Spouses of schizophrenics: a blind comparative study

The 3DPT dimensions S, E, and N: A critical evaluation of Eysenck's Psychoticism model

In this article a critical evaluation is given of Eysenck's Psychoticism model. It is argued that in this model two sub‐models can be distinguished, which, contrary to Eysenck's presentation, cannot be regarded as true extensions of each other. With respect to one of these models, the ‚genotypic’︁ P‐model, the theory is criticized in that both schizophrenia and affective psychosis are determined by a common genetic predisposition which can phenotypically manifest itself in variations of P. Instead of this theory, the likelihood is put forward that a high EPQ‐P score, albeit in combination with a high N and a low E score (and notwithstanding the fact that criminals or psychopaths can also obtain high P scores), is (only) related to the schizoid state, and hence, that P seems to be relevant either as a predisposing factor contributing to the development of schizophrenic psychosis, or as a factor on which biological relatives of schizophrenics obtain higher scores on average than normals do. In this respect, Eysenck's theory that the non‐schizoid form of psychopathy can also be found among first‐degree relatives of schizophrenics, and hence, that psychopathy and schizoidia are genetically related, is also criticized. Furthermore, it is argued that Eysenck's EPQ‐P scale is not optimal for measuring those traits of the schizoid personality which are independent of N and/or E. Both arguments regarding the contents of this scale and arguments with respect to the demonstrated lack of invariance of the EPQ‐P factor are adduced to support this statement. Thus, an alternative scale for measuring ‚P’︁ (labelled S or Insensitivity) was designed by us. The S‐scale is based on literature concerning the schizoid state and reflects the results of a series of principal components analyses of (potential) S items, together with N and E items, put into execution with the intention of investigating the invariance of the S factor (and of E and N) with respect to six sample and other parameters. These investigations were carried out on a large, representative sample of the Dutch population. Additional investigations were carried out concerning the reliability and validity of the three newly formed scales. The results of these investigations turned out to be very satisfactory or, in some respects, at least promising. Finally, in this article, comments are made on the nature of the S factor, comparing this dimension with both Eysenck's P factor and the dimensions Agreeableness and Conscientiousness, as proposed, for instance, in McCrae and Costa's version of Nor‐man's 5‐factor model. As against P, the S or Insensitivity factor seems to be only (negatively) related to Agreeableness and not to Conscientiousness. It is also argued that this finding seems to be in accord with the supposed schizoid nature of S and the criticisms levelled at Eysenck's EPQ‐P scale.

Spouse similarity for psychological distress and well-being: a population study

While spouse similarity for psychiatric morbidity has been the object of numerous studies, most of these focused on clinical samples and, consequently, the interpretation of their results is limited by the existence of a selection bias. In this study, conducted on a sample of 845 general population couples, significant spouse similarity was observed for psychological distress and well-being, characterized by a marked symmetry in the relation between spouses' scores. The sex differences observed in many earlier studies would appear essentially to be artefactual. Spouse similarity was also found to be significant in the subpopulation of couples married less than two years, which pointed to assortative mating for psychological distress and well-being. While many studies have found educational dissimilarity and age difference between spouses to be associated with certain health variables, such as high blood pressure and coronary heart disease, these variables do not have a significant influence on individual levels of psychological distress and well-being. Spouse similarity for socio-demographic characteristics does not play a significant role in explaining spouse similarity for mental health. Consequently, assortative mating for psychological distress and well-being would appear to be primarily due to personal preference.

Postnatal psychiatric illness: the impact on partners

Out of 24 spouses of women with postnatal psychiatric illness admitted to a mother and baby unit over 12 months, 12 were found to be psychiatrically ill, as defined by RDC or DSM-III criteria. The rate of psychiatric disorder was higher in these men than in a control group of men whose partners remained well after childbirth and a group of men whose partners were admitted to a psychiatric hospital with non-puerperal illness. The onset of psychiatric illness in the men typically followed admission of their wives to the mother and baby unit. Other associations with illness in the man were a history of chronic social problems, previous psychiatric episodes, and a poor relationship with his own father.

Morbid risks for major disorders and frequencies of personality disorders among spouses of psychiatric inpatients and controls

Three hundred fifty-three psychiatric inpatients and their 192 living spouses and 98 control subjects and their 54 living spouses were examined and interviewed for affective, schizoaffective, schizophrenic (Research Diagnostic Criteria [RDC]), and personality disorders (DSM-III-R) using the Lifetime Version of the Schedule for Affective Disorders and Schizophrenia (SADS-L) and the Structured Clinical Interview for DSM-III-Personality Disorders (SCID). The morbid risks of spouses for unipolar depression were between .15 and .25, and those for other major disorders were below .03. The morbid risks of spouses of bipolar patients for unipolar depression exceeded those of other spouses by 50% without reaching statistical significance. Personality disorders were found in 44.6% of patients, in 8.4% of patients' spouses, and in 9.8% of healthy controls. There was only one couple in which the husband and wife had each had a major disorder before marriage. Only four husband-wife pairs suffered the same personality disorder. Spouses of patients do not have significantly more psychiatric disorders than healthy controls; therefore, assortative mating can only be of minor relevance in family studies.

Crime and the schizophrenia spectrum: a diathesis-stress model

Previous studies support a relationship between schizophrenia and antisocial behavior. In the present study, offspring of schizophrenics showed a greater degree of antisocial behavior than did offspring of parents without psychopathology. The present study clarifies the interplay between risk for schizophrenia and developmental factors in determining antisocial behavior. Those variables which distinguished high-risk criminal behavior from high-risk non-criminal behavior were irritability and shortened attention span in infancy, paternal absence during ages 15 to 17, lower WAIS Verbal IQ, impoverished neighborhood, family discord and negative attitude towards father. In a multiple regression analysis, paternal absence in adolescence, shortness of attention span, and low Verbal IQ each contributed a unique portion of the variance in antisocial behavior. A block of interaction terms (Stressor X Risk) did not contribute a significant portion of the variance in antisocial behavior, suggesting that those factors which predict antisocial behavior in the high-risk group are the same factors which predict antisocial behavior in the low-risk group. In addition, a significant portion of the variance in phenotypic outcome (criminal vs. schizophrenic) was accounted for by passivity in infancy (predictive of schizophrenia) and low Verbal IQ (more common in high-risk criminals). Shortened attention spans in infancy were found to precede both criminal behavior and schizophrenia in this sample. This feature may therefore indicate a genetic vulnerability to schizophrenia.

Psychiatric morbidity in spouses of women admitted to a mother and baby unit

The spouses of 40 women admitted to a psychiatric Mother and Baby Unit were interviewed to detect psychiatric morbidity, and aspects of their social and marital functioning. This group was compared with 25 men whose wives had not shown obvious psychiatric disorder in the puerperium. Psychiatric morbidity, using DSM-III (American Psychiatric Association, 1980) criteria, was present in 42% of the index group, and 4% of the comparison group. The main diagnoses were major depressive episode and generalised anxiety disorder. This was associated with poorer marital and social function in the index group. Male psychopathology after delivery has been studied little but may be significant in the management of postpartum syndromes.

Assortative mating in schizophrenia: results from the Copenhagen High-Risk Study

Assortative mating denotes a tendency for mated pairs to be more similar for some phenotypic trait (similar constitution) than would be the case if the choice of a partner occurred at random. Assortative mating occurs for a variety of physical (e.g., anthropometric variables) and psychological traits (e.g., IQ), including mental illness (Vandenberg 1972). Several studies have shown an excess of married couples suffering from a variety of psychiatric syndromes as compared to the frequency expected on the basis of noncontingent admissions into treatment facilities (Kreitman 1962, 1964, 1968; Nielsen 1964), a finding confirmed in a community study by Hagnell and Kreitman (1974). A recent review of the research literature (Merikangas 1982) concluded that there exists a true primary assortative mating for mental illness. This conclusion is strongly supported by the demonstration of an increased prevalence of mental disorders in the spouses' first-degree relatives (Slater and Woodside 1951; Guze et al. 1970; Cloninger et al. 1975; Gershon et al. 1973; Merikangas et al., in this issue.

[Manic decompensation]

The author stresses early detection of the premonitory signs of a manic breakdown with a view towards an efficient therapeutic intervention. Some of the most typical signs are described with their corresponding dynamic implication. The manic-depressive's lack of impulse control often forces a member of the patient's circle to take control. After a review of the main personality traits belonging to the manic-depressive patient, the author gives a description of the patient's spouse in whom appear similar and complementary elements of the patient's personality. Finally, some steps are suggested to rationalize treatment. Emphasis is on educational methods combined with lithium therapy within the framework of a therapeutic relationship where the interactive dynamic forces are acknowledged.

Mates of schizophrenic mothers. A study of assortative mating from the American-Danish high risk project

Both mates of schizophrenic mothers and a control group consisting of mates of non-schizophrenic mothers were diagnostically examined. The former were more frequently psychiatrically deviant than their controls, both with respect to a life-time syndrome diagnosis and a personality diagnosis. Mating between a schizophrenic mother and a father who suffered from schizophrenia spectrum disorder significantly increased the offspring's risk of developing a schizophrenia spectrum disorder himself. Assortative mating was negatively correlated with age of onset of maternal schizophrenia. It is proposed that defective emotional rapport or sub-psychotic features constitute the phenotypic traits by which assortative mating operates in schizophrenia.

Assortative mating for major affective disorder

The families of 26 married bipolar manic depressives were examined in detail. The rate of affective disorder in their spouses, and the parents and siblings of their spouses, was ascertained. The prevalence of affective disorder among the parents and siblings and of the spouses of age- and social class-matched schizophrenics and well controls was also ascertained. Finally, the prevalence of affective and other psychiatric disorders in the adult offspring of the bipolar probands was ascertained and related to the presence or absence of affective disorder in the spouse. We did not find clear evidence of assortative mating for major affective disorder, although dual mating for affective disorder had the expected result of increasing the risk for affective disorder in the adult offspring.

Is there an increase of reproductive rates in schizophrenics? I. Critical review of the literature

It is well-known that the fertility of schizophrenic patients, particularly males, is below the population average. The main measures of fertility (reproductivity) are marriage rate, marital fertility, and rate of reproduction. A review of the literature reveals the rate of reproduction of schizophrenic patients to be 30% to 80% of the general population, the reduction being mainly due to reduced probability of marriage. At least one investigation presented evidence for an increase in marriage rate and rate of reproduction in schizophrenic patients relative to the general population in recent time. If this increase were to be confirmed it would undoubtedly have practical as well as theoretical implications. The hypothesis of a compensatory higher fertility of healthy relatives of schizophrenics based on a physiological advantage is empirically unproven. Additionally, the concept of a balanced polymorphism in schizophrenia rests on a superficial analogy with Mendelian traits.

The spouses of depressive and schizophrenic patients. A controlled study

The personality structures and the well-being of the partners of a representative sample of 103 married depressive or schizophrenic hospitalised patients were examined. As a means of examination we used a semi-structured interview, the Giessen-test (Beckmann and Richter 1972, 1979) and the Eigenschaftswörterliste (Janke and Debus 1978). Concerning personality, the comparison of self-image of the partners with the patient's estimation of his or her spouse resulted in good mutual agreement. The spouses of schizophrenic and depressive patients differed neither as far as the average profiles were concerned nor according to the cluster-analysis findings. In addition to this, both groups differed only to a minor extent from a representative sample of the general population. Whereas personal attitude and the well-being of the marital partners were for the most part independent of the depressive or schizophrenic kind of illness, personality and well-being of the spouses correlated with the course of the illness. The more phases of illness the spouses had witnessed, the more unattractive, self-controlled and uncommunicative they proved to be and the less irritated and sensitive they were when the patient was hospitalised. These findings are discussed in the light of further research.

Platelet MAO activity and evoked potentials in the identification of subjects biologically at risk for psychiatric disorders

Individuals potentially at risk for psychiatric disorders were identified by screening 375 college student volunteers for low platelet monoamine oxidase (MAO) activity levels. The lower and upper 10% in MAO activity were administered a personal and family history interview, psychological tests and average evoked response (AER) electroencephalographic procedures. Results indicated that low MAO males and females were socially more active, had more psychiatric contact, and had relatives who were psychiatrically more disturbed than high MAO subjects. Low MAO males had more convictions, experimented more with illegal drugs and had elevated scores on the MMPI. AER criteria further defined a high risk group of low MAO-AER augmenters which had more suicides among their relatives and higher scores on the schizophrenia scale of the MMPI.

Assessment of familial risks in the functional psychoses and their application in genetic counselling

Now that the evidence for genetic factors in the major psychoses is very strong but still essentially circumstantial (what is transmitted is unknown), there is a danger that myths about the nonexistence of mental illness may be replaced by equally misleading myths about its inheritance. The need for genetic counselling is therefore likely to increase (counselling is advice given as a result of consultation). Admittedly, the literature on counselling in mental illness is scanty, the author's own experience slight, and the public demand small. Reed (1972) stated that less than 1 per cent of the 3,000 cases seen at the Dight Institute over 20 years were concerned with schizophrenia. Nevertheless, it is probable that much unrequested and ill-informed advice is being given.

Non-psychotic disorders in the families of process schizophrenics

The present study was designed to test the hypothesis of "schizophrenic spectrum" disorders. The families of 60 process schizophrenics were systematically interviewed with structured interview forms, and evaluated for psychiatric illness according to strict diagnostic criteria. The interviewed persons were then separated into two groups for comparative analysis according to a positive (FH+) or negative (FH-) family history for schizophrenia. The frequencies of affective disorder and all non-psychotic conditions did not differ to a convincingly significant degree between the two groups. Our data thus fail to support the "schizophrenic spectrum" hypothesis in which neurosis and sociopathy occur as a consequence of a genetic loading for schizophrenia.?