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Minor Physical Anomalies and Quantitative Measures of the Head and Face in Patients With Psychosis
John McGrath, MBBS, PhD, FRANZCP;
Ossama El-Saadi, MD, MPH;
Vivian Grim, MD;
Sue Cardy, RPN;
Ben Chapple, BA;
David Chant, PhD;
Daniel Lieberman, PhD;
Bryan Mowry, MBBS, MD, FRANZCP
Arch Gen Psychiatry. 2002;59:458-464.
Background The aim of this study was to examine minor physical anomalies and quantitative
measures of the head and face in patients with psychosis vs healthy controls.
Methods Based on a comprehensive prevalence study of psychosis, we recruited
310 individuals with psychosis and 303 controls. From this sample, we matched
180 case-control pairs for age and sex. Individual minor physical anomalies
and quantitative measures related to head size and facial height and depth
were compared within the matched pairs. Based on all subjects, we examined
the specificity of the findings by comparing craniofacial summary scores in
patients with nonaffective or affective psychosis and controls.
Results The odds of having a psychotic disorder were increased in those with
wider skull bases (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.02-1.17),
smaller lower-facial heights (glabella to subnasal) (OR, 0.57; 95% CI, 0.44-0.75),
protruding ears (OR, 1.72; 95% CI, 1.05-2.82), and shorter (OR, 2.29; 95%
CI, 1.37-3.82) and wider (OR, 2.28; 95% CI, 1.43-3.65) palates. Compared with
controls, those with psychotic disorder had skulls that were more brachycephalic.
These differences were found to distinguish patients with nonaffective and
affective psychoses from controls.
Conclusions Several of the features that differentiate patients from controls relate
to the development of the neuro-basicranial complex and the adjacent temporal
and frontal lobes. Future research should examine both the temporal lobe and
the middle cranial fossa to reconcile our anthropomorphic findings and the
literature showing smaller temporal lobes in patients with schizophrenia.
Closer attention to the skull base may provide clues to the nature and timing
of altered brain development in patients with psychosis.
From the Queensland Centre for Schizophrenia Research, Wolston Park
Hospital, Wacol, Australia (Drs McGrath, El-Saadi, Grim, Chant, and Mowry,
Ms Cardy, and Mr Chapple); and the Department of Anthropology, Harvard University,
Cambridge, Mass (Dr Lieberman).
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