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Am J Psychiatry 1995; 152:755-764
Copyright © 1995 by American Psychiatric Association
Examining the validity of DSM-III-R schizoaffective disorder and its putative subtypes in the Roscommon Family Study
KS Kendler, M McGuire, AM Gruenberg and D Walsh
Department of Psychiatry, Medical College of Virginia, Richmond 23298- 0710, USA.
OBJECTIVE: The authors sought to assess whether the DSM-III-R category of
schizoaffective disorder differs meaningfully from schizophrenia and
affective illness in clinical features, outcome, and familial
psychopathology. In addition, the authors evaluated the validity of two
proposed subtyping systems for schizoaffective disorder: 1) bipolar versus
depressive (based on presence or absence of a full manic syndrome in the
past) and 2) good versus poor interepisode recovery. METHOD: In the
epidemiologically based Roscommon Family Study, index probands with
diagnoses of schizophrenia or affective illness were selected from a case
registry. Personal interviews were conducted with 88% of traceable, living
probands and 86% of traceable, living first- degree relatives. RESULTS:
Probands with schizoaffective disorder differed significantly from both
those with schizophrenia and those with affective illness on lifetime
psychotic symptoms as well as on outcome and negative symptoms assessed as
follow-up. Relatives of probands with schizoaffective disorder had
significantly higher rates of affective illness than relatives of
schizophrenic probands and significantly higher rates of schizophrenia than
relatives of probands with affective illness. Probands with bipolar and
depressive schizoaffective disorder did not differ substantially with
respect to psychotic symptoms, negative symptoms, outcome, or family
history. Schizoaffective disorder probands with good interepisode recovery
had fewer negative symptoms and a better outcome than those with poor
recovery, but there were no significant differences in family history. Both
the epidemiologic and family data are consistent with the hypothesis that
schizoaffective disorder results from the co-occurrence of a high liability
to both schizophrenia and affective illness. CONCLUSIONS: On the basis of
the validators examined, DSM-III-R criteria for schizoaffective disorder
define a syndrome that differs meaningfully from both schizophrenia and
affective illness. The division of schizoaffective disorder into bipolar
and depressive subtypes was, however, not validated. The separation of
schizoaffective disorder into subtypes based on level of interepisode
recovery defined subtypes that differed clinically but not with respect to
familial psychopathology.
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