expressivity, speaking in a monotone, and reduced expressive gestures. It has recently been proposed that such behaviors may reflect the neuromotor abnormalities that are prevalent in schizophrenia. This suggests that some individuals with schizo- phrenia may manifest affective blunting because the motoric expression of their emotions is compromised and not because they are unable to experience emotion as intensely as others. We therefore hypothesized that affective blunting in schizophre- nia reflects neuromotor dysfunction as well as affective deficits. To test this hypothesis, inpatients with schizophrenia who had been withdrawn from all neuroleptic medication were adminis- tered two measures of affecting blunting, a measure of neuro- motor dysfunction, and a measure of diminished affective experience (i.e., anhedonia). The correlations among these measures supported the hypothesis that existing measures of flat or blunted affect in schizophrenia reflect not only affective deficits but also the neuromotor abnormalities that are charac- teristic of individuals with this disorder. Because they are not confounded with neuromotor dysfunction, measures of dimin- ished affective experience may have greater validity in research on affective deficits in schizophrenia than measures of dimin- shed affective expression.

S C H I Z O P H R E N I A S P E C T R U M D I S O R D E R S

I N D I S C O R D A N T C O - T W I N S O F

P R O B A N D S W I T H S C H I Z O P H R E N I A O R

S C H I Z A F F E C T I V E D I S O R D E R

B. Coid*, C.M. Gilvarry, A.M. Reveley

Genetics Section, Institute of Psychiatry, Denmark Hill, London SE5 8AF, UK

Several family and adoption studies have confirmed that schizophrenia and nonpsychotic schizophrenia spectrum disor- ders aggregate in families. It is not clear, however, which specific personality disorders (PD) and nonschizophrenic disor- ders should be included in the schizophrenia spectrum. Further, there is contradictory information on diagnostic specificity, e.g. increased rates of schizophrenia spectrum traits/disorder in relatives of schizo-affective and affective disorders probands. We address these issues in a twin study involving 76 twin pairs discordant for DSM-III-R schizophrenia or schizo-affective disorder. Both Axis I and II assessments were made with semi- structured interviews (SADS-L & IPDE) on 32 available co-twins. 7 (21.8%) co-twins (3 MZ and 4 DZ-OS) met criteria for DSM-III-R PD. As expected, schizoid (3 MZ & 1 DZ) and schizotypal PD (2 MZ & 1 DZ) were more common and likely to co-exist, followed by avoidant and borderline PD. Paranoid traits were uncommon in the subsample interviewed. All 3 MZ- co-twins with schizoid PD were from the schizo-affective pro- band group. Among lifetime Axis I disorders, minor depressive disorder was reported by a quarter of the sample, followed by generalised anxiety disorder (19%) and major depressive disor- der (7.5%). Results will be discussed in terms of the severity of proband's illness, type ("negative" or "mixed" vs "positive") schizophrenia, and utilisation of dimensional scores for PD on all co-twins.

T H O U G H T D I S O R D E R P R O F I L E S I N

O F F S P R I N G O F S C H I Z O P H R E N I C

P A R E N T S I N T H E N E W Y O R K

H I G H - R I S K P R O J E C T

Michael J. Coleman*, Mar tha E. Shenton, Barbara Maminski Shapiro, L. Erlenmeyer-Kimling

McLean Hospital, 115 Mill Street, Belmont, MA 02178, USA

Offspring of schizophrenic parents are at increased risk for developing schizophrenia or schizophrenia spectrum disorders during adolescence or adulthood (Erlenmeyer-Kimling, 1977; Gottesman and Shields, 1982). The New York High-Risk Project (NYHRP) has examined offspring of schizophrenic parents prospectively, with the goals of ( 1 ) early identification of biological and behavioral indicators of a genetic liability to develop schizophrenia, and (2) longitudinal follow-up of the subjects to assess the predictive validity and specificity of variables tentatively flagged as indicators (Erlenmeyer-Kimling and Cornblatt, 1987). Two independent samples of offspring of schizophrenic parents, offspring of affectively ill parents and offspring of parents with no psychiatric illness have been followed from childhood (in 1971, Sample A, or 1978, Sample B) to adulthood. Among the many measures examined in the NYHRP as possible indicators of a genetic liability is thought disorder, as measured by the Thought Disorder Index (TDI) (Johnston and Holzman, 1979; Solovay et al., 1986; Coleman et al., 1994). Thought disorder was assessed in adolescence or young adulthood in 238 of the subjects in Samples A and B combined. We will compare the thought disorder profiles of offspring of schizophrenic parents, offspring of parents with affective disorders, and offspring of normal parents, and examine the relation between thought disorder and adult psychopathology.

T H E M E N T A L H E A L T H R E S E A R C H

I N S T I T U T E U N U S U A L P E R C E P T I O N S

S C H E D U L E ( M U P S )

David Copolov*, Dorothy Carter

Mental Health Research Institute of Victoria and NH & MRC Schizophrenia Unit, Private Bag 3, Parkville, Victoria 3052, Australia

Despite the prevalence and distressing nature of auditory hallucinations to patients, the descriptive phenomenology of the symptom in the literature seems sparse. While some scales or test instruments provide partial information about the experience of auditory hallucinations, none provides a compre- hensive framework to detail the many variables involved in this phenomenon. A test instrument, the Mental Health Research Institute Unusual Perceptions Schedule (MUPS) has been developed in an effort to address this lack.

The MUPS is an hypothesis-generating, descriptive instru- ment developed to thoroughly map hallucinators' experiences

of auditory hallucinations. The Schedule endeavours to con- struct a picture of the patient's experience of this phenomenon via a semi-structured interview technique. Particular interest is paid to understanding the nature of the factors which might precipitate, exacerbate or ameliorate hallucinations and the nature of adaptive strategies used by patients to reduce their frequency and impact. Finally, patients' personal views are sought as to meaning and origin of the hallucinations. Using a reliable instrument such as the MUPS has elicited information not normally elicited from patients.

One of the more striking results from interviews with 100 subjects is the fact that despite the often punitive and derogatory content of auditory hallucinations, 36% of the subjects would miss the voices; of those who say they would, nearly half (47%) believe they would miss them a lot. In some patients poor compliance with treatment may be a consequence of not wishing to be free of their hallucinations.

PROTOTYPICAL OUTCOMES AND THE PERSISTENT HETEROGENEITY OF SCHIZOAFFECTIVE DISORDER

William H. Coryell*

Psychiatry Research-- MEB, University of lowa, Iowa City, IA 52242, USA

Outcome studies usually compare disorders using recovery rates and global measures of functioning. This approach permits a ranking of disorders according to good and bad outcomes. However, questions concerning the boundary between two disorders are probably better addressed when outcomes are qualified phenomenologically.

To explore the boundary between schizophrenia and psychotic depression, we recruited consecutively admitted patients who had a functional psychosis without a current manic syndrome. These patients were re-evaluated after one, three and six years. They also participated in neuroendocrine evaluations and in a family study. Of ninety-seven patients who, at intake, had either RDC schizophrenia, schizoaffective disorder or psychotic major depressive disorder, seventy (72.2%) were re-evaluated at six years. Active psychotic features in the absence of an affective syndrome indicated a "schizophre- nia outcome". The co-existence of mood-incongruent psychotic features and an affective syndrome indicated a "schizoaffective outcome". "Full recovery" required no symptoms of an affec- tive disorder or psychosis, no social impairment and a GAS score greater than 70.

Three fourths of those who began the study with RDC schizophrenia had a schizophrenia outcome (13 of 17 or 76.5%). This outcome was seen in six of the thirty (20.0%) who began with RDC schizoaffective disorder and in only one (4.4%) of the twenty-three who began with MDD and psychotic features. Only one (5.9%) of the original schizophrenics was recovered after six years. Schizophrenic outcomes were more common in schizoaffective patients than in psychotic MDD patients; schizo- affective outcomes were also more common in schizoaffective patients than in schizophrenic patients. This heterogeneity was

largely confined to those who had met criteria for the RDC "mainly schizophrenic" subtype of schizoaffective disorder, criteria essentially identical to the DSMIV definition of schizo- affective disorder. Thus, the separation of DSMIV schizoaffec- tive disorder from both psychotic MDD and schizophrenia is prognostically meaningful.

SUICIDE IN YOUNG SCHIZOPHRENIC PATIENTS, A CASE CONTROL STUDY

M. D e H e r t , J. Peuskens

UC St Jozef Leuvensesteenweg 517. B-3070 Kortenberg, Belgium

Schizophrenia is a life-shortening disease and suicide turns out to be the major cause of death. The aim of our study is to identify possible risk factors for suicide in young schizophre- nic patients.

We studied a large cohort of 870 DSM-1II-R young schizo- phrenic patients (age < 30 at index admission), consecutively admitted between 1973 and 1992. The mean duration of follow- up was 11 years and all patients were located. We adapted a matched case control design with matching for: sex, age and subtype. Lifetime psychiatric history was obtained for both cases and controls.

At follow-up 7.2% (n = 63) of all patients committed success- ful suicide, this is 9.1% for males and 4.2% for female patients. 81% used a high-lethal mean and 52% died during an inpatient stay. 77% of the suicides were male. The mean age of suicide was 28.5 years.

Major risk factors are: n admissions >4 (p<0.000); short duration hospital stay (p<0.000); past suicidal behaviour (p < 0.000) and attempts (p < 0.000); negative attitude towards treatment, fugues (p<0.000), acting-out (p<0.000), non- compliance (p<0.000); major loss (p<0.000); psychosis (p < 0.000); depression (p < 0.000). Other risk factors are: 1Q > 100; discharge against advice; use of antidepressants; living alone at index admission; residential psychiatric care. Odds ratios are calculated for every risk factor.

THE SYNDROME OF LUJAN-FRYNS IN THE DIFFERENTIAL DIAGNOSIS OF SCHIZOPHRENIA

M. De Hert, D. Steemans, J. Peuskens, J.P. Fryns

UC St Jozef Leuvensesteenweg 517, B-3070 Kortenberg, Belgium, Center for Human Genetics, UC Gasthuisberg, K. U., Louvain, Belgium

Schizophrenia is considered a heterogenous disorder. Different etiopathophysiological mechanisms can attribute to a similar clinical picture as described in DSM-criteria. We present a case of a young man diagnosed on different occasions with DSM-III-R schizophrenia and mild mental retardation.