Early brain trauma and schizophrenia in Nigerian patients

Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
American Journal of Psychiatry (Impact Factor: 12.3). 04/1994; 151(3):368-71.
Source: PubMed


A number of reports have suggested that early brain trauma, especially obstetric complications, may be associated with schizophrenia. This observation seems at variance with the similar rates of schizophrenia reported for advanced and developing countries when viewed against the high rate of perinatal morbidity in developing countries. Using patients with mania as comparison subjects, the authors investigated the association of early brain trauma with schizophrenia in adult life among Nigerian patients.
The manic (N = 12) and schizophrenic (N = 26) groups, both diagnosed according to the Research Diagnostic Criteria, were compared in respect to the prevalence of events commonly regarded as definite obstetric complications and the prevalence of childhood brain injury for which hospitalization was required.
A history of early brain trauma was associated with an adult diagnosis of schizophrenia. Schizophrenic patients with a history of early brain trauma were more likely than those without early brain trauma to have shown poor scholastic performance in childhood. They also showed mixed cerebral laterality in adulthood.
Early brain trauma may be a specific risk factor for the later development of schizophrenia. Patients with such a history may evidence other features of neurodevelopmental deviance.

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    • "Studies were included in the analysis if the Lewis- Murray scale was used or if we could apply the scale to the study data (Lewis et al. 1989). A total of 13 studies were identified (Eagles et al. 1990; McCreadie et al. 1992; O'Callaghan et al. 1992; Heun and Maier 1993; McNeil et al. 1993; Stober et al. 1993; Verdoux and Bourgeois 1993; Gunther-Genta et al. 1994; Gureje et al. 1994; Rifkin et al. 1994; Kendell et al. 1996; Taylor et al. 1996; Willinger et al. 1996) and individual patient data were obtained from all but one (Gureje et al. 1994) (see table 1). Some studies included patients with other psychotic disorders and several control groups. "
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    ABSTRACT: Several epidemiological studies have reported an association between complications of pregnancy and delivery and schizophrenia, but none have had sufficient power to examine specific complications that, individually, are of low prevalence. We, therefore, performed an individual patient meta-analysis using the raw data from case control studies that used the Lewis-Murray scale. Data were obtained from 12 studies on 700 schizophrenia subjects and 835 controls. There were significant associations between schizophrenia and premature rupture of membranes, gestational age shorter than 37 weeks, and use of resuscitation or incubator. There were associations of borderline significance between schizophrenia and birthweight lower than 2,500 g and forceps delivery. There was no significant interaction between these complications and sex. We conclude that some abnormalities of pregnancy and delivery may be associated with development of schizophrenia. The pathophysiology may involve hypoxia and so future studies should focus on the accurate measurement of this exposure.
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