Current and lifetime psychopathology was assessed in 50 Israeli children of parents with schizophrenia who were either of kibbutz families and raised collectively with the help of child care workers, or of urban families and raised by their parents. Index subjects were compared with 50 matched control children of healthy parents by means of the Schedule for Affective Disorders and Schizophrenia-Israel. Subjects were evaluated in adulthood at a mean age of 31 years; schizophrenia was found exclusively among children of ill parents, and no effect of town or kibbutz rearing on risk for schizophrenia was observed. Major affective illness was more common among kibbutz index subjects. Affective symptomatology observed in some index parents was evenly distributed among town and kibbutz parents and was not related to the diagnosis of affective disorders in at-risk children. Current adult functioning was similar between town-and kibbutz-raised subjects (and in general reflected good adjustment); an excess of personality disorders was found among index subjects. The present findings support the concept that both familial and environmental factors operate in the expression of psychopathology.
"S.L. Hans et al. parents with nonschizophrenic disorders (Erlenmeyer- Kimling et al. 1995). In one sample, offspring of parents with schizophrenia appeared to be at increased risk for affective disorder at age 25 (Mirsky et al. 1985) but not by age 31 (Ingraham et al. 1995). Typically, these studies rely on diagnostic information from a single proband parent , even though nonproband parents mated with parents with schizophrenia may also be likely to have a mental disorder that could contribute to an offspring's disorder (Quinton et al. 1993). "
[Show abstract][Hide abstract] ABSTRACT: Although offspring of parents with schizophrenia are at risk for schizophrenic illness as adults, little is known about their pattern of symptoms as children and adolescents. Lifetime Axis I and II DSM-III-R diagnoses were made for 116 young people (ages 12-22). Forty-one subjects had a parent with schizophrenia, 39 had a parent with a nonschizophrenic mental disorder, and 36 had parents with no mental illness. Schizophrenia spectrum disorders occurred at higher rates among young people with a parent with schizophrenia (17.1%) than in other young people (5.3%), even after controlling for mental disorder in the nonproband parent. Schizophrenia and schizotypal personality disorder occurred exclusively in offspring of parents with schizophrenia. Offspring of parents with schizophrenia were also at increased risk for avoidant personality disorder but not paranoid personality disorder. Although lifetime anxiety disorders were common in all young people regardless of parent diagnosis, current anxiety disorders were more prevalent for the adolescent offspring of parents with schizophrenia. These data strongly suggest familial vulnerability to schizophrenia spectrum disorder that is observable before adulthood, particularly for males.
"This means focusing on patients who have manifest symptoms and impaired functioning and demonstrate a substantially increased risk of psychosis onset Traditional or Genetic High-Risk Model. A range of studies recruited individuals with a family history of psychotic disorder (usually schizophrenia) during early childhood and monitored them over time—in some studies for up to 35 years (Nagler 1985; Fish et al. 1992; Cannon and Mednick 1993; Erlenmeyer-Kimling et al. 1995, 1997; Ingraham et al. 1995; Hodges et al. 1999; Johnstone et al. 2001). Selection of subjects for these studies on the basis of a crude measure of genetic risk (family history) restricts the generalizability of any findings to the early detection of schizophrenia, as most cases do not in fact have a first degree relative with the disorder (McGuffin et al. 1984; Kendler 1986; Asamow 1988). "
[Show abstract][Hide abstract] ABSTRACT: The development of a new frontier for research and early intervention in psychotic disorders is highly dependent on the construction of synergistic clinical infrastructures. This has catalyzed great progress in the recognition, enhanced treatment, and study of first episode psychosis, and the task is even more challenging when the boundaries are extended to include the earliest clinical phase of illness, the prodromal or prepsychotic phase. This article describes the conceptual and practical building blocks for the construction of service models for intervention in the postonset clinical phase prior to the attainment of current diagnostic thresholds. This is best regarded as indicated prevention, a form of very early secondary prevention, which involves a blend of immediate clinical care combined with research-oriented preventive intervention. The experience of the Personal Assessment and Crisis Evaluation (PACE) Clinic in Melbourne across several stages of growth is described and contrasted with that of several emerging centers in Europe and North America. The progress to date, the lessons learned, and the unresolved challenges and opportunities are detailed. It is concluded that service models can be developed that are acceptable and helpful to young people and their families, and that create a unique environment for the study of the transition to frank psychotic disorder. The ultimate clinical utility and general safety of this approach and the range of effective treatments remain unclear, and will be determined by more extensive research. Such research must be conducted in a logical and rigorous manner with the best designs possible, sensitive to input from consumers and caregivers and to ethical considerations.
"1981). Other extrafamilial environments may be less harmful: the kibbutz communal rearing environment showed no differential effect on lifetime psychosis outcomes (Ingraham et al. 1995), and high-risk children raised by relatives had a more favorable outcome than did their peers raised by mothers with schizophrenia (Mednick et al. 1984). "
[Show abstract][Hide abstract] ABSTRACT: Univariate prediction models of schizophrenia may be adequate for hypothesis testing but are narrowly focused and limited in predictive efficacy. Therefore, we used a multivariate design to maximize the prediction of schizophrenia from premorbid measures and to evaluate the relative importance of various predictors. Two hundred twelve Danish subjects with at least one parent diagnosed in the schizophrenia spectrum (high risk) and 99 matched subjects with no such parent (low risk) were assessed on 25 premorbid variables in seven domains (genetic risk, birth factors, autonomic responsiveness, cognitive functioning, rearing environment, personality, and school behavior) when the subjects averaged 15 years of age. Twenty-five years later, 33 subjects had received lifetime diagnoses of schizophrenia. Discriminant function analyses were used to discriminate schizophrenia outcomes from no mental illness and nonschizophrenia outcomes on the basis of premorbid measures. Regardless of the comparison group used, schizophrenia was predicted by the interaction of genetic risk with rearing environment, and disruptive school behavior. Within the high-risk group, two-thirds of schizophrenia outcomes were correctly predicted by these premorbid measures; three-quarters of those with no mental illness were also correctly predicted. Prediction was enhanced among those with two schizophrenia spectrum parents, lending support to a multiplicative gene x environment model. Implications for early identification/primary prevention efforts are discussed.
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