Exposure to genocide and the risk of schizophrenia: a population-based study.

BACKGROUND: No evidence exists on the association between genocide and the incidence of schizophrenia. This study aims to identify critical periods of exposure to genocide on the risk of schizophrenia. METHOD: This population-based study comprised of all subjects born in European nations where the Holocaust occurred from 1928 to 1945, who immigrated to Israel by 1965 and were indexed in the Population Register (N = 113 932). Subjects were followed for schizophrenia disorder in the National Psychiatric Case Registry from 1950 to 2014. The population was disaggregated to compare groups that immigrated before (indirect exposure: n = 8886, 7.8%) or after (direct exposure: n = 105 046, 92.2%) the Nazi or fascist era of persecutions began. The latter group was further disaggregated to examine likely initial prenatal or postnatal genocide exposures. Cox regression modelling was computed to compare the risk of schizophrenia between the groups, adjusting for confounders. RESULTS: The likely direct group was at a statistically (p < 0.05) greater risk of schizophrenia (hazard ratio = 1.27, 95% confidence interval 1.06-1.51) than the indirect group. Also, the likely combined in utero and postnatal, and late postnatal (over age 2 years) exposure subgroups were statistically at greater risk of schizophrenia than the indirect group (p < 0.05). The likely in utero only and early postnatal (up to age 2 years) exposure subgroups compared with the indirect exposure group did not significantly differ. These results were replicated across three sensitivity analyses. CONCLUSIONS: This study showed that genocide exposure elevated the risk of schizophrenia, and identified in utero and postnatal (combined) and late postnatal (age over 2 years) exposures as critical periods of risk.

Schizophrenia and violent crime: a population-based study.

BACKGROUND: Previous studies have found that patients with schizophrenia are more likely to be violent than the general population. The aim of this study was to investigate the association between schizophrenia and violent crime in the Israeli population. METHOD: Using the Israeli Psychiatric Hospitalization Case Registry we identified 3187 patients with a discharge diagnosis of schizophrenia. For each proband we identified parents and siblings, and gender- and age-matched controls for patients, parents and siblings. Information on violent crimes was obtained from police records. RESULTS: Patients with schizophrenia were at increased risk for violent crimes compared with controls [odds ratio (OR) 4.3, 95% confidence interval (CI) 3.8-4.9], especially women (OR 9.9, 95% CI 6.2-15.7). Risk for violent crimes was higher among patients with co-morbid substance misuse than in patients without such co-morbidity (OR 5.1, 95% CI 4.2-6.3). CONCLUSIONS: The results of this study suggest that increased risk of violence is part of the clinical picture of schizophrenia and needs to be recognized as a legitimate, essential, aspect of clinical management.

Increased number of offspring in first degree relatives of psychotic individuals: a partial explanation for the persistence of psychotic illnesses.

OBJECTIVE: As patients with psychotic illness have fewer offspring than controls, the persistence of psychotic illness is puzzling. We hypothesized that unaffected first-degree relatives of patients have more offspring than controls. METHOD: Probands were 4904, individuals with non-affective psychotic disorders identified from a hospitalization registry. Unaffected first degree relatives and matched controls were identified from the Israeli Population Registry. The number of offspring of unaffected parents, biological siblings and controls was ascertained. RESULTS: Unaffected parents of psychotic patients had more offspring/person than controls; 4.5 +/- 2.7 vs. 3.4 +/- 2.2, P = 0.000. Unaffected parents from familial psychosis families (more than one affected family member) had 1.83 more offspring than controls; unaffected parents from non-familial psychosis families had 0.97 more offspring than controls (both P < 0.001). CONCLUSION: These findings might imply that genes which increase susceptibility for schizophrenia may be associated with increased number of offspring, perhaps supplying a partial explanation for the persistence of psychosis.

Self-report of family functioning and risk for psychotic disorders in male adolescents with behavioural disturbances.

OBJECTIVE: Previous studies indicate that a poor family environment might affect vulnerability for the later manifestation of psychotic illness. The current study aims to examine family functioning prior to the onset of psychosis. METHOD: Subjects were 42,948, 17-year old males with behavioural disturbances who were asked about the functioning of their family by the Israeli Draft Board. Data on later psychiatric hospitalizations were obtained from a National Psychiatric Hospitalization Registry. RESULTS: Poorer self-reported family functioning was associated with greater risk for later hospitalization for psychosis [adjusted hazard ratio (HR) = 1.16, 95% CI = 1.05-1.27], with a trend in the same direction for schizophrenia (adjusted HR = 1.1, 95% CI = 0.98-1.24). CONCLUSION: In male adolescents with behavioural disturbances, perceived poorer family functioning is associated with increased risk for non-affective psychotic disorders and schizophrenia. These data do not enable us to determine if perceived familial dysfunction increases vulnerability for psychosis, if premorbid behavioural abnormalities disrupt family life, or neither.

Elaboration on immigration and risk for schizophrenia.

BACKGROUND: Being a small and culturally different minority, or having a different appearance, has been invoked to account for the increased prevalence of psychotic disorders among immigrants. The majority of the Jewish Israeli population are first- or second-generation immigrants from Europe, North Africa or Asia, and during the late 1980s and 1990s, 885 000 persons immigrated to Israel from the former Soviet Union and 43 000 immigrated from Ethiopia. These Ethiopian immigrants came from a very different culture compared to the rest of the population, and have a distinct appearance. To further understand the association between immigration and schizophrenia, we compared risk for later schizophrenia between adolescents who immigrated from Ethiopia with risk among the other immigrant groups, and with native-born Israelis. MethodOf 661 792 adolescents consecutively screened by the Israeli Draft Board, 557 154 were native-born Israelis and 104 638 were immigrants. Hospitalization for schizophrenia was ascertained using a National Psychiatric Hospitalization Case Registry. All analyses controlled for socio-economic status (SES). RESULTS: Risk for schizophrenia was increased among both first- [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.18-2.22] and second-generation immigrants [HR 1.41, 95% CI 1.01-1.95 (one immigrant parent) and HR 1.49, 95% CI 1.11-2.0 (two immigrant parents)]. When risk for schizophrenia was calculated for each immigrant group separately, immigrants from Ethiopia were at highest risk of later schizophrenia (HR 2.95, 95% CI 1.88-4.65). ConclusionThis comparison between diverse groups of immigrants supports the notion that immigrants who differ in culture and appearance from the host population are at increased risk for schizophrenia.

Increase in laboratory-confirmed cases of herpes genitalis and neonatal herpes infections in Israel.

Jewish women have been considered to be at low risk for genital herpes simplex virus Type 2 (HSV-2) infections. During the period 1973 to 1981, genital herpes simplex infections were laboratory confirmed in 129 cases (81 women and 48 men). Until 1976, only sporadic cases were reported to our laboratory. Since then, the number of cases has gradually increased, reaching 31 new reported cases in 1981. The age distribution was typical for a sexually transmitted disease, with the peak of infection at childbearing age (20 to 39 years). As a result, rising morbidity of neonates--due to active genital herpes virus infection in the mother during delivery--could be expected, and monitoring of high-risk pregnancies for prevention of perinatal infections was introduced. Of 14 pregnant women monitored, herpesvirus was isolated in 4 in the last week before delivery, and cesarean section was advised. In addition, during the last 3 years, neonatal herpes was confirmed in six, and suspected in three neonates whose mothers were not monitored for genital herpesvirus infection during pregnancy.

Genital herpes simplex infections in Israel: 1973 throughout 1980.

Ninety-eight cases of genital herpes simplex virus infection (HSV-2) were confirmed by laboratory examinations during the years 1973-80. Until 1975 there were less than five cases per year, but from 1976 the number of cases gradually increased, reaching 24 in 1980. The age distribution is typical of a sexually transmitted disease; and since the peak of susceptibility is at childbearing age, an increase in neonatal HSV infection could be expected. In 1980, laboratory testing confirmed neonatal HSV infection in four newborns. The need to monitor pregnancies in women at high risk for HSV-2 infection is stressed.

Seroepidemiologic aspects of varicella zoster virus infections in an Israeli Jewish population.

Sera from 872 healthy subjects among the Jewish population of Israel were examined for antibodies to varicella zoster virus (VZV) by a simplified technique for the detection of immunofluorescent antibody to membrane antigen. The difference in the geometric mean titer of antibodies to the virus among the the different age groups was highly significant (P less than 0.0001). The highest titers were found in the five-to-seven-years and 21-to-30-years age groups. In 211 subjects, aged 17 to 40 years, the antibody titres were not influenced by sex or ethnic origin. The percentage of seronegative subjects (titer less than 2) was relatively high--between 18.7 and 32.9% in the 21-to-60-years age groups--and it was 19.5% in the population of childbearing age. The importance of screening for VZV immune status in pregnant women is emphasized.