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Chronicity in Schizophrenia: Revisited

Published online by Cambridge University Press:  06 August 2018

Courtenay M. Harding ,
Joseph Zubin  and
John S. Strauss
Courtenay M. Harding*
Affiliation:
Department of Psychiatry, University of Colorado School of Medicine, Denver, USA
Joseph Zubin
Affiliation:
Veterans Administration Medical Center, Pittsburgh, USA
John S. Strauss
Affiliation:
Department of Psychiatry, Yale University School of Medicine, New Haven
*
Correspondence
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Extract

Derived simply from the Greek work chronos, meaning time, the label ‘chronic’ denotes an illness of long duration or one of frequent recurrence. However, when chronic is paired with schizophrenia, as in ‘this person is a chronic schizophrenic’, the connotation becomes an expectation of deterioration, defect, or deficit states (Cutting, 1983). These perceptions about schizophrenia have pervaded and guided clinical judgements (Feighner et al, 1972; American Psychiatric Association, 1980, 1987), treatment programming (Bachrach, 1979; Lamb, 1981; Strauss & Glazer, 1982), policy formulation (Greenblatt, 1978; Talbott, 1979), and decisions about priority for funding (Kraft, 1981). These perceptions have also stripped hopes of recovery from patients and their families (Chamberlin, 1979; Lovejoy, 1984). Further, the use of phrases such as ‘deinstitutionalisation of chronic mental patients’ glosses over the large heterogeneity of patient types, courses of illness and recovery, and the actual shifts in composition and migrations of groups of patients within society (Lamb, 1979; Leighton, 1982; Harding & Ashikaga, 1982).

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Information
The British Journal of Psychiatry , Volume 161 , Issue S18: Onset and Course of Schizophrenic Disorders: Dynamic Interactions between Relevant Factors , October 1992 , pp. 27 - 37
Copyright
Copyright © The Royal College of Psychiatrists 

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References

Achté, K. A. (1967) On prognosis and rehabilitation in schizophrenia and paranoid psychoses. A comparative follow-up study of two series of patients first admitted to hospital in 1950 and 1960 respectively. Acta Psychiatrica et Neurologica Scandinavica, (suppl. 196), 1–217.Google Scholar
Alexander, F. G. & Selesnsick, S. T. (1966) This History of Psychiatry: An Evaluation of Psychiatry Thought and Practice from Prehistoric Times to the Present. New York: Harper & Row.Google Scholar
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd edn) (DSM-III). Washington, DC: APA.Google Scholar
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.Google Scholar
Anderson, C. M., Hogarty, G. E. & Reiss, D. J. (1980) Family treatment of adult schizophrenic patients: A psychoeducational approach. Schizophrenia Bulletin, 6, 490–505.Google Scholar
Andreasen, N. C. (1982) Negative symptoms in schizophrenia. Definition and reliability. Archives of General Psychiatry, 39, 789–794.Google Scholar
Anthony, W. A. (1977) Psychological rehabilitation: A concept in need of a method. American Psychologist, 32, 658–662.Google Scholar
Astrup, C. & Noreik, K. (1966) Functional Psychoses: Diagnostic and Prognostic Models. Springfield: Charles C. Thomas.Google Scholar
Bachrach, L. L. (1976) A note on some recent studies of released mental hospital patients in the community. American Journal of Psychiatry, 133, 73–75.Google Scholar
Bachrach, L. L. (1979) Planning mental health services for chronic patients. Hospital & Community Psychiatry, 30, 387–393.Google Scholar
Barton, R. (1959) Institutional Neurosis. Bristol: Wright.Google Scholar
Bland, R. C. & Orn, H. (1978) Fourteen-year outcome in early schizophrenia. Acta Psychiatrica Scandinavica, 58, 327–338.Google Scholar
Bleuler, E. (1911) Dementia Praecox or the Group of Schizophrenias. (Translated (1950) by J. Zinkin.) New York: International Universities Press.Google Scholar
Bleuler, M. (1955) Research and changes in concepts in the study of schizophrenia, 1941–1950. Bulletin of the Isaac Ray Medical Library, 3, 1–132.Google Scholar
Bleuler, M. (1963) Conception of schizophrenia within the last fifty years and today. Proceedings of the Royal Society of Medicine, 56, 945–952.Google Scholar
Bleuler, M. (1968) A 23-year longitudinal study of 208 schizophrenics and impressions in regard to the nature of schizophrenia. In The Transmission of Schizophrenia (eds D. Rosenthal & S. S. Kety). Oxford: Pergamon Press.Google Scholar
Bleuler, M. (1969) The genesis and nature of schizophrenia. Psychiatry Digest, 30, 17–26.Google Scholar
Bleuler, M. (1972a) Die schizophrenen Geistesstörungen im Lichte langjähriger Kranken- und Familiengeschichten. Stuttgart: Georg Thieme. Translated (1978) by S. M. Clemens as The Schizophrenic Disorders, Long-Term Patient and Family Studies. New Haven: Yale University Press.Google Scholar
Bleuler, M. (1972b) Die schizophrenen Geistesstörungen im Lichte langjähriger Kranken- und Familiengeschichten. Stuttgart: Georg Thieme; as reviewed (1978) by G. C. Teschke. Schizophrenia Bulletin, 4, 48–55.Google Scholar
Bleuler, M. (1974) The long-term course of the schizophrenic psychoses. Psychological Medicine, 4, 244–254.Google Scholar
Bleuler, M. (1983) Schizophrenic deterioration (a multi-author discussion section). British Journal of Psychiatry, 143, 78–79.Google Scholar
Bockus, H. L. (1974) Perspective prognosis in peptic ulcer. In Gastroenterology (3rd edn) (ed. H. L. Bockus). Philadelphia: Saunders.Google Scholar
Breier, A. & Strauss, J. S. (1983) Self-control in psychotic disorders. Archives of General Psychiatry, 40, 1141–1145.Google Scholar
Breier, A. & Strauss, J. S. (1984) Social relationships in the recovery from psychotic disorder. American Journal of Psychiatry, 141, 949–955.Google Scholar
Brenner, M. H. (1973) Mental Illness & the Economy. Cambridge: Harvard University Press.Google Scholar
Brooks, G. W. (1959) Opening a rehabilitation house. In Rehabilitation of the Mentally III (eds M. Greenblatt & B. Simon). Washington DC: American Association for the Advancement of Science.Google Scholar
Brooks, G. W. (1960a) Rehabilitation of hospitalized chronic schizophrenic patients. In Chronic Schizophrenia (eds L. Appleby, J. Scher & J. Cumming). Chicago: The Free Press.Google Scholar
Brooks, G. W. (1961a) Rural community influences and supports in a rehabilitation program for state hospital patients. In Mental Patients in Transition (eds M. Greenblatt, D. J. Levinson & G. L. Klerman). Springfield: Charles C. Thomas.Google Scholar
Brooks, G. W. (1961b) Motivation for work in psychiatric rehabilitation. Diseases of the Nervous System, 22, 129–132.Google Scholar
Brooks, G. W. (1981) Vocational rehabilitation. In The Chronic Mentally III - Treatment, Programs, System (ed. J. A. Talbott). New York: Human Sciences Press.Google Scholar
Brooks, G. W. & Deane, W. N. (1960) Attitudes of released chronic schizophrenic patients concerning illness and recovery as revealed by a structured post-hospital interview. Journal of Clinical Psychology, 16, 259–264.Google Scholar
Brooks, G. W., Deane, W. N., Lagor, R. C., et al (1963) Varieties of family participation in the rehabilitation of released chronic schizophrenic patients. Journal of Nervous & Mental Disease, 136, 432–444.Google Scholar
Brooks, G. W., Deane, W. N. and Lagor, R. C., et al (1965) The chronic mental patient in the community. Diseases of the Nervous System, 26, 85–90.Google Scholar
Brooks, G. W., Deane, W. N. and Laqueuer, H. P. (1970) Fifteen years of work therapy. Diseases of the Nervous System (GWAN Supp), 31, 161–165.Google Scholar
Brown, G. W. (1960) Length of hospital stay and schizophrenia: a review of statistical studies. Acta Psychiatrica et Neurologica, 35, 414–430.Google Scholar
Brown, G. W., Bone, M., Dalison, B., et al (1966) Schizophrenia & Social Care. London: Oxford University Press.Google Scholar
Calabro, J. J. (1979) Juvenile rheumatoid arthritis. In: Arthritis and Allied Conditions: A Textbook on Rheumatology (9th edn) (ed. D. J. McCarthy). Philadelphia: Lea & Febiger.Google Scholar
Cannon, W. B. (1963) The Wisdom of the Body. New York: WW Norton.Google Scholar
Chamberlin, J. (1979) On Our Own - Patient Controlled Alternative to the Mental Health System. New York: McGraw-Hill.Google Scholar
Chittick, R. A., Brooks, G. W., Irons, F. S., et al (1961) The Vermont Story. Burlington: Queen City Printers.Google Scholar
Ciompi, L. (1980a) Catamnestic long-term study on the course of life and aging schizophrenics. Schizophrenia Bulletin, 6, 606–618.Google Scholar
Ciompi, L. (1980b) Is chronic schizophrenia an artifact? Arguments and counter-arguments. Fortschritte der Neurologie - Psychiatrie, 48, 237–248.Google Scholar
Ciompi, L. & Müller, C. (1976) Lebensweg und Alter Schizophrener. Eine katamnestische Langzeitstudie bis ins Alter. Berlin: Springer Verlag. Translated (1984) as The Life Course and Aging in Schizophrenia: A Catamnestic Longitudinal Study into Advanced Age by E. Forsberg for the Vermont Longitudinal Research Project.Google Scholar
Cohen, P. & Cohen, G. (1984) The clinician's illusion. Archives of General Psychiatry, 41, 1178–1182.Google Scholar
Cousins, N. (1979) Anatomy of an Illness as Perceived by the Patient: Reflections on Healing & Regeneration. New York: Norton.Google Scholar
Cutting, J. (1983) Schizophrenic deterioration (a multi-author discussion of the topic). British Journal of Psychiatry, 132, 77–84.Google Scholar
Daniele, R. P. (1982) Asthma. In The Textbook of Medicine, (eds J. B. Wyngaarden & L. H. Smith). Philadelphia: W. B. Saunders.Google Scholar
Davison, K. & Bagley, C. (1969) Schizophrenic-like psychoses associated with organic disorders of C.N.S. - a review of the literature. In Current Problems in Neuropsychiatry (ed. R. N. Herrington). British Journal of Psychiatry, Special Publication No. 4, Ashford: Headley Brothers.Google Scholar
Dunham, H. W. (1976) Society, culture, and mental disorder. Archives of General Psychiatry, 33, 147–156.Google Scholar
Feighner, J. P., Robbins, E., Guze, S. B., et al (1972) Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 57–63.Google Scholar
Freyhan, F. A. (1958) Eugen Bleuler's concept of the group of schizophrenias at mid-century. American Journal of Psychiatry, 114, 769–779.Google Scholar
Gardos, G. & Cole, J. O. (1980) Overview: public health issues of tardive dyskinesia. American Journal of Psychiatry, 137, 776–781.Google Scholar
Gardos, G., Cole, J. O. & Labrie, R. A. (1982) A twelve-year follow-up study of chronic schizophrenics. Hospital & Community Psychiatry, 33, 983–984.Google Scholar
Gilliland, B. C. & Mannik, M. (1983) Rheumatoid arthritis. In Harrison's Principles of Internal Medicine (ed. R. G. Petersdorf). New York: McGraw-Hill.Google Scholar
Goffman, E. (1961) Asylums: Essays on the Social Situation of Mental Patients and Other Inmates. New York: Doubleday Anchor.Google Scholar
Greenblatt, M. (1978) Psychopolitics. New York: Grune & Stratton.Google Scholar
Haley, J. (1969) The art of being schizophrenic. In The Power Tactics of Jesus Christ and Other Essays. New York: Avon Books.Google Scholar
Harding, C. M. (1988) The outcome of schizophrenia. The Harvard Medical School Mental Health Letter, 4, 3–5.Google Scholar
Harding, C. M. & Brooks, G. W. (1980) Longitudinal assessment for a cohort of chronic schizophrenics discharged twenty years ago. The Psychiatric Journal of the University of Ottawa, 5, 274–278.Google Scholar
Harding, C. M. & Ashikaga, T. (1982) Utilization of Community Mental Health Clinics, the State Hospitals, and Social Support Networks by the Vermont Story Cohort - Twenty Years After Deinstitutionalization. Report prepared for Dr. R. Surles, Department of Mental Health, Vermont.Google Scholar
Harding, C. M. & Brooks, G. W. (1984) Life assessment of a cohort of chronic schizophrenics discharges twenty years ago. In The Handbook of Longitudinal Research, Vol. 2 (eds S. A. Mednick, M. Harway & K. M. Finello). New York: Prager Press.Google Scholar
Harding, C. M. & Strauss, J. S. (1984a) Changing views about prognosis in schizophrenia. Biological Psychiatry, 19, 1597–1600.Google Scholar
Harding, C. M. & Strauss, J. S. (1984b) The course of schizophrenia: An evolving concept. In Controversies in Schizophrenia: Changes and Constancies (ed M. Alpert). New York: Guilford Press.Google Scholar
Harding, C. M., Brooks, G. W., Ashikaga, T., et al (1987a) The Vermont longitudinal study of persons with severe mental illness: I. Methodology, study sample, and overall status 32 years later. American Journal of Psychiatry, 6, 718–726.Google Scholar
Harding, C. M., Brooks, G. W., Ashikaga, T., et al (1987b) The Vermont longitudinal study: II. Long-term outcome of subjects who retrospectively met DSM-III criteria from schizophrenia. American Journal of Psychiatry, 144, 727–735.Google Scholar
Harding, C. M., Zubin, J. & Strauss, J. S. (1987c) Chronicity in schizophrenia: fact, partial fact or artifact? Hospital & Community Psychiatry, 38, 477–486.Google Scholar
Harding, C. M., Brooks, G. W., Ashikaga, T., et al (1987d) Aging and social functioning on once-chronic schizophrenic patients 22–62 years after first admission: The Vermont story. In Schizophrenia and Aging: Schizophrenia, Paranoia, and Schizophreniform Disorders in Later Life (eds N. Miller & G. D. Cohen). New York: Guilford Press.Google Scholar
Hawk, A. B., Carpenter, W. T. & Strauss, J. S. (1975) Diagnostic criteria and five-year outcome in schizophrenia: a report from the International Pilot Study of Schizophrenia. Archives of General Psychiatry, 32, 343–347.Google Scholar
Hollingshead, A. B. & Redlich, F. C. (1958) Social Class & Mental Illness. New York: Wiley.Google Scholar
Holt, W. L. Jr., & Holt, W. M. (1952) Long-term prognosis in mental illness: a thirty year follow-up of 141 mental patients. American Journal of Psychiatry, 108, 735–739.Google Scholar
Houghton, J. (1980) One personal experience before and after mental illness. In Attitudes Toward the Mentally III: Research Perspectives (eds J. G. Rabkin, L. Gelb & J. B. Lazare). DHSS, Washington DC: Government Printing Office (80–1031).Google Scholar
Huber, G., Gross, G. & Schüttler, R. (1975) A long-term follow- up study of schizophrenia: Psychiatric course of illness and prognosis. Acta Psychiatrica Scandinavica, 52, 49–57.Google Scholar
Huber, G., Gross, G. & Schüttler, R. et al (1980) Longitudinal studies of schizophrenic patients. Schizophrenia Bulletin, 6, 592–605.Google Scholar
Jaspers, K. (1963) General Psychopathology. Translated from the German by J. Hoenig & M. W. Hamilton. Chicago: University of Chicago Press.Google Scholar
Jones, W. L. (1983) Ministering to Minds Diseased: A History of Psychiatric Treatment. London: Heinemann Medical.Google Scholar
Kendell, R. E., Brockington, I. F. & Leff, J. P. (1979) Prognostic implications of six alternative definitions of schizophrenia. Archives of General Psychiatry, 35, 25–31.Google Scholar
Kraepelin, E. (1899) Psychiatrie. Leipzig: Barth.Google Scholar
Kraepelin, E. (1902) Clinical Psychiatry: Aq Textbook for Students and Physicians (6th edn) (translated by Å. R. Diefendorf). New York: Macmillan.Google Scholar
Kraft, J. K. & Stainey, T. A. (1977) The natural history of symptomatic recurrent bacteriuria in women. Medicine, 56, 55–60.Google Scholar
Kraft, A. M. (1981) Discussion: systems for the chronically mentally ill. In The Chronically Mentally III. Treatment, Programs, Systems (ed. J. A. Talbott). New York: Human Sciences Press.Google Scholar
Kramer, M., Goldstein, H., Israel, R. H., et al (1955) A historical study of the disposition of first admissions to a State Hospital. Experiences of the Warren State Hospital during the period 1916–1950. Public Health Monograph #32. Washington DC: U.S. Department of Health, Education & Welfare.Google Scholar
Lamb, H. R. & Goertzel, V. (1972) High expectations of long- term ex-state hospital patients. American Journal of Psychiatry, 129, 471–475.Google Scholar
Lamb, H. R. (1979) Staff burnout in work with long-term patients. Hospital & Community Psychiatry, 30, 396–398.Google Scholar
Lamb, H. R. (1981) What did we really expect from deinstitutionalization? Hospital & Community Psychiatry, 32, 105–109.Google Scholar
Langfeldt, G. (1937) The prognosis in schizophrenia and the factors influencing the course of the disease. Acta Psychiatrica et Neurologica Scandinavica, suppl. 13, 1–228.Google Scholar
Langfeldt, G. (1939) Schizophreniform States. Copenhagen: E. Munksgaard.Google Scholar
Leighton, A. (1982) Caring for Mentally 111 People. New York: Cambridge University Press.Google Scholar
Leonhard, K. (1961) Cycloid psychoses: Endogenous psychoses which are neither schizophrenic nor manic depressive. Journal of Mental Science, 107, 633–648.Google Scholar
Lovejoy, M. (1984) Recovery from schizophrenia: A personal Odyssey. Hospital & Community Psychiatry, 35, 809–812.Google Scholar
Ludwing, A. M. (1971) Treating the treatment failures: The challenge of chronic schizophrenia. New York: Grune & Stratton.Google Scholar
Mandell, M. R., Severe, J. B., Schooler, N. R., et al (1982) Development and prediction of post psychotic depression in neuroleptic-treated schizophrenics. Archives of General Psychiatry, 39, 197–203.Google Scholar
McGlashan, T. (1988) A selective review of recent North American long-term follow-up studies of schizophrenia. Schizophrenia Bulletin, 14, 515–542.Google Scholar
Rennie, T. A. C. (1939) Follow-up study of five hundred patients with schizophrenia admitted to the hospital from 1913–1923. Archives of Neurology & Psychiatry, 42, 877–891.Google Scholar
Rosenhan, D. (1973) On being sane in insane places. Science, 179, 250–258.Google Scholar
Rupp, C. & Fletcher, E. K. (1939) A five to ten year follow-up study of 641 schizophrenic cases. American Journal of Psychiatry, 96, 877–888.Google Scholar
Schneider, K. (1959) Clinical Psychopathology. Translated (1959) from the German by M. W. Hamilton & E. W. Anderson. New York: Grune & Stratton.Google Scholar
Scull, A. T. (1979) Museums of Madness. New York: St. Martin's Press.Google Scholar
Shapiro, R. & Shader, E. (1979) Chapter II Selective review of results of previous follow-up studies of schizophrenia and other psychoses. In Schizophrenia: An International Pilot Study (ed. World Health Organization) Chichester: Wiley.Google Scholar
Simpson, H., Russell, G. & Forfor, J. O. (1984) Respiratory disorders. In Textbook of Paediatrics, Vol. 1 (3rd edn) (eds J. O. Forfor & F. C. Arneil). Edinburgh: Churchill-Livingstone.Google Scholar
Spitzer, R. L., Endicott, J. & Robins, E. (1975) Research Diagnostic Criteria (RDC). New York: Biometrics Research.Google Scholar
Stephens, J. H. (1970) Long-term course and prognosis in schizophrenia. Seminars in Psychiatry, 2, 464–485.Google Scholar
Strauss, J. S. (1980) Chronicity: Causes, prevention, and treatment. Psychiatric Annals, 10, 328–332.Google Scholar
Strauss, J. S. & Carpenter, W. T. (1972) The prediction of outcome in schizophrenia: I. Characteristics of outcome. Archives of General Psychiatry, 27, 739–746.Google Scholar
Strauss, J. S., Carpenter, W. T. & Bartko, J. J. (1974) Speculations on the processes that underlie schizophrenic symptoms. Schizophrenia Bulletin, 11, 61–70.Google Scholar
Strauss, J. S., & Bartko, J. J. (1974) The prediction of outcome in schizophrenia: II. Relationships between predictor and outcome variables. Archives of General Psychiatry, 31, 37–42.Google Scholar
Strauss, J. S., & Bartko, J. J. (1977) Prediction of outcome in schizophrenia: III. Five-year outcome and its predictors. Archives of General Psychiatry, 34, 159–163.Google Scholar
Strauss, J. S., & Hafez, H. (1981) Clinical questions and “real” research. American Journal of Psychiatry, 138, 1592–1597.Google Scholar
Strauss, J. S., Lovesky, L., Glazer, W., et al (1981) Organizing the complexities of schizophrenia. Journal of Nervous & Mental Disease, 169, 120–126.Google Scholar
Strauss, J. S. & Glazer, W. (1982) Treatment of the so-called chronically psychiatrically ill. In Current Psychiatric Therapies (ed. J.H. Masserman). New York: Grune & Stratton.Google Scholar
Strauss, J. S., Hafez, H., Lieberman, P., et al (1985) The course of psychiatric disorder: III. Longitudinal principles. American Journal of Psychiatry, 142, 289–296.Google Scholar
Strauss, J. S., Harding, C. M., Hafez, H., et al (1987) The role of the patient in recovery from psychosis. In Psychosocial Management of Schizophrenia (eds J. Strauss & H. Brenner). Toronto: Hans Huber.Google Scholar
Strömgren, E. (1961) Recent studies of prognosis and outcome in the mental disorders. In Comparative Epidemiology of the Mental Disorders (eds P. Hoch & J. Zubin). New York: Grune and Stratton.Google Scholar
Swaiman, K. F. & Wright, F. S. (1982) Seizure disorders. In The Practice of Pediatric Neurology (2nd edn) (eds F. S. Wright, F. E. Dreifus & G. J. Wolcott, et al). St. Louis: Mosby.Google Scholar
Talbott, J. A. (ed.) (1979) The Chronic Mental Patient: Problems, Solutions, and Recommendations for a Public Policy. Washington DC: APA.Google Scholar
Tsuang, M., Woolson, R. & Fleming, J. (1979) Long-term outcome of major psychoses: I. Schizophrenia and affective disorders compared with psychiatrically symptom-free surgical conditions. Archives of General Psychiatry, 36, 1295–1301.Google Scholar
Vaillant, G. E. (1969) The natural history of urban narcotic drug addiction: some determinants. In Scientific Basis of Drug Dependence (ed. H. Steinberg). London: J. & A. Churchill.Google Scholar
Vaillant, G. E. (1978) A ten-year follow-up of remitting schizophrenics. Schizophrenia Bulletin, 4, 78–85.Google Scholar
Vaillant, G. E. (1980) Adolf Meyer was right: Dynamic psychiatry needs the life chart. Journal of the National Association of Private Psychiatric Hospitals, 11, 4–14.Google Scholar
Warner, R. (ed.) (1985) Recovery From Schizophrenia. In Psychiatry and the Political Economy. London: Routledge & Kegan Paul.Google Scholar
Watt, D. C., Katz, K. & Shepherd, M. (1983) The natural history of schizophrenia: a five-year prospective follow-up of a representative sample of schizophrenics by means of a standardized clinical and social assessment. Psychological Medicine, 13, 663–670.Google Scholar
Wing, J. K. (1962) Institutionalism in mental hospitals. British Journal of Social & Clinical Psychology, 1, 38–51.Google Scholar
Wing, J. K. & Brown, G. W. (1970) Institutionalism & Schizophrenia. London: Cambridge University Press.Google Scholar
Winokur, G., Morrison, J., Clancy, J., et al (1972) The Iowa 500: II. A blind family history comparison of mania, depression and schizophrenia. Archives of General Psychiatry, 27, 462–464.Google Scholar
World Health Organization (1979) Schizophrenia: An International Follow-up Study. New York: Wiley.Google Scholar
Zubin, J. & Spring, B. (1977) Vulnerability: A new view of schizophrenia. Journal of Abnormal Psychology, 86, 103–126.Google Scholar
Zubin, J., Magaziner, J. & Steinhauer, S. R. (1983) The metamorphosis of schizophrenia: From chronicity to vulnerability. Psychological Medicine, 13, 551–571.Google Scholar
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