Marriage and the development of schizophrenia

Gender Differences in the Clinical Characteristics of Psychotic Depression: Results from the CRESCEND Study

OBJECTIVE

To test whether there are gender differences in the clinical characteristics of patients with psychotic depression (PD).

METHODS

Using data from the Clinical Research Center for Depression (CRESCEND) study in South Korea, we tested for potential gender differences in clinical characteristics among 53 patients with PD. The Psychotic Depression Assessment Scale (PDAS) and other psychometric scales were used to evaluate various clinical features of the study subjects. Independent t-tests were performed for normally distributed variables, Mann-Whitney U-tests for non-normally distributed variables, and χ(2)tests for discrete variables. In addition, to exclude the effects of confounding variables, we carried out an analysis of covariance (ANCOVA) for the normally distributed variables and binary logistic regression analyses for discrete variables, after adjusting the effects of marital status.

RESULTS

We identified more prevalent suicidal ideation (adjusted odds ratio [aOR]=10.316, p=0.036) and hallucinatory behavior (aOR=8.332, p=0.016), as well as more severe anxiety symptoms (degrees of freedom [df]=1, F=6.123, p=0.017), and poorer social and occupational functioning (df=1, F=6.265, p=0.016) in the male patients compared to the female patients.

CONCLUSION

Our findings suggest that in South Korean patients with PD, suicidal ideation, hallucinatory behavior, and anxiety is more pronounced among males than females. This should be taken into consideration in clinical practice.

Vulnerability to schizophrenia and psychotherapeutic treatment of schizophrenic patients: towards an integrated view

My approach to schizophrenia and its treatment has evolved gradually over my forty-year experience as a family researcher and a psychotherapist to schizophrenic patients. I am convinced that we must maintain a comprehensive view, both with regard to the factors contributing to vulnerability to schizophrenia and concerning our treatment activities, and not limit our views with studies focusing on restricted spheres of interest. I will present some viewpoints concerning both the biological and the psychosocial factors contributing to the vulnerability to schizophrenia. My aim is to indicate that these factors are heterogeneous and differently weighted in different cases. However, an integrated notion of the pathways leading to schizophrenia can be proposed. I will also review the therapeutic approach-the need-adapted treatment of schizophrenic psychoses-which I and my coworkers have developed in Finland and which, in many respects, is related to these views.

Syringohydromyelia as a complication of Goldenhar syndrome

Goldenhar syndrome is a multifocal developmental disorder consisting of ocular, auricular and vertebral anomalies. A case of Goldenhar syndrome is presented with a previously undescribed association with syringohydromelia. The pertinent literature is reviewed and possible mechanisms of the pathogenesis of syringohydromyelia in this syndrome are discussed.

Spouse similarity for psychological distress and well-being: a population study

While spouse similarity for psychiatric morbidity has been the object of numerous studies, most of these focused on clinical samples and, consequently, the interpretation of their results is limited by the existence of a selection bias. In this study, conducted on a sample of 845 general population couples, significant spouse similarity was observed for psychological distress and well-being, characterized by a marked symmetry in the relation between spouses' scores. The sex differences observed in many earlier studies would appear essentially to be artefactual. Spouse similarity was also found to be significant in the subpopulation of couples married less than two years, which pointed to assortative mating for psychological distress and well-being. While many studies have found educational dissimilarity and age difference between spouses to be associated with certain health variables, such as high blood pressure and coronary heart disease, these variables do not have a significant influence on individual levels of psychological distress and well-being. Spouse similarity for socio-demographic characteristics does not play a significant role in explaining spouse similarity for mental health. Consequently, assortative mating for psychological distress and well-being would appear to be primarily due to personal preference.

Selection bias in the study of spouse similarity for psychiatric morbidity in clinical samples

The existing literature on spouse similarity for health variables can be divided into two fields of application, high blood pressure and other coronary risk factors and psychiatric morbidity. In the former field, almost all studies have been conducted on general-population samples, whereas in the psychiatric field, most of the investigations studied clinical samples, i.e., where one or both members of the couple were under psychiatric treatment. In this report, we demonstrate that studies of spouse similarity for psychiatric morbidity are subject to selection bias whenever they are conducted on clinical samples. This selection bias has a double origin. First, some bias arises from the fact that the probability of a couple being drawn for a clinical sample is dependent on whether one or both spouses are afflicted with the illness in question. A second source of bias lies in the likelihood that each spouse's help-seeking behavior is not independent of the other's. It would appear then that, owing to this selection bias, it is preferable to restrict the study of spouse similarity for psychiatric morbidity to general-population samples.

Morbid risks for major disorders and frequencies of personality disorders among spouses of psychiatric inpatients and controls

Three hundred fifty-three psychiatric inpatients and their 192 living spouses and 98 control subjects and their 54 living spouses were examined and interviewed for affective, schizoaffective, schizophrenic (Research Diagnostic Criteria [RDC]), and personality disorders (DSM-III-R) using the Lifetime Version of the Schedule for Affective Disorders and Schizophrenia (SADS-L) and the Structured Clinical Interview for DSM-III-Personality Disorders (SCID). The morbid risks of spouses for unipolar depression were between .15 and .25, and those for other major disorders were below .03. The morbid risks of spouses of bipolar patients for unipolar depression exceeded those of other spouses by 50% without reaching statistical significance. Personality disorders were found in 44.6% of patients, in 8.4% of patients' spouses, and in 9.8% of healthy controls. There was only one couple in which the husband and wife had each had a major disorder before marriage. Only four husband-wife pairs suffered the same personality disorder. Spouses of patients do not have significantly more psychiatric disorders than healthy controls; therefore, assortative mating can only be of minor relevance in family studies.

Psychiatric morbidity in spouses of women admitted to a mother and baby unit

The spouses of 40 women admitted to a psychiatric Mother and Baby Unit were interviewed to detect psychiatric morbidity, and aspects of their social and marital functioning. This group was compared with 25 men whose wives had not shown obvious psychiatric disorder in the puerperium. Psychiatric morbidity, using DSM-III (American Psychiatric Association, 1980) criteria, was present in 42% of the index group, and 4% of the comparison group. The main diagnoses were major depressive episode and generalised anxiety disorder. This was associated with poorer marital and social function in the index group. Male psychopathology after delivery has been studied little but may be significant in the management of postpartum syndromes.

Assortative mating in schizophrenia: results from the Copenhagen High-Risk Study

Assortative mating denotes a tendency for mated pairs to be more similar for some phenotypic trait (similar constitution) than would be the case if the choice of a partner occurred at random. Assortative mating occurs for a variety of physical (e.g., anthropometric variables) and psychological traits (e.g., IQ), including mental illness (Vandenberg 1972). Several studies have shown an excess of married couples suffering from a variety of psychiatric syndromes as compared to the frequency expected on the basis of noncontingent admissions into treatment facilities (Kreitman 1962, 1964, 1968; Nielsen 1964), a finding confirmed in a community study by Hagnell and Kreitman (1974). A recent review of the research literature (Merikangas 1982) concluded that there exists a true primary assortative mating for mental illness. This conclusion is strongly supported by the demonstration of an increased prevalence of mental disorders in the spouses' first-degree relatives (Slater and Woodside 1951; Guze et al. 1970; Cloninger et al. 1975; Gershon et al. 1973; Merikangas et al., in this issue.

Mates of schizophrenic mothers. A study of assortative mating from the American-Danish high risk project

Both mates of schizophrenic mothers and a control group consisting of mates of non-schizophrenic mothers were diagnostically examined. The former were more frequently psychiatrically deviant than their controls, both with respect to a life-time syndrome diagnosis and a personality diagnosis. Mating between a schizophrenic mother and a father who suffered from schizophrenia spectrum disorder significantly increased the offspring's risk of developing a schizophrenia spectrum disorder himself. Assortative mating was negatively correlated with age of onset of maternal schizophrenia. It is proposed that defective emotional rapport or sub-psychotic features constitute the phenotypic traits by which assortative mating operates in schizophrenia.

The spouses of depressive and schizophrenic patients. A controlled study

The personality structures and the well-being of the partners of a representative sample of 103 married depressive or schizophrenic hospitalised patients were examined. As a means of examination we used a semi-structured interview, the Giessen-test (Beckmann and Richter 1972, 1979) and the Eigenschaftswörterliste (Janke and Debus 1978). Concerning personality, the comparison of self-image of the partners with the patient's estimation of his or her spouse resulted in good mutual agreement. The spouses of schizophrenic and depressive patients differed neither as far as the average profiles were concerned nor according to the cluster-analysis findings. In addition to this, both groups differed only to a minor extent from a representative sample of the general population. Whereas personal attitude and the well-being of the marital partners were for the most part independent of the depressive or schizophrenic kind of illness, personality and well-being of the spouses correlated with the course of the illness. The more phases of illness the spouses had witnessed, the more unattractive, self-controlled and uncommunicative they proved to be and the less irritated and sensitive they were when the patient was hospitalised. These findings are discussed in the light of further research.