Another Schizophrenia Twin Study That Only Looks Good When You Skim The Results

 In medical school, my Psychiatry Residency, and even the Psychiatry Board Exams, the concordance rate noted for Schizophrenia was 50%. The assumption here is that if one identical twin was diagnosed with schizophrenia, then the other one had a 50% chance of also being diagnosed with schizophrenia (I am told this is still the conventional wisdom). This is an impressive number, even if it doesn't explain why the other 50%, also genetically identical to their schizophrenic sibling is not also diagnosed with schizophrenia. Well, it appears this is far from accurate, as I've discovered when looking at the actual studies, which we admittedly rarely did in our training, as we filled our heads with the "facts" we needed to pass our training and board certification. It appears to be a bit of statistical sleight of hand. [Hat tip to Jay Joseph (blog linked in my blog roll) for looking at this study a bit past the abstract]:

Heritability of Schizophrenia and Schizophrenia Spectrum Based on the Nationwide Danish Twin Register

If one peruses the abstract of this study, you are met with this:

The probandwise concordance rate of SZ is 33% in monozygotic twins and 7% in dizygotic twins. We estimated the heritability of SZ to be 79%. 

Does that mean that if your identical twin has schizophrenia, you have a 33% chance of having schizophrenia? No, I don't think it does. Does it mean that you have a 79% chance with that stated heritability? No, it doesn't, either.

In fact, based on this study, if one identical twin is diagnosed with schizophrenia, the other was diagnosed with schizophrenia only 14.8% of the time. While that's higher than you would expect at random, it is a far cry from what you might think if you skim the study and feels a bit deceptive, really. So let's see where they come up with their figures.

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).