James R. Stabenau

Antisocial Behavior, Psychopathology and Problem Drinking in the Natural History of Alcoholism

It is well known that alcoholism often occurs in persons having an antisocial personality. Conversely, the behavior of persons with alcoholism often appears to be antisocial in nature. Thus, the differentiation of alcoholism from antisocial personality can be quite difficult and lead to diagnostic confusion [27]. While these two disorders are similar in some respects, and may sometimes occur together, their natural histories probably differ.

Biological, psychological and historical differences in a series of monozygotic twins discordant for schizophrenia

THERE is an old Chinese proverb that says: “The beginning of wisdom is to call things by their right names.” To begin with, let us try to make sure that we are using the “right” words, and at a minimum, mutually understood words, by briefly defining our thoughts concerning the two phenomena which together constitute the subject of this meeting: transmission and schizophrenia. When we use the term schizophrenia, we mean a behavioral syndrome which (a) is a disease process in that there is a demonstrable breakdown of normal function, comfort and effectiveness in a given individual; (b) has a set of common denominator symptoms (thought, affect, and action disorder, delusions, hallucinations and other psychotic manifestations) such that the “typical”, hardcore patient presents no diagnostic difficulty to psychiatric workers of many different points of view and nationalities; and (c) a behavioral syndrome which has very unclear limits, so that as one moves away from the hardcore cases there is an increasing degree of difficulty in arriving at diagnostic consensus. In regard to the other major concept with which we are concerned, i.e. transmission, Webster tells us that transmission is the act, operation or process of sending or transferring from one person to another; or passing on or down to others. Some question may be raised concerning how germane this concept is, at the present stage of our knowledge of schizophrenia. However, if we consider the various models that are implied by the concept of transmission of illness, its usefulness becomes clear. Illness can be transferred from one individual to another by means of the transfer of an active pathogen, as in bacteria1 infection; or by genetic transmission as in phenylketonuria. There is also a type of social transmission in the sense that children of poverty stricken, socially backward, slum dwellers have a much greater likelihood of coming down with tuberculosis, for example, not necessarily because their parents have transmitted to them a particular bacillus or a given genetic predisposition, but because they have been given a particular social heritage and have been reared in a particular environment which influences the susceptibility to the bacillus which is the prime source of the illness. Another model we need keep in mind demonstrates the fact that though children may very predictably show the behavior of their parents, this need not have any genetic component, as exemplified by the fact that children of French-speaking parents speak French, of English-speaking parents speak English, and so forth.

Familial distribution of alcohol use. I: Assortative mating in the parents of alcoholics

The distribution of alcoholism and other patterns of alcohol use in the ancestors of 242 alcoholic probands was evaluated by the family history method. Associations in drinking style were found among family members, particularly those of the same sex and generation. Assortative mating for drinking patterns was indicated by interparent correlations which were higher than those found between each parent and the spouses samesex sibling. Alcoholic probands with two problem-drinking parents were found to have a low percentage of moderate-drinking siblings but a high frequency of those who either were abstinent or were problem drinkers.

Basic research on heredity and alcohol: implications for clinical application.

Abstract Alcoholism has been described as a behavioral condition comprised of symptoms of alcohol dependence and the psycho‐socio‐biologic consequences of chronic alcohol dependence. Progress in clarifying the role of genetic factors in explaining differences in onset of dependence upon alcohol, frequency of consequences of chronic alcohol use, and transmission of patterns of alcoholism within a family pedigree has been based upon use of diagnostic methods that reliably and validly separate alcohol dependence from alcohol abuse. Twin methods, which control for genotypic variation, and adoption studies, which control for differences in rearing, have provided significant support for a genetic vulnerability hypothesis for development of alcoholism and a genetic heterogeneity hypothesis for type of alcoholism. The author reviews data from basic and clinical investigation of two subtypes of alcoholism: one associated with antisocial personality, and one that is “familial” (family‐history‐positive alcoholism). ...

The nature of alcoholism in patients with different family histories for alcoholism

1. The course and consequences of alcohol abuse were examined in male and female patients being treated for alcoholism. 2. Demographic characteristics, family history for alcoholism, psychopathology, drinking history and social and physical consequences of alcohol abuse were assessed. 3. Probands with alcoholism on both the maternal and paternal sides of their pedigree experience greater psychosocial and physical consequences of alcohol abuse than other alcoholic patients. 4. Sex of the proband and type of family pedigree for alcoholism were found not to be interactive but to contribute separate additive effects.

Minimal Brain Dysfunction and Neuropsychological Test Performance in Offspring of Alcoholics

Previous studies have indicated that alcoholics report a high frequency of problem behaviors in childhood. Additionally, certain neuropsychological deficits are often evident. Both childhood problem behavior and antecedent neuropsychological deficits have been suggested as risk factors for the later development of alcoholism. However, neither set of variables nor their interrelationship have been previously investigated in a sample at high risk for the development of alcoholism. In this study, unaffected offspring of an alcoholic parent and unaffected offspring of nonalcoholic parents were examined. Although attention deficit disorder/hyperactivity and conduct disorder prior to age twelve predicted the onset of drinking, the frequency of childhood behaviors was similar in both groups. Further, the neuropsychological performances of the high-risk and low-risk samples were also similar and within normal limits. The theoretical and methodological implications of these findings for future research are discussed.

Heredity and environment in schizophrenia, revisited. The contribution of twin and high-risk studies.

Life history study of monozygotic (MZ) twins discordant for schizophrenia led to the 1967 hypothesis that phenotypic schizophrenia was an expression of genotypic vulnerability interacting with prenatal and/or perinatal environmental experience. This report is a selected review of partial answers to five questions facing research efforts that have attempted to clarify the interactive gene-environment model of schizophrenia. Follow-up study of the offspring of MZ twins with a diagnosis of schizophrenia and their MZ co-twins without schizophrenia demonstrated equal rates of schizophrenia; hence, each group of offspring carried equal genetic vulnerability for schizophrenia. Magnetic resonance imaging study of MZ discordant twins found that phenotypic schizophrenia was characterized by brain ventricular enlargement and hippocampal reduction in 87-93% of the schizophrenic twins, when compared with their nonschizophrenic co-twins. A longitudinal study of teenage children at differential risk for schizophrenia showed that brain ventricular enlargement in adulthood correlated significantly and positively with genetic risk for schizophrenia and number of perinatal complications, and negatively with birth weight. Significantly greater dysmorphological hand skin signs among schizophrenic MZ twins when compared with their nonschizophrenic co-twins have suggested an in utero second trimester fetal developmental abnormality for the schizophrenic subjects. Simultaneous neuroanatomic, neurophysiological, and neurocognitive evaluation of MZ twin pairs discordant for schizophrenia demonstrated decreased prefrontal physiological cerebral blood flow activation during Wisconsin Card Sorting Test for affected twins correlated with decreased hippocampal volume determined by magnetic resonance imaging. These neurocognitive studies have suggested that schizophrenia involves neocortical-limbic pathology and dysfunction implicated in performance of cognitive tasks requiring working memory. They support an interactive model of schizophrenia in which the likelihood of expression of the schizophrenic genotype is increased by intervening prenatal and/or perinatal factors, associated with subsequent adult brain changes.

Affective Disorder in Alcoholism

In an attempt to explore the relationship between alcoholism and depression, family history data were examined in a sample of 90 alcoholic patients, 39 of whom were also depressed. Although subtypes of depression could not be distinguished on the basis of family history data, patients with depression were almost twice as likely to have a depressed biological relative and were more likely to have depression in two consecutive generations than nondepressed alcoholics. The implications of these results are discussed in terms of differential diagnosis, treatment, and future research.