A three-dimensional aetiologic view of the schizophrenias. II. Hypothetical clinical consequences

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Abstract
The schizophrenias constitute a heterogeneous, composite group, sometimes with dominant signs of genetic vulnerability, sometimes with elements of brain damage, and sometimes with serious psychosocial problems. Elements of various aetiologic dimensions will be decisive in the prognosis and setting of treatment goals: much speaks in favour of the genetically 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 disorder that may be enhanced in a psychotic direction by a genetic vulnerability. All these types can doubtless attain a good or improved level of functioning, but the paths they must take differ, and experiences from one group cannot as a matter of course be translated to another. The type of psychotherapeutic and pharmacologic treatments and the needs of the relatives also appear to be dependent on the type of disorder in question.