Choice Gp

Early life and adult disease

BMJ 1999; 318 doi: (Published 13 February 1999) Cite this as: BMJ 1999;318:a

The idea that what happens early in life is important in determining disease in adulthood is gaining ever more credence, and three papers in this BMJ add more evidence.

An association between perinatal events and adult schizophrenia has been reported for over 30years, but many studies have been small. The case-control study from Sweden reported on p 421 includes 167patients with schizophrenia, 198with affective psychosis, 292with reactive psychosis, and five controls for each. Schizophrenia was positively associated with multiparity, maternal bleeding during pregnancy, and birth in late winter. John Geddes thinks that the study is a methodological advance but suggests attempts to pool the data from all studies undertaken so far (p 426).

Another large Scandinavian study builds on our knowledge that thin babies have higher rates of adult heart disease than normal babies (p 427). The new study shows that the highest rates of adult heart disease occur in those who are born thin but whose weight catches up so that they are average or above by 7years. One possible clinical implication is that obesity programmes in children should concentrate on those overweight children who were thin at birth.

The third study—again from Scandinavia—has negative results (p 433). Previous studies have raised the possibility that the use of uterotonic drugs in labour might affect cognitive function in adulthood. Oxytocin can, for example, induce tetany, uterine rupture, and water intoxication. But the study among 4300young men enrolling in the army finds no effect of the drugs on cognitive function. GP choice

A study on why general practitioners “fail” to diagnose depression prompts an interesting debate. The study authors note that general practitioners are diagnosing less than half of “depressed” patients and are particularly likely to “miss” the diagnosis in patients who “normalise” their symptoms—that is, explain them by their life circumstances (p 436). There is evidence that diagnosing the depression improves outcome, but Iona Heath is bothered that over half the patients in a consecutive series were considered by the researchers to have measurable depression (p 439). She thinks that patients who normalise their experience may have begun the process of finding meaning, making sense, and learning to cope. Will outcomes really be better if these patients are pressurised into accepting psychiatric explanations for their symptoms? The depression “missed” by general practitioners may run a benign course. “There must,” she writes, “be limits to the medicalisation of human distress.”


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