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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

 

August 20, 2012

Vera A. Morgan, PhD

 

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.