A Contribution to The Aetiology of Manic-Depressive Insanity (1940)

 The Colouring of Schizophrenic Psychoses in Manic‑Depressive Families

    In this connection the interesting point arises how far schizophrenic psychoses occurring in the families of manic‑depressives show an atypical colouring. I am not in a position, on the basis of my material, to contribute very much to this subject. Among the parents and children of my propositi I found in all twelve schizophrenics. The majority of these are reported in detail in the case material. Nevertheless, a few points will be further em­phasized here. Among these twelve there are the three schizo­phrenic parents of childless propositi, not reported in the case material, which will be briefly described here.

Case 1

The whole family shows a remarkable mixture of manic‑depressive and schizophrenic psychoses (see Pedigree, Figure 5). The pro­posita had a schizophrenic mother, a schizophrenic and a manic­depressive uncle on the mother's side, and a manic‑depressive fa­tiier and paternal grandfather. A manic‑depressive sister of the proposita married a man who went insane and had two schizophrenic sons. The mother of the proposita had six separate attacks of mental disorder which were all diagnosed as "circular" psychoses (the German equivalent of recurrent affective psychoses). In the first, which appeared at the age of 52, she showed a florid hallu­cinosis in the course of a severe attackof mania. This illness ended with complete recovery. After later illnesses she left the hospital, for the most part still in a depressed state. Her last illness, which came on when she was 46 years old, lasted six years to her death, and developed from a mania to a clearly schizophrenic defect‑state. The proposita herself showed in her recurrent ill­nesses some schizophrenic‑like symptoms.

Case 2

The proposita herself showed no atypical symptoms. Her mother fell ill at the age of 27 with an attack of "mania". She suffered from severe excitement, heard people making nasty remarks about her,

thought that the house was being set fire to, the windows being broken in, was disturbed and anxious, showed flight of ideas, was disturbed and anxious, showed flight of ideas, was confused, grad­ually passed into repeated attacks of stupor with impulsive out­bursts, and. developed a progressive schizophrenic dementia.

Case 3

The proposita had four attacks of quite typical mania. After the last, however, she was described by her sister as having never made a perfect recovery, was often somewhat excited, would not brook the slightest opposition, and if opposed would become uncontrolled and aggressive. On the other hand, she was very sensitive, ready to help everywhere, very amiable and friendly. "During her house­hold work her thoughts are mostly otherwise engaged, and she talks aloud to herself if she thinks she is alone" ....."rites apposite and amusing poetry". Her mother fell ill at the age of 34, with a state of excitement in which she became very exalted, wanted to earn her living as an authoress, expected the end of the world, laughed aloud, and would stand staring fixedly into space, wrote letters to the Burgomaster, announced a revolution against "the Blacks", which she signed with the name of Pallas Athene, intro­duced herself to a priest as a new Messiah, had hallucinations of sight and hearing. She gradually entered on a slight but un­mistakable schizophrenic defect‑state. It is interesting that her mother also, the grandmother of the proposita, was four times in hospital for melancholia, and that this woman's mother was said. also to have suffered from some form of mental disorder.

    I shall now give a few remarks about the other schizophrenic parents and children who, apart from the children of propositi 43, 108, and 148, are reported in more detail in the case material.

Case 4.

The Schizophrenic father of proposita 201 fell ill twice, on the first occasion at the age of 38; that time he made an app­met recovery from a paranoid. illness that lasted six months. Apart from this, neither the first nor the second illness showed any colouring of a schizophrenic kind.

Case 5

The son of propositus 43 fell ill for the first time at the age of 21 and was diagnosed as a case of mania. His second ill­ness at the age of 26 was a state of excitement with, in my opinion, manic features.

Case 6.

The daughter of proposita 108 was always a melancholy indivi­dual and fell ill at the age of 31 with a state of anxiety and depression, clearly of schizophrenic nature.

Case 7.

The daughter of proposita 148 (not included in the statistics) fell ill for the first time at 22 and was regarded in the Kraepelin Clinic as a case of mania; at the age of 29 she fell ill with an attack of schizophrenia, in which, however, a number of manic features could be seen.

Case 8.

The son of proposita 23 showed at the beginning of his single schizophrenic illness a mild apathetic depression, which later passed over into a state of excitement, with pressure of talk of an incoherent and bizarre kind. But, in fact, in his illness there is little that is suggestive of manic‑depressive insanity.

Case 9.

The daughter of proposita 35 fell ill three times at inter­vals of 9 and 2 years. Between whiles she made an attempt at suicide; otherwise nothing suggestive of the affective tape of psycILsis.

Case 10

The son of proposita 73 clearly shows the qualities of an ex­psnsive hyperthymic type of personality.

Case 11.

The son of proposita 91 shows no symptoms of the affective type.

Case 12

The daughter of proposita 96. In her psychosis are to be seen swings of mood and clearly manic features.

Case 13.

The daughter of proposita 119 shows a depressive admixture.

    Of the four schizophrenic parents and nine schizophrenic children, three parents and five children show a symptomatic col­ouring of a clearly manic‑depressive kind. The diagnosis of schizophrenia is, however, in every case assured.