ABSTRACT
Background: Bipolar disorder appears to be related to anatomic abnormalities in medial temporal lobe, in particular amygdale, prefrontal cortex and cerebellum. Two recent MRI findings have supported a neuro developmental etiology of bipolar disorders.Methods: It was a cross-sectional comparative hospital based study. The subjects were recruited for the study by the purposive sampling technique. The study was conducted at the Institute of Mental Health and Hospital Mathura Road Agra. The study sample consisted of 20 bipolar disorder patients diagnosed as per ICD-10 DCR (WHO, 1992) criteria, 20 first degree relatives, one for each patient. Total sample size is 40.Results: It was observed that in bipolar patients’ maximum anomalies were seen in Mouth (0.35±0.48) head (0.30±0.57) followed by anomalies of eyes (0.25±0.55) hand (0.20±0.41) and ear (0.05±0.22). It was observed that in Bipolar FDRs maximum anomalies were seen in mouth (0.20±0.04) ear (0.15±0.45) head (0.1±0.3) and then anomalies of eye and hand in equal propensity (0.05±0.22) and least anomalies in feet (0.00±0.00).Conclusions: The rate of MPAs in bipolar patients was more than their FDRs but not statically significant. Both sibling groups had fewer MPAs than the patients. When viewed within a vulnerability-stress model, the results are consistent with the theory that MPAs may reflect early, largely extra-genetic, stressful events.
ABSTRACT
OBJECT AND METHOD: Minor physical anomalies(MPAs) are frequently seen in patients with schizophrenia. MPAs are considered to arise from the anomalous development of ectoderm-originated tissues in the developing fetus. Since the central nervous system originates from ectoderm, MPAs can be regarded as externally observable and objective indicators of the aberrant development which might have taken place in the central nervous system. To investigate whether MPAs are more frequent in schizophrenic patients, the frequencies of MPAs were compared between schizophrenic patients and normal controls. Total 245 schizophrenic patients diagnosed with DSM-IV(male : 158, female : 87), and 418 normal control subjects(male : 216, female : 202) were included in this study. The MPAs were measured using the modified Waldrop scale with fifteen items in six bodily regions; head, eye, ear, mouth, hand, and foot. RESULT: The total scores of Waldrop scale were 4.40+/-1.93(mean+/-standard deviation) in patients and 3.43+/- 1.68 in controls for females, and for males, 4.58+/-1.75 in patients and 4.28+/-1.59 in controls. For females, the excess of MPAs in schizophrenic patients was statistically significant(t-test : p<0.001). For males, schizophrenic patients also showed more MPAs than normal controls, but this tendency did not reach statistical significance (t-test : p=0.094). When the modified Waldrop total scores excluding head circumference were compared, the total scores in schizophrenic patients were significantly higher for both male and female subjects(t-test : male p<0.001, female p=0.001). The individual anomaly items included in Waldrop scale were also investigated. The items of epicanthus, hypertelorism, malformed ears, syndactylia were significantly more frequent in schizophrenic patients. In contrast, the items of adherent ear lobes, asymmetric ears, furrowed tongue, curved fifth finger, single palmar crease and big gap between toes did not show any differences in frequency between schizophrenic patients and normal controls. Since a lot of statistical analyses showed different results between male and female subjects, it seems to be necessary to consider gender as an important controlling variable for the analysis, however only the item of head circumference showed statistically significant gender-related difference according to log-linear analysis. CONCLUSION: With a relatively large sample size, the frequencies of MPAs enlisted in Waldrop scale were compared between schizophrenic patients and normal controls in this study. MPAs were more frequently seen in schizophrenic patients and, especially, several specific items in the Waldrop scale showed prominent excess in schizophrenic patients. Although definite conclusions cannot be drawn due to the inherent limitation of the study using Waldrop scale, these results seem to support the possibility that aberrant neurodevelopmental process might be involved in the pathogenesis of schizophrenia in some of the patients.