Neurodevelopmental model Schizophrenia - NDMSZ |
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Neurodevelopmental model Schizophrenia (NDMSZ)
Basics
Stress-diathesis model
diathesis=genes
eg chromosome 6 & 8
predispose to vulnerability to different stressors
stress needed for pathology
embryology
temporal & anatomical correlation
Ectoderm development
face
skin
Endoderm development
CNS
PNS
Critical period
6-18 weeks
insult =
anomalies in all
genetic defect =
anomalies in all
Face development
craniofacial dysmorphology
Central nervous system
CNS anomalies
Schizophrenia
Down's syndrome
large ventricles
related to obstetric complications in twins
not related to physical anomalies
McNeil 2000
Peripheral nervous system
Neurological soft signs
hand development
dermatoglyphic anomalies
life course model
integrates post-birth influences
expansion of NDMSZ
Craniofacial dysmorphology
Mary Waldrop
1970s
18 item scale
Gualtieri
1982
schizophrenia
schizophrenia
12 anomalies
Linked to temporal & frontal lobe development
mouth
ears
Lane 1997
genetic or environmental?
Case studies
assoc w obstetric complications
delivery
asphyxia
uterine atony
emergency C-section
development
low birth weight
small head circ.
pregnancy
pre-eclampsia
rhesus incompatibility
diabetes
sibling studies
more anormalities in siblings
do not correlate to cases
Ismail 1998
offspring studies
no relationship
McNeil 1992
stronger environmental link
Dermatoglyphic anomalies
hand development
6-8 weeks
volar pads
week 10-12
volar pads regress
dermatoglyphic patters form
week 24
complete
Associations
congenital Rubella
Foetal alcohol syndrome
Down's syndrome
cytomegalovirus
schizophrenia
reduced total a-b ridge counts (TABRC)
low familial correlation values
discordant twin studies
affected twin
lower TARBC
conflicting results
TABRC mainly environmental
eg obstetric complications
Neurological soft signs (NSS)
Definition
subtle impairments
sensory integration
motor coordination
no focal pathology
schizophrenia
sensory
bilateral extinction
audio-visual integration
agraphasthesia
asterognosis
motor
intention tremor
finger-thumb opposition
balance
gait
repetitive alternating hand positions
Ozeretski test
fist-ring test
fist-edge palm test
NSS score associations
thought disorder
negative symptoms
emotional instability
genetic or environmental?
assoc w relatives of cases
assoc w offspring
assoc w high genetic risk people
discordant twins
affected twin more NSS
unaffected more NSS than control
likely both genes and environment
Scales
Rossi
Heidelberg
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