CONTEXT:

Consistent evidence indicates that some, but not most, patients with schizophrenia have below-average intelligence years before they manifest psychosis. However, it is not clear whether this below-average premorbid intelligence is stable or progressive.

OBJECTIVE:

To examine whether increased risk for schizophrenia is associated with declining intellectual performance from childhood through adolescence.

DESIGN:

Historical cohort study of an entire population using record linkage for psychiatric hospitalization during an 8- to 17-year follow-up period.

SETTING:

Mandatory assessment by the draft board of Israeli conscripts.

PARTICIPANTS:

Population-based cohort of 555 326 adolescents born in Israel. Data were available on 4 intelligence subtests as well as on reading and spelling abilities and on behavioral and psychosocial variables. A regression-based approach was used to assess the discrepancy between actual IQ at age 17 years and estimated IQ during childhood based on reading and spelling abilities.

MAIN OUTCOME MEASURES:

Hospitalization for schizophrenia (as per the International Statistical Classification of Diseases, 10th Revision criteria).

RESULTS:

Lower-than-expected IQ at age 17 years was associated with increased risk for later hospitalization for schizophrenia. Results were held after controlling for potential confounders. For 75% of patients with schizophrenia with low actual IQ (<85) at age 17 years and for 23% of patients with actual IQ within the normal range (> or =85), actual IQ was 10 or more points lower than expected. Lower-than-expected IQ was not associated with bipolar disorder or with depression or anxiety disorder.

CONCLUSIONS:

Indirect evidence suggests that intellectual deterioration from childhood through adolescence is associated with increased risk for schizophrenia. Despite within-normal-range premorbid IQ scores, apparently healthy adolescents who will later manifest schizophrenia nevertheless have intellectual decline.