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Neonatal origins of schizophrenia
  1. MARY CANNON,
  2. ROBIN M MURRAY
  1. Department of Psychological Medicine
  2. Institute of Psychiatry
  3. De Crespigny Park
  4. Denmark Hill
  5. London SE5 8AF

    https://doi.org/10.1136/adc.78.1.1

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      Schizophrenia is not an illness which impinges much upon the daily practice of paediatricians or, indeed, child psychiatrists, as only a tiny proportion of diagnosed cases (< 5%) arise before the age of 16 years.1 Schizophrenia is one of the few chronic diseases which arise principally during late adolescence and early adulthood, normally the healthiest period of life. There is increasing evidence, however, that neurodevelopmental factors, acting in utero and in early childhood, are important in determining the risk for later schizophrenia.2 3

      Key messages

      • Most schizophrenics have subtle brain abnormalities of developmental origin, and many show impairments of motor, cognitive, and social function in childhood, decades before the onset of frank psychosis. These findings have led to the conclusion that schizophrenia is a neurodevelopmental disorder

      • The strongest risk factor for schizophrenia is having an affected relative. Prenatal and perinatal risk factors, in particular prenatal viral exposure and fetal hypoxia, also appear to be important

      • An important clinical implication of the existence of prenatal and neonatal risk factors is that some forms of schizophrenia may be preventable

      Genetic risk

      There is no doubt that genetic factors are involved in the aetiology of schizophrenia.4 First degree relatives of patients have a morbid risk of developing schizophrenia which is eight to 10 times higher than the risk in the general population; this risk rises to approximately 50% in the identical twins of schizophrenics. Now that a neurodevelopmental aetiological model is considered most likely, genes that control early development have come under particular suspicion. Unfortunately, in spite of an intensive effort to locate and identify susceptibility genes for schizophrenia, none has yet been found.5

      Environmental risk

      The fact that the monozygotic concordance rate for schizophrenia is only 50% indicates that environmental factors must also be involved, and simple additive models suggest that between …

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