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Premorbid Intellectual Decline and Risk for Schizophrenia

Abraham Reichenberg, PhD; Mark Weiser, MD; Michael A. Rapp, MD, PhD; Jonathan Rabinowitz, PhD; Asaf Caspi, MD; James Schmeidler, PhD; Haim Y. Knobler, MD; Gad Lubin, MD; Daniela Nahon, MA; Philip D. Harvey, PhD; Michael Davidson, MD

Arch Gen Psychiatry. 2005;62:1297-1304.

Context  Consistent evidence indicates that some, but not most, patients with schizophrenia have below-average intelligence years before they manifest psychosis. However, it is not clear whether this below-average premorbid intelligence is stable or progressive.

Objective  To examine whether increased risk for schizophrenia is associated with declining intellectual performance from childhood through adolescence.

Design  Historical cohort study of an entire population using record linkage for psychiatric hospitalization during an 8- to 17-year follow-up period.

Setting  Mandatory assessment by the draft board of Israeli conscripts.

Participants  Population-based cohort of 555 326 adolescents born in Israel. Data were available on 4 intelligence subtests as well as on reading and spelling abilities and on behavioral and psychosocial variables. A regression-based approach was used to assess the discrepancy between actual IQ at age 17 years and estimated IQ during childhood based on reading and spelling abilities.

Main Outcome Measures  Hospitalization for schizophrenia (as per the International Statistical Classification of Diseases, 10th Revision criteria).

Results  Lower-than-expected IQ at age 17 years was associated with increased risk for later hospitalization for schizophrenia. Results were held after controlling for potential confounders. For 75% of patients with schizophrenia with low actual IQ (<85) at age 17 years and for 23% of patients with actual IQ within the normal range (85), actual IQ was 10 or more points lower than expected. Lower-than-expected IQ was not associated with bipolar disorder or with depression or anxiety disorder.

Conclusions  Indirect evidence suggests that intellectual deterioration from childhood through adolescence is associated with increased risk for schizophrenia. Despite within-normal-range premorbid IQ scores, apparently healthy adolescents who will later manifest schizophrenia nevertheless have intellectual decline.

Author Affiliations: Departments of Psychiatry (Drs Reichenberg, Rapp, Schmeidler, Harvey, and Davidson) and Biomathematical Science (Dr Schmeidler), Mount Sinai School of Medicine, New York, NY; Department of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer, Israel (Drs Weiser, Caspi, and Davidson); School of Social Work, Bar Ilan University, Ramat Gan, Israel (Dr Rabinowitz); Medical Corps, Israel Defense Forces, Tel Hashomer (Drs Knobler and Lubin); and Ministry of Health, Jerusalem, Israel (Ms Nahon).

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