842

general hospital psychiatric unit were selected for invesngation because they were thought to have schizophrenia or a schizophrenia-like illness and were willing to undergo lumbar puncture. This group included the 38 patients reported in the previous paper’ and another 9 patients from whom c.s.F. but not other samples (throat swab, etc.) were obtained. Present

CHARACTERISTICS OF PATIENTS WITH SCHIZOPHRENIA OR NEUROLOGICAL DISORDER AND VIRUS-LIKE AGENT IN CEREBROSPINAL FLUID T. J. CROW E. C. JOHNSTONE D. G. C. OWENS D. A.

J.

trict

I. N. FERRIER J. F. MACMILLAN R. P. PARRY TYRRELL

examinationwas carried out in 46 cases, and in the remaining case the syndrome check list was applied. In 44 cases the patients cooperated with full present state examination but 2 patients were unable to do so and the behavioural ratings alone were made. From the present state examination and syndrome check list ratings a diagnosis was demed according to the Catego system. The diagnostic criteria of Feighner et al. for definite or probable schizophrenia were also applied. Response to drug treatment was assessed on a 0-2 rating scale. Outcome was similarly assessed at the time of latest clinical contact (2 to 20 months after index admission on rating scales for persisting positive symptoms (delusions, hallucinations, and thought disorder) and presence of negative symptoms (loss of affective response and drive) indicating the development of a defect state.

state

Divisions of Psychiatry and Communicable Diseases, Clinical Research Centre, Northwick Park Hospital, Harrow, Middlesex, HA1 3UJ

A virus-like agent (V.L.A.) with a cytopathic effect on cultured cells was found in the cerebrospinal fluid of 18 of 47 patients with schizophrenia, of whom 10 had nuclear schizophrenic symptoms. In most patients with V.L.A., blood and C.S.F. protein concentrations were normal. Patients with and without V.L.A. had similar clinical characteristics but serum IgA levels were higher in those with V.L.A. V.L.A. was also detected in the C.S.F. of 8 of 11 patients with serious or chronic neurological disease (Huntington’s

Summary

chorea, multiple sclerosis, and unexplained alterations

of consciousness). Introduction IN the preceding paper we described the detection of virus-like agent (V.L.A.) or agents from the cerebrospinal fluid (c.s.F.) of patients with some psychiatric and neurological disorders. Here we describe the clinical characteristics of the patients in whom this agent was

Non-psychiatric Patients Samples of c.s.F. were obtained as described in the preceding paper’ from patients under investigation for neurological and orthopaedic conditions and patients with non-neurological disease being subjected to spinal anxsthesia (e.g., for varicose vein surgery). The studies were conducted with the prior approval of the ethical committee of North wick Park Hospital.

a

recognised. Patients

Psychiatric Patients 47

patients

with

acute

psychotic

illnesses admitted

to a

dis-

Results In 18 of 47 schizophrenic patients the presence of a in c.s.F. was suggested by a cytopathic effect in tissue culture1 (table i). No clinical features clearly distinguished patients with V.L.A. from those without V.L.A. in c.s.F. (table n). 10 of the 18 patients with evidence of V.L.A. had features of nuclear schizophrenia (table III), 4 had paranoid

v.L.A.

TABLE I-CLINICAL CHARACTERISTICS OF SCHIZOPHRENIA PATIENTS

Catego diagnoses:

N.S.

nuclear

schizophrenia;

A.P.

affective

psychosis;

P.D.

psychotic depression;

R.S.

residual

schizophrenia;

D.P.

paranoidpsn-

chosis. *c.s.F. protein

or serum

immunoglobulin concentration at or outside normal limits.

t7x I06leucocytes/l m C.S.F. No other patients had leucocytes in c.s.F. Except for patients 15, 18, 31, 34, 38,44, and 47 all the patients had had 1-3 episodes of schizophrenia from