Motherhood and early interaction in a schizoaffective patient: the story of a long-term psychotherapy.

This paper focused on motherhood in a patient with a schizoaffective disorder. The core of the treatment was to build a strong therapeutic alliance in which compliance with medication and elaboration of mental processes could be achieved. Pregnancy and motherhood are a time of crisis in the life of women. For the schizoaffective patient this crisis threatens the deepest level of functioning and challenges attachment patterns. Comprehensive treatment including psychosocial support, medication and psychotherapy is able to protect the baby to be, the early relationship between mother and baby, and the development of the child over time in this high-risk family. However, the commitment over years of the same psychotherapist also seems one of the most powerful tools.

Does attachment theory offer new resources to the treatment of schizoaffective patients?

This paper focused on considering schizoaffective disorder in the light of Attachment Theory: a case of intensive psychotherapy with a patient with a schizoaffective disorder was presented. In this case, Attachment Theory provided a useful framework for understanding the patient as well for her treatment. The core of the treatment was to build a strong therapeutic alliance in which compliance with medication and elaboration of psychological processes could be achieved. This paper could contribute to opening the discussion about the relationship between schizoaffective disorder and Attachment Theory.

I. Genotype-environment interaction in the schizophrenia spectrum: genetic liability and global family ratings in the Finnish Adoption Study.

In the Finnish Adoption Study, a national sample of adoptees with high versus low genetic liability for schizophrenia spectrum disorders was indexed by DSM-III-R diagnoses of their biological, adopting-away mothers. The rearing-family environments of the adoptees were independently evaluated from global ratings of directly observed adoptive family relationships. The interaction of high genetic liability and dysfunction of the rearing families predicted highly significantly to schizophrenia spectrum disorder of the adoptees at 21-year follow-up. Either low genetic liability or healthy rearing protected against a spectrum outcomes for the adoptees. Initial adoptive parent diagnosis, as a proxy for rearing family dysfunction, predicted to adoptee outcome only as a trend.

II. Genotype-environment interaction in the schizophrenia spectrum: qualitative observations.

Previous reports from the Finnish Adoptive Family Study of Schizophrenia have documented significant interplay between genetics (G) and family rearing (E), leading to adoptee outcomes of schizophrenia spectrum disorders. Quantitative evidence for this interplay is significantly enhanced when both high genetic liability and severe environmental dysfunction are present. However, when either genetic liability is low or the rearing environment is healthy, the adoptees appear to be resiliently protected against a pathologic outcome. Nevertheless, exceptions to this pattern do occur. Six qualitative vignettes, together with quantitative measures and categorical diagnoses from the same families, illustrate how multiple methods partially confirm one another and also suggest where further exploration of gene-environment interaction is needed.

Observing relationships in Finnish adoptive families: Oulu Family Rating Scale.

Adoption studies were intended to separate genetic from environmental "causal" factors. In earlier adoption studies, psychiatric diagnostic labels for the adoptive parents were used as a proxy for the multiple dimensions of the family rearing environment. In the Finnish Adoption Study, research design provided the opportunity to study directly the adoptive family rearing environment. For this purpose 33 sub-scales were selected creating what we call Oulu Family Rating Scale (OPAS, Oulun PerheArviointiSkaala). In this paper, the manual for scoring of these sub-scales is presented.

Genotype-environment interaction in schizophrenia-spectrum disorder. Long-term follow-up study of Finnish adoptees.

BACKGROUND: Earlier adoption studies have convincingly confirmed the importance of a genetic contribution to schizophrenia. The designs, however, did not incorporate observations of the rearing-family environment. AIMS: To test the hypothesis that genetic factors moderate susceptibility to environmentally mediated risks associated with rearing-family functioning. METHOD: A Finnish national sample of adopted-away offspring of mothers with schizophrenia-spectrum disorders was compared blindly with adoptees without this genetic risk. Adoptive rearing was assessed using family rating scales based upon extended family observations at initial assessment. Adoptees were independently re-diagnosed after a median interval of 12 years, with register follow-up after 21 years. RESULTS: In adoptees at high genetic risk of schizophrenia, but not in those at low genetic risk, adoptive-family ratings were a significant predictor of schizophrenia-spectrum disorders in adoptees at long-term follow-up. CONCLUSIONS: Adoptees at high genetic risk are significantly more sensitive to adverse v. 'healthy' rearing patterns in adoptive families than are adoptees at low genetic risk.

Genetic boundaries of the schizophrenia spectrum: evidence from the Finnish Adoptive Family Study of Schizophrenia.

OBJECTIVE: Identification of the genetically related disorders in the putative schizophrenia spectrum is an unresolved problem. Data from the Finnish Adoptive Family Study of Schizophrenia, which was designed to disentangle genetic and environmental factors influencing risk for schizophrenia, were used to examine clinical phenotypes of schizophrenia spectrum disorders in adopted-away offspring of mothers with schizophrenia spectrum disorders. METHOD: Subjects were 190 adoptees at broadly defined genetic high risk who had biological mothers with schizophrenia spectrum disorders, including a subgroup of 137 adoptees at narrowly defined high risk whose mothers had DSM-III-R schizophrenia. These high-risk groups, followed to a median age of 44 years, were compared diagnostically with 192 low-risk adoptees whose biological mothers had either a non-schizophrenia-spectrum diagnosis or no lifetime psychiatric diagnosis. RESULTS: In adoptees whose mothers had schizophrenia, the mean lifetime, age-corrected morbid risk for narrowly defined schizophrenia was 5.34% (SE=1.97%), compared to 1.74% (SE=1.00%) for low-risk adoptees, a marginally nonsignificant difference. In adoptees whose mothers had schizophrenia spectrum disorders, the mean age-corrected morbid risk for a schizophrenia spectrum disorder was 22.46% (SE=3.56%), compared with 4.36% (SE=1.51%) for low-risk adoptees, a significant difference. Within the comprehensive array of schizophrenia spectrum disorders, schizotypal personality disorder was found significantly more often in high-risk than in low-risk adoptees. The frequency of the group of nonschizophrenic nonaffective psychoses collectively differentiated high-risk and low-risk adoptees, but the frequencies of the separate disorders within this category did not. The two groups were not differentiated by the prevalence of paranoid personality disorder and of affective disorders with psychotic features. CONCLUSIONS: In adopted-away offspring of mothers with schizophrenia spectrum disorders, the genetic liability for schizophrenia-related illness (with the rearing contributions of the biological mothers disentangled) is broadly dispersed. Genetically oriented studies of schizophrenia-related disorders and studies of genotype-environment interaction should consider not only narrowly defined, typical schizophrenia but also schizotypal and schizoid personality disorders and nonschizophrenic nonaffective psychoses.