical anomalies, together with obstetric complications, family history, and handedness status, were assessed to explore putative neurodevelopmental disturbance(s) in patients with schizophrenia whose cerebral structure had been examined previously by magnetic resonance imaging. Minor physical anomalies were related to negative symptoms in males and to premorbid intellectual function in females, but not to ventricular volume; however, three patients with evident neurodevelopmental anomalies of the ventricular system showed prominent minor physical anomalies. In exploratory analyses, obstetric complications were associated with left ventricular asymmetry, and a positive family history with inverse profiles of asymmetry in males vs. females; non-right-handedness was associated with increased ventricular volume in males but with poorer premorbid intellectual function in females. This nexus of relationships and their gender specificities suggest early dysmorphogenesis in schizophrenia that is related to sexual dimorphism.

Pharmacological characterization of behavioural responses to SK&F 83959 in relation to 'D1-like' dopamine receptors not linked to adenylyl cyclase

1. Behavioural responses to the new benzazepine derivative, SK&F 83959, a compound that both fails to stimulate adenylyl cyclase and inhibits the stimulation of adenylyl cyclase induced by dopamine, were characterized in detail. 2. In rat striatal membrane preparations, radioligand binding studies with [3H]-SCH 23390 and [3H]-spiperone indicated SK&F 83959 had a high affinity and >250 fold selectivity for D1 over D2 receptors. 3. Using a rapid time-sampling behavioural check list technique, SK&F 83959 (0.01-1.25 mg kg(-1)) induced grooming in the manner of all known D1 receptor agonists, together with some vacuous chewing, which declined at higher doses with the emergence of directed chewing and rearing as an adjunct to prominent sniffing; no stereotyped behavioural was evident. 4. Grooming to SK&F 83959 (0.05 mg kg(-1)) was blocked by the selective D1 receptor antagonists, SCH 23390 (0.01-1.0 mg kg(-1)) and BW 737C (0.04-5.0 mg kg(-1)) and was attenuated by the selective D2 receptor antagonist, YM 09151-2 (0.005-0.5 mg kg(-1)); vacuous chewing to SK&F 83959 was not influenced by either SCH 23390 or BW 737C and was enhanced by YM 09151-2. 5. The paradoxical induction of typical D1 receptor agonist-induced grooming by SK&F 83959, an agent satisfying criteria for a D1 receptor antagonist as classically defined, together with its blockade by typical D1 antagonists, strongly suggests mediation via a 'D1-like' site that appears to respond similarly to agents independent of whether they exert agonist or antagonist actions at the classical adenylyl cyclase-coupled D1 receptor. This direct functional evidence for a 'D1-like' site that is not linked to adenylyl cyclase readily complements neurochemical data suggesting the existence of a cyclase-independent 'D1-like' receptor that may be coupled to phosphoinositide hydrolysis.

Behavioural pharmacology of 'D-1-like' dopamine receptors: further subtyping, new pharmacological probes and interactions with 'D-2-like' receptors

1. D-1 receptors are now recognised to play a critical psychopharmacological role in the regulation of unconditioned motor and numerous other aspects of behaviour. 2. There appears to exist a broad family of 'D-1-like' receptors in terms both of differential coupling to distinct messenger/transduction mechanisms and of gene cloning, whose behavioural roles remain to be clarified. 3. The adenylyl cyclase-inhibiting benzazepine SK&F 83959 induces behavioural responses in rats that are similar to those induced by the full efficacy cyclase-stimulating isochroman A 68930 but not to those induced by its high efficacy partial agonist benzazepine congener R-6-Br-APB; these data indicate roles for individual 'D-1-like' receptors in mediating distinct elements of dopaminergic behaviour. 4. The putative D-1 autoreceptor agonist B-HT 920 and the putative D-3 agonist 7-OH-DPAT demonstrate different behavioural profiles when given both alone and in combination with the selective 'D-1-like' antagonist BW 737C; D-3 receptors may participate in cooperative/synergistic but not in oppositional 'D-1-like': 'D-2-like' interactions. 5. Such interactions apparent at the level of behaviour are complemented by evidence for similar interactions at numerous alternative levels of function, though these may differ between rodent and primate species. 6. A broader range of more selective agonists and antagonists, able to distinguish between individual members of the 'D-1-like' and of the 'D-2-like' receptor families are needed to clarify these issues.

Basal ganglia T2 relaxation times in schizophrenia: a quantitative magnetic resonance imaging study in relation to tardive dyskinesia

Transverse, or spin-spin, relaxation times (T2) from magnetic resonance images of basal ganglia structures were compared between control subjects and patients with schizophrenia, who were subdivided on the basis of the presence or absence of tardive dyskinesia. As a group, schizophrenic patients showed evidence of somewhat more prolonged T2 relaxation times in the right putamen and globus pallidus than did control subjects; there were no significant correlations between hemispheric T2 values and corresponding volumes of the lateral ventricles. Overall, there was little difference in T2 values between patients with and without tardive dyskinesia. These data extend the range of evidence for basal ganglia dysfunction in schizophrenia, but they do not support earlier reports of prominent T2 changes associated with tardive dyskinesia.

Sequential cross-sectional and 10-year prospective study of severe negative symptoms in relation to duration of initially untreated psychosis in chronic schizophrenia

Current clinical correlates of duration of initially untreated psychotic symptoms were investigated in a cross-sectional analysis followed by a 10-year prospective study among 88 in-patients with a long-standing schizophrenic illness, many of whom had experienced prolonged periods of untreated psychosis due to illness onset and hospital admission in the pre-neuroleptic era. After controlling for the effects of age, and duration and continuity of subsequent neuroleptic treatment, the primary clinical correlate of duration of initially untreated psychosis was muteness. Over the subsequent 10-year-period, no new cases of muteness emerged and some existing cases of muteness partially resolved, though the speech that emerged remained very sparse and revealed generally gross cognitive debility. The pathophysiology underlying active, unchecked psychosis may also constitute an active morbid process that is associated with the further progression of severe negative symptoms and cognitive dysfunction in the long-term.

Tardive dyskinesia in schizophrenia. Relationship to minor physical anomalies, frontal lobe dysfunction and cerebral structure on magnetic resonance imaging

BACKGROUND

It was hypothesised that schizophrenic patients with tardive dyskinesia show an excess of neurodevelopmental disturbance, particularly minor physical anomalies, in association with cognitive dysfunction and abnormalities of cerebral structure.

METHOD

Forty-seven out-patients with a DSM-III diagnosis of schizophrenia were examined for tardive dyskinesia using the Abnormal Involuntary Movement Scale; they were examined also for minor physical anomalies and neuropsychological test performance. Cortical atrophy, signal hyperintensities and lateral ventricular volume were determined on magnetic resonance imaging.

RESULTS

Patients with and without tardive dyskinesia could not be distinguished by age, gender distribution or a number of clinical measures; however, patients with tardive dyskinesia sorted fewer categories on the Wisconsin Card Sorting Test (P = 0.04). Cerebral structure in patients with and without tardive dyskinesia could not be distinguished on magnetic resonance imaging but those with dyskinesia, all of whom showed involvement of the orofacial region, showed more evident minor physical anomalies of the head relative to those of the periphery (P = 0.02).

CONCLUSIONS

Tardive orofacial dyskinesia in schizophrenia appears to be associated particularly with poorer frontal lobe function, while predominance of craniofacial dysmorphogenesis may constitute a vulnerability factor that is related to the early origins of the disease process.

Dopamine-induced reduction in the density of guanine nucleotide-sensitive D1 receptors in human postmortem brain in the absence of apparent D1: D2 interactions

The effects of dopamine and guanine nucleotides on the binding of the D1 dopamine receptor antagonist ligand [3H]SCH 23390 were examined in membranes prepared from putamen, caudate and nucleus accumbens of human postmortem brain. Dopamine induced a concentration-dependent decrease in the apparent maximum number of binding sites (Bmax) in each brain region studied, and displaced binding in a biphasic manner consistent with the presence of both high and low affinity states of the D1 receptor; the GTP analogue Gpp(NH)p transformed this biphasic displacement to a monophasic pattern consistent with a shift of high affinity sites to a low affinity state. However, the selective D2 antagonist eticlopride did not reverse the action of dopamine to decrease Bmax. These data suggest that dopamine decreases Bmax for D1 receptors through a high affinity, guanine nucleotide-sensitive agonist binding site, but fail to reveal D1:D2 interactions at this synaptic level.

Reproductive behaviour in schizophrenia relative to other mental disorders: evidence for increased fertility in men despite decreased marital rate

Using case register data, the overall marital rate among 5158 patients with mental illness was found to be comparable to the general population. The proportion of those ever married was markedly reduced in the schizophrenic group relative to those with a manic or neurotic illness. Men with schizophrenia had a particularly low rate of marriage. The overall marital fertility of the 3 groups was comparable to each other and appeared to be higher than that in the general population. In the schizophrenic group only, married men, particularly those with a family history of mental disorder, produced more children than married women. Men might represent a more fertile group of schizophrenic patients with some biological advantage of increased fecundity, which may help to compensate for negative selection pressures.

Confinement of winter birth excess in schizophrenia to the urban-born and its gender specificity

BACKGROUND

The season of birth phenomenon in schizophrenia was reexamined in relation to place of birth, in order to test the hypothesis that a seasonal factor might operate preferentially among those who were urban-born.

METHOD

The seasonal distribution of births was examined among 3253 patients in two case registers having an ICD-9 diagnosis of schizophrenia and compared with the distribution of births among the normal population born in those catchment areas over the same period; those subjects born in population centres greater than 50,000 were defined as urban-born.

RESULTS

Patients who were urban-born showed an excess of winter births relative to controls that was absent among their rural-born counterparts. On comparing patient groups, those who were urban-born were more likely to be born in the winter, while those who were rural-born were more likely to be born in the spring; this urban-rural distinction was confined essentially to female patients.

CONCLUSIONS

These findings might be accommodated most readily in terms of a spatially as well as seasonally varying environmental factor that is associated with urbanicity and to which female offspring are more vulnerable.

1H-magnetic resonance spectroscopy of the left temporal and frontal lobes in schizophrenia: clinical, neurodevelopmental, and cognitive correlates

Twenty eight schizophrenic patients and 20 normal volunteers underwent proton magnetic resonance spectroscopy (MRS) on the left temporal and frontal lobe regions. Male patients showed a significant reduction in frontal but not temporal n-acetylaspartate (an intraneuronally distributed metabolite) in comparison with either male controls or female patients; frontal choline was raised in male patients relative to these groups. Putative neurodevelopmental indices, including obstetric complications, family history of schizophrenia, and minor physical anomalies, proved unrelated to MRS resonances. However, multiple aspects of memory function in patients were related to temporal but not frontal creatine, a pattern that was not apparent among controls. These MRS findings complement some previous structural MRI studies and much clinical and epidemiological evidence of important gender differences in schizophrenia. The findings also suggest that memory dysfunction in patients with schizophrenia may be associated with a particular pattern of temporal lobe metabolism on MRS.