Elsevier

Schizophrenia Research

Volume 59, Issue 1, 1 January 2003, Pages 85-92
Schizophrenia Research

Psychosis proneness and ADHD in young relatives of schizophrenia patients

https://doi.org/10.1016/S0920-9964(01)00400-5Get rights and content

Abstract

Symptoms resembling the attentional deficit hyperactivity disorder (ADHD) are frequently observed in young relatives at risk for schizophrenia (HR). We examined the frequency of the ADHD syndrome and its relationship to psychosis related psychopathology and neurobehavioral abnormalities in young HR subjects (n=29) and healthy comparison subjects (HC; n=30). Thirty-one percent of HR subjects (n=9) had ADHD as a lifetime Axis-I diagnosis (HR-A). Compared to healthy comparison subjects, the HR-A group had impaired neurological function. The HR-A group but not the HR subjects without ADHD had higher scores on the Chapman's magical ideation and perceptual aberration scales. Thus, ADHD-like features are more prevalent in the HR population than the one described in the general population and are associated with more frequent psychosis-like clinical features. Longitudinal studies can clarify whether an “ADHD subgroup” within HR subjects predict an increased risk for future emergence of schizophrenia.

Introduction

It is currently widely believed that schizophrenia is a neurodevelopmental disorder based on clinical, epidemiological, and neuropathological evidence Murray and Lewis, 1987, Weinberger, 1987. However, the neurodevelopmental deviations that may predate the clinical manifestations of the illness have not been precisely characterized. One approach to study the early developmental and neurobehavioral markers of vulnerability to psychosis is to evaluate the first-degree relatives of schizophrenia patients who have an increased risk for developing the illness (Gottesman and Shields, 1982). Impaired attention is frequently seen among patients with schizophrenia and their high-risk (HR) relatives and has been considered as one of the robust markers of risk for the eventual emergence of the illness (Erlenmeyer-Kimling et al., 2000). Attention deficits have been shown to be present throughout the course of the illness in schizophrenia, are evident even before the illness starts, persist during treatment and are heritable (Cornblatt and Keilp, 1994).

It is unclear whether the impairment in attention in the population at risk for schizophrenia is associated with the clinically diagnosed Attention Deficit Hyperactivity Disorder (ADHD). It has been shown earlier that the motor, perceptual, and attentional difficulties observed in the offspring of schizophrenia patients resemble the behavioral pattern defined as ADHD in the Diagnostic and Statistical Manual of Mental Disorders (DSM) (Marcus et al., 1987). In a retrospective study, Gomez et al. (1981) reported that 32% of the psychiatric inpatients reported symptoms similar to ADHD in their childhood. Only the psychosis subgroup of these inpatients had a significantly elevated incidence of attentional deficits. Prospective studies of children who eventually developed schizophrenia have reported an increased prevalence of attentional impairments (Cornblatt and Keilp, 1994). A high-risk study of 207 adolescent children of schizophrenic mothers showed that subjects who subsequently developed schizophrenia had a higher frequency of attentional impairments during childhood (Parnas et al., 1982). Menkes et al. (1967) followed 14 hyperkinetic children at a child outpatient psychiatric clinic and four of them were found to develop psychosis. While this (28%) high incidence could be due to biased selection of severely ill children, it does raise the question whether ADHD represents a factor for the emergence of psychotic disorders.

It is an intriguing question whether ADHD-like features in young relatives at risk for schizophrenia are associated with an increased frequency of schizophrenia-related psychopathology or “psychosis-proneness”. Such psychosis proneness may underlie an inherited liability to schizophrenia Lenzenweger and Moldin, 1990, Meehl, 1989. Several studies have documented the predictive value of subtle psychopathological manifestations for future emergence of psychosis. In particular, two scales, the magical ideation and perceptual aberrations (Chapman et al., 1994) have some predictive value. Some Barnes et al., 2000, Lenzenweger et al., 1991, though not all studies Franke et al., 1994, Laurent et al., 1999, suggest a relation between the psychometrically identified psychosis-proneness and attentional impairment. However, it is unclear whether such psychosis proneness is related to the attentional impairment in children and adolescents with a genetic predisposition to schizophrenia.

In this study, we examined the neurobehavioral parameters and psychosis proneness scores among a series of young offspring and siblings of schizophrenia patients (HR relatives) and a group of healthy comparison subjects. We hypothesized that the psychopathological features such as ADHD would be more frequent among HR relatives. We also predicted that the putative neurobehavioral indicators of vulnerability to schizophrenia (attentional measures, neurological abnormalities), as well as psychosis proneness scores will be elevated in the ADHD group as compared to the HC subjects and the HR subjects without any Axis-I psychiatric disorder.

Section snippets

Methods

This study was carried out at the Western Psychiatric Institute and Clinic (WPIC) of the University of Pittsburgh Medical Center. The study was approved by the Institutional Review Board of the University of Pittsburgh Medical Center. After a complete description of the study to the subjects, written informed consent was obtained. The parent/guardian also provided an informed consent for subjects whose age are less than 18. HR subjects were recruited by approaching parents who were patients in

Results

We compared the four groups for CPT (digits and shapes) d′ scores, neurological soft sign scores, and psychosis proneness scores on the Chapman scale (magical ideation and perceptual aberration). Table 1 shows the group comparisons. CPT d′ scores (digits) were significantly lower for HR subjects with ADHD as compared to the HR-N subjects. Significant group differences were seen in the NES scores; post-hoc tests revealed that the total average, motor coordination, and sensory integration

Discussion

A central feature common to ADHD and schizophrenia is the attentional dysfunction. In our study, we observed that the HR subjects with ADHD performed poorly on the CPT (digits) as compared to the HR subjects without any psychopathology. Earlier studies have shown that both high-risk offspring and schizophrenia patients have deficits in attention and poor performance on the CPT (Cornblatt and Keilp, 1994). Deficits in cognitive tasks involving the earliest phase of visual information processing

Acknowledgments

This work was supported in part by NIMH grants MH45203, MH01180, MH01433, and a NARSAD established Investigator award (MSK). We thank Melissa Zeigler, M.A. for assistance in the clinical assessments, and Drs. Michael De Bellis and Antonio Hardan for their advice on the design and the manuscript.

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