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Corcoran C, Perrin M, Harlap S, Deutsch L, Fennig S, Manor O, Nahon D, Kimhy D, Malaspina D, Susser E. Incidence of schizophrenia among second-generation immigrants in the jerusalem perinatal cohort. Schizophr Bull 2009; 35:596-602. [PMID: 18648022 PMCID: PMC2669576 DOI: 10.1093/schbul/sbn089] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Increased incidence of schizophrenia is observed among some immigrant groups in Europe, with the offspring of immigrants, ie "second-generation" immigrants particularly vulnerable. Few contemporary studies have evaluated the risk of schizophrenia among second-generation immigrants in other parts of the world. METHODS We studied the incidence of schizophrenia in relation to parental immigrant status in a population-based cohort of 88 829 offspring born in Jerusalem in 1964-1976. Parental countries of birth were obtained from birth certificates and grouped together as (1) Israel, (2) Other West Asia, (3) North Africa, and (4) Europe and industrialized countries. Cox proportional hazards methods were used in adjusting for sex, parents' ages, maternal education, social class, and birth order. RESULTS Linkage with Israel's Psychiatric Registry identified 637 people admitted to psychiatric care facilities with schizophrenia-related diagnoses, before 1998. Incidence of schizophrenia was not increased among second-generation immigrants in this birth cohort, neither overall nor by specific group. CONCLUSIONS The difference in risk of schizophrenia among second-generation immigrants in Europe and in this Israeli birth cohort suggests that the nature of the immigration experience may be relevant to risk, including reasons for migration, the nature of entry, and subsequent position in the host country for immigrants and their offspring. Minority status may be of importance as, in later studies, immigrants to Israel from Ethiopia had increased risk of schizophrenia.
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Affiliation(s)
- Cheryl Corcoran
- New York State Psychiatric Institute, Unit 2, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Mary Perrin
- Department of Psychiatry, New York University, New York
| | - Susan Harlap
- Department of Psychiatry, New York University, New York,Department of Epidemiology, Mailman School of Public Health, New York
| | - Lisa Deutsch
- Braun School of Public Health, Hebrew University-Hadassah School of Public Health, Jerusalem
| | - Shmuel Fennig
- Department of Psychiatry, Shalvata Mental Health Center, Sackler School of Medicine, Tel Aviv University, Ramat Aviv
| | - Orly Manor
- Braun School of Public Health, Hebrew University-Hadassah School of Public Health, Jerusalem
| | - Daniella Nahon
- Mental Health Services Section, Israel Ministry of Health, Tel Aviv
| | - David Kimhy
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York
| | - Dolores Malaspina
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York,Department of Psychiatry, New York University, New York
| | - Ezra Susser
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York,Department of Epidemiology, Mailman School of Public Health, New York
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Levav I, Kohn R, Barchana M, Lipshitz I, Pugachova I, Weizman A, Grinshpoon A. The risk for cancer among patients with schizoaffective disorders. J Affect Disord 2009; 114:316-20. [PMID: 18675461 DOI: 10.1016/j.jad.2008.06.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2008] [Revised: 06/15/2008] [Accepted: 06/17/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several epidemiological studies explored the risk for cancer among both persons with schizophrenia and their first-degree relatives, and among patients with bipolar disorder. No studies have yet explored the risk among persons with schizoaffective disorders. METHOD Linkage analysis was conducted based on the psychiatric and the cancer national databases. Standardized incidence ratios (SIR) for aggregated cancer sites were calculated by comparing the incidence rates among patients in the psychiatric case register with schizoaffective disorders with the incidence rates in the Jewish-Israeli general population. RESULTS No significant alteration in cancer risk was found for both genders: males, SIR=1.11, 95% CI (0.48-1.73) and females, SIR=1.38, 95% CI (0.96-1.80). LIMITATIONS Our sample was derived from patients with a history of psychiatric hospitalization. Putative factors such as diet, smoking and medications were not investigated. CONCLUSIONS Our study showed no significant increase in the risk for cancer in schizoaffective disorders. Those results appear to be positioned between the schizophrenia findings that show a lower risk for cancer and the bipolar disorder findings that show an increased risk.
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Affiliation(s)
- Itzhak Levav
- Mental Health Services, Ministry of Health, Jerusalem, Israel.
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Corcoran C, Perrin M, Harlap S, Deutsch L, Fennig S, Manor O, Nahon D, Kimhy D, Malaspina D, Susser E. Effect of socioeconomic status and parents' education at birth on risk of schizophrenia in offspring. Soc Psychiatry Psychiatr Epidemiol 2009; 44:265-71. [PMID: 18836884 PMCID: PMC2983097 DOI: 10.1007/s00127-008-0439-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 09/10/2008] [Indexed: 11/25/2022]
Abstract
Although it is known that schizophrenia is associated with social class, controversy exists as to the nature of this association. The authors studied the incidence of schizophrenia in relation to social class at birth in a population-based cohort of 88,829 offspring born in Jerusalem in 1964-1976. They constructed a six-point scale to index social class, based on paternal occupation at the time of birth, with each of 108 occupations being ranked by mean education. Cox proportional hazards methods were used in adjusting for sex, parents' ages, duration of marriage and birth order. Linkage with Israel's Psychiatric Registry identified 637 people admitted to psychiatric care facilities with schizophrenia-related diagnoses, before 1998. There was no gradient of risk for schizophrenia associated with social class at birth; however, offspring of fathers in the lowest social class showed a modest increase in risk (adjusted Relative Risk = 1.4; 95% Confidence interval = 1.1-1.8, P = 0.002). These data suggest that in contrast to many other health outcomes, there is not a continuous gradient for increasing schizophrenia with decreasing social class of origin. Instead, a modest increase in risk for schizophrenia was observed only for those born at the bottom of the social ladder.
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Affiliation(s)
- Cheryl Corcoran
- Dept. of Psychiatry, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 2, New York, NY 10032, USA.
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Caspi A, Vishne T, Reichenberg A, Weiser M, Dishon A, Lubin G, Shmushkevitz M, Mandel Y, Noy S, Davidson M. Refractive errors and schizophrenia. Schizophr Res 2009; 107:238-41. [PMID: 19019632 DOI: 10.1016/j.schres.2008.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 09/22/2008] [Accepted: 09/28/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Refractive errors (myopia, hyperopia and amblyopia), like schizophrenia, have a strong genetic cause, and dopamine has been proposed as a potential mediator in their pathophysiology. The present study explored the association between refractive errors in adolescence and schizophrenia, and the potential familiality of this association. METHODS The Israeli Draft Board carries a mandatory standardized visual accuracy assessment. 678,674 males consecutively assessed by the Draft Board and found to be psychiatrically healthy at age 17 were followed for psychiatric hospitalization with schizophrenia using the Israeli National Psychiatric Hospitalization Case Registry. Sib-ships were also identified within the cohort. RESULTS There was a negative association between refractive errors and later hospitalization for schizophrenia. Future male schizophrenia patients were two times less likely to have refractive errors compared with never-hospitalized individuals, controlling for intelligence, years of education and socioeconomic status [adjusted Hazard Ratio=.55; 95% confidence interval .35-.85]. The non-schizophrenic male siblings of schizophrenia patients also had lower prevalence of refractive errors compared to never-hospitalized individuals. CONCLUSIONS Presence of refractive errors in adolescence is related to lower risk for schizophrenia. The familiality of this association suggests that refractive errors may be associated with the genetic liability to schizophrenia.
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Affiliation(s)
- Asaf Caspi
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Israel.
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Kleinhaus K, Harlap S, Perrin MC, Manor O, Calderon-Margalit R, Friedlander Y, Malaspina D. Twin pregnancy and the risk of schizophrenia. Schizophr Res 2008; 105:197-200. [PMID: 18722752 PMCID: PMC2599949 DOI: 10.1016/j.schres.2008.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 06/21/2008] [Accepted: 06/29/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Twins are exposed to intrauterine environments that differ significantly from those of singletons. These diverse environments might alter the risk for schizophrenia in twins and make it difficult to generalize from findings in twins when studying the risk of schizophrenia in the general population. Previous studies report contradictory findings on the risk for schizophrenia in twins. METHODS We studied the incidence of schizophrenia spectrum disorders, ascertained from Israel's National Psychiatric Registry, in a cohort of 2124 twins and 87,955 singletons. These offspring were followed from their birth in 1964-76 in the Jerusalem Perinatal study. Cox proportional hazards methods were used to compare outcomes over 28-41 years, adjusting for ages of parents. RESULTS Twins showed a relative risk [RR] of .84 relative to singletons, with a 95% confidence interval [CI] of (.51-1.4). RRs and CIs for males and females were .68 [.34-1.4] and 1.1 [.55-2.2] respectively. Twins in male-male, female-female or opposite-sex sets showed no significant variation in RRs; furthermore, first- or second-born twins did not differ significantly from each other. Siblings of twins had the same risk of schizophrenia as siblings of singletons. CONCLUSION Twins have the same risk for schizophrenia as the general population.
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Affiliation(s)
- K Kleinhaus
- Department of Psychiatry, New York University School of Medicine, New York, NY 10016, United States.
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56
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Abstract
BACKGROUND The aim of the current study was to test the predictive and concurrent validity of the Premorbid Adjustment Scale (PAS) by comparing it with another similar but more elaborate retrospective measure and with data collected during late adolescence. METHODS We compared PAS late adolescence scores (age 16-18 years) of 91 males with schizophrenia or schizoaffective disorder with data on behavior collected in adolescence, before the first psychotic episode as part of standardized Draft Board screening, and with the same measure readministered during adulthood and modified to collect the same data again retrospectively. RESULTS The correlation of the PAS social withdrawal and social relations items with the social behavior scale of the Draft Board were .76 and .80, respectively, for the concurrent ratings and .52 and .53, respectively, for the data collected at age 17 years. The correlation of the PAS school achievements and school adjustment items with the functioning in structured environments scale of the Draft Board were .71 and .72, respectively, for the concurrent ratings and .43 and .47, respectively, for the data collected at age 17 years. CONCLUSIONS Our results support the predictive and concurrent validity of the PAS and the validity of self-reported data on premorbid functioning in persons with schizophrenia.
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Affiliation(s)
- N. Brill
- Ashkelon Academic College, Askelon, Israel,Bar Ilan University, Ramat Gan, Israel
| | | | - M. Weiser
- Tel Aviv University, Tel Aviv, Israel
| | - J. Rabinowitz
- Bar Ilan University, Ramat Gan, Israel,To whom correspondence should be addressed; tel: +972-9-748-3679, fax: +972-9-740-1318, e-mail:
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Malaspina D, Corcoran C, Kleinhaus KR, Perrin MC, Fennig S, Nahon D, Friedlander Y, Harlap S. Acute maternal stress in pregnancy and schizophrenia in offspring: a cohort prospective study. BMC Psychiatry 2008; 8:71. [PMID: 18717990 PMCID: PMC2546388 DOI: 10.1186/1471-244x-8-71] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 08/21/2008] [Indexed: 01/27/2023] Open
Abstract
UNLABELLED Schizophrenia has been linked with intrauterine exposure to maternal stress due to bereavement, famine and major disasters. Recent evidence suggests that human vulnerability may be greatest in the first trimester of gestation and rodent experiments suggest sex specificity. We aimed to describe the consequence of an acute maternal stress, through a follow-up of offspring whose mothers were pregnant during the Arab-Israeli war of 1967. A priori, we focused on gestational month and offspring's sex. METHOD In a pilot study linking birth records to Israel's Psychiatric Registry, we analyzed data from a cohort of 88,829 born in Jerusalem in 1964-76. Proportional hazards models were used to estimate the relative risk (RR) of schizophrenia, according to month of birth, gender and other variables, while controlling for father's age and other potential confounders. Other causes of hospitalized psychiatric morbidity (grouped together) were analyzed for comparison. RESULTS There was a raised incidence of schizophrenia for those who were in the second month of fetal life in June 1967 (RR = 2.3, 1.1-4.7), seen more in females (4.3, 1.7-10.7) than in males (1.2, 0.4-3.8). Results were not explained by secular or seasonal variations, altered birth weight or gestational age. For other conditions, RRs were increased in offspring who had been in the third month of fetal life in June 1967 (2.5, 1.2-5.2), also seen more in females (3.6, 1.3-9.7) than males (1.8, 0.6-5.2). CONCLUSION These findings add to a growing literature, in experimental animals and humans, attributing long term consequences for offspring of maternal gestational stress. They suggest both a sex-specificity and a relatively short gestational time-window for gestational effects on vulnerability to schizophrenia.
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Affiliation(s)
- D Malaspina
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA.
| | - C Corcoran
- Department of Psychiatry, Columbia University, New York, NY, USA,New York State Psychiatric Institute, New York, NY, USA
| | - KR Kleinhaus
- Department of Psychiatry, Columbia University, New York, NY, USA
| | - MC Perrin
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - S Fennig
- Shalvata Mental Health Center, Ramat Gan, Israel,Sackler School of Medicine, Tel Aviv University, Israel
| | - D Nahon
- Department of Information and Evaluation, Ministry of Health, Jerusalem, Israel
| | - Y Friedlander
- Braun School of Public Health, Hebrew University of Jerusalem, Israel
| | - S Harlap
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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58
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Weiser M, Werbeloff N, Vishna T, Yoffe R, Lubin G, Shmushkevitch M, Davidson M. Elaboration on immigration and risk for schizophrenia. Psychol Med 2008; 38:1113-1119. [PMID: 17988415 DOI: 10.1017/s003329170700205x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Being a small and culturally different minority, or having a different appearance, has been invoked to account for the increased prevalence of psychotic disorders among immigrants. The majority of the Jewish Israeli population are first- or second-generation immigrants from Europe, North Africa or Asia, and during the late 1980s and 1990s, 885 000 persons immigrated to Israel from the former Soviet Union and 43 000 immigrated from Ethiopia. These Ethiopian immigrants came from a very different culture compared to the rest of the population, and have a distinct appearance. To further understand the association between immigration and schizophrenia, we compared risk for later schizophrenia between adolescents who immigrated from Ethiopia with risk among the other immigrant groups, and with native-born Israelis. MethodOf 661 792 adolescents consecutively screened by the Israeli Draft Board, 557 154 were native-born Israelis and 104 638 were immigrants. Hospitalization for schizophrenia was ascertained using a National Psychiatric Hospitalization Case Registry. All analyses controlled for socio-economic status (SES). RESULTS Risk for schizophrenia was increased among both first- [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.18-2.22] and second-generation immigrants [HR 1.41, 95% CI 1.01-1.95 (one immigrant parent) and HR 1.49, 95% CI 1.11-2.0 (two immigrant parents)]. When risk for schizophrenia was calculated for each immigrant group separately, immigrants from Ethiopia were at highest risk of later schizophrenia (HR 2.95, 95% CI 1.88-4.65). ConclusionThis comparison between diverse groups of immigrants supports the notion that immigrants who differ in culture and appearance from the host population are at increased risk for schizophrenia.
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Affiliation(s)
- M Weiser
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Israel.
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59
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Dong BR, He P, Lu Z, Wu T, Liu GJ, Huang CQ. Exercise for older depressed people. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd007317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Anglin DM, Malaspina D. Ethnicity effects on clinical diagnoses compared to best-estimate research diagnoses in patients with psychosis: a retrospective medical chart review. J Clin Psychiatry 2008; 69:941-5. [PMID: 18494534 PMCID: PMC5336694 DOI: 10.4088/jcp.v69n0609] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Ethnicity effects on diagnoses are frequently reported and have variably been attributed to diagnostic biases versus ethnic differences in environmental exposures, and other factors. METHOD We compared best-estimate gold standard research diagnoses to clinical diagnoses (DSM-III-R and DSM-IV criteria) among 129 white, 57 African American, and 50 Hispanic patients with psychosis admitted to an inpatient research unit from 1990 to 2003. RESULTS Clinical and research diagnoses showed greater agreement in Hispanic than in African American patients (white patients were intermediate). Diagnostic agreement for paranoid schizophrenia was likewise the best in Hispanic patients. While paranoid schizophrenia tended to be overdiagnosed in African American patients, it was underdiagnosed in white patients. Patterns of diagnostic agreement for schizoaffective disorder and "other" diagnoses were similar among the 3 ethnic groups. CONCLUSIONS Diagnostic unreliability may explain the excess of paranoid schizophrenia reported for African Americans. Further research is needed to elucidate the influence of ethnicity on clinical diagnosis before other theories to explain group differences can be reasonably proposed and reliably tested.
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Affiliation(s)
- Deidre M. Anglin
- Columbia University, Department of Psychiatry, New York State Psychiatric Institute New York, NY
| | - Dolores Malaspina
- New York University School of Medicine, Department of Psychiatry, New York, NY
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Candiago RH, Belmonte de Abreu P. [Use of Datasus to evaluate psychiatric inpatient care patterns in Southern Brazil]. Rev Saude Publica 2008; 41:821-9. [PMID: 17923904 DOI: 10.1590/s0034-89102007000500017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 05/08/2007] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe the construction and testing of a routine to assess psychiatric hospitalizations in the Brazilian Health System based on its database (DATASUS), and to assess characteristics and trends of these hospitalizations. METHODS Data were extracted from hospital admission authorizations in the state of Rio Grande do Sul, Southern Brazil, from 2000 to 2004. Data from 91,233 admissions were processed through a routine (syntaxes) using SPSS program and their reliability was tested. Hospitalization rates in general and psychiatric hospitals and main diagnoses were described, and trends were analyzed using polynomial regression models. RESULTS Intra and inter-rater reliabilities were 100%. There was seen a trend of increasing hospitalization rates due to mood disorders and decreasing rates due to schizophrenia and organic disorders. Hospitalization rates due to substance use disorders remained stable. There was an increasing trend in the number of psychiatric hospitalizations in general hospitals with a 97.7% growth in the period studied. CONCLUSIONS Routines proved to be reliable and feasible, suggesting the use of data from Hospital Information System database as a source of information for continuous evaluation of psychiatric hospitalizations in Brazilian Health System. Psychiatric hospitalization rates may have changed due to changes in the type of patients; diagnostic patterns, known as treatment-oriented diagnostic bias; and legislation.
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Affiliation(s)
- Rafael Henriques Candiago
- Programa de Pós-Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
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62
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Weiser M, Lubin G, Caspi A, Rabinowitz J, Shmushkevitz M, Yoffe R, Werbeloff N, Halperin D, Davidson M. Dysthymia in male adolescents is associated with increased risk of later hospitalization for psychotic disorders: a historical-prospective cohort study. Early Interv Psychiatry 2008; 2:67-72. [PMID: 21352135 DOI: 10.1111/j.1751-7893.2008.00060.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Retrospective studies indicate that patients with psychotic disorders and schizophrenia often suffer from depressive symptoms before the onset of psychosis. In a historical-prospective design, we studied the association between dysthymia in adolescence and later hospitalization for psychotic disorders and schizophrenia. METHODS The Israeli Draft Board screens the entire, unselected population of 16-17 years old male adolescents for psychiatric disorders. These adolescents were followed for hospitalization for psychotic disorders and schizophrenia using the Israeli National Psychiatric Hospitalization Case Registry. Of 275,705 male adolescents screened, 1267 (0.5%) were hospitalized for psychotic disorders (International Classification of Diseases [ICD]-10 20.0-29.9), and 757 (0.3%) were hospitalized for schizophrenia (ICD-10 20.0-20.9) over the next 1-10 years. RESULTS Of 275,705 male adolescents screened, 513 (0.2%) were diagnosed as suffering from dysthymia by the Draft Board. Of these adolescents, 10/513 (2.0%) were later hospitalized for psychotic disorders (including schizophrenia, HR=3.967, 95%CI (confidence intervals): 2.129-7.390), and 4/513 (0.8%) were later hospitalized for schizophrenia (HR=2.664, 95%CI: 0.997-7.116). CONCLUSIONS In this population-based cohort of male adolescents, dysthymia was associated with increased risk for future psychotic disorders. Dysthymia in some adolescents might be a prodromal symptom, while in others it might be a risk factor for later psychosis. Clinicians assessing dysthymic adolescents should be aware that these symptoms might be part of the prodrome.
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Affiliation(s)
- Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Israel.
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63
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Weiser M, Reichenberg A, Werbeloff N, Kravitz E, Halperin D, Lubin G, Shmushkevitch M, Yoffe R, Addington J, Davidson M. Self-report of family functioning and risk for psychotic disorders in male adolescents with behavioural disturbances. Acta Psychiatr Scand 2008; 117:225-31. [PMID: 18241305 DOI: 10.1111/j.1600-0447.2007.01143.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Previous studies indicate that a poor family environment might affect vulnerability for the later manifestation of psychotic illness. The current study aims to examine family functioning prior to the onset of psychosis. METHOD Subjects were 42,948, 17-year old males with behavioural disturbances who were asked about the functioning of their family by the Israeli Draft Board. Data on later psychiatric hospitalizations were obtained from a National Psychiatric Hospitalization Registry. RESULTS Poorer self-reported family functioning was associated with greater risk for later hospitalization for psychosis [adjusted hazard ratio (HR) = 1.16, 95% CI = 1.05-1.27], with a trend in the same direction for schizophrenia (adjusted HR = 1.1, 95% CI = 0.98-1.24). CONCLUSION In male adolescents with behavioural disturbances, perceived poorer family functioning is associated with increased risk for non-affective psychotic disorders and schizophrenia. These data do not enable us to determine if perceived familial dysfunction increases vulnerability for psychosis, if premorbid behavioural abnormalities disrupt family life, or neither.
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Affiliation(s)
- M Weiser
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Israel.
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64
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Brill N, Reichenberg A, Rabinowitz J, Harary E, Lubin G, Davidson M, Weiser M. Accuracy of self-reported premorbid functioning in schizophrenia. Schizophr Res 2007; 97:103-8. [PMID: 17628432 DOI: 10.1016/j.schres.2007.05.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Revised: 05/13/2007] [Accepted: 05/14/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Information on premorbid functioning is often based on patients recalling their past. Premorbid functioning is relevant as it is associated with treatment response and other outcomes. The extent to which memory impairments of persons with schizophrenia may bias such reporting has not been investigated. The purpose of the current study was to assess the extent to which persons with schizophrenia might exhibit biased reporting relative to controls. METHODS Seventy males with schizophrenia or schizoaffective disorder and 51 males with no psychiatric symptoms participated in the study. Contemporaneous and retrospective reports from a behavioral functioning assessment conducted as part of the Israeli Draft Board were compared. This assessment routinely administered to all 17 years old males in the country assesses social functioning, individual autonomy, organizational ability, physical activity and functioning in structured environments. We compared the groups on the Draft Board behavioral measures at age 17 and at re-assessment. We also examined the relationship between symptom severity, neuropsychological performance and differences between age 17 and current behavioral assessment scores. RESULTS In a repeated measures MANCOVA of the five measures there was no overall significant difference in accuracy of reporting between persons with schizophrenia and those without. Both groups showed a slight tendency to glorify their past. Consistency of reporting was not significantly correlated with neuropsychological performance or levels of psychotic symptoms. CONCLUSIONS We found that when reporting on personal and social functioning during teen age years persons with schizophrenia report with the same level of consistency as persons without schizophrenia. This suggests that self-report of premorbid functioning of persons with schizophrenia can be trusted as being reasonably accurate.
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Affiliation(s)
- N Brill
- Ashkelon Academic College, Israel
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65
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Weiser M, Reichenberg A, Rabinowitz J, Nahon D, Kravitz E, Lubin G, Knobler HY, Davidson M, Noy S. Impaired reading comprehension and mathematical abilities in male adolescents with average or above general intellectual abilities are associated with comorbid and future psychopathology. J Nerv Ment Dis 2007; 195:883-90. [PMID: 18000449 DOI: 10.1097/nmd.0b013e31815928b0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research indicates that persons with learning disorders often suffer from psychopathology. We assessed current and future psychopathology in male adolescents with discrete impairments in reading comprehension (IRC) or arithmetic abilities (IAA) but with average or above-average general intellectual abilities. Subjects were a population-based cohort of 174,994 male adolescents screened by the Israeli Draft Board with average or above-average intellectual abilities but with low scores (8.6th and 10th lowest percentile respectively) on reading or arithmetic tests. They were compared with adolescents who scored in the 10th percentile and above on these tests (comparison group). Relative to the comparison group, male adolescents with IRC, IAA, or IRC and IAA (0.69%), had poorer scores on most behavioral assessments and higher prevalence of current psychopathology: 4.2% (comparison group), 8.0% (IRC), 7.0% (IAA), and 9.8% (IRC and IAA). Adolescents with IRC were also at increased risk for later hospitalization for schizophrenia (hazard ratios = 1.8, 95% confidence interval: 1.3-2.6). Male adolescents with average and above-average general intellectual abilities but with IRC or IAA are more likely to have current and future psychopathology. Impairments in intellectual functioning and abnormal behaviors leading to mental illnesses may share common neurobiological substrates. The results support screening male adolescents with learning disorders for psychopathology.
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Affiliation(s)
- Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Israel.
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Werner S, Malaspina D, Rabinowitz J. Socioeconomic status at birth is associated with risk of schizophrenia: population-based multilevel study. Schizophr Bull 2007; 33:1373-8. [PMID: 17443013 PMCID: PMC2779876 DOI: 10.1093/schbul/sbm032] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Inconsistent findings obscure understanding the relationship between socioeconomic status (SES) and schizophrenia. The aim of the current study was to test the association between individual and community SES at birth and risk of schizophrenia. METHOD Population-based longitudinal follow forward study of a 13-year birth cohort (n = 71 165). Effects of individual and community socioeconomic variables were examined using multilevel regression in MLwiN. RESULTS Years of education of fathers and mothers, respectively, (0-8 vs 13+ odds ratio [OR] = 1.17, P < .0001; OR = 1.14, P < .001) lower occupational status of fathers (OR = 1.29, P = .036), and poorer residential area SES (OR = 1.26, P = .012) were risk factors for schizophrenia. CONCLUSIONS Individual- and community-level SES at the time of birth are associated with an increased risk of schizophrenia.
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Affiliation(s)
- Shirli Werner
- School of Social Work, Bar-Ilan University, Ramat-Gan, 52900, Israel
| | - Dolores Malaspina
- New York University Medical Center, 550 First Avenue, New York, NY 10016-6484
| | - Jonathan Rabinowitz
- School of Social Work, Bar-Ilan University, Ramat-Gan, 52900, Israel
- To whom correspondence should be addressed; tel: (972)-3-5317567/7736, fax: (972)-3-5347228, e-mail:
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67
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Weiser M, van Os J, Reichenberg A, Rabinowitz J, Nahon D, Kravitz E, Lubin G, Shmushkevitz M, Knobler HY, Noy S, Davidson M. Social and cognitive functioning, urbanicity and risk for schizophrenia. Br J Psychiatry 2007; 191:320-4. [PMID: 17906242 DOI: 10.1192/bjp.bp.106.031328] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Previous work suggests that the association between urbanicity and schizophrenia may be greatest in those with pre-existing vulnerability. AIMS To test for synergism in risk of schizophrenia between population density and a combined exposure of poor premorbid social and cognitive functioning. METHOD For 371 603 adolescent males examined by the Israeli Draft Board on social and cognitive functioning, data on population density of place of residence and later hospitalisation for schizophrenia were obtained from population-based registries. RESULTS There was an interaction between population density (five levels) and poor premorbid social and cognitive functioning (interaction chi(2)=4.6, P=0.032). The adjusted increase in cumulative incidence associated with one unit change in population density was 0.10% in the vulnerable group (95% CI 0.019-0.18, P=0.015), nine times larger than that in the non-vulnerable group (0.011%, 95% CI 0.0017-0.020, P=0.021). CONCLUSIONS Risk of schizophrenia may increase when people with a genetic liability to the disorder, expressed as poor social and cognitive functioning, need to cope with city life.
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Affiliation(s)
- Mark Weiser
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, IDF, Division of Mental Health, and Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel.
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68
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Caspi A, Reichenberg A, Weiser M, Rabinowitz J, Shmushkevich M, Lubin G, Nahon D, Vishne T, Davidson M. Premorbid behavioral and intellectual functioning in schizophrenia patients with poor response to treatment with antipsychotic drugs. Schizophr Res 2007; 94:45-9. [PMID: 17544633 DOI: 10.1016/j.schres.2007.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 03/05/2007] [Accepted: 04/15/2007] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Approximately one third of schizophrenia patients show partial or no response to pharmacotherapy. Despite intensive investigations, the phenomenological and biological characteristics of such patients are far from elucidated. This study examined the premorbid behavioral and intellectual functioning of schizophrenia patients who showed poor response to antipsychotic treatment. METHOD One hundred twenty-nine schizophrenia patients who showed poor response to treatment were ascertained from a national register and matched by gender, age and education to 129 patients who showed adequate response. The groups were compared on premorbid measures of behavioral and intellectual functions. RESULTS As a group, treatment-resistant male patients had significantly lower (worse) social functioning [p=0.002], and individual autonomy [p<0.0001] scores before the onset of the illness compared to treatment non-resistant patients. Male and female treatment-resistant patients did not differ from non-resistant patients in premorbid intellectual functioning [p>0.1]. CONCLUSIONS Low premorbid social functioning and individual autonomy, but not intellectual functioning, could serve as predictors of poor treatment response in schizophrenia.
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Affiliation(s)
- Asaf Caspi
- Sheba Medical Center, Tel Hashomer, Israel
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69
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Rabinowitz J, Levine SZ, Haim R, Häfner H. The course of schizophrenia: progressive deterioration, amelioration or both? Schizophr Res 2007; 91:254-8. [PMID: 17293084 DOI: 10.1016/j.schres.2006.12.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2006] [Revised: 12/03/2006] [Accepted: 12/08/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Schizophrenia may follow a course of amelioration, deterioration or stability. It is possible that deterioration at the aggregate level may be due to a sub-group of patients with a tendency to deteriorate. AIMS To examine the course of schizophrenia in a national population-based cohort. METHODS All first admissions for schizophrenia in Israel 1978-1986 were followed for readmissions in the Israeli psychiatric hospitalization registry for 10 years (n=6865). Readmission rates were examined using cluster analysis. This was followed by an examination of changes in readmission patterns. RESULTS Cluster analysis identified a small cluster of patients who spent more days in the hospital over time and two clusters that improved. A priori classification of the patients into deteriorating, improving and stable (based on days hospitalized per year) revealed that approximately 75% of patients improved over time. CONCLUSIONS Over time a majority of patients appear to improve and a minority appear to deteriorate.
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70
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Levav I, Lipshitz I, Novikov I, Pugachova I, Kohn R, Barchana M, Ponizovsky A, Werner H. Cancer risk among parents and siblings of patients with schizophrenia. Br J Psychiatry 2007; 190:156-61. [PMID: 17267933 DOI: 10.1192/bjp.bp.106.024943] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A reduced risk of cancer has been noted among people with schizophrenia. Given that genetic causes have been proposed as an explanation of this finding, one would expect that the risk of cancer among first-degree relatives would be equally reduced. AIMS To investigate the risk of cancer among the biological parents and full siblings of people receiving in-patient care for schizophrenia. METHOD Linkage analysis was conducted between national population, psychiatric and cancer databases. Standardised incidence ratios for all cancer sites were calculated by comparing the incident rates among first-degree relatives with national incidence rates. RESULTS A reduced cancer risk was found across all groups examined. Among parents, whose numbers were adequately large, the findings reached statistical significance. For index cases and siblings--a markedly younger population--only a trend was elicited. CONCLUSIONS The genetic hypothesis--namely, the presence of a gene with the dual effect of reducing the cancer risk and disrupting neurodevelopment--is a plausible explanation for these findings.
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Affiliation(s)
- I Levav
- Mental Health Services, Cancer Registry, Ministry of Health, 2 Ben Tabai Street, Jerusalem 91010, Israel.
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71
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Perrin MC, Opler MG, Harlap S, Harkavy-Friedman J, Kleinhaus K, Nahon D, Fennig S, Susser ES, Malaspina D. Tetrachloroethylene exposure and risk of schizophrenia: offspring of dry cleaners in a population birth cohort, preliminary findings. Schizophr Res 2007; 90:251-4. [PMID: 17113267 PMCID: PMC2739584 DOI: 10.1016/j.schres.2006.09.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 09/26/2006] [Accepted: 09/27/2006] [Indexed: 10/23/2022]
Abstract
Tetrachloroethylene is a solvent used in dry cleaning with reported neurotoxic effects. Using proportional hazard methods, we examined the relationship between parental occupation as a dry cleaner and risk for schizophrenia in a prospective population-based cohort of 88,829 offspring born in Jerusalem from 1964 through 1976, followed from birth to age 21-33 years. Of 144 offspring whose parents were dry cleaners, 4 developed schizophrenia. We observed an increased incidence of schizophrenia in offspring of parents who were dry cleaners (RR=3.4, 95% CI, 1.3-9.2, p=0.01). Tetrachloroethylene exposure warrants further investigation as a risk factor for schizophrenia.
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Affiliation(s)
- Mary C Perrin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, 10032, USA.
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72
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Rabinowitz J, Levine SZ, Häfner H. A population based elaboration of the role of age of onset on the course of schizophrenia. Schizophr Res 2006; 88:96-101. [PMID: 16962742 DOI: 10.1016/j.schres.2006.07.007] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2006] [Revised: 06/22/2006] [Accepted: 07/17/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite suggestions that an earlier age of onset and being male confer to a poorer course of schizophrenia, evidence regarding when these effects are most salient appears to be ambiguous. AIMS To examine the relationship of age of first hospitalization and sex with the course of hospitalization in a population based cohort. METHOD All first admissions for schizophrenia in a national population based cohort in Israel from 1978 to 1992 were followed through 1996 (n=12,071) using data from the National Psychiatric Hospitalization Case Registry of the State of Israel, a complete national registry of psychiatric admissions. Recursive partitioning was conducted to empirically determine cut-off points for age groups showing the greatest difference on the variables of interest. RESULTS A younger age of first hospital admission was associated with a greater likelihood of having more than one hospital admission, longer first admissions, more hospital admissions and more inpatient days per year. Of patients with age of first admission below 17, 82.5% had more than one admission which decreased for subsequent age groups to 73.54% (18-28), 69.36% (29-31), 62.88% (32-45), and 50.77% (over 45). Men had an earlier first admission than women, and had slightly more cut-off values. Irrespective of sex, the relationship between age at first admission and later hospitalization conformed to a linear trend. CONCLUSIONS An earlier onset corresponds linearly with the severity of the course of illness and appears to have prognostic value.
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73
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Reichenberg A, Weiser M, Rapp MA, Rabinowitz J, Caspi A, Schmeidler J, Knobler HY, Lubin G, Nahon D, Harvey PD, Davidson M. Premorbid intra-individual variability in intellectual performance and risk for schizophrenia: a population-based study. Schizophr Res 2006; 85:49-57. [PMID: 16626941 DOI: 10.1016/j.schres.2006.03.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Accepted: 03/03/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Some, but not most, schizophrenia patients have below-average intelligence years before they manifest psychosis. However, it is not clear if those whose intelligence falls within-normal-range nevertheless have cognitive abnormalities. We examined the association between intra-individual variability in intellectual performance and risk for schizophrenia in individuals with normal IQ. METHODS 555,326 adolescents, mandatory assessed by the Israeli Draft Board were followed up over 8 to 17 years for psychiatric hospitalization by means of the Israeli National Psychiatric Hospitalization Case Registry. Data were available on 4 intelligence sub-tests, and on behavioral and psychosocial variables. Variability was computed from the variance of the four intelligence tests' standardized scores. RESULTS There was a significant monotonic association between increased intra-individual variability in intellectual performance and risk of schizophrenia in individuals with within-normal-range IQ. Individuals with the highest variability were 3.8 times more likely to have schizophrenia [95%CI: 2.32-6.08; p < 0.0001] compared with individuals with the lowest variability. This association held after controlling for the effects of potential confounders. CONCLUSIONS Despite within-normal-range premorbid IQ, apparently healthy adolescents who will later on manifest schizophrenia, nevertheless have cognitive abnormalities such as increased variability across intellectual tasks, possibly related to frontal lobe abnormalities.
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Affiliation(s)
- Abraham Reichenberg
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
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74
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Reichenberg A, Goldenberg J. Self-reported mental health difficulties and subsequent risk for schizophrenia in females: a 5-year follow-up cohort study. Schizophr Res 2006; 82:233-9. [PMID: 16364598 DOI: 10.1016/j.schres.2005.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Revised: 11/03/2005] [Accepted: 11/10/2005] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with schizophrenia often report a history of premorbid mild to severe psychological distress. We investigated the association between self-reported mental health difficulties and later psychiatric hospitalization for schizophrenia. METHODS 13,357 females aged 17, mandatory assessed by the Israeli Draft Board were followed up over 5 years for psychiatric hospitalization by means of the Israeli National Psychiatric Hospitalization Case Registry. Seventeen females, judged healthy at Draft Board assessment, were hospitalized for schizophrenia or schizoaffective disorder over the follow-up period. RESULTS There was a significant monotonic association between increasing self-reported mental health difficulties (psychological distress and increasing need for psychological counseling) and prevalence of schizophrenia [odds ratios over four levels: 1.56; 95% CI:1.04 to 2.34; chi2 (1) = 4.62, p = 0.03], after controlling for low IQ, immigration, SES, and presence of psychiatric disorders at age 17. Increasing severity of self-reported mental health difficulties was related to earlier age of first hospitalization [r = -0.48, p = 0.05]. CONCLUSIONS Increased undifferentiated self-reported mental health difficulties are associated with increased risk of later hospitalization for schizophrenia prior to age 23 in females. This may reflect the prodromal phase of the illness.
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Affiliation(s)
- Abraham Reichenberg
- Department of Psychiatry, Mount Sinai School of Medicine, One Gustave L Levy Place, Box 1230, New York, NY 10029, USA.
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Grinshpoon A, Zilber N, Lerner Y, Ponizovsky AM. Impact of a rehabilitation legislation on the survival in the community of long-term patients discharged from psychiatric hospitals in Israel. Soc Psychiatry Psychiatr Epidemiol 2006; 41:87-94. [PMID: 16508720 DOI: 10.1007/s00127-005-0008-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND The aim of the present study was to examine the impact of the Rehabilitation Law 2000 in Israel (which provides a basket of rehabilitation services for every mentally disabled patient) on the survival in the community of a population of long-stay psychiatric patients released from psychiatric hospitals. METHODS A naturalistic follow-up study was performed on long-stay patients discharged ("key discharge") from two Israel psychiatric hospitals closed before (in 1997) and after (in 2000) introduction of the Rehabilitation Law 2000. The data source was the National Psychiatric Hospitalization Registry. RESULTS The study population consisted of 611 patients. The percentage of patients who, at closure of hospital, were discharged directly into the community was eightfold higher following the Rehabilitation Law 2000 than before. There was also a trend for a lower readmission rate for those patients who were discharged into the community in the post-law period, both for those whose key discharge was directly to the community and for those who were later discharged after being transferred to another hospital at key discharge. Concerning the mean duration of inpatient stay, there was no difference between the two cohorts, whether hospitalizations followed transfer to another hospital from key discharge or rehospitalization from the community. Interestingly, the Rehabilitation Law did not have a significant effect on patients' mortality after key discharge. CONCLUSION The Rehabilitation Law 2000 has a beneficial effect on the opportunities of long-stay psychiatric patients to resettle in the community without increasing risk of death.
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Affiliation(s)
- Alexander Grinshpoon
- Research and Planning, Mental Health Services, Ministry of Health, 2 Ben Tabai St., Jerusalem, 93591, Israel
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