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Non-psychotic psychiatric disorder and subsequent risk of schizophrenia

Cohort study

Division of Psychological Medicine, University of Wales College of Medicine, Cardiff

ANTHONY S. DAVID, FRCPsych

Institute of Psychiatry, London

ASLÖG MALMBERG, MRCPsych

Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford

PETER ALLEBECK, MD

Department of Social Medicine, Göteborg University, Vasa Hospital, Göteborg, Sweden

Correspondence: Glyn Lewis, Division of Psychological Medicine, University of Wales College of Medicine, Monmouth House, Heath Park, Cardiff CF4 4XN, UK. E-mail: wpcghl{at}cardiff.ac.uk

Declaration of interest Supported by the Swedish Medical Research Council and the Söderberg-Königska Foundation. No conflict of interest.

Background Those with schizophrenia often give a history of premorbid non-psychotic psychiatric disorder.

Aims To investigate the association between non-psychotic psychiatric disorders and the later development of schizophrenia.

Method Men aged 18 or 19 years, conscripted to the Swedish army in 1970 (n=50 054) were linked to the Swedish National Psychiatric Case Register.

Results There was an increased risk of schizophrenia in those with ICD-8 diagnoses of neurosis (OR=4.6,95% Cl 3.2-6.9), personality disorder (OR=8.2, 95% Cl 5.4-12.3), alcohol abuse (OR=5.5, 95% Cl 1.7-17.5) or substance abuse (OR=14.0, 95% Cl 7.8-25.0) at age 18. Of those who developed schizophrenia, 38% (95% Cl 32-45) received a diagnosis of non-psychotic psychiatric disorder at age 18. Only those with personality disorder had a significantly increased risk of schizophrenia (OR=2.4, 95% Cl 1.1-5.2) with onset after age 23.

Conclusions Personality factors could represent an underlying vulnerability to schizophrenia. Other diagnoses occurring before schizophrenia may reflect a prodromal phase of the illness.

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