Neuroleptic modification of basic schizophrenic disorders

After a short review of the German literature dealing with basal schizophrenic disturbances, the authors present the results of their own studies involving 135 schizophrenics. A large inventory of statistical methods is used to present the findings gained during differential neuroleptic therapy by means of the Frankfurt complaints questionnaire and the structured psychopathic assessment system (SPES-A). The studies indicate that basal schizophrenic disturbances are accessible to (differential) neuroleptic influence.     

A deficit of primary affective facial expression independent of bucco-facial dyspraxia in chronic schizophrenics

Abstract

Chronic schizophrenics are known to manifest a deficit of categorisation and recognition of primary emotional facial expression despite intact recognition of face identity. An equivalent deficit of expression of the same primary facial emotions in schizophrenics has not been clearly established. Twenty chronic hospitalised schizophrenics and 20 normals were therefore tested on tasks of facial emotional expression upon verbal command, of facial emotional expression imitation, and of non-affective bucco-facial praxic imitation. Results indicate that chronic schizophrenics do manifest a deficit of facial emotion expression which can best be explained by task parameters, such as verbal cueing of emotions, perceptual recognition, and bucco-facial dyspraxia in decreasing order of importance. The deficit does not appear to result from neuroleptic or anticholinergic medication nor length of hospitalisation or disease.     

Discriminant validity of the Multiple Affect Adjective Check List - revised

Four groups of patients (depressives, schizophrenics, substance dependents and abusers), a miscellaneous group of other patients, and a group of matched normals from a general population sample were compared on the scales of the Multiple Affect Adjective Check List - Revised (MAACL-R). All scales showed highly significant differentiation among the groups. An index consisting of Depression minus Positive Affect scales was particularly effective in discriminating between depressive and other groups. A discriminant function analysis showed that the depressive could be distinguished from other patient groups and normals with an accuracy of 72% correct. The normals could be distinguished from all of the patient groups with a 60% accuracy, and 87% if the substance abuser group is ignored. The discriminant validity among the nondepressive patient groups was not nearly as good.     

Suicidal behavior in hospitalized schizophrenics

A group of 131 hospitalized schizophrenics who had attempted suicide within the past year was compared with another group of 70 hospitalized schizophrenics who had not attempted suicide, using the Present State Examination (PSE) depressive symptoms. The former had a significantly higher number of symptoms indicative of a depressive disorder.     

Schizophrenia--a high-risk factor for suicide: clues to risk reduction.

Suicide is the chief cause of premature death among schizophrenic persons. The lifetime incidence of suicide for patients with schizophrenia is 10% to 13% compared to a general population estimate of about 1%, and is quite close to that observed among those with major affective disorder. The magnitude of increased risk for suicide among schizophrenics peaks before middle age and declines thereafter, although schizophrenic persons tend to be at increased risk throughout the life span. Among psychiatric patients, schizophrenics are overrepresented among suicides, and often schizophrenics constitute the majority of inpatient suicides. It is important in evaluating suicide risk among schizophrenic persons to assess depression and suicidal ideation especially during index admission and during acute phases of the illness. It is noteworthy that schizophrenic persons often commit suicide as the overall level of psychopathology decreases during a nonpsychotic phase. Research has yielded salient risk factors for suicide in schizophrenic persons and "types" of especially vulnerable patients, even though statistical prediction of individual suicides has not proven effective.     

Schizophrenically disordered time perception and its modification by neuroleptics

The authors deal with the question as to whether the target symptom "disturbed time perception" is to be considered a basic schizophrenic symptom and whether therapeutical (neuroleptic) control possibilities exist. 135 schizophreniacs have given statistical evidence (intensity quotient, Wilcoxon comparison, Hotelling-Pabst test, exact probability test according to Fisher/Yates) that the disturbed time perception of schizophreniacs is accessible by a differentiated neuroleptic therapy but is not a basic schizophrenic disturbance.     

Cognitive and attentional deficits in children vulnerable to psychopathology

Cognitive and attentional deficits were assessed in children with either a schizophrenic, an affectively disordered or a normal parent. The children were grouped both by their parents' DSM-II diagnoses (broadly defined group of schizophrenics and heterogeneous group of depressives)and by a new set of diagnoses (narrowly defined group of schizophrenics, unipolar depressive group and bipolar group). Children whose parents met the more stringent criteria for schizoprhenia performed somewhat more deviantly than children whose parents met only DSM-II criteria. In addition, the importance of splitting the heterogeneous depressive group into more homogeneous subgroups is indicated by the findings that children of unipolar parents generally could not be distinguished from children whose parents are schizophrenic. On the other hand, children of bipolar parents performed reliably better than children of schizophrenics. These findings are viewed within the context of current high-risk studies and psychological deficit literature and suggest that diagnostic issues require more attention by researchers in these areas.This research was supported by Grant MH 21145 from the National Institute of Mental Health. The authors are indebted to Lina Jandorf for assistance in testing the children and with the data analyses.     

Neuroleptic malignant syndrome--3 case reports

An account is given of three patients who exhibited a malignant neuroleptic syndrome after the administration of neuroplegics. Like other authors, we identified typical elicitation factors and clinical characteristics. In one case a catatonic dilemma with lethal issue was observed. In the final case dealt with in this paper, the renewed application of neuroplegics following the termination of the malignant neuroleptic syndrome was tolerated without complications, whereas in the case of an epileptic patient with damage to the brain, the malignant neuroleptic syndrome returned upon dosage increase.     

Mueller-Lyer illusion and size estimation performance in schizophrenics compared to normal controls

A size estimation (SE) paradigm and the Mueller-Lyer (ML) illusion were used to examine perceptual disturbances in schizophrenics. 35 reliably diagnosed (DSM III-R) schizophrenics were compared to 20 subjects with no history of psychiatric illness. Perceptual distortions found in previous studies of schizophrenics were only to a certain extent confirmed in the present results. More overestimators were found among the schizophrenics than among the normals on the SE task. The schizophrenics, first of all the chronic patients, also proved to be more prone to the Mueller-Lyer illusion. A reason why the very clear differences between schizophrenics and normals found in previous examinations were not confirmed in the present study, might be that a reliable diagnostic instrument was for the first time used in this kind of study.     

Sudden gains in interpersonal psychotherapy for depression

Sudden, precipitous improvements in depressive symptom severity have been identified as occurring among unipolar depressed individuals. These "sudden gains" have been associated with superior acute treatment outcome in several treatment modalities, including cognitive therapy. A better understanding of sudden gains may provide insight into the mechanisms of action in these and other psychotherapies. One efficacious therapy that has been overlooked in sudden gains research is interpersonal psychotherapy (IPT; Weissman, M. M., Markowitz, J. C., & Klerman, G. L. (2000). Comprehensive guide to interpersonal psychotherapy. New York: Basic Books). The present research examined the rates and concomitant features of sudden, precipitous improvements in depressive symptomotology among 185 women receiving IPT for recurrent depression. Sudden gains, defined using extant criteria for the Beck Depression Inventory, were assessed over 12 weeks of acute IPT treatment for depression and occurred for 33.5% of the sample. Sudden gains were not associated with diagnostic and demographic characteristics or with differential likelihood of achieving depression remission with IPT monotherapy during active treatment. Further, those with sudden gains were no more likely to maintain their recovery through maintenance treatment. The lack of impact of sudden gains on eventual outcome is discussed in terms of potentially disparate emphases and mechanisms of change between IPT and cognitive-behavioral therapy (CBT).     

Bright light therapy in schizophrenic diseases

20 patients with schizophrenic disorders, displaying a depressive syndrome, were given bright-light therapy, and compared with 11 patients treated by means of partial deprivation of sleep. Against a figure of 27% in the case of sleep-deprivation, syndrome remittance was 55% in the case of bright-light therapy. Psychometric data were obtained by use of three external-assessment schemes (HAMD, BPRS, and NOSIE) and two self-assessment procedures (TSD, POMS). As depressive syndromes improve under bright-light therapy, schizophrenic symptoms also recede, which suggests close syndromatologic links in the sense of a universal genesis of psychoses.     

ABSTRACTS

This is one of a series of research studies comparing parents and siblings of 30 schizophrenics with 30 neurotics. The parents of schizophrenics had a greater incidence of schizophrenia, personality disorders, and borderline disorders than did the normals. The siblings of the schizophrenics showed more varied disturbance than the parents. Of 30 schizophrenic families, 14 were "schizmatic" and 7 were "skewed"; 10 families were chaotic, 11 were rigid, 6 showed both patterns, and three were atypical. The families from which schizophrenics come are usually disturbed both genetically and environmentally.     

Response-selection processes in paranoid and nonparanoid schizophrenia

Previous research (Marshall, 1973) has shown that the most pronounced component of deficit on a choice reaction time task among a mixed schizophrenic sample involved response-selection processes. Other evidence has indicated that paranoids may be more deficient in this respect than nonparanoids. Hence, it was hypothesized that the former subgroup of schizophrenics would display response-selection deficit while the latter subgroup would display either less or no deficit. Response-selection processes were re-examined using the CRT paradigm with comparisons carried out among paranoid and nonparanoid schizophrenics and a group of nonschizophrenic controls. Results indicated that only the paranoid schizophrenics displayed abnormally retarded response-selection operations, the nonparanoid schizophrenics being nonsignificantly discriminable from the controls. It was suggested that past evidence of CRT response-selection deficit among mixed schizophrenics might have been attributable primarily to the performance of the paranoids, whose performance appears to be adversely affected by an increase in the number of dimensions relevant to response selection.     

ABSTRACTS OF LITERATURE

This is a report of a panel discussion oriented around family dynamics and therapy held at the Thirteenth Congress of Scandinavian Psychiatrists in 1962. Fleck described findings of the Yale studies on families. Hemer talked about parental interaction and the resulting disturbed body images of schizophrenic patients. Tuovinen discussed the reactions of the family when the patient is in individual psychotherapy, and Siirale raised the question of the families of schizophrenics in relation to the "larger families" of our contemporary societies.     

Continuity in childhood depression

It is only in recent years that childhood depression has received widespread attention from mental health specialists. Its status as a clinical syndrome of childhood remains unclear. Many controversies surround various facets of this condition, foremost among these are questions relating to the duration of depressive disorders, the likelihood of recurrence, and the long-term outcome of depressed children. In the course of addressing these issues, attention is devoted to the outcomes as well as the advantages and disadvantages of commonly used research designs (prospective, retrospective, and catch-up prospective), the level of diagnosis used (symptom, syndrome, disorder), the significance of the age of onset on severity, and specific areas in need of further research. Among the tentative conclusions, it is asserted that many depressive symptoms are transient, diminishing or disappearing with age and/or changing environmental circumstances, but that severe depressive disorders do persist, with periods of remission, at least into the early adult years.     

Changes in the gangliosides of erythrocyte membranes of schizophrenic patients

The pattern of gangliosides in membranes of erythrocytes was examined in healthy donors, in acute schizophrenics without neuroleptic treatment and in alcohol-dependent patients. 7 different gangliosides could be detected after extraction, purification by column chromatography and fractionation by TLC. Healthy donors were characterized by the following pattern of gangliosides: GX = 5.8%, GT1b = 6.7%, FucGD1b = 5.2%, und GD1a = 12.6%, GD3 = 9.2%, SPG = 43.5% and GM3 = 17.0%. In schizophrenic patients the GM3- and GD3-fraction were increased. No difference was found between the control group and the alcoholics.     

Psychometric detection of schizotypy: perceptual aberration and physical anhedonia in relatives of schizophrenics.

We administered scales of Perceptual Aberration (PERAB) and Physical Anhedonia (PHYSAN), traits that may be related to risk for schizophrenia, to 54 schizophrenics, 146 of their first-degree relatives (evaluated for schizophrenia-related disorders), and 178 normal subjects (screened for psychotic disorders in them or their relatives). For both scales, there was a significant effect of group membership. For the PERAB scale, the schizophrenics had higher scores than the normal subjects, who had higher scores than the relatives. For the PHYSAN scale, schizophrenics had higher scores than their relatives, who had higher scores than the normal subjects. Patterns of familial correlations also suggested that physical anhedonia, but not perceptual aberration, may be familial among schizophrenics and their relatives. The PHYSAN scale, but not the PERAB one, may be a useful indicator of liability for schizophrenia among the relatives of affected probands.     

An analysis of 17 catatonic patients diagnosed with neuroleptic malignant syndrome

This study was conducted to show that catatonia is a predisposing factor for neuroleptic malignant syndrome (NMS) and to review the nosological relationship between catatonia and NMS. Seventeen consecutive cases of NMS were analyzed prospectively with reference to clinical and investigative findings before and after exposure to a neuroleptic. The series comprised eight males and nine females, ranging in age from 18 years to 65 years. Prior to neuroleptic exposure, all patients exhibited features compatible with criteria for catatonia (mutism/excitement) according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, (DSM-III-R). Following neuroleptic administration (single dose in nine cases), patients deteriorated into a febrile, rigid, and obtunded state accompanied by autonomic dysfunction and raised creatine phosphokinase levels. These features were consistent with a diagnosis of NMS. Neuroleptics were discontinued and supportive medical treatment instituted. Benzodiazepines were beneficial in eight cases in relieving stupor, but bromocriptine and dantrolene were generally ineffective. In all patients diagnosed with NMS in the authors' series, catatonia was an invariable prodromal state. It appears that the administration of a neuroleptic intensified the preexisting catatonic state and precipitated a malignant variant of the disorder, which is currently recognized as NMS. The authors, therefore, challenge the separate nosological status of NMS and catatonia and suggest that these syndromes are part of a unitary pathophysiological disorder.     

Un déficit de mémoire de la source spécifique chez les patients schizophrènes comparés à des volontaires sains et des patients présentant un épisode dépressif majeur

One of the main cognitive models of positive symptoms in schizophrenia proposes that they arise through impaired self-monitoring. The most replicated findings is that, compared to healthy volunteers, schizophrenics patients have impairment in source monitoring tasks required to distinguish between memories of their self-generated material and externally generated events, generally words, as a consequence of a malfunction in either a central monitor or in a reality discrimination process. However, only few studies have investigated the specificity of those tasks. The aim of this study was to compare performances in 2 source monitoring tasks of 3 groups: 30 schizophrenic patients with positive symptoms, 22 patients presenting a major depressive disorder and 24 healthy volunteers. Tasks were built using current French words extracted from a verbal fluency task. We reported a specific significant deficit in source monitoring task in patients with schizophrenia, no difference was observed between healthy volunteers and major depressive disorder patients.     

Psychoanalytic Explorations in Art by Ernst Kris

A review of 43 controlled studies was conducted which evaluated the effectiveness of group therapy for schizophrenics. Group therapy was judged to be an effective modality of treatment for schizophrenics in 67 percent of the inpatient studies. It was especially useful in groups lasting more than three months. Therapy groups were effective for schizophrenics in 80 percent of the outpatient studies. Interaction-oriented approaches were more effective than insight-oriented approaches, which were found to be harmful for some schizophrenics.