Avoidant personality disorder symptoms in first-degree relatives of schizophrenia patients predict performance on neurocognitive measures: The UCLA family study
Whether avoidant personality disorder symptoms are related to neurocognitive impairments that aggregate in relatives of schizophrenics is unknown. We report the relationship between avoidant personality disorder symptoms and neurocognitive performance in the first-degree relatives of probands with schizophrenia. 367 first-degree relatives of probands with schizophrenia and 245 relatives of community controls were interviewed for the presence of avoidant personality symptoms and symptoms of paranoid and schizotypal personality disorders and administered neurocognitive measures. Relationships between neurocognitive measures and avoidant symptoms were analyzed using linear mixed models. Avoidant dimensional scores predicted performance on the span of apprehension (SPAN), 3-7 Continuous Performance Test (3-7 CPT), and Trail Making Test (TMT-B) in schizophrenia relatives. These relationships remained significant on the SPAN even after adjustment for paranoid or schizotypal dimensional scores and on the TMT-B after adjustment for paranoid dimensional scores. Moreover, in a second set of analyses comparing schizophrenia relatives to controls there were significant or trending differences in the degree of the relationship between avoidant symptoms and each of these neurocognitive measures even after adjustments for paranoid and schizotypal dimensional scores. The substantial correlation between avoidant and schizotypal symptoms suggests that these personality disorders are not independent. Avoidant and in some cases schizotypal dimensional scores are significant predictors of variability in these neurocognitive measures. In all analyses, higher levels of avoidant symptoms were associated with worse performance on the neurocognitive measures in relatives of schizophrenia probands. These results support the hypothesis that avoidant personality disorder may be a schizophrenia spectrum phenotype.
Avoidant personality disorder is a separable schizophrenia-spectrum personality disorder even when controlling for the presence of paranoid and schizotypal personality disorders The UCLA family study
It is unresolved whether avoidant personality disorder (APD) is an independent schizophrenia (Sz)-spectrum personality disorder (PD). Some studies find APD and social anxiety symptoms (Sxs) to be separable dimensions of psychopathology in relatives (Rels) of schizophrenics while other studies find avoidant Sxs to be correlated with schizotypal and paranoid Sxs. Rates of APD among first-degree Rels of Sz probands, attention-deficit/hyperactivity disorder (ADHD) probands, and community control (CC) probands were examined. Further analyses examined rates when controlling for the presence of schizotypal (SPD) and paranoid (PPD) personality disorders, differences in APD Sxs between relative groups, and whether APD in Rels of Szs reflects a near miss for another Sz-spectrum PD. Three hundred sixty-two first-degree Rels of Sz probands, 201 relatives of ADHD probands, and 245 Rels of CC probands were interviewed for the presence of DSM-III-R Axis I and II disorders. Diagnoses, integrating family history, interview information, and medical records, were determined. APD occurred more frequently in Rels of Sz probands compared to CC probands (p<0.001) and also when controlling for SPD and PPD (p<0.005). Two Sxs of APD were most characteristic of the Rels of Sz probands: "avoids social or occupational activities..." and "exaggerates the potential difficulties..." 65% of the Rels of Sz probands who had diagnoses of APD were more than one criterion short of a DSM-III-R diagnosis of either SPD or PPD. This indicates that APD is a separate Sz-spectrum disorder, and not merely a sub-clinical form of SPD or PPD.
MMPI vulnerability indicators for schizophrenia and attention deficit disorder: UCLA family study of biological parents of offspring with childhood-onset schizophrenia or ADHD
Minnesota Multiphasic Personality Inventory (MMPI) scores were examined for 50 parents of children with an onset of schizophrenia prior to 14 years of age, 153 parents of children with attention deficit hyperactivity disorder (ADHD), and 168 parents of community comparison children. The parents were participants in the UCLA Family Study. The mean scores on all standard MMPI scales were within normal limits for all three groups of participants. Parents of schizophrenia probands were significantly higher on scale Sc than parents of community comparison children. Previous research has shown that scale Sc may be associated with a genetic liability to developing schizophrenia. Thus, scale Sc shows promise as an indicator of a heightened risk for the development of schizophrenia. The parents of the ADHD probands were significantly higher on standard clinical scale Pd than community comparison parents. Mothers of both schizophrenia and ADHD probands shared some personality indicators of stress reactivity. Although this study, like all non-adoptee family studies, cannot disentangle genetic effects on the development of these personality characteristics from environmental effects, we speculate that the emotional distress resulting in higher levels of the MMPI characteristics seen in the patients’ mothers reflects the impact of raising a psychiatrically ill offspring.
The Dexamethasone Suppression Test in Psychotic Disorders
Dexamethasone suppression tests were given to 69 consecutively admitted psychiatric patients. Nonsuppression rates for depression with or without melancholia and for schizophrenia were similar to those previously reported, but for mania and other psychoses the frequencies were higher than expected.
DSM III Schizophreniform Disorder
Using five methods of validation the authors evaluated six patients satisfying DSM-III criteria for schizophreniform disorder. These patients did not differ importantly from patients with affective disorders but differed markedly from schizophrenic patients in past psychiatric history, family history, acute treatment response, short- term course, and dexamethasone suppression test results. The findings suggest that schizophreniform disorder, as defined by DSM-III, may not be a valid entity separate from affective disorder and that acuteness of onset, even in the absence of affective symptoms, implies the presence of affective disorder. The authors suggest that a diagnosis of schizophreniform disorder should not exclude patients from treatment with lithium and antidepressants.
Dialysis for Schizophrenia: Review of Clinical Trials and Implications for Further Research
At least 67 schizophrenic patients have undergone dialysis for renal failure, without improvement in schizophrenic symptoms. Ninety-two nonuremic schizophrenic patients have received dialysis in nonblind studies; 22 improved, 21 improved partially, 47 showed no change, and 2 became worse. The authors point out factors other than dialysis that may affect outcome, including family respones and reduction in drug dose. They believe that until the results of current double-blind, sham-controlled trials are known, dialysis should not be prescribed as a treatment for schizophrenia.