Analysis of genetic diversity in patients with major psychiatric disorders versus healthy controls: A molecular-genetic study of 1698 subjects genotyped for 100 candidate genes (549 SNPs)

BACKGROUND

This study analyzed the extent to which irregularities in genetic diversity separate psychiatric patients from healthy controls.

METHODS

Genetic diversity was quantified through multidimensional "gene vectors" assembled from 4 to 8 polymorphic SNPs located within each of 100 candidate genes. The number of different genotypic patterns observed per gene was called the gene's "diversity index".

RESULTS

The diversity indices were found to be only weakly correlated with their constituent number of SNPs (20.5 % explained variance), thus suggesting that genetic diversity is an intrinsic gene property that has evolved over the course of evolution. Significant deviations from "normal" diversity values were found for (1) major depression; (2) Alzheimer's disease; and (3) schizoaffective disorders. Almost one third of the genes were correlated with each other, with correlations ranging from 0.0303 to 0.7245. The central finding of this study was the discovery of "singular genes" characterized by distinctive genotypic patterns that appeared exclusively in patients but not in healthy controls. Neural Nets yielded nonlinear classifiers that correctly identified up to 90 % of patients. Overlaps between diagnostic subgroups on the genotype level suggested that (1) diagnoses-crossing vulnerabilities are likely involved in the pathogenesis of major psychiatric disorders; (2) clinically defined diagnoses may not constitute etiological entities.

CONCLUSION

Detailed analyses of the variation of genotypic patterns in genes along with the correlation between genes lead to nonlinear classifiers that enable very robust separation between psychiatric patients and healthy controls on the genotype level.

Predicting response to psychopharmacological treatment: survey of recent results

INTRODUCTION

Treatment with antidepressants and antipsychotics, though effective, is unspecific as agents that differ greatly in their biochemical and pharmacological actions have virtually the same efficacy. Half of the patients with initial improvement show incomplete response, while a large proportion of patients exhibit a refractory clinical picture which is resistant to all treatment modalities.

METHODS

Our analyses were based on a reference study of 2,848 depressive inpatients under monotherapeutic treatment with 7 different antidepressants or placebo, along with a naturalistic study of depressive and schizophrenic patients (296 inpatients, 363 outpatients) under today's "standard" polypharmaceutic treatment regimens.

RESULTS

The empirical data suggested the following predictors of response: (1) severity at baseline, (2) early onset of improvement, (3) unwanted side-effects, and (4) medical comorbidity. A combination of these predictors with Therapeutic Drug Monitoring (TDM) methods has direct clinical relevance.

DISCUSSION

Evidence-based approaches to personalized treatment help improving the unsatisfactory situation patients and clinicians are faced with, given today's incomplete treatments and the fact that the mechanisms by which antidepressants and antipsychotics ultimately exert their therapeutic effects are only marginally understood.

Ethnicity-independent genetic basis of functional psychoses: a genotype-to-phenotype approach

The functional psychoses schizophrenia, schizoaffective disorder, and bipolar illness represent complex clinical syndromes that are characterized by phenotypic heterogeneity. Yet evidence from numerous studies suggests that (1) the prevalence of schizophrenia and bipolar illness is with 1% very similar across ethnicities, and (2) a strong genetic component is involved in the disorders' pathogenesis. Using data from different US-American ethnicities (77 families with a total of 17 unaffected and 170 affected sib pairs; 276 marker loci), we searched for ethnicity-independent oligogenic susceptibility loci for which the between-sib genetic similarity in affected sib pairs deviated from the expected values. Specifically, we addressed the question of the extent to which genetic risk factors and their interactions constitute multigenic inheritance of functional psychoses across populations and might constitute universal targets for treatment. Our novel multivariate genotype-to-phenotype search strategy was based on a genetic similarity function that allowed us to quantify the inter-individual genetic distances d(x(i), x(j)) between the allelic genotype patterns x(i), x(j) of any two subjects i, j with respect to n loci l(1), l(2), em leader l(n). Thus, we were able to assess the between-ethnicity, the within-ethnicity, and the within-family genetic similarities. The problem of ethnicity-independent vulnerability was addressed by treating the Afro-American families as "training" samples, while the non-Afro-American families served as independent "test" samples. We evaluated the between-sib similarities, which were expected to deviate from "0.5" in affected sib pairs if the region of interest contained markers close to vulnerability genes. The reference value "0.5" was derived from the parent-offspring similarities that are always 0.5, irrespective of the affection status of parents and offspring. We found 12 vulnerability loci on chromosomes 1, 4, 5, 6, 13, 14, 18, and 20, that were reproducible across the two samples under comparison and therefore, likely to constitute an ethnicity-independent, oligogenic vulnerability model of functional psychoses. The elevated vulnerability appeared to be unspecific and to act in such a way that exogenous factors become more likely to trigger the onset of psychiatric illnesses.

[The "Psychopathologic laboratory" at Burghölzli. Development and termination of the working relationship of C.G. Jung and Eugen Bleuler]

C.G. Jung was on the staff of the University Psychiatric Clinic in Zurich ("Burghölzli"), headed by Eugen Bleuler, from 1900 to 1909; he became a senior physician in 1905. In correspondence with Sigmund Freud, Jung claimed that he had informed Bleuler about the subject of psychoanalysis and had recruited him for the movement. In fact, it can be shown that Bleuler was familiar with Freud's publications even before Jung came to Burghölzli and that he had written a very positive review of the hysteria study. Jung received his doctorate (1902) and postdoctoral qualification as university lecturer based on Bleuler's reports to the Department of Medicine and continued to give lectures on certain recurring topics, such as the theory of hysteria, until the summer semester of 1914, well after his resignation. Minutes of department meetings that have not previously been evaluated appear to indicate that the department's rejection of the founding of a "psychopathologic research laboratory," expected by Jung,was a major factor leading to his resignation on March 7, 1909. The importance of other events for Bleuler's relationship with Jung--the unsuccessful attempt at an analytical treatment of Otto Gross or Jung's relationship with Sabina Spielrein--cannot be demonstrated based on current sources.

Development and termination of the working relationship of C. G. Jung and Eugen Bleuler 1900-1909

From 1900 to 1909, C. G. Jung was on the staff of the University Psychiatric Clinic in Zurich ('Burghölzli'), headed by Eugen Bleuler, where he became a senior physician (Sekundararzt) in 1905. Jung received his doctorate (1902) and postdoctoral qualification as a university lecturer (Habilitation) based on Bleuler's reports to the department of medicine, and he continued to give lectures on certain recurring topics, such as the theory of hysteria, until summer semester 1914, well after his resignation. Minutes of department meetings that have not previously been evaluated appear to indicate that a major factor leading to Jung's resignation on 7 March 1909 was the department's rejection of the founding of the 'psychopathologic research laboratory' that he had expected. The importance of other events for Bleuler's relationship with Jung - the unsuccessful attempt at an analytical treatment of Otto Gross, and Jung's relationship with Sabina Spielrein - cannot be determined from current sources.

Oligogenic approaches to the predisposition of asthma in ethnically diverse populations

Using the genome-wide screening data of the Collaborative Study on the Genetics of Asthma (CSGA) (226 families, 1,461 genotyped subjects, 323 marker loci) and Hutterite studies (129 families, 690 genotyped subjects, 365 marker loci), we applied a genetic similarity function in order to quantify the inter-individual genetic distances d(xi,xj) between feature vectors xi, xj made up by the allelic patterns of subjects i,j with respect to loci li, l2,..., ln. Based on this similarity function, we structurally decomposed the genetic diversity of the CSGA population in order to address the question of ethnicity-related asthma vulnerability for genetically homogenous CSGA subgroups. The question of ethnicity-independent asthma vulnerability was investigated with all CSGA families as training and the Hutterite families as replication samples. We evaluated the between-sib similarities, which were expected to deviate from "0.5" in affected sib pairs if the region of interest contained markers close to disease-causing genes. The reference value 0.5 was derived by determining the parent-offspring similarities, which are always 0.5, irrespective of the affection status of parents and offspring. We found 18 vulnerability loci on chromosomes 1, 3, 4, 5, 6, 8, 12, 13, and 14, which were remarkably reproducible in the CSGA and the Hutterite data and constituted an ethnicity-independent oligogenic model.

[The schizophrenic spectrum: an epidemiological viewpoint]

In epidemiological terms there is no clear demarcation between health and illness. This is also true for the schizophrenic spectrum, where sub-clinical (sub-syndromal, sub-diagnostic) syndromes embrace schizotypical, schizoid and paranoid personality disorders and personality features, which in the general population are much more prevalent than schizophrenias themselves. Early recognition of risk cases and mild cases is decisive for prophylaxis. Several diagnostic instruments are available for this purpose, but satisfactory confirmation of their predictive power and validity by prospective studies is lacking. Alongside traditional, clinical research on schizophrenia, future epidemiological research, focusing increasingly on the whole schizophrenic spectrum, may be expected to yield important new insights confirming a dimensional rather than a categorical distribution of traits and syndromes and providing powerful arguments against the discrimination and stigmatisation suffered by schizophrenic patients.

[Intersubjectivity and interpersonal relations of schizophrenics]

Original accounts of an introspectively and linguistically highly gifted schizophrenic woman serve as a means to reflect about the meaning of the concept of intersubjectivity in the sense of Husserl, the constitution of self and world and its failure in the schizophrenic ego disorder. Concerning general psychopathology, there can be attempted to propose a typology of disordered intersubjectivity and consequently interpersonality. Psychotherapy of schizophrenics means reconstruction of intersubjectivity.

Schizophrenia and smoking: evidence for a common neurobiological basis?

Several previous investigations have suggested that the gene for the alpha 7-nicotinic receptor may play a role in the pathogenesis of schizophrenia and may be responsible for the heavy smoking among schizophrenic patients. In a study of 129 healthy controls and 127 schizophrenic, schizoaffective, and bipolar patients we have aimed 1) to confirm the potential association between schizophrenia and the alpha 7-nicotinic receptor, 2) to test the diagnostic specificity of alpha 7-receptor subunits with respect to psychiatric diagnoses, and 3) to investigate potential receptor differences between smokers and nonsmokers in the general population. Our analysis included the two dinucleotide polymorphisms D15S1360 and L76630 that are localized in a genomic fragment containing the alpha 7-nicotinic receptor gene CHRNA7. Highly significant differences (P < 0.0001) between the allele distributions of patients and controls were detected for these two markers with all three diagnostic subgroups contributing to the discrimination. An independently ascertained replication sample of 24 patients confirmed this finding. Our results suggested an unspecific vulnerability that depended on the severity of overall psychopathology in terms of the co-occurrence of psychopathology with no clear-cut boundary between the diagnostic entities. In comparison with healthy controls, this vulnerability was lowest among schizophrenics, intermediate among bipolars, and highest among schizoaffectives. As to the question of alpha 7-receptor differences between smokers and nonsmokers among the healthy control subjects, our analysis revealed no significant differences, thus indicating that the differences between patients and controls are more than just a smoker/nonsmoker distinction. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:173-177, 2000.

Integration of genetic maps by polynomial transformations

Currently available genetic maps differ in a variety of basic features; in particular, with respect to the total length of the genome. Consequently, the question arises as to the extent to which genetic maps are compatible to each other, as well as to the methods with which genetic maps can be transformed into one another. We propose a set of nonlinear, polynomial transformations that enable the integration of genetic maps at a sufficiently high overall precision. Our analysis of six major, publicly available maps, and iteratively optimized polynomials of up to degree 5, yielded differences of </= +/-0.8 cM between empirical and reconstructed marker locations for >90% of points. Similarly, we determined, at a slightly worse overall fit, those polynomials that enabled the reconstruction of sex-specific recombination estimates from sex-averaged data. Our results suggest that polynominal transformations may become a valuable extension of standard map construction methods due to a rapid integration of newly developed markers into existing maps. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 96:108-113, 2000.

Structural decomposition of genetic diversity in families with alcoholism

Using genotypes of 280 marker loci on the 22 autosomes of 105 alcohol-dependent probands, their affected and unaffected sibs, as well as their parents, we iteratively constructed a genetic similarity function that enabled us to quantify the interindividual genetic distances d(x(i), xj) between feature vectors x(i), xj made up by the allelic patterns of individuals i, j with respect to loci l1, l2,...,ln. Based on this similarity function, we investigated the sib-sib similarities that are expected to deviate from "0.5" in affected sib pairs if the region of interest contains markers close to disease-causing genes. The reference value "0.5" was derived from the parents-offspring similarities, because these are independent of the affection status. The question of population admixture was addressed by means of multivariate structural analyses. These analyses led to four "natural" groups whose validity was tested through the father-mother similarities. Additionally, we determined the eigenvectors that optimally represented the genetic variation and found several marker configurations on chromosomes 1, 3, 7, 15, and 17 that reproducibly discriminated (p < or = 0.01) affected probands/sibs from unaffected sibs, while no such differences were found between affected probands and affected sibs.

[Orthodoxy against heretics. Correspondence of Gaupp and Kretschmer to Eugen Bleuler]

A letter of R. Gaupp to Eugen Bleuler (1906) illustrates the contradictory reception of psychoanalysis. Letters from E. Kretschmer to Eugen Bleuler (1920) reflect the devalorization of Kretschmer by E. Kraepelin. The orthodox systems of the authorities are intolerant towards heretics.

[Dissociation and schizophrenia. Schizophrenias--a dissociative nosopoietic construct?]

The historical roots of the nosopoietic construct schizophrenia are traced: the nosographic construction by Kraepelin, an act of unification and split at the same time. The name schizophrenia reflects the tradition of the model of dissociation which is aetiologically connected with the idea of weakness of the synthetic power of the psyche: psychasthenia. In the establishment of the supposed nosological entity schizophrenia, the name-giving idea of dissociation was almost forgotten. Thus, nowadays Dissociative Disorders are classified in ICD and DSM separately from schizophrenic disorders, but it must be borne in mind that the schizophrenic disorders represent the most severe of disorders, hypothetically based on dissociation, namely, fragmentation of the ego.

[Occultism, parapsychology and the esoteric from the perspective of psychopathology]

The concepts and main themes of occultism, parapsychology and esoterics are set in comparison to religion, spirituality, mysticism. The cultural relativity of these concepts is emphasised. Occultism means dealing with phenomena, processes, and/or powers which are not accessible to "normal perception". The manipulation of such powers is effected via (white, black, grey) magic. Parapsychology, in its popular sense, deals with occult phenomena, whereas scientific parapsychology investigates them empirically. Esoterics is a complex of beliefs within a hermetic tradition about occult processes and about desting after death. Transpersonal psychology deals with these issues while calling them "spiritual". Effects of paranormal experiences and actions on the side of the actor as well as the adept are discussed: personality types, interpersonal effects, crises and psychoses (mediumistic psychoses). The concept of dissociation of subpersonalities (subselves) appears to be a viable perspective to explain these phenomena. In mediumistic psychoses, the splitting of non-ego parts of the psyche leads to a manifestation of schizophrenic symptoms. Dangers for mental health are an ego inflation by self-attribution of "superhuman" power. A personality disposition for parapsychological perception and/or action may be seen in schizotypia and similar near-psychotic "personalities up the border". Adepts of occultism may present with a "false self" in the sense of Winnicott.

Speaking behavior and speech sound characteristics in acute schizophrenia

Based on a sample of 45 hospitalized, acute-schizophrenic patients and 45 carefully matched controls, we investigated the non-verbal characteristics of schizophrenic speech by means of an 'acoustic' speech analysis and determined the extent to which speaking behavior and speech sound characteristics had adjusted toward normal values at the time of hospital release. Using a multivariate discriminant function derived from a previous study of chronic schizophrenics, totally 77 (85.6%) individuals of our patient and control sample could be correctly classified by a set of 12 acoustic variables at entry into study. At hospital release, the majority of patients (64.4%) still exhibited speech impairment although acute psychopathology had significantly improved. A configuration of 6 acoustic variables, assessed at the time point of entry into study, predicted at high reliability the severity of the negative syndrome at hospital release. Acute medication effects did not explain these findings, thus underlining the potential diagnostic relevance of the speech analysis method. With respect to the relationship between speech characteristics and acute psychopathology throughout the time course of recovery, our results suggest that changes in speaking behavior and speech sound characteristics may be distinct aspects of schizophrenia that can persist in a subgroup of patients over a long period, mostly beyond the time point of hospital release. Accordingly, the speech analysis method might become very useful in detailing the nature and severity of deficits in patients after remission of positive symptoms.

Positron emission tomography and fluorodeoxyglucose studies of metabolic hyperfrontality and psychopathology in the psilocybin model of psychosis

The effects of the indolehallucinogen psilocybin, a mixed 5-HT2 and 5-HT1 agonist, on regional cerebral glucose metabolism were investigated in 10 healthy volunteers with PET and [F-18]-fluorodeoxyglucose (FDG) prior to and following a 15- or 20-mg dose of psilocybin. Psychotomimetic doses of psilocybin were found to produce a global increase in cerebral metabolic rate of glucose (CMRglu) with significant and most marked increases in the frontomedial and frontolateral cortex (24.3%), anterior cingulate (24.9%), and temporomedial cortex (25.3%). Somewhat smaller increases of CMRglu were found in the basal ganglia (18.5%), and the smallest increases were found in the sensorimotor (14.7%) and occipital cortex (14.4%). The increases of CMRglu in the prefrontal cortex, anterior cingulate, temporomedial cortex, and putamen correlated positively with psychotic symptom formation, in particular with hallucinatory ego disintegration. The present data suggest that excessive 5-HT2 receptor activation results in a hyperfrontal metablic pattern that parallels comparable metabolic findings associated with acute psychotic episodes in chronic schizophrenics and contrasts with the hypofrontality in chronic schizophrenic patients.

Metabolic hyperfrontality and psychopathology in the ketamine model of psychosis using positron emission tomography (PET) and [18F]fluorodeoxyglucose (FDG)

To date, the ketamine/PCP model of psychosis has been proposed to be one of the best pharmacological models to mimic schizophrenic psychosis in healthy volunteers, since ketamine can induce both positive and negative symptoms of schizophrenia. At subanesthetic doses, ketamine has been reported to primarily block N-methyl-D-aspartate (NMDA) receptor complex giving support to a glutamate deficiency hypothesis in schizophrenia. Positron emission tomography was used to study ketamine-induced psychotic symptom formation in relation to cerebral metabolic alterations in healthy volunteers. Our study shows that NMDA receptor blockade results in a hyperfrontal metabolic pattern. Increased metabolic activity in the frontomedial and anterior cingulate cortex correlated positively with psychotic symptom formation, in particular with ego pathology. Analysis of correlations between syndrome scores and metabolic rate of glucose (CMRglu) or metabolic gradients (ratios) revealed that each psychopathological syndrome was associated with a number of metabolic alterations in cortical and subcortical brain regions, suggesting that not a single brain region, but distributed neuronal networks are involved in acute psychotic symptom formation.

[Harmony--idea and ideal]

The concept of the whole as an ideal of gestalt and value is sketched. In the concrete situation of healer and patient a multiperspective approach rather than a realization of wholeness has to be enough, taking into account somatic, physiological, intraindividual-psychological, interpersonal-social and transpersonal aspects of personalities in diagnosis and treatment.

Speaking behavior and voice sound characteristics associated with negative schizophrenia

Based on a sample of 42 chronic schizophrenic patients and 42 carefully matched controls, we investigated potential relationships between acoustic variables on the one hand, and negative syndromes, positive syndromes and affective disturbances, on the other. A set of 12 acoustic variables automatically assessed in a standardized experimental setting allowed an almost perfect discrimination between schizophrenic patients and normal subjects. Acute side-effects of medication did not explain this finding. However, the question of whether the observed changes in speaking behavior and voice sound characteristics were caused by long-term neuroleptic treatment, for example, as a consequence of tardive dyskinesia, could not be answered by our investigation. In view of a biological validation of the negative-positive model of schizophrenia, the reliability of various psychopathological subscales was tested through repeated assessments at 14 day intervals. We found most psychopathology scores to be sufficiently stable and reproducible over time, thus representing a suitable basis for the estimation of severity with respect to the negative and positive component of schizophrenia. Using the first measurements as training samples and the second measurements of 14 days later as test samples, discriminant analysis yielded conclusive proof of a close relationship between acoustic variables and the severity of the negative and positive component of schizophrenia. In particular, by means of "objective" acoustic variables and under the constraint of reproducibility, 75.9% of patients were correctly classified as low or high scorers with respect to the negative syndrome, 71.9% of patients with respect to the positive syndrome, and 79.4% of patients with respect to their depressive symptomatology.

Towards an understanding of sensory soft signs of schizophrenia

Neurological soft signs are considered to be non-localizing findings and clinical neurodysfunctional correlates of schizophrenia. Sensory signs in 21 chronic schizophrenic patients were compared with those of healthy subjects. The schizophrenic patients differed significantly from the controls in graphesthesia testing; there was no clear-cut impairment of other somatic sensory modalities. The graphesthesia learning effect was weaker in the patient group. No unequivocal correlation could be found between psychopathology or course variables and dysgraphesthesia. The authors hypothesize that an impairment in graphesthesia testing may reflect a working memory deficit in schizophrenics.

Investigation of gestural and pantomime performance in chronic schizophrenic inpatients

The present study compared the performance on apraxia tests and additional motor tasks between medicated chronic schizophrenic inpatients (n = 21) and healthy subjects (n = 21). Praxis testing did not reveal a clear-cut apractic syndrome in the patient group. The most striking difference between patients and healthy controls was the more frequent use of body parts as object (BPO) by schizophrenic patients (P < 0.0003). There was no significant difference in psychopathology between subgroups classified according to their BPO performance, although a tendency towards a difference in duration of illness and the actual hospitalization period existed between BPO subgroups. Schizophrenic patients performed more poorly than controls in frontal motor tasks: sequencing, including oral sequential movements, and reciprocal innervation. Frontal motor task performance tended to be related to the negative dimension of schizophrenia in accordance with previous studies. The data do not support the assumption that BPO performance is part of a multidimensional concrete attitude in schizophrenic patients. Nevertheless, this peculiarity in motor behaviour might be a link between neurophysiology and psychopathological phenomenology in schizophrenia. We therefore suggest further investigation focusing the performance of object-related pantomime movements in schizophrenic patients.

[Olfactory hallucinations in depression]

Olfactory hallucinations are rarely mentioned as a symptom of depressive disorder. This paper presents a review of the literature including a conceptual clarification and epidemiological aspects with an emphasis on the significance of olfactory hallucinations for psychopathology, in particular with respect to sensory perception and body self-awareness. The close relation to the olfactory reference syndrome is pointed at. Olfactory hallucinations are considered important for the biological interpretation of affective disorders. In this regard disturbed olfactory perception can be understood as an example of disturbed brain function in the state of depression. Olfactory symptoms are shown to be elements connecting primary affective disorders with other neuropsychiatric diseases as well as with neuroanatomical and neurophysiological models. A primary role is accordingly attributed to the temporal lobe epilepsies in which olfactory hallucinations as well as affective disturbances occur. The need for further investigation in this field is pointed out.

[Eros therapeutikós. Love and ethics in psychotherapy]

Love in the deepest and highest level, as conceived by Platon in his symposium, is considered in the context of occidental philosophy's "feelings of sympathy" (Max Scheler), empathy and the mystic feeling of cosmic oneness. The buddhistic concepts of loving kindness (metta) reaches its highest level in the Bodhisattva of Mahayana. Love is an essential element of the development of knowledge. Love and knowledge increase the awareness of a universal responsibility. Therapeutic love is an essential medium of any humane therapy and can be cultivated in the mental personal development of the therapist.

On the prognostic relevance of ego-psychopathology in schizophrenia: a 2.5-year follow-up

Based on a calibration sample comprising 552 schizophrenic patients, ego-psychopathology was modelled in terms of three empirical scales. For this purpose, a special assessment instrument (EPIS) had been designed which measures the phenomena of self-experience in psychotic individuals. Within the scope of these investigations, a 2.5-year follow-up study was carried out with 85 schizophrenic patients. The principal goal of this study was to test the predictive power of typical patterns of self-experience with respect to social functioning. In order to analyse the homogeneity of the data multidimensional scaling and cluster analysis was employed. The results derived from the initial interview suggested a partitioning of the population into two extreme groups termed, according to our model, high-risk and low-risk cases. The predictive power of ego-psychopathology with regard to the social situation was then tested by comparing the outcome of both groups after 2.5 years. The analyses yielded no indication that there is a strong relationship between ego-psychopathology and social adaptation. Only a tendency could be found suggesting that subjects with few ego-psychopathological disturbances have a better occupational behaviour.

Familial syndrome patterns in schizophrenia, schizoaffective disorder, mania, and depression

A major problem with studies in the field of quantitative genetics is that of phenotypical heterogeneity. In particular, such heterogeneities show up in psychiatric investigations: index cases often tend to display more severe forms of disorders than the respective affected relatives. The principal goal of the present investigation was to test the phenotypical equivalence of the two populations of index cases and their affected relatives. Our analyses were based on 269 hospitalized patients with functional psychoses and 350 affected first degree relatives. As opposed to the majority of earlier investigations in which phenotypes were uniquely defined by diagnoses, phenotypes were represented in this study by a list of 22 psychiatric syndromes. Accordingly, multivariate statistical procedures were applied to analyze the intrinsic properties of the empirical lists. The results showed that typical syndrome patterns clearly appeared in both populations and that the phenotypical equivalence of the corresponding population sample sets lay between satisfactory and good. Furthermore, it was possible to select phenotypically homogeneous and reproducible subsets on the basis of the 22 syndromes. These subgroups can be used as basic material to study the genetic modes via current models from quantitative genetics. Nevertheless, our analyses revealed no clear breeding true of either affective disorders or schizophrenia.

Morbid risks of subgroups of affective disorders: some methodological and empirical results

Based on two independently ascertained family studies, the problem of analysing disorders with variable age of onset has been investigated by means of survival analysis. This method of approach results in empirical risk functions which can be used directly as weights for age correction in the analysis of pedigrees. The main interest of the present investigation has been focused on the reproducibility of such risk functions and on their specificity with respect to clinical diagnosis. For this purpose, one family study was referred to as a calibration sample for estimating empirical risk functions, whereas, the second family study served as a test sample in order to test the hypotheses under discussion. As it turned out, the empirically derived functions from both the calibration and test samples are indeed comparable, thus suggesting that, for sufficiently representative calibration samples, the differences between the two populations of (1) affected and (2) susceptible individuals may be less important than expected. As to the specificity of these risk functions, the underlying diagnostic structure of the calibration samples (as represented by four diagnostic subgroups) could be characterized by distinct types of risk functions, each of which, in addition, reflects the severity of the respective affective disorder.

A family hereditary study of post-partum "psychoses"

A group of 80 women suffering from a severe psychiatric post-partum disorder and hospitalized for the first time in their lives was followed up between 4 and 35 years later. Besides the further evolution of psychic health of the patients, the occurrence of endogenous (i.e., functional) psychoses in first degree relatives was investigated. A global morbidity risk for endogenous psychoses of 10.9% was found, affective psychosis accounting for two-thirds of secondary cases. Subdivision of the sample according to the criterion of absence or presence of further psychotic episodes unrelated to childbirth revealed that first degree relatives of patients with exclusively puerperal decompensations had a low morbidity risk of 2.0%, but relatives of patients with later nonpuerperal episodes of illness one of 15.2%, the difference being statistically significant (P less than 0.002). This suggests that severe psychiatric disorders occurring exclusively in the post-partum period are nosologically distinct from those followed by nonpuerperal psychotic episodes of illness. Only the latter seem to be related to the traditionally recognized subgroups of endogenous psychoses.

A family study of psychotic symptomatology in schizophrenia, schizoaffective disorder, unipolar depression, and bipolar disorder

An evaluation was made of schizophrenics (140), schizoaffectives (40), unipolar depressives (59), and bipolars (30), and their relatives who had a chart diagnosis of psychosis or depressive neurosis. The purpose was to determine whether the psychosis (delusions and hallucinations) was transmitted independently of the illness itself. If this were true, there would be an excess of pairs of probands and relatives both positive for psychosis and pairs of relatives and probands both negative for psychosis when compared to relatives and probands who were not concordant for the variable. This was found to be true in schizophrenia and schizoaffective disorder and is probably the result of the simple transmission of an illness which includes the presence of psychotic symptoms in the definition. Thus, this would be a manifestation of the genetic propensity in schizophrenia. For the affective disorders there was no evidence that psychotic probands were more likely than the nonpsychotic to have psychotic relatives. So far the reason why some patients have psychosis and others not in the affective disorders remains unexplained.

Stability of psychotic symptomatology (delusions, hallucinations), affective syndromes, and schizophrenic symptoms (thought disorder, incongruent affect) over episodes in remitting psychoses

A study was made on 140 schizophrenics, 40 schizoaffectives, 59 unipolar depressives, and 30 bipolar affective disorder patients in order to determine the quality of psychopathology over multiple episodes. The schizoaffectives were the most likely to have multiple episodes. Among the schizophrenics, there were few episodes that lacked psychotic symptoms, but almost half of the episodes for the schizoaffectives were associated with an absence of psychotic symptoms. Three-quarters of the patients with unipolar depression and bipolar illness showed no psychotic symptoms either congruent or noncongruent. There was a striking finding that all diagnoses were associated with a decrease in psychotic symptoms over time. These psychotic symptoms (delusions and hallucinations) became particularly more scarce among the schizoaffectives, unipolars, and bipolars. There was a 50% to 67% decrease of episodes with psychotic symptoms as more episodes occurred. For schizophrenia and schizoaffective disorder the first ten episodes were very similar to each other for affective syndromes, formal thought disorder and/or incongruent affect, and delusions and hallucinations. It was not until much time had passed that the symptom pictures changed.

The diagnostic value in assessing mood congruence in delusions and hallucinations and their relationship to the affective state

An examination was carried out on 140 schizophrenics, 34 schizoaffective manics, 6 schizoaffective depressives, 59 unipolars, and 30 bipolars to determine the variables of affective states and mood-congruent and mood-incongruent psychotic symptoms. These patients had been admitted to a hospital in Zürich and were systematically diagnosed, using both clinical and computer-derived systems. Forty-eight patients (18%) had both mood-congruent and incongruent psychotic symptoms. However, the affective disorders usually showed mood-congruent symptoms and the schizophrenics the mood-incongruent types. The schizoaffectives were likely to show both types. There was a marked dissociation between affective states and mood congruence in the schizophrenics. Though the majority of these patients showed depressive syndromes, they were quite unlikely to have mood-congruent symptoms. Likewise, 25% of the schizophrenics had manic-like syndromes, which contrasted with the fact that they rarely had mood-congruent psychotic delusions and hallucinations.

[Automanipulation of disease. Self-induced, aggravated, simulated disease and automutilation]

Self-induced physical and psychological symptomatology is reviewed in regard to differential diagnosis (DSM-III), epidemiology, interpretation, treatment and prognosis. The phenomenon of automutilation is discussed in the psychopathological context.

The syndrome concept: history and statistical operationalizations

A historical analysis of the syndrome concept shows that this term has been used in many different ways, ranging from clinical experience to records of coinciding symptoms. However, there seems to be broad agreement on the use of the word 'syndrome' in daily practice. If empirical-mathematical methods are applied in syndrome detection, however, a precise operationalization of the syndrome concept is needed. Traditional procedures have often used models more dictated by methodological considerations than derived from the field of application, i.e. psychiatric syndromatology. An alternative approach, Boolean factor analysis, is presented in this paper. This relatively new method is illustrated by means of the analysis of a small artificial sample with a known structure. As a point of reference, traditional methods (factor analysis, cluster analysis, and multidimensional scaling) are also briefly discussed. It is demonstrated that they all share a deficiency of information about inter-group structure. In contrast, Boolean factor analysis uses a syndromic definition which builds on the basic notion of concurrent symptoms. Moreover, this approach can easily be understood by clinicians.

Classification of schizo-affective patients by multidimensional scaling and cluster analysis

269 patients with schizophrenia, schizo-affective or affective disorders admitted to a hospital in Zürich were examined by the AMP system and the syndrome checklist of Wing and co-workers. The data were analyzed using a special set-theoretical similarity measure for nonlinear graduations, multidimensional scaling to achieve a metric representation of the similarity matrices, and a cluster analysis, originally described by Meisel in 1972.

Schizophrenia's classical subtypes. A family heredity study

A genetic family study of the classical schizophrenic subgroups (33 hebephrenics, 38 catatonics, 69 paranoid schizophrenics) demonstrated a tendency towards differences in the global morbidity risk of schizophrenia (greatest in the relatives of catatonics) and a tendency towards a predominance of homotypical secondary cases. However, as these results are statistically not significant, they cannot be used as arguments in discussing the genetic separation of schizophrenic subtypes.

[Trampers in India - Description of a population (author's transl)]

50 trampers in India and Sri Lanka were studied in a semistructured interview by a questionnaire for socio-demographic data, for their medical and psychiatric history and their drug-experience. The MPI (Eysenck) and SSS (Zuckermann) were applied as tests for describing personality. Most of the trampers are around 25 years, stem from medium economical strata, have an education of high school or university. Nearly all of them are experienced drug-users (mainly hashish), most of them for long time without increase of intake and without bodily or mental or social deterioration. In the MPI the score for extraversion and neuroticism is within the (English) norm rage. Female probands showed a higher score of neuroticism than males. The total score in the SSS was significantly higher than in the standard population, mainly due to significantly elevated scores in the scale for disinhibition and boredom susceptibility.

Subdividing the functional psychoses: a family hereditary approach

Family genetic data, based on standardized and independent diagnostic procedures of index and secondary cases, confirmed the dichotomy between schizophrenias and affective disorders. The classical schizophrenic subtypes exhibited a significant tendency towards homotypia among their secondary cases. The genetic evidence did not support the monopolar-bipolar subdivision of affective disorder. Schizo-affective disorders impinged on the clear-cut schizophrenic and affective psychotic disorders and there was no homotypical tendency among the relatives of index cases with this diagnosis.

Ego-psychopathology: the concept and its empirical evaluation

A phenomenological construct of ego-consciousness, subdivided into 5 aspects (vitality, activity, consistency, demarcation, identity) may help for systematic overview of the schizophrenic syndrome. Its construction and empirical evaluation, and the data of 260 schizophrenic probands are presented. The therapeutic implications of the model are elaborated in body-oriented treatment, especially of acute and severely ill cases.