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.     

Recognition of posed and genuine facial expressions of emotion in paranoid and nonparanoid schizophrenia

Most previous research reporting emotion-recognition deficits in schizophrenia has used posed facial expressions of emotion and chronic-schizophrenia patients. In contrast, the present research examined the ability of patients with acute paranoid and nonparanoid (disorganized) schizophrenia to recognize genuine as well as posed facial expressions of emotion. Evidence of an emotion-recognition deficit in schizophrenia was replicated, but only when posed facial expressions were used. For genuine expressions of emotion, the paranoid-schizophrenia group was more accurate than controls, nonparanoid-schizophrenia patients, and depressed patients. Future research clearly needs to consider the posed versus genuine nature of the emotional stimuli used and the type of schizophrenia patients examined.     

An event-related brain potential substrate of disturbed response monitoring in paranoid schizophrenic patients.

Response monitoring in schizophrenic patients and healthy controls was assessed by measuring performance and event-related brain potentials in the flanker priming task. Three visual-context conditions were construed: Flankers and targets pointed either into the same direction or into different directions. Stimuli without any response assignment were used as flankers in the neutral context condition. The schizophrenic patients were further subdivided into paranoid (n = 19) and nonparanoid (n = 10) patients and compared with healthy controls (n = 18). Performance scores revealed that the flankers induced a similar degree of distraction by visual context in all 3 groups. Although the schizophrenic patients showed normal error correction performance, the error negativity (NE) was significantly reduced in paranoid schizophrenic patients. The attenuation of the NE possibly reflects disturbed response monitoring in these patients.     

Primary process content in paranoid schizophrenic speech

Free speech samples given by paranoid schizophrenics, nonschizophrenic paranoids, and nonpsychotic psychiatric patients were submitted to computerized content analysis. Speech samples were searched for words belonging to the Regressive Imagery Dictionary (Martindale, 1975), which yields a well-validated measure of primary process content. Three word-concreteness dictionaries were also employed. Compared to the other groups, paranoid schizophrenics produced speech higher in primary process content as well as in transitive verb concreteness. Results are consistent with psychoanalytic theory.     

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.     

Temperament and character inventory in homicidal, nonaddicted paranoid schizophrenic patients: a preliminary study

This study assessed the personalities of 13 murderer schizophrenics using Cloninger's Temperament and Character Inventory, controlling different factors such as institution, treatment, detention or loss of liberty, and can discriminate between schizophrenic patients involved in homicide, schizophrenics with no past violent behavior, paranoiac murderers, and imprisoned murderers with no psychiatric history. Results show significantly that murderer schizophrenics had significantly higher scores on the subscale, Self-transcendence, than other groups, which suggests that Self-transcendence as measured may be an aggravating factor for schizophrenia and may be found in the personality of schizophrenic subjects who performed homicidal acts. This dimension constitutes a way and an additional element for diagnosis not available with the DSM-IV criteria. It may help understanding and predicting violent behavior among schizophrenic patients.     

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.     

Depression and suicide in schizophrenic patients

This study supports the idea that schizophrenic patients represent a distinctive subgroup of patients who can suffer from a major depressive illness and also can commit suicide. The study showed that 22.4% of the schizophrenic population in a medium-sized psychiatric facility showed severe depressive symptoms that met the criteria for the diagnosis of a major depressive episode according to the DSM-III classification. Seven patients committed suicide during the acute phase of the illness--five during hospitalization, and two within a year of discharge. Nine patients attempted suicide during the hospitalization period, and 10 attempted suicide within a year of discharge. Nearly one-third (215) of the patients were readmitted during that year because of a recurrence of acute schizophrenic symptoms; of these, 84 were having severe depressive symptoms. The study also provides indications of the causes of suicide in these patients.     

Concurrent and predictive electrodermal correlates of symptomatology in recent-onset schizophrenic patients.

Electrodermal activity and symptomatology were interrelated in a group of 56 male and 13 female recent-onset schizophrenic patients. Electrodermal activity was indexed by the frequency of nonspecific skin conductances responses and the number of trials to habituation of the skin conductance orienting response. Symptomatology was assessed by the Brief Psychiatric Rating Scale (BPRS) on two separate test occasions. The first test occasion was during the inpatient period when psychotic symptoms were prevalent and medications were variable. The second test occasion was several months later during an outpatient period when symptoms were stabilized and medications held constant. Electrodermal activity was positively and significantly related to a number of symptoms in male patients, most reliably the BPRS factors Activation and Hostility/Suspiciousness. These relationships were most consistent during the outpatient period. Of particular theoretical interest, greater electrodermal activity during the inpatient period was associated with greater outpatient psychopathology. The results suggest that heightened inpatient electrodermal activity is predictive of poor short-term symptomatic recovery in recent-onset, acute, male schizophrenic patients.