A 3-DIMENSIONAL ETIOLOGIC VIEW OF THE SCHIZOPHRENIAS .2. HYPOTHETICALCLINICAL CONSEQUENCES

The schizophrenias constitute a heterogeneous, composite group, someti mes with dominant signs of genetic vulnerability, sometimes with eleme nts of brain damage, and sometimes with serious psychosocial problems. Elements of various aetiologic dimensions will be decisive in the pro gnosis and setting Of treatment goals: much speaks in favour of the ge netically vulnerable patient as having a different long-term prognosis from the patient who has an atrophic brain alteration. Furthermore, a complicated childhood situation may have led to a personality disorde r that may be enhanced in a psychotic direction by a genetic vulnerabi lity. All these types can doubtless attain a good or improved level of functioning, but the paths they must take differ, and experiences fro m one group cannot as a matter of course be translated to another. Tle type of psychotherapeutic and pharmacologic treatments and the needs of the relatives also appear to be dependent on the type of disorder i n question.