Early-onset schizophrenia: Symptoms and social class of origin.

BACKGROUND: The genesis of schizophrenia is multifactorial, including biological and environmental risk factors. We tested for an interactive effect between early-onset schizophrenia (EOS) and social class of origins (socioeconomic status (SES)). Data were further analyzed for a possible connection to type of schizophrenic symptoms. Sampling/Methods: Data for the study are taken from the medical records of 642 patients from a large state hospital in the northeastern United States. Clinical assessments were divided into positive and negative symptomatology through application of the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS) and the Positive and Negative Syndrome Scale (PANSS). Detailed information about age of onset and SES of origin was obtained through Social Service Assessment interviews. RESULTS: We uncovered a significant impact of EOS among the poor that elevates risk for negative symptomatology. CONCLUSION: Poor SES alone does not increase the likelihood of EOS, but it magnifies the deleterious effect of EOS on negative symptoms. Future research on these variables may inform the relative contribution of each.

Stressful Life Events, Social Class and Symptoms of Schizophrenia.

We test to see if severe stressful life events precede onset of specific symptoms of schizophrenia. Our analyses extend to possible variations in the effect by socioeconomic status (SES) of origin. The medical records of 431 schizophrenic patients were categorized into negative and positive subtypes by application of SANS, SAPS and PANSS scales. SES was bifurcated into low-SES and high-SES groups. Stressful life events were classified into four domains. The study variables were tested by the use of chi-square analysis. Our results show that there is an elevated rate of positive symptoms among low-SES patients who underwent a stressful life event before symptom onset. Significance is confirmed with an χ(2) value of 5.418, p=.020. The finding does not hold true for high-SES patients and is not related to type of stressful life event. Thus, we conclude that environmental stressors frequently precede onset of positive symptoms of schizophrenia. This is only true for patients of low SES of origin. We hypothesize that low-SES patients have a heightened reactivity to stressors, a reactivity that is incubated by the human toll of impoverishment.

Neglect and hereditary risk: Their relative contribution to schizophrenia with negative symptomatology.

BACKGROUND: There is evidence that genetic and environmental stressors contribute to the genesis of schizophrenia. However, the relevant impact of each factor remains unclear. We tested for an interactive effect between childhood neglect and family history of serious mental illness. Data were further analyzed for a possible connection to type of schizophrenic symptoms. SAMPLING/METHODS: Data for the study are taken from the medical records of 641 patients with schizophrenia from a large state hospital in the northeastern United States. Clinical assessments were divided into positive and negative symptomatology through application of the Scale for the Assessment of Negative Symptoms (SANS), the Scale for the Assessment of Positive Symptoms (SAPS) and the Positive and Negative Syndrome Scale (PANSS). Detailed information about childhood neglect and family history of serious mental illness was obtained through Social Service Assessment interviews at intake and during hospital stay. RESULTS: Among clients with no family history of mental illness, childhood neglect does not meaningfully affect the risk of negative versus positive schizophrenia. For clients with such history, on the other hand, neglect significantly raises the risk of schizophrenia with negative symptomatology. CONCLUSION: Our central finding is that risk for negative symptoms of schizophrenia are elevated by childhood neglect combined with a history of serious mental illness within the family. This is the only report to combine schizophrenic symptoms, familial risk and childhood neglect to date. Implications for primary prevention and treatment are discussed.

A sex-specified effect of obstetrical complications in symptoms of schizophrenia.

Research on obstetrical complications (OCs) reports a connection with the development of more severe (negative) schizophrenic symptoms. To date, no study has tested to see if this association varies by sex. A large sample (n=786) of patients from a state hospital population in the United States was screened for study variables. Statistical tests employed were crosstabular analysis and analysis of variance. The central finding is a significant connection between OCs and negative symptoms for females but not for males. The authors speculate that there may be differences in the ways by which male and female fetuses respond to OCs or a distinction between the sexes in genetic predisposition toward severe schizophrenia.

Stressful life events, social class and symptoms of schizophrenia.

We test to see if severe stressful life events precede onset of specific symptoms of schizophrenia. Our analyses extend to possible variations in the effect by socioeconomic status (SES) of origin. The medical records of 431 schizophrenic patients were categorized into negative and positive subtypes by application of SANS, SAPS and PANS scales. SES was bifurcated into low SES and high SES groups. Stressful life events were classified into four domains. The study variables were tested by the use of chi-square analysis. Our results show that there is an elevated rate of positive symptoms among low SES patients who underwent a stressful life event before symptom onset. Significance is confirmed with a X2 value of 5.418, p=.020. The finding does not hold true for high SES patients and is not related to type of stressful life event. Thus, we conclude that environmental stressors frequently precede onset of positive symptoms of schizophrenia. This is only true for patients of low SES of origin. We hypothesize that low SES patients have a heightened reactivity to stressors, a reactivity that is incubated by the human toll of impoverishment.

Childhood stressors and symptoms of schizophrenia.

There are many psychiatric disorders for which severe adverse events in childhood have been shown to be significant risk factors. This is particularly true for schizophrenia. The authors designed this study to determine whether specific childhood stressors might contribute to the specific symptoms of schizophrenia and not merely to increased risk for the psychosis. The authors divided childhood stressors into two domains: 1-"Childhood Neglect" in which the stressor is passively experienced as in the case of absent parenting and 2-"Childhood Abuse" in which the trauma is actively inflicted as in the case of physical maltreatment. Data for the study consist of the cumulative anonymous records of 134 schizophrenia patients carefully separated by positive or negative symptomatology. MANOVA testing yielded a statistically significant finding; childhood neglect is correlated with negative symptoms of schizophrenia and childhood abuse is associated with positive symptoms of the psychosis. The authors speculate that type of childhood stressor may incubate the specific symptoms of adult schizophrenia. They also call for more research on this topic since this is the first study of its kind.

Obstetrical complications, social class and type of schizophrenia.

The emerging neurodevelopmental model posits that prenatal and perinatal factors can play an etiological role in schizophrenia. Consistently, the research on obstetrical complications (OCs) reports an association with the development of more severe schizophrenic symptoms. Low socioeconomic status (SES) has also been linked to both limited prenatal healthcare and to worse prognosis of schizophrenic symptoms. A large sample (n=437) of patients from a state hospital population in the U. S. was screened for study variables. A sequential analysis was conducted, first applying cross tabulations using the chi-square test, and then building separate logit models for poor and nonpoor patients. The cross tabulations indicated an association between OCs and negative symptoms for poor schizophrenic patients, but not for nonpoor patients. Multivariate logit models further supported this result. This is the first study to examine the interaction of OCs, schizophrenic symptomatology and SES of origin.

Social class, family history and type of schizophrenia.

To date, there are numerous studies supporting a genetic model of schizophrenia. There is a paucity of studies, however, screening for a connection between family history of serious mental illness and deficit vs. nondeficit schizophrenia. The aim of the present study was to explore the association between family history, deficit vs. nondeficit schizophrenia and socioeconomic status (SES) of family of origin. Patients (N=437) from a United States psychiatric hospital were separated into deficit vs. nondeficit presentation and bifurcated into poor vs. nonpoor SES. Family history data were utilized to classify patients into subgroups characterized by serious mental illness within immediate family, within extended family, or no evidence of mental illness. Statistical testing was conducted using logistic regression analysis. SES of family of origin was significantly associated with schizophrenic subtype independently of family history, sex and race; specifically, poverty raised the risk of deficit schizophrenia. Family history of mental illness showed no net association, and no statistical interaction with poverty, in predicting risk of deficit schizophrenia.

Schizophrenic subtype, seasonality of birth and social class: a preliminary analysis.

OBJECTIVE: The neurodevelopmental model of schizophrenia includes the etiological impact of fetal brain stressors possibly connected with birth seasonality. Specification of social class of origin (SES) as a related risk factor remains unexamined as does type of schizophrenia as an outcome variable. The objective of this study was to test for an interconnection between SES, type of schizophrenia and seasonality of birth. METHODS: Patients (N=436) from a United States psychiatric hospital were separated into deficit/non-deficit presentation and bifurcated into poor/non-poor SES. Birth seasonality was assessed by months hypothetically connected with winter-related trimesters of gestation. RESULTS: Results showed that there is a significant difference (p=0.0411) in the monthly birth patterns of poor vs. non-poor patients and that the difference connects with the likelihood of deficit vs. non-deficit schizophrenia. Specifically, an elevated proportion of patients with deficit schizophrenia were born to impoverished women who likely conceived in January. Findings were confirmed by multiple levels of statistical assessment including log linear analysis. CONCLUSION: The resultant model suggests the environmental location (lower SES) and timing (winter conception) of adult schizophrenia with poor outcome (deficit).