Course Of Schizophrenic Illness Research Articles

Ventricular enlargement, neuropsychological status, and premorbid function in schizophrenia

Ventricular enlargement is one of the most consistently documented neurobiological abnormalities in schizophrenia. The timing of the development of this abnormality in the course of schizophrenic illness and its relationship to neuropsychological dysfunction and premorbid adjustment is, however, unclear. To address these questions, we examined the relationship between ventricle-brain ration (VBR), premorbid adjustment, and neuropsychological function, in 23 acutely exacerbated chronic schizophrenic inpatients. We obserged that larger ventricles were associated with better current neuropsychological test performance, better premorbid cognitive ability, greater cognitive deterioration, better childhood premorbid social function, and greater decline in social function from premorbid levels. These data suggest that at least two developmental processes may operate in the genesis of cognitive and social dysfunction in schizophrenia: (1) childhood onset associated with poor premorbid childhood function, low educational achievement, lower intelligence quotient (IQ) and variably with VBR; and (2) adolescent onset associated with relatively normal childhood social function, higher academic achievement and IQ and increased VBR. Ventricular enlargement may reflect a late developmental or degenerative pathological process in schizophrenia.

Therapist-patient relationship as a predictor of the course of schizophrenic illness

SummarySchizophrenic patients seem to react sensitively to expressed affect. Expressed emotion research has shown the negative impact of specific family communication styles on the course of illness. Further studies have discussed its relation to gender. This study examines the dyadic aspects of the therapist-patient relationship, the interaction between therapist's ratings and patient's psychopathology, and the predictive value concerning the course of illness. Results show a significant association with gender. Male therapists were inclined to reduce their therapeutic commitment when being confronted with patients who suffered from disturbances Of ego-function, attention, or perception. Female therapists felt rejected by patients with delusions and with formal thought disorders, but perceived themselves as competent when dealing with anergic patients. Furthermore, patients with a less favorable course of illness at the 2-year follow-up could be discriminated by the quality of the therapist-patient relationship at the end of the primary therapeutic intervention.

The Vermont longitudinal study of persons with severe mental illness, I: Methodology, study sample, and overall status 32 years later.

The authors report the latest findings from a 32-year longitudinal study of 269 back-ward patients from Vermont State Hospital. This intact cohort participated in a comprehensive rehabilitation program and was released to the community in a planned deinstitutionalization effort during the mid-1950s. At their 10-year follow-up mark, 70% of these patients remained out of the hospital but many were socially isolated and many were recidivists. Twenty to 25 years after their index release, 262 of these subjects were blindly assessed with structured and reliable protocols. One-half to two-thirds of them had achieved considerable improvement or recovery, which corroborates recent findings from Europe and elsewhere.

Beyond diagnosis: the phenomenology of schizophrenia.

The authors believe that sharp distinctions of schizophrenia based on cross-sectional signs and symptoms provide the basis for precise and reliable diagnoses, but they do not believe that diagnoses derived from a narrow descriptive base are generously informative on the broad range of human functioning vulnerable to impairment in the course of schizophrenic illness. They comment on the 12-point flexible diagnostic system, illustrating the strengths and weaknesses of well-defined but narrow models for diagnosis, and on the results of testing the predictive validity of several diagnostic approaches. Finally, they contrast the phenomenologic approaches to schizophrenic illness with modern-day descriptive psychiatry, noting implications for clinical practice.

Influence of Family Life on the Course of Schizophrenic Illness

Much of the literature on the family of the schizophrenic patient has suggested that a number of common features are present in the personalities of the parents, and that these are significant in the aetiology of the illness. Most studies have been con cerned with the parent-child relationship and only a few with the adult patient and his parents. Tietze's description of mothers as generally over-anxious, obsessional, and domineering is typical (Tietze, 1949); and Fromm-Reichmann (1948) coined the term schizophrenogenic to describe such women. The more systematic work has indicated a high frequency of domineering and over-solicitous be haviour among mothers (Mark, 1953; Freeman and Grayson, 1955; Gerard and Siegel, 1950; Kohn and Clausen, 1956). Two studies, however, have pro duced negative evidence (Neilsen, 1954; Hotchkiss, Carmen, Ogilby, and Wiesenfeld, 1955) and the second of these was the only one in which the behaviour of the mother and patient was directly observed. Even if differences exist between the mothers of schizophrenics and other mothers, this need not be of aetiological importance. The possibility must first be excluded that behaviour such as over protectiveness may be the result of the patient's unusual behaviour influencing the parents (Kasanin, Knight, and Sage, 1934). Once an illness has developed in one member of a family, a heightened level of tension is probably common. Once estab lished, tense relationships in turn may have an important effect on the later stages of the illness. Some evidence that family relationships can in fluence the course of schizophrenia was provided by a previous study, which showed that re-admission of long-stay patients was related to the type of living group to which they returned (Brown, Carstairs, and Topping, 1958; Brown, 1959). Patients who lived with wives and parents showed a higher re-admission rate than those going to brothers, sisters, or more distant kin, or in lodgings. There was evidence that the risk of deterioration in clinical condition was increased when prolonged contact with close rela tiv s in the house was unavoidable?when, for example, both patient and mother were unemployed. Results could not be explained entirely by the length or past severity of illness or by differences in clinical condition at the time of discharge; and it was concluded that it might not always be best for the schizophrenic patient to return to the close emo tional ties of affection or hostility often found in parental and marital homes. These close emotional ties are not, of course, confi ed to households of any particular kinship, c tegory. It was therefore decided to continue the work by studying the relationships within each home to which discharged patients returned. The majority of patients in this second study were short-stay schizophrenics, and a different survey method was used. Patients and their families were interviewed at the time of discharge and during the year, if the patient was re-admitted, as well as at the end of the follow-up period. In this way the difficulties inherent in the previous exploratory survey, which relied on one interview at the time of follow-up, were avoided. In particular, since patients and families were seen at discharge, predictions could be made about outcome which were not influenced by knowledge of the later course of the illness; and the clinical condition of patients (assessed at the time of discharge) could be controlled in testing the pre dictions. The two hypotheses were: