Journal of Psychiatry & Neuroscience 22(1):56-60, 1997
Ample evidence supports sex differences in the clinical features of schizophrenia. In this regard, estrogen may contribute to later onset and less severe course of illness in women. Direct investigation of hormonal status in schizophrenia is extremely difficult. The present report documents the clinical features of schizophrenia in a young woman with long-standing hyperandrogenism related to polycystic ovarian disease. We postulate that hyperandrogenism contributed to a relatively early onset, olfactory dysfunction, and other clinical features of schizophrenia more commonly associated with men. Additionally, acute estrogen depletion following cessation of oral contraceptives may have precipitated psychosis, while recommencement of oral contraceptives could have contributed to subsequent improvement in symptoms.
Behavior Modification 21(1):78-85, 1997
The role of social skill in mediating perceived physical attractiveness among individuals with chronic schizophrenia was investigated. Twenty-five inpatients participated in an unstructured role play. The physical attractiveness of the individuals was rated both before and after observation of the role play by 2 pairs of raters. Social skill was rated by a third pair of raters. The 2 ratings of physical attractiveness were only weakly correlated with one another. Social skill contributed variance independent of initial attractiveness to post-role-play attractiveness. Practical implications of the findings (ie, stigma issues and social skills training) are discussed.
American Journal of Psychiatry 154(1):99-105, 1997
OBJECTIVE: The purposes of the study were (1) to characterize the quality of life of 3 patient groups with chronic mental illness, (2) to evaluate differences in reported life quality among the 3 groups, and (3) to evaluate the validity of a self-report methodology by comparing these results with several objective indicators of life quality. METHOD: The study group consisted of chronically mentally ill patients with schizophrenia (n = 69), bipolar disorder (n = 37), or major depression (n = 35). Subjects were administered the Quality of Life Index, and comparisons of both objective and self-report life quality indices were made among the 3 groups. Quality of life ratings of these subjects were also compared with those of patients with a chronic physical illness. RESULTS: The 2 groups with mood disorders reported significantly lower scores on the Quality of Life Index than the patients with schizophrenia. Moreover, the scores on the Quality of Life Index for patients with schizophrenia were very similar to those of the comparison group of physically ill patients. The opposite trend emerged when groups were compared with respect to objective indicators of life quality. Schizophrenic patients experienced more objectively aversive life circumstances than either of the affectively disturbed groups. CONCLUSIONS: The validity of self-report measures of life satisfaction is questioned, particularly for use with affectively disturbed populations, since scores may be influenced by affective bias, poor insight, and recent life events.
American Journal of Psychiatry 154(1):64-68, 1997 Jan.
OBJECTIVE: The purpose of this study was to examine the relationships between clinical and neurobiological measures of childhood-onset schizophrenia. It was hypothesized that there would be a more striking pattern in the rare cases with very early onset than is seen in subjects with later onset. METHOD: Premorbid, clinical, prenatal, perinatal, and magnetic resonance imaging brain measures were examined in 29 children and adolescents who met the DSM-III-R criteria for schizophrenia with onset before age 12. Specifically, gender, premorbid adjustment, and clinical symptoms were examined in relation to cerebral volume, ventricular volume, and maternal obstetrical complications. RESULTS: Males were more likely to have had an insidious onset than females. There was a significant negative correlation between score on the Scale for the Assessment of Negative Symptoms and total cerebral volume. CONCLUSIONS: These neurobiological associations support the continuity of early-onset schizophrenia with the later-onset disorder; the striking association between smaller cerebral volume and negative symptoms suggests a more homogeneous or more potent neurobiological basis for very early-onset schizophrenia.
Archives of General Psychiatry 53(12):1114-1121, 1996
BACKGROUND: Altered sensory response is a prominent feature of schizophrenia. Inhibitory gating mechanisms, shown by diminished P50 evoked responses to repeated auditory stimuli, seem to be deficient in schizophrenic persons. These inhibitory mechanisms usually are studied by averaging the electroencephalographic responses to many presentations of pairs of stimuli. Although averaging increases signal-to-noise ratio, it may obscure trial-to-trial differences. We compared differences between schizophrenic and normal persons in single trials and averages of P50 response. METHODS: Recordings from 10 schizophrenic patients and 10 normal subjects were analyzed using conventional averaging and single-trial measurements. A computer simulation of both methods examined their ability to extract evoked responses from background activity. Related single-neuron activity in the hippocampus in an animal model also was studied, because neuronal action potentials can be reliably identified in single trials. RESULTS: Averaged evoked potentials showed significant suppression of the P50 response to the second stimulus of the pair in normal patients, but not in schizophrenic patients. Single-trial analysis did not detect a response above background activity. Computer simulations gave similar results, suggesting that failure to detect suppression in single trials comes from inadequate differentiation of signal from noise. Recordings in animals confirmed almost complete suppression of the response of hippocampal pyramidal neurons to the second stimulus. CONCLUSIONS: The normal inhibition of response to repeated auditory stimuli seems to be compromised in schizophrenia. This loss of inhibitory gating could reflect a physiological deficit of hippocampal interneurons that is consonant with other evidence for interneuron pathologic defects in schizophrenia.
Archives of General Psychiatry 53(12):1105-1112, 1996
BACKGROUND: Schizophrenic patients show various deficits in cognitive functions that have been difficult to understand in terms of a common unifying hypothesis. Previously described neural network models of cognitive tasks suggest that several schizophrenic performance deficits may be related to a single function--an impairment in maintaining contextual information over time and in using that information to inhibit inappropriate responses. METHODS: We tested first-episode schizophrenic patients and patients later in the course of their illness on a new variant of the Continuous Performance Test designed specifically to elicit deficits in the processing of contextual information. RESULTS: Unmedicated schizophrenic patients showed a deterioration of their signal detection performance that followed the pattern predicted by the context hypothesis, ie, they responded inappropriately when correct responding required the maintenance of context information over time to inhibit the expression of a habitual response. This deficit correlated with positive symptoms. The results also suggested that the deficit may be worse in unmedicated patients who have had a longer course of illness. Medicated patients showed a more diffuse performance deficit. CONCLUSIONS: These results support the view that a single deficit in the processing of context information may underlie various cognitive impairments observed in schizophrenia. They also suggest that such an impairment is associated with positive rather than negative symptoms, and that it may worsen with the course of the illness as in the kraepelinian view of schizophrenia.
Archives of General Psychiatry 53(12):1098-1104, 1996
BACKGROUND: The goal of this study was to test a path analytic model that reflects the hypothesis that family cohesion and family adaptability underlie family members' expressed emotion (critical comments and emotional overinvolvement), that these family variables underlie the preponderance of positive symptoms in a patient with schizophrenia 9 months after relatives are interviewed, and that all of these variables influence the patient's social adjustment at follow-up. METHODS: The subjects were 69 patients who met the DSM-III-R criteria for schizophrenia and 108 of their relatives. Relatives were assessed with the Camberwell Family Interview and the Family Adaptability and Cohesion Evaluation Scales III. Patients were interviewed 9 months later with the Brief Psychiatric Rating Scale and the Social Adjustment Scale II. RESULTS: Significant amounts of variance were explained by the model for 3 of the 5 social adjustment components. Neither family cohesion nor adaptability was associated with either critical comments or emotional overinvolvement. Family cohesion was negatively associated and emotional overinvolvement was positively associated with a preponderance of positive symptoms. Greater family adaptability was associated with lower social adjustment scores, and greater emotional overinvolvement was associated with higher social adjustment. Cohesion had a significant positive indirect effect on social adjustment through its association with symptom type. CONCLUSIONS: Critics of expressed emotion will be pleased to see that 1 component of high expressed emotion (emotional overinvolvement) is actually associated with a better social outcome in patients. Proponents of the expressed emotion concept will be pleased to see the applicability of expressed emotion to other facets of schizophrenic outcome. The results highlight the importance of using the expressed emotion scales in their continuous rather than dichotomized state and of analyzing critical comments and emotional overinvolvement separately.
American Journal of Psychiatry 153(12):1585-1592, 1996
OBJECTIVE: The authors evaluated the effectiveness of behaviorally oriented social skills training and supportive group therapy for improving the social adjustment of schizophrenic patients living in the community and for protecting them against psychotic relapse. METHOD: Eighty male outpatients with schizophrenia were stabilized with a low dose of fluphenazine decanoate (5 to 10mg every 14 days), which was supplemented with oral fluphenazine (5mg twice daily) or a placebo when they first met criteria for a prodromal period. (Half of the patients did so at some time during the study.) Patients were randomly assigned to receive either social skills training or supportive group therapy twice weekly for 6 months and then weekly for the next 18 months. Rates of psychotic exacerbation were monitored, as were scores on the Social Adjustment Scale II. RESULTS: There were significant main effects favoring social skills training over supportive group therapy on 2 of the 6 Social Adjustment Scale II cluster totals examined (personal well-being and total) and significant interactions between psychosocial treatment and drug treatment for 3 items (external family, social and leisure activities, and total). In each case, these interactions indicated that the advantage of social skills training over supportive group therapy was greatest when it was combined with active drug supplementation. Social skills training did not significantly decrease the risk of psychotic exacerbation in the full group, but an advantage was observed (post hoc) among patients who received placebo supplementation. CONCLUSIONS: These findings suggest that social skills training resulted in greater improvement in certain measures of social adjustment than supportive group therapy. The greatest improvement in social outcomes occurred when social skills training was combined with a pharmacological strategy of active drug supplementation at the time prodromal worsening of psychotic symptoms was first observed. However, these improvements were modest in absolute terms and confined to certain subgroups of patients.
American Journal of Psychiatry 153(12):1564-1570, 1996
OBJECTIVE: Schizophrenic patients have repeatedly demonstrated the inability to rapidly process information when tasks are timed or the processing load is relatively high. Schizophrenic patients show consistent deficits in the visual backward masking paradigm. In visual backward masking, an informational target stimulus is presented, followed after an interstimulus interval by a masking stimulus that interferes with or interrupts target identification. METHOD: In order to clarify whether the visual backward masking deficits of schizophrenic patients are indeed central rather than peripheral in origin, the authors compared visual backward masking to psychometrically matched visual forward masking performance in 35 normal comparison subjects and then 35 schizophrenic patients. In visual forward masking, the mask precedes the target, and visual forward masking mechanisms are felt to be more peripheral (retinal) than are visual backward masking mechanisms. RESULTS: For psychometrically matched forward and backward masking tasks, the schizophrenic patients had a selective and differential deficit in the backward masking condition. CONCLUSIONS: These results support the interpretation that the observed visual backward masking deficits of schizophrenic patients are centrally mediated.