Craniofacial dysmorphology in Swedish schizophrenia patients Introduction A growing body of evidence indicates that dis- turbed prenatal development significantly increases risk of schizophrenia, in at least some individuals (1, 2). This observation is supported by multiple studies demonstrating that adults with schizophre- nia have increased rates of anomaly across a range of markers of disturbed prenatal development, including atypical dermatoglyphic patterns (3, 4), neurological soft signs (5, 6) and subtle anomalies of craniofacial regions (7–9). Existing studies of craniofacial dysmorphology, however, are limited by a number of methodolo- gical constraints. No studies to date have per- formed assessments of craniofacial shape blind to diagnosis, owing largely to the nature of the assessment procedure which involves up to 45 min of close contact with the subject. Lack of blinding is a particular limitation in the majority of existing studies which have used versions of the Waldrop scale (10) for the assessment of craniofa- cial dysmorphology in adults with schizophrenia (7, 11–13). This scale was originally designed for use in children, is based on unpublished data, and comprises a series of subjective judgements about a limited range of physical anomalies. These charac- teristics of the scale, in addition to the lack of blinding, raise the possibility of significant observer bias in existing studies of craniofacial dysmorphol- ogy in schizophrenia. We have previously described a more objective, anthropometrically-based scale which we used to assess craniofacial dysmorphology in subjects with schizophrenia in Ireland (8) and which was subse- quently used (in a shortened form) in a similar study in Australia (14). There remains, however, a paucity of detailed, objective, anthropometrically- based studies of craniofacial dysmorphology in individuals with schizophrenia from other coun- tries and ethnic groups (15). Aims of the study We aimed to perform detailed assessments of craniofacial dysmorphology in individuals with Kelly BD, Lane A, Agartz I, Henriksson KM, McNeil TF. Craniofacial dysmorphology in Swedish schizophrenia patients. Acta Psychiatr Scand 2005: 111: 202–207. Ó Blackwell Munksgaard 2005. Objective: To perform detailed assessments of craniofacial dysmorphology in individuals with schizophrenia and controls in Sweden, in order to further elucidate the neurodevelopmental origins of schizophrenia. Method: We performed detailed, anthropometric assessments of craniofacial dysmorphology in male patients with schizophrenia (n ¼ 24), healthy controls (n ¼ 16), and patientsÕ siblings with schizophrenia (n ¼ 2) in Sweden, while remaining as blind as possible to schizophrenia/control status. Results: Individuals with schizophrenia evidenced significantly more craniofacial dysmorphology than controls, especially in the ears and mouth. At a group level, there was a dose–response type relationship between total dysmorphology score and patient/control status. Conclusion: The consistency of results across multiple studies supports the hypothesis that individuals with schizophrenia have increased rates of prenatal developmental disturbances. The presence of a dose–response type relationship between total dysmorphology score and patient/control status supports the importance of neurodevelopmental disturbance as a contributory cause of schizophrenia. B. D. Kelly 1 , A. Lane 1 , I. Agartz 2 , K. M. Henriksson 3 , T. F. McNeil 3 1 Stanley Research Unit, St John of God Psychiatric Service, Stillorgan, Co Dublin, Ireland, 2 Department of Clinical Neuroscience, Human Brain Informatics (HUBIN), Karolinska Institute and Hospital, Stockholm, Sweden, and 3 Stanley Medical Research Center, Department of Psychiatric Epidemiology, University Hospital, Lund University, Lund, Sweden Key words: schizophrenia; aetiology; human development Dr Abbie Lane, St John of God Hospital, Stillorgan, Co. Dublin, Ireland. E-mail: abbie.lane@sjog.ie Accepted for publication October 22, 2004 Acta Psychiatr Scand 2005: 111: 202–207 All rights reserved DOI: 10.1111/j.1600-0447.2004.00473.x Copyright Ó Blackwell Munksgaard 2005 ACTA PSYCHIATRICA SCANDINAVICA 202