Schizo-affective symptomatology in late life.

Abstract

Kasanin (10) seems to have been the first author to use the term 'schizo-affective psychosis'. He drew attention to Lange's observations of catatonic features in mania, and to Claude's concept of 'schizomanie’. The case records of his young and acutely ill patients make one wonder, however, whether Kasanin had been sufficiently ready to recognize mixed manic-depressive states. Arising from the study of more prolonged illnesses, the Kleist-Leonhard school attempted to construct a number of sub-categories of schizophrenia in order to accommodate ‘cycloid’ cases. In this country, the term 'schizo-affective’ is at the present time in bad odour. Aubrey Lewis (11), employing very searching criteria, discovered schizophrenic symptoms in 23 of his 61 patients with affective psychoses, but derived them from hereditary and personality factors. Both Batchelor (2) and Mayer-Gross, Slater, and Roth (13), while admitting the occasional co-existence of manic-depressive and schizophrenic psychoses largely ascribed to mixed inheritance, have indicated that the schizo-affective label could be avoided by a more rigorous diagnostic approach and follow-up. These were employed recently by Clayton et al. (6), and of 39 schizo-affective patients 33 were re-assessed after at least one year; only 13 were still ill; and although 5 of them continued to show some schizophrenic symptoms, the authors interpreted their findings to indicate that schizophrenic deterioration was not a usual result of schizo-affective illness. Moreover, the family histories suggested a very strong relationship with ordinary affective illnesses rather than with schizophrenia or schizo-affective psychoses. These workers did not, therefore, confirm the claims of others (e.g. those arising from Mitsuda's (14) twin studies) to the effect that atypical psychoses were in a genetically different category from schizophrenia and manic-depression. The concept of 'schizo-affective’ has been devastatingly criticized by Foulds and Caine (7) on logical grounds.