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Abstract: Studies of schizophrenia in twins have historically influenced the psychiatric world in shifting the focus of the etiology of psychiatric disorders from a psychodynamic to a genetic one. Although twinning is as frequent a phenomenon as schizophrenia, clinical issues relating to the development of twins and treatment of psychiatrically sick twins are relatively infrequent in the literature. This article presents the treatment of adolescent schizophrenic twins, and focuses on specific developmental, educational and therapeutic issues that must be considered when treating twins. The recent treatment of identical schizophrenic twins has allowed us to review the literature and revisit some of these issues.
Introduction
The recent emphasis on the biology of psychiatric disorders in general, and on schizophrenia in particular, have not rendered the investigation of environmental factors invalid. It is becoming increasingly clear that in order to understand the genetics of a psychiatric illness we must understand the influence of the environment. In this report we present the case of schizophrenia in twins where these issues were central to understanding of the patients.
Although there are many excellent epidemiological studies of twins in schizophrenia, there have not been many in-depth reports of how the illness develops in the context of twinship.
It is now known that the heritability of schizophrenia is about 60% (1, 2), leaving about 40% to unknown environmental factors. These unknown environmental factors may include a whole gamut of variables ranging from viruses to complex intrapsychic and intrafamilial-dynamic constellations. The old nature-nurture controversy is now largely held to be irrelevant. Much more important is to study the interactive effects between environment and biology. This of course is more easily said,, than done since such studies are extremely difficult to perform. However, in-depth studies such as the one presented below may give us some clues as to where to look.
Case Presentation
A and B are 19-year-old male twins hospitalized for the first time in two different adolescent psychiatric in-patient units at hospitals in the Tel Aviv area.
The first twin (A) was admitted due to aggressive behavior and psychotic symptoms that included confusion, mutism and delusions of persecution. His twin brother (B) was hospitalized 10 days later and he also suffered from mutism and similar delusions of persecution. After...