Outcome and Familial Psychopathology in Schizophrenia

We examine whether the variation in outcome in schizophrenia is associated with differences in familial psychopathology. We begin with a methodologically oriented review of the large number of previous studies that have addressed this question. Although some trends are evident, the findings are variable. Most of the studies have important methodologic limitations. We then examine the relationship between short-term outcome and four dimensions of long-term outcome in 253 DSM-III schizophrenics and psychiatric illness in their 723 first-degree relatives. No relationship is found between any dimension of outcome in schizophrenics and risk in their relatives for schizophrenia, all nonaffective psychoses, bipolar illness, or anxiety disorder. A marital outcome of divorce was strongly associated with a family history of alcoholism. Good long-term marital, residential, and occupational outcomes were positively correlated with the risk for unipolar illness in relatives. These results do not support the hypothesis that poor outcome schizophrenia is the "genetic" form of the disorder. However, they are compatible with the hypothesis that the liability to affective illness may influence outcome in schizophrenia.