'Deficit' schizophrenia follows unique path.

Schizophrenia usually gets treated as a single disease that spawns several variations on its theme of fragmented thought and emotion. But some psychiatrists view schizophrenia as a shifting mix of psychotic symptoms, such as hallucinations and delusions, and a "deficit syndrome" that reflects disengagement from oneself and others. A longitudinal study now suggests that cases of deficit schizophrenia display a distinct natural history that features an ironic twist.

Over the long haul, patients hospitalized for schizophrenia stand a greater chance of returning to the hospital and sinking into social isolation if they suffer from deficit symptoms, assert Wayne S. Fenton of Chestnut Lodge Research Institute in Rockville, Md., and Thomas H. McGlashan of Yale University, Yet the deficit syndrome also appears to shield its bearers from suicide, they note.

The two psychiatrists present their findings in the March AMERICAN JOURNAL OF PSYCHIATRY.

Researchers have observed a limited ability to experience depression in many people with deficit schizophrenia, which may contribute to their low suicide rate, asserts William T. Carpenter Jr., a psychiatrist at the University of Maryland in Baltimore, in an accompanying comment.

"If [depression] mediates suicide, then patients with restricted emotional experience may be protected from self-destruction," Carpenter writes.

Fenton and McGlashan's data derive from an ongoing assessment of 187 schizophrenic patients an average of 19 years after their admission to Chestnut Lodge, a private psychiatric hospital (SN: 3/21/92, p. 181).

At admission, 46 patients displayed an enduring deficit syndrome, which includes lack of emotion, absence of interest in social activities, sparse communication with others, and little sense of purpose in life. These symptoms did not stem from the use of antipsychotic medication, depression, demoralization, or social isolation resulting from psychosis, the researchers hold.

Two-thirds of the deficit patients received initial clinical ratings of substantial thought disorganization or bizarre behavior, compared with one-third of their nondeficit counterparts, Fenton and McGlashan contend.

The deficit syndrome usually worsened in the 5 years after its appearance, with few remissions, they note. After that, it remained largely unchanged.

The large majority of deficit patients spent most of the follow-up period in psychiatric hospitals and rarely landed jobs; patients without deficit symptoms spent less than half the follow-up period in psychiatric hospitals and held jobs for one-third of that time.

No confirmed suicides occurred among deficit patients, compared to 10 suicides in the nondeficit group.

Unlike most people currently suffering from schizophrenia, the Chestnut Lodge patients rarely received antipsychotic medication early in the course of their illness. However, their drug free status made possible a relatively clear look at cases of deficit syndrome, the researchers maintain.