Epidemiology For Persistent Psychological Disorder: Obstetric Events And Risk Of Schizophrenia

Overview of a Peer Reviewed Article

Discuss about the Epidemiology for Persistent Psychological Disorder.

Schizophrenia is an acute and persistent psychological disorder, which influences the thought process, feelings and behavioral pattern of a person. They seem to lose touch and connection from the reality. The symptoms of Schizophrenia are extremely disabling. The signs generally emerge within the age group of 16 to 30 years (Ripke et al., 2014). The symptoms can be categorized as positive, negative and cognitive. The positive symptoms are the frantic behavioral patterns that are not commonly seen in healthy subjects. They include hallucination, delusion, unusual thinking pattern and restricted body movements (Ripke et al., 2014). The negative symptoms are further drastic and results in memory impairment. The patients have reduced pleasure in day-to-day life, reduced expression of thoughts and feelings, difficulty in sustaining and starting actions and reduced speech. The cognitive symptoms are sometimes precised in some people while in others they are serious. The symptoms include lack of comprehensibility and attention. Schizophrenia has several predisposing factors that contribute to the development of the disease. They can be due to genetic inheritance and several environmental factors like virus exposure, lack of nutrition before birth, problems during the gestation period and delivery. The other factors include psychosocial determinants, difference in brain structure and chemistry (Stadnick, Haine-Schlagel & Martinez, 2016). Obstetrics or obstetric events are related to the process of childbirth. The obstetric events are increasing the incidence and chances of schizophrenia. The epidemiological studies have investigated the incidence rate and frequency of the disease across a wide range of population and geography (Beary, Hodgson & Wildgust, 2012). The assignment vividly discusses the rationale of the study, overview of a peer reviewed article and review of few other related articles to assess the associations between obstetric events and risk of developing Scizophrenia.

According to a Danish national register based study, a nested case control study was made to examine the obstetric events associated with the risk of developing Schizophrenia. 1039 subjects were taken as samples who were not previously contacted by the Danish Psychiatric services that were under the ICD-8 or ICD-10 diagnosis of the disease and 24,826 subjects were taken as controls. The obstetric factors, family history of psychiatry, sociological and economical factors along with demographic determinants were the considered risk factors. The chance of developing Schizophrenia was found to be associated with a range of obstetric events. The incidence rate ratio was 2.08, with 95% confidence interval at 1.0 and 4.4 in maternal non-attendance at antenatal appointments. The incidence rate ratio was 1.51, with 95% confidence interval at 1 and 2.2 in the duration of gestational period or below. The incidence rate ratio was 8.2, with 95% confidence interval at 1.4 and 48.8 in the maternal influenza. The incidence rate ratio was 2.72, with confidence interval of 955 at 1.0 and 7.3 in preeclampsia. In cases of threatened premature delivery, the incidence rate ratio was 2.39, with 95% confidence interval at 1.4 and 4.1. The incidence rate ratio was found to be 2.43 with 95% confidence interval at 1.1 and 5.6 in cases where hemorrhage occurred during the delivery of the baby. In cases where the babies have been extracted manually, the incidence interval ratio was found to be 2.15, with confidence interval of 95% at 1.1 and 4.4. In cases of maternal sepsis during childbirth and puerperium, the incidence rate ratio was found to be 2.91, with confidence interval of 95% at 1.1 and 7.9. Univariate models and multivariate models were used for estimations of the interaction between the several obstetric factors. The various criteria like family history, demographic factors, age, and mother’s citizenship were used for the analysis and interpretation of results. Significant interactions were not witnessed in case of either of the models. It was finally stated that a strong association might be found between risk of developing the disease and factors. The factors are hemorrhage, pre-eclampsia and rupturing of membrane during and prior to the labor period (Dalman et al., 1999). The risk of developing the disease increased significantly on exposure to pre-eclampsia, hypoxia might develop during delivery and was found to be associated with hemorrhage. Obstetric complications like pre-matured birth, pre term delivery, anemia of the mother and manual extraction are the other associated factors that increase the probability of its occurrence. The study did not find any significant or prominent interaction among the various obstetric factors and sex or family history of psychosis. However, the data obtained during the conduct of the experimental study indicated that there was an association between a range of obstetric determinants and likelihood of developing Schizophrenia. The determinants of obstetric events were prematurity, infections to the mother, maternal behavioral pattern and hypoxia indicators. The association was found by making fewer adjustments with the most possible confounding factors (Byrne et al., 2007). 

Critical Appraisal on Observed Association Between Exposure and Outcome using Hierarchy of Evidence

According to a study, association between the obstetric events and chances of development of Schizophrenia was found. 538 children were taken as case with Autism Spectrum disorder, which is a form of Schizophrenia, 163 of them was taken who had developmental delays. 421 individuals were taken as developmental controls. The information related to exposure were taken via telephonic interviews. The outcomes were confirmed clinically. It was found that neither of the Autism Spectrum Disorder and developmental delays were found to be associated with influenza rather they were found to have associations with maternal fever during the gestation period. The association between maternal fever (exposure) and the disorder or delays (outcomes) was due to the biological mechanism. When bacteria or virus invade the human body, leukocytes respond by stimulation of the inter-leukins and interferon. This results in elevation of the temperature. However, there are multiple pathways for induction of the fever by interleukins. It had been reported that associations had been found between maternal infections and risk of neurological developmental disorders (Zerbo et al., 2013). 

A study was made on obstetric complications and schizophrenia. The study compared the incidence of obstetric events among children of such mothers who had schizophrenia spectrum psychoses and the control groups included normal healthy children. The study also investigated the relation between the obstetric complications and mortality rate of children with such psychiatric disorders. The females who were born within the period of 1916-1948 were monitored who were admitted for the first time in the Helsinki Psychiatric hospitals. 271 cases and 242 controls were selected for the study. The Cox regression model were applied for assessment and analysis of the exposure and outcome association. It was reported at the end of the study that the hazard rate ratio was 3.73 with confidence interval of 95% at 1.27 and 11.01 in case of maternal infections. In the cases of hypertension during the pregnancy period, the hazard rate ratio was found to be 4.09 with confidence interval of 95% at 1.15 and 14.58. In cases of placental abnormalities, the ratio was found to be 4.09 with confidence interval of 95% at 1.59 and 10.49. Hence, it was assessed and concluded that the risk of developing Schizophrenia developed with the associated obstetric complications.. It implies that there is a modest association between exposure and outcome (Suvisaari et al., 2013). 

According to a case-control study, the obstetric complications along with other factors like dysfunctional motor activities and others were associated with risk of developing Schizophrenia. The case group consisted of the subjects diagnosed with Schizophrenia and control groups were selected from the healthy population. The interactions between the obstetric factors and risk of development of the disease were found to be strong. However, the lack of sufficient prospective data was considered as the limitations of the study (Laurens et al., 2015). 

According to a study, it was found that the psychological state of the mother could have negative impact on the pregnancy and the fetal health. The study measured the exposure levels of a selected population with similar complications and risk factors rather than assessment at the individual level. The studies examined that the maternal stress was linked with the outcomes. The off springs were diagnosed with the disease and the interactions had been found between the obstetric events and the outcomes of the disease (Kenny, Everard & Khashan, 2014). 

A study analyzed the association between the obstetric events and later development of Schizophrenia. A cohort study was made in Australia, which examined the stress full experience of the mothers during the pregnancy period and occurrence of the disease in the off springs in later phase of life. The results of the study showed that the prenatal stressful incidents had indirect relationship with behavioral problems in the children. There was no such interactions observed in cases where the individuals were selected within the age group of 5. It was found that above 5 years the children showed some levels of behavioral changes and were diagnosed with Psychiatric disorders. The study further confirmed the part played by the stressful prenatal period by further analysis of the children at early developmental stages (Betts et al., 2014). 

A study examined the associations between perinatal factors and risk of development of psychiatric disorders like Schizophrenia. The study involved 56 subjects with psychological disorder related to the perinatal complications. The study was based on case-control design. The sample cases were selected from a national registered sample that was assessed during the period of 1988-2000. The controls were selected from healthy population who had no psychiatric diagnosis. The statistical logistic regression technique was used to compare the exposure and outcomes in the case and control groups. It was found that the asphyxia and delivery complications might contribute to the risk of developing the psychiatric disorder. The other important finding of the study was that the disorder was dependant on the selected control population. It reported significant associations of the disease with low birth weight, premature birth.  However, the study had limitations of using selected sample with the disease. It can be implied that there were strong associations of the disease found to be linked with obstetric factors and genetic factors (Fazel et al., 2012). 

According to a study, Schizophrenia is the outcome of early neurological developmental abnormalities, which involves obstetric events. The study was based on case-control design. The study involved 67 healthy participants and 29 patients with the disease. The assessments were made for duration of 0 to 8 weeks. Assessments of clinical aspects as well as neurological status were made for two hours. Obstetric complications were assessed in the study based on national health registry. It was assessed on the bases of maternal health prior to the birth of the babies as well as their mental and physical health status during the  gestation period along with other associated obstetric complications. It was found that poor neurological developments are due to obstetric complications to some extent. The gestational length was the parameter to be assessed, which showed that the lengthy gestational period contributed to the development of the disease (Teigset, Mohn & Rund, 2016). 

According to a study, environmental factors of the prenatal and perinatal aspects elevated the chances of developing Schizophrenia. The study involved 457 participants. It was reported that the obstetric events as birth weight of the babies was a contributing factor to the risk of schizophrenia. The high birth weight of more than 400 grams was found to be associated with the higher risks of the disease (Wegelius et al., 2015).

A study analyzed the association of genetic inheritance, maternal stress and such obstetric events with schizophrenia. Genetic risk factors as well as environmental factors were taken into consideration for assessing the association between the exposure and outcome. It was found that the prenatal and factors related to family setup was associated with schizophrenia (Walder et al., 2014).

According to a study, it was investigated that there were associations between psychological disorders in parents and risk of developing schizophrenia. The study involved 10,526 subjects. It was a cohort-control study. The reports said that high weight of the babies at birth and higher levels of literacy among the mothers were the contributing factor to the disease development (Keskinen et al., 2013). 

According to a study, restrictions in the growth of fetus were associated with the risk of developing schizophrenia. It was a cohort study based on population. The odds ratio or the incidence rate of the study regarding the disease showed that the risk of the disease increased proportionally with decrease in the birth weight. It was identified that among 15,622 pre-eclampsia births, 49 people were diagnosed with schizophrenia. However, further investigations could be carried regarding the associations between fetal growth retardation and developing the disease (Eide et al., 2013). 

A study was conducted to examine the associations between psychological disorders like schizophrenia and obstetric events. The obstetric complication considered in this study was delivery, pre and post birth complications. It was based on a case-control design. 124 children and adults were involved in the study. The results of the study stated that the children and adults with mothers having obstetric complications were at higher risk of developing schizophrenia (Ketzer et al., 2012). 

According to a study, demographic factors and habits like drug use during gestational period were associated with the onset of the disease of schizophrenia. It was found that use of drugs like cannabis and cocaine were associated with the outbreak of schizophrenia. It was reported that strict monitoring, delivery and family history were contributing to the development of schizophrenia (Rubio-Abadal et al., 2015). 

A study examined the extent to which obstetric events were associated with schizophrenia in adolescent patients. The study involved 508 adults within the age group of 12 to 17 years. The study also accounted for the sex differences. It was found that more males were diagnosed with the disease as compared to females. The disease was found to be associated with the obstetric complications (Lukkari et al., 2012).

Conclusion

Schizophrenia is a severe psychological disorder, which results in restricted movement and changes in behavioral pattern. The assignment critically assessed the associations of various obstetric factors with psychiatric disorders. The conclusions drawn from the selected peer reviewed article is that the development of the disease was closed related to the obstetric events like preterm birth, premature delivery, manual extraction, bleeding during the delivery of the baby, maternal infection. The other factors were also found to be related with the risk factors of the disease. It was found that the risk increased when the exposure was extended to difficult and unfavorable birth conditions and adverse pregnancy. The other reviewed articles focused on the other aspects of the obstetric events like the mental state of the pregnant mothers and stressful events during the pregnancy period. It can be concluded from the findings of the mentioned articles that the factors like psychological status of the mother could result in development of Schizophrenia among the children in later parts of life. The interactions of the factors with the causative outcome were found to be strong. A modest association between the disease and obstetric factors were found.  Hence, it can be concluded that the occurrence of Schizophrenia is strongly related with the obstetric complications. 

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