title: Educational achievement in psychiatric patients and their siblings: a register-based study in 30 000 individuals in The Netherlands.
abstract: BACKGROUND
  Poor educational achievement is associated with a range of psychiatric disorders. Several studies suggest that this underperformance is due to cognitive deficits that commence before disease onset and reflect a genetic risk for this disorder. However, the specificity and the familial contribution of this cognitive deficit are not clear. We analysed lifetime educational achievement of psychiatric patients diagnosed with schizophrenia, bipolar or depressive disorder and their unaffected siblings.
  
  
  METHODS
  In a register-based case-control study, 1561 patients with schizophrenia, 813 patients with bipolar disorder, 8112 patients with depression, and their siblings were each matched with eight population controls. Patients, siblings and controls were compared on the highest educational stream they completed.
  
  
  RESULTS
  Lower educational achievement was present in schizophrenia patients from primary school onwards [completing primary school: odds ratio (OR) 0.69; completing secondary school: OR 0.69; completing academic education: OR 0.46], compared to patients with bipolar disorder or depression. Siblings of schizophrenia, bipolar or depressed patients showed no underachievement at primary or secondary school, but siblings of schizophrenia patients as well as siblings of depressed patients were less successful in their educational achievement after secondary school (completing academic education, schizophrenia siblings: OR 0.90; depressive disorder siblings: OR 0.91).
  
  
  CONCLUSIONS
  Educational underachievement from primary school onwards is specifically related to schizophrenia and not to bipolar disorder or depression. Moreover, it appears to be a harbinger of the illness, since it is not found in their siblings. These results add to evidence that early cognitive deficits are a distinct feature of the schizophrenia phenotype.
authors.affiliation: Department of Psychiatry,Brain Center Rudolf Magnus,University Medical Centre Utrecht,Utrecht,The Netherlands.
authors.forename: W M
authors.initials: WM
authors.lastname: Tempelaar
authors.affiliation: Julius Centre for Health Sciences and Primary Care,University Medical Centre Utrecht,Utrecht,The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Termorshuizen
authors.affiliation: Department of Psychosis Studies,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK.
authors.forename: J H
authors.initials: JH
authors.lastname: MacCabe
authors.affiliation: Department of Psychiatry,Brain Center Rudolf Magnus,University Medical Centre Utrecht,Utrecht,The Netherlands.
authors.forename: M P M
authors.initials: MP
authors.lastname: Boks
authors.affiliation: Department of Psychiatry,Brain Center Rudolf Magnus,University Medical Centre Utrecht,Utrecht,The Netherlands.
authors.forename: R S
authors.initials: RS
authors.lastname: Kahn
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000453:epidemiology*; D016022:Case-Control Studies; D003866:Depressive Disorder / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000453:epidemiology*; D035781:Siblings; D055815:Young Adult
keywords: Bipolar disorder; depression; educational achievement; psychiatric disorders; schizophrenia