Coeliac disease and schizophrenia
http://www.100md.com
《英国医生杂志》
EDITOR—As noted in the original paper, we agree that coeliac disease is almost certainly underascertained in the study: but we do not agree it is a confounding factor. The question is whether the ascertainment in cases and controls, and in cases and controls with other autoimmune intestinal diseases, is differential (biased).
The numbers are small, but the logic of bias is weak in cases, and even weaker in parents. The figure of 0.5 in the table, for prevalence in controls, includes coeliac disease in controls or their parents (as noted in the table). The numbers with coeliac disease in the controls were: 27 controls, 48 mothers of controls and 18 fathers of controls (93/199 915, or 0.5 per 1000). This compares to figures given in the paper of 4, 5, and 3 in cases, mothers of cases, and fathers of cases, respectively (12/7997, or 1.5 per 1000).
We are also not yet convinced. But, we are led to direct our attention further in this area in the light of current research, including the availability of new screening tests for coeliac disease, which identify subclinical cases; prior trials of gluten withdrawal which usually identify a small proportion who respond positively1-4; and some dramatic case studies.5
William Eaton, professor
Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Baltimore, MD 21205, USA weaton@jhsph.edu
Preben Bo Mortensen, professor, Esben Agerbo, assistant professor, Majella Byrne, assistant professor, Ole Mors, professor
Institute of Basic Psychiatric Research, Psychiatric Hospital in Aarhus, Skovagervej 2, 8240 Risskov, Denmark
Competing interests: None declared.
References
Dohan FC, Grasberger JC, Lowell FM, Johnston HT, Arbegast A. Relapsed schizophrenics: more rapid improvement on a milk- and cereal-free diet. Br J Psychiatry 1969;115: 595-6.
Rice JR, Ham CH, Gore WE. Another look at gluten in schizophrenia. Am J Psychiatry 1978: 1417-8.
Singh MM, Kay SR. Wheat gluten as a pathogenic factor in schizophrenia. Science 1976: 401-2.
Vlissides DM, Venulet A, Jenner FA. A double-blind gluten-free/gluten-load controlled trial in a secure ward population. Br J Psychiatry 1986: 447-52.
De Santis A, Addolorato G, Romito A, Caputo S, Giordano A, Gambassi G, et al. Schizophrenia symptoms and SPECT abnormalities in a coeliac patient: regression after gluten-free diet. J Intern Med 1997; 242: 421-3.
The numbers are small, but the logic of bias is weak in cases, and even weaker in parents. The figure of 0.5 in the table, for prevalence in controls, includes coeliac disease in controls or their parents (as noted in the table). The numbers with coeliac disease in the controls were: 27 controls, 48 mothers of controls and 18 fathers of controls (93/199 915, or 0.5 per 1000). This compares to figures given in the paper of 4, 5, and 3 in cases, mothers of cases, and fathers of cases, respectively (12/7997, or 1.5 per 1000).
We are also not yet convinced. But, we are led to direct our attention further in this area in the light of current research, including the availability of new screening tests for coeliac disease, which identify subclinical cases; prior trials of gluten withdrawal which usually identify a small proportion who respond positively1-4; and some dramatic case studies.5
William Eaton, professor
Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Baltimore, MD 21205, USA weaton@jhsph.edu
Preben Bo Mortensen, professor, Esben Agerbo, assistant professor, Majella Byrne, assistant professor, Ole Mors, professor
Institute of Basic Psychiatric Research, Psychiatric Hospital in Aarhus, Skovagervej 2, 8240 Risskov, Denmark
Competing interests: None declared.
References
Dohan FC, Grasberger JC, Lowell FM, Johnston HT, Arbegast A. Relapsed schizophrenics: more rapid improvement on a milk- and cereal-free diet. Br J Psychiatry 1969;115: 595-6.
Rice JR, Ham CH, Gore WE. Another look at gluten in schizophrenia. Am J Psychiatry 1978: 1417-8.
Singh MM, Kay SR. Wheat gluten as a pathogenic factor in schizophrenia. Science 1976: 401-2.
Vlissides DM, Venulet A, Jenner FA. A double-blind gluten-free/gluten-load controlled trial in a secure ward population. Br J Psychiatry 1986: 447-52.
De Santis A, Addolorato G, Romito A, Caputo S, Giordano A, Gambassi G, et al. Schizophrenia symptoms and SPECT abnormalities in a coeliac patient: regression after gluten-free diet. J Intern Med 1997; 242: 421-3.