Karl-Erik Wahlberg

Interaction of genetic risk and adoptive parent communication deviance: longitudinal prediction of adoptee psychiatric disorders

BACKGROUND In the Finnish Adoptive Family Study of Schizophrenia, adoptee thinking disorders have been shown to be a joint effect of genetic liability for schizophrenia spectrum disorders and adoptive rearing-parent communication patterns. However, longitudinal predictions of clinical psychiatric disorders of the adoptees have not been reported. METHOD Adoptees (n = 109) who had no DSM-III-R disorder at initial assessment (median age 18 years) were selected from the total sample of the Finnish Adoption Study of Schizophrenia. They were defined as at high versus low genetic risk based upon the lifetime diagnoses of their biological, adopting-away mothers - schizophrenia spectrum disorder versus no spectrum disorder. At initial assessment, adoptive rearing parents were independently evaluated from tape-recorded Rorschach protocols scored as manifesting either high or low Communication Deviance (CD), a composite index of communication patterns that distract and befuddle listeners. Adoptees were independently re-diagnosed after a median interval of 14 years and followed-up from national registers for an additional 7 years. RESULTS The main effects of genetic liability (G) and CD of the adoptive parents (E), each taken separately, predicted significantly for psychiatric disorders of the adoptees as adults. However, when G, E, and their joint interaction effect were entered into the same logistic model, only the interaction effect was significant. The sample included seven adoptees with schizophrenia spectrum disorders, but a separate analysis to predict them was non-significant. CONCLUSION Genetic liability for schizophrenia spectrum disorder and an adoptive family rearing variable interact, predicting longitudinally and significantly to broadly defined adoptee psychiatric disorder.

Early presence of thought disorder as a prospective sign of mental disorder

The purpose of this study was to assess whether premorbid signs, such as thought disorder, could predict the subsequent manifestation of psychiatric disorders. A group of 75 adoptees at high genetic risk for schizophrenia and 96 low-risk adoptees without any psychiatric disorder at the initial assessment were assessed blindly with the Thought Disorder Index (TDI). Their psychiatric status was re-assessed according to DSM-III-R criteria in a re-interview 11 years later and based on available registers 16 years later. High scores on several TDI variables at the initial assessment predicted a psychiatric disorder of all adoptees at follow-up. Prediction was statistically unsuccessful among the high-risk adoptees because of the small number of cases, but high scores at the 0.50 severity level did predict mental disorders among the low-risk adoptees.

Long-term stability of communication deviance

Communication deviance (CD), forms of communication that are not bizarrely thought disordered but are hard to follow and that make difficult the consensual sharing of attention and meaning, has been hypothesized as a nonspecific contributor of rearing parents to psychopathology of offspring, including schizophrenia. This hypothesis, or an alternative of genetic transmission, would gain plausibility if CD has long-term stability. CD was evaluated, using tape-recorded and reliably scored Rorschachs in 158 Finnish adoptees, and retested after a median interval of 11 years. Adolescent CD was not stably correlated with follow-up CD. However, initial CD at a mean age of 32 and follow-up CD were significantly correlated. Gender, genetic risk for schizophrenia, and DSM-III-R (American Psychiatric Association, 1987) psychiatric diagnoses had no effect on adult CD stability. CD appears to be a stable, traitlike feature of adult but not adolescent functioning.

Videoconferencing in family therapy: a review

Videoconferencing is used in psychiatry for various purposes. There is a need for research on videoconferencing in family therapy, as there are hardly any reports on the topic: in a literature search, we found only four references to family therapy and videoconferencing. In the Department of Psychiatry at Oulu University Hospital, the use of videoconferencing has steadily increased over the last few years, and in 2002 the equipment was used for 600 hours, of which 84 hours (14%) involved consultation and 12 hours (2%) family therapy. We postulate that the use of videoconferencing for family therapy will incur various restrictions, but may also open up new opportunities. Videoconferencing may allow people in remote regions to benefit from family therapy services. Using modern equipment, it is possible to attain television broadcast quality in a videoconference, but we do not know the effect of videoconferenced delivery on the outcome of therapy. It will therefore be important to collect systematic data on family therapy delivered via videoconference.

Communication Deviance in parents of families with adoptees at a high or low risk of schizophrenia-spectrum disorders and its associations with attributes of the adoptee and the adoptive parents

Communication Deviance (CD) in rearing parents is a known indicator of a psychopathology risk in the offspring, but the direction of the effects of these two factors on each other has remained an unresolved question. The purpose of the present study was to clarify this issue by assessing the relationship of CD in adoptive parents with certain attributes of the adoptee and adoptive parents themselves. The subjects were 109 adoptees at a high or low risk of schizophrenia-spectrum disorders and their adoptive parents. Communication Deviance was measured in individual, spouse and family Rorschach situations. Thought disorders in the adoptees were assessed using the Thought Disorder Index. The variability of CD in the adoptive parents in individual Rorschach situations was not significantly explained by any characteristics of the child. The variability in parental CD in family Rorschach situations was most closely associated with the characteristics of the parents themselves. The results strongly support the hypotheses that the frequency of Communication Deviance is an enduring trait rather than a fluctuating state and that frequent CD in parents speech may impair the growing childs cognitive development and predispose him/her to schizophrenia-spectrum disorders.

Psychometric deviance measured by MMPI in adoptees at high risk for schizophrenia and their adoptive controls

Psychometric deviance in personality traits as assessed by the Minnesota Multiphasic Personality Inventory (MMPI; Dahlstrom, Welsh, & Dahlstrom, 1982) was compared between adopted-away, high-risk (HR) offspring of schizophrenic biologic mothers and low-risk (LR) controls. A subsample of the Finnish Adoptive Family Study (Tienari et al., 2000) included 60 HR adoptees and 76 LR control adoptees who were tested by the MMPI before the onset of any psychiatric disorder at the mean age of 24 years. The HR group was found to be distinguishable based on deviant scores on the scales HOS and HYP, indicating emotional unresponsiveness, restricted affectivity, and decreased energy. These may also be considered possible premorbid and prodromal signs of future schizophrenia among the HR adoptees.

Verbal learning and memory and their associations with brain morphology and illness course in schizophrenia spectrum psychoses.

The California Verbal Learning Test and structural brain imaging were administered to 57 subjects with schizophrenia spectrum disorders and 94 controls in a general population sample. Cases had lower semantic cluster scores. Poorer verbal memory strategies were associated with longer duration of illness and heavier use of antipsychotic medication. After controlling for duration of illness, sex, and total gray matter, poorer verbal memory was associated with lower gray matter volume in the cingulate cortex, juxtapositional lobule, right superior temporal gyrus, and precuneus. After controlling for use of antipsychotic medication, there was an association between higher serial clustering and smaller anterior cingulate gyrus and larger intracalcarine cortex.

Interaction of genetic vulnerability to schizophrenia and Communication Deviance of adoptive parents associated with MMPI schizophrenia vulnerability indicators of adoptees

The aim of this study was to establish possible genotype–environment interaction in high-risk and low-risk adoptees’ vulnerability to schizophrenia. The study population consisted of a subgroup of 41 adoptive families with a high genetic risk adoptee and 58 families with a low genetic risk adoptee from the Finnish Adoptive Family Study of Schizophrenia. Communication style was assessed based on the Communication Deviance (CD) of the adoptive parents, and the adoptees’ vulnerability indicators were measured with the Minnesota Multiphasic Personality Inventory (MMPI). Taken separately, only the genetic liability to schizophrenia, but not the communication style of the adoptive parents, was significantly associated with the Lie, Correction and Hostility scales in the MMPI of the adoptees. Analyses of the genotype–environment interactions showed that the high-risk adoptees with high-CD rearing parents had an increased risk of vulnerability on the MMPI Social Maladjustment scale compared with the corresponding low-risk adoptees. Genetic vulnerability to schizophrenia and genotype–environment interaction are manifested in adoptees’ MMPI.

Genetic vulnerability and premature death in schizophrenia spectrum disorders: a 28-year follow-up of adoptees in the Finnish Adoptive Family Study of Schizophrenia.

Background: Excess mortality is widely reported among schizophrenia patients, but rarely examined in adoption study settings. Aim: We investigated whether genetic background plays a role in the premature death of adoptees with schizophrenia. Methods: Mortality among 382 adoptees in the Finnish Adoptive Family Study of Schizophrenia was monitored from 1977 to 2005 through the national causes-of-death register. The sample covered 190 adoptees with a high genetic risk of schizophrenia (HR) and 192 with a low risk (LR). Results: Overall mortality among the adoptees did not differ between the HR and LR groups, as 10% and 9% respectively had died during the follow-up, at mean ages of 45 and 46 years. Schizophrenia spectrum disorder was the most significant predictor of premature death in both groups, with dysfunction in the rearing family environment associated with mortality, unnatural deaths and suicides in the HR but not in the LR group. All the suicides involved HR cases. Conclusions: Mortality among the adoptees was not related to genetic factors but to environmental ones. The association of unnatural deaths and suicides with dysfunction in the rearing environment among the HR adoptees may indicate that they had a greater genetically determined vulnerability to environmental effects than their LR counterparts. The genetic and rearing environments can be disentangled in this setting because the biological parents give the offspring their genes and the adoptive parents give them their rearing environment. Our findings add to knowledge of the factors associated with the premature death of adoptees in mid-life.

Possibilities for Prevention of Schizophrenia: Suggestions from Research on Genotype–Environment Interaction

Prevention of and early intervention in schizophrenia continue to be a serious public health problem. Despite the availability of medications with enhanced efficacy and reduced side effects, large numbers of patients are unable to resume the previous trajectory of their life course. The critical period for vulnerability to relapse and the enduring development of impaired functioning is during the early years after the initial onset of psychosis [1]. Before the onset of psychosis, primary preventive intervention during the prodromal phase has been recognized as a possibility for decades, but only recently has been explicitly attempted [2]. The potential value of prevention can be envisioned on many levels. Schizophrenic illness most often emerges in late adolescence or early adulthood, disrupting the life course of those afflicted, often with a lasting impact on education, occupational choice, and the development of crucial social skills. The impact on family caregivers is all too often of staggering proportions. The direct costs of prolonged treatment and the indirect costs of lost productivity continue to be a huge burden on the community and larger society. With these issues in mind, we wish to offer an overview of current knowledge about schizophrenia in order to assess the possibilities of prevention. A genetic contribution to the illness is now accepted, but the fact remains that much about environmental contributions will still be relevant even if current research on genetic linkage is successful. For example, genetically identical