Mental Health and Neurobehavioral Function in Young Adult Offspring of Women with a History of Psychosis and Control Offspring

Detta är en avhandling från Erland Schubert, Dept. of Psychiatric Epidemiology, Barngatan 2, Universitetssjukhuset i Lund USiL, S-221 85 Lund, Sweden

Sammanfattning: Schizophrenia is now generally considered to be a brain disease resulting from disturbed neurodevelopment, mediated by genetic and/or adverse events in utero and/or in early childhood. This process manifests itself in schizophrenia in young adulthood, when the brain completes its maturation. The background and development of affective psychosis have been less extensively investigated. Our aim was to study mental health and neurobehavioral characteristics in 75 young adult offspring of mothers with a history of psychosis (38 offspring with heightened risk for schizophrenia, and 37 with heightened risk for affective psychosis), and 91 normal-risk offspring of mothers with no history of psychosis. In a 93%-effective (total n=166) follow-up of this longitudinally studied sample, mental disturbance, neurological abnormality and neuropsychological performance were blindly investigated at mean 22.4 yr of age. The subjects were previously assessed with a standard test of vision at 4 yr of age, and neurological examinations were blindly performed in infancy and at 6 yr of age. · Offspring at high-risk for schizophrenia showed more (a) mental disturbance (DSM-III-R Axis I and Axis II disorders, poor global functioning, high Symptom Check List-90 (SCL-90) scores and a history of mental health care and psychopharmacological medication), (b) diverse neurological abnormalities, and (c) neuropsychological impairments (on verbal memory, selective attention and grammatical reasoning tests). A neurobehaviorally deviant subgroup was identified only among this offspring group. · Offspring at high-risk for affective psychosis showed high SCL-90 scores, and more frequent poor functioning and receipt of mental health care, with an increase only in Axis I depressive disorders. No increase of neurological abnormality or neuropsychological impairments was found for this group. · Neurological abnormalities at 22 yr were associated with (a) neurological abnormalities at 6 yr of age, but not in infancy, and with (b) multiple adult neuropsychological functions in offspring at high-risk for schizophrenia and in normal-risk offspring, but not among offspring at high-risk for affective psychosis. · Offspring mental disturbance and neurobehavioral characteristics were generally similar when defining offspring risk by maternal “core” psychosis cases vs. additional maternal “psychosis spectrum” cases. · Offspring neurobehavioral deficits were related to offspring schizophrenia-spectrum disorder in a different manner from that for offspring affective disorders. · Visual dysfunction at 4 yr of age predicted offspring schizophrenia-spectrum disorders but no other psychiatric disorders in adulthood. Visual dysfunction at 4 yr of age was significantly related to neurological abnormality at 6 yr of age, suggesting a neurodevelopmental basis for schizophrenia-spectrum disorders. · The findings in total show a different pattern of mental disturbance and neurobehavioral characteristics in offspring with genetic high-risk for schizophrenia, in comparison with offspring at high-risk for affective psychosis and offspring at normal-risk. This suggests that schizophrenia may be part of a probably genetically mediated neurobehavioral syndrome and a consequence of disturbed neurodevelopment that belongs to a different neurobiological spectrum from that for affective disorders. Nevertheless, neurobehavioral deviations in general are not pathognomonic for schizophrenia-spectrum disorders or other psychiatric disturbance.

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