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Ask Dr. Sue
SCHIZOPHRENIA IN THE FAMILY
Dear Dr. Sue,
My 18 month old daughter is a much more difficult child
than my first two. She is very irritable and cranky and
has a terrible temper. What mainly worries me about this
is the fact that her aunt (her dad's sister) has
schizophrenia. Her dad, too, will sometimes say odd
things that make me wonder about whether he might have
something going on. How worried should I be that our
daughter might end up with schizophrenia?
Dear Mom,
First, for those who don't really know what
schizophrenia is, let me describe the disorder. The name
"schizophrenia" actually implies a "split personality,"
bringing to mind a multiple personality disorder. This
is not what schizophrenia is, however. The symptoms of
schizophrenia are described as positive or negative, in
the sense that some have been added to a patient's life
(not that they are desirable additions); while some are
skills that are lacking. The positive symptoms include:
-
A thinking disorder. This may include nonsensical
language.
-
Delusions. These are false and illogical beliefs.
-
Delusions of Paranoia. Some schizophrenics believe
that others are conspiring against them or plan to hurt
them.
-
Delusions of Grandeur. Believing that one is very
important, even when the only sign of their importance
is how many organizations are working toward their
destruction, or that a world leader on television is
talking specifically to them.
-
Hallucinations. Hearing voices or seeing things that
aren't there.
-
Illusions. Seeing something that is actually present
but misinterpreting what it is (seeing a person enter a
room and believing them to be an animal, for example).
Negative symptoms in schizophrenia are losses of normal
mental abilities or emotions.
They may include a severe loss of emotional
expressiveness, social withdrawal, or a loss of activity
even to the point of sitting and doing nothing all day
long.
It is not clear yet exactly what causes schizophrenia,
although advances are being made in understanding the
disease. Various differences in the actual structure of
the brain have been found that probably play some role. (The brains of schizophrenics are lighter than other
people's brains, and certain parts of the brain are
smaller. There appear to be differences in the structure
of the left brain compared to the right brain that are
not found in other people).
There are also chemical differences in the brain of
schizophrenics. One of the chemicals that allows nerves
to communicate with each other, dopamine, is present in
higher levels in their brains. The antipsychotic
medications that help to control the symptoms of
schizophrenia do so by decreasing the level of this
chemical.
How and why these changes occur, and what role each
plays in the disorder are still being questioned. We
know that slightly more people with schizophrenia were
born in winter months, when viral illnesses are more
common. So perhaps an infection inside the womb plays a
role. Also, the onset of schizophrenia is often preceded
by a large number of stressful life events. But it is
clear that whatever tips the scales in favor of
developing schizophrenia, an inborn susceptibility has
to be present, and it is this susceptibility that is
inherited. It is thought that a tendency to develop
schizophrenia may be passed on through a lot of genes,
each one with only a small effect. When a person
inherits too many of those genes, and then is affected
by the right combination of exposures and events in
their life, schizophrenia might result.
In less civilized times, schizophrenics were often
treated in terrible ways. Many may have been burned as
witches. In other societies they were often punished for
behavior that they couldn't control. Not long ago
electroshock therapy and frontal lobotomies were thought
to hold promise. (Neither one helped.) And many
schizophrenics spent their lives in mental institutions
where various degrees of deprivation and abuse were the
norm. The first antipsychotic drug that actually helped
schizophrenics wasn't developed until the 1950s. Since
then others have followed. These medications help
diminish the delusions and bizarre behavior and thoughts
that are the most devastating part of the illness. They
do not cure the disorder, and if medications are
stopped, the symptoms nearly always come back. They
have, however, offered the possibility of a near-normal
life back to many, many people with this disease.
So what about the risk of inheritance? All three of your
children have an increased risk over the general
population, though it will be difficult to define just
how much their risk is elevated. The risk of further
cases in a family with schizophrenia is likely affected
by how closely related the person with the disease is
(if her father had schizophrenia her risk would be
higher). It is also affected by the number of other
family members with the disease. And it may be affected
by how early the other family members developed
symptoms.
Even in identical twins, if one twin develops
schizophrenia, the other goes on to develop it only
about 50% of the time (one recent study put that number
closer to 85% of the time, but still not 100%). People
with no known relatives with schizophrenia have a 1%
chance of developing it. The National Schizophrenia
Fellowship in England cites a 10% risk of schizophrenia
in someone who has EITHER a parent or a brother or
sister or a child with schizophrenia. (Dr. Adrianne Reveley). Dr. Anne Bassett, head of the schizophrenia
research program in Toronto, however, believes the
numbers vary depending on WHICH close relative has the
disease. She says "For somebody who is a brother or
sister of someone with schizophrenia, their risk of
getting the illness is in the neighborhood of 10 to 15%,
and the risk to their offspring is only 2 to 3%."
Remember, these numbers don't apply if only an aunt is
affected, and we don't have any evidence that your
husband has schizophrenia. If he were to develop this
disease, and he has a 10 to 15 % chance of doing so,
then your children's risk would rise from 1% to
somewhere between 2 and 10%.
As far as your youngest, who sounds like a demanding
toddler to raise, remember that every child is
different, and many children are strong-willed,
demanding, resistant to change, and irritable. It is
most likely that your little girl is one of those
difficult, but very normal children. Be sure to talk to
your pediatrician about parenting techniques for such
children. Read everything you can about strong willed
children (see the book suggestions below). If, in spite
of your best efforts, her behavior becomes more and more
difficult to control by the time she starts kindergarten,
talk to your pediatrician. It may be reasonable at that
time to consider seeing a Child Psychiatrist. Meanwhile,
you should consider meeting with a pediatrician who
specializes in Genetics, to discuss your concerns in
greater detail. Ask for a referral!
Books to read:
• James C.Dobson, The Strong-Willed Child: Birth Through
Adolescence
• James C. Dobson, On Parenting: The Strong Willed
Child: Parenting Isn't for Cowards
• Mary Sheedy Kurcinka,
Raising Your Spirited Child
 
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