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Four Sisters With Schizophrenia, Four Decades of Scrutiny

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Oct. 20, 2000 -- In a midsize Midwestern town, four elderly sisters are living out their remaining years in a way that might be called unremarkable. But the sisters, known as the Genains, are far from typical: Born in 1930, they are among the oldest living quadruplets, and they are all identical.

And the uniqueness of the Genains does not stop there, for all four of the sisters developed schizophrenia, a disease said to afflict only 1% of the total population. For this reason, they have been the object of intense scrutiny, beginning in the 1950s, by researchers hoping to discern clues about the cause and course of their illness.

Study of the Genains has taught researchers much about schizophrenia. But it has also taught them how much is still to be learned about "the interaction" of contributing factors that may lead to the disease, says Allan Mirsky, PhD, author of a recent report in Schizophrenia Bulletin that follows up on the Genains' progress through the years.

In his report, Mirsky and colleagues conducted psychological tests of the Genains at age 66, and compared them to similar tests conducted earlier in life. The results showed stable or even improved performance in thought functions over time, supporting the notion that schizophrenia is not a degenerative illness, as many physicians believe it to be. Mirsky is chief of the section on clinical and experimental neuropsychology in the laboratory of brain and cognition in the intramural research program at the National Institutes of Mental Health.

Mirsky says that what stands out about the Genains is not the remarkable and terrible serendipity of their common disease -- but the significant differences in the course of their illness, and its effect on their lives. One sister, known as Myra, has worked, married, and raised a family despite her illness. Another sister, Hester, never completed high school and has never been able to function independently outside a home or institution. Two other sisters, Nora and Iris, fared somewhat better than Hester but have never married or had a substantial career.

It is an observation that has profound meaning for researchers. And despite much consensus in the field, there remains wide disagreement about how to explain the different outcomes of people who have schizophrenia, Mirsky and other experts tell WebMD.

Mirsky says that because they have exactly the same genetic makeup, the Genains are confirmation of the widely acknowledged fact that genes are necessary to "predispose" an individual to schizophrenia. But he believes the sisters' experience also points to the fact that a host of other variables -- including the treatment they received at the hands of their parents -- can have a role in the different courses their disease has taken.

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