Showing papers by "Robin M. Murray published in 1993"
TL;DR: The findings suggest that the production of auditory hallucinations in schizophrenia is associated with increased activity in a network of cortical areas specialised for language.
424 citations
TL;DR: This study provides some of the strongest evidence for a link between life events and the emergence of psychotic symptoms, particularly in the three months before onset of psychosis.
Abstract: Data from the Camberwell Collaborative Psychosis Study were used to examine the proposition that there is an excess of life events preceding the onset of psychoses of all types. Of 97 patients from the study who had episodes within the past year that were datable, 51 had developed psychotic symptoms from an essentially symptom-free state, 29 had been suffering only from neurotic symptoms, and 17 had experienced a marked exacerbation of psychotic symptoms. DSM-III diagnoses were collapsed into three major groups: 51 cases of schizophrenia; 31 cases of mania; and 14 cases of depressive psychosis. Life-event histories were taken for the six months before onset, and when these were compared with equivalent histories from a psychiatrically healthy sample from the local general population, there was a significant excess of life events, particularly in the three months before onset of psychosis. This was apparent in all groups, and remained even when events were restricted to the independent category. The excess of events began rather earlier than has been found in previous studies. In our view, this study provides some of the strongest evidence for a link between life events and the emergence of psychotic symptoms.
248 citations
TL;DR: The volume of the frontal and anterior parietal lobes was significantly reduced in the schizophrenic group as a result of a selective decrease in cortical volume, with a corresponding increase in the volume of sulcal fluid.
Abstract: The MRI scans of 48 schizophrenic patients, fulfilling RDC criteria, were compared to those of 34 healthy controls matched for age, ethnicity and parental social class. The volume of the frontal and anterior parietal lobes was significantly reduced in the schizophrenic group as a result of a selective decrease in cortical volume, with a corresponding increase in the volume of sulcal fluid. Reduction in the volume of the temporal grey matter was more marked on the right, but was not in excess of the loss of volume observed in other areas of the cortex. MRI abnormalities correlated poorly with clinical parameters, although both unemployment and poor pre-morbid adjustment predicted reduced cerebral volume and increased sulcal volume. These results question whether the medial temporal lobes are the only site of structural pathology in schizophrenia.
217 citations
TL;DR: Schizophrenic patients who failed to achieve their fathers' social status had poorer educational qualifications than those who equalled or bettered their paternal social class, despite similar premorbid IQ scores and age at onset of psychosis.
Abstract: In an investigation of the timing and precursors of social decline in schizophrenia and affective psychosis, 195 subjects from the Camberwell Collaborative Psychosis Study were currently of lower social class than were their fathers. A comparison between father's occupation and proband's best premorbid occupational level indicated underachievement confined to DSM-III schizophrenia, there being no such effect in affective psychosis. Decline in social status following onset of psychosis, analysed by comparing best premorbid occupation with current occupation, was marked in both schizophrenia and affective psychosis, indicating a non-specific effect. Schizophrenic patients who failed to achieve their fathers' social status had poorer educational qualifications than those who equalled or bettered their paternal social class, despite similar premorbid IQ (NART) scores and age at onset of psychosis. These results indicate that schizophrenia may be manifest before the onset of psychosis, and lend weight to the notion of a developmental origin to this disorder.
216 citations
TL;DR: The results suggest that schizophrenia syndrome is heterogeneous, and young males are especially prone to a severe neurodevelopmental form of illness associated with premorbid deficits.
Abstract: In a case-record study, all first-contact patients with non-affective functional psychosis from a defined area over 20 years were diagnosed according to operational criteria of varying stringency and emphasis, and incidence rates for each set of criteria determined by sex and age at onset; data on premorbid adjustment were also analysed by sex and age at onset. The overall first-contact incidence of non-affective functional psychosis was approximately equal in men and women; however, the ratio of male to female incidence rates rose progressively when RDC (1.2), DSM-III-R (1.3), DSM-III (2.2), and Feighner (2.5) criteria for schizophrenia were applied. Schizophrenia was most common in young males and least common in older males, with females occupying an intermediate position. Schizophrenia in young males, particularly when stringently defined, was especially likely to be associated with single status, poor work and social adjustment, and premorbid personality disorder. The results suggest that schizophrenia syndrome is heterogeneous, and young males are especially prone to a severe neurodevelopmental form of illness associated with premorbid deficits.
198 citations
TL;DR: An analysis of a large catchment area sample of patients with nonaffective functional psychoses presenting across all ages at onset revealed distinct differences between patients with early and late onset of illness.
Abstract: We report an analysis of a large catchment area sample of patients with nonaffective functional psychoses presenting across all ages at onset. The male:female ratio was 1.56:1 in the 16-25-year age group; it reached unity around 30 years of age and declined to 0.38:1 in the 66-75-year group. Contrary to expectation, a higher proportion of patients with onset of illness after 45 years than of younger onset patients fulfilled DSM-III-R criteria for schizophrenia (52% vs. 38%). The distribution by age at onset was much the same irrespective of stringency of diagnosis. The highest rates were in the 16-25-year age group, with a slight second peak in the 46-55-year group, and a third (more emphatic) peak in the over-65 group. A closer analysis of demographic and phenomenologic variables revealed distinct differences between patients with early and late (after 44 years) onset of illness.
176 citations
TL;DR: The role of aberrant neurodevelopment in the etiology of schizophrenia is reviewed and it is suggested that such environmental hazards and aberrations in the control of early brain development produce the neuronal phenotype that manifests as schizophrenia with early age of onset of symptoms associated with soft neurologic signs.
123 citations
TL;DR: It is concluded that although there are clinical similarities between cases of schizophrenia with early and late onset, there are sufficient differences between them to suggest that they are not phenotypically homogeneous.
Abstract: The presence or absence of 22 schizophrenic symptoms was recorded with the age at onset of illness in 470 patients with non-affective, non-organic psychoses. Positive and negative formal thought disorder, affective symptoms, inappropriate affect, delusions of grandiosity or passivity, primary delusions other than delusional perception, and thought insertion and withdrawal were all more common in early-onset cases (age at onset 44 years or less; n = 336). Persecutory delusions with and without hallucinations, organised delusions, and third-person, running commentary and accusatory or abusive auditory hallucinations were all more common in late-onset cases (age at onset 45 years or more; n = 134). There was no difference between cases of early and late onset in the prevalence of delusions of reference, bizarre delusions, delusional perception, or lack of insight. We conclude that although there are clinical similarities between cases of schizophrenia with early and late onset, there are sufficient differences between them to suggest that they are not phenotypically homogeneous.
107 citations
TL;DR: Poor clinical response does not appear to be accounted for by differential blockade, or inadequate occupancy of striatal dopamine D2 receptors by antipsychotic medication, and there was no difference in striatal D2 receptor availability between the patient groups.
Abstract: The hypothesis that poor response to antipsychotic medication is due to inadequate occupancy of central D2 receptors was tested in vivo. We assessed striatal D2 dopamine receptor availability for binding with the specific ligand 123I IBZM by single photon emission tomography (SPET) in two groups of DSM-III-R diagnosed schizophrenic patients on typical antipsychotic medication, and a group of healthy controls (N = 20). Patients were characterized by clinical ratings as antipsychotic responders (N = 10) or non-responders (N = 8). Dynamic single slice SPET, at a slice chosen to include the basal ganglia, began immediately following intravenous injection of 185 MBq 123I IBZM. Semiquantitative analysis generated indices of D2 receptor availability for binding. There was no difference in striatal D2 receptor availability between the patient groups, both showing a similar degree of occupancy by antipsychotic medication compared to the control group. Thus, poor clinical response does not appear to be accounted for by differential blockade, or inadequate occupancy of striatal dopamine D2 receptors by antipsychotic medication.
101 citations
TL;DR: It is proposed that prenatal exposure to influenza induces maternal antibodies which then cross-react with proteins in the developing foetal brain, becomingfoetal autoantibodies, the biological substrate for a proportion of adult schizophrenia.
Abstract: Thirty years ago, Eliot Slater suggested that the reason schizophrenia was not progressively eliminated from the population was that the responsible gene also conveyed a compensatory advantage in terms of increased resistance to infection. If this selective advantage lies in the antibody response to certain viral infections, this could explain recent studies suggesting that exposure to influenza in the second trimester of gestation increases the risk of later schizophrenia. We propose that prenatal exposure to influenza induces maternal antibodies which then cross-react with proteins in the developing foetal brain, becoming foetal autoantibodies. Thus an immunogenetic response by the mother results in aberrant foetal neurodevelopment, the biological substrate for a proportion of adult schizophrenia. Initial research strategies to test this hypothesis are proposed.
88 citations
TL;DR: Analysis of epidemiological data regarding admission to psychiatric units in England, France, and Germany over the period 1973-1986, as well as examination of 97 psychotic adolescents referred to an adolescent unit over a 14 year period, supported prediction that females would show earlier onset of psychotic illness arising around puberty and onset of psychosis in females would be related to menarche.
TL;DR: The results were compatible with the notion that socio-economic deprivation during gestation and early life predisposes to later schizophrenia.
Abstract: We employed a case-control study design to investigate whether schizophrenic patients differed from non-psychotic psychiatric patients in terms of place of birth and paternal occupation. “Cases” were first-contact schizophrenic patients ascertained from the Camberwell Cumulative Psychiatric Case Register. “Controls” were the next (non-psychotic) patient on the Register matched for age and sex. In comparison with controls, cases were more likely to have: (1) been born in the deprived innercity Camberwell catchment area (odds ratio 2.3), and (2) had fathers who had “manual” as opposed to “non-manual” occupations (odds ratio 2.1). The results were compatible with the notion that socio-economic deprivation during gestation and early life predisposes to later schizophrenia.
TL;DR: The results suggest that most of the region can be excluded from containing a gene of major effect in the aetiology of this disease.
Abstract: We report the results of a collaborative linkage study using 12 polymorphic markers (9 loci) from the long arm of chromosome 11, and 24 families multiply affected with schizophrenia and other closely related disorders. This region is of interest because several families have been reported in which balanced translocations involving 11q apparently co-segregate with psychotic illness. In addition, the dopamine D2 receptor, porphobilinogen deaminase, and tyrosinase genes map within the region studied and may be aetiologically involved in schizophrenia. We have primarily analysed genotypic data by the LOD score method using a range of single gene models. In order to minimize error due to mis-specification of genetic parameters we have analysed data from markers at candidate gene loci by the non-parametric extended sib-pair method in addition to the LOD score method. Our results suggest that most of the region can be excluded from containing a gene of major effect in the aetiology of this disease.
TL;DR: Eighty-two Caucasian patients receiving treatment for alcohol-related problems and eighty four controls were DNA typed for variants in the alcohol dehydrogenase (ADH2 and ADH3) and mitochondrial aldehyde dehydrogenases (ALDH2) gene loci.
Abstract: Eighty-two Caucasian patients receiving treatment for alcohol-related problems and eighty four controls were DNA typed for variants in the alcohol dehydrogenase (ADH 2 and ADH 3 and mitochondrial aldehyde dehydrogenase (ALDH 2 ) gene loci. No association was observed between individual, or combined gene frequencies and the presence of alcohol-related problems
TL;DR: Preliminary findings suggest that prenatal exposure to influenza impairs the neurodevelopment of some females with a predisposition to affective psychosis, in such a way that their later illness shows schizophrenic rather than affective features.
Abstract: We examined the relationship between influenza epidemics and the number of schizophrenic and affective psychotic individuals born each month between 1938 and 1965 in England and Wales. Increased death rates from influenza were followed 5 months later by a significant increase in schizophrenic births and a concurrent fall in the number of births of affective psychotic individuals. When the sexes were examined separately, both the positive effect of influenza on schizophrenic births and its negative effect on affective psychotic births were evident for females but not for males. Furthermore, during February to June in high influenza years, there was an inverse relationship between the number of female schizophrenic and affective psychotic births. The explanation for these surprising findings may be that prenatal exposure to influenza impairs the neurodevelopment of some females with a predisposition to affective psychosis, in such a way that their later illness shows schizophrenic rather than affective features.
TL;DR: There is little evidence to support the concept of a cannabis psychosis, and it is proposed that psychosis occurring in the context of cannabis use may be par ticularly likely in those with a genetic predisposition to psychotic illness, rather than producing a specific —¿ cannabis p ychosis' denovo.
Abstract: SIR: Thomas (Journal, August 1993, 163, 141—149) reviewed the evidence for †̃¿ cannabis psychosis' being valid as a diagnostic entity. We have investigated this issue empirically in a consecutive series of psy chotic admissions which has been described else where (Jones et a!, Journal, January 1993, 162, 65—71).The Present State Examination (PSE) was used to assess the psychopathology of 23 acute psychotic admissions who were cannabis positive on urinary screening, and 46 matched drug-free psychotic controls. Cases and controls were indis tinguishable in terms of the prevalence of PSE syndromes. Moreover, the groups were also similar with respect to DSM—III—R diagnoses, ethnicity and socio-economic class, differing only, as expected, in terms of their histories of substance use. We also examined the morbid risk of psychiatric illness in first-degree relatives, using maternal inter views and RDC—FHcriteria, and Weinberg's shorter method of age correction. Cannabis positive cases had a significantly higher familial morbid risk of schizophrenia than the controls (7.1% v.0.7%; odds ratio= 10.2; 95% CI 1.12—234,P=0.02), but similar rates for other conditions. We agree with the author's conclusion that there is little evidence to support the concept of a †̃¿ cannabis psychosis'. Furthermore, we propose that psychosis occurring in the context of cannabis usemay be par ticularly likely in those with a genetic predisposition to psychotic illness; cannabis usemay trigger a †̃¿ func tional' psychosis in those with a psychotic diathesis, rather than producing a specific †̃¿ cannabis p ychosis' denovo.
TL;DR: It was found that both psychiatric disorder in first-degree relatives and a history of obstetric complications were associated with early onset, and Childhood symptoms did not predict the type of adult affective disorder.
Abstract: Early-onset affective disorder is associated with obstetric complications and a high familial risk of psychiatric illness, in particular psychosis. In a matched case-control study, we investigated 47 adult in-patients with major depressive disorder or bipolar 1 disorder, who had earlier in life presented to a child psychiatry department. Cases were matched on sex, social class and ethnic group with 47 controls, who were admitted to hospital for affective disorders in adult life but had no psychiatric contact before the age of 21. We found that both psychiatric disorder in first-degree relatives and a history of obstetric complications were associated with early onset. Childhood symptoms did not predict the type of adult affective disorder.
TL;DR: The schizophrenic syndrome may represent a stereotyped response by the developing brain to various insults, including micro-organisms, and the hypothesis that exposure to influenza during fetal life increases the risk of later schizophrenia is examined.
Abstract: The schizophrenic syndrome may represent a stereotyped response by the developing brain to various insults, including micro-organisms. We review studies that have examined the association between schizophrenia and infectious agents, and examine the current evidence for the hypothesis that exposure to influenza during fetal life increases the risk of later schizophrenia. A prenatal autoimmune basis for some cases of schizophrenia is proposed.
TL;DR: No significant correlation was found between cerebral cortical ratings and ventricular size and the relationship between family history of psychosis and cortical sulcal widening on CT scans was investigated.
Abstract: The relationship between family history of psychosis and cortical sulcal widening on CT scans was investigated. Forty-two schizophrenic subjects with a positive family history were individually matched to 42 schizophrenics with no documented family history and 42 healthy controls. Abnormally wide sulci, as defined on the basis of the normal control data, were significantly more common in the family history negative group (9/42) than in the family history positive group (1/42) or the controls (2/36). No significant correlation was found between cerebral cortical ratings and ventricular size.
TL;DR: Burns et a! appear to have given further support to his claims by showing that home-based services are cheaper and reduce bed use and Dingleton's success can no bongerbedismissed because it has not been systematically evaluated.
Abstract: At Dingleton we have routinely seen out-patients at home, preferably with a co-therapist for 25 years. Up until now this model has not been evaluated in a well controlled trial, although several new services have made favourable comparisons between themselves and previous or adjacent hospital-based services. Punukollu (1991) reported reduced bed occupancy after introducing a crisis intervention team to one of the sector teams in Huddersfield. Pullen & Gilbert (1985) and Dean & Gadd (1989) reported fewer admissions if the initial emergency assessment was done at home rather than hospital. Home assessment was introduced by Querido in Amsterdam in the b930sin an effort to save money by reducing admissions (Querido, Journal, 1968, 14, 293—302).Burns et a! appear to have given further support to his claims by showing that home-based services are cheaper and reduce bed use. It is import ant to remember that Querido felt that there were other advantages in having the first assessment at home where “¿ a picture is unfolded which I am con vinced never can be obtained in any other way.― This theme is repeated throughout descriptions of home assessment services and there is a general belief that home assessment allows a better assessment of social and family circumstances. All the home-care studies quoted by Burns eta!, with the exception of Dean & Gadd(l989), involved initial contact with the patient at hospital. For example, Muijen et al's (1992) patients were randomised after initially being assessed as needing admission in the Maudsley 24hour walk-in clinic. This is a home-treatment rather than a home-assessment service and I feel it is important to emphasise the difference. Home assessment also improves access to care. Dingleton's failure-to-attend rate runs at around 5%. This is similar to the 7% in Burns et al's experimental group while their 25% control-group rate is similar to ratesinotherhospital-basedservicesreported recently. Dingleton's successcan no bongerbedismissed because it has not been systematically evaluated.