Multiple approaches to treatment in schizophrenia and discussion of indications.

Abstract

1. Schizophrenia is a disease of unknown etiology. It appears to be multifactorial in origin, and may represent a group of diseases with similarity in clinical mental symptomatology, but with a wide range in prognosis. 2. The great variety of benign and malignant forms of schizophrenia require that we define as many objectively verifiable aspects of the disease as possible, and determine the spontaneous recovery potential for all of the resulting subgroups based on as many objectively measurable variables as are or may become available. 3. Variables affecting prognosis favorably are: recent onset, high intelligence, relatively unimpaired capacity for abstract categorical thinking, good educational background, better than average occupational status, stress-induced onset, and autonomic reaction pattern (adrenalin-mecholyl test pattern) similar to that of depressions. 4. Apparently schizophrenic illnesses in highly intelligent adolescents (pseudoschizophrenic neuroses) respond well to psychotherapy. 5. Schizophrenic patients showing an adrenalin-mecholyl test pattern similar to that of depressions respond well to electroshock therapy. 6. Patients with epinephrine-precipitable anxiety do better with insulin and the new drugs. 7. Response to all types of treatment declines with duration of illness, most markedly for the shock and coma therapies, somewhat less for the drug therapies and for psychotherapy, least for frontal lobotomy. 8. Recovery rates (complete and/or social recovery) obtained spontaneously as well as on various treatment regimens (intensive psychotherapy, electroshock therapy, insulin coma therapy, tranquilizing drug therapy and frontal lobotomy) at the various levels of duration of illness are given. 9. A practical treatment program is formulated based on the findings presented.