Leading and internationally recognized researchers review what is known about the liability to schizophrenia, how it progresses, what it looks like clinically-with an emphasis on a specific (proposed) syndrome of liability (schizotaxia)-and how best it might be treated now and in the near future. The authors summarize the latest findings on the genetic, early environmental, and neurodevelopmental origins of schizophrenia.

One of the most important questions of our previous common volumes about affective, schizoaffective, and schizophrenic disorders was the question of what connects and what separates psychotic disorders (Marneros and Tsuang, Schizo affective Psychoses, Springer-Verlag, 1986; Marneros and Tsuang Affective and Schizoaffective Disorders, Springer-Verlag, 1990; Marneros, Andreasen, and Tsuang, Negative and Positive Schizophrenia, Springer-Verlag 1993). The boundaries between various psychotic disorders are not always clearly defined. Some groups of psychotic disorders, such as schizoaffective disorders and all the other "atypical" psychoses, occupy a position between "typical" mental disorders, such as schizophrenia, and affective disorders. The question is: Do psychotic disorders form a continuum, or are they, despite their unclear boundaries, distinct entities? On what basis should we assume there is a continuity of psychotic disorders? Solely symptomatology? Or perhaps also a continuity in genetic predispositions? Or in biological, pharmacological, and other dimensions? Is the old idea of "Einheitspsychose" (unitary psychosis) really always wrong? The contributions contained in this new volume cannot provide a definite answer to the above questions. But they try to describe some relevant aspects of the problem, and to give some partial answers. Halle-Wittenberg, Germany A. MARNEROS Brockton, USA M. T. TSUANG Iowa, USA N. C. ANDREASEN October 1994 Contents Part I Psychotic Continuum: An Introduction A. MARNEROS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Psychotic Continuum or Distinct Entities: Perspectives from Psychopathology CH. MUNDT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Psychotic Continuum Under Longitudinal Considerations A. MARNEROS, A. ROHDE, and A. DEISTER. . . . . . . . . . . . . . . . . . . . . . . . . . 17 Psychotic Continuum or Distinct Entities: Perspective from Psychopharmacology H. Y. MELTZER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

The positive versus negative distinction of schizophrenic disorders has pro- moted ongoing research. Phenomenology, psychopathology, biology, genet- ics, pharmacological and nonpharmacological treatment, psychosocial and longitudinal research: all have found a new focus of interest. This volume attempts to provide an unbiased picture of the status of American and Eu- ropean knowledge regarding the positive/negative distinction. Researchers from North America and Europe describe the relation of modern concepts of positive and negative symptomatology to the original models of Rey- nolds and Jackson. Integrating phenomenological, genetic, and biological factors, the authors depict current methods of assessing positive and nega- tive symptomatology, differentiating between primary and secondary symp- tomatology, and using pharmacological and nonpharmacological treatment. The stability of positive and negative symptoms over time and evidence for the occurrence of separate positive and negative episodes over a long-term course of schizophrenia are extensively discussed in terms of their implica- tions on the positive/negative construct. The relevance of the positive/nega- tive dichotomy to child and adolescent schizophrenia is also debated. The main aim of this book is not to advocate a single concept and present only arguments supporting it, but to discuss important controversies. Prob- lems concerning a concept cannot be solved by ignoring them. However, unanswered questions may be resolved through discussion, debate, and con- structive compromise.

Several contributions in our first book about schizo affective disorders (Marneros and Tsuang, Schizoaffective Psychoses, Springer-Verlag, 1986) supported the assumption that schizoaffective disorders differ in relevant ways from schizophrenic disorders. The classification of schizo affective disorders as a subgroup of schizophrenia has also been criticized, and empirical research in clinical, genetic, therapeutic, and prognostic areas supports the idea that there are some strong similari ties between schizo affective and affective disorders. Of course, there are not only similarities between these two groups, but also differences just as there are between schizo affective and schizophrenic disorders. It is precisely the existence of similarities and differences between schizo affective disorders and the other two so-called typical mental disorders, i.e., schizophrenia and affective disorders, which makes them a challenge in psychiatric research, a challenge to the traditional dichotomy in the classification of disorders which originated with Kraepelin. This challenge is certainly proving fruitful in psychiatric research. These "cases in between" may well demonstrate that sep arating, dividing, and limiting is not always meaningful. Sometimes it can be more meaningful to unify; to unify in the sense of building bridges between typical groups. It is here that the assumption of a "psychotic continuum" can become relevant, and the investigation of schizoaffective disorders is of prime importance in research on a possible continuum of psychosis.

As more patients seek information about family risks of psychiatric illness -- an interest likely to increase as gene-identification studies are publicized -- most psychiatrists agree it is their role to discuss these issues but admit they are ill-prepared to do so. Psychiatric Genetics addresses that need as the first book to focus on clinical applications of genetics in psychiatry. It covers issues involved in genetic counseling, the interpretation of familial and genetic information for clinical use, information regarding risks associated with specific psychiatric disorders, risk/benefit considerations related to medication use during pregnancy, and the ethical and social implications of psychiatric genetic knowledge and research -- including the prospects for genetic testing.

While other books have been written for the genetics community, this volume is addressed to practitioners: a clinically relevant resource that can help them understand the often bewildering flood of information about genetics -- information difficult to interpret, let alone integrate into practice -- and enable them to respond to patients' requests to predict the risk of recurrence of psychiatric illness or provide information about reproductive and pregnancy-related issues. Experts from psychiatry, genetic epidemiology, molecular genetics, genetic counseling, cognitive psychology, and ethics focus on issues that have received little attention elsewhere yet are of increasing importance to clinicians. Written at a level that assumes no particular expertise in genetics, the book features these immediately applicable benefits: - It offers a framework for understanding and critically evaluating the psychiatric genetic research literature, enabling clinicians to better understand the meaning and limitations of genetic discoveries when patients raise questions about media reports. - It provides a resource for clinicians who would like more information about the role and content of genetic counseling, outlining a typical counseling session while demonstrating how risks are estimated and discussed.- It summarizes genetic aspects of major psychiatric conditions -- from childhood-onset disorders through psychotic, mood, and anxiety disorders to dementia -- as well as neuropsychiatric manifestations of other genetic disorders.- It alerts clinicians to risk/benefit considerations related to medication use during pregnancy.- It covers the ethical, legal, and social implications of genetic research and counseling, illustrating the dilemmas that arise with new advances. Whether used as a clinical guide, reference, or ancillary text, this book sets the standard for the application of psychiatric genetic knowledge in everyday practice. Psychiatrists, mental health clinicians, and genetic counselors will find it an essential resource for all patient encounters in which genetic issues arise.

Recognizing that favorable clinical outcomes are associated with earlier initiation of treatment -- and even more ideally with prevention -- this volume addresses the current status of early intervention in, and prevention of, major mental and substance use disorders. A team of distinguished participants addresses this problem at many levels -- from the DNA molecule to public policy -- in order to show how prevention efforts should be informed by a better understanding of etiology and by a knowledge of indicators of vulnerability.

In considering the current standing of etiological knowledge, Recognition and Prevention of Major Mental and Substance Use Disorders addresses issues that are critical precursors to the prevention of mental disorders and offers an understanding of factors that contribute to the disorders' development. The contributors review genetic methodologies and current findings in mental disorders, with an emphasis on schizophrenia, and then show how biological and psychosocial environmental variables may affect vulnerability. Chapters devoted specifically to lessons in prevention drawn from recent research into schizophrenia discuss the implications of prodromal studies and relationships between stress, critical periods, and the development of the disorder. The book includes contributions from NIH representatives on how basic scientific understanding of mental disorders can be translated into public policy. It also features chapters that describe cutting-edge projects in prevention research for Alzheimer's disease, drug dependence, antisocial behavior, and posttraumatic stress disorder -- each providing compelling accounts of how existing knowledge can be adapted to promising prevention efforts. Among the volume's contributions: - New data on the role of substance abuse -- particularly marijuana and psychostimulants -- in increasing vulnerability to schizophrenia- Review of vulnerability factors for several relevant disorders, examining stress and its concomitant psychobiological responses and the contribution of cognitive factors to vulnerability to depression- Intriguing approach for translating successful treatment methods for schizophrenia into efforts to prevent the transition from the prodrome of the disorder to the full-blown illness- Program for prevention of antisocial behavior that can be implemented as early as the first grade- Secondary prevention efforts for posttraumatic stress disorder, with a focus on pharmacological interventions

Each chapter reviews clinical implications of the research presented, contributing to a volume that will benefit clinicians and researchers who share the goal of preventing these debilitating conditions. This multidimensional, interdisciplinary work represents a major step toward cutting the social costs of these disorders -- and, more important, their untold cost in human suffering.

Schizophrenia is one of the most traumatic psychiatric disorders, both for the affected person and their family. It also carries an unfortunate stigma and suffers from frequent misinterpretation by the popular media. The disorder usually manifests itself through significant periods of hallucinations, bizarre delusions, and disorganized behaviour, but the individuals who suffer from this brain disorder are not generally violent, and do have periods of remission. However it is often difficult for these individuals to maintain a regular lifestyle and relationships at home and at work, and many individuals with schizophrenia end up unable to live independently or, worse, homeless. This new edition in the popular Facts series provides a concise and up-to-date account of the underlying causes and symptoms of schizophrenia, as well as current theories about the disorder. The authors look at all the current treatment options, both medical and psychological, together with likely side-effects and the problem of compliance with treatment. The role of the family and the community in caring for individuals with schizophrenia is also considered. The authors are experienced psychiatrists and psychologists with many years' experience in the treatment and study of schizophrenia. This book will provide a welcome source of information for individuals with schizophrenia, their family members, and those involved in caring for them.

Leading and internationally recognized researchers review what is known about the liability to schizophrenia, how it progresses, what it looks like clinically-with an emphasis on a specific (proposed) syndrome of liability (schizotaxia)-and how best it might be treated now and in the near future. The authors summarize the latest findings on the genetic, early environmental, and neurodevelopmental origins of schizophrenia.