Journal of Autism and Childhood Schizophrenia, 1971, 1, 1,106-114

Abstracts

Each issue of the Journal o f Autism and Childhood Schizophrenia will include a section devoted to reviews o f current articles which appear in the

international literature. Such reviews will be presented in the form of informative abstracts, some with annotations and a few as brief critical

commentaries. It is essential for the sake of the broadest possible orientation that

contributions made anywhere, particularly outside the English-speaking area, be

reported to out readers. Since access to contributions published abroad is

generally limited due to language barriers, we plan to emphasize material

forthcoming from the non-English-speaking countries of the European con-

tinent, the Soviet Union, Japan, Latin America, and the test of the world.

Commencing with material published in 1970, we shall endeavor to base our

presentations on comprehensive surveys of all scientific periodicals in the

respective geographic areas that publish relevant information. As a beginning, we examined 14 Russian-language periodicals that were published from January to November 1970.1 Only the leading Soviet psychiatric periodical Zhurnal

Nevropatologii i Psikhiatrii imeni S. S. Korsakova, known in the Western world

as the Korsakov Journal o f Neuropathology and Psychiatry (KJNP), published

material relevant to out journal; each of the other journals had been known to

include some such material prior to 1970. Out survey of Soviet contributions indicated that Russian researchers are

investigating essentially the same problems that are the focus of interest of

lin alphabetic order, these were: Farmakologiya i Toksikologiya, Fiziologicheskiy Zhurnal SSSR imeni L M. Sechenova, Khimiko-Farmatsevticheskiy Zhurnal, Meditsinskiy Referativnyy Zhurnal-Detskiye Zabolevaniya, Meditsinskiy Referativnyy Zhurnal-Psikhia- triya, Neyrofiziologiya, Pediatriya, Terapevticheskiy Arkhiv, Voprosy Meditsinskoy Khimii, Voprosy Neyrokhirurgii, Voprosy Psikhologii, ZhurnaI Evolyutsionnoy Biokhimii i Fiziologii, Zhurnal Nevropatologii i Psikhiatrii imeni S. S. Korsakova, and Zhurnal Vysshey Nervnoy Deyatel'nosti imeni L P. Pavlova.

106

Copyright �9 1971 by Scripta Publishing Corporation.

SOVIET SER IALS 107

Western workers. The problem of nosology is central to most papers and the

relationship to specific language disorders is probed in considerable detail (e.g.,

study by Mastyukova). Although the Russians have subdivided the clinical varieties comprised under the term childhood schizophrenia, they have not separated autism from the cluster even though a group of Soviet clinicians headed by Prof. S. Mnukhin of Leningrad had attempted to do so in 1967 (see page 110.) It appears that most Soviet investigators do not share the prevailing Western opinion that childhood schizophrenia does not exist as a separate category.

The abstracts are presented in the sequence of the articles' appearance in the 1970 volume of KJNP. Except for my review of the paper by Bashina &

Pivovarova, all abstracts as well as the literature search were performed by the staff of Scripta Technica, Inc., an organization affiliated with the publishers of this journal.

L.K.

SOVIET SERIALS

January-November, 1970

Parents of Children with Insidious Form of Schizophrenia by L. l. Golovan', KJNP, 70, 242-246. An attempt is ruade to identify and classify behavioral disorders of parents of 25 young schizophrenic patients, 7 to 16 years old. Among the patients (15 boys and 10 girls), 13 were schizophrenic since early childhood. In 9, schizophrenia was noted when they were 7 to 10 years old,

while in 3 it was traced to puberty. In all, the disease followed a slow but progressive course. The 50 adults, representing 25 sets of parents, were interviewed and classified into 3 categories. The first comprised 2 mothers

diagnosed schizoph�98 in puberty and 2 in their twenties, and also 3 fathers with schizophrenic episodes that included hallucinations. Most of the 12 fathers and 6 mothers in the second category had behavioral disorders and profound deviations of character, even though manifest symptoms of schizophrenia were not present. Nine, particularly fathers, showed autistic tendencies during childhood. The 25 parents in the third included 8 schizoid personalities with asthenia, 11 hypersthenic personalities with schizoid traits, and 6 with hypersthenia and asthenia. References to Western sources include Bender (1953), Kanner (1957), and Meyers and Goldfarb (1962).

108 ABSTRACTS

Selected Clinical and Genealogical Data on Families of Preschool ChUdren with Insidious Form of Schizophrenia by V. M. Bashina, KJNP, 70, 246-251. A study of 16 randomly selected families of schizophrenic children is reported in an attempt to distinguish results from those reported in similar studies involving

preselected psychotic relatives. A sample of 236 relatives of 13 boys and 3 girls, 5 to 8 years old, with early onset of the insidious form of schizophrenia was

studied for periods ranging from 2 to 4 years. Autism was noted in 7 children. The disease began so gradually in all 16 patients that in most cases the exact t�9 of onset could not be established. It followed a slow course and periods of acute exacerbation of the symptoms were generally absent. Only 3 relatives were

psychotic at the time of 'the study. Serious behavioral disorders were discovered in 74 adults, with schizophrenia (manifested in symptomatically simple forms)

in 15, schizoid traits in 52, schizothymia in 6, and psychasthenia in one. Schizoid disorders were detected in three successive generations. They were traced to 47 adults in 11 families on the paternal line and to 27 adults in 5 farnilies on the maternal line. Notwithstanding the random selection, the

detection of schizophrenia in three generations i s consistent with other reports in the Western and Soviet literature noting that an insidious course of schizophrenia is predominant among males. During the course of the study, changes in the clinical course of the disorder in schizophrenic children were less pronounced than the changes in their schizophrenic parents, an observation at- tributed to longer duration of schizophrenia rather than to differences in age.

Schizophrenia with Psychopathic Manifestations in Children and Adolescents by l. A. Shashkova, KJNP, 70, 251-256. Lack of comprehensive data on the clinical course and symptoms of schizophrenia with psychopathic manifestations in children and adolescents is cited as a reason for the study of 50 schizophrenic children. Among these patients (40 boys and 10 girls), 7 to 15 years old, 30 suffered from the continuous, and 20 from an intermittent-progressive develop- ment of the disease. Early onset at the age of 2 was found in 16 and at 2 to 4 years in 21. Seven first exhibited symptoms when they were 7 to 9 years old and 6 around the age of 11. Poor social adaptation, psychopathic behavior dominated by emotional disturbances and autistic tendencies were noted in ail. Clinical symptoms were polymorphous and varied with the stage of the disease. In ail patients, atypical development and indications of dysontogenesis were traced to the premorbid period. None of the patients were severely retarded intellectuaily, even in instances involving early onset of the disease. Inadequaeies in social adaptation and particularly in ability to learn were related to intensities of psychopathic manifestations rather than to the diminished level of intellectual

functioning.

SOVIET SERIALS 109

Paraphrenia in Adolescents with Remittent Schizophrenia by V. M. Lopandin and S. Stoyanov, KJNP, 70, 256-260. Clinical data on 50 adolescents selected from 200 with remittent schizophrenia are analyzed and reported mainly to establish the age when manifestations of paraphrenia are most frequentl and to compare such manifestations with those in schizophrenic adults. Results of a

7-year follow-up study of 30, and data on 20 treated by Sukhareva from 1935 to 1945 were used to substantiate the analysis. Case histories of 13 boys and 37 girls revealed that onsets with acute exacerbations of the symptoms were reported when they were 8 to 16 years old. Fourteen suffering from the

intermittent form, 20 with intensified symptoms after onset, and 16 with paranoid disorders pfior to detection of the remittent form were distinguished by classification into three groups. This distinction appeared to be related to

significant differences in the nature of delusions. Manifestations of paraphrenia were not reported prior to the age of 13. Except for similafities in their psychopathological structures, and stereotype p” of development, they differed from those in adult schizophrenics. Their polymorphism notwith- standing, the delusions in adolescents were more rudimentary in character. Sensory disturbances were more pronounced. Moreover, catatonic disorders were often sufficiently intense to obscure other psychopathological phenomena.

Psychopathology and Clinical Course of Intermittent Schizophrenia with Acute Exacerbation of Symptoms in Children and Adolescents by V. M. Lupandin, KJNP, 70,425-430. A follow-up study of 41 girls and 13 boys selected from 215 schizophrenic children and adolescents by the Institute of Psychiatry of the Academy of Medicine of USSR is presented as the first part of an extensive

investigation of the disease. The 50 patients were hospitalized at different periods from 1935 to 1968. Twenty-nine wœ examined when they were psychotic, and also interviewed 1 to 8 years thereafter, whereas 25 were interviewed 20 to 30 years after hospitalization. Affective disorders and acute manifestations appeared in all, most frequently at the ages of 8 to 10 and 13 to

16. Acute onset, rapid development, frequent pendular changes from excitation to inhibition and abrupt changes in the intensity of the psychotic state were also traced to all. Acute exacerbations of symptoms were simitar to those experienced by schizophrenic adults. Their psychopathological structure, how- ever, was more elementary. They were also of shorter duration then in adults and motor and sensory disturbances more pronounced. Nearly all subjects recovered, exhibiting fairly typical personality changes. Such changes commonly included psychic hypersthenia together with mild autistic tendencies as well as rigidity, pedanticism and hyperactivity with asthenia. They were more pro- nounced in subjects diagnosed in childhood than in those during puberty.

110 ABSTRACTS

The Syndrome of Autism in Children by V. M. Bashina and G. N. Pivovarova, KJNP, 70, 941-947. The authors, who are weU versed in the Western literature,

give a comprehensive summary extending from Kanner (1943) and Asperger

(1944) to almost, but not quite, the present. They cite Prof. S. Mnukhin 2 of the

Leningrad College of Pediatrics as the first Soviet clinician who in 1967 made

autism the subject of a special investigation. 3 This is because, as the authors

declare categorically, "in Soviet literature autistic disorders of children are

always covered primarily within the framework of schizophrenia and schizoid

psychopathy." They may be forgiven for finding it difficult to correlate

terminologies current in non-Russian areas with terms and concepts of local

coinage, though they do try valiantly to think of possible common denomi-

nators. The article, on the whole reasonably detailed in many respects, pays

(intentionally?) scant attention to the publications of advocates of psycho-

genicity. It also gives little heed to the writings about the basic tenets, methods

and results of operant conditioning. Biochemical and psychopharmacological

studies are barely touched upon. The main emphasis is placed on phenomenol-

ogy, views about nosological allocation, and differential diagnosis. It seems that, probably hot in the authors' awareness, the well-known tendency to claire

Russian precedents for innovations outside the USSR, has somehow crept into

the account. Much is ruade of a 1929 treatise by T. P. Simson on Neuropathy,

Psychopathy and Reactive Conditions in Childhood. In a chapter entitled Autis-

tic Children, a syndrome was described which indeed had much in common with

early infantile autism and was said to "constitute a reason for including such

children in the group of schizoid psychopaths." But, aside from the semantic nebulousness shared to this day by many people everywhere, it must be

conceded that Simson's chapter can ~be seen as one of the precursors of later,

more concise delineations. Of the 84 cited in the bibliography, only 17 have their

origin in the USSR. Most of the others are in English, a few are German and

2Syndrome of Early lnfantile Autism or Kanner 's Syndrome in Children by S. S. Mnukhin, A. E. Zelenetskaya and D. N. Isayev, KJNP, 67, 1501-1505.

3 The above reference to Mnukhin as "a fkst" made it seem advisable to consult the original paper. The article is based on the observation of 44 patients between 2 and 14 years of age. It does indeed represent "a first," insofar as the authors had sufficient tradition. With a modicum of diplomatie caution, they agree with those non-Soviet writers who consider autism "separately from early schizophrenia." Their credo is expressed thus: "We believe that infantile autism represents a unique psychic development in which affective disorders and schizophrenic behavior are prompted by underdevelopment of the energizing system of the brain." They planned to report in the future on expefiments which may connect autism "with biological reactivity, particularly the state of the hypophyseal-adrenal apparatus and

certain vegetative reactions."

SOVIET SERIALS l l l

Dutch, and two each are French and Japanese. The authors conclude: "In this article, we attempted to show how infantile autism, which is most likely closest to schizophrenia and schizoid psychopathy, has been described at different times in different countries, including the USSR."

Dysontogenesis in Schizophrenic Children by O. P. Yur'yeva, KJNP, 70, 1229-1235. Case studies of 136 boys and 36 girls are analyzed to establish a correlation between dysontogenesis in schizophrenic children and the degree and progress of the disease in the course of its manifestation. At the time of the investigation, the age of subjects ranged from 5 to 33. The subjects had been observed from 1 to 15 years. Two principal types of dysontogenesis were distinguished at stages prior to manifestation of schizophrenia. The first, identified as the distorted type, was traced to 35 patients, whereas the second, arrested or repressed type, to 32. The first was distinguished by symptoms of disharmonious infantilism, autistic behavior, narrowly confined but intense interest in specific fields of endeavor, and pedanticism. In the second, various disorders such as disturbances in sleep, lack of appetite, hypotrophy, constipa-

tion, and oblivious reactions to environment were traced to birth. Later, poor vocabulary and inability to communicate were fairly typical. Conclusions

emphasize the complexities of schizophrenia prior to its manifestation in children. Dysontogenesis tends to reflect the course of the disease as well as impairment of the physiological development due t o i t s presence. Also, dysontogenesis as well as specific psychopathological symptoms are in effect the initial manifestations of the actual disease.

Role of Age in the Clinical Course of Childhood Psychoses by G. Ye. Sukhareva, KJNP, 70, 1513-1517. A theoretical paper discussing influences of age on the clinical course of psychoses in childhood is presented by a leading authority in Soviet child psychiatry. The author's clinical observations disclosed that children a~e occasionally unable to adapt themselves to conditions caused by minor pathogenic disorders. Such conditions are primarily due to inadequacies in the development of the brain, and also rapid growth prompting disharmonious development during transitional periods. Incomplete development of the cerebral hemisphere is particularly significant during the first three years of life. Of significance also are biological changes occurring in transitional periods of ontogenesis from the third to the fourth year of life and again from the seventh to eighth. Clinical manifestations tend to be more intensive during puberty when impairments of the nervous and endocrine systems are more pronounced. Pathological reactions in these transitional periods are usually prompted by the

112 ABSTRACTS

personality of the child and lais predisposition to mental disorders, residual symptoms that foUow early impairment of the cerebral hemisphere, and the environment in which the child is raised, particularly that pertaining to his family. While the role of biological changes is stressed, age is of considerable significance, particularly in heboidophrenia. The author concludes that the influences of age on the clinical course of psychoses are not pathoplastic. At preschool age, younger children are more susceptible due to somatic influences on the nervous system. In older children with more stable defenses, suppression of psychic development by onset is less dangerous. Prior to puberty, slow development and gradual deterioration in schizophrenia is more common. During puberty the intermittent form is most frequent. Prognosis depends not only on the degree of disorder but also on age of onset.

The Impact of Accelerated Sexual Maturation on the Clinical Course of Childhood Psychoses by K. S. Lebedinskaya, N. S. Rotinyan and S. V. Nemirovskaya, KJNP, 70, 1517-1521. A study of 225 adolescents with severe behavioral disorders traced to different causes is presented to assess the impact of accelerated maturation of sexual development. The subjects, each with a history of such development, were psychopathic, schizophrenic and also psychotic due to brain damage. In 79, comprising the first group, thœ etiology of disorders was traced to organicity. In the second, 65 girls with premorbid personality exhibited symptoms of anorexia nervosa. The remaining 81 were schizophrenic. In the first group, symptoms of diencephalic dysfunctions were noted long before puberty. Accelerated sexual maturation in girls prompted psychopathic behavior with simulated attempts at suicide and excessive aggression. The boys were drifters, frequently with sadistic tendencies. In the second group, eady menstruation and obesity were common. In the schizo- phrenic group, dysmorphism dominated in 28, psychopathic behavior in 22, delusions and hallucinations in 4, and hypochondrical complaints in 8 patients. Conclusions imply that accelerated sexual maturation constitutes a pathogenic link between the psychotic disorder and the critical age of its occurrence. Such maturation is not deemed pathoplastic.

Significance of Sialic Acid in Cerebrospinal Fluid and Blood Serum of Schizophrenic Children Ye. G. Zal'tsman, KJNP, 70, 1521-1523. The study of sialic acid levels in childhood schizophrenia attempts to assess their significance as diagnostic cdteria and in treatment. Methods for determining levels in cerebrospinal fluid involved diphenylamine reactions described by Saifer and Siegel. 4 Those involving serum were developed in USSR and reported in 1957.

4journal of Laboratory and Clinical Medicine, 1959, 53,474.

SOVIET SERIALS 113

Results for 105 schizophrenic and 44 control subjects with severe behavioral

disorders are given below.

Group N

Schizophrenic: malignant 20 insidious 63 intermittent 22

Control: rheumafic psychosis 12 organic brain damage 10 psychopathic behavior 22

Cerebrospinal fluid Blood serum

M • SD range Me SD range

171.7 • 5.3 140-210 216.6 e 3.8 170-270 260.2 • 5.5 230-300

354.5 • 17.9 290-445 142.5 • 5.6 120-165 194.3 • 3.1 180-280

217.6 • 7.7 222.5 -+ 8.6 238.7 -+ 6.2

339.0 • 24.3

210.7 +- 2.7

170-270 170-270 190-330

270-508

190-230

Note.-M = optical density x 10 3

Clinical observations disclosed that levels in cerebrospinal fluid tended to

diminish in borderline patients exhibiting neurotic and psychopathic symptoms

with passivity, asthenia and depressions. Increases in such levels were noted in

schizophrenics during acute exacerbation of symptoms. Chlorpromazine in-

creased the levels in cerebrospinal fluid and blood serum of treated schizo-

phrenic patients. Relatively high levels in cerebrospinal fluid tended to impede

insulin therapy. Since sialic acid levels reflect intensities of the disorder and thus

offer guidance in psychopharmacology, their determination in schizophrenic

children is recommended.

Differences in Speech Disorders Associated with Schizophrenia and Motor Aphasia in Preschool Children by Y. M. Mastyukova, KJNP, 70, 1523-1528. A

comparative study of speech disorders is presented to facilitate differential

diagnosis of schizophrenia and motor aphasia in young children, usually a

difficult problem because such disorders in each of the two diseases have many

features in common. Thirty-four children, 9 with catatonic form of schizo-

phrenia and 25 with motor aphasia, all 3 to 6 years old, were observed for that

purpose. Speech patterns were so similar that misdiagnoses of sensorimotor

aphasia in 4, and retardation due to impaired hearing in one child, preceded their

eventual identification with schizophrenia. Reasonably detailed differences in- cluded mutism which frequently alternated with explosive speech in the schizophrenic patients. Repetitive speech patterns tended to create greater

114 ABSTRACTS

difficulties for the aphasic. Echolalia, noted in ail schizophrenics, was present in only 4 aphasie children. Unlike in the former, i t tended to follow questions, possibly due to poor vocabulary and inability to respond. Perseveration and logorrhea found in the schizophrenic in conjunction with echolalia, was not detected in aphasie children. Anamnestic data reflected delays in locomotion, emergence of words and phrases and near absence of babbling. In schizophrenic children motor activity tended to develop normally. While babbling and isolated words were noted eafly in lire, intonation, communication, and use of sentence structures were substantially delayed. Nosology tends to attribute many more or less evident symptoms to both disorders. These include underdeveloped and meager vocabulary, primitive sentence structures and phonetic inadequacies.

Traceable to organicity, they frequently obscure other symptoms found in the catatonic form of childhood schizophrenia. Conclusions stressed analysis of behavior as the most significant factor in differential diagnosis. Other recom- mended diagnostic criteria included etiology, age of onset and degree of disorder as well as careful analysis of autistic tendencies and negativism in speech.

Clinical Observations of ChUdren with Intermittent-Progressive Schizophrenia by I. I. Kalugina, KJNP, 70, 1528-1532. Observations with data pertaining to age

and duration of onset are presented to contribute to the inadequate material on nosology and clinical course of intermittent-progressive forms of schizophrenia prior to puberty. Fifty-three patients (43 boys and 10 girls), with onset at the

ages of 2 to 6 in 28, at 7 to 10 in 20, and at 10 to 12 in 5, were observed and

then divided into 3 groups. In the first group of 9 with dysontogenesis of the distorted type, the age of onset could not be determined. Successive onsets

occurred at the age of 10 to 11. Secondary onsets lasted 3 to 5 months and renaissions less than 1 year. In the second group further distinguished by severity of the course, initial onset in 12 with remissions lasting from 1�89 to 2 years, occurred at ages below 7, and in 20 at 2�89 to 3. Successive onsets, 2 to 3 months long, in those with malignant manifestations occurred within 2 to 3 years, and secondary, 2 to 2�89 years long, at the ages of 7 to 8. In the third group, initial onsets were 2 to 3 months long while remissions lasted 1 to 2 years. Psychopathology tended t o b e similar in all children to that in adults, particularly with respect to affective disorders, polymorphism of symptoms and deterioration after each onset. Fears and morbid fantasies were common. Absence of oneirodynia and paraphrenia and simplicity of depressions and paranoic symptoms were equally typical. Remissions exhibited signs that development is suppressed in the rnilder forms of schizophrenia. In malignant forms remissions tended to disclose oligophrenia.