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A long-term (the average 22.4 years) follow-up study of 757 schizophrenic patients displayed in 22% of the cases full recoveries, in 42,3% -- atypical types of recovery and in 35.7% -- characterisctic deficiency symptoms. At the time of the last follow-up 85.5% of the patients were living at home. 14.5% were permanently in hospital. The author gives a clinical analysis of the examined patients and prognostically favourable and unfavourable factors.

SyonpsisTwenty-two boys with schizoid personality were followed-up some 10 years later and compared with a matched control group with other diagnoses who had been referred to the same child psychiatry department. The diagnostic category is shown to have predictive validity. A start has been made towards an operational definition of the syndrome.

Studies of adopted individuals and their biological and adoptive families offer a means of disentangling the genetic and environmental contributions to a disorder such as schizophrenia and permit an examination of the effects of one type of influence while the other is randomized or controlled. Using this strategy in a series of studies, we have obtained results pertinent to genetic and family-interaction theories of etiology subject in a considerably lesser degree to the confounding of these influences that have flawed previous studies in both fields. There is every reason that these studies should be presented and criticized in an issue of the Schizophrenia Bulletin devoted to genetics, just as another strategy—high risk studies—was previously examined. The masterful review by Garmezy (Garmezy with Streitman 1974 and Garmezy 1974) on individuals at high risk for schizophrenia, published in the Schizophrenia Bulletin, presented the hypotheses, research design, results obtained, and conclusions permissible in that area, as reported by the various investigators. The reader could readily judge the pertinence and validity of the reviewer's critique. In contrast, the reviews of the adoption studies to be found in the critical essays by Gottesman and Shields (1976) and by Lidz (1976) suffer from a selective and incomplete presentation of the data obtained in the studies under examination, the omission of important conclusions, and the paraphrasing

To try to encompass what is meant by borderline with parameters that are too delineating can lead to conceptual difficulties and confusion for several reasons: The human psyche is too complex and probably has too much of the quality of a gestalt to be understood adequately by dichotomizing thinking; an individual does not experience himself as operating in discrete units, but as a unified whole; and the most characteristic manifest quality of the borderline picture is its tendency toward a chaotic functioning that somehow always spills over any defining boundaries which are set up to attain conceptual containment. If we then accept our limitations on the precision and order with which we can comprehend it, the understanding of borderline might be supplemented by seeing it in terms of the subjective experience of an integrated self. This offers a more holistic approach that tends not to be so subject to objectifying compartmentalization. It is more in tune with the subjective experiencing a person has of that which defines and moves him in the world. And it offers a referent axis along which the distance one has traveled in the borderline direction might be gleaned. Finally, the relationship of the borderline diagnosis to character disorder might be looked this way: The diagnosis does not refer to a particular character disorder or to a group of disorders. It emerges in all character pathology to the degree that the experiencing of an integrated and whole sense of self, which is at the heart of character structure, is diminished.

38 schizoid and 70 hysterical patients with neurotic disturbances are compared with regard to social data, intelligence and triggering situation. Schizoids are more frequently single, childless and live alone, while hysterics are married, remarried or divorced, have one child and live with their partner and the child. With nearly the same education and intelligence, schizoid patients are more often workers/skilled workers, pupils/apprentices/students or have no profession; hysterically structured individuals, being predominantly women, are more frequently housewives. Nearly half of the most frequent triggering events are equally distributed in both structure groups; these are particularly events signalling a change during development, which, in degree of severity, can just as well be minor threshold situations as serious reverses. With an earlier age of onset, schizoids decompensate significantly more often in "developmental stages", whereas hysterical patients are more likely to do so in connection with events of "love-sexuality" and those which provoke hysterical anxieties. Of the 15 most frequent events, only 6 each occur in either the schizoids (starting school, puberty, moving away from home, entering into a heterosexual relationship in terms of a casual encounter, beginning an apprenticeship or studies, failure in a test) or the hysterically structured individuals (vacation, marriage, pregnancy/delivery, marital disharmony, extra-marital relationship and severe illness of the patient).

The paper concerns similarities and differences between childhood schizophrenia and schizophrenia of the adults from the standpoint of the genealogical background in the respective families. The degree of loading by manifest psychoses and the typology of nonmanifest disturbances among the parents of probands with an unfavorable development of early childhood schizophrenia was studied. The data obtained demonstrate heterogeneity of this form of childhood schizophrenia, confirmed as well by genealogical studies in a comparative age aspect.

An integrative model of schizophrenic defect is offered. The model presumes the negative changes to extend over all the levels of psychic activity, though in uneven manner, rather than be confined to a distinct sphere. In 200 schizophrenic patients the defect had a complicated structure integrating the negative changes of schizoid and pseudoorganic types. Extreme variants of integration of schizoid and pseudoorganic changes can be regarded as two distinct defect types with prevailing personality deformations (combination of verschroben-type changes with personality level decreasing) and the fall in psychic activiity (combination of pseudobradyphrenia with schizoid deficit-type changes).

The present study attempts to correct design weaknesses in earlier studies which assessed the use of early memories (EMs) in identifying psychopathology in children. A new EM scoring system, the CEMSS, was developed to provide an objective, comprehensive analysis of the reported EMs. Subjects were 64 boys, SES IV and V, 8 through 12 years old from four diagnostic groups--Delinquent, Hyperactive, Somatic Complaints, and Schizoid. Overall, the CEMSS provided an effective means to distinguish the diagnostic groups, p less than or equal to .01. The results suggest that content variables best distinguished the type of presenting psychopathology, whereas an earlier study found that structural EM variables most reliably identified the degree of psychopathology.

Under observation there were 18 children and adolescents with the sthenic variant of schizoid (autism) psychopathy. A 2- to 6-year-long dynamic observation has enabled the author to trace some regularities of the formation of that psychopathy variant and to specify some peculiarities of the psychogenic reactions in the children and adolescents with that anomaly of the personality.

The purpose of this paper is to introduce the autistic character as a diagnostic entity and then delineate the formative early object relations, the symptoms and how they develop out of the early object relations, and the related defensive behavior. The paper will end with recommendations for treatment.

This part examines the symptoms and diseases of neurotics with either a schizoid (38) or a hysterical (70) personality structure, comprising 5% and 10% respectively of the first admissions in 7 years. Compared to the hysterical structure, schizoids more frequently show the following characteristics: they are men and have as their secondary component a mixed character structure, an earlier age of onset, a longer duration of illness but earlier referral for psychotherapy. They suffer mainly from psychic symptoms--depressive states and contact difficulties as the indicating signs. Further complaints are defective concentration, feelings of apprehension and difficulty in working, also bulimia and the inability to breathe deeply. They were mostly born between 1940 and 1959. Their relatives suffered from psychiatric disorders. Compared to the schizoids, hysterically structured individuals are almost exclusively women, their second most important structural component being obsessive-compulsive. They develop their illness later, have it for a shorter time and are referred for psychotherapy later. Their indicating signs manifest themselves more often somatically, less frequently as anxiety states or phobias. The symptoms occur simultaneously in several organ systems, particularly the respiratory tract, the gastrointestinal tract and the musculoskeletal system. Common symptoms are dyspnea and/or hyperventilation tetany, nausea, weight gain, frigidity and fluor as well as crying fits. They formerly suffered from gynecological disorders and had to undergo operations. They were mainly born between 1920 and 1939. Their relatives had cardiac disorders and their symptoms were identical or similar to those of their father.

The concurrent validity of the MCMI as compared to the MMPI was assessed by administering both tests to 106 newly admitted outpatients and calculating the intercorrelations between these two tests. Of the 20 MCMI scales, 12 were found to correlate with the MMPI in a manner that suggested that they do measure some degree of personality dysfunction, emotional disturbance, or specific psychological symptomatology. Eight of the MCMI scales failed to show correlations that would indicate that they effectively measure any of the pathological personality characteristics or clinically significant symptom patterns known to be measured by the MMPI.

R. D. Laing never fully brings together his extraordinary empathy for schizophrenic individuals and his critical view of schizogenic families. In his writings, family and social interactions increasingly dissolve into subjective "scenarios," and ultimately, "inner space" becomes the source of the redeeming light. This development has unfortunate psychiatric, philosophical, and political implications. Language: en

The major concern of this study was to identify the personality traits connotated by a number of diagnostic labels such as paranoid, schizoid, hysterical, and cyclothymic. Twenty psychiatrists were given a list of nonpsychotic personality disorders and were asked to indicate what personality traits were typically associated with them. Results showed good agreement among psychiatrists on the personality traits they believed to be implied by the diagnostic terms. A factor analysis of the ratings showed a circular configuration of relative similarity among the different diagnoses. The results are interpreted as indicating that diagnostic labels are types of codes for various sectors of an implicit space of traits, signs, and symptoms.

SUMMARY Twenty -four elective mute children were studied–this proved to be a rare condition, affecting slightly more girls than boys. They were compared with 84 speech-retarded controles and 102 normal control children. The main findings in the case of the elective mute children were as follows. 1. Evidence of immaturity of development, particularly of speech, and an excess pf speech abnormalities. 2. A higher rate of behaviour problems, and high levels of enuresis and soiling. 3. In the majority of cases, an insidious development of excessive shyness from the earliest years of life. 4. Performance LQ. covering most ranges of ability, but with a significant excess in the lower ranges. 5. A high rate of Psychiatric disturbance in the families of elective mute children. 6. And, finally, on follow-up, elective mutism proved to be a rather intractable condition.

Evaluated an assumption from previous psychotherapy analogue studies, namely, that trained psychotherapists and untrained quasi-therapists with personality similarities will respond similarly to patient presentations. Ss were 24 male psychotherapists and 24 male undergraduate students, chosen partially on the basis of their responses to an A-B personality scale derived from the work of Whitehorn and Betz (1954). The three-factor experimental design included S personality type (A or B), S professional status (psychotherapist vs. student), and videotaped patient simulations (neurotic vs. schizoid), with all Ss exposed to both patient prototypes. Therapists demonstrated a higher degree of accurate empathy, were less active, made shorter responses, and used more declarative sentences (p less than .01 for each variable). Second-order interaction effects indicated that therapist personality type X patient type pairings produced opposite results for quasi-therapists when compared to professional therapists.

While the schizoid dimension of personality has often been thought to be unitary, it has recently been suggested that several dimensions may be involved. In this study two separately derived normal population personality scales from within the psychoticism domain, the Rust Inventory of Schizotypal Cognitions (RISC), a scale designed to measure the positive cognitive schizotypal dimension, and the Eysencks' P scale from within the Eysenck Personality Questionnaire, were administered to a group of 608 Venezuelan university students. It was found that the RISC and the EPQ had only a small correlation of 0.12. It was concluded that at least two dimensions were involved in the schizophrenic/normal spectrum, and that the EPQ Psychoticism scale was in fact measuring a dimension of personality disorder rather than a general factor of psychoticism.

This paper is presented primarily for its historical interest. The author's first attempted publication in psychiatry or psychoanalysis, it was submitted successively to two publications in 1949, rejected by each, and filed away until now. In it, the author suggests that transference phenomena constitute projections, and that all projective manifestations-including transference reactions-have some real basis in the analyst's behavior and represent, therefore, distortions in degree only. The latter of these two suggestions implies a degree of emotional participation by the analyst which is not adequately described by the classical view of him as manifesting sympathetic interest, and nothing else, toward the patient. It has been the writer's experience that the analyst actually does feel, and manifest in various ways, a great variety of emotions during the analytic hour. The analytic usefulness of this actual richness of emotional participation, by the analyst, is detailed.

615 neurotic patients from two outpatient Clinics were divided into three groups: only children, siblings with minimal age difference group, siblings not of minimal age difference group. The following hypothesis were to be examined: The younger of two siblings with minimal age difference are at greater risk to develop schizoid disorders. The hypothesis was proved correct. Amongst our patients the younger of two siblings of minimal age difference were at a particularly high risk in becoming schizoid. In addition we found the following risiko configuration in the early developmental period. Frequently these patients originated from families with many children, the age difference to the next sibling is also minimal, the mother is frequently lost before the age of three and the father is often self employed. These results confirm the so called "hypothesis of neglect" as it is observed in the development of schizoid disorders. A reexamination of the result of this research is to be desired.

The early signs and symptoms of schizophrenic decompensation are subtle and variegated. Today's community patient often presents with vague complaints of brief duration making it imperative that today's diagnostician be able to recognize and appropriately treat early psychopathology. This paper collates a number of observations of developing psychotic phenomena -- self reports, clinical studies and controlled experiments -- and provides a useful format for organizing these complex and changing behaviors. Data are presented and discussed using our clinical schema for detailing the natural progression of developing psychotic phenomena into four distinct stages. Efficacy of early recognition and treatment in aborting or diminishing a major psychotic episode is discussed. The advantages of recognizing the early signs of psychotic decompensation are apparent. First, with adequate intervention and treatment, the overt psychotic state may be attenuated. Although the feasibility of reducing the incidence of schizophrenia through intervention in "high risk" groups, or those experiencing insidious symptoms remain speculative (further investigation in this area is urgently needed), nonetheless, early diagnosis and comprehensive rehabilitative care significantly improves social and occupational adjustment. A second advantage accrues from early diagnosis. It enables patient and family to better cope with the illness. We have previously outlined a schema detailing the natural progression of developing psychotic phenomena into four distinct stages. The phenomena, when identified, can be seen as a continuum. However, many clinicians fail to recognize the earlier phases and typically the diagnosis of psychosis is made relatively late at what we call stage three of the four stages we described.

This paper describes the relationship between the experiential aspects of the concept of inner space and of emptiness. This is based on the change of inner experience of a borderline patient during analysis from one of empty space to one of real space. The analysis is described and the relationship of inner space to schizoid and depressive emptiness elaborated, together with the emergence of a healthy inner space (positive emptiness). The components of the capacity to experience inner space from infancy onwards are enumerated and discussed.

The author assessed the traits of the mental development of children from schizophrenic patients. A prevalence of schizoid types of personality was seen. The personality was also being analyzed from the point of view of age traits in asthenic, sthenic and mixed variants of the schizoid type. An analysis of a group of ill children (96) with a schizophrenic hereditary loading gave grounds to assume that the differences in the premorbid development of the children correlate with the differences of the initial stage and the type of development of schizophrenia.

The report covers a group of schizophrenic parents and their children (219 patients from 101 families); the author studied variants of premorbid personality traits, the patient's age at the onset of the disease, the duration of the initial period, its syndromes in the descending generation. Comparing signs in the pairs of parents-children the author detected the most stable signs in transmission to the descending generations. The following signs were attributed to such stable traits: schizoid personality traits, a short initial period, a psychopathlike syndrome in the initial period. Special tables were formed permitting to prognosticate the appearance of some signs in children when some signs were known in parents.

The authors examined clinically and psychopathologically, and followed up 39 children and adolescents with various borderline nervous and psychic disorders in whom a super-worship fantasy or other psychic formations were accompanied with visualized imagination that consisted in fancying bright, sensual images localized within the patient's subjective space and having a dynamic subject character corresponding to the fantasies and other experiences subjectively important for the patient. The visualized imagination is regarded as an independent productive-dysontogenetic syndrome.

The premorbid personality, features of early ontogenesis and childhood crises periods were studied in 226 patients with attack-like forms of schizophrenia, manifesting itself in adolescence with florid psychotic attacks. The authors describe 8 types of the premorbid personality: 1) hyperthymic; 2) sthenic; 3) sensitive; 4) dissociated; 5) passive; schizoid; 6) explosive; 7) model and 8) deficitary personalities. A clinical analysis of the studied cases deomnstrated that the premorbid type of the patient, along with some other factor may be considered as one of the important indices when making a probability prognosis of the development of the disease.

A clinico-genetic investigation of 61 probands with attacklike childhood schizophrenia and 188 relatives including 143 individuals of the first relationship degree (121 parents, 22 sibs) and 45 members of the families of the second and third degree of relationship was conducted. Among the parents 20 manifesting schizophrenic psychoses were detected which equals to 16,5% of the total number of the parents of this group. The parents suffered from attack-like schizophrenia. Besides, the percentage (37,1%) of alleviated forms of psychoses in the parents of this group appeared to be high. The sibs of probands with attacklike schizophrenia had a high risk of schizophrenia (27,2%).

The author describes the development of the borderline concept and the apparent inaccuracy of the original hypothetical framework. The signs and symptoms used to describe a "borderline syndrome" are often shared with other psychiatric illnesses. The author recommends that clinicians consider patients with only those features as "undiagnosed" until further research determines whether a distinct syndrome exists.

This paper explores two marital constructs set forth by Peter Giovacchini. The first is based on a symbiotic reenactment in which the investment of both partners is tenacious and reciprocal, an attachment which Giovacchini refers to as a "character object" relationship. It represents intrapsychic homogramy. In the second construct, this deep form of attraction is absent and the dyadic bond is superficial, frequently transitory. The latter couples do not require an elementary, intrapsychic bond but do share particular defensive traits or symptoms. Thus these unions are termed "symptom object" relationships and are characterologically heterogamous. By means of a group case study approach, this distinction was statistically supported. Furthermore, it was found that homogamous marriages stay in treatment longer, maintain a lower divorce rate, and respond best to individual psychoanalytic psychotherapy. Heterogamous marriages, by contrast, show a higher divorce rate and tend to leave therapy prior to termination. The research also suggests that the initial treatment of choice for this type of marriage may well be conjoint or group psychotherapy.

Previous studies by the author and his collaborators, Rosenthal, Wender, Schulsinger, and Jacobsen, of the biological and adoptive relatives of schizophrenic adoptees are reviewed in conjunction with more recent studies by Spitzer and Endicott and by Kendler, Gruenberg, and Strauss, who independently made operational diagnoses using the Research Diagnostic Criteria or DSM-III specifications, both of which showed good agreement with the authors' global diagnoses based on the descriptions in DSM-II. Both the DSM-III diagnoses and the authors' global diagnoses found a highly significant concentration of chronic, latent, and uncertain schizophrenia or schizotypal personality disorder in the biological relatives of adoptees who developed chronic schizophrenia. A response is made to recent criticisms published in this journal by Lidz and Blatt and by Abrams and Taylor.

Compared to the hysterical structure, the following characteristics are more frequent in schizoids: they are illegitimate, are born late after several siblings and are quiet and shy as children. The mother is irascible, the father aloof; on the other hand, the parental combination "mother and father affectionate" is more common. The father is often absent in early childhood, and there is the additional stress caused by changes of residence. In their earliest childhood memory, the mother and father are named as central reference persons. According to the impairment score, the schizoids are more severely disturbed. In contrast, hysterical patients have young mothers that taboo sexuality and irascible fathers; they criticize the mothers more and also idealize the father. The hysterically structured individual is an only child or has few siblings. As children, these patients are well-behaved, lively, athletic, have many friends, fight and compete with siblings. In their earliest childhood memory, they name other adults--not family members--and topics centering on possession and contact. Their childhood is affected by stress arising from the death of the father and other close reference persons as well as from flight experiences. The results make it possible to describe a markedly different line of development in the structure groups and a greater degree of stress due to various risk factors in the schizoids.

The clinical course of schizoepileptic and schizopsychoasthenic variants of developing schizoid psychopathy are reviewed. On the basis of the study of 45 patients in childhood and adolescence, specific characteristics of the psychopathic, pathocharacterologic and neurotic reactions are described and their role in the evolution of an abnormal personality is shown. The role of constitutional-genetic and microsocial-environmental factors in the structural formation of these variants of psychopathies is discussed. It is concluded that the combination of various psychopathic radicals observed in the structure of an abnormal personality do not present mere summation of these factors but is manifested in complex dialectical interaction.

It has been reported about the results of ambulatory psychotherapy in groups. We believed that the process in a group will be stimulated specifically by different concepts and kinds of intervention. Thus, the behaviour of the therapeut seems to be very important. Special attention is also paid to the preparation of the patients within a complex therapy programme. In this way it is possible, also to improve ambulatory ability and indication of dynamie psychotherapy in a group.