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The Natural History of Mania, Depression, and Schizophrenia

George Winokur, M.D., and Ming T. Tsuang, M.D., Ph.D., D.Sc.

  • ISBN 978-0-88048-726-9
  • Item #8726

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The Natural History of Mania, Depression, and Schizophrenia takes an unusual look at the course of mental illness, based on data from the Iowa 500 Research Project. This project involved the long-term (30-40 years) follow-up of patients diagnosed with schizophrenia, depression, and bipolar illness.

After presenting a history and background of the study, the authors provide fascinating, verbatim interviews with patients at the time of hospital admission in the 1930s and 1940s. Eight of the 15 chapters are dedicated to the modern, systematic follow-up and family study of these patients. Medical students, residents, psychiatrists, social workers, psychologists, ministers, and clinicians are offered an interesting look at what might be expected should treatment not be instituted with such patients.

Unlike earlier works that focused on the descriptive aspects of mental illness, this book provides clinicians with a more systematic evaluation of the symptom picture, course and outcome, and family history. It concludes with useful information on the diagnosis and classification of the affective disorders and chronic nonaffective psychoses.


  • Introduction to the Iowa 500. Historical perspective. Background findings in course and follow-up of the affective disorders and schizophrenia. The family background in the major functional psychoses. The Iowa 500 genesis. Real people: histories and verbatim interviews. The follow-up of untreated patients: the course of the illness unaffected by effective therapy. Families: familial psychiatric illnesses obtained by systematically obtained family histories. Special aspects: life events, early parental loss, premorbid asociality, clinical characteristics, outcome after short follow-up, heterogeneity in bipolar illness, subtyping schizophrenia, delusional disorder, affective symptoms in schizophrenia, sporadic depressive disease. The gospel according to field work: methodology of follow-up and epidemiological findings. What the future held: 30–40 year course and outcome in patients according to final diagnosis. Familial psychiatric illness in schizophrenia and the affective disorders: psychiatric illness in relatives obtained by personal examination. Early clinical and family history findings in light of the final Feighner diagnosis: admission clinical picture and family history relevant to follow-up diagnosis. Zero—symptom schizophrenia: symptoms present in schizophrenic patients after a 30—40 year follow-up. Diagnosis and classification of the affective disorders and chronic nonaffective psychoses: the contribution of the Iowa 500 to diagnosis and classification. References. Appendix I: The Iowa 500—bibliography. Appendix II: Code book—index admission and chart follow-up for the Iowa 500 Study. Index.

About the Authors

George Winokur, M.D., is the Paul W. Penningroth Professor of Psychiatry at the University of Iowa College of Medicine in Iowa City, Iowa.

Ming T. Tsuang, M.D., Ph.D., is The Stanley Cobb Professor of Psychiatry at Harvard Medical School, Boston, Massachusetts.

This volume describes a landmark study conducted on the life course of severe mental disorders. Aspects of the Iowa 500 study have been described in dozens of peer-reviewed papers, however, the essence of this very important and pioneering study are now included in one integrated and comprehensive volume. As such, it is a remarkable book, providing many unique and valuable insights into the life course and outcome of severe mental diseases. Equally important, Drs. Winokur and Tsuang should be warmly congratulated, since the book is clearly and concisely written and very readable. I recommend The Natural History of Mania, Depression and Schizophrenia highly to all students, clinicians, and researchers who are interested in severe psychiatric disorders.—Lewis Judd, M.D., Mary Gilman Marston Professor, Chair, Department of Psychiatry, University of California, San Diego, Former Director, National Institute of Mental Health

Using the power of the classical clinical approach and based on the landmark Iowa 500 study, Drs. Winokur and Tsuang—two of our leading naturalists—paint the definitive longitudinal portraits of the major psychiatric disorders. It is an historic achievement.—Hagop S. Akiskal, M.D., Professor of Psychiatry and Director of the International Mood Clinic, University of California at San Diego

This is a landmark book. It summarizes a tremendous amount of data from the systematic, long-term follow-up of the Iowa 500 samples. George Winokur and Ming Tsuang began working on this study approximately 25 years ago, and it is a monument to their unflagging commitment, excellent judgment, and high standards concerning psychiatric investigation. The data are invaluable, but their discussion and critique are equally important. I can't imagine any psychiatrist who would not want to read this book or who would not gain greatly from doing so. I fully expect the book to win wide respect and even a prize or two.—Samuel B. Guze, M.D., Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri

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