Risk Factors in Schizophrenia: The Stony Brook High-risk Project

Abstract

The goals of the Stony Brook High-Risk Project are to identify precursor patterns, environmental stressors, and protective factors that are differentially predictive of psychopathology. In phase I we assessed 219 families and 544 children aged 7-15, including 31 families and 80 children with a schizophrenic parent, 70 families and 154 children with a unipolar depressed parent, 58 families and 134 children with a bipolar parent, and 60 normal control families with 176 children. A 3-year followup was conducted on 84 percent of the sample, and an additional followup is underway. Our data include measures of: (1) psychological functioning of the parents; (2) the environment, including family functioning, marital adjustment, and parenting practices; (3) child adjustment, including peer, or teacher, parent, and self-ratings; (4) early signs or precursors to the development of schizophrenia or affective disorder, including cognitive slippage, attentional deficits, hedonic capacity, depressogenic attributional styles, and subsyndromal affective patterns. Considerable deviance in family functioning, expressed in conflict, marital discord, and parenting skills, was characteristic of the families with an ill parent, and this discord was related to child adjustment. Children with a schizophrenic parent showed multiple and extensive cognitive, attentional, and social impairments, and at the 18+ followup, 22.8 percent of them compared with 9.6 percent of the normal controls were assigned a DSM-III diagnosis.

Critical Issues for Parents with Mental Illness and their Families

“…The quality of a marital or partner relationship has been shown to be a strong mediator of the relationship between parental diagnosis and child outcomes (Goodman & Gotlib, 1999;Weintraub, 1987). Although research has focused on marital discord as a negative mediator, some recent work indicates that supportive partnerships may contribute to resilient outcomes in children .…”

“…This phenomenon will be discussed further in the following section on moderators. Marital discord and divorce are more common among families in which a parent has a mental illness, and adversely effect both the ill parent and children (Downey & Coyne, 1990;Fendrich, Warner & Weissman, 1990;Weintraub). Marital discord predicts a host of child and adolescent problems, including lower academic performance, poor social skills, and conduct problems (Downey & Coyne;Emery, Weintraub, & Neale, 1982;Fendrich et al).…”

“…A chaotic home environment, lower family cohesion, increased parent-child discord, and poorer communication are more prevalent among families with a parent with depression or schizophrenia (Fendrich et al, 1990;Warner et al, 1995;Weintraub, 1987). These features of family functioning are, in turn, associated with increased risk for emotional and behavioral problems in children (Davies & Windle, 1997;Warner et al;Weintraub).…”

“…These features of family functioning are, in turn, associated with increased risk for emotional and behavioral problems in children (Davies & Windle, 1997;Warner et al;Weintraub). In a study comparing different levels of family relationships, Dickstein et al (1998) found that family-level interactions may be more influenced by the presence of parental mental illness than individual parent-child, or spousal relationships.…”

Childhood Cognitive Functioning in Schizophrenia Patients and Their Unaffected Siblings: A Prospective Cohort Study

“…These results suggest that during the period from age 4 to age 7 years, premorbid cognitive dysfunction in schizophrenia represents a relatively stable indicator of vulnerability deriving from primarily genetic (and/or shared environmental) etiologic influences. Findings of cytoarchitectural and morphologic brain changes consistent with a prenatal and perinatal origin have led to the notion that neurodevelopmental disturbances contribute to the etiology of at least some cases of adult schizophrenia (Kovelman and Scheibel 1984;Jakob and Beckmann 1986;Weintraub 1987;Arnold et al 1991;Akbarian et al 1993;Cannon et al 1993). However, the etiologic correlates of these disturbances and the proportion of the population with schizophrenia that they characterize remain to be determined (Lewis and Murray 1987;Cannon and Mednick 1991).…”