Middle-ear disease and schizophrenia: Case-control study
Cheshire & Wirral Partnership NHS Foundation Trust, The Stein Centre, St Catherine's Hospital, Birkenhead CH42 0LQ, UK. The British Journal of Psychiatry
(Impact Factor: 7.99).
10/2008; 193(3):192-6. DOI: 10.1192/bjp.bp.108.052795
One hundred years ago psychiatrists thought that ear disease could cause insanity by irritation of the brain. Current understanding of the role of the temporal lobes in schizophrenia and their proximity to the middle ear supports this hypothesis.
To establish the rate of middle-ear disease pre-dating the onset of schizophrenia.
Eighty-four patients with schizophrenia were each matched to four non-psychiatric controls by age, gender and season of birth. History of ear disease was obtained from general practice records. Additional information on symptoms was collected for participants in the case group, who also had audiometry.
The odds ratio of recorded middle-ear disease pre-dating schizophrenia was 3.68 (95% CI 1.86-7.28). This excess was particularly marked on the left (OR=4.15, 95% CI 2.08-8.29). Auditory hallucinations were associated with middle-ear disease but not with hearing loss.
There is an association between middle-ear disease and schizophrenia which may have aetiological significance.
Available from: Km Abel
- "hypoxia, hyperbilirubinaemia, very low birthweight ) (Bergman et al. 1985 ; Roizen, 2003), middle ear infections (Davidson et al. 1989) and low socioeconomic status (Chadha et al. 2006). These are all known risks for psychotic illness (Mason & Winton, 1995 ; Cannon et al. 2002b ; Wicks et al. 2005 ; Mason et al. 2008 ; Abel et al. 2010 ; Arias et al. 2012) and therefore also may act as potential confounders of any association between hearing impairment and psychosis . In a contemporaneous Swedish study of preschool children (Darin et al. 1997), the aetiology of hearing loss was reported to be 58 % prenatal causes (with heredity in 33 %), 7 % perinatal causes, 12 % postnatal causes and 23 % unknown. "
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Schizophrenia often becomes manifest in late adolescence and young adulthood but deviations in physical and behavioural development may already be present in childhood. We investigated the relationship between hearing impairment (measured with audiometry) and speech impairment (broadly defined) at age 4 years and adult risk of non-affective psychosis.
We performed a population-based, case–control study in Sweden with 105 cases of schizophrenia or other non-affective psychoses and 213 controls matched for sex, date and place of birth. Information on hearing and speech impairment at age 4, along with potential confounding factors, was retrieved from Well Baby Clinic (WBC) records.
Hearing impairment [odds ratio (OR) 6.0, 95% confidence interval (CI) 1.6–23.2] and speech impairment (OR 2.6, 95% CI 1.4–4.9) at age 4 were associated with an increased risk of non-affective psychotic illness. These associations were mutually independent and not explained by parental psychiatric history, occupational class or obstetric complications.
These results support the hypothesis that psychosis has a developmental aspect with presentation of antecedent markers early in childhood, long before the disease becomes manifest. Our findings add to the growing evidence that early hearing impairment and speech impairment are risk indicators for later non-affective psychosis and possibly represent aetiological clues and potentially modifiable risk factors. Notably, speech impairment and language impairment are both detectable with inexpensive, easily accessible screening.
Available from: Su Golder
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ABSTRACT: Promoting the mental health of people bereaved through suicide is a key aim of the National Suicide Prevention Strategy.
To evaluate the effects of interventions to support people bereaved through suicide.
We conducted a systematic review of data from controlled studies of interventions for people bereaved through suicide. Studies were identified using systematic searches, the methodological quality of included studies was assessed and narrative synthesis conducted.
Eight studies were identified. None was UK-based and all but one study had substantial methodological limitations. When compared with no intervention, there was evidence of some benefit from single studies of a cognitive-behavioural family intervention of four sessions with a psychiatric nurse; a psychologist-led 10-week bereavement group intervention for children; and 8-week group therapy for adults delivered by a mental health professional and volunteer. The findings from studies comparing two or more active interventions were more equivocal.
Although there is evidence of some benefit from interventions for people bereaved by suicide, this is not robust. Further methodologically sound evidence is required to confirm whether interventions are helpful and, if so, for whom.
Available from: rcpsych.org
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