Primary Versus Secondary Schizophrenia : A Theoretical Review

The present review presents a conceptualization of dividing schizophrenia into a primary versus a secondary type. Primary schizophrenia is that which is caused by primarily genetic factors, while secondary schizophrenia has an environmental etiology such as occurs in brain injury. The research dealing with schizophrenia is reviewed, and suggests that this formulation can be helpful in dealing with the etiology of schizophrenia. Introduction The presently proposed conceptualization is that of dividing schizophrenia into primary versus secondary such as epilepsy is sometimes divided. In secondary epilepsy there is some sort of brain injury or medical condition that produces the epilepsy. In primary epilepsy no such specific cause can be identified, and it is assumed that the patient is more constitutionally, perhaps genetically, predisposed to epilepsy. It is here proposed that secondary schizophrenia is a function of an injury or acquired disorder of the brain. Primary schizophrenia has more of a constitutional, probably genetic, basis. In primary process schizophrenia, brain anomaly appears at an earlier age and with more of an intrinsic as opposed to extrinsic origin. Although this conceptualization is being presented as a dichotomy, it is recognized that a continuum may better characterize schizophrenic Psychopathology. It is not here claimed that this conceptualization is radically innovative. Other similar conceptualizations have been developed. In fact, a major purpose in this present paper is to tie the present formulation to other proposed dichotomies and continua, as well as to tie the formulation to possible etiological factors. Process versus reactive schizophrenia The process versus reactive distinction, which moved more toward a continuum conceptualization during the massive amount of research on the topic of schizophrenia in the 1950's and 60s, has a resemblance to the primary versus secondary formulation here proposed. In process schizophrenia, the disorder has an earlier age of onset, is more insidious in its onset, and shows less adequate premorbid psychosexual and psychosocial functioning. This type of schizophrenia shows evidence of fewer environmental precipitators, and produces a less favorable prognosis (Phillips, 1953). The main difference between the reactiveprocess formulation of schizophrenia and the current primary-secondary formulation is that in the era of process-reactive research, environmental assaults were viewed to be in the psychosocial realm. Buttressed by the impressive evidence in the last two decades on the biological nature of schizophrenia etiology, the assault in secondary schizophrenia would appear to be on the brain. The primary-secondary formulation here presented suggests that psychosocial factors play a very minor role. Brain atrophy A disproportionate number of schizophrenics have been found to have enlarged ventricles (Johnstone, Crowe, Frith, 1976; Weinberger, Bigelow, Kleinman, Klein, Rosenblatt and Wyatt, 1980; Rieder, Donnelly, Herdt, 1979; Golden, Moses & Zelazowski, 1980; Famuyiwa, Eccleston, Donaldson, 1979; Huag, 1962; Huber, 1957; Nagy, 1963). It has been found that 1. California School of Professional Psychology, Fresno