Old Schizophrenia Twin Study That Tells a Different Story

 This study of Finnish Twins is originally from 1984:

Psychiatric Hospitalization in Twins

I think it makes some interesting points and I'm surprised I hadn't seen it before (Hat tip to Jay Joseph). Throughout my residency, I was told that there was a 50% concordance rate for schizophrenia among identical twins. I don't recall this study ever being referenced. It used hospitalization records and seems to have found a much lower concordance rate:

Pairwise concordance rates for schizophrenia (11.0% for MZ and 1.8% for DZ) seem to indicate great environmental influence (high proportion of discordant pairs) with apparent genetic liability (6.1-fold ratio in concordance between MZ and DZ pairs).

That's a surprisingly low figure. Perhaps because they used hospitalization records rather than interviews there was less bias or perhaps one twin wasn't hospitalized when the other was. 

Of course, one might jump on the fact that at least the concordance rate is significantly higher for MZ than DZ, even if not impressive. It's worth pointing out, though, that since doctors are regularly trained to take a family history and are more likely to diagnose someone with schizophrenia if they have a close relative with that diagnosis, that there is potential for inflation. 

I think such inflation would favor MZ twins in particular and this is an impressive point in the article:

Of the MZ pairs concordant for psychiatric hospitalization, 47% had lived together for their whole life time; of those discordant, 16% lived together. The corresponding figures for DZ pairs were 18% and 15%.

It is interesting that the MZ twins who lived together were more frequently diagnosed concordantly with schizophrenia, while not true of DZ twins. I am extrapolating, here, but it also appears that MZ twins are more likely to live together than DZ twins, which suggests some bonding that again brings into question the idea that MZ twins and DZ twins can be compared in this way (for more, see Jay Joseph's work on the EEA).