Early trauma/dysmorphogenesis and adult neurodysfunction in schizophrenia

University dissertation from Dept. of Psychiatric Epidemiology, Lund University Hospital USiL, S-221 85 Lund

Abstract: To measure the importance of early neurodevelopmental disturbance for schizophrenia, early trauma and dysmorphogenesis (i.e. obstetric complications (OCs), minor physical anomalies (MPAs), head circumference (HC) and dermatoglyphic characteristics) were studied in relationship to adult neurodysfunction (i.e. neurological abnormality (NA), neurocognitive dysfunction (NCGD), tardive dyskinesia (TD) and parkinsonism) in 60 schizophrenia patients, 21 of their non-ill siblings and 75 normal comparison subjects. Patients showed reduced neonatal HC (nHC), increased rates of OCs, MPAs, NA and NCGD, and frequent signs of TD and parkinsonism. Siblings showed increased rates of MPAs, NA, and NCGD and frequent signs of TD, implicating a general familial vulnerability for schizophrenia-related neurodysfunction. Patients differed from siblings by having reduced nHC and increased OCs, and higher rates of MPAs and adult neurodysfunction, signalling two different levels of early trauma/dysmorphogenesis and neurodysfunction: one characterising at-risk families in general, and another higher, disease-related level characterising the patient group. Early trauma/dysmorphogenesis was generally unrelated to adult neurodysfunction. HC in patients was reduced at birth but disproportionately large in males in adulthood. NA was related to level of global functioning in adulthood. Early trauma/dysmorphogenesis thus seems to initiate an early pathophysiological process, but additional factors influence adult neurodysfunction in schizophrenia. The findings in total would be consistent with a 'multi-hit' neurodevelopmental model of schizophrenia. The effective factors would vary from individual to individual and include both genetic and early/later environmental components.

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