Background: Reproductive fitness is an important factor in understandi
ng inheritance in genetic disorders. The purpose of this study was to
determine whether fitness is reduced in familial schizophrenia (FS) an
d if fitness in siblings differs from the norm. Method: The number of
offspring in 36 subjects with RDC schizophrenia or schizoaffective dis
order (SZ) and their 101 siblings from large FS families was compared
with age-adjusted census figures. Results: Fitness in the SZ group was
significantly reduced: 23% of expected in males and 51% of expected i
n females. Fitness of unaffected siblings was within census expectatio
ns. However, female siblings with schizophrenia spectrum features had
increased fitness over census norms. Reduced fitness was correlated wi
th low marital rates, poor functioning and positive symptoms. Conclusi
ons: These results indicate that reduced fitness is an important genet
ic force in FS and is likely inherent to the illness. Sex differences
are important and would need to be considered when examining maternal
and paternal transmission of schizophrenia. The results support a prop
osed high mutation rate for schizophrenia, consistent with a dynamic m
utation mechanism.