The effects of haloperidol on thought disorder and IQ in schizophrenia

The impact of haloperidol treatment on the Wechsler Adult Intelligence Scale (WAIS) and the Thought Disorder Index was investigated in a group of 19 patients with schizophrenia tested both before and after 26 days of treatment with haloperidol. Thought disorder scores declined significantly over the course of treatment and fewer patients demonstrated severe forms of thought disorder at the end of the trial. WAIS performance improved significantly but the magnitude of change was consistent with the literature on expected practice effects. Thought disorder scores were negatively correlated with IQ at baseline, but not at Day 26. The results suggest a partial dissociation of thought disorder and other cognitive functions in schizophrenia.     

Thought Disorder on the WAIS-R Relative to the Rorschach: Assessing Identity-Disordered Adolescents

Clinical researchers have noted that compared with other diagnostic groups, adults with Borderline Personality Disorder tend to demonstrate relatively more thought disorder on unstructured projective tests (e.g., Rorschach) than on structured objective tests of cognitive performance (e.g., Wechsler Adult Intelligence Scale; WAIS). Using archival data, our study found evidence that adolescents with Identity Disorder tend to exhibit this same phenomenon. The records of 62 adolescent inpatients who had been administered the WAIS or WAIS-R and the Rorschach were examined. Of the 62 cases, 25 were diagnosed with Identity Disorder, 14 with Conduct Disorder (Group Type), 15 with Oppositional Defiant Disorder, and 8 with Schizophreniform Disorder. For each participant, the WAIS or WAIS-R and the Rorschach were scored according to the Thought Disorder Index (TDI; Johnston & Holzman). Adolescents with Identity Disorder revealed a significantly larger discrepancy between TDI scores on the WAIS or WAIS-R and TDI scores on the Rorschach than did adolescents with other diagnoses. The findings suggested that the discrepancy between the degree of thought disorder on structured versus unstructured psychological tests (i.e., differential decompensation) is related to diagnosis.     

A comparison between the Grid Test of Schizophrenic Thought Disorder and diagnostic psychologicaI testing

Abstract.— Bannister and Fransella's Grid Test of Schizophrenic Thought Disorder based on Personal Construct Theory and the concept of "loosened construing", as measurable in the scores of Intensity and Consistency between intercorrelations, has been applied to a Scandinavian sample of psychiatric patients. The validity of the test was illustrated, and a significant difference was found between a group of schizophrenics and schizophrenic borderline states and a group without schizophrenic thought disorders. The Grid Test scores were found to agree with thought disorder manifestations as evaluated in qualitative terms on the basis of cognitive and projective tests, but they did not differentiate between developmental levels of thinking corresponding to con-creteness in organic impairment versus diffuseness in schizophrenia. Thus, the concept of "loosened construing" as applied in this thought disorder test seems too unspecific.     

Thought control strategies in schizophrenia: a comparison with non-patients

This study tested the hypothesis that patients with a diagnosis of schizophrenia would report the use of different thought control strategies in comparison with non-patients. The Thought Control Questionnaire [TCQ; Wells, A. & Davies, M. (1994). The thought control questionnaire: a measure of individual differences in the control of unwanted thoughts. Behaviour Research and Therapy, 32, 871–878.] was administered to 22 patients who met DSM-IV criteria for schizophrenia and 22 non-patients. The results showed that schizophrenic patients used different thought control strategies (more worry and punishment-based strategies, less distraction-based strategies) in comparison with non-patients. The theoretical and clinical implications of these findings are discussed.     

Low heart rate variability is not caused by typical neuroleptics in schizophrenia patients

Both elevated cardiovascular mortality and low cardio-vagal (parasympathetic) heart rate variability (HRV)--a risk factor for postmyocardial infarction--are reported in schizophrenia (SZ). Since a number of medications have strong effects of cardiac conductivity, we thought it important to examine if typical neuroleptic medications might also affect HRV. We examined cardiac vagal activity during both neuroleptic treatment and a drug-free condition in seven SZ patients who were participating in a pilot double-blind, crossover study of placebo and haloperidol treatment. Twenty-four-hour Holter electrocardiograms were analyzed for high frequency HRV, quantitated as the percent of successive normal interbeat intervals greater than 50 milliseconds (PNN50), which is a good index of parasympathetic cardiac modulation. The patients showed unchanged PNN50 (8.4+/-9.5 versus 8.3+/-10.5; t=.22, df=6, P=.5) between the haloperidol treatment and drug-free conditions. Despite the elapsed time, change in medication, and altered clinical state, the PNN50s were highly correlated (Spearman r=.98, P=.000). SAPS positive symptom scores declined with treatment from 12.8+/-6.5 to 8.5+/-3.5; paired t=3.26: df=6; P=.01. PNN50s were significantly associated with positive (r=-.86, df=6, P=.012) and negative symptom scores (r=-.87, df=6, P=.01). We found low cardiovagal modulation in medication-free SZ patients that was associated with core SZ symptoms and was unchanged by haloperidol and benztropine treatment. The reduced HRV in SZ patients at baseline may render them at greater cardiovascular risk than healthy subjects when treated with medications having strong cardiovascular effects.     

The presence of magical thinking in obsessive compulsive disorder

Two research groups have raised the possibility that magical ideation may be a fundamental feature of obsessive-compulsive disorder. It has been proposed to underlie thought action fusion and superstitious beliefs. In this study, the Magical Ideation scale, the Lucky Behaviours and Lucky Beliefs scales, the Thought Action Fusion-Revised scale, the Padua Inventory, and the Obsessive Compulsive Inventory-Short Version were completed by 60 obsessive compulsive patients at a hospital clinic. Of all the measures, the Magical Ideation (MI) scale was found to be the most strongly related to obsessive compulsive symptoms. Large and significant relationships between MI scores and the measures of OCD were obtained even when alternative constructs (Lucky Behaviours, Lucky Beliefs, Thought Action Fusion-Revised scales) were held constant. No other variable remained significantly related to the Obsessive Compulsive Inventory-Short Version when magical ideation scores were held constant. The findings suggest that a general magical thinking tendency may underpin previous observed links between superstitiousness, thought action fusion and OCD severity.     

The use of the Ego Impairment Index across the schizophrenia spectrum

The goal of this study was to assess perceptual and thought disturbance, as indexed by the Ego Impairment Index (EII; Perry & Viglione, 1991), a Rorschach-derived measure, across the schizophrenia spectrum. We hypothesized that there would be an increase in EII scores (indicating increased disturbance) across the spectrum from nonpatients to severely disturbed, hospitalized schizophrenia patients. Normal comparison participants (n = 66), students with elevated scores on either the Perceptual Aberration/Magical Ideation or the Physical Anhedonia Scales (n = 24), first-degree relatives of schizophrenia patients (n = 36), participants diagnosed with Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) schizotypal personality disorder (n = 36), outpatient schizophrenia participants (n = 33), and hospitalized schizophrenia patients (n = 56) were studied. As hypothesized, we found increased EII scores in all of the schizophrenia spectrum groups when compared against normal comparison participants. Furthermore, the EII was significantly different between the schizophrenia patients and the other schizophrenia spectrum groups. These findings support the use of the EII as a sensitive measure of perceptual and thought disturbance across the schizophrenia spectrum that yields specific information regarding the type of thinking problems that occur within schizophrenia spectrum subgroups.     

Role of structure in disordered thinking in borderline and schizophrenic disorders

Qualitative studies have noted that individuals with "borderline" psychopathology exhibit extreme thought disorder on unstructured tests, yet manifest relatively normal performance on more structured tests of cognitive performance. The present study provides empirical support for this clinical observation. Borderline syndrome patients, defined by DSM-III criteria for borderline personality disorder and/or schizotypal personality disorder, demonstrated significantly greater thought disorder on the Rorschach, as measured by Johnston and Holzman's (1979) Thought Disorder Index (TDI), than did nonpsychiatric controls and were indistinguishable from patients with schizophrenic disorder of relatively recent onset. Borderline patients did not differ from controls on a structured test of cognitive slippage. Further examination of the role of structure in the assessment and treatment of borderline syndrome disorders seems warranted.     

Borderline and schizophrenic patients: A comparison using the MCMI-II

In the present study we examined the Millon Clinical Multiaxial Inventory-II scores of psychiatric patients with a diagnosis of either borderline personality disorder (BPD;n=13) or schizophrenia (n=13). The analyses revealed that the BPD patients were significantly elevated on a number of scales in addition to the Borderline scale. The second goal of this study was to assess the discriminative validity of the Borderline and Thought Disorder Scales with both base rate (BR) cutoffs and the number of endorsed prototypic items. The Borderline scale demonstrated the most diagnostic power when using BR cutoffs, whereas the Thought Disorder scale performed poorly, no better than chance levels, with all cutoffs.This research was supported by Social Sciences and Humanities Research Council of Canada Grant 410-89-0335 and by a grant from the Department of Research and Programme Evaluation, Brockville Psychiatric Hospital. The authors thank Renate Simmons for her assistance.     

Clinical correlates of anhedonia and perceptual aberration in first-episode patients with schizophrenia and affective disorder.

We examined the association between scales measuring physical anhedonia, social anhedonia, and perceptual aberration and premorbid functioning, clinical state, and current level of adjustment in 91 psychotic subjects. The patients were examined at the onset of their first psychotic episode and again 18 months later. For patients with schizophrenia, anhedonia was significantly related to premorbid functioning. No association was found between the scales and clinical state or level of adjustment at intake or follow-up. In affective disorder patients, no correlation was found between premorbid functioning (a stable characteristic) and scale scores, but moderately large correlations emerged between the scales and clinical state and level of adjustment at both assessment times. These results suggest that schizophrenic and affective disorder patients endorse items on these scales for different reasons. We hypothesize that for patients with schizophrenia, the scales assess enduring personality characteristics, whereas for the affective disorder patients, they assess clinical condition at the time of testing.     

Autobiographical memory in depressed and nondepressed patients with borderline personality disorder after long‐term psychotherapy

The present study investigated whether scores on the Autobiographical Memory Test (AMT) in 55 patients with borderline personality disorder (BPD) were modified after long‐term psychotherapy and whether the pretreatment AMT scores would predict improvement in depression severity or BPD symptom severity at the end of treatment. In addition, it was analysed whether changes in ratings of mood, thought suppression, dissociation, and BPD symptom severity following treatment were associated with changes in AMT scores. Only patients with BPD and a comorbid diagnosis of depression at time 1, generated significantly more specific memories and fewer categoric memories after 15 months of therapy. Moreover, these changes were unrelated to type of therapy and changes in depression severity, borderline symptom severity, dissociation, or thought suppression. The AMT scores at initial assessment did not predict depression severity at 15 months. The percentage of negative specific memories tended to predict BPD symptom severity.     

Cognitive impairments and disordered speech in schizophrenia: thought disorder, disorganization, and communication failure perspectives

This article posits that basic cognitive impairments in schizophrenia are more highly related to speech disorder measured as communication failures than speech disorder measured as thought disorder or disorganization. The author tested 47 schizophrenia patients and 36 control participants for sustained attention, sequencing, and conceptual sequencing ability. Their speech was also rated for communication failures, thought disorder, and conceptual disorganization. Attention and sequencing impairments, examined hierarchically, explained a substantial 38% of the variance in the communication measure of speech disorder but little of the variance in formal thought disorder or conceptual disorganization. The author concludes that (a) impairments in attention and sequencing abilities contribute substantially to schizophrenic communication failures, and (b) it is important to consider lower level cognitive "3rd variables" when examining higher level cognitive associates of speech disorder.     

A comparison of metacognitions in patients with hallucinations,delusions, panic disorder,and non-patient controls

This study tested the hypothesis that metacognitions are a general vulnerability factor for psychological disorder. It was predicted that patients with psychosis (hallucinations or delusions), and patients with panic disorder would score higher than non-patients on measures of metacognition. Moreover, it was hypothesised that patients showing most dysregulation of thinking (voice-hearers) would endorse significantly higher metacognition scores than individuals in the other groups. The Meta-Cognitions Questionnaire (MCQ: ) was administered to patients who met DSM-IV criteria for schizophrenia spectrum disorders with auditory hallucinations, patients who met DSM-IV criteria for schizophrenia spectrum disorders with persecutory delusions, patients who met DSM-IV criteria for panic disorder and non-patients. The results showed that psychotic patients who experience auditory hallucinations tended to exhibit higher levels of dysfunctional metacognitive beliefs than other patient groups, scoring significantly higher than at least two of the three control groups on positive beliefs about worry, negative beliefs about uncontrollability and danger, cognitive confidence and negative beliefs including superstition, punishment and responsibility. It was also found that the metacognitive beliefs of patients with persecutory delusions and panic patients were often similar to each other, and elevated in comparison to non-patients, suggesting that such beliefs are generic vulnerability factors. The theoretical and clinical implications of these findings are discussed.     

MMPI and Rorschach Indices of Schizophrenic and Depressive Diagnoses Among Adolescent Inpatients

Although adolescent norms have been developed for the MMPI (e.g., Marks, Seeman, & Haller, 1974) and Rorschach (e.g., Exner, 1986a), little is known regarding the discriminate diagnostic validity of these measures with adolescents. This study investigated the usefulness of these measures in the detection of depression and schizophrenia among adolescent inpatients. Subjects (mean age = 15.3) consisted of 134 adolescents who received Rorschach and MMPI administrations at hospital admission. Clinical diagnoses resulted in the following groupings for this sample: schizophrenia = 15, dysthymic disorder = 41, major depression = 26, conduct disorder = 28, personality disorder = 18. MMPI scale Sc elevation was found to be the most effective single predictor of schizophrenic diagnoses, with a hit rate of .76, sensitivity of .62, and specificity of .78. Neither MMPI scale D scores nor Rorschach DEPI scores were found to be significantly related to patients' diagnoses. Results were interpreted in terms of prior findings in adult psychiatric populations and in relation to implications for the clinical assessment of adolescents.     

MMPI and Rorschach indices of schizophrenic and depressive diagnoses among adolescent inpatients

Although adolescent norms have been developed for the MMPI (e.g., Marks, Seeman, & Haller, 1974) and Rorschach (e.g., Exner, 1986a), little is known regarding the discriminate diagnostic validity of these measures with adolescents. This study investigated the usefulness of these measures in the detection of depression and schizophrenia among adolescent inpatients. Subjects (mean age = 15.3) consisted of 134 adolescents who received Rorschach and MMPI administrations at hospital admission. Clinical diagnoses resulted in the following groupings for this sample: schizophrenia = 15, dysthymic disorder = 41, major depression = 26, conduct disorder = 28, personality disorder = 18. MMPI scale Sc elevation was found to be the most effective single predictor of schizophrenic diagnoses, with a hit rate of .76, sensitivity of .62, and specificity of .78. Neither MMPI scale D scores nor Rorschach DEPI scores were found to be significantly related to patients' diagnoses. Results were interpreted in terms of prior findings in adult psychiatric populations and in relation to implications for the clinical assessment of adolescents.     

WAIS digit span-based indicators of malingered neurocognitive dysfunction: classification accuracy in traumatic brain injury

The present study determined specificity and sensitivity to malingered neurocognitive dysfunction (MND) in traumatic brain injury (TBI) for several Wechsler Adult Intelligence Scale (WAIS) Digit Span scores. TBI patients (n = 344) were categorized into one of five groups: no incentive, incentive only, suspect, probable MND, and definite MND. Performance of 1,063 nonincentive patients (e.g., cerebrovascular accident, memory disorder) was also examined. Digit Span scores included reliable digit span, maximum span forward both trials correct, maximum span forward, combined maximum forward and backward span, Digit Span scaled score, maximum span backward both trials correct, and maximum span backward. In TBI, sensitivity to MND ranged from 15% to greater than 30% at specificities of 92% to 98%. Patient groups with documented brain pathology had higher false-positive error rates. These results replicate previous known-groups malingering studies and provide valuable data supporting the WAIS Digit Span scores in detection and diagnosis of malingering.     

Correlations Between the MMPI and the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms in Schizophrenic Patients

Our study examined the relationship between the Minnesota Multiphasic Personality Inventory (MMPI) and the Scale for the Assessment of Positive Symptoms (SAPS; Andreason, 1984) and the Scale for the Assessment of Negative Symptoms (SANS, Andreason, 1983) in patients who met the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) diagnostic criteria for schizophrenia (n = 125). A significant correlation was found between the SAPS Delusions scale and Scale 6 (Paranoia), the SAPS Positive Thought Disorder Scale and Scale F (Infrequency), and the SAPS Positive Thought Disorder and Scale 9 (Hypomania). Additional analysis also shows, however, that severity of symptoms was the best predictor of MMPI scores. Consistent with previous studies, the MMPI appears useful for screening but not for the detailed evaluation of symptomatology of schizophrenic patients.     

How to suppress obsessive thoughts

Thought suppression (i.e. consciously trying to avoid certain thoughts from entering consciousness) has been argued to be an inadequate strategy in case of unwanted intrusions. That is, thought suppression seems to result in more rather than less intrusions. Although this experimental finding has been explained in terms of failing attempts to distract oneself from the target thought, the White Bear Suppression Inventory (WBSI; a scale that measures chronic thought suppression tendencies) does not address the means by which respondents try to suppress unwanted thoughts. To examine which strategies of mental control people use to suppress unwanted thoughts, obsessive-compulsive disorder patients (N=47) completed the WBSI, the Thought Control Questionnaire, and two measures of psychopathology. Results suggest that the crucial mechanism in thought suppression may not be distraction, but self-punishment.     

Boyhood separation anxiety disorder: thought disorder and object relations psychopathology as manifested in Rorschach imagery

Rorschach scales were used to examine the quality of thought disturbance and object relations in boys meeting the Diagnostic and Statistical Manual of Mental Disorders, third edition (DSM-III; American Psychiatric Association, 1980) criteria for separation anxiety disorder (SAD). Nineteen urban, middle and low socioeconomic status (SES), SAD boys were compared to a group of 14 male control subjects. The hypotheses of the study were that SAD boys as compared to controls would: (a) have significantly more thought disordered responses as measured by a Rorschach Thought Disorder Scale (Blatt & Ritzler, 1974), and (b) evidence significantly less adaptive object relations scale scores as measured by the Mutuality of Autonomy Scale (Urist, 1977). Results confirmed both hypotheses. The SAD group had more thought disordered responses and more disrupted object relations scores than the controls. Ideas and images of these boys were found to generally be more unstable, boundary compromised, fluid, idiosyncratic, tangential, and psychotic-like than the controls. It was concluded that these boys possess a significant potential to have thinking abnormalities that will interfere with their independent functioning. Concerning their object relations scores, the SAD subjects were found to have significantly fewer benign, adaptive object interactional percepts, and a greater number of dependent and/or clinging interactional object representations (imagery) than the controls. This study supports the viewpoint that SAD boys are deeply psychologically troubled.     

The effect of inquiry on the Exner Comprehensive System

The effect of inquiry on the Comprehensive System was tested by scoring 130 protocols of patients and normals with and without inquiry. The absence of inquiry significantly reduced the means for Developmental Quality-vague (DQv), Form Quality-unusual (FQu), the sum of color responses (SumC), the sum of shading responses (Sum Shading), and the weighted thought disorder measure (W Sum6 SP SC), but significantly increased pure form (F). The effect for W Sum6 SP SC was strongest for schizophrenic protocols. Liberalized scoring rules were established in an attempt to restore the interpretative validity of the scoring categories distorted by the lack of inquiry. The new rules significantly improved the accuracy of color and shading categories, but did not improve the special scores measure of thought disorder.