Cognition in schizophrenia: does working memory work?

Recent research suggests that disturbances in social and occupational functioning in individuals with schizophrenia may be more influenced by the severity of cognitive deficits than by the severity of symptoms such as hallucinations and delusions. In this article, I review evidence that one component of cognitive dysfunction in schizophrenia is a deficit in working memory, associated with disturbances in the dopamine system in dorsolateral prefrontal cortex. I suggest that although the cognitive deficits in schizophrenia include working memory dysfunction, because they arise from a disturbance in executive control processes (e.g., the representation and maintenance of context), they extend to a range of cognitive domains. Finally, I discuss the need for further research on the ways in which contextual processing deficits may influence other aspects of this illness, including emotional processing.     

REEXAMINING SCHREBER THROUGH THE LENS OF A PRESENT‐DAY CASE: FANTASIES OF DEATH,REBIRTH, AND GENDER TRANSFORMATION

In the history of psychoanalysis, the Schreber case has long been a source of controversy. Speculations about Schreber have abounded essentially because none of the speculators, including Freud ( 1911 ), has been constrained by the reality of interactive dynamics with Schreber on the couch. This author contends, however, that knowing someone analytically must involve the transference experience. He presents the case of Z, a middle‐aged patient of his who described a fantasy that was uncannily similar to Schreber's, permitting a present‐day reexamination of the original case, as well as ongoing speculations that include the way in which live clinical material can interact with the reading of a historical document.     

基于努力决策任务在精神分裂症患者动机缺失评估中的应用

国外运用基于努力决策任务,与阴性症状量表和访谈相结合,对精神分裂症患者的阴性症状特别是动机缺失进行研究。本文从基于努力决策任务出发,重点介绍该任务范式及其在精神分裂症患者动机缺失评估中的最新研究,并从心理学、神经生物学和脑神经科学三个维度,阐述动机缺失的认知神经机制,论文结尾讨论了该任务范式在评估精神分裂症患者或其他患者动机缺失中可能遇到的挑战,以及未来的发展趋势。     

John Nash: Three Phases in the Career of a Beautiful Mind

This article is the Helen Flanders Dunbar Lecture presented at Columbia-Presbyterian Hospital in New York City in 2002, the centennial year of her birth. It focuses on three periods in the evolution of Nash’s mental illness, the predelusional, delusional, and postdelusional periods, and provides a psychoanalytic interpretation of each. Donald Capps is Professor of Pastoral Psychology at Princeton Theological Seminary. His books include Men, Religion, and Melancholia (1997), Living Stories: Pastoral Counseling in Congregational Context (1998), Social Phobia: Alleviating Anxiety in an Age of Self-Promotion (1999), Jesus: A Psychological Biography (2000), Giving Counsel: A Minister’s Guidebook (2001), Men and Their Religion: Honor, Hope, and Humor (2002), and A Time to Laugh: The Religion of Humor (2005). He has served as President of the Society for the Scientific Study of Religion and has an honorary doctorate in theology from the University of Uppsala, Sweden. Correspondence to Donald Capps, joan.blyth@ptsem.edu     

精神分裂症患者的情绪调节

日常生活中, 个体通常有不同的理想与目标, 当个体被特定的目标驱动, 试图去影响自身将要体验到的情绪类别、将要体验到的情绪感受发生的时间, 以及如何体验、表达此种情绪时, 情绪调节就发生了。精神分裂症是一种复杂的精神疾病, 该类疾病患者普遍存在情绪方面的缺陷, 通过操控各种内外因素, 可以帮助精神分裂症患者进行有效的情绪调节, 有利于帮助他们构建健全的情绪体验, 对促进其身心健康发展具有现实临床意义。     

The relationship between history of violent and criminal behavior and recognition of facial expression of emotions in men with schizophrenia and schizoaffective disorder

Social psychological research underscores the relation between aggression and emotion. Specifically, regulating negative affect requires the ability to appraise restraint‐producing cues, such as facial signs of anger, fear and other emotions. Individuals diagnosed with major mental disorders are more likely to have engaged in violent behavior than mentally healthy members of the same communities. We examined whether violent and criminal behavior in men with schizophrenia is related to emotion recognition abilities. Forty‐one men with schizophrenia underwent a computerized emotion discrimination test presenting mild and extreme intensities of happy, sad, angry, fearful and neutral faces, balanced for gender and ethnicity. History of violence was assessed by the Life History of Aggression Scale and official records of arrests. Psychopathology was rated using the Positive and Negative Symptom Scale. Criminal behavior was associated with poor emotion recognition, especially for fearful and angry facial expressions. History of aggression was also associated with more severe positive symptoms and less severe negative symptoms. These findings suggest that misinterpretation of social cues such as angry and fearful expression may lead to a failure in socialization and adaptive behavior in response to emotional situation, which may result in a higher number of criminal arrests. Aggr. Behav. 32:1–8, 2006. © 2006 Wiley‐Liss, Inc.     

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.     

循证医学在精神分裂症治疗中的应用

目前对精神分裂症的治疗未取得令人满意的疗效。循证医学是遵循科学证据的临床医学,是临床流行病学和现代信息学与临床医学结合的典范。将循证医学应用在精神分裂症的治疗中,有利于提高精神分裂症的治疗效果。     

Social and non‐social measures of cognition for predicting self‐reported and informant‐reported functional outcomes in early psychosis

The main aim of this study was to investigate the individual contributions of neurocognitive and social‐cognitive domains to self‐reported and informant‐reported functional outcome in early psychosis. We also sought to further characterize the nature of cognitive impairments in this sample and explore the interrelationships between the social‐cognitive measures and how they correlate with measures of neurocognition and clinical symptoms. In this study, 70 patients (mean age: 24.1; 87.1% males) with primary psychotic disorder diagnosed in the previous 5 years were assessed on multiple neurocognitive (processing speed, attention, working memory, immediate verbal memory, delayed recall, visual reasoning, inhibition, planning, cognitive flexibility), and social‐cognitive domains (theory of mind (ToM), emotion recognition, attributional style, metacognitive overconfidence) as well as measures of clinical symptoms. Functional outcome was assessed with three self‐reports and two informant‐reports. On average, patients performed one or more SD below healthy controls on measures of delayed recall, ToM and metacognitive overconfidence. Emotion recognition and ToM were intercorrelated and correlated with multiple neurocognitive domains and negative symptoms. Attributional style correlated with positive symptoms. In the context of multiple variables, self‐reported functional outcomes were predicted by attributional style, whereas emotion recognition and immediate verbal memory predicted variance in informant‐reported community functioning. These results support the suggestion of a likely distinction between the predictive factors for self‐reported and informant‐reported functional outcome in early psychosis and suggest that consideration of self‐assessment of functional outcome is critical when attempting to evaluate the effects attributional style has on functional disability.     

Schizophrenia,psychoeducation and group psychoanalysis: Contributions and limitations

Schizophrenia involves difficulties with aspects of relating that make traditional psychotherapeutic practices more difficult. Drawing on the observation of a psychoeducation group comprising 10 patients with schizophrenia (primarily paranoid schizophrenia) we highlight group processes that help show how the conduct of psychoeducational groups can benefit from a group therapy approach. In the research example discussed, we review a psychoeducation group which took place over a period of one year at a day hospital, facilitated by professionals trained in psychoanalytic group psychotherapy.