The New York High-Risk Project. Psychoses and cluster A personality disorders in offspring of schizophrenic parents at 23 years of follow-up.

BACKGROUND: We herein present lifetime prevalence rates of psychoses and DSM-III-R cluster A personality disorders in sample A of the New York High-Risk Project, a prospective study following offspring of parents with schizophrenia (HRSz subjects) and affective illness (HRAff subjects) and of psychiatrically normal parents (NC subjects) from midchildhood to adulthood. METHODS: We interviewed the offspring in adulthood with the Schedule for Affective Disorders and Schizophrenia, Lifetime Version, for Axis I disorders and the Personality Disorder Examination for Axis II disorders. RESULTS: Lifetime prevalence rates (+/- SE) of schizophrenia and unspecified psychosis were 11.1% +/- 4.3% and 5.6% +/- 3.1%, respectively, in the HRSz group and 0% in the HRAff and NC groups. Rates of schizoaffective disorder subclassified as mainly schizophrenic, however, were highest in the HRAff group. Rates of psychotic affective disorders did not differ between the HRSz and other groups. Age-corrected morbidity risks were similar to lifetime prevalence rates. Rates of the three cluster A personality disorders did not differ among the groups, but the combined rate was greater in the HRSz and HRAff groups than in the NC group. CONCLUSIONS: Our data strongly support a specific familial liability to narrowly defined schizophrenia that is not shared by families of probands with affective disorder. Schizoaffective disorder and cluster A personality disorders, however, occur in families of both schizophrenic probands and probands with affective disorder. Psychotic affective disorders, which are not increased in HRSz subjects, do not appear to be an expression of the liability to schizophrenia.

Childhood schizophrenia: theoretical and treatment issues.

Michael is an 8.5-year-old Caucasian male inpatient who presented at admission with severe agitation, suicidal impulses, and aggression toward his 18-month-old sister. He had been treated with stimulant medications before admission. Past history revealed bilateral genetic loading with two primary family members having a history of hallucinations and hospitalization, and two paternal aunts who were hospitalized since early childhood. Michael was raised in a chaotic, violent family environment where there was emotional, physical, and perhaps sexual abuse. Medical history included frequent staring spells. During residential treatment, more extensive interviews revealed a year's history of auditory hallucinations, inappropriate and labile affect, and a fixed delusional system. The patient was switched to neuroleptics and showed a slow response despite high doses.

The creative process in child psychotherapy.

A brief review of the psychological literature concerning the creative process is presented with a focus on Arieti's formulation regarding creativity and on Kubie's hypothesis about the importance of the preconscious. Childrens' use of fantasy and imaginative play through storytelling is presented as a useful therapeutic modality. Three cases vignettes are offered for illustration.

Clinical and psychological assessment of children of bipolar probands.

Thirty-one children (age range, 7-14 years) of 18 probands with a bipolar disorder according to Research Diagnostic Criteria were assessed on clinical and psychological measures and compared with 18 matched normal control children. The authors found higher rates of childhood psychopathology in the children of the probands than in the control children. In addition, the experimental group was characterized by 1) a pattern on the WISC-R of higher verbal than performance IQs, 2) higher ratios of color to movement determinants on the Rorschach test, and 3) an overrepresentation of left-handedness. The implications of these findings are briefly discussed.

Children at risk for schizophrenia.

Etiological factors in the transmission of schizophrenia are reviewed; models include psychogenic, genetic, gene/environment interaction. Investigation of premorbid history is discussed employing retrospective, follow-back, follow-up, and prospective studies. Certain symptom clusters (attentional and cognitive deficits, poor socialization, withdrawal) in genetically predisposed individuals may predict schizophrenia. Stress-reducing therapeutic environments are proposed.

Some practical considerations in the assessment and treatment of adolescent girls with separation problems.

Five cases are presented of adolescent girls with severe problems in leaving home. Though the psychodynamics were similar (preoedipal conflicts in the separation-individuation phase), the psychopathology and underlying causative factors were different in each case. Factors to be considered in the initial diagnostic assessment are outlined. These include constitutional and congenital factors, the developmental history, maternal emotional illness, and gene-environment interactions. Various treatment modalities are described and illustrated. In four of the cases specific parameters were necessary, particularly behavioral technics and conjoint family therapy. The manner in which the analyst may serve, in cases amenable to psychoanalytic treatment, as transference object plus real object is discussed and illustrated.