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Patients with schizophrenia demonstrate abnormalities in early visual encoding of facial features that precedes the ERP response typically associated with facial affect recognition. This suggests that affect recognition deficits, at least for happy and sad discrimination, are secondary to faulty structural encoding of faces. The association of abnormal face encoding with delusions may denote the physiological basis for clinical misidentification syndromes. ~ Bruce I. Turetsky, Christian G. Kohler, Tim Indersmitten, Mahendra T. Bhati, Dorothy Charbonnier, and Ruben C. Gur
Unfortunately, at the same time that Western mental-health professionals have been convincing the world to think and talk about mental illnesses in biomedical terms, we have been simultaneously losing the war against stigma at home and abroad. Studies of attitudes in the United States from 1950 to 1996 have shown that the perception of dangerousness surrounding people with schizophrenia has steadily increased over this time. Similarly, a study in Germany found that the public’s desire to maintain distance from those with a diagnosis of schizophrenia increased from 1990 to 2001. ~ Ethan Watters
  • Our own definition of childhood schizophrenia has been a clinical entity, occurring in childhood before the age of eleven years, which "reveals pathology in behavior at every level and in every area of integration or patterning within the functioning of the central nervous system, be it vegetative, motor, perceptual, intellectual, emotional, or social. Further more, this behavior pathology disturbs the patterns of every functioning field in a characteristic way. The pathology cannot therefore be thought of as a focal in the architecture of the central nervous system, but rather as striking at the substratum of integrative functioning or biologically patterned behavior" (1) At present the only concept we have of this pathology is in terms of field forces in which temporal rather than spatial factors are emphasized. Within the concept of field force3s, one can accept some idea of a focal disorder, since no one integrated function is ever completely lost or inhibited, and since there are different degrees of severity of disturbance in the life history of any child and between two different children. This also differs with the period of onset.
    The diagnostic criteria for the 100 schizophrenic children which make up this study have been rigid. In each child it has been possible to demonstrate characteristic disturbances in every patterned functioning field of behavior. Every schizophrenic child reacts to the psychosis in a way determined by his own total personality including the infantile experiences and the level of maturation of the personality. This reaction is usually a neurotic one determined by the anxiety stirred up by the disturbing phenomena in the vaspvegetative, motility, perceptual, and psychological fields. Interferences in normal developmental patterns and regressive phenomena with resulting primitive reactions are related to both the essential psychosis and the reaction of the anxiety-ridden personality.
    There are. of course, children in whom the diofferential diagnosis is very difficult. Those with some form of diffuse encephalopathy or diffuse developmental deviations in which the normally strong urges for normal development push the child into frustration and reactive anxiety may present many schizphrenic features in the motility disturbances, intellectual interferences, and psychological reactions.
  • Rationale for Treatment with LSD and UML

    Our interest in these drugs was due in part to their psychotomimetic effect, hoping thereby that the autistic defenses of schizophrenic children might be broken down. Of equal interest, on a theoretical basis, is the serotonin inhibiting effect and of greater interest is their effect on the autonomic and central nervous system. Brodie has described the effects of LSD and other hallucinogenic agents as "arousal and increased responsiveness to sensory stimuli, preponderance of sympathetic activity and increased skeletal muscle tone and activity." Of particular interest is their tonic effect on the vascular bed especially of the brain, as has been shown with UML in vascular headaches. The known effects of these drugs on perception further increases¬ their interest in the treatment of schizophrenia.

    Such drugs were of interest to us for the treatment of childhood schizophrenia since our definition of this condition is a disorder in maturation characterized by an embryonic primitive plasticity in all areas of integrative brain functioning from which behavior subsequently arises. This includes all autonomic functions, perception, emotion, intelligence. It was hoped that 'these drugs might prove some-what specific in modifying the basic process as well as the secondary symptoms. Autism is seen as a withdrawal or denial defense against disturbing sensations arising from disturbed autonomic function and perceptual function and anxiety in the young child with lagging and atypical maturation. It was hoped that this autism might be disrupted and that more normal autonomic functions in the vascular bed, brain, intestines, skin and other organs as well as in perception would permit more normal development.
  • The high prevalence and chronic evolution of schizophrenia are responsible for a major social cost. The adverse consequences of such psychiatric disorders for relatives have been studied since the early 1950s, when psychiatric institutions began discharging patients into the community. According to Treudley (1946) "burden on the family" refers to the consequences for those in close contact with a severely disturbed psychiatric patient. Grad and Sainsbury (1963) and Hoenig and Hamilton (1966) developed the first burden scales for caregivers of severely mentally ill patients, and a number of authors further developed instruments trying to distinguish between "objective" and "subjective" burden. Objective burden concerns the patient's symptoms, behaviour and socio-demographic characteristics, but also the changes in household routine, family or social relations, work, leisure time, physical health.... Subjective burden is the mental health and subjective distress among family members. While the first authors referred to those problems which are deemed to be related to, or caused by the patient, Platt et al. (1983) tried to distinguish between the occurrence of a problem, its alleged aetiology, and the perceived distress, when developing the SBAS questionnaire. These authors also proposed separate evaluations of behavioral disturbance and social performance by relatives, and a report of extra-disease stressors in family life. The SBAS is actually the most complete, but also complex instrument for evaluating burden in caregivers. Since 1967 Pasamanick and others proposed questionnaires for burden evaluation in relatives of schizophrenic patients. Relatives may be included in specific psychoeducational programs, but few of these programs have been evaluated in terms of caregiver burden.
  • Patients with schizophrenia demonstrate abnormalities in early visual encoding of facial features that precedes the ERP response typically associated with facial affect recognition. This suggests that affect recognition deficits, at least for happy and sad discrimination, are secondary to faulty structural encoding of faces. The association of abnormal face encoding with delusions may denote the physiological basis for clinical misidentification syndromes.
  • Impaired emotional functioning is a core feature of schizophrenia described by Eugen Bleuler (1911)nearly 100 years ago. Emotional abnormalities in schizophrenia are now receiving more attention by clinicians and investigators and include a variety of symptoms such as flat or constricted affect, inappropriate affect, and depression (Kohler et al., 2000a). In addition to negative symptoms' influence on the experience and expression of emotions, there is evidence that schizophrenia patients are impaired in recognizing and discriminating facial emotions (Morrison et al., 1988; Mandal et al., 1998; Edwards et al., 2001; Kohler et al., 2003). It is unclear whether emotion recognition deficits represent a specific or generalized form of cognitive impairment in schizophrenia (Kerr and Neale, 1993; Whittaker et al., 2001), yet recent studies show that emotion processing deficits are uniquely related to clinical symptoms (Kohler et al., 2000b; Silver et al., 2002; Sachs et al., 2004).
  • Unfortunately, at the same time that Western mental-health professionals have been convincing the world to think and talk about mental illnesses in biomedical terms, we have been simultaneously losing the war against stigma at home and abroad. Studies of attitudes in the United States from 1950 to 1996 have shown that the perception of dangerousness surrounding people with schizophrenia has steadily increased over this time. Similarly, a study in Germany found that the public’s desire to maintain distance from those with a diagnosis of schizophrenia increased from 1990 to 2001.
  • NOWHERE ARE THE limitations of Western ideas and treatments more evident than in the case of schizophrenia. Researchers have long sought to understand what may be the most perplexing finding in the cross-cultural study of mental illness: people with schizophrenia in developing countries appear to fare better over time than those living in industrialized nations.
    This was the startling result of three large international studies carried out by the World Health Organization over the course of 30 years, starting in the early 1970s. The research showed that patients outside the United States and Europe had significantly lower relapse rates — as much as two-thirds lower in one follow-up study. These findings have been widely discussed and debated in part because of their obvious incongruity: the regions of the world with the most resources to devote to the illness — the best technology, the cutting-edge medicines and the best-financed academic and private-research institutions — had the most troubled and socially marginalized patients.
  • The course of a metastasizing cancer is unlikely to be changed by how we talk about it. With schizophrenia, however, symptoms are inevitably entangled in a person’s complex interactions with those around him or her. In fact, researchers have long documented how certain emotional reactions from family members correlate with higher relapse rates for people who have a diagnosis of schizophrenia. Collectively referred to as “high expressed emotion,” these reactions include criticism, hostility and emotional over involvement (like overprotectiveness or constant intrusiveness in the patient’s life). In one study, 67 percent of white American families with a schizophrenic family member were rated as “high EE.” (Among British families, 48 percent were high EE; among Mexican families the figure was 41 percent and for Indian families 23 percent.)
    Does this high level of “expressed emotion” in the United States mean that we lack sympathy or the desire to care for our mentally ill? Quite the opposite. Relatives who were “high EE” were simply expressing a particularly American view of the self. They tended to believe that individuals are the captains of their own destiny and should be able to overcome their problems by force of personal will. Their critical comments to the mentally ill person didn’t mean that these family members were cruel or uncaring; they were simply applying the same assumptions about human nature that they applied to themselves. They were reflecting an “approach to the world that is active, resourceful and that emphasizes personal accountability,” Prof. Jill M. Hooley of Harvard University concluded. “Far from high criticism reflecting something negative about the family members of patients with schizophrenia, high criticism (and hence high EE) was associated with a characteristic that is widely regarded as positive.”
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