One adult subgroup of the schizophrenic syndrome seems to share minimal brain dysfunction (MBD) as Anlage, mostly but not exclusively on a familial basis and occurring in varying degree. Pathogenically, MBD usually involves problems of spatial orientation, the development of language, and a low external and internal stimulus barrier. These cortical problems can lead to problems of establishing self-boundaries and coordination, to feelings of perplexity, difficulties with the written and spoken word and abstract conceptualization, poor impulse control and defenses, overload by external stimuli, and resulting disorganization. These phenomena in turn cause secondary emotional problems, especially during the school years. In addition to neuropsychological and soft neurological signs and symptoms, this group is diagnostically characterized by a poor response to phenothiazines alone. Therapeutically, energizers, together with diphenylhydantoin, at times in combination with lithium, are often useful. Psychotherapy must include education concerning MBD and must deal with the primary and secondary cognitive and emotional aspects of MBD as well as other problems. Prevention of overload and genetic counseling may be indicated.
