Risk Factors and Prevention in Schizophrenia

  • Michael J. Goldstein
Part of the International Perspectives Series: Psychiatry, Psychology, and Neuroscience book series


Current thinking concerning the prevention of schizophrenia focuses on two issues, whether or not the initial onset of the disorder is preventable and whether recurrence can be prevented or delayed substantially once the initial episode has occurred. To answer these questions it is necessary to establish risk factors either within the individual or his or her social environment whose modification can alter the probability of the initial onset or recurrence of a schizophrenic disorder. The purpose of the present chapter is to review the current state of evidence regarding the establishment of risk factors within the domain of psychosocial variables (including those usually termed neurobehavioral), as well as to review any attempts to use these risk factors in intervention studies. The emerging data from studies of high-risk populations (see Goldstein and Asarnow1 and Goldstein and Tuma2 for a summary of some of these studies) have not generated as yet controlled clinical trials designed to prevent the initial episode of schizophrenia. Most intervention studies have focused on the important but more modest goal of preventing recurrence.


Middle Childhood Affective Style Emotional Overinvolvement Autonomic Nervous System Reactivity Schizophrenic Mother 
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  1. 1.
    Goldstein MJ, Asarnow JR: Prevention of schizophrenia: what do we know?, in Barter JT, Talbot SW (eds): Primary Prevention in Psychiatry: State of the Art. Washington, DC, American Psychiatric Press, 1986; pp 87–115.Google Scholar
  2. 2.
    Goldstein MJ, Tuma AH: High-risk research: editor’s introduction. Schizophr Bull 1987;13:369–371.Google Scholar
  3. 3.
    Zubin J, Spring BJ: Vulnerability: a new view of schizophrenia. J Abnorm Psychol 1977;86:103–126.PubMedCrossRefGoogle Scholar
  4. 4.
    Nuechterlein K: Vulnerability models for schizophrenia: state of the art, in Hafner H, Gattaz WF, Janzarik (eds): Search for the Causes of Schizophrenia. Heidelberg, Springer-Verlag, 1987, pp 296–316.Google Scholar
  5. 5.
    Asarnow JR, Goldstein MJ: Schizophrenia during adolescence: a developmental perspective on risk research. Clin Psychol Rev 1986;6:211–235.CrossRefGoogle Scholar
  6. 6.
    Walker E, Emory E: Infants at risk for psychopathology: offspring of schizophrenic parents. Child Devel 1983;54:1269–1285.CrossRefGoogle Scholar
  7. 7.
    McNeil TF, Kaij L, Malmquist-Larsson A, et al: Development of a longitudinal study of children at high risk. Acta Psychiatr Scand 1983;68:234–250.PubMedCrossRefGoogle Scholar
  8. 8.
    Fish B: Characteristics and sequelae of the neurointegrative disorder in infants at risk for schizophrenia: 1952–1982, in Watt N, Anthony EJ, Wynne L, Rolf J (eds): Children at risk for schizophrenia: a longitudinal perspective. New York, Cambridge University Press, 1984, pp 423–439.Google Scholar
  9. 9.
    Ragins N, Schacter J, Elmer E, et al: Infants and children at risk for schizophrenia. J Am Acad Child Psychiatr 1975;14:150–177.CrossRefGoogle Scholar
  10. 10.
    Fish B: Infant predictors of the longitudinal course of schizophrenic development. Schizophr Bull 1987;13:395–409.PubMedGoogle Scholar
  11. 11.
    Marcus J, Hans S, Lewow E, et al: Neurological findings in the offspring of schizophrenics: childhood assessment and 5-year follow-up. Schizophr Bull 1985;11:85–100.PubMedGoogle Scholar
  12. 12.
    Marcus J, Hans SL, Nagler S, et al: Review of the NIMH Israeli Kibbutz-City study and the Jerusalem infant development study. Schizophr Bull 1987;13:425–438.PubMedGoogle Scholar
  13. 13.
    Parnas J, Schulsinger F, Schulsinger H, et al: Behavioral precursors of schizophrenia spectrum. Arch Gen Psychiatry 1982;39:658–644.PubMedGoogle Scholar
  14. 14.
    Parnas J, Schulsinger F, Teasdale TW, et al: Perinatal complications and clinical outcome within the schizophrenia spectrum. Br J Psychiatry 1982; 140: 416–420.PubMedCrossRefGoogle Scholar
  15. 15.
    Nasland R, Persson-Belnnow I, McNeil T, et al: Offspring of women with nonorganic psychosis: fear of stranger during the first year of life. Acta Psy- chiatrica Scand 1984;69:435–444.CrossRefGoogle Scholar
  16. 16.
    Ainsworth MD, Wittig, BA: Attachment and exploratory behavior of 1-year- olds in a strange situation, in Foss BM (ed): Determinants of Infant Behavior IV. London, Methuen, 1969, pp 111–136.Google Scholar
  17. 17.
    Sameroff AJ, Barocas R, Seifer R: The early development of children born to mentally ill women, in Watt NF, Anthony EJ, Wynne LC, Rolf JE (eds): Children at Risk for Schizophrenia: A Longitudinal Perspective. New York, Cambridge University Press, 1984, pp 482–514.Google Scholar
  18. 18.
    Hanson D, Gottesman I, Heston L: Some possible childhood indicators of adult schizophrenia inferred from children of schizophrenics. Br J Psychiatry 1976;129:142–154.PubMedCrossRefGoogle Scholar
  19. 19.
    Goodman SH: Emory University Project on children with disturbed parents. Schizophr Bull 1987;13:411–423.PubMedGoogle Scholar
  20. 20.
    Erlenmeyer-Kimling L, Cornblatt BA, Golden R: Early indicators of vulnerability to schizophrenia in children at high genetic risk, in Guze SB, Earls FJ, Barrett JE (eds): Childhood Psychopathology and Development. New York, Raven Press, 1983, pp 247–261.Google Scholar
  21. 21.
    Reider RO, Nichols PL: The offspring of schizophrenics. Part III. Arch Gen Psychiatry 1979;36:665–674.Google Scholar
  22. 22.
    Orvaschel H, Mednick S, Schulsinger F, et al: The children of psychiatrically disturbed parents. Arch Gen Psychiatry 1979;36:691–695.PubMedGoogle Scholar
  23. 23.
    Asarnow JR: Schizophrenia, in Tarter R (ed) The Child at Psychiatric Risk. New York, Oxford University Press, 1983, pp 150–194.Google Scholar
  24. 24.
    Harvey P, Weintraub S, Neale J: Span of apprehension deficits in children vulnerable to psychopathology: a failure to replicate. J Abnorm Psychol 1985;94:410–413.PubMedCrossRefGoogle Scholar
  25. 25.
    Cornblatt BA, Erlenmeyer-Kimling L: Global attentional deviances as a marker of risk for schizophrenia: specificity and predictive validity. J Abnorm Psychol 1985;94:470–486.PubMedCrossRefGoogle Scholar
  26. 26.
    Nuechterlein K: Signal detection in vigilance tasks and behavioral attributes among offspring of schizophrenic mothers and among hyperactive children. J Abnorm Psychol 1983;92:4–28.PubMedCrossRefGoogle Scholar
  27. 27.
    Rutschmann J, Cornblatt B, Erlenmeyer-Kimling L: Sustained attention in children at risk for schizophrenia: report on a continuous performance test. Arch Gen Psychiatry 1977;34:571–575.PubMedGoogle Scholar
  28. 28.
    Wynne LC: The University of Rochester Child and Family Study: overview of research plan, in Watt NF, Anthony EJ, Wynne LC, Rolf JE (eds): Children at Risk for Schizophrenia: A Longitudinal Perspective. New York, Cambridge University Press, 1984, pp 335–347.Google Scholar
  29. 29.
    Wynne LC, Cole RE, Perkins P: University of Rochester Child and Family Study: risk research in progress. Schizophr Bull 1987;13:463–476.PubMedGoogle Scholar
  30. 30.
    Rolf JE: The social and academic competence of children vulnerable to schizophrenia and other behavior pathologies. J Abnorm Psychol 1972;80: 225–243.PubMedCrossRefGoogle Scholar
  31. 31.
    Fisher L, Harder D, Kokes R, et al: School functioning of children at risk for behavioral pathology, in Baldwin A, Cole R, Baldwin C (eds): Parental Pathology, Family Interaction, and the Competence of the Child in School. Monographs of the society for research in child development, 1982; 47:12–16.PubMedCrossRefGoogle Scholar
  32. 32.
    Watt NF: Patterns of childhood social development in adult schizophrenics. Arch Gen Psychiatry 1978;35:160–165.PubMedGoogle Scholar
  33. 33.
    Weintraub S, Neale J: The Stony Brook high-risk project, in Watt NF, Anthony EJ, Wynne LC, Rolf JE (eds): Children at Risk for Schizophrenia: A Longitudinal Perspective. New York, Cambridge University Press, 1984, pp 243–263.Google Scholar
  34. 34.
    Marcuse Y, Cornblatt B: Children at high risk for schizophrenia: predictions from infancy to childhood functioning, in Erlenmeyer-Kimling L, Miller N (eds): Life Span Research on the Prediction of Psychopathology. New Jersey, Lawrence Earlbaum and Associates, 1986, pp 84–100.Google Scholar
  35. 35.
    Erlenmeyer-Kimling L, Cornblatt B: The New York high-risk project: a follow-up report. Schizophr Bull 1987;13:451–461.PubMedGoogle Scholar
  36. 36.
    Mednick SA, Schulsinger F: Some premorbid characteristics related to breakdown in children with schizophrenic mothers, in Rosenthal D, Kety SS (eds): The Transmission of Schizophrenia. New York, Pergamon Press, 1968, pp 267–291.Google Scholar
  37. 37.
    Dawson ME, Nuechterlein KH: Psychophysiological dysfunctions in the developmental course of schizophrenic disorders. Schizophr Bull 1984; 10:204–232.PubMedGoogle Scholar
  38. 38.
    Lidz T, Cornelison AR, Fleck S, et al: The intrafamilial environment of schizophrenic patients: II. Marital schism and marital skew. Am J Psychiatry 1957;114:241–248.Google Scholar
  39. 39.
    Bowen M: A family concept of schizophrenia, in Jackson DD (ed): The Etiology of Schizophrenia. New York, Basic Books, 1960, pp 346–372.CrossRefGoogle Scholar
  40. 40.
    Bateson B, Jackson D, Haley J, et al: Toward a theory of schizophrenia. Behav Sci 1956;1:252–264.Google Scholar
  41. 41.
    Massie HN, Beels CC: The outcome and family treatment of schizophrenia. Schizophr Bull 1972;(Fall):24–36.Google Scholar
  42. 42.
    Wynne LC, Singer, MT, Bartko JJ, et al: Schizophrenics and their families: research on parental communication, in Tanner JM (ed): Developments in Psychiatric Research. London, Hodder & Stroughton, 1977, pp 254–286.Google Scholar
  43. 43.
    Vaughn CE, Leff JP: The influence of family and social factors on the course of psychiatric illness: a comparison of schizophrenic and depressed neurotic patients. Br J Psychiatry 1976;129:125–137.PubMedCrossRefGoogle Scholar
  44. 44.
    Doane JA, West KL, Goldstein MJ, et al: Parental communication deviance and affective style: predictors of subsequent schizophrenia spectrum disorders in vulnerable adolescents. Arch Gen Psychiatry 1981;38:679–685.PubMedGoogle Scholar
  45. 45.
    Goldstein MJ, Judd LL, Rodnick EH, et al: A method for the study of social influence and coping patterns in the families of disturbed adolescents. J Nerv Ment Dis 1968;147:233–251.PubMedCrossRefGoogle Scholar
  46. 46.
    Goldstein MJ: Family factors that antedate the onset of schizophrenia and related disorders: the results of a fifteen year prospective longitudinal study. Acta Psychiatr Scand 1985;71:7–18.CrossRefGoogle Scholar
  47. 47.
    Goldstein MJ: The UCLA high risk project. Schizophr Bull 1987;13:505–514.PubMedGoogle Scholar
  48. 48.
    Miklowitz DJ, Goldstein MJ, Nuechterlein KH, et al: Family factors and the course of bipolar affective disorder. Arch Gen Psychiatry 1988;45:225–231.PubMedGoogle Scholar
  49. 49.
    Tienari P, Sorri A, Naarala M, et al: The Finnish adoptive and family study: adopted-away offspring of schizophrenic mothers, in Stierlin H, Wynne LC, Wirsching M (eds): Psychosocial Intervention in Schizophrenia. Berlin, Springer-Verlag, 1983, pp 21–34.Google Scholar
  50. 50.
    Tienari P, Sorri A, Lahti I, et al: Genetic and psychosocial factors in schizophrenia: the Finnish adoptive family study. Schizophr Bull 1987;13:477–484.PubMedGoogle Scholar
  51. 51.
    Leff J, Vaughn C: Expressed Emotion in Families, new York, Guilford Press, 1985.Google Scholar
  52. 52.
    Brown GW: The discovery of expressed emotion: induction or deduction? in Leff J, Vaughn C (eds): Expressed Emotion in Families. New York, Guilford Press, 1985, pp 7–25.Google Scholar
  53. 53.
    Brown GW: Experiences of discharged chronic schizophrenic mental hospital patients in various types of living groups. Millbank Memorial Fund Quarterly 1959;37:105–131.CrossRefGoogle Scholar
  54. 54.
    Rutter M, Brown GW: The reliability and validity of measures of family life and relationships in families containing a psychiatric patient. Soc Psychiatry 1966;1:38–53.CrossRefGoogle Scholar
  55. 55.
    Brown GW, Monck EM, Carstairs GM, et al: Influence of family life on the course of schizophrenic illness. Br J Prevent Social Medicine 1962;16:55–68.Google Scholar
  56. 56.
    Brown GW, Birley JLT, Wing JK: Influence on the course of schizophrenic disorders: a replication. Br Psychiatry 1972;121:241–258.CrossRefGoogle Scholar
  57. 57.
    Vaughn CE, Snyder KS, Jones S, et al: Family factors in schizophrenic relapse: replication in California of the British research on expressed emotion. Arch Gen Psychiatry 1984;41:1169–1177.PubMedGoogle Scholar
  58. 58.
    Jenkins JH, Karno M, de la Selva A, et al: Expressed emotion, maintenance pharmacotherapy, and schizophrenic relapse among Mexican-Americans. Psychopharmacol Bull 1986;22:621–627.PubMedGoogle Scholar
  59. 59.
    Nuechterlein KH, Snyder KS, Dawson ME, et al: Expressed emotion, and fixed-dose fluphenazine decanoate maintenance, and relapse in recent-onset schizophrenia. Psychopharmacol Bull 1986;22:633–639.PubMedGoogle Scholar
  60. 60.
    MacMillan JF, Gold A, Crow TJ, et al: Expressed emotion and relapse. Br J Psychiatry 1986;148:133–143.PubMedCrossRefGoogle Scholar
  61. 61.
    Hogarty GE: Expressed emotion and schizophrenic relapse: implications from the Pittsburgh study, in Alpert M (ed): Controversies in Schizophrenia. New York, Guilford Press, 1985, pp 354–365.Google Scholar
  62. 62.
    Dulz B, Hand I: Short-term relapse in young schizophrenics: can it be predicted and affected by family (CFI), patient and treatment variables? An experimental study, in Goldstein MJ, Hand I, Hahlweg K (eds): Treatment of Schizophrenia: Family Assessment and Intervention. Berlin, Springer-Verlag, 1986, pp 59–75.Google Scholar
  63. 63.
    McCreadie RG, Phillips K: 1988: The Nithsdale schizophrenia survey. VII. Does relatives’ high expressed emotion predict relapse? Br J Psychiatry 1988;152:477–481.PubMedCrossRefGoogle Scholar
  64. 64.
    Parker, G, Johnston P, Hayward: Parental expressed emotion as a predictor of schizophrenic relapse. Arch Gen Psychiatry 1988;45:806–813.PubMedGoogle Scholar
  65. 65.
    Miklowitz DJ, Goldstein MJ, Falloon IRH: Premorbid and symptomatic characteristics of schizophrenia from families with high and low levels of expressed emotion. J Abnorm Psychol 1983 92:359–367.PubMedCrossRefGoogle Scholar
  66. 66.
    Mintz LI, Nuechterlein KH, Goldstein MJ, et al: The initial onset of schizophrenia and family expressed emotion: some methodological considerations. Br J Psychiatry 1989; 154;212–217.PubMedCrossRefGoogle Scholar
  67. 67.
    Valone K, Norton JP, Goldstein MJ, et al: Parental expressed emotion and affective style in an adolescent sample at risk for schizophrenia spectrum disorders. J Abnorm Psychol 1983;92:399–407.PubMedCrossRefGoogle Scholar
  68. 68.
    Miklowitz DJ, Goldstein MJ, Falloon IRH, et al: Interactional correlates of expressed emotion in the families of schizophrenics. Br J Psychiatry 1984;144:482–487.PubMedCrossRefGoogle Scholar
  69. 69.
    Strachan AM, Leff JP, Goldstein MJ, et al: 1986: emotional attitudes and direct communication in the families of schizophrenics. Br J Psychiatry 1986;149: 279–287.PubMedCrossRefGoogle Scholar
  70. 70.
    Miklowitz DJ, Goldstein MJ, Doane JA, et al: Does expressed emotion index a transactional process? I: Relative’s affective style. Fam Process 1989; 28:153–167.PubMedCrossRefGoogle Scholar
  71. 71.
    Magana AB, Goldstein MJ, Karno M, et al: A brief method for assessing expressed emotion in relatives of psychiatric patients. Psychiatr Res 1986;17:203–212.CrossRefGoogle Scholar
  72. 72.
    Tarrier N, Vaughn, C, Lader MH, et al: Bodily reactions to people and events in schizophrenia. Arch Gen Psychiatry 1979;36:311–315.PubMedGoogle Scholar
  73. 73.
    Sturgeon D, Kuipers L, Berkowitz R, et al: Psychophysiological responses of schizophrenic patients to high and low expressed emotion relatives. Br J Psychiatry 1981;138:40–45.PubMedCrossRefGoogle Scholar
  74. 74.
    Falloon IRH, Boyd JL, McGill CW, et al: Family management in the prevention of exacerbations of schizophrenia: a controlled study. N Engl J Med 1982;306:1437–1440.PubMedCrossRefGoogle Scholar
  75. 75.
    Doane JA, Falloon IRH, Goldstein MJ, et al: Parental affective style and the treatment of schizophrenia: predicting the course of illness and social functioning. Arch Gen Psychiatry 1985;42:34–42.PubMedGoogle Scholar
  76. 76.
    Doane J A, Goldstein MJ, Miklowitz DJ, et al: The impact of individual and family treatment on the affective climate of families of schizophrenics. Br J Psychiatry 1986;148:279–287.PubMedCrossRefGoogle Scholar
  77. 77.
    Hogarty GE, Anderson CM, Reiss DJ, et al: Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. Arch Gen Psychiatry 1986;43:633–644.PubMedGoogle Scholar
  78. 78.
    Hahlweg K, Goldstein MJ, Nuechterlein KH, et al: Expressed emotion and patient-relative interaction in families of recent-onset schizophrenics. J Consult Clin Psychol 1989;57:11–18.PubMedCrossRefGoogle Scholar
  79. 79.
    Strachan AM, Feingold D, Goldstein MJ, et al: Does expressed emotion index a transactional process? II. Patient’s coping style. Fam Process 1989;28:169–181.Google Scholar
  80. 80.
    Goldstein MJ(ed): New Developments in Interventions with Families of Schizophrenics. San Francisco, Jossey-Bass, 1981.Google Scholar
  81. 81.
    Goldstein MJ, Rodnick EH, Evans JR, et al: Drug and family therapy in the aftercare of acute schizophrenics. Arch Gen Psychiatry 1978;35:1169–1177.PubMedGoogle Scholar
  82. 82.
    Leff JP, Kuipers L, Berkowitz R, et al: A controlled clinical trial of social intervention in the families of schizophrenic patients. Br J Psychiatry 1982;141:121–134.PubMedCrossRefGoogle Scholar
  83. 83.
    Schooler NR, Keith SJ: Treatment Strategies in Schizophrenia Study Protocol. Rockville, MD, National Institute of Mental Health, 1983.Google Scholar

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  • Michael J. Goldstein

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