Article

Does urbanicity shift the population expression of psychosis?

Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, P.O. Box 616 (DRT 10), 6200 MD Maastricht, The Netherlands.
Journal of Psychiatric Research (Impact Factor: 4.09). 11/2004; 38(6):613-8. DOI: 10.1016/j.jpsychires.2004.04.003
Source: PubMed

ABSTRACT Growing up in an urban area has been shown to be associated with an increased risk of psychotic disorder in later life. While it is commonly held that a only a tiny fraction of exposed individuals will develop schizophrenia, recent evidence suggests that expression of psychosis in exposed individuals may be much more common, albeit at attenuated levels. Findings are based on a population sample of 2548 adolescents and young adults aged originally 14-24 years, and followed up over almost 5 years up to ages 17-28 years. Trained psychologists assessed all these subjects with the core psychosis sections on delusions and hallucinations of the Munich-Composite International Diagnostic Interview. Growing up in an urban area was associated with an increased risk of expression of psychosis in the adolescents and young adults (adjusted OR 1.31, 95% CI 1.03-1.66). The proxy environmental risk factor that urbanicity represents may shift a relatively large section of the adolescent population along a continuum of expression of psychosis. Other causal influences may be required to make the transition to schizophrenia in adult life.

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    • "An important observation is that studies have demonstrated that the generally good (because the symptoms are only transitory as described above) outcome of subclinical psychotic experiences can be modified to poorer outcomes of persistence and clinical need for care if subjects are exposed to additional (proxy) environmental risk factors. Examples of these are trauma (Spauwen et al. 2006b), cannabis (Henquet et al. 2005) and urbanicity (Spauwen et al. 2004, 2006a). This fact, together with the above discussed findings of a high prevalence of psychotic experiences, their familial clustering, age-associated expression and low rate of transition to psychotic disorder, suggests a model of psychosis that considers genetic background factors impacting on a broadly distributed and transitory population expression of psychosis during development, the poor prognosis of which, in terms of persistence and clinical need, is predicted by environmental exposures interacting with genetic risk. "
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    • "Their effects are small and many may be involved. They are likely to interact with environmental exposures that impact on the individual over the life course, such as fetal hypoxia (Cannon et al., 2002), the proxy environmental risk factor: season of birth (Mortensen et al., 1999), adverse rearing environments (Tienari et al., 2004), the stresses of urban life during upbringing (van Os et al., 2003, Spauwen et al., 2004), cannabis use (Verdoux et al., 2003), stress in daily life (Myin-Germeys et al., 2001) and a minority position (Hutchinson et al., 1996). The causes of schizophrenia impact on brain development, as evidenced by a small reduction in the volume of grey matter (Wright et al., 2000) that appears to progress over time, and may be linked to social deterioration, use of medication or factors intrinsic to the disease itself (Cahn et al., 2002, Ho et al., 2003a,b). "
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    • "The review carried out regarding psychotic experiences in adolescence (see Table 1) seems to point out that the distribution and proportion of these can vary considerably as a function of the measurement instrument employed. R e g u l a r a r t i c l e 66 ATTENUATED PSYCHOTIC EXPERIENCES IN ADOLESCENTS TABLE 1 PREVALENCE STUDIES OF ATTENUATED PSYCHOTIC EXPERIENCES IN ADOLESCENTS Study (Pearson et al., 2008) (Scott et al., 2008) (Scott et al., 2008) (De Loore et al., 2008) (Horwood et al., 2008) (Laurens et al., 2007) (Spauwen et al., 2006a) (Spauwen et al., 2006b) (Yung et al., 2006) (Henquet et al., 2005) (Yoshizumi et al., 2004) (Spauwen et al., 2004) (Ferdinand et al., 2004) (Spauwen et al., 2003) "
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