The discriminative validity of the Whitaker Index of Schizophrenic Thinking

An attempt was made to assess the discriminative validity of the WIST with a sample of psychiatric inpatients. Through the use of a standardized structured interview and a diagnostic system for schizophrenia based on the use of discriminant function analysis with nonpathognomic symptom combinations, a reliable and valid system was used to establish the criterion diagnosis. Approximately 63% of patients reliably diagnosed as schizophrenic were detected via the WIST while only 14% of nonschizophrenic patients scored in the schizophrenic range on the WIST. The assets and liabilities of using the WIST to diagnose schizophrenia are discussed.     

An Evaluation of the Rorschach Method for the Study of Brain Injury

Hospitalized psychiatric patients (n = 115) completed either Form A or Form B of the Whitaker Index of Schizophrenic Thinking, along with the Beck Depression Inventory, State Anxiety Inventory, and the MMPI. Only error scores on the WIST were calculated in an effort to assess validity of the WIST for use in group testing situations where individual timing and administration is cumbersome. Results supported the convergent and discriminant validity of Form A where significant correlations were found with measures of thought disorder (M M PI F, Pt, Sc and Pa) but not with indices of other symptomatology, such as depression and anxiety. Form B did now show such validity, with only one significant correlation with other measures (MMPI Pd). Both WIST Forms correctly identified nonschizophrenics (76% for Form A and 73% for Form B) more often than schizophrenics (57% for each form). Also, Form A was found to be negatively related to years of education. Suggestions for further research on the influence of intelligence and social class variables on WIST scores were made. Overall, Form A emerged as the most valid WIST form, with suggestions for its clinical use being offered.     

Follow-up Validation of Rorschach Tempo and Color Use Indicators of Schizophrenia

Two to five year psychiatric follow-ups through a case register of original cross-validating samples for some Rorschach tempo and color use indicators of schizophrenia found subsequent diagnosis of schizophrenia associated (a) beyond the .001 level with certain deviations from normative tempo and (b) beyond the .01 level with presence of pure C or two or more of the following: 1–2 CF, Sum C 1.5–3.0, CF without C. Combined classification by the tempo and color variables was accurate in 90% of schizophrenic and 80% of nonschizophrenic cases manifesting neither or both variables. These findings, occurring within a population of psychiatric patients referred for testing, recommend the clinical utility of the variables.     

Sexualdelinquenz bei Schizophrenie

Studies suggest a complex relationship between schizophrenia and sexually offensive behaviour. This study aimed to preserve first findings of sex offence features and behaviours exhibited by psychotic men in Germany. Furthermore a typology of the schizophrenic offender group was developed. A comparative trial design was used to differentiate the psychotic and non psychotic offender group. A checklist was developed and applied to the records of 64 male restricted hospital order in-patients in Berlin with an index conviction for a contact sex offence against a woman. Social isolation, antisocial behaviour, psychosexual variables and adverse childhood experiences are found for schizophrenic and sexual offenders in general. Different sexual offensive behaviours appeared in the schizophrenic subgroups. Negative symptoms of schizophrenia as well as antisocial traits had a great impact on schizophrenic sexual offending. A heterogeneous group of psychotic offenders can be supposed.     

The Relation of Self-Hatred and Suicidality in People With Schizophrenia-Spectrum Symptoms

It is well known that depressive symptoms represent a risk for suicidality in general. It is less clear, however, that general depressive symptoms comprise a definite suicide risk factor for people with schizophrenia. Based on this, as well as on the early writings of E. Bleuler (1911/1987), it was hypothesized that there may be a particular aspect of depressive symptoms that combines with schizophrenia to encourage suicidality. Specifically, schizophrenia may impart to self-concept a quality of self-hatred that encourages suicidality in schizophrenic people. If so, then an index of self-hatred should be more correlated with suicidality among people with schizophrenia-spectrum symptoms than among people with fewer such symptoms. Two studies evaluated this possibility. In Study 1 on 243 suicidal outpatients affiliated with the military, self-hate and suicidality were more correlated among people with schizotypal symptoms than among other patients. In Study 2 on 113 VA psychiatric inpatients, self-hate and suicidality were more correlated among people with a diagnosis of schizophrenia than among patients with a diagnosis of major depression. Study limitations were noted, and it was suggested that self-hatred be a focus of suicide risk assessment in schizophrenic people.     

Hemispheric processing deficits in patients with paranoid schizophrenia

The purpose of the present study was to investigate hemispheric deficits in individuals with paranoid schizophrenia on four kinds of tasks: dichoptic viewing tasks involving verbal and nonverbal visual stimuli, and dichotic listening tasks involving verbal and nonverbal auditory stimuli. As dependent measures, both accuracy and speed of (correct) responding were measured. The sample recruited for this study consisted of 18 patients with paranoid schizophrenia, 15 outpatients with anxiety disorders, and 20 controls with no history of psychiatric disorders. Results indicated that, relative to the controls, the paranoid schizophrenic patients were less accurate and less efficient on auditory-verbal tasks requiring right hemisphere processing. Unlike the controls the paranoid schizophrenic patients manifested a lateralized left hemisphere advantage.     

Differentiating between schizophrenic and manic inpatients by means of the MMPI

Forty-five psychiatric inpatients with DSM-III diagnoses of schizophrenia and 31 inpatients with DSM-III diagnoses of bipolar disorder (and currently manic) were compared on the MMPI. Results indicated that although the schizophrenic patients achieved significantly higher scores on several of the MMPI scales (F, Pt, Sc, Si), these findings were of questionable clinical significance. On the other hand, the schizophrenic group did produce a significantly greater percentage of MMPI high-point pairs containing Scale 8(Sc): that is, 64.4% versus 35.5%.     

Hemispheric Processing Deficits in Patients with Paranoid Schizophrenia

The purpose of the present study was to investigate hemispheric deficits in individuals with paranoid schizophrenia on four kinds of tasks: dichoptic viewing tasks involving verbal and nonverbal visual stimuli, and dichotic listening tasks involving verbal and nonverbal auditory stimuli. As dependent measures, both accuracy and speed of (correct) responding were measured. The sample recruited for this study consisted of 18 patients with paranoid schizophrenia, 15 outpatients with anxiety disorders, and 20 controls with no history of psychiatric disorders. Results indicated that, relative to the controls, the paranoid schizophrenic patients were less accurate and less efficient on auditory-verbal tasks requiring right hemisphere processing. Unlike the controls, the paranoid schizophrenic patients manifested a lateralized left hemisphere advantage.     

Theory of Mind in schizophrenia: first person vs third person perspective

Patients suffering from schizophrenia have an impaired meta-representation also known as Theory of Mind (ToM). Moreover, the presence of delusions or other positive symptoms of schizophrenia has been correlated to poor ToM performances. Lack of insight is a common symptom of schizophrenia and can be considered a critical manifestation of impaired ToM abilities. In particular, the present study addresses the role of perspective ToM ability in schizophrenic patients. Thirty severely delusional schizophrenic patients completely lack insight when interviewed about their delusions. Seven subsequently gain insight about their mental state when perspective is shifted from the first person to third person. These data suggest that in some delusional schizophrenic patients, it may be possible to gain access to and modify their mental states.     

Exaggerated leftward bias in the mental number line of patients with schizophrenia

Several visuo-motor tasks can be used to demonstrate biases towards left hemispace in schizophrenic patients, suggesting a minor right hemineglect. Recent studies in neglect patients used a new number bisection task to highlight a lateralized defect in their visuo-spatial representation of numbers. To test a possible lateralized representational deficit in schizophrenia, we used the number bisection task in 11 schizophrenic patients compared to 11 healthy controls. Participants were required to orally indicate the central number of an interval orally presented. Whereas healthy subjects showed no significant bias, schizophrenic patients presented a significant leftward bias. Therefore, these results suggest an impairment in higher order representations of the number space in patients with schizophrenia, an impairment that is qualitatively similar to the deficit described in neglect patients.     

Determination of fucokinase activity in the blood of schizophrenic patients

An investigation was conducted into whether dopamine induces an alteration in the fucolysation of glycoproteins, starting from the dopamine hypothesis of schizophrenia and taking the fucokinase activity determined in erythrocytes of schizophrenic patients as parameter. As with patients with "schizoaffective psychosis" and those with manic-depressive disorders, who were likewise examined, it was found that the enzyme activity of schizophrenic patients was no different than that found in the blood of a control group.     

Reported childhood trauma and suicide attempts in schizophrenic patients

Childhood traumas are associated with suicidal behavior but this aspect has not been examined in relation to schizophrenia. In this study, 50 chronic schizophrenic patients who had attempted suicide were compared with 50 chronic schizophrenic patients who had never attempted suicide for their scores on the 34-item Childhood Trauma Questionnaire (CTQ). It was found that schizophrenics who had attempted suicide reported significantly higher CTQ scores for emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect than schizophrenics who had never attempted suicide. Therefore, childhood trauma may be a risk factor predisposing schizophrenic patients to attempt suicide.     

Deficits of subliminal self-face processing in schizophrenia

Most studies show that self-processing in schizophrenia is impaired at the supraliminal level. Schizophrenic patients generally lack the ability to prioritize the processing of self-related information, such as their own face. However, some evidence suggests that schizophrenic patients may retain intact subliminal processing abilities even though their conscious experiences are compromised. We conducted the first study exploring schizophrenic patients’ subliminal self-face processing. Using a breaking continuous flash suppression (bCFS) paradigm, we interocularly suppressed face images (self, famous, and unknown faces). Participants’ reaction times to detect the faces when they broke the suppression were recorded as an index for the subliminal processing of faces. Unlike the healthy controls, schizophrenic patients did not demonstrate a processing advantage for their own face when it broke interocular suppression; only a face familiarity effect was found. These findings contribute to the understanding of self-processing deficits in schizophrenia.     

自然自明性的失落——Blankenburg精神分裂理论述评

传统的精神分裂研究,关注的主要是精神分裂的妄想症候群。因为精神分裂中相对特殊的症状,在妄想形式中可以得到最轻易的把握。Blankenburg则认为:精神分裂的本质结构变异是先于妄想的。因此,他致力于在精神分裂的症状贫乏型(主要是青春型和单纯型)中,寻找精神分裂的本质变异。他发现:精神分裂异常中的核心缺损是自然自明性的失落。根据胡塞尔的超越现象学,自然自明性失落有四个原因:与世界关系的改变、时间建构的改变、自我建构的改变、交互主体性的改变。Blankenburg的精神分裂理论,作为二十世纪有关精神分裂的最重要工作之一,对于今天的精神分裂研究仍然有极其重要的意义。     

Tatbilder schizophrener und wahnhafter Täter

Besides the ongoing discussion on whether persons with schizophrenia have a higher prevalence of criminal offences, it is also of special interest for the prognosis in this group of offenders whether there is a causal relationship between the schizophrenic disease and the type of delinquency. For the construction of causal relationships it is important to determine a typology of offences committed by schizophrenic persons. This article deals with the problem by analyzing the offences of 133 patients diagnosed with schizophrenia, schizo-affective and delusional disorders at the Landschaftsverband Westfalen-Lippe (LWL) Center for Forensic Psychiatry in Lippstadt.     

Optimizing treatment of schizophrenia. Enhancing affective/cognitive and depressive functioning

Recognition and treatment of schizophrenia has largely focused on positive symptoms of the disorder, such as delusions, hallucinations, and disorganization. However, other important symptoms, such as depression, cognition, and social functioning, have not received comparable attention. Fifty percent of schizophrenic patients suffer from comorbid depression, which is a major risk factor for suicide in this population, while 10% to 25% suffer from comorbid obsessive-compulsive disorder. Cognitive deficits commonly observed in patients with schizophrenia include problems with concentration, attention, and memory, as well as problem-solving and verbal skills. These deficits are observed at early stages of the illness and can predict deficits in functional capabilities, such as occupational and social skills, educational attainment, and the ability to live independently. The severity of such impairments affects all patient in this population, including up to 10% of patients working full time and up to one third of those working part time. In light of the debilitating effects of depression, cognitive impairment, and other aspects of affective functioning on the quality of life of patients with schizophrenia, physicians need to partner with their patients to address these concerns and determine an appropriate treatment regimen. This can be done with simple functional-based cognitive questioning, the use of evidence-based psychosocial practices, and psychoeducation on the many pharmacotherapeutic options. It is recommended that depressive or suicidal symptoms of schizophrenia be treated with an antidepressant or mood stabilizer only if the symptoms have not subsided after treatment of the psychosis with an atypical antipsychotic. Additionally, relative to older medications, atypicals have demonstrated benefit in improving some of the cognitive impairments.     

Revisiting the association of aggression and suicidal behavior in schizophrenic inpatients

Our study investigated the association of aggression and suicidal behavior in schizophrenic inpatients. Eight thousand nine hundred one admissions for schizophrenia (1998-2007) to a psychiatric university hospital were included. Schizophrenic suicides (n = 7)/suicide attempters (n = 40) were compared to suicides (n = 30)/suicide attempters (n = 186) with other diagnoses and to schizophrenic non-attempters regarding aggression. Logistic regression analysis was performed to explore risk factors for attempted suicide. Schizophrenic suicides/suicide attempters did not differ from other suicides/suicide attempters or from schizophrenic non-attempters with regard to aggression. Risk of inpatient suicide attempt was increased for patients with attempted suicide at admission, high school graduation, and disorganized subtype. Aggression could not be found to be a predictor of attempted suicide. Aggression seems to have a minor role for suicidal behavior in schizophrenia.     

Cerebral evoked responses in schizophrenia

Results of previous studies of evoked responses in schizophrenic disorders are reviewed, and data from a new study of somatosensory recovery functions in schizophrenia are presented. Subjects in the latter study were 18 schizophrenic patients and 18 nonpatients matched for age and sex. Latencies and amplitudes of eight consecutive evoked-response peaks were measured. Only one amplitude and one latency of the response to the first stimulus discriminated between patients and controls, whereas four amplitudes and three latencies of the second response did so. Amplitude recovery was less in patients, whereas latency recovery was greater. The data verified previous findings of impaired amplitude recovery in schizophrenia, but did not confirm previous findings of increased amplitude in response to a single stimulus. Evoked-response deviations so far determined are not specific to schizophrenic disorders, inasmuch as they have been found in several other psychiatric syndromes. The data are in accord with the idea that psychiatric disorders involve deviant cerebral processing of sensory information.     

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.     

Copying strategies and memory on the Complex Figure Test in psychiatric patients

We assessed three copying strategies on the Rey-Osterrieth Complex Figure Test among 50 psychiatric patients. The strategies were featural (detail-focused), contextual (framework-focused), and mixed. Reliable classification of each patient's copying strategy showed 7 patients used a featural and 7 patients used a contextual strategy. The remaining 36 used a mixed strategy involving both elements. Analysis indicated that patients who met DSM-III-R criteria for schizophrenia tended to use a mixed strategy. Nonschizophrenic patients also favoured the mixed approach. Moreover, when subjects were divided into groups based on their strategies, there were no differences in copying accuracy. However, the groups differed on immediate and delayed recall of the Complex Figure Test. Patients who adopted a featural strategy on the copy trial had the lowest recall scores. "Process" variables may be important in understanding neurocognitive functioning in schizophrenia; however, there is little evidence that schizophrenic patients use copying strategies consistent with lateralized impairment of brain function.