Treatment of nonpsychotic relatives of patients with schizophrenia: Six case studies

Abstract

There is growing support for the notion that the genetic liability for schizophrenia could be manifested in brain dysfunction, even without the full manifestations of schizophrenia [Meehl, 1962, 1989; Seidman, 1997; Faraone et al., 2001]. This liability is characterized clinically by neurologic, neurobiological, psychiatric, neuropsychological, and psychosocial impairments in nonpsychotic, first-degree relatives of people with schizophrenia and includes eye tracking dysfunction [Levy et al., 1994], allusive thinking [Catts et al., 1993], neurologic signs [Erlenmeyer-Kimling et al., 1982], biochemical abnormalities [Callicott et al., 1998], char acteristic auditory evoked potentials [Friedman and Squires-Wheeler, 1994], neuroimaging assessed brain abnormalities [Seidman et al., 1997], and neuropsycho logical impairment [Kremen et al., 1994]. Paul Meehl introduced the term ‘‘schizotaxia’’ in 1962 to describe the genetic predisposition to schizophrenia [Meehl, 1962], and we have modified the concept to take account of subsequent research [Faraone et al., 2000]. The concept of schizotaxia raises at least three fundamental issues: 1) What is the conceptual basis of schizotaxia? 2) Is it a valid syndrome? and 3) perhaps most importantly from the point of view of the eventual prevention of schizo phrenia, is it treatable? In this paper, we review the model of schizotaxia by focusing first on its nature and extent. We then describe preliminary research criteria for its diagnosis in nonpsychotic relatives of schizo phrenic patients, followed by a presentation of our initial attempts to treat schizotaxia. Finally, prospects for the future focus on the need to validate the proposed syndrome further and on the clinical implications of treating schizotaxia.