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Neuropsychiatric Outcomes in Children of
Mothers with Psychotic Illness
In Session
With Vera A. Morgan, PhD:
Neuropsychiatric
Outcomes in Children of Mothers with Psychotic
Illness
Neuropsychiatric Epidemiology
Research Unit, School of Psychiatry and Clinical
Neurosciences, The University of Western
Australia
First published in
Psychiatry Weekly, Volume 7, Issue
16, on August 20, 2012
Q: Children of mothers
with a psychotic illness are known to be at greater
risk of worse mental health outcomes. What are
those risks?
A: We know
that children of mothers with a psychotic illness are
at greater genetic risk of developing psychotic
illness. They also appear to be at greater risk of
other adverse neurological and neuropsychiatric
outcomes than the general population; growing
evidence from genetic studies shows that
phenotypically varied neuropsychiatric disorders
cluster within families.
Our study was designed to look at
the risk of early onset adverse neuropsychiatric
outcomes—including intellectual
disability—in children at high risk for
psychosis. In particular, we wanted to disentangle
genetic risk factors from environmental risk factors
in order to better understand the independent
contribution of parental mental illness, parental
intellectual disability, and exposure to obstetric
complications, to the risk of intellectual disability in
these children.
We found a three-fold increase in
the prevalence of intellectual disability in the
children of mothers with psychosis, compared to
children of mothers with no recorded history of
mental illness. The risk was similarly distributed
across children of mothers with schizophrenia,
bipolar disorder, and unipolar major depression.
Our analyses indicated that parental intellectual
disability, maternal psychosis, paternal psychiatric
history, and childbirth complications (specifically
neonatal encephalopathy and fetal distress) were all
independently associated with the risk of intellectual
disability in these children.
We also looked at whether the
timing of birth relative to the first onset of maternal
illness affected our results. We found that timing
made no difference for children of mothers with
schizophrenia or unipolar major depression.
However, for children of mothers with bipolar
disorder, timing was significantly relevant only if
maternal illness predated the birth. This suggests
that environmental risk factors that come into play
after the onset of illness may be affecting the
outcomes; these could be related to psychotropic
medication use by the mother after illness onset.
Rates of rare syndromes in these
high-risk children were well above population rates.
There was also an increased risk of pervasive
developmental disorder, reaching significance in
children whose mothers had bipolar disorder, and
an increased risk of epilepsy in children whose
mothers had unipolar major depression.
Q: Are follow-up studies
planned?
A: Yes. The
next step is to look at mental health outcomes in
these children. We have now extended the study
database to cover almost 500,000 children born in
Western Australia, and we are currently compiling
data on their mental health outcomes, including
whether they themselves have gone on to develop
a psychotic illness. Our pending analyses will
provide important insights into the role of both
genetic and environmental mechanisms in the risk
for psychotic illness.
Disclosure: Dr. Morgan
reports no affiliations with, or financial interests in,
any organization that may pose a conflict of
interest.
Reference:
Morgan VA, Croft ML, Valuri GM,
et al. Intellectual disability and other
neuropsychiatric outcomes in high-risk children of
mothers with schizophrenia, bipolar disorder and
unipolar major depression. Br J
Psychiatry. 2012;200:282-289.