The group of schizoaffective and related psychoses: IV. A family study

There is increasing evidence that numerous affective symptoms are present during every stage of schizophrenia, often persisting throughout the patient's schizophrenic life.This study has shown that sick first-degree relatives have manifested a very similar clinical picture, course and outcome as the probands.Since the course of illness in both probands and relatives was chronic psychotic and deteriorating, it was characteristic of schizophrenia and not of affective disorder.Neither the presence of numerous affective symptoms, nor the family study indicated the presence of schizoaffective psychosis as a diagnostic entity.We suggest, therefore, that the term “undiagnosed” rather than schizoaffective psychosis be used when encountering acute cases of psychotic and affective symptoms.The methodological shortcomings of this study were discussed.     

Reactions to hospitalization: Passive dependency factors. Recurrence of original symptoms and attempts to prolong hospitalization on the announcement of discharge

Thus, 25 out of 95 patients showed recurrence of original symptoms, 24 developed new symptoms, 57 attempted to prolong hospital stay, while 71 showed separational anxiety in the predischarge period. In patients who showed the symptom recurrence, most patients (24 out of the 25) showed recurrence of their major symptom complex. Thus, 1 out of 4 patients showed symptom recurrence with $\text{1}\text{4}$ of these recurrences being of moderate degree. One out of four patients developed new symptoms in the predischarge period, the majority of these symptoms were somatic in nature.     

Humanizing the student-cadaver encounter

In a recently accredited medical school, the curriculum, which emphasizes the psychologic and social aspects of disease, includes innovative features aimed toward training students to provide humanistic health care in underserved areas. As part of this curriculum, an educational experiment was designed to explore issues concerning the medical student's first exposure to a cadaver. The authors describe the experiment as it evolved over a three-year period, and they discuss its value based on student evaluation and faculty opinion.     

Obsessive compulsive disorder

Centuries ago, obsessive compulsive disorder (OCD) was considered the result of possession by outside forces and was treated by witch doctors or religious leaders who tried to rid the patient of his tormenting invader.¹ Even though our knowledge has increased considerably, OCD is still probably the least understood of all the major psychiatric syndromes.     

Heatstroke in a chronic schizophrenic patient treated with high-potency neuroleptics

A fatal case of heatstroke occurred in a chronic schizophrenic patient treated with high-potency neuroleptics. The author differentiates heatstroke from other hyperthermic syndromes related to treatment with major tranquilizers and suggests that an awareness of factors that predispose psychiatric patients to the development of heatstroke may aid in its prevention.     

Experimental reinnervation of the rat hippocampus by grafted sympathetic ganglia. I. Axonal regeneration along the hippocampal fimbria

The effect of diphenylhydantoin (DPH) on certain synapses of neurons in the abdominal ganglion ofAplysia and on the γ-aminobutyric acid (GABA) mediated inhibitory synapse of the crayfish stretch receptor neuron (SRN) has been studied. DPH decreases the amplitude of the excitatory postsynaptic potential, but is ineffective on the “short” ACh mediated, Cl^? dependent, inhibitory postsynaptic potential (IPSP) inAplysia. However, it facilitates the “long” ACh mediated, K⁺ dependent, IPSP, in this same group of neurons. DHP has a profound effect on the GABA mediated, Cl^? dependent, inhibitory synapse of the SRN. The time course of the IPSP is prolonged up to 10 times control values, due to an increased and prolonged postsynaptic conductance. Similar results have been obtained in the SRN with iontophoretic application of GABA. This selective effect of DPH on synaptic mechanismis, especially in view of the role of GABA and ACh as putative transmitters in the mammalian an nervous system, may play an important role for the anticonvulsant action of DPH.     

The effects of response contingent parental reinforcement upon schizophrenics' learning

Forty schizophrenic and 40 non-schizophrenic male psychiatric inpatients, matched for age, intelligence, and social competence, were administered equivalent form nonsense syllable discrimination tasks under each of four conditions: an initial baseline information feedback condition, two response contingent reinforcement conditions, and a final baseline information feedback condition. Subjects of both diagnostic groups were further divided into eight groups of ten patients each. Half the groups received praise and half received censure during the response contingent conditions. In counterbalanced order, the reinforcing agent was the experimenter in one condition and a recorded voice of one of the parents in the other. Half received the mother's and half received the father's voice. Schizophrenics responded faster under experimenter than under parent reinforcement. Poor premorbid schizophrenics, making more errors than goods, responded faster under experimenter as opposed to parent reinforcement. Among non-schizophrenics, education, social competence, and I.Q. were all negatively correlated with response latency and number of errors. Among schizophrenics, the higher the I.Q., the fewer the errors and the shorter the response latency, except when such subjects were reinforced by their parents. Then no significant relationship existed. Marital status, however, was significantly related to performance, with unmarried status positively correlated with slower response to parents. All subjects responded more quickly and accurately in the final than in the first baseline condition regardless of diagnosis or interpolated reinforcement experiences. Data were interpreted as providing limited support for the social censure hypothesis of Garmezy and his colleagues, but as consistent with recent formulations concerning the schizophrenic patient in relation to his family.     

X-chromosome threshold models of bipolar manic-depressive illness

The hypothesis of single X-locus two alleles transmission of manic-depressive illness (BP and UP forms) has been tested with a comprehensive genetic model. The model takes into account the prevalence and type of illness in all categories of first degree relatives of the patients according to sex. It makes provision for the posibility of phenocopies, multiple manifestations of the genotypes for affective illness and explicity specifies threshold effects which might affect penetrance and determine polarity of illness, it test also for a dominance variance.

Three threshold models were applied to three sets of family data from the literature: Winokur (1969), ¹ Mendlewicz (1974), ⁴⁴ Gershon (1975), ³ These three models are: (a) a single threshold model with UP relatives considered in the same class as normal relatives so that only the transmission of BP is tested in the model (Model I); (b) a single threshold for illness in the relatives considering UP equivalent to BP with regard to genetic transmission (Mode II); and (c) separate thresholds for UP and BP illness in the relatives (Model III).

Each model was studied separately with or without sex effect on the position of the thresholds. For Winokur all three hypotheses gave an acceptable solution (p0.05), but qualitatively Models I and III are the best fitted to the data, the gene frequencies are 0.03 (Model I) and 0.022 (Model III). For Mendlewicz, the only testable hypothesis did not give any acceptable fit, whereas for Gershon's, Models II and III can be rejected and Model I gives a tentatively acceptable fit with a gene frequency of 0.19.

These results show that X-chromosome single-locus transmission does not consistently describe the transmission of affective illness in the families of BP probands. The different results for each author compared to the other might be due to heterogeneity of mode of transmission: certain families being strictly X-linked (Winokur) and other mixing autosomal and X-linked mode of transmission (Gershon, Mendlewicz). The implications of these results for currently available X-linkage analysis in BP manic-depressive illness is discussed.     

Lithium, red blood cell choline and clinical state. A prospective study in manic-depressive patients

Red blood cell (RBC) choline and ergothioneine levels were measured after repeated sampling of bipolar manic-depressive patients over 11 months of lithium maintenance. In addition, blood levels were measured in healthy volunteers, newly hospitalised lithium-free patients and from patients prior to, and after, initiating lithium. RBC choline levels did not differ between normal volunteers and newly admitted lithium-free patients with either mania or depression. After 4 weeks of lithium treatment RBC choline levels increased 6-fold, whereas the levels of the closely related compound ergothioneine did not change. Significant changes in mood during lithium maintenance were not accompanied by changes in RBC choline levels. These data indicate that lithium produced a specific accumulation of choline in erythrocytes. However the increased levels appear to be unrelated to clinical state and do not distinguish lithium responders from non-responders