[The concept of schizoidia in psychiatry : From schizoidia to schizotypy and cluster A personality disorders]. / Das Schizoidie-Konzept in der Psychiatrie : Von der Schizoidie über die Schizotypie zu den Cluster­A­Persönlichkeitsstörungen.

From a perspective of conceptual evolution schizoidia was initially considered to describe features both of the premorbid personality of schizophrenic patients and of the personalities of non-psychotic family members (Bleuler, Kahlbaum, Kraepelin). On a psychopatholocial level a close link to the complex basic symptom of autism was stressed. From the very beginnings of modern psychiatry schizoidia was discussed within a conceptual frame of schizophrenia spectrum disorders (Kretschmer, Hoch, Polatin). Approaches to operationalize these conceptual works laid the basis for the cluster A personalities in DSM-III. Due to the prominent concept of schizotypy (Kety, Rado, Meehl) three split up diagnostic categories of schizotypal, schizoid and paranoid personality disorders resulted. Cluster A personality disorders are frequent in community-based epidemiological studies. Health-care seeking behaviour due to primary personality-related problems, however, seems to be less paramount compared to cluster B and C personality disorders. Many family- and twin-based genetic studies convincingly stress a close link between schizotypal personality disorder and schizophrenia. This link is less pronounced for paranoid personality disorder, and even vanishingly low for schizoid personality disorder. From a perspective of schizophrenia spectrum disorders a vast amount of data from molecular genetic, neurobiological, neuropsychological and psychosocial research has impressingly confirmed this link for schizotypal personality disorder. Major research deficits, however, have to be noticed for paranoid and schizoid personality disorder.

Taxometric analyses of paranoid and schizoid personality disorders.

There remains debate about whether personality disorders (PDs) are better conceptualized as categorical, reflecting discontinuity from normal personality; or dimensional, existing on a continuum of severity with normal personality traits. Evidence suggests that most PDs are dimensional but there is a lack of consensus about the structure of Cluster A disorders. Taxometric methods are adaptable to investigating the taxonic status of psychiatric disorders. The current study investigated the latent structure of paranoid and schizoid PDs in an epidemiological sample (N=43,093) drawn from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) using taxometric analyses. The current study used taxometric methods to analyze three indicators of paranoid PD - mistrust, resentment, and functional disturbance - and three indicators of schizoid PD - emotional detachment, social withdrawal, and functional disturbance - derived factor analytically. Overall, taxometrics supported a dimensional rather than taxonic structure for paranoid and schizoid PDs through examination of taxometric graphs and comparative curve fit indices. Dimensional models of paranoid and schizoid PDs better predicted social functioning, role-emotional, and mental health scales in the survey than categorical models. Evidence from the current study supports recent efforts to represent paranoid and schizoid PDs as well as other PDs along broad personality dimensions.

Schizoid personality disorder.

Schizoid personality disorder (ScPD) is one of the "odd cluster" or "cluster A" personality disorders in DSM-IV. In the present article, the authors review information pertaining to the psychometric characteristics of ScPD as gleaned from a search of relevant publications as well as from databases of personality disorder study groups. Comparatively little evidence exists for the validity and reliability of ScPD as a separate, multifaceted personality disorder. Some authors, moreover, have contended that the group of patients termed "schizoid" actually fall into two distinct groups--an "affect constricted" group, who might better be subsumed within schizotypal personality disorder, and a "seclusive" group, who might better be subsumed within avoidant personality disorder. The research-based justification for retaining ScPD as an independent diagnosis is sufficiently sparse for it to seem reasonable to remove ScPD from the list of personality disorders in DSM-V, and instead to invite clinicians to code for schizoid traits using a dimensional model.

[An elevation in the level of autoantibodies to nerve-growth factor in the blood serum of schizophrenic children]. / Povyshenie urovnia autoantitel k faktoru rosta nervov v syvorotke krovi detei, bol'nykh shizofreniei.

The level of autoantibodies (AAB) to nerve growth factor (NGF) was examined in blood of mentally healthy children, children with early children schizophrenia as well as with Kanner's and Asperger's syndromes too. The elevated titer of AAB to NGF was determined in blood of children with acute, active state of disease; meanwhile the same titer wasn't changed in the state of stable remission or steady defective state as compared with control group. The correlation was found between the level of AAB to NGF and the degree of disease progression. The correlations which were revealed between AAB to NGF level and peculiarities of the clinical state of patients permitted to use this index as the objective marker of both the acuteness and the severity of the patient's state.

Schizoid personality in girls: a follow-up study--what are the links with Asperger's syndrome?

Child psychiatric records of 33 girls given a diagnosis of "schizoid" personality in childhood, were compared with records of a control group of other referred girls and with those of 32 pairs of "schizoid" and control boys. Seventeen "schizoid" girls were seen again in adult life and compared with 32 "schizoid" boys previously followed up at the same age. The features of "schizoid" girls in childhood and adult life were very similar to those of the boys. A striking finding, possible due to referral bias, was the high rate of antisocial conduct in "schizoid" girls, both in childhood and later life. The dilemmas of diagnostic classification of this group of patients are discussed.

Positive and negative symptoms/syndromes in schizophrenia: reliability and validity of different diagnostic systems.

The paper explores the reliability, concurrent validity and overlap of some positive/negative symptom rating scales and typological criteria in 100 schizophrenic patients. Rating scales include Andreasen's Scales for the Assessment of Positive and Negative Symptoms, Abrams and Taylor's Scale for Emotional Blunting, and Kay's Positive and Negative Syndrome Scale. Criteria for categorizing individual patients include Andreasen's and Kay's criteria for positive and negative types of schizophrenia as well as Carpenter's criteria for the deficit syndrome. The correlations among positive as well as among negative scales were high. The agreement among criteria tended to be lower. Both positive scales showed low internal consistency. Kay's negative scale had the greatest internal consistency, which suggests that it is measuring a homogeneous syndrome. All negative symptom scales and categorical syndromes identified a group of patients who were single and exhibited schizoid or schizotypal pre-morbid personality disorders, poor premorbid sexual/social adjustment, poor response to neuroleptics and poor prognosis.

[Descriptive approach to latent forms of schizophrenia]. / Approche descriptive des formes frontières des schizophrénies.

The computerized medical file, used in routine work in an Adult Psychiatry University-Hospital Unit enabled us to select 113 cases among 1,000 consecutive hospitalizations, the diagnosis of which could possibly lead to schizophrenia. These cases which we named "paraschizophrenic states" are linked to DSM III-R criteria of borderline (27 cases), schizoid (40 cases) or schizotypical (15 cases) personalities, schizophreniform trouble and unspecified psychotic trouble (17 cases), brief reactional psychosis (14 cases). We selected 196 cases of schizophrenia in the same cohort of hospitalized patients. As it is now usually admitted, we marked out two subgroups in this second group: the positive schizophrenia which gather together the paranoid and undifferentiated patterns and the negative schizophrenia which correspond to disorganized, catatonic and residual models, according to DSM III-R criterion. We compared the "paraschizophrenic states'" group and its five subgroups (we indeed joined schizophreniform trouble and unspecified psychotic trouble under the name of "other psychotic trouble" by reason of their relative nosographic lacks of precision and of their too small sizes) with the schizophrenia's group and its two subgroups. Each group is matched for sex (1.51 men for 1 woman in the first group and 1.45 men for 1 woman in the second group). We evaluated statistics for markers usually studied in schizophrenia in each subgroup. These markers are of three classes: biographical: age during the study, age of troubles' onset, season of birth; socioeconomic: socioeconomic level of family and patient's student status; psychiatric: family (history affective trouble, psychotic trouble, alcoholism), treatment response and short- and middle-term prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Empirical findings on the personality structure of borderline patients]. / Empirische Befunde zur Persönlichkeitsstruktur von Borderlinepatienten.

In the present study the question of personality structure in borderline patients is studied empirically. The "Diagnostic Interview for Borderlines" of Gunderson and Kolb is used to classify the patients. In an inpatient sample of borderline patients (n = 26) the clinical diagnoses of personality structure according to psychoanalytic criteria are investigated and compared to those of an inpatient sample of patients with neurotic disorders (n = 24). According to the results most of the borderline patients (88%) had received a diagnosis of a schizoid personality structure according to psychoanalytic criteria, in contrast to the neurotic patients. The results are compared to those of studies using descriptive psychiatric criteria.

[The premorbid characteristics of schizophrenia in adolescent and young patients with overevaluation tendencies]. / Osobennosti premorbida bol'nykh shizofreniei podrostkovo-iunosheskogo vozrasta so sverkhtsennymi vlecheniiami.

The author studied premorbid traits of personality in 42 patients with juvenile schizophrenia. The age-scale of the overvalued bents was determined with reference to a premorbid type of personality, the patients' age at the onset of schizophrenia and the appearance of the initial positive and negative schizophrenic symptoms.

Paranoid schizophrenia in adolescence.

BACKGROUND: Paranoid schizophrenia is considered to be a rare condition in adolescence. Since this is contrary to the authors' clinical experience, they hypothesized that a controlled study would show that a significant number of adolescents would be diagnosed with paranoid schizophrenia and that scores from the childhood version of the Schedule for Affective Disorders and Schizophrenia (K-SADS) would differentiate between the paranoid schizophrenic adolescents and adolescents with other types of schizophrenia or with affective disorder. METHOD: The authors conducted a prospective study of 120 adolescents admitted consecutively to an adolescent psychiatric inpatient department. Patients were diagnosed on the basis of DSM-III after an 8-week period during which they were evaluated with a structured psychiatric history and psychiatric examination, the K-SADS, repeated nonstructured interviews, and extensive ward observations. RESULTS: Thirty-eight percent of the schizophrenic adolescents and 14% of the total hospitalized population met the DSM-III criteria for paranoid schizophrenia. The symptom profile of the paranoid schizophrenic adolescents clearly distinguished them from adolescents with other psychiatric disorders. CONCLUSIONS: Given the incidence of paranoid schizophrenia in an adolescent population, adolescent psychiatrists are likely to encounter this disorder. DSM-III-R should be used in future studies to further clarify the issue of the prevalence of paranoid schizophrenia in adolescents.

[Personality disorders related to schizophrenia]. / Troubles de personnalité liés à la schizophrénie.

Personality disorders related to schizophrenia were described since Kraepelin's works. According to the DMS III-R those disorders are gathered into the A cluster of personality disorders consisting in: schizotypal, schizoid and paranoid personality disorders. Schizotypal and paranoid personalities are biologically linked to schizophrenia and support the concept of "schizophrenia spectrum". Until now such a link is not found between schizoid personality and schizophrenia. Future research in the field of those personality disorders will bring a better knowledge in the pathogenesis of schizophrenia.

Dimensions of personality disorder. The DSM-III-R cluster A diagnoses.

The authors adopt a construct validity approach to examine the structural validity of diagnoses of paranoid, schizoid, and schizotypal personality disorders. Systematic descriptions of these diagnoses were developed based on features identified from the literature that were organized using the clinicians' ratings. Each diagnosis was described in terms of a series of behavioral dimensions. Sets of behavioral exemplars were developed to assess each dimension. Dimensions and diagnoses were found to exhibit satisfactory levels of internal consistency that were cross-validated in a general population sample of 274 subjects and a clinical sample of 133 patients with a diagnosis of personality disorder. Some dimensions did not correlate highly with the total diagnosis score. Diagnoses could probably be refined by eliminating these dimensions. The structural relationships between dimensions delineating each diagnosis were explored using factor analysis. Diagnoses were not unifactorial. Instead, each diagnosis was found to be composed of two factors. The factorial structure of each diagnosis was found to be similar in the general population and clinical sample. It is suggested that the results support a dimensional representation of these diagnoses using three dimensions: paranoid behaviors, social avoidance, and perceptual cognitive distortion.

[Classification of the course of childhood schizophrenia in the light of long-term follow-up]. / Sistematika form techenia detskoi shizofrenii v svete otdalennogo katamneza.

The work deals with the catamnestic substantiation of the systematics of schizophrenia in children. A group of 328 patients was selected in 1982-1987 from a cohort of schizophrenic patients studied in 1962-1972 in which the onset of the disease fell on their first 5 years. The stability of the course patterns was evidenced in the early childhood schizophrenia. A set of subspecies of disorders similar to schizoactive psychoses and peculiar affective schizoid states was differentiated out of the general pool of slow progredient and attack-like schizophrenia. This allowed to prove the notion of the whole continuum of endogenous psychoses in not only adults but also in children.

Covariation of criteria sets for avoidant, schizoid, and dependent personality disorders.

Avoidant personality disorder was a new addition to DSM-III. Reaction to its inclusion was mixed. Critics cited the lack of empirical data and the overlap with schizoid disorder. The authors consider the overlap and covariation among avoidant, schizoid, and dependent symptoms and diagnoses in a sample of 84 inpatients diagnosed by using a semistructured interview. Items for avoidant disorder covaried with criteria for dependent disorder but not with criteria for schizoid disorder. The authors point out the implications of these results for the revision of DSM-III (DSM-III-R).