Precursors and developmental course of predominantly negative and positive forms of schizophrenia in a high-risk population

In the context of a prospective, longitudinal study of children at risk for schizophrenia, this study tested recently developed models of the precursors and developmental course of schizophrenia with predominantly negative symptoms and schizophrenia with predominantly positive symptoms. Objective assessments of perinatal history, early family conditions, premorbid behavior disturbances, and autonomic nervous system functioning were conducted in 1962 when the subjects averaged 15 years in age. Adult psychiatric evaluations were conducted in 1972-74 and 1986-89.

Among a group of 153 high-risk individuals, those at elevated genetic risk (i.e., schizophrenia in the mother and schizophrenia spectrum illness in the father) who suffered severe delivery complications and who were autonomic nonresponders during adolescence were significantly more likely than those without this pattern to evidence outcomes of schizophrenia with predominantly negative symptoms. In late childhood and early adolescence predominantly negative symptom schizophrenics were rated by their teachers as passive, socially isolated, and unresponsive to praise; they evidenced a stable pattern of severe negative symptoms and relatively less severe positive symptoms in the adult course of illness.

Among a group of 178 high-risk subjects, those at elevated genetic risk who escaped delivery complications, who evidenced a high degree of autonomic responsiveness in adolescence, and who experienced severe disruption of the early family rearing environment, were significantly more likely than those without this pattern to evidence outcomes of schizophrenia with predominantly positive symptoms. In late childhood and early adolescence predominantly positive symptom schizophrenics were rated by their teachers as overactive, irritable, distractible,aggressive; they showed a pattern of severe positive symptoms and relatively less severe negative symptoms in the adult course of illness. (Copies available exclusively from Micrographics Department, Doheny Library, USC, Los Angeles, CA 90089-0182.)