Review of Clinical Genetics in Psychiatry. Problems in Nosological Classification, edited by Hisatoshi Mitsuda; Tokyo, Igaku Shoin, 1967
Journal of Medical Genetics, 5, 1968, p. 360-1
This handsomely produced volume is the presentation to the world, through the medium of translation into English, of some of the most important work done in clinical psychiatry by Professor Mitsuda and his pupils and colleagues at the Osaka Medical College. It consists of 40 separate papers, most of which have been previously published, many of them however in Japanese and accordingly remaining inaccessible to European readers apart from their English summaries. Now that these works are brought together, with an introductory paper by the editor and most considerable contributor, we can see what significant results have been obtained by the systematic exploitation of a particular direction of study, i.e. by applying the chosen method of investigation (clinical, psychological, biochemical, electrophysiological, etc.) to groups of patients classified on a genetical principle. What emerges is a considerable body of knowledge which has been largely neglected by the West. There is now no further excuse for this neglect, since these papers have been translated into excellent English and are presented, most lucidly, with all the required detail.
Professor Mitsuda's most distinctive personal contribution is in the study of the atypical psychoses. He gives us a number of models of his way of looking at psychiatric syndromes, one of the simplest being to see the three syndromes of manic‑depression, epilepsy, and schizophrenia as lying respectively at the three apices of a triangle ABC; then half‑way along the side AB we shall find the ictal depressions, along the side BC oneirophrenia, and along the side CA the schizo‑affective psychoses. Investigating the families of patients suffering from atypical schizophrenic‑ illnesses, Mitsuda finds psychotic states of a heterogeneous kind, typical and atypical schizophrenias, affective illnesses and epilepsy, a raised incidence of abnormal EEG rhythms, etc. Family pedigrees may suggest dominance (e.g. with affected individuals on only one side of the family), recessivity (excess of abnormality only in the sibs), or intermediate (e.g. neither of the above but with some morbidity in sibs of parents or cousins). Classifying schizophrenic patients according to their family histories, one finds recovery or a periodic course predominating in the dominant group, chronic and deteriorating course of illness with recessive family history. Secondary cases of psychosis found in the families of schizophrenics tend to have a bad prognosis in the families of nuclear schizophrenics, a good one in the families of patients of the peripheral (atypical) groups. EEG abnormalities were found in 67% of cases of the peripheral group, as against 24% in the nuclear group but atrophic brain changes shown pneumoencephalographically were commoner in the nuclear than the peripheral cases.
There is a wealth of information, gathered along clinicogenetic lines by the investigation of parents and sibs and twins, now made available to easy reference in this book. Apart from the intensive work on the atypical psychoses, there are interesting studies on childhood schizophrenia, involutional depression, chronic alcoholism, early childhood neuroses, and juvenile delinquency in twins.