Showing papers by "Robin M. Murray published in 1992"

A Neurodevelopmental Approach to the Classification of Schizophrenia

Abstract: The conventional distinction between schizophrenia and manic depression has received little objective support from recent studies of phenomenology, outcome, or familial homotypy. Instead, much clinical, epidemiological, and morphological evidence suggests that within the broad range of Schneiderian schizophrenia there exists one form (congenital schizophrenia) that can be distinguished from other types, the manifestations of which are confined to adult life. We hypothesize that congenital schizophrenia is a consequence of aberrant brain development during fetal and neonatal life. Such patients show structural brain changes and cognitive impairment, and in their male predominance, early onset, and poor outcome, they reflect Kraepelin's original description of dementia praecox. We contend that adult-onset schizophrenia is itself heterogeneous. One important component is a relapsing and remitting disorder that is more frequent in females than in males, exhibits positive but not negative symptoms, and has much in common etiologically with affective psychosis. There also exists a very-late-onset group in which degenerative brain disorder is implicated.

Schizophrenia following pre-natal exposure to influenza epidemics between 1939 and 1960.

Abstract: We examined the relationship between the dates of births of schizophrenic patients admitted to hospitals for the first time in England and Wales between 1970 and 1979, and the occurrence of influenza epidemics between 1939 and 1960. Our results indicate that exposure to influenza epidemics between the third and seventh month of gestation is associated with schizophrenia in adult life. The hypothesis that maternal viral infection is an important cause of schizophrenia can explain many aspects of the enigmatic epidemiology of the condition.

Seasonality of admissions in the psychoses: effect of diagnosis, sex, and age at onset.

Abstract: A summer peak was found in first admissions to hospitals in England and Wales between 1976 and 1986 for both affective psychoses and schizophrenia, but not for neurotic conditions or personality disorders. There was no significant relationship between age at first admission and season of admission. The summer peak was most prominent for mania, where it was present in both sexes; for schizophrenia, it was present only in females. These findings suggest that schizophrenia in females, and mania in both sexes, have some aetiological or precipitating factor in common.

The relationship of environmental temperature to the incidence and outcome of schizophrenia.

Abstract: This paper presents new analyses of data from two multicentre studies carried out by the WHO. The morbid risk of developing schizophrenia, as broadly defined by the Determinants of Outcome Study, was positively related to the mean daily range of temperature. The outcome of schizophrenia, as determined by the International Pilot Study of Schizophrenia, was found to be positively related to mean environmental temperature. Further studies are needed to examine the relationship of geographical and climatic variables to schizophrenia in order to complement what is already known about the role of sociocultural factors.

Schizophrenia and neurodevelopment.

Abstract: Schizophrenia is characterised by the psychotic symptoms of hallucinations and delusions, accompanied by variable degrees of loss of insight. Whilst there is heterogeneity in the clinical profile, and presumably in the pathogenesis of what is currently called 'schizophrenia', it has become absolutely clear over the past decade that schizophrenic symptoms are consequent upon serious brain dysfunction. This new perspective has laid to rest a variety of 'crazy' theories, including the notion that mental illness was a myth, or that schizophrenia could be caused by faulty child rearing. The use of dopamine-blocking drugs has led to an improvement in symptom control, and diminished the need for prolonged hospital stays. It was hoped that the clear relationship between antipsychotic activity and dopamine blockade would help to elucidate the pathophysiology of schizophrenia, but to date no consistent abnormalities of the dopamine system have been found. Nevertheless, we have learned much about both the aetiology of schizophrenia and the origin of particular symptoms. Much of this has stemmed from increased understanding of the brain abnormalities underlying the disorder.

GABAA receptor subunit genes as candidate genes for bipolar affective disorder - an association analysis

Abstract: Polymorphic DNA segments can be used as genetic markers to test for allelic association between a disease and a candidate gene locus. Here we report the results of a study of 60 unrelated bipolar patients in which we sought for evidence of association between bipolar affective disorder and alleles at two candidate genes (GABRA1 and GABRA3) involved in GABAergic neurotransmission. The data obtained were analysed in a number of ways. None of these produced conclusive evidence for association, although allele A6 at the GABRA1 locus was significant (p = 0.025) before correcting for multiple testing.

Can one predict the long-term outcome of hospitalized depressives?

Abstract: This paper summarizes the methodological aspects and findings of a long-term study involving 89 depressed patients who were admitted to the Royal Maudsley Hospital between 1965 and 1966, and who were followed- up 18 years later. Less than 20% of the survivors had remained well and > 33% of the series suffered unnatural death or severe chronic distress and handicap. Patients whose index episode marked their first psychiatric contact had a 50% chance of readmission within their lifetime, but those with previous admissions had a 50% chance of readmission within 3 years. High neuroticism scores on the Eysenck Personality Inventory on recovery, and when ill but referring to the pre-morbid state, were associated with poor overall outcome and chronicity. High obsessional interference scores on the Leyton Obsessional Inventory on recovery were also associated with poor long-term outcome, impaired social adjustment, more time spent in hospital and with the subsequent development of schizophrenic or schizoaffective episodes. Subtyping according to the Research Diagnostic Criteria, DSM-III, Newcastle Index and PSE/Catego criteria had little prognostic utility. However, DSM-III melancholia was shown to have an interactive effect with the personality measure neuroticism such that melancholic individuals, who at index had high neuroticism scores, were very likely to have a poor outcome.