Baher Ismail

Obstetric complications and congenital malformation in schizophrenia.

Recent years have witnessed increasingly intense research activity concerning early life somatic trauma and dysmorphogenesis which are associated with the later development of schizophrenia. The two somatic factors that have received the most extensive scientific attention as antecedents of schizophrenia are obstetric complications (OCs) and the congenital malformations termed minor physical anomalies (MPAs). Head circumference (HC) at birth has also been studied as a measure of prenatal cerebral development. A great number of studies indicate clearly that schizophrenia patients have a significantly increased history of OCs, representing many different OCs from pregnancy, labor-delivery and the neonatal period. The probable common denominator of these OCs is oxygen deprivation. Especially labor-delivery OCs relate strongly to brain structure abnormality in ill twins from monozygotic pairs discordant for schizophrenia. Schizophrenia patients very consistently have evidenced an increased frequency of MPAs in the global head, eyes, mouth, ears, hands, feet and limbs. Specific MPAs occur with considerable frequency even among normal comparison subjects, but combination models for specific MPAs efficiently discriminate most patients from comparison subjects. Schizophrenia patients also have significantly reduced HC at birth, independently of gestational age, suggesting a disturbance in prenatal cerebral development, and most frequently observed in female patients. Evidence has thus accumulated, increasingly, for the role of various forms of early trauma and dysmorphogenesis in subsequent schizophrenia, and efforts continue to determine the manner in which these early trauma influence both the early developing brain and the brain of the adult patient with manifest schizophrenia.

Minor physical anomalies in schizophrenia: Cognitive, neurological and other clinical correlates

Minor physical anomalies (MPAs) are minor congenital malformations which are found with significantly increased frequency among both patients with schizophrenia and their siblings, suggesting the effect of early developmental disturbance in their families. The aim of this study was to explore the relationship between these signs of early dysmorphogenesis and cognitive and neurological dysfunction in the patients and their siblings as well as the clinical characteristics of the patients. Sixty patients with schizophrenia, 21 nonpsychotic siblings and 75 normal comparison subjects were studied. Increased rates of cognitive and neurological dysfunction and high MPA scores were found in both the patients and their siblings. High rates of MPAs were not significantly related to cognitive or neurological dysfunction in the patients or siblings, or to premorbid history or other characteristics of the clinical disease process in the patients. These results suggest that MPAs are possibly markers of general early neuromaldevelopment rather than markers of a specific cognitive/neurological or clinical subtype of schizophrenia.

Are neurological abnormalities in schizophrenic patients and their siblingsthe result of perinatal trauma

Objective: Previous findings of increased neurological abnormalities in schizophrenic patients and their non‐psychotic siblings raise the question of possible causes. The purpose of the present study was to examine the role of perinatal trauma in the aetiology of neurological abnormality.

Neurological abnormalities in schizophrenia: clinical, etiological and demographic correlates

An increased rate of neurological abnormality (NA) is typically observed in samples of schizophrenic patients, but the origin and relevance of the NA remain unclear. To investigate this further, relationships were studied between the patients degree of NA and a range of clinical, putative etiological and demographic characteristics among 60 patients with schizophrenia who had previously been shown to have an elevated rate of NA. No significant relationships were found between NA and demographic, etiological or most clinical history characteristics, including past and current neuroleptic exposure. However, an increased rate of NA was significantly related to current poor global functioning. In total, the findings suggest that NA may represent one manifestation of an early and rather stable disease process, with an additional fluctuating clinically related component.

Neonatal head circumference and related indices of disturbed fetal development in schizophrenic patients

Neonatal head circumference and dermatoglyphic patterns were examined in 60 schizophrenic patients with previous findings of elevated rates of minor physical anomalies. Neonatal head circumference was reduced in patients vs neonatal matched-controls. Patients did not differ from healthy adult controls on total finger ridge count, a-b palmar ridge count, or pattern type asymmetry. No significant relationships were found in patients between neonatal head circumference, dermatoglyphics and minor physical anomalies, with one exception: reduced a-b palmar ridge count was associated with abnormalities of the mouth. No relationship was found between patients neonatal head circumference and their adult head circumference. Adult male schizophrenic patients had larger head circumference relative to body length than their male controls.