Cited by 114Schizophrenia research and treatmentBipolar Disorder and TreatmentAutism Spectrum Disorder Research

The DOI matches its Crossref record; 68 of the 70 references it cites were found in a registry or an index; 2 of the 158 sources its claims cite were checked for support.

Developmental Differences Between Schizophrenia and Bipolar Disorder

Open access
Parellada, Mara, Gomez-Vallejo, Sandra, Burdeus, Monica, Arango, Celso·2017·Schizophrenia Bulletin

Abstract

Ample evidence supports a neurodevelopmental origin in some cases of schizophrenia (SZ). More inconsistent information is available for bipolar disorder (BD). We herein review studies with a focus on premorbid (adjustment and functionality) and early developmental milestones that include both SZ and BD patients. A search was performed in the PubMed electronic database, retrieving 619 abstracts; 30 were ultimately included in this systematic review. Eight prospective cohorts, 15 retrospective studies, and 7 studies based on national registries. Psychomotor developmental deviations and general adjustment problems characterize the childhood of subjects later diagnosed with SZ or BD; they are more marked in those later diagnosed with SZ vs BD, earlier onset vs later onset, and psychotic vs nonpsychotic disorders. Cognitive impairment follows a linear risk trend for SZ and a U-shaped trend for BD. Social isolation and visuoperceptual/reading anomalies more frequently antecede SZ. Pervasive developmental disorders increase the risk for both SZ and BD, more so in cases with normal intelligence. The predictive risk of each isolated developmental marker is low, but a significant percentage of subjects with SZ and a minority of adults with BD showed signs of premorbid abnormalities in childhood. The great limitation is still the lack of studies comparing SZ and BD that include psychotic and nonpsychotic bipolar cases separately. There are many cases, even in childhood/adolescent SZ, where no premorbid anomalies are found, and immunological disorders or other etiologies should be searched for. At least in cases with clear neurodevelopmental markers, rare genetic variants should be investigated.

Overview

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Written from the paper’s full text.

TL;DR

This systematic review compares premorbid developmental and adjustment markers in schizophrenia (SZ) and bipolar disorder (BD), finding that childhood psychomotor deviations and adjustment problems occur in both but are generally more prominent in SZ. Cognitive risk patterns differ, with a linear trend for SZ and a U-shaped relationship for BD.

Key findings

  • Across 30 included studies (8 prospective cohorts, 15 retrospective studies, 7 national-registry studies), premorbid psychomotor deviations and general adjustment difficulties were more marked in later SZ than later BD, in earlier-onset than later-onset cases, and in psychotic than nonpsychotic disorders.
  • Cognitive findings diverged: lower childhood IQ predicted SZ-spectrum risk (each 1-SD increase in childhood IQ was linked to a 42% lower odds of lifetime SZ-spectrum diagnosis), while BD showed a U-shaped school-performance pattern (low grades about 2-fold risk; very high grades about 4-fold risk). In one cohort, below-average IQ at age 18 conferred a 3% risk of SZ, and among children not speaking words at age 1, only 0.88% later developed SZ.
  • Social isolation and visuoperceptual/reading anomalies more often preceded SZ. Autism spectrum disorder increased risk for both nonaffective psychosis and BD (5.6 and 5.8 times higher than controls, respectively), with stronger risk in ASD without intellectual disability.
  • Individual developmental markers had low predictive value. Even in early-onset SZ, fewer than half showed premorbid abnormalities; one sample reported broadly impaired social development in 34%, and another reported any delayed milestone in 27% of severely ill hospitalized adolescents with SZ.

Methods

  • Systematic review using a PubMed search on June 17, 2017, retrieving 619 abstracts; 41 were selected for full review, 23 more came from reference lists, 64 were fully reviewed, and 30 were included.
  • Inclusion required studies with both SZ and BD in the population and structured or semistructured assessment of psychomotor milestones, premorbid general/social adjustment, educational attainment, premorbid cognition, or learning difficulties. No publication-year limit was set; English, German, French, and Spanish articles were eligible.
  • Data extraction covered study design, sample characteristics, premorbid assessment, outcome measures, and main findings; two authors reviewed abstracts and two independently reviewed full texts.

Limitations

  • The authors state that the main limitation is the scarcity of studies directly comparing SZ and BD while separating psychotic from nonpsychotic bipolar cases. They also note that ideal prospective unselected cohorts are constrained by low psychosis prevalence, changing nosology, assessment-instrument availability, limited follow-up duration, and attrition that is not independent of diagnosis.
  • Stated retrospective-study limitations include recall bias, selection bias toward hospitalized and more severe patients, and the fact that most included bipolar patients had psychotic BD. Assessment limitations include variability in premorbid adjustment and cognition measures, use of the PAS (designed for SZ) in BD, self-report PAS during acute decompensation, school grades as an imperfect proxy for cognition, and cognitive testing too close to illness onset in some studies.
  • The text also makes evident additional concerns: several included samples had very small BD or mania subgroups, diagnostic systems and instruments varied across studies, and the authors explicitly raise possible information bias or a Pygmalion effect in which current diagnosis may influence retrospective assessment of premorbid problems.

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Integrity signals

Registry

Crossref · 10.1093/schbul/sbx126

Cites

68 of 68 references verified0 citation errors · 0 not checkable

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Verification

Claims the paper makes

111 Not checked yet · 19 Own interpretation · 14 No basis given · 10 Own method · 7 Own result · 1 Supported · 1 Not supported · accuracy not yet measured

Verify all 156 references — free account
  • It may state two separate claims as one. 56
  • Probably not a substantial claim. 18
71 of 71
  • The paper relies on this without support.

    Information about neurodevelopmental origins in bipolar disorder is more inconsistent than for schizophrenia.

    “More inconsistent information is available for bipolar disorder (BD).”
  • The paper relies on this without support.

    Few studies have examined premorbid abnormalities in both schizophrenia and bipolar disorder within the same study to assess specificity of developmental deviations.

    “However, very few studies have looked at premorbid abnormalities in both disorders in the same study in order to assess the specificity of the predictive value of distinct developmental deviations.”
  • The paper relies on this without support.

    Few available studies have made premorbid adjustment or functioning their main objective.

    “In addition, among the available studies, very few have made premorbid adjustment or functioning their main objective.”
3 of 3

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  1. 2013, Schizophrenia

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Metadata

Authors
Parellada, M., Gomez-Vallejo, S., Burdeus, M., & Arango, C.
Affiliations
Universidad Complutense de Madrid (ES)
Corresponding author
Parellada, Mara
Venue
Schizophrenia Bulletin
Published
2017-10-14
Volume
43
Issue
6
Pages
1176-1189
ISSN
  • 0586-7614 (ISSN-L)
  • 1745-1701
OpenAlex
W2763058017
Cited by
114
References
70
Citations by year
2026: 5 · 2025: 9 · 2024: 10 · 2023: 15 · 2022: 20 · 2021: 14 · 2020: 18 · 2019: 13 · 2018: 7 · 2017: 3
FWCI
9.20
Type
journal article
Language
en
Open access
Locations
  • Schizophrenia Bulletin (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Keywords
schizophrenia, bipolar disorder
MeSH terms
Bipolar Disorder, Humans, Human Development, Psychotic Disorders, Schizophrenia, Cognitive Dysfunction

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