High concordance for schizophrenia in monozygotic (MZ) twins is often cited as evidence for the etiological influence of genetics; however, even if twins are separated at birth, MZ twin concordance is influenced by the shared prenatal environment. Study of the placentation status of MZ twins provides a way to investigate some prenatal influences, including the possible role of viral infections. The probability of shared infections is likely to be greater in monochorionic MZ twin pairs than in dichorionic pairs because of shared fetal circulation in the monochorionic pairs. We drew from published twin studies and used reported concordance for handedness as a retrospective marker of placentation status. We found that MZ twin pairs with opposite-hand preferences were concordant for psychosis in 9 of 15 cases (60), while only 18 of 56 twin pairs (32) with same-hand preferences were concordant for psychosis. These results suggest that shared prenatal viral infection may account for much of the high concordance for schizophrenia in identical twins.
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