The continuum of psychosis and its genetic origins: the sixty-fifth Maudsley lecture

Article Abstract:

For the past 80 years, scientific attempts to preserve the theory that schizophrenia and affective (mood) disorders are unrelated have failed. Recent genetic evidence supports the hypothesis that these disorders represent a continuum, and that the mechanisms behind them are genetic. Post-mortem examinations comparing schizophrenics with age-matched controls demonstrated structural changes in the brains of schizophrenics that were not found in other types of psychotic disorders. In most humans, particularly right-handed humans, structures in the left temporal lobe, which encompass areas responsible for speech and communication, are larger than those located in the right temporal lobe. The left temporal lobe of schizophrenic brains was slightly smaller than those of matched comparisons. If such asymmetry is specific to schizophrenia, then the schizophrenic disease process may be linked to mechanisms that produce this lack of symmetry in the human brain, so that the gene for cerebral dominance may also be the human psychosis gene. Furthermore, the genetic locus for psychiatric disease is within the exchange regions of the sex-linked (X and Y) chromosomes. This type of 'pseudoautosomal' (exchange between X and Y chromosomes) genetic transmission has been firmly established by molecular studies. A characteristic feature of pseudoautosomal transmission is same-sex concordance (sibling pairs will be of the same sex more often than expected). The fact that schizophrenic siblings have high same-sex concordance and share a piece of chromosome at the psychosis locus inherited from a carrier parent offers strong molecular evidence of sex-linked inheritance. It is posited that psychoses may be related to aberrations of late evolutionary development associated with increases in brain weight over time as man evolved from primates. Thus, while the cerebral dominance gene may permit evolutionary developments, psychosis may reflect a disadvantageous product of the evolutionary process. (Consumer Summary produced by Reliance Medical Information, Inc.)

Genetic aspects, Affective disorders, Mood disorders, Schizophrenia

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Post-partum psychosis in the Assir Region of Saudi Arabia

Article Abstract:

The increased risk to the mental health of women in the period just after delivery, the puerperium, is established by the fact that women are more likely to be admitted to a mental hospital following delivery than at other times. However, most conclusions about puerperal psychosis are based on the results of studies conducted in Western countries. In the mountainous Assir Region of Saudi Arabia, psychiatric services are provided by an 82-bed unit in Abha, the capital of the province. Between September 1, 1986 and August 31, 1988, the case notes of 91 women admitted to the psychiatric hospital who had given birth within nine months before admission were evaluated. The records were examined for final diagnosis, symptoms in the first week, course of illness during admission, time after delivery admission occurred, and other factors. The rate of puerperal illness was calculated as 3 per 1,000, similar to results of other studies. Major depression was diagnosed in 26 patients, and 10 of those had previous psychiatric illness that was related to childbirth. Affective psychosis was found in two thirds of the patients, which was lower than expected. One curious finding was that women who had given birth before were more numerous than those having their first child. It is conjectured that this is a cultural artifact, reflecting the fact that multigravida patients have less support during and after pregnancy in this part of the Middle East. (Consumer Summary produced by Reliance Medical Information, Inc.)

Saudi Arabia, Puerperium

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Psychosis in migrants from the Indian subcontinent and English-born controls: a preliminary study of the use of psychiatric services

Article Abstract:

In 1979, a major study of schizophrenia showed that the two-year patient outcome was better in developing countries than in developed countries. Other reports have supported this observation. In the present study, 86 first-generation Indian immigrants to England were compared with 86 matched subjects native to England. All subjects were diagnosed with a non-organic psychosis. Case records were reviewed, and data were collected for three time periods after the initial contact with the hospital: two years, five years, and the total time between initial contact and the beginning of the study. Calculations were made of the total percentage of time spent as an in-patient, the total number of admissions per year, and the average length of each stay. During all time periods, the Asians had significantly lower scores for use of in-patient services than English-born subjects; Asians had significantly fewer previous psychiatric admissions as well. Social and cultural factors that may account for these differences between Asian and English patients need to be explored. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, United Kingdom, Usage, Psychiatric clinics, Indians (Asian people), Indians in United Kingdom, Great Britain

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