Showing papers in "Schizophrenia Bulletin in 1987"

The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia

Abstract: The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.

Neurobiological Studies of Sensory Gating in Schizophrenia

Abstract: The sensory disturbance in schizophrenia is often described as an inability to filter out extraneous noise from meaningful sensory inputs. The neurobiological basis of this inability to filter has been examined using auditory evoked potentials, which are computerized averages of the brain's electrical response to sound. The sounds are presented in pairs to test the ability of the brain to inhibit, or gate, its response to a repeated stimulus. Schizophrenic patients lack the ability to gate the neuronal response shown by a particular wave, the P50 wave. The measurement of this deficit in human subjects and the exploration of its neurobiology in animals has produced evidence about several issues in the pathophysiology of schizophrenia: (1) the role of dopamine in improvement of sensory function in schizophrenic patients treated with neuroleptic drugs, (2) the interaction between familial or genetic deficits in sensory functioning in schizophrenic patients and possible abnormalities in dopamine metabolism, and (3) a mechanism by which noradrenergic hyperactivity in mania and other psychiatric illnesses might mimic some pathophysiological deficits in schizophrenia.

Startle Habituation and Sensorimotor Gating in Schizophrenia and Related Animal Models

Abstract: Studies of the habituation and sensorimotor gating of startle responses to strong exteroceptive stimuli provide some unique opportunities for cross-species explorations into information processing and attentional deficits in schizophrenia. The behavioral plasticity of startle paradigms greatly facilitates the development of animal models of specifiable behavioral abnormalities in schizophrenic patients. This article reviews the promising findings of studies in which measures of startle have been used to clarify the importance of habituation and central inhibition deficits in schizophrenia. In addition, the development of closely related animal models of habituation and sensory gating of startle is discussed. Such animal model studies allow us to make strong inferences about the neurobiological substrate of schizophrenia. Recent evidence from animal studies of prepulse inhibition provides strong support for a schizophrenia-like loss of sensory gating with nucleus accumbens dopamine overactivity. These data are consistent with hypotheses regarding the significance of mesolimbic dopamine overactivity in schizophrenia. New results are also presented from animal model studies of the effects of serotonergic drugs on startle habituation, extending earlier findings of LSD-induced habituation deficits which are similar to those exhibited by schizophrenic patients. These new data indicate that the serotonergic system, working through serotonin-2 receptors, may play a pivotal role in the modulation of startle habituation. The relationship of serotonergic and catecholaminergic mechanisms is also discussed. Collectively, these studies demonstrate the utility of operationally defined measures of preattentive processes in the study of the neurobiological basis of the group of schizophrenias.

Treatment of schizophrenia

Abstract: Antipsychotic medication remains a mainstay of treatment in both acute and chronic schizophrenia. Emphasis in recent years has focused on maximizing benefits and minimizing risks of medication by attempting to establish minimum effective dosage requirements for all phases of treatment and to provide alternative strategies for individuals who fail to benefit from antipsychotic drug treatment. At present all approaches to the treatment-refractory patient remain experimental, and further research in this area is of critical importance. Definite advances have been made in exploring the impact of psychological and psychosocial treatments administered in conjunction with various antipsychotic drug strategies. More sophisticated and comprehensive assessment measures have been applied in long-term treatment trials, enabling us to be more specific about treatment goals and treatment evaluation. Although no major "breakthrough" has occurred in the treatment of schizophrenia, incremental advances which can reduce rates of relapse and rehospitalization, improve the quality of adaptation, and reduce the risk of significant adverse effects are of enormous importance to affected individuals, their families, and society at large.

Early Indicators of Developmental Risk: Rochester Longitudinal Study

Abstract: Early indicators of schizophrenic outcomes were sought in a group of children of chronically ill schizophrenic women. A sample of pregnant women with varying degrees of mental illness were examined during the perinatal period and recruited into a 4-year longitudinal evaluation, which included cognitive, psychomotor, social, and emotional assessments at birth, 4, 12, 30, and 48 months of age. The mothers varied on mental health dimensions of diagnosis, severity of symptomatology, and chronicity of illness. Other factors included in the analyses were socioeconomic status (SES), race, sex of child, and family size. Hypotheses were tested to determine the relative impact of three sets of variables on the child's behavior: (1) specific maternal psychiatric diagnosis, (2) severity and chronicity of disturbance independent of diagnosis, and (3) general social status. We found that a specific maternal diagnosis of schizophrenia had the least impact. Neurotic-depressive mothers produced worse development in their children than schizophrenic or personality-disordered mothers. Both social status and severity/chronicity of illness showed a greater impact on development. Children of more severely or chronically ill mothers and lower-SES black children performed most poorly. These results do not support etiological models based on simple biological or environmental transmission of schizophrenia. The role of social and family environmental factors in predicting child cognitive and socialemotional competence was further evaluated using a multiple risk index. Children with high multiple environmental risk scores had much worse outcomes than children with low multiple risk scores. We have been conducting a longitudinal study since 1970 that investigates the role of parental mental illness, social status, and other family cognitive and social variables that might be risk factors in the early development of children from birth through 4 years of age. Our investigation was cast as an attempt to identify variables that place a child at risk for the later development of schizophrenia. The target population was the offspring of schizophrenic women, who have been shown to be more than 10 times

The Disorder of Consciousness in Schizophrenia

Abstract: The schizophrenic experience is described as an inability to sustain an intentional focus to attention. Attention is captured by incidental details in the schizophrenic patient's environment, and this gives rise to a spurious sense of significance. The patient's inability to direct a train of thought prevents full access to long-term memory so that early components of perception, which are designed to give early warning . of threat, are overly influential and unmodulated by further mental processing. These hasty ideas are given delusional conviction when they capture attention and induce a sense of significance similar to the false significance of perception. The schizophrenic patient's lack of control over his mental processes makes him passive in relation to his own thinking. It prevents him from attending to the slight promptings of his subconscious, and when these emotions and intuitions are not amplified by being brought into focus, he loses a sense of himself. There have long been reports in the literature, both from clinicians (McGhie and Chapman 1961; Chapman 1966) and from patients themselves (MacDonald I960), that people with schizophrenia have difficulty filtering out irrelevant stimuli and controlling what they pay attention to:

Recent Studies of Psychophysiology in Schizophrenia

Abstract: Eye movement dysfunctions have been shown to be reliably associated with schizophrenia as a trait, suggesting disorders of nonvoluntary attention in association with those brain areas involved in smooth pursuit and saccadic eye movements. The familial distributions of the eye movement dysfunction and of schizophrenia, when considered together, suggest the existence of a latent trait whose transmission fits an autosomal dominant transmission mode. Chronic schizophrenic patients show diminished variation and shorter latencies of early components of somatosensory brain related potentials, which reflect stimulus registration, and investigators have interpreted the finding as indicating impaired modulation of stimulus input, which allows too much information to reach higher brain centers. Laterality differences, in which the left hemisphere may be less efficient than the right, have also been reported. Schizophrenic patients show reduced amplitudes of later component waves of event related potentials, a finding that has been interpreted as reflecting impaired selective attention. The issue of whether these deviations are state or trait related has not yet been resolved. Directed attention in the form of vigilance shows significant performance impairment, as measured by the continuous performance test and the span of apprehension, not only in schizophrenic patients but in some populations at high risk for schizophrenia. Studies of backward masking suggest that the time taken to transfer a stimulus from the stage of registration to short-term memory may be slowed in schizophrenia, although other interpretations are possible. Skin resistance orienting responses are absent in about 50 percent of adult schizophrenics, and there is some evidence that this absence may reflect a trait. Studies should now test the trait status of all these psychophysiological variables and probe into the significance of the measures used. In these efforts, both the testing of first degree family members and the standardization of testing techniques are recommended.

Clinical Genetics as Clues to the "Real" Genetics of Schizophrenia: (A Decade of Modest Gains While Playing for Time).

Abstract: Although a decade has passed since the genetics of schizophrenia was examined for the Schizophrenia Bulletin, the epigenetic puzzle of schizophrenia has not yielded its secrets to any scientific break-through. In this article we review a sample of the highlights relevant to enlightened genetic thinking, i.e., a broad diathesis-stressor framework with multifactorial causation assumed and with provision for the epigenetic interaction of psychosocial as well as neurobiological factors. The clinical genetic epidemiologist needs to know the lifetime morbid risks generated by different definitions of schizophrenia, as well as the consequences for the familial risks generated by the various family, twin, and adoption strategies. Schizophrenia appears to occur through an interaction of a genetic susceptibility with some kind of environmental stress; the stress need not be an environment containing a person with a diagnosis in the schizophrenia spectrum; the genetic factors in schizophrenia have specificity as they do not increase the risk for major affective disorders or delusional disorder. Clearly, schizophrenia is clinically or phenotypically heterogeneous, but whether this variety is paralleled by etiological heterogeneity or to what extent is problematic. Once the existence of an important genetic predisposition to developing schizophrenia has been established, it becomes important to provide a theory (or theories) to account for its mode (modes) of transmission. Psychiatric geneticists have not yet solved the problem, in part because of the difficulty of specifying the appropriate phenotype to analyze and also because of the unknown degree of heterogeneity. Genetic markers are a special category of biological markers. In addition to conventional markers, the advent of "the new genetics" of recombinant DNA has meant that many more genetic markers (probes) are now available and that the day is not far off when the human genome will be extensively mapped. Considerable optimism exists about the future usefulness of genetic markers in detecting major gene effects and resolving problems of heterogeneity in schizophrenia.

The Search for Symptoms Predictive of Schizophrenia.

Abstract: Of several scales developed in our laboratory for identifying psychosis-prone young adults, the most promising appears to be the Perceptual Aberration-Magical Ideation Scale. High-scoring subjects (2 SD greater than the mean) report many psychotic-like and isolated psychotic symptoms. Subjects were seen for a followup interview 25 months after the initial identification and interview. Three of 162 high-scoring perceptual aberration-magical ideation subjects reported having received their first clinical attention for psychosis during the followup period. Additional measures are being used in attempts to eliminate the false positives as well as to distinguish persons prone to schizophrenia from those prone to affective disorder with psychosis.

Schizophrenia and the Hippocampus: The Embryological Hypothesis Extended

Abstract: Recent studies suggest that consistent structural changes exist in the hippocampi of schizophrenic patients. These alterations are characterized by a significant degree of disorientation of the hippocampal pyramidal cells when compared with age-matched nonschizophrenic controls. The degree of neuronal disorientation seems to correlate positively with the severity of the clinical picture. A hypothesis on the pathogenesis of this process, suggested in an earlier article, is extended here. Putative maternal infection with one of several neuraminidase-bearing viruses, especially during the second trimester of pregnancy, may severely affect the migration of primitive neurons into the primordial hippocampus. The "neuraminidase effect," expressed through alteration of the normal sequential patterns of N-CAM (neuronal-cell adhesion molecule) maturation, may result in the cellular disarray we have noted. This alteration may prove useful as a cell marker for schizophrenia, even though its actual relation to clinical symptomatology has still to be evaluated. Genetic factors also are believed to be involved, perhaps in the form of certain patterns of reduced immunocompetence, which might render the mother more susceptible to viral infection.

Infant Predictors of the Longitudinal Course of Schizophrenic Development

Abstract: This study was begun in 1952 to test the hypothesis that specific neurointegrative disorders in infancy predict vulnerability to later schizophrenia and schizotypal disorder. Twelve offspring of chronic schizophrenic mothers and 12 controls from similar low socioeconomic status (SES) backgrounds have been studied since their births in 1952-53 and 1959-60. The infants were ranked according to the severity of their neurointegrative disorder, or "pandysmaturation" (PDM), based on analysis of Gesell tests and physical growth measures repeated 10 times between birth and 2 years. Twenty-three subjects (96 percent) completed all 10-, 15- and 20/22-year followup examinations. PDM was significantly related to maternal schizophrenia but not to obstetrical complications, SES, sex, or ethnic background. The severity of PDM was significantly related to the blind evaluations of the severity of psychopathology at 10 years. One 26-year risk subject has been chronically schizophrenic since age 17. The author, nonblind, provisionally diagnosed six other risk subjects as schizotypal or paranoid personality. All seven had PDM; six required 6 to 18+ years of treatment; four with "negative" symptoms remain severely impaired. All six sick subjects had severe social-affective symptoms by 3-6 years of age; four had perceptual deficits by 2 years. Some social-affective, cognitive, academic, and vocational impairments included in the "negative" symptoms and "process" traits of schizophrenia had antecedents before 2 years of age. Primary prevention requires research into the mechanisms underlying these dysfunctions in infancy.

Genetic and Psychosocial Factors in Schizophrenia: The Finnish Adoptive Family Study

Abstract: A nationwide Finnish sample of schizophrenic mothers' offspring given up for adoption was compared blindly with matched controls (i.e., adopted-away offspring of nonschizophrenic biological parents). The offspring were born 1927-79. To date, a total of 247 adoptive families (112 index and 135 controls) have been investigated and rated. Of the 10 psychotic case's, 8 are offspring of schizophrenics and 2 are control offspring. However, no seriously disturbed offspring is found in a healthy or mildly disturbed adoptive family, and of those offspring who were psychotic or seriously disturbed, nearly all were reared in disturbed adoptive families. This supports the hypothesis that a possible genetic vulnerability has interacted with the adoptive rearing environment.

The Copenhagen High-risk Project, 1962–86

Abstract: Since 1962 we have followed a sample of 207 children at high risk for schizophrenia as well as 104 control children. For these individuals, the following factors and their interaction are related to an increased risk for schizophrenic breakdown: (1) greater schizophrenia family backgrounds, (2) perinatal trauma, and (3) unstable parenting and public institutional child care. The perinatal difficulties are positively related to adult periventricular atrophy. Results of a subsequent study tentatively suggest that part of the neurological deviance in schizophrenia may be produced by disruption occurring in the second trimester of fetal development.

The New York High-risk Project: A Followup Report

Abstract: The New York High-Risk Project began in 1971 as a prospective, lon- gitudinal study of (1) children of one or two schizophrenic parents and (2) comparison groups of chil- dren whose parents had other or no psychiatric disorders. The former were examined because they were known to be at high risk—some 10- 25 percent for children with one af- fected parent and 35-45 percent with two affected parents—for de- veloping schizophrenia or schizo- phrenia spectrum disorders during adolescence or adulthood (Erlen- meyer-Kimling 1977; Gottesman and Shields 1982). Children of par- ents with affective disorders were included because we wished to de- termine whether variables that might differentiate the children of schizophrenic parents from the chil- dren of normal parents also dif- ferentiated them from children of parents with other psychiatric disorders. Major goals of the program were (1) identification of biological and behavioral indicators of a genetic li- ability to develop schizophrenia and (2) longitudinal followup of the subjects to assess the predictive va- lidity and specificity of variables tentatively flagged as early indica- tors. Other goals have included evaluation of the developmental course of such variables and docu- mentation of the history of the de- velopment of schizophrenic disorders.

Review of the NIMH Israeli Kibbutz-city Study and the Jerusalem Infant Development Study

Abstract: The National Institute of Mental Health (NIMH) Israeli Kibbutz-City Study has followed the development of offspring of schizophrenic parents from middle childhood through early adulthood. During childhood, a subgroup of offspring of schizophrenic patients showed clear neurobehavioral deficits often accompanied by poor social competence. Early followup data suggest that this subgroup of high-risk children is at greatest risk for adult schizophrenia spectrum illness. The Jerusalem Infant Development Study has followed a similar population of children at risk for schizophrenia from before birth through middle childhood. A subgroup of dysfunctioning in the high-risk children showed sensorimotor dysfunctioning in the first year of life, which was followed by perceptual, motor, and attentional dysfunctioning in childhood--identical to that found in the NIMH cohort. Results from both studies support the hypothesis that schizophrenic illness involves constitutional factors whose expression can be observed as early as infancy. Results also illustrate the importance of using data-analytic approaches that (1) look for subgroups within high-risk groups rather than only group differences between high- and low-risk groups, and (2) examine profiles of behavior rather than only single variables.

Biological Studies in Schizophrenia

Abstract: The question of whether schizophrenia is associated with structural or functional abnormalities of the nervous system, or both, has become the principal focus of biological studies of schizophrenia. Computed tomography studies have revealed ventricular enlargement and cortical atrophy in a subgroup of schizophrenic patients. While present from the early stages of the illness, they appear to be most severe in patients with negative symptoms and poor outcome. Quantitative neuropathological studies have tentatively demonstrated decreased volume of specific brain areas, neuronal loss, and other changes in the limbic system, basal ganglia, and frontal cortex. Dopamine (DA) remains the neurotransmitter most likely to be involved in schizophrenia, although there is also evidence for disturbances of serotonin and norepinephrine. Post-mortem and positron emission tomographic studies suggest an increased number of D2 DA receptors in some schizophrenics. Neuroendocrine studies reinforce the role of DA in schizophrenics. Viral infections and autoimmune disturbances may be responsible for some types of schizophrenia, but there is no firm experimental evidence to support either hypothesis. The possibility that mixtures of structural abnormalities and functional changes involving DA occur in the same patients rather than independently as part of two syndromes (Type I, II) seems attractive. Future studies should identify subtypes of schizophrenia based on biological criteria and contribute to identification of specific genetic abnormalities which increase vulnerability to manifest the schizophrenic phenotype.

Elevated Thalamic Dopamine: Possible Link to Sensory Dysfunctions in Schizophrenia

Abstract: Sensory-processing dysfunctions, deficit states, and the combinations of seemingly disparate behavioral symptoms of schizophrenia are addressed with regard to a common thread--the possibility of dysfunctional processing in the thalamus. Recent views of the connectional neuroanatomy and electrical activity of thalamus are examined. A hypothesis is presented in which disturbances in the timing and phasic neuronal activity of the thalamus and, especially, its connections with other brain regions may result in many of the behavioral manifestations of schizophrenia. It is suggested that neurotransmitter or other chemical imbalances might produce such thalamic disturbances. Experimental findings of enhanced dopamine content in the thalami of schizophrenic patients are reported. Several varieties of distributional patterns of this elevated dopamine are shown and evaluated.

The diagnosis of schizophrenia.

Abstract: Diagnosis refers to developing the best methods for classifying disorders and for identifying their characteristic symptoms. Most importantly, however, diagnosis refers to the identification of particular disorders that differ in their underlying mechanisms and causes, and therefore defines them as discrete diseases. Most current work on schizophrenia attempts to identify the best ways to classify it and the best ways to identify and define its characteristic symptoms to improve the ongoing search for mechanisms and causes. One idea that is currently widely discussed is the distinction between positive or florid symptoms and negative or defect symptoms. Much more research needs to be done on this model, however, and we need many more studies that attempt to integrate biological research with the careful work that has been done to date on clinical description. The astute modern investigator must be able to move freely between the biotype and the phenomenotype if he or she is to understand fully the clinical picture and ultimately the cause of schizophrenia.

Expressed Emotion: A Family Perspective

Abstract: Although mental health professionals have shown much enthusiasm for the concept "expressed emotion (EE)," little critical analysis of the concept has appeared in the literature. Placing families in dichotomous categories of high EE and low EE amounts to stereotyping; such an approach does little to help professionals in understanding the complexities of family life with a mentally ill relative. High EE is seen as a factor that maintains mental illness in a relative. Once more, families feel hurt and alienated. Once more, families feel negatively labeled, but not empathically understood.

Functional and Anatomical Brain Imaging: Impact on Schizophrenia Research

Abstract: A group of related new technologies has made it possible to study the brain's regional changes in metabolism, blood flow, electrical activity, and neurochemistry. Positron emission tomography (PET) produces slice images of radioisotope density--brain metabolism or receptor concentration can be quantitated. Studies in schizophrenia have indicated relative metabolic underactivity of the frontal lobes of schizophrenics. Decreased activity in the basal ganglia, which can be reversed with neuroleptic treatment, is also seen in schizophrenia. PET studies are in the early stages; standard methodology for isotope selection, task during tracer uptake, and quantitative analysis is still developing. Cerebral blood flow studies have shown similar patterns in the cortical surface. The electroencephalogram provides a short time resolution approach which can assess attention and arousal, but lacks some of the anatomic exactness and depth capabilities of PET. Magnetic resonance imaging furnishes anatomical images of gray and white matter previously unavailable with x-ray computed tomography. Advances in methodology and clinical studies with imaging are making neuroanatomic theories of schizophrenia more directly testable than ever before.

Risk Factors in Schizophrenia: The Stony Brook High-risk Project

Abstract: The goals of the Stony Brook HighRisk Project are to identify precursor patterns, environmental stressors, and protective factors that are differentially predictive of psychopathology. In phase I we assessed 219 families and 544 children aged 7-15, including 31 families and 80 children with a schizophrenic parent, 70 families and 154 children with a unipolar depressed parent, 58 famines and 134 children with a bipolar parent, and 60 normal control families with 176 children. A 3-year followup was conducted on 84 percent of the sam

Role of the Thalamus in Language: Is It Related to Schizophrenic Thought Disorder?

Abstract: Crosson (1985) proposed a model for language production which integrated cortical with subcortical functions. The implications of this model for schizophrenia are explored. One conclusion is that neural systems, as opposed to a single neural focus, account for schizophrenic symptoms. In this light, data regarding dysfunction in the limbic system, nucleus accumbens, globus pallidus, and prefrontal cortex, which are often seen as contradictory, can be viewed as complementary. Another conclusion is that Crosson's model may have implications specific to schizophrenic thought disorder. Random triggering of semantic segments and inability to maintain contextual referents are discussed in the context of the language production theory.

Animal Models for Schizophrenia: The Hippocampally Lesioned Animal

Abstract: Animals with hippocampal lesions are evaluated as models for schizophrenia according to the criteria of McKinney and Bunney (1969). They seem to comply adequately with the following requirements: similarity of inducing conditions; similarity of behavioral states; similarity of underlying neurobiological mechanisms; and reversibility by usual pharmacological treatment. The model seems adequate to reproduce several symptoms of the disorder, offering a good experimental tool for the analysis of its inducing conditions, affected neurobiological mechanisms, and clinical treatment.

The UCLA High-risk Project

Abstract: The UCLA High Risk Project studied a cohort of 64 families over a 15-year followup period. At entry to the study, the families each contained one adolescent who was having behavioral difficulties for whom help was sought from a psychological clinic. Two criteria of the degree of risk for schizophrenia were devised initially, one based on the form of the adolescent's problem and the other on the parental attributes of communication deviance (CD), affective style (AS), and expressed emotion (EE). It was hypothesized that schizophrenia would be the likely outcome when certain patterns of adolescent disturbance and negative communicational and affective patterns were present in the family. The index offspring of 54 of the 64 families were successfully followed up over the 15-year period (mean age = 30 at last followup), and blind psychiatric diagnoses were done. Contrary to the initial hypothesis, the form of the adolescent problem had limited prognostic value; however, the combination of CD and AS correctly identified the overwhelming number of cases who developed schizophrenia and related disorders. CD did even better if the dependent variable was the risk for schizophrenia spectrum disorder in any offspring in the family.

Studies Toward the Subcortical Pathogenesis of Schizophrenia

Abstract: In addition to introducing the six articles joined by our thematic outlook, this article addresses the importance of subcortical structures as they may be related to information processing and the life experience of schizophrenic patients. This is a heuristic exercise aimed at bridging the conceptual gaps between clinical and research approaches to schizophrenia. A brief overview is then provided of current conceptualizations of a number of subcortical structures, each of which may play a part in the subcortical pathogenesis of schizophrenia in specific patients. The central concepts are failures in the "automaticity" with which prior experience may be recreated in parallel with current stimulus input in schizophrenia (with concomitant failures in future orientation or contextually generated expectancy), and the view of subcortical structures as constituting a "system" in which no single type of defect may be common to all schizophrenic patients.

Emory University Project on Children of Disturbed Parents

Abstract: Young children (from birth to 5 years of age) of schizophrenic , depressed, and well mothers were studied to assess their intellectual, social, and neuropsychiatric functioning. The sample derived from predominantly black, low-income, single-parent families. An extensive battery of laboratory and homebased tests was administered three times, each 1 year apart, to test the stability of findings. Schizophrenic offspring, as a group, had more problems than others. They showed more deficits on social competence, had lower IQ's (the youngest children only), and were overrepresented in the group of children with multiple negative indices. However, both schizophrenic offspring

Social Functioning of Schizophrenic Patients: Clinical and Research Issues

Abstract: Social dysfunction is generally considered an essential feature of schizophrenia. However, despite considerable interest in the social functioning of schizophrenic patients, the precise nature of the social deficits exhibited by these patients remains unspecified. No widely accepted criterion of social competence has been used to investigate their social functioning. Also, social skills researchers have often failed to recognize the heterogeneity of schizophrenia and the impact that this heterogeneity may have on attempts to implement psychosocial interventions. The adverse findings regarding the social behavior of schizophrenic patients are reviewed. Factors relating to schizophrenia that may affect their social functioning are discussed, as are directions for future research that may lead to more effective psychosocial interventions for schizophrenia.

Orienting Response Research in Schizophrenia: Where We Have Come and Where We Might Go

Abstract: This review and critique of orienting response (OR) research in schizophrenia examines the initial Western work, outlines current positions, and notes several areas in which further lines of research are needed. Discussion involves characteristics of schizophrenic patients who are OR nonresponders; OR nonresponding as a possible trait marker; the question of OR nonresponding in child patients; the association between negative symptoms and OR nonresponding as well as the possible existence of a specific subgroup marked by emotional withdrawal and cognitive disorganization; slow habituation as a prognostic index in high-risk children and adult acute patients; the need for research into defensive and startle responses as well as the OR, and possible interactions among them; electroencephalographic-autonomic differences in OR; and the need to explore the functional meaning of OR nonresponding in schizophrenia.

Swedish High-Risk Study: Sample Characteristics at Age 6

Abstract: High-risk offspring of women with a history of nonorganic psychosis and control offspring of women with no history of psychosis were studied from the mother's pregnancy through 2 years of age and followed up at 6 years of age. The mothers tended to be older and have somewhat higher parity than did Swedish mothers in general. Sample attrition during the 6-year longitudinal period was significantly higher in the high-risk than the control sample, and selective in both groups. A limited set of early-life variables, investigated prospectively, was selected for studying the antecedents of mental disturbance in the offspring at 6 years. In the high-risk group, disturbance in the offspring was related to maternal anxiety during pregnancy, negative maternal attitude toward pregnancy, and maternal psychotic condition during the period from 6 months to 2 years post-partum, and tended to be related to low social class, male child, active maternal-mental disturbance during pregnancy, prolonged labor and low Apgar score at delivery, neonatal neurological abnormality, and anxious attachment to the mother at 1 year of age. None of these relationships (except low social class) appeared in the control group, and no significant antecedents of mental disturbance in control offspring were found among the limited set of variables studied in these analyses.

Living With the Mentally Ill: Factors Affecting Household Complaints

Abstract: Data provided by case managers in community support programs are used to analyze the problems of families providing shelter to mentally ill relatives. Factors affecting complaints in 345 family households are contrasted with factors leading to complaints in a subsample of 622 other residential alternatives. Behavioral problems are the best predictors of complaints from all households regardless of type, but some causal factors identified are unique to family residences, notably failure to perform household chores and infrequently socializing with friends. Active and passive rule violations, encompassing both do's and don'ts, are more important than clinical history and social background in understanding complaints.