Smooth-pursuit eye tracking in first-episode psychotic patients and their relatives.

We wished to determine the specificity of smooth-pursuit eye tracking dysfunction to schizophrenia and the prevalences of dysfunction among functionally psychotic and normal individuals. Therefore, we investigated pursuit tracking in a large sample of psychotic patients, normal subjects, and first-degree relatives (N = 482). Patients were recruited as part of an epidemiological study of first-episode psychosis that used a broadly based referral network to identify all cases in a major metropolitan area over a 2 1/2-year period. Patients received diagnoses of schizophrenia, schizophreniform disorder, psychotic mood disorder, and paranoid or other psychotic disorder based on the third edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1980). The distribution of tracking performance was bimodal for the schizophrenic patients and their relatives, perhaps reflecting major gene action. Moreover, poor tracking ran in families. Pursuit tracking dysfunction was relatively specific to schizophrenic patients and their relatives and occurred infrequently in other psychotic patients and normal subjects.     

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.     

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.     

Cavum septi pellucidi in first-episode patients and young relatives at risk for schizophrenia

Studies on schizophrenia (SZ) have documented an increased presence of cavum septi pellucidi (CSP) in individuals suffering from the illness. Moreover, the presence of CSP has been cited in support of the early neurodevelopmental hypothesis in SZ. Our objective was to assess the magnetic resonance imaging (MRI) scans of first-episode patients and healthy controls to evaluate the frequency of CSP. The presence and the size of CSP were visually assessed on the MRI scans of 40 first-episode SZ patients, 19 nonpsychotic child and high-risk adolescent offspring of patients with SZ or schizoaffective disorder, and 59 controls. Our analysis revealed an absence of statistically significant differences in the occurrence of CSP between SZ patients, high-risk subjects, and controls. Even when the analysis was restricted to large CSP, no differences were found. Furthermore, no association between CSP and sex or handedness was observed. The absence of CSP abnormalities in first-episode SZ subjects might indicate that SZ is not characterized by developmentally mediated alterations in CSP. Also, family history of SZ might not increase likelihood for CSP.     

Basic anxieties affecting psychiatric staff and their attitudes to psychotic patients

SUMMARY

Institutions can be used by their individual members to strengthen mechanisms of defence, especially against early paranoid and depressive anxieties. This is not to imply that institutios become psychotic, but that we would expect to find in them manifestations of unreality, splitting, hostility, suspicion and other forms of maladaptive behaviour which are the equivalent of psychotic symptoms of an individual.

This paper describes some of the attitudes of those who care for psychotic patients in a hospital setting. These attitudes seem to be influenced by basic fears that are provoked by the relationship with the patients and by coming in contact with their needs and disturbance from a position of responsibility. Such fears are accompanied by phantasies and are related to specific defence mechanisms.     

Quality of life assessment in Turkish patients with schizophrenia and their relatives

Quality of life of first-degree relatives living in the same household with patients having schizophrenia has not been sufficiently explored. 30 patients with schizophrenia (16 women, 14 men), diagnosed using DSM-IV criteria, 31 of their relatives (15 women, 16 men), and 34 control subjects (21 women, 13 men) were included in the study. The mean age of the patients, their relatives, and the control subects were 39.8 +/- 10.9, 58.1 +/- 12.5 and 37.3 +/- 17.0, respectively. The World Health Oranization Quality of Life-Brief Form was administered to all subjects. Quality of life was worse for the patient group than for their relatives and control subjects, but relatives of the patients and control subjects were not significantly different on Quality of life. Quality of life was negatively correlated with the severity of psychopathology and extrapyramidal side effects induced by antipsychotic drugs in the patients.     

Spatial ability in classic dancers and their perceptual style

The relation between spatial ability (body orientation and body awareness) and field dependence/independence was assessed by measuring performance on the Embedded Figures Test and WISC or WAIS Block Design at four different training levels in classical ballet, beginners to advanced, and a control group with no training in ballet, gymnastics, or sports (n = 70). No significant correlation was found between perceptual style or Block Design performance and body orientation or body awareness at any of the four levels of training. No significant differences were observed between the advanced group and the control group. Training in a particular type of spatial skill such as orientation within surrounding space was not related to the skill required to manipulate an abstractly represented space.     

Immune disorders and handedness in dyslexic boys and their relatives

Thirty dyslexic and 30 control boys aged 7–11 years were compared for frequency of immune disorders and handedness as well as for family history of immune disorders and learning disabilities (dyslexia and stuttering). They were also compared for neurological status and for history of speech and language difficulties. There were no significant differences between the two groups in the frequency of immune disorders and in handedness. The results showed significantly more dyslexic boys with soft neurological signs and signs of speech and language disorders. The frequency of dyslexia was significantly higher in the relatives of the dyslexic boys. Also significantly more mothers of the dyslexic boys reported difficulties during pregnancy and complications at delivery. The results are discussed in terms of Geschwind's hypothesis and neuromaturational delay as possible determinants of developmental dyslexia.     

Position,direction, and their perceptual integrality

Subjects were shown an arrow inside a rectangle and were asked to decide on either its vertical direction (up vs. downl or its height (high vs. low) as quickly as possible. Whenever vertical direction was criterial, height was irrelevant, and vice versa. In four conditions, the irrelevant dimension (1) did not vary, (2) covaried positively with the criterial dimension, up with high and down with low, (3) covaried negatively with the criterial dimension, up with low and down with high, or (4) varied orthogonally with the criterial dimension. Height and vertical direction satisfied one of W. R. Garner’s prerequisites for “integral” dimensions in that Condition 4 took longer than Condition 1. But Condition 2 was faster than 1, and 3 was slower than 1, a pattern unlike those of other known integral dimensions. The positive correlation in Condition 2 facilitates, and the negative correlation in 3 interferes, it is argued, because height and vertical direction have interpretations with components in common or in conflict. This research was supported in part by Grant MH 20021 from the National lnstitute of Mental Health.     

Expressed emotion and familial interaction: a study with agoraphobic and obsessive-compulsive patients and their relatives

Patients with panic disorder with agoraphobia (n = 40) or obsessive- compulsive disorder (n = 61) participated in a 10-min problem-solving interaction with their primary relative. Relatives were categorized as hostile or nonhostile toward the patient on the basis of a measure of expressed emotion (EE). Observed interactions between patients and their hostile relatives, relative to those of dyads with a nonhostile relative, were marked by higher rates of relatives' criticism and of patients' negativity but not by higher rates of negative reciprocity. Analyses of sequences indicated that the dyads with a hostile relative had a higher rate of sequences in which the relative was first critical and the patient then negative than was the case for dyads with nonhostile relatives. Moreover, hostile relatives were more frequently critical than nonhostile relatives whether patients' preceding behavior was positive, negative, or neutral. The findings are consistent with the stress-vulnerability model of the effect of EE on mental health, in that patients living with a high EE relative appear to be exposed to higher levels of interpersonal stress.     

The role of recollection in source memory: an examination of schizophrenia patients and their first-degree relatives

Source recognition memory deficits have repeatedly been observed in people with schizophrenia (SZ), and have also recently been observed in their first-degree relatives. These deficits have been hypothesized to result, at least in part, from impairments in the conscious recollection process. Although other processes are clearly also affected in SZ, it has been proposed that impairments in the conscious recollection process could be a parsimonious explanation for the source memory deficits observed in their relatives. Here, we tested 25 patients with SZ and 34 of their non-affected parents, as well as two groups of matched healthy controls, on a short-term associative memory task that shares the characteristics of standard source recognition tasks but minimizes the need for recollection of stored information from memory. This task was administered in order to determine if deficits can still be observed in these people when involvement of the conscious recollection process is minimized. We observed deficits on our short-term source memory task in people with SZ, but their first-degree relatives did not share this deficit. These results support the idea that multiple memory processes supporting associative/source memory are affected in SZ, whereas the source memory deficits previously observed in relatives of SZ seem specific to tasks that rely on the conscious recollection process.     

Tactile perceptual processes and their relationship to somatoform disorders

The Somatic Signal Detection Task (SSDT) is a recent paradigm serving to examine perceptual processes likely relevant for somatoform disorders. We tested whether touch illusions are more easily induced in individuals suffering from somatoform disorders (SFD) and whether their perceptual threshold for tactile stimuli is lower compared to healthy controls. Thirty-three participants with SFD and 32 healthy controls reported whether they recognized near-threshold tactile stimuli at their fingertip, which were presented in half of the test trials. With a probability of 0.5, an auxiliary visual stimulus was additionally presented. Tactile detection thresholds, tactile sensitivity, response bias, and the rate of false-positive perceptions of the tactile stimulus were assessed. In both groups, the light stimulus led to an amelioration of tactile sensitivity as well as to a more liberal response style. The SFD group was characterized by a more liberal response bias in the first half of the light-absent condition compared to the healthy controls. Within the SFD group, the report of somatoform (especially pseudoneurological) symptoms correlated positively with illusory tactile perceptions in the SSDT. Tactile thresholds in the SSDT were measured reliably (rtt = .86) and were significantly lower in the SFD group. The notion that general perceptual dispositions influence the formation of symptom perception may thus complement cognitive models of SFD.     

Schizotypy in relatives of patients with schizophrenia

Previous studies indicate that relatives of patients with schizophrenia are more likely to present characteristics of schizotypal personality than the general population. Few transcultural studies of schizotypy have been carried out. Most instruments constructed to measure schizotypy have been applied in specific cultures; conceivably, in other populations its components may be distributed in different ways. These cultural differences may affect the relations between schizotypy and schizophrenia. The objective of this study is to obtain data on schizotypy in relatives of patients with schizophrenia and relatives of patients with other disorders in a Latin American rural population. The results suggest that cultural factors must be taken into account in order to establish the relationship between schizotypy and schizophrenia.     

Anhedonia and emotional numbing in combat veterans with PTSD

We explored relationships between anhedonia and posttraumatic stress disorder (PTSD) symptom clusters, including their role in predicting psychiatric comorbidity. Our measure of anhedonia was derived from an examination of the latent structure of the Beck Depression Inventory. We found evidence for a two-factor solution, leading to anhedonia and undifferentiated, global depressive symptoms scales. In primary analyses, anhedonia had a unique positive relationship with PTSD's emotional numbing symptoms and minimal relationships with other PTSD symptoms. Upon examining the incremental validity of appetitive functioning (i.e., anhedonia, emotional numbing) over and above aversive functioning (i.e., re-experiencing, avoidance, and hyper-arousal PTSD symptoms) variables, greater emotional numbing increased the likelihood of being diagnosed with a major depressive disorder, and greater anhedonia increased the likelihood of being diagnosed with additional anxiety disorders and to a lesser extent, psychotic disorders. Results were consistent with research on the distinction of appetitive and aversive functioning, providing insight into the nature of PTSD.     

Kinematic cues in perceptual weight judgement and their origins in box lifting

When accepting a parcel from another person, we are able to use information about that person’s movement to estimate in advance the weight of the parcel, that is, to judge its weight from observed action. Perceptual weight judgment provides a powerful method to study our interpretation of other people’s actions, but it is not known what sources of information are used in judging weight. We have manipulated full form videos to obtain precise control of the perceived kinematics of a box lifting action, and use this technique to explore the kinematic cues that affect weight judgment. We find that observers rely most on the duration of the lifting movement to judge weight, and make less use of the durations of the grasp phase, when the box is first gripped, or the place phase, when the box is put down. These findings can be compared to the kinematics of natural box lifting behaviour, where we find that the duration of the grasp component is the best predictor of true box weight. The lack of accord between the optimal cues predicted by the natural behaviour and the cues actually used in the perceptual task has implications for our understanding of action observation in terms of a motor simulation. The differences between perceptual and motor behaviour are evidence against a strong version of the motor simulation hypothesis. A. F. de C. Hamilton and D. W. Joyce have contributed equally to this work.     

Modified group therapy for psychotic and depressed patients

This paper describes a group treatment program for chronically ill patients which has been found to be more economical than traditional modalities of treatment of such patients and to minimize transference and countertransference problems. Technical guidelines and the theoretical rationale are discussed, as are the therapeutic factors in such a group. Case vignettes are given to illustrate both the group process and the individual patient's use of the group.The authors are deeply grateful to the residents of the department who, as cotherapists, shared in the planning and work of the coffee lounge groups. Invaluable to us also were the interest and ideas of Dr. Donald Miller who served as a consultant to this project.This is a revised version of a paper presented at Grand Rounds, Montefiore Hospital and Medical Center, Bronx, N.Y. in September, 1975.Miss Emery is, and Mrs. Levitan was, a social worker at Montefiore Hospital and Medical Center, Bronx, N.Y. Mrs. Levitan was formerly Principal Associate in Psychiatry (Social Work), Albert Einstein College of Medicine. Dr. Gadlin is Director of the Group Therapy Training Program at Montefiore Hospital and Medical Center, and Assistant Professor, Albert Einstein College of Medicine.