The relationship of clinical, cognitive and social measures in schizophrenia: a preliminary finding combining measures in probands and relatives

This study examines performance of schizophrenia patients, unaffected relatives and controls in social cognition, cognitive and psychiatric scales looking for possible markers of vulnerability in schizophrenia. Performance of schizophrenia patients from multiplex families, first-degree relatives, and matched controls was compared and, subsequently, discriminant analysis method was used for identifying the best predictors for group membership. By using Multigroup Discriminant Analyses on the three groups, the best predictors were PANSS, Premorbid Adjustment Scale, Faux Pas test, and a face/emotion categorizing task. This model obtained 82% correct global classification, suggesting that the combination of psychiatric scales and neuropsychological/social cognition tasks are the best approach for characterizing this disease. Although preliminary, our results suggest that social cognition tasks are robust markers of schizophrenia family impairments, and that combining clinical, social and neuropsychological measures is the best approach to asses patients and relatives vulnerability.     

Childhood Schizophrenia and Autism: An Empirical Study of Perceived Social Support

Although there is an abundance of literature focusing on social support for children and adults with mental illness, there is a paucity of research examining social support for individuals diagnosed with childhood and adolescent onset schizophrenia. Literature suggests that measuring social support in youth with schizophrenia poses unique challenges, which may be why it is so under-represented in existing research. In an effort to learn more about the availability of social support for children in this population, the current study compared measures of social support for children and adolescents, 5 to 17 years old, diagnosed with childhood schizophrenia to those for children diagnosed with autism spectrum disorder. The study surveyed parents of children with schizophrenia and autism using the Family Needs Questionnaire to measure perceived social support, and a subsection of the Ohio Youth Problem, Functioning, and Satisfaction Scales to measure the parent’s assessment of children’s level of functioning. A Family Questionnaire was also administered to collect demographic information about the children and their families. Results indicated, contrary to the original hypothesis, that parents of children with schizophrenia perceived their offspring as having more social support than children with autism, even though overall parents of children in the schizophrenia group rated their children as having a lower level of functioning. However, the study also found that when assessing the importance of social support needs, parents of children with schizophrenia rated their children’s needs as being significantly more important than parents of children with autism. A discussion of the research findings and limitations of the study are offered, in addition to suggestions for future research.     

Using latent class analysis to identify aggressors and victims of peer harassment

This study used latent class analysis (LCA) to identify and classify individuals into aggressor and victim latent classes. Participants were over 2,000 sixth grade students who completed peer nomination procedures that identified students who had reputations as perpetrators and/or victims of physical, verbal, or relational harassment. Results showed five latent classes. Consistent with previous research, LCA identified latent classes of victims, aggressors, and socially adjusted students. However, rather than a single aggressive-victim subgroup, LCA identified latent classes of highly-victimized aggressive-victims and highly-aggressive aggressive-victims. Comparisons showed differences in mean profiles and classification criteria between LCA and traditional dichotomization approaches. Adjustment outcomes showed that highly-victimized aggressive-victims generally experienced greater negative psychological and social adjustment outcomes than highly-aggressive aggressive-victims. Implications of these findings for better assessment of victim and aggressor subgroups were discussed.     

Exploring Predictors of Outcome in the Psychosis Prodrome: Implications for Early Identification and Intervention

Functional disability is a key component of many psychiatric illnesses, particularly schizophrenia. Impairments in social and role functioning are linked to cognitive deficits, a core feature of psychosis. Retrospective analyses demonstrate that substantial functional decline precedes the onset of psychosis. Recent investigations reveal that individuals at clinical-high-risk (CHR) for psychosis show impairments in social relationships, work/school functioning and daily living skills. CHR youth also demonstrate a pattern of impairment across a range of cognitive domains, including social cognition, which is qualitatively similar to that of individuals with schizophrenia. While many studies have sought to elucidate predictors of clinical deterioration, specifically the development of schizophrenia, in such CHR samples, few have investigated factors relevant to psychosocial outcome. This review integrates recent findings regarding cognitive and social-cognitive predictors of outcome in CHR individuals, and proposes potential directions for future research that will contribute to targeted interventions and improved outcome for at-risk youth.     

Development of social functioning in preschizophrenia children and adolescents: a systematic review

Schizophrenia is associated with severe deficits in social functioning. Similar deficits may be present prior to psychosis onset, in childhood and adolescence. If so, then prepsychosis social deficits could provide clues to the development of pathological processes in preschizophrenia children and could potentially improve early identification of the disorder and suggest targets for intervention. Evidence is reviewed from birth cohort, case- control, and familial high-risk studies within distinct periods of development to clarify the nature, timing, and specificity of social deficits in preschizophrenia children and adolescents. The results indicate that poor social functioning does differentiate preschizophrenia children and adolescents from their peers and can be a sensitive and potentially specific predictor of schizophrenia, not just psychopathology in general. Furthermore, age (but not sex) appears to be an important moderator of the strength and specificity of the association between particular social deficits (e.g., externalizing, internalizing) and later schizophrenia. Results are discussed in the context of current developmental theories of timing and pathophysiology of schizophrenia involving hypothalamic- pituitary-adrenal dysregulation. Implications for the early identification and treatment of preschizophrenia individuals are also considered.     

Consumer satisfaction and attributions of improvement among fully recovered schizophrenics

As people with serious mental illness are viewed as consumers rather than patients, their views and needs are increasingly seen as essential to the treatment process. The aim of the present study is to add valuable knowledge about how to help patients by reporting what fully recovered schizophrenics, as consumers, had found helpful in their treatment as well as which factors contributed to their recovery. In addition to a semistructured interview, two instruments were used: the "UCLA Social Attainment Survey Premorbid Adjustment Scale" (SASPAS) to measure patients' premorbid adjustment and the "Global Assessment Scale" (GAS) to obtain an assessment of the present general functioning of the subjects. The results showed that a majority of the recovered subjects emphasized their own will-power and the human qualities in their therapists as helpful to them in the process towards recovery. The therapeutic relationships were characterized by the kindling and sustaining of hope in the clients.     

Traumatic Brain Injury in School-Age Children Academic and Social Outcome

School-aged children with a traumatic brain injury (TBI) require extraordinary effort and energy from individuals in their school, home, and community. The purpose of this study was to examine the academic, behavioral, and social outcomes of a cohort of children and adolescents following TBI. A comprehensive assessment of cognitive functioning, achievement, and adaptive behavior was administered to 43 school-aged children 2 years after their TBI. Premorbid functioning for each participant was obtained from state-mandated test scores assessed prior to the TBI. The predictive utility of premorbid functioning, TBI severity, and age at injury were examined. Findings revealed that premorbid functions were significant predictors of reading and spelling achievement and adaptive functioning. Severity of injury was predictive of adaptive functioning. Implications of findings include program development, reintegration into school, and educating parents and teachers.     

家庭功能与社会适应:个人自主的中介作用

采用大学生社会适应量表、自我调控问卷和家庭功能问卷调查了643名大学生社会适应的基本特点及其与家庭功能、个人自主间的关系。结果发现:(1)男生在校园生活适应上得分高于女生;大三学生在人际关系适应、自我适应维度上得分高于大四,大一学生在学习适应维度上得分高于大二、在满意度维度上得分高于大三;(2)除投射调控维度外,个人自主的其余维度与家庭功能及社会适应各维度及总均分间均存在显著相关;(3)分层回归结果表明,除投射调控维度外,个人自主其余各维度和家庭功能的亲密性能显著预测社会适应,且个人自主在家庭功能的亲密性和社会适应间起完全中介作用。     

Comparison of measured and estimated cognitive ability in older adolescents with and without ADHD

Premorbid intellectual function estimation is a crucial part of patient evaluation following a traumatic brain injury (TBI), especially in individuals with ADHD who are at higher risk for TBI compared to their non-ADHD peers. This study investigates the value of using regression-based estimates of intelligence for concurrently predicting measured intelligence in a sample of older adolescents with and without a childhood history of ADHD. Correlations between measured and estimated intelligence are highly significant in the full sample and in the individual groups. Adding reading performance to the regression equation increases the accounted-for variance in both groups. Results indicate that regression equations based on demographic characteristics constitute a valid method for estimating premorbid functioning in adolescents with ADHD and that they can play an essential role in the assessment of individuals with ADHD who sustain TBI, especially when measures of word reading are used to augment demographic estimates.     

Comparing the Housing Trajectories of Different Classes Within a Diverse Homeless Population

The paper presents findings from a longitudinal study identifying different classes of homeless individuals in a mid‐size Canadian city based on health‐related characteristics and comparing the housing trajectories of these classes 2 years later. Using data collected through in‐person interviews with a sample of 329 single persons who have experienced homelessness, the paper presents results of a latent class analysis. Results found four distinct latent classes characterized by different levels of severity of health problems—i.e., a class of individuals who are “Higher Functioning” (28.7%), a second class with “Substance Abuse Problems” (27.1%), a third class with “Mental Health Substance Abuse Problems” (22.6%), and a fourth class with “Complex Physical and Mental Health Problems” (21.6%) that included having diminished physical functioning, multiple chronic physical health conditions, mental health difficulties, and in some cases substance abuse problems. Follow‐up interviews with 197 of these individuals (59.9%) 2 years later showed the class of individuals with substance abuse problems experiencing the greatest difficulty in exiting homelessness and achieving housing stability. Implications of these findings for social policy development and program planning are discussed.     

Social anxiety and premorbid personality disorders in paranoid schizophrenic patients treated with clozapine

The concept of anxiety as a distinct comorbid disorder in schizophrenia has recently been rediscovered after having been neglected for a long period of time due to both theoretical and clinical approaches adopted from the appearance of the first edition of the Diagnostic and Statistical Manual of Mental Disorders in 1950. This rediscovery was accentuated by the fact that the concept of comorbidity in various psychiatric disorders has recently won widespread favor within the scientific community, and that the use of atypical neuroleptic medication to treat patients with schizophrenia has been reported to lead to the emergence of anxiety symptoms. Of the atypical neuroleptic medications used to treat schizophrenia, clozapine has most frequently been reported to induce anxiety symptoms. In this paper, 12 cases of patients with paranoid schizophrenia who developed social phobia during clozapine treatment are reported, and their response to fluoxetine augmentation is assessed. Premorbid personality disorders were also investigated; patients were assessed using the Structured Clinical Interview for DSM-III-R-Patient Version and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (DSM-III-R=Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised; DSM-IV=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). In addition, the Scale for the Assessment of Negative Symptoms, the Scale for the Assessment of Positive Symptoms, the Liebowitz Social Anxiety Scale (LSAS), the Frankfurt Beschwerde Fragebogen (Frankfurt Questionnaire of Complaints), and the Brief Psychiatric Rating Scale were used to rate clinical symptomatology. All patients were reevaluated after 12 weeks of cotreatment with clozapine and fluoxetine. In 8 (66.6%) of the 12 cases, symptoms responded (>/=35% LSAS score reduction) to an adjunctive regimen of fluoxetine. Furthermore, in 7 (58.3%) of the 12 cases, an anxious personality disorder (avoidant=33.3%; dependent=25%) was identified, but no significant differences in the prevalence of comorbid personality disorders emerged in comparison with a group of 16 patients with paranoid schizophrenia treated with clozapine who did not show symptoms of social phobia. The clinical relevance of the assessment and treatment of anxiety disorders is discussed in light of a clinical therapeutic approach that overcomes the implicit hierarchy of classification. Considering that the onset of anxiety-spectrum disorders (such as social phobia) can occur during the remission of psychotic symptoms in clozapine-treated patients with schizophrenia, a comprehensive approach to pharmacological therapy for patients with schizophrenia (or, at least for those treated with clozapine) should be adopted.     

Development and validation of a brief version of the dyadic adjustment scale with a nonparametric item analysis model

The main purpose of the current research was to develop an abbreviated form of the Dyadic Adjustment Scale (DAS) with nonparametric item response theory. The authors conducted 5 studies, with a total participation of 8,256 married or cohabiting individuals. Results showed that the item characteristic curves behaved in a monotonically increasing function for all items of the brief 4-item version of the DAS (DAS-4). The DAS-4 proved to be informative at all levels of couple satisfaction. Compared with the 32-item version of the DAS (DAS-32), it was as effective in predicting couple dissolution and was significantly less contaminated by socially desirable responding. In addition, structural equation modeling demonstrated that the underlying latent construct measured by the DAS-4 was very stable over a 2-year period. This brief version has the advantage of being less time consuming and constitutes a promising alternative to the original DAS-32 for clinicians and researchers.     

大学新生生活困扰的初步研究

本研究尝试对大学新生的生活困扰问题做一个初步的调查。在广州市某大学新生入学的第一学期末对 2 97名新生用大学新生适应量表进行了测试。结果发现 :( 1 )大学新生的生活困扰涉及人际关系、专业与职业期望、独立生活、资源信息利用和学习等五大方面。 ( 2 )平均而言 ,大学新生明显感到困扰的三个方面依次是资源信息利用、人际关系和学习方面 ;而在专业与职业期望和独立生活两个方面没有感到明显的困扰。 ( 3 )在上述新生生活困扰的五个方面没有发现显著的性别差异。结论 :大学新生的生活困扰问题值得引起足够的重视 ,应该有针对性地采取一些干预措施。     

Does Childhood Executive Function Predict Adolescent Functional Outcomes in Girls with ADHD?

We prospectively followed an ethnically and socioeconomically diverse sample of preadolescent girls with ADHD (n = 140) and matched comparison girls (n = 88) over a period of 5 years, from middle childhood through early/mid-adolescence. Our aim was to examine the ability of measures of childhood executive function (EF) to predict functional outcomes in adolescence. Measures of neuropsychological functioning comprised the childhood predictors, with academic, social, and global functioning serving as adolescent criterion measures. Results indicated that childhood EF predicted (a) academic achievement and social functioning across our entire sample (independent of diagnostic group status) and (b) global functioning only in girls with ADHD (independent of IQ). These results highlight the non-specificity of EF deficits and suggest the importance of assessing and developing interventions that target EF impairments, particularly in those at high-risk for negative outcomes, in order to prevent long-term difficulties across a range of important functional domains.     

Psychological resilience and dysfunction among hospitalized survivors of the SARS epidemic in Hong Kong: a latent class approach

OBJECTIVE: To examine trajectories of psychological functioning using latent class analysis on a sample of hospitalized survivors of the 2003 severe acute respiratory syndrome (SARS) epidemic in Hong Kong. DESIGN: A longitudinal study of 997 survivors, recruited from among 1,331 individuals hospitalized for SARS, were interviewed at 6, 12, and 18 months after hospitalization. MAIN OUTCOME MEASURES: Psychological and physical functioning at each time point was measured using the 12-item Medical Outcome Study Short-Form Health Survey (SF-12). RESULTS: Four latent classes were identified--chronic dysfunction, delayed dysfunction, recovery, and resilience. All groups had better physical health than the chronic group. Resilient and recovered individuals had greater social support and less SARS-related worry, and resilient individuals were more likely to be male. The resilient group also had greater social support than the delayed group and better physical functioning than the recovered group. CONCLUSION: This study demonstrated that longitudinal outcome trajectories following a major health-threat event in an Asian sample bear close resemblance to prototypical trajectories observed in trauma studies using Western samples. Unique predictors of the trajectories included factors observed in previous studies, such as social support, as well as factors of particular relevance to a major disease outbreak, such as SARS-related worry.     

Can I trust you? Negative affective priming influences social judgments in schizophrenia

Successful social interactions rely on the ability to make accurate judgments based on social cues as well as the ability to control the influence of internal or external affective information on those judgments. Prior research suggests that individuals with schizophrenia misinterpret social stimuli and this misinterpretation contributes to impaired social functioning. We tested the hypothesis that for people with schizophrenia, social judgments are abnormally influenced by affective information. Twenty-three patients with schizophrenia and 35 healthy control participants rated the trustworthiness of faces following the presentation of neutral, negative (threat-related), or positive affective primes. Results showed that all participants rated faces following negative affective primes as less trustworthy than faces following neutral or positive primes. Importantly, this effect was significantly more pronounced for participants with schizophrenia, suggesting that schizophrenia may be characterized by an exaggerated influence of negative affective information on social judgment. Furthermore, the extent that the negative affective prime influenced trustworthiness judgments was significantly associated with patients' severity of positive symptoms, particularly feelings of persecution. These findings suggest that for people with schizophrenia, negative affective information contributes to an interpretive bias, consistent with paranoid ideation, when judging the trustworthiness of others. This bias may contribute to social impairments in schizophrenia.     

Bifactor and item response theory analyses of interviewer report scales of cognitive impairment in schizophrenia

A psychometric analysis of 2 interview-based measures of cognitive deficits was conducted: the 21-item Clinical Global Impression of Cognition in Schizophrenia (CGI-CogS; Ventura et al., 2008), and the 20-item Schizophrenia Cognition Rating Scale (SCoRS; Keefe et al., 2006), which were administered on 2 occasions to a sample of people with schizophrenia. Traditional psychometrics, bifactor analysis, and item response theory methods were used to explore item functioning and dimensionality and to compare instruments. Despite containing similar item content, responses to the CGI-CogS demonstrated superior psychometric properties (e.g., higher item intercorrelations, better spread of ratings across response categories) relative to the SCoRS. The authors argue that these differences arise mainly from the differential use of prompts and how the items are phrased and scored. Bifactor analysis demonstrated that although both measures capture a broad range of cognitive functioning (e.g., working memory, social cognition), the common variance on each is overwhelmingly explained by a single general factor. Item response theory analyses of the combined pool of 41 items showed that measurement precision is peaked in the mild to moderate range of cognitive impairment. Finally, simulated adaptive testing revealed that only about 10 to 12 items are necessary to achieve latent trait level estimates with reasonably small standard errors for most individuals. This suggests that these interview-based measures of cognitive deficits could be shortened without loss of measurement precision.     

Schizotypy: An Organizing Framework for Schizophrenia Research

ABSTRACT— Schizophrenia is the most devastating form of psychopathology known to humankind, and it has been slow to yield clues to its origins. Meehl's (1962, 1990) model detailed the nature of the latent liability for schizophrenia known as schizotypy and provided a major organizing function for research on schizophrenia. The schizotypy model integrates genetic and environmental contributions to liability as well as accounting for a range of clinical outcomes, all deriving from a genuine liability for the illness. Schizotypy, as a latent personality organization that harbors the liability for schizophrenia, provides a framework for detecting fundamental features of liability to schizophrenia prior to the onset of clinical illness. The schizotypy model is reviewed, the strategic benefits of it are discussed, and methods for detecting schizotypy are presented. A focus on perceptual aberrations—a schizotypic feature—in individuals unaffected by schizophrenia has yielded valuable clues to preclinical disturbances in neurocognitive processes, risk for schizophrenia among biological relatives, and genomic substrates, all of which are of interest to schizophrenia researchers.     

The Draw-A-Person Test and Process-Reactive Schizophrenia

The Draw-A-Pcrson test was administered to three matched groups of 32 male Ss each: reactive schizophrenics, process schizophrenics, and normal control subjects. Patients were rated for prognosis using the Premorbid Subscale of the Phillips Scale. Drawings were rated by two judges on 80 diagnostic signs culled from the literature. No signs were found to significantly differentiate reactive and process schizophrenics, and only three signs significantly differentiated normals from schizophrenics. It was concluded that a sign approach to the DAP is insensitive to the reaction-process dimension of schizophrenia, and of only limited value in differentiating between normals and schizophrenics in general.     

Dimensions of premorbid functioning in schizophrenia: a review of neuromotor, cognitive, social, and behavioral domains

After a brief discussion of methods for studying the premorbid period in schizophrenia, the authors review relevant experimental literature to assess the validity of current theories. A critical review is provided that includes representative empirical investigations on premorbid functioning in schizophrenia in the domains of neuromotor, intellectual, academic, cognitive, social, emotional, and behavioral functioning. Limitations of past research, such as lack of specificity to schizophrenia populations, high incidences of false positives, questionable definitions of the premorbid period, inconsistent measures of premorbid functioning, and problems with the current method of DSM classification are discussed. Alternative approaches to studying early functioning in schizophrenia are highlighted.