Heterogeneity in schizophrenia: an extended replication of the hebephrenic-like and paranoid-like subtypes

Hebephrenic-like (H) and paranoid-like (P) subtypes of schizophrenia have previously been described by Farmer et al. (1983, 1984). The stability of this subtypology of schizophrenia was explored using multivariate statistical techniques on a large independent data set. Both a discriminant function analysis and an admixture analysis produced strong evidence for a bimodel distribution of scores consistent with the H-like and P-like subtypes.

Sex and schizophrenia: effects of diagnostic stringency, and associations with and premorbid variables

In a case-record study, all first-contact patients with non-affective functional psychosis from a defined area over 20 years were diagnosed according to operational criteria of varying stringency and emphasis, and incidence rates for each set of criteria determined by sex and age at onset; data on premorbid adjustment were also analysed by sex and age at onset. The overall first-contact incidence of non-affective functional psychosis was approximately equal in men and women; however, the ratio of male to female incidence rates rose progressively when RDC (1.2), DSM-III-R (1.3), DSM-III (2.2), and Feighner (2.5) criteria for schizophrenia were applied. Schizophrenia was most common in young males and least common in older males, with females occupying an intermediate position. Schizophrenia in young males, particularly when stringently defined, was especially likely to be associated with single status, poor work and social adjustment, and premorbid personality disorder. The results suggest that schizophrenia syndrome is heterogeneous, and young males are especially prone to a severe neurodevelopmental form of illness associated with premorbid deficits.

Does social deprivation during gestation and early life predispose to later schizophrenia?

We employed a case-control study design to investigate whether schizophrenic patients differed from non-psychotic psychiatric patients in terms of place of birth and paternal occupation. "Cases" were first-contact schizophrenic patients ascertained from the Camberwell Cumulative Psychiatric Case Register. "Controls" were the next (non-psychotic) patient on the Register matched for age and sex. In comparison with controls, cases were more likely to have: (1) been born in the deprived inner-city Camberwell catchment area (odds ratio 2.3), and (2) had fathers who had "manual" as opposed to "non-manual" occupations (odds ratio 2.1). The results were compatible with the notion that socio-economic deprivation during gestation and early life predisposes to later schizophrenia.

The epidemiology of late-onset schizophrenia

We report an analysis of a large catchment area sample of patients with nonaffective functional psychoses presenting across all ages at onset. The male:female ratio was 1.56:1 in the 16-25-year age group; it reached unity around 30 years of age and declined to 0.38:1 in the 66-75-year group. Contrary to expectation, a higher proportion of patients with onset of illness after 45 years than of younger onset patients fulfilled DSM-III-R criteria for schizophrenia (52% vs. 38%). The distribution by age at onset was much the same irrespective of stringency of diagnosis. The highest rates were in the 16-25-year age group, with a slight second peak in the 46-55-year group, and a third (more emphatic) peak in the over-65 group. A closer analysis of demographic and phenomenologic variables revealed distinct differences between patients with early and late (after 44 years) onset of illness.

A neurodevelopmental approach to the classification of schizophrenia

The conventional distinction between schizophrenia and manic depression has received little objective support from recent studies of phenomenology, outcome, or familial homotypy. Instead, much clinical, epidemiological, and morphological evidence suggests that within the broad range of Schneiderian schizophrenia there exists one form (congenital schizophrenia) that can be distinguished from other types, the manifestations of which are confined to adult life. We hypothesize that congenital schizophrenia is a consequence of aberrant brain development during fetal and neonatal life. Such patients show structural brain changes and cognitive impairment, and in their male predominance, early onset, and poor outcome, they reflect Kraepelin's original description of dementia praecox. We contend that adult-onset schizophrenia is itself heterogeneous. One important component is a relapsing and remitting disorder that is more frequent in females than in males, exhibits positive but not negative symptoms, and has much in common etiologically with affective psychosis. There also exists a very-late-onset group in which degenerative brain disorder is implicated.

Carotid artery disease in young adults

The angiographic and clinical findings in 17 young adults (14-39 years) with stenosis and/or occlusion of at least one of the common or internal carotid arteries were reviewed to determine the spectrum of carotid artery disease in this age group. Five aetiological groups were identified: atherosclerosis (3 patients), arteritis (4), non-inflammatory arteriopathies (6), compression by neoplasm (1), and occlusions of undetermined cause (3). Over a mean follow-up time of 19.7 months, 2 patients died (12.5%) and further cerebrovascular events occurred in 4 others (25%). We conclude that carotid angiography plays a meaningful role in providing a definitive diagnosis in young adults with carotid artery disease and thus may assist with therapy and prognosis.

Nemaline myopathy: a report of two siblings as evidence of autosomal recessive inheritance of the infantile type

We report two opposite-sex siblings with the severe infantile form of nemaline myopathy; diagnoses were made on muscle biopsy. Neither parent showed clinical or electromyographic evidence of myopathy, and both had negative muscle biopsies. Autosomal recessive inheritance seems likely.

Red or rufous albinism in southern Africa

Red or rufous albinism is a rare type of oculocutaneous albinism described, but not as yet fully investigated, in Africa and New Guinea. Twelve rufous albino subjects from 10 families participated in this preliminary study. The prevalence of rufous albinism was found to be approximately one in 8,580 among school children in the negroid population. The combination of the unusual red skin colour, ginger to reddish hair colour, low susceptibility to sun damage, and minimal visual problems, in affected individuals, suggested that they form a group which is distinct from the brown and other types of albinism. The mode of inheritance was found to be recessive. Tyrosinase assays showed that rufous albinos are tyrosinase positive and on electron microscopy studies normal melanosomes and melanocytes were observed in hair bulbs and skin. Visual evoked potential testing did not show the gross decussation abnormalities of the optic pathway detected in other types of albinism. Rufous albinism might be at one end of the spectrum of types of oculocutaneous albinism and, because affected people have such mild symptoms, their inclusion in this group might be debatable.

The oculocerebral syndrome in association with generalised hypopigmentation. A case report

A 14-year-old girl with generalised hypopigmentation, mental retardation, abnormal movements, and ocular anomalies is described. It is suggested that she represents a further case of oculocerebral albinism, a rare autosomal recessive condition. Reference is made to previous similar cases.