Family factors that antedate the onset of schizophrenia and related disorders: the results of a fifteen year prospective longitudinal study.

The present study evaluates, within the context of a prospective study, whether certain discrete, pathological styles of communication antedate the onset of schizophrenia and schizophrenia-spectrum disorders. The three parental styles evaluated were: communication deviance (CD; Wynne & Singer), affective style (AS; Doane), and expressed emotion (EE; Vaughn and Leff). These measures were obtained on a sample of 64 intact families who appeared for help, from a psychological clinic, for their moderately disturbed teenager over 15 years ago. The sample of offspring and selected siblings were followed up at two subsequent time periods, 5 and 15 years after the initial family assessments at which times blind psychiatric evaluations were done. The lifetime prevalence of schizophrenia and schizophrenia-spectrum disorders in the sample were evaluated. Of the 64 teenagers, follow-ups were feasible on 50 of the cases. Of these, 45 had all three parental measures available. Within that subsample, schizophrenia-spectrum disorders were predominantly associated with the combined parental pattern of high CD, negative AS and high EE. When data for siblings was included, the predictive value of CD was even greater. These findings strongly suggest that disturbed patterns of intrafamilial communication and affect expression antedate the onset of schizophrenia-spectrum disorders and are not reactions to psychotic behaviors in already schizophrenic offspring.