has important implications for health service planners. A number of recent studies suggest that the incidence of schizophrenia is declining in a number of Western countries, but little attention has hitherto been given to an exploration of gender and birth cohort effects. We are in a position to use the comprehensive West Australian Mental Health Register, which recorded all admissions with a diagnosis of schizophrenia in Western Australia from 1966, to explore the nature of secular trends in schizophrenia more closely. In particular, we have given attention to the effects of gender, and of birth-date, to ascertain whether the incidence of schizophrenia is changing for both sexes similarly, and whether different generations of individuals show different trends. The results will be interpreted in terms of current aetiological theories of schizophrenia.
DEPRESSIVE SYMPTOMS IN CHRONIC SCHIZOPHRENIA: A 12 Y E A R F O L L O W U P STUDY M.A. Davies*, S. Cooley, K. Lichius, D. Cola
Department of Psychiatry, Case Western University, Cleveland, OH 44160, USA Twelve years later, we set out to find 161 outpatients with chronic schizophrenia (RDC criteria) to determine the prevalence of depression and to examine determinants of depression. Forty-two patients were lost to follow-up, seventy-four patients were interviewed, 33 were known deceased, 7 refused to be interviewed and 5 were unable to be interviewed. The sample was predominantly older, white females who had never married and lived in a rural community. Forty-seven subjects (63.5%) passed the Mini-Mental State Examination and thus were more extensively interviewed. Clinicians determined that twenty of the 47 subjects (42.5%) had depression over time; and that 24 subjects (51%) were in a current depressive episode. Akinesia, found in 30% of those interviewed and in 37.5% of the subjects with a current episode of depression, was a major determinant of depression. For those 33 subjects who had no symptoms of akinesia, we found no significant differences between depressed (n = 15) and non-depressed (n = 18) groups on several variables of interest. However, some trends emerged. Despite the high prevalence of depression in chronic schizophrenia it is a subject that has received little systematic attention. We suggest continued attention to depression in clinical practice and in future research studies. Larger sample sizes are encouraged in future studies.
DOES GENDER INFLUENCE OUTCOME MODERN DAY SCHIZOPHRENIA?
M a r t i n H a r r o w * , L i n d a G r o s s m a n , James R. Sands, T h o m a s Jobe, Joseph Flaherty
Dept. of Psychiatry, Univ. of Illinois College of Medicine, Chicago, IL 60612, USA Is gender a major influence on clinical course and outcome in schizophrenia? The current research was designed to provide
longitudinal data on this issue. The research, derived from the Chicago Follow-up Study, assessed a sample of 79 schizophrenics, 41 schizoaffective patients, 70 other psychotic patients, and 84 non-psychotic depressive patients. The patient were evaluated prospectively at index hospitalization and then followed up four times over the next 9 11 years. We assessed positive and negative symptoms, psychosocial functioning, suicidal activity, rehospitalization and treatment variables. The results indicate that: ( 1) With the change in the diagnostic system from a broad to a narrow concept of schizophrenia, a larger percentage of modern-day schizophrenics ae men, due to the presence of affective syndromes in many psychotic women. (2) Using older, broader criteria for schizophrenia, female schizophrenics showed significantly better outcome than male schizophrenics. ( 3 ) Using more modern diagnostic criteria of schizophrenia, female schizophrenics still tend to show better outcomes than male schizophrenics. However, the outcome differences are not as large. (4) Male schizophrenics show significantly greater risk for completed suicides than female schizophrenics. (5) When premorbid functioning and other variables related to life role were controlled, the sex differences in outcome diminished. (6) Gender and race differences in outcome are influenced by a variety of factors including premorbid functioning, differences in societal demands, treatment differences and other variables.
RHESUS HEMOLYTIC DISEASE IN THE FETUS AND NEWBORN AS A RISK FACTOR FOR SCHIZOPHRENIA IN MALE ADULTS J.M. Hollister*, P. Laing, S.A. M e d n i c k
Social Science Research Institute, DRB 129, University of Southern CaloCornia, Los Angeles, CA 90089-1111, USA Fetal environment and neurodevelopment have been suggested as important in schizophrenia. Rhesus hemolytic disease of the fetus and newborn (Rh-HDN) is caused by the transplacental transfer of maternal alloantibodies against paternally inherited fetal Rh D erythrocyte antigens and can result in damage to the hippocampus and basal ganglia for the fetus. The hippocampus and basal ganglia have also been implicated in the neuropathology of schizophrenia. We examine the hypothesis that Rh-HDN may be a risk factor for schizophrenia. Data from the Danish Perinatal Cohort were analyzed for this study. The rate of schizophrenia for subjects at high risk for Rh-HDN was compared to those at low risk. The rate of schizophrenia in the risk and control groups was 2.1% and 0.8% (p<0.016). Since, the risk of Rh-HDN increases with second and later pregnancies, it is noteworthy that second and later born risk offspring exhibited a significantly higher rate of schizophrenia than second and later born control offspring (p<0.03), but, that no significant difference was observed between first born subjects. These data indicate that Rh-HDN may be a risk factor for schizophrenia. These findings are discussed with respect to neuropathology, age of onset charac-