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Schizophrenia Bulletin Advance Access originally published online on September 15, 2006
Schizophrenia Bulletin 2007 33(4):853-858; doi:10.1093/schbul/sbl041
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© The Author 2006. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.

Schizophrenia and Neural Tube Defects: Comparisons From an Epidemiological Perspective

Stanley Zammit1,2,3, Sarah Lewis2, David Gunnell2 and George Davey Smith2
2 University of Bristol, UK
3 Cardiff University, UK

1 To whom correspondence should be addressed; Department of Psychological Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN, UK, tel: +44 (0)29-2074-3058, fax: +44 (0)29-2074-7839, e-mail: zammits{at}cardiff.ac.uk.

In this review, we examine and compare epidemiological studies of schizophrenia and neural tube defects (NTDs). Although there is no apparent link between these 2 disparate disorders in terms of clinical manifestation or phenotypes, overlapping patterns in the variation of incidence of schizophrenia with that of NTDs indicate the existence of one or more shared etiological risk factors. Evidence in support of such a phenomenon may enhance our understanding of underlying pathological mechanisms and may guide future studies of etiology and prevention. The similarities that occur in a number of epidemiological observations for these disorders are in keeping with a hypothesis of nutritional deficiencies in utero acting as a risk factor for both schizophrenia and NTDs. Programes of periconceptual folate and multivitamin supplementation aimed to reduce the risk of NTDs are already in place in many countries. Nevertheless, evidence of additional effects of specific maternal micronutrient deficiency on risk of schizophrenia may not only increase enthusiasm for expansion of such programes but also enhance understanding of etiology of this disorder and offer the potential for targeted interventions in high-risk groups.

Keywords: epidemiology / folic acid / 5,10-methylenetetrahydrofolate reductase / micronutrients / neural tube defects / schizophrenia


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