Α Case of Triplets Concordant for Schizophrenia: Psychopathological Considerations

Abstract

A case of monozygotic triplets suffering from schizophrenia is presented. The three brothers had grown in a strikingly common environment and they developed an almost identical psychotic symptomatology at the age of 19. We thoroughly assessed their symptomatology using the structured interview Schedules for Clinical Assessment in Neuropsychiatry, blindly to results of zygosity testing. Brain MRI scans were also performed. The patients’ psychopathology included trichotillomania in the context of an elaborate pseudo-philosophical world view, which led them to grandiose self-perception; withdrawal and social isolation; decline in every aspect of functioning; finally, physical aggressiveness. The vast majority of symptoms were practically identical and the MRI findings did not differ substantially among the three siblings. This case, by showing that the clinical presentation of the disease was similar in three men having in common both genes and environment, provides support for the hypothesis that, once the disease develops, the type of schizophrenic symptoms is almost exclusively influenced by genetic and environmental factors.