Two adolescents at risk for schizophrenia: A family case study

This is a study of the complex factors that contributed to the development of adolescent psychoses in two stepbrothers, ages 12 and 15. The identified patient, the younger boy, was in what appeared to be a reversible stage of early adolescent psychosis and his 15 year old newly acquired stepbrother in a nonreversible stage. Each boy was a mentally gifted, neurologically handicapped adolescent who was inextricably vulnerable on the basis of his neurodevelopmental sensitivity to specific immobilizing parental fears and conflicts. Their inherent problems set them apart from their intact teenage sisters and affected the nature and quality of their total life experience. Those working with psychotic children and their families must bear these relationships in mind for optimal strategic intervention and change. In the management of psychotic adolescents and their families, the individual and family therapist could work to everyone's disadvantage if these important neurodevelopmental difficulties are not considered.1979, SummerThis study was supported in part by the Maternal and Child Health Services Training and Study Project No. 144, Department of Health, Education and Welfare.     

Two adolescents at risk for schizophrenia: A family case study

This is a study of the complex factors that contributed to the development of adolescent psychoses in two stepbrothers, ages 12 and 15. The identified patient, the younger boy, was in what appeared to be a reversible stage of early adolescent psychosis and his 15 year old newly acquired stepbrother in a nonreversible stage. Each boy was a mentally gifted, neurologically handicapped adolescent who was inextricably vulnerable on the basis of his neurodevelopmental sensitivity to specific immobilizing parental fears and conflicts. Their inherent problems set them apart from their intact teenage sisters and affected the nature and quality of their total life experience. Those working with psychotic children and their families must bear these relationships in mind for optimal strategic intervention and change. In the management of psychotic adolescents and their families, the individual and family therapist could work to everyone's disadvantage if these important neurodevelopmental difficulties are not considered.This study was supported in part by the Maternal and Child Health Services Training and Study Project No. 144, Department of Health, Education and Welfare.     

Oculomotor delayed response abnormalities in young offspring and siblings at risk for schizophrenia

Individuals with schizophrenia are know to demonstrate cognitive and behavioral difficulties, particularly alterations in executive functions, including working memory. It is unclear whether these deficits reflect trait-related vulnerability to schizophrenia indicators and can be assessed by studying nonpsychotic relatives of patients with schizophrenia. In this study, we used an oculomotor delayed response (ODR) paradigm to examine spatial working memory in 37 "high-risk" child and adolescent offspring and siblings (age range=6-25 years) of patients with schizophrenia or schizoaffective disorder. Compared with 37 age- and sex-matched healthy controls (age range=6-23 years), high-risk subjects showed nonsignificantly greater errors in the ODR task at longer delay intervals. Statistical analyses suggested that performance improved with age in healthy control subjects, whereas it worsened with age in high-risk subjects. In both groups, the ODR errors were generally associated with poorer sustained attention (Continuous Performance Test: visuospatial d prime), somewhat poorer executive function (Wisconsin Card Sorting Test), and elevated Heinrichs-Buchanan neurological soft signs scores. These findings indicate the presence of spatial working memory abnormalities in individuals at risk for schizophrenia. Furthermore, these abnormalities may be progressive in nature. The ODR task is a valuable indicator of prefrontal cortical function and spatial working memory and may be a potentially valuable marker for familial risk of schizophrenia.     

Interval-timing deficits in individuals at high risk for schizophrenia

A duration-bisection procedure was used to study the effects of signal modality and divided attention on duration classification in participants at high genetic risk for schizophrenia (HrSz), major affective disorder (HrAff), and normal controls (NC). Participants learned short and long target durations during training and classified probe durations during test. All groups classified visual signals as shorter than equivalent duration auditory signals. However, the difference between auditory and visual signal classification was significantly larger for the HrSz group than for the NC group. We posit a model in which there is a clock rate difference between auditory and visual signals due to an attentional effect at the level of a mode switch that gates pulses into an accumulator. This attentionally mediated clock rate difference was larger for the HrSz participants than for the NC participants, resulting in a larger auditory/visual difference for the HrSz group.     

Motor impairment and antisocial behavior in adolescent males at high risk for schizophrenia

A familial link between schizophrenia and antisocial behavior has been established (e.g., Silverton, 1985). This study examined this relationship in a Danish cohort. The subjects were 36 high-risk males (offspring of a schizzophrenic parent) and 36 low-risk males (offspring of parents without psychopathology). This high-risk subjects exhibited more antisocial behavior than the low-risk subjects. We tested the hypothesis of a correlation between neurointegrative deficits, as defined by motor impairment, and antisocial behavior, rated at ages 10–13, in subjects at genetic risk for schizophrenia. Path analyses were conducted from motor impairment at 1 year and motor impairment at 10–13 years to antisocial behavior separately for high-risk and low-risk subjects. Adolescent motor impairment was a significant predictor of antisocial behavior for high-risk subjects. Motor impairment at 1 year was also associated with antisocial behavior for these subjects, although the association was partly due to the indirect effects of motor impairment at 1 year on motor impairment at 10–13 years, which, in turn, was associated with changes in antisocial behavior. As predicted, none of the path coefficients nor the effect coefficient was significant for low-risk subjects.     

Emotion-cognition interaction in people at familial high risk for schizophrenia: the impact of sex differences

Cognitive deficits are fundamental to schizophrenia, and research suggests that negative emotion abnormally interferes with certain cognitive processes in those with the illness. To a lesser extent, cognitive impairment is found in persons at risk for schizophrenia, but there is limited research on the impact of emotion on cognitive processing in at-risk groups. It is unknown whether interference of negative emotion precedes illness and contributes to vulnerability for the disorder. We studied the extent to which negative emotional information interferes with working memory in 21 adolescent and young adult first-degree relatives of people with schizophrenia and 22 community controls. Groups were comparable in age, sex, education, ethnicity, and socioeconomic status. Primary measures were n-back tasks varying in cognitive load (1-back, 2-back, 3-back) with emotional faces (neutral, happy, fearful) as stimuli. The control group's response times (RTs) and the women's RTs, regardless of group, differed depending on the emotion condition. In contrast, the RTs of the relatives and of the men, regardless of group, did not differ by emotion. This study is the first to examine emotion-cognition interactions in relatives of individuals with schizophrenia. Reduced efficiency in processing emotional information may contribute to a greater vulnerability for schizophrenia that may be heightened in men. Additional research with larger samples of men and women is needed to test these preliminary findings.     

Symptom and substance use reporting consistency over two years for offspring at high and low risk for depression

We examined 2-year recall of reports of lifetime symptomatology and substance use questions on the K-SADS-E in a sample of offspring at high and low risk for depression. Comparisons were made between those who forgot and those who remembered reports of screening symptoms made at the initial interview. In general, recall for symptoms of internalizing disorders (depression and anxiety disorder) was much worse than recall for symptoms of externalizing disorders (conduct disorder and substance use). Less than two-thirds of those initially meeting the lifetime depression screening criteria provided reports which met the lifetime screening criteria at followup. Significant correlates of screening criteria recall included the following variables (measured at the initial interview): history of treatment for any disorder, impairment on the GAS (a score less than 61), and the presence of hypersomnia and suicidal symptoms (thoughts or ideation). Logistic regression suggested that a prior report of suicidal symptoms (including thoughts, ideation, or behavior) was the most important correlate of screen recall.This research was supported in part by grants from the National Institute on Drug Abuse (grant R29DA07995), the National Institute of Mental Health (grant P50MH43878-03) and from the University of Illinois Campus Research Board. The authors would like to thank Dr. Myrna Weissman for making the data available and acknowledge the data analytic assistance provided by Yanchun Xu.     

Self-esteem in schizophrenia: relationships between self-evaluation,family attitudes,and symptomatology

Participants with schizophrenia (N = 59) were assessed on self-evaluation, symptomatology, and positive and negative affect (expressed emotion) from significant others. An interview-based measure of self-evaluation was used and two independent dimensions of self-esteem were derived: negative and positive evaluation of self. As predicted, negative self-evaluation was strongly associated with positive symptoms, a more critical attitude from family members was associated with greater negative self-evaluation, and analyses supported a model whereby the impact of criticism on patients' positive symptoms was mediated by its association with negative self-evaluation. The interview-based method of self-esteem assessment was found to be superior to the questionnaire because its predictive effects remained after depressed mood was accounted for.     

Lack of acknowledgment in the family Rorschachs of families with a child at risk for schizophrenia.

Lack of acknowledgment, a characteristic of the direct interactions of families of schizophrenics, was found also to characterize the Family Rorschach interactions of families whose disturbed, non-psychotic adolescents were assessed at high risk for schizophrenia on the basis of parental communication deviance. The same high-risk families had unbalanced interaction patterns as reflected in three measures of family structure.     

Psychometric deviance measured by MMPI in adoptees at high risk for schizophrenia and their adoptive controls

Psychometric deviance in personality traits as assessed by the Minnesota Multiphasic Personality Inventory (MMPI; Dahlstrom, Welsh, & Dahlstrom, 1982) was compared between adopted-away, high-risk (HR) offspring of schizophrenic biologic mothers and low-risk (LR) controls. A subsample of the Finnish Adoptive Family Study (Tienari et al., 2000) included 60 HR adoptees and 76 LR control adoptees who were tested by the MMPI before the onset of any psychiatric disorder at the mean age of 24 years. The HR group was found to be distinguishable based on deviant scores on the scales HOS and HYP, indicating emotional unresponsiveness, restricted affectivity, and decreased energy. These may also be considered possible premorbid and prodromal signs of future schizophrenia among the HR adoptees.     

Children's perceptions of the sibling relationship in middle childhood: Connections within and between family relationships

Although sibling warmth and hostility have been shown to be statistically independent, they are intertwined in children's everyday experiences. We developed a multidimensional characterization of children's perceptions of their sibling relationships and examined differences in other family relationship measures as a function of different combinations of sibling hostility and warmth. Participants included 91 firstborn children between 10 and 11 years of age with younger siblings between 6 and 10 years of age. Children reported their levels of satisfaction, intimacy, and rivalry in their sibling relationships and their satisfaction with parent-child relationships. Parents rated their marriages. As compared with children in families with “affect-intense” sibling relationships (high hostility/high warmth), children in “hostile” sibling relationships (high hostility/low warmth) rated their sibling and parent-child relationships more negatively, and their parents rated their marriages more negatively. Results are discussed in terms of the role of hostility in sibling experiences and the importance of understanding multidimensional patterns in the sibling relationship.     

The influence of parent negative emotional expression on adolescents' perceptions of their relationships with their parents

The purpose of this study was to examine the relationship between parent affective expression in interactions and adolescent perceptions of their relationship. Observational and self-report data were collected on 85 intact families with adolescents in grades 5 to 9 (n = 44 males, 41 females). Each parent and adolescent took part in two 8-minute conversations–one about an activity they reported enjoying together and one about a disagreement or area of conflict. Conversations were coded on a speaker turn basis for positive, negative, neutral, mixed, and altered affect (kappa = .76). Physical maturation was related to adolescent perceptions of increased negative communication quality in all parent-adolescent dyads. Stepwise regression analyses indicated that expression by fathers of negative and mixed affect significantly predicted adolescent perceptions of communication quality, psychological autonomy, and firm/lax control, in addition to the effects of adolescent pubertal maturation. Mother affective expression in interactions was less consistently related to adolescent perceptions of relationship satisfaction. Implications for the salience of father versus mother affective expression in interactions with adolescents are discussed.     

Links between community violence and the family system: evidence from children's feelings of relatedness and perceptions of parent behavior

In this study, we examined some of the ways in which broader ecological systems may influence the organization of behavior within the family system. Specifically, links between exposure to community violence and children's relationships with maternal caregivers were investigated in a sample of 127 urban children between the ages of 7 and 13 years. Children were asked to indicate whether they had been exposed to a wide variety of violent events. In addition, their feelings of relatedness and separation anxiety, and their perceptions of maternal behavior were assessed. It was expected that exposure to community violence would be associated with feeling less secure with caregivers. Consistent with predictions from ecological-transactional theory, data supported this hypothesis. Children who reported that they had been exposed to high levels of community violence also indicated that they felt less positive affect when with their caregiver, were dissatisfied with how close they felt to her, felt more separation anxiety, and reported more negative maternal behavior than children exposed to less violence. Findings are discussed in terms of how violence may affect the family system and the protective function of human attachment.     

Neuropsychology,genetic liability,and psychotic symptoms in those at high risk of schizophrenia

Neuropsychological assessments were compared among individuals at enhanced genetic risk of schizophrenia (n = 157) and controls (n = 34). The relationship between cognitive impairments and the presence of psychotic symptoms and measures of genetic risk was explored in the high-risk subjects. Neuropsychological differences were identified in many areas of function and were not accounted for by the presence of psychotic symptoms. Genetic liability was not associated with neuropsychological performance or with psychotic symptoms, but exploratory analysis showed some tests were associated with both liability measures. These results suggest that what is inherited is not the disorder itself but a state of vulnerability manifested by neuropsychological impairment, occurring in many more individuals than are predicted to develop the disorder.     

Narrative self and high risk for schizophrenia: remembering the past and imagining the future

ABSTRACT

We examined the narrative self of those at high psychometric risk for schizophrenia (HR). Eighty undergraduate students wrote personal narratives about a turning-point event in their life, and about a possible future. The turning-point narratives were coded for topic, specificity, event valence, valence of causal coherence link, overall level of causal coherence, and agency. The future narratives were coded for the number and valence of goals, topic of goals, and specificity of goals. Word count was applied to all narratives. The HR group expressed lower levels of agency and a trend of lower levels of causal coherence when narrating turning-point events. When imagining their futures, HR participants produced shorter narratives and showed a trend of having fewer goals. Including the dimensions of both the turning point and the future narratives revealed that the HR group membership was best predicted by lower levels of agency and of causal coherence in the turning-point narrative, and fewer words in the future narrative. Narratives differed specifically in those few elements that are critical for the achievement of narrative continuity. Consistent with the theory, people at high risk for schizophrenia already present, to some extent, an impoverishment in their narrative sense of self.