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Objective: The prevalence of cigarette smoking among schizophrenia patients is significantly higher than in the general population; this may reflect self-medication of symptoms and/or adverse effects of neuroleptics. The authors examined the prevalence of cigarette smoking in apparently healthy adolescents later hospitalized for schizophrenia. Method: Each year, a random sample of male Israeli military recruits, who have been screened and found not to be suffering from major psychopathology, complete a smoking questionnaire. Through the Israeli National Psychiatric Hospitalization Case Registry, 14,248 of these adolescents were followed to determine later psychiatric hospitalization. Results: Of the 14,248 adolescents assessed, 4,052 (28.4%) reported smoking at least one cigarette a day. Over a 4-16-year follow-up, the prevalence of schizophrenia in the entire cohort was 0.3% (N= 44). Smokers were at greater risk for later schizophrenia; the adjusted relative risk was 1.94, and the 95% confidence interval (CI) was 1.05 3.58. The number of cigarettes smoked was significantly associated with the risk for schizophrenia. Compared to nonsmokers, adolescents who smoked 1-9 cigarettes/day were 1.38 times (95% CI-0.48-4.00) as likely to be hospitalized later for schizophrenia, and adolescents who smoked 10 cigarettes/day or more were 2.28 times (95% CI=1.19-4.34) as likely; the latter difference was statistically significant. Conclusions: Taken together with the existing data on abnormalities in nicotinic transmission in patients and their relatives, this higher prevalence of smoking in future schizophrenia patients, before the onset of their illness, might indicate that impaired nicotinic neurotransmission is involved in the pathophysiology of schizophrenia.

Objective: The goal of this study was to characterize the symptoms of geriatric, chronically ill, institutionalized schizophrenic patients and investigate age-related differences in schizophrenic symptoms and cognitive performance from early adulthood to late senescence. Method: The Positive and Negative Syndrome Scale and the Mini-Mental State examination were used to assess the schizophrenic symptoms and cognitive performance, respectively, of 393 institutionalized schizophrenic patients stratified into seven groups designated by 10-year age intervals from 25 years to over 85 years. Results: In the comparisons of the seven age groups, significant differences between groups in positive and negative subscale scores on the Positive and Negative Syndrome Scale and in Mini-Mental State scores were revealed. Significant correlations between Mini-Mental State scores and Positive and Negative Syndrome Scale negative symptom scores, but not positive symptom scores, were found for all age groups, except for the youngest patients studied. Current treatment with neuroleptics and prior treatment with ECT, insulin coma, or leukotomy could not account for the poor cognitive performance of the older schizophrenic patients. Conclusions: The older schizophrenic patients continued to experience psychotic and nonpsychotic symptoms in senescence. Their positive symptoms were moderately less severe and their negative symptoms and cognitive impairment were significantly more severe than those of the younger patients. Somatic treatment appeared not to be responsible for the severe cognitive impairment and negative symptoms of the older patients. These data are relevant to chronically hospitalized geriatric schizophrenic patients but not necessarily to all geriatric schizophrenic patients.

Objective: This study attempted to examine the relationship between month and season of birth and risk for autism spectrum disorders. Method: The cohort included all Jewish individuals born in Israel over 5 consecutive years (N=311,169) and assessed by the Israeli Draft Board as part of the mandatory assessment of eligibility for military service conducted at age 17. The outcome of autism spectrum disorders was ascertained from the Draft Board Medical Registry, which contains information about medical and psychiatric disorders for this population of adolescents. Results: There was no association between month or season of birth and the prevalence of autistic spectrum disorders. Conclusions: The findings from this historical, populationbased cohort study do not support an association between season of birth and autistic spectrum disorders.

Folie a trois (madness for three) is a rare disorder characterized by the shared paranoid delusions of three individuals. Two case reports of folie a trois in two different Russian-Jewish families who had immigrated to Israel in the 1970s are presented. In the first, a 45-year-old single man, living with his elderly parents, was hospitalized after attacking a psychiatrist. He believed that he and his family were being terrorized by his mother's sister. His parents supported his claim, and his mother insisted that her sister was an Israeli agent plotting to kill her son. His mother had been born in a Russian ghetto and at age seven, had witnessed the beheading of her father during the 1919 Civil War. The patient's father was a passive man, who always felt persecuted because he was Jewish. The family led an isolated life, had no friends, and survived on social security. Treatment with antipsychotic medication and separation from his family had no effect on the son's paranoid belief system. In the second case, a Russian-Jewish 39-year-old single woman still living with her parents claimed that a neighbor was pouring poison gas into their apartment. Both parents supported her claim. She was diagnosed as paranoid schizophrenic, and treated with antipsychotic medication. After she was hospitalized several times, her family moved to a new apartment, but believed that the neighbor had tracked them down and was poisoning them again. Her father had lost his first wife and two children when their home was bombed during World War II. Both her mother and father had suffered a great deal of persecution while living in Russia. The development of folie a trois in these families appears to have been related to past hardships, social isolation, and dependent family relations. Both families seemed unable to adjust to a society in which they were free of hostility and persecution. (Consumer Summary produced by Reliance Medical Information, Inc.)