Relation between current diagnostic criteria for schizophrenia and the dimensions of premorbid adjustment, paranoid symptomatology, and chronicity.

46 broadly defined schizophrenics were diagnosed according to 7 current diagnostic criteria for schizophrenia, and the subtyping dimensions of premorbid adjustment, paranoid symptomatology, and chronicity were assessed. Despite the minimal overlap between many of these criteria, samples selected by each of these systems were comparable in terms of the 3 subtyping dimensions. Results indicate that patients diagnosed as schizophrenic by each of these criteria were similar to schizophrenics who failed to meet those particular criteria with respect to premorbid adjustment, paranoid symptomatology, and chronicity. (39 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Embedded figures performance of schizophrenics as a function of chronicity, premorbid adjustment, diagnosis and medication.

Presents data on the Embedded Figures Test (EFT) performance of 487 schizophrenics and other hospitalized patients divided in terms of chronicity, premorbid adjustment, diagnosis, and medication. Results indicate that chronicity was related to EFT performance, with chronic Ss generally more field dependent than acute Ss. Some schizophrenics, however, were relatively field dependent when entering the hospital and did not change with extensive hospitalization. Medication interacted with premorbid adjustment and diagnosis, with the medicated poor paranoid performing in a field-independent manner while the nonmedicated poor paranoid was quite field dependent. The effects of institutionalization are discussed. (21 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Skin conductance basal level and reactivity in schizophrenia as a function of chronicity, premorbid adjustment, diagnosis, and medication.

Examined the skin conductance basal level and GSR of 384 male schizophrenics divided into subgroups according to chronicity, premorbid adjustment, diagnosis, and medication. 10 male psychiatric aides served as normal controls. Results indicate that basal level differences between schizophrenic subgroups or between schizophrenics and normals were mainly due to long-term institutionalization. The novelty of the experimental situation, as contrasted with the usual minimal stimulation domicile of the chronic patient, resulted in extensive responsivity not exhibited by the acute schizophrenic, other hospitalized patients, or normals. An interaction of premorbid adjustment and diagnosis within the chronicity subgroups was also found. The GSR differences between schizophrenic subgroups were primarily due to begin on or off medication, and this was mainly evident in the premorbid adjustment grouping. The results of an examination of social censure stimulus effects were not supportive of a social censure hypothesis. (35 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronicity, severity, and timing of maternal depressive symptoms: Relationships with child outcomes at age 5.

The relationships between severity, chronicity, and timing of maternal depressive symptoms and child outcomes were examined in a cohort of 4,953 children. Mothers provided self-reports of depressive symptoms during pregnancy, immediately postpartum, and when the child was 6 months old and 5 years old. At the age 5 follow-up, mothers reported on children's behavior and children completed a receptive vocabulary test. Results suggest that both the severity and the chronicity of maternal depressive symptoms are related to more behavior problems and lower vocabulary scores in children. The interaction of severity and chronicity of maternal depressive symptoms was significantly related to higher levels of child behavior problems. Timing of maternal symptoms was not significantly related to child vocabulary scores, but more recent reports of maternal depressive symptoms were associated with higher rates of child behavior problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronicity of back problems during working life

STUDY DESIGN: A follow-up study of a cohort of 444 patients aged 16 to 59 years who consulted with their general practitioners (GPs) in 1987-1988 for an incident episode of back pain. OBJECTIVES: To determine the proportion of patients with back pain in whom chronic back problems develop after a follow-up of 7 years, to compare health outcomes and labor force participation of patients with and without chronic back problems and to identify determinants of chronicity. SUMMARY OF BACKGROUND DATA: The incidence and prevalence of back pain are very high. A large proportion of the costs related to medical consumption, absence from work, and disability are probably caused by chronic back problems. It is unknown what proportion of back problems become chronic, especially after a long follow-up period, and which factors can predict chronicity. METHODS: Data on the course of the symptoms and medical consumption from the period between 1987-1988 and 1991 were gathered retrospectively. Data on several health outcomes, including LFP, and data on some work characteristics were collected prospectively in 1991. A more extensive data set on health outcomes including psychologic status and working situation was collected in 1994. RESULTS: Chronic back problems developed in 28% of the patients. These patients reported more pain, higher levels of medical resource consumption, worse health outcomes, and lower labor force participation. Episodes of back pain before 1987-1988, severe pain in 1991, and disability score in 1991 were positively associated with chronicity in 1994, difficulties with job performance in 1991, and frequent stooping in the subgroup of patients who held a paying job in the follow-up period. CONCLUSIONS: Even after a follow-up of 7 years, the proportion of people with chronic back problems was high. The consequences for quality of life, labor force participation, and consumption of medical resources are clear. Further research is necessary to examine determinants and ways to prevent chronicity.     

Proprioception and schizophrenia: a replication study with nonschizophrenic patient controls

In 3 experiments, weight discrimination, arm flexion discrimination, and a test of kinesthetic figural aftereffects were used to evaluate the proprioceptive functioning of 40 schizophrenic patients, 30 nonschizophrenic (psychotic and nonpsychotic) patients, and 10 normals. The additional variables of premorbid functioning and paranoia were also examined. Previous findings of a subtle proprioceptive deficit for schizophrenics in comparison with normals were replicated for nonparanoid schizophrenics of a weight-discrimination procedure and poor premorbid schizophrenics on an arm-flexion task. The kinesthetic-figural-aftereffects schizophrenic deficit previously reported by the author and E. Ebner (see record 1974-23243-001) was not replicated. Deficits in proprioception also were found for all nonschizophrenic patient groups on the weight-discrimination procedure and for poor premorbid nonschizophrenic psychotics and neurotics on the arm-flexion task. It is concluded that a deficit in proprioception is not unique to schizophrenia but appears to be related to chronicity and severity of pathology in both schizophrenic and nonschizophrenic hospitalized patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The two factors present in the Embedded Figures Test and a suggested short form for hospitalized psychiatric patients.

Explored the difficulties of using the Embedded Figures Test (EFT) with hospitalized psychiatric patients. A factor analysis of the EFT indicated the presence of a reversible perspective factor in addition to a pure embedded figures factor. No differences were found in the performance of 383 male 20-60 yr old psychiatric patients divided in terms of chronicity, premorbidity, and diagnosis on the reversible perspective factor. However, acute good premorbid nonschizophrenics were more field independent and chronic poor premorbid schizophrenics were more field dependent on the pure embedded figure factor. The factors previously considered to account for poor patient performance were redefined in terms of test length and the compounding effects of early failure. A short form of the EFT was devised to minimize such effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Size estimation in schizophrenia as a function of censure, diagnosis, premorbid adjustment, and chronicity.

72 male schizophrenics divided in terms of chronicity, diagnosis, and premorbid adjustment estimated the size of a line embedded in different affective and neutral content. The main result was that premorbid adjustment and chronicity interacted in size-estimation performance with the good, premorbid-adjustment group exhibiting a smaller size estimation in the chronic condition than in the acute, while the poor, premorbid-adjustment group exhibited the opposite effect. Although a Premorbid Adjustment * Chronicity interaction was predicted in previous work, the specific over- or underestimation tendency found for each schizophrenic subgroup differed from those previously predicted. The differences in the present results and predictions derived from a review of the literature are discussed in terms of possible difficulties inherent in making inferences from studies which did not directly control the relevant subject dimensions. Results indicate little support for the social-censure hypothesis and suggest the greater effect of organismic variables relative to stimulus variables in predicting schizophrenic task performance. (18 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Premorbid adjustment and paranoid-nonparanoid status in schizophrenia: A further investigation.

Investigated the interrelations between premorbid social competence, role orientation as expressed in symptomatology, and paranoid-nonparanoid status in 295 Veterans Administration (VA) hospital and 300 state hospital male schizophrenic patients. Among state hospital paranoid schizophrenics, paranoids had higher premorbid social competence scores (Phillips-Zigler Social Competence Index) than nonparanoids. For VA hospital schizophrenics, paranoid-nonparanoid status was unrelated to premorbid social competence. State hospital patients had lower premorbid competence scores and a higher incidence of nonparanoid diagnosis than VA hospital patients. The prevalence of a number of symptoms also differed between the 2 hospitals. The role orientation symptom pictures differed both for hospitals and for paranoid and nonparanoid status. The relationships between role orientation, paranoid-nonparanoid status, and premorbid social competence are discussed within a developmental framework. (23 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional Labor Demands and Compensating Wage Differentials.

The concept of emotional labor demands and their effects on workers has received considerable attention in recent years, with most studies concentrating on stress, burnout, satisfaction, or other affective outcomes. This study extends the literature by examining the relationship between emotional labor demands and wages at the occupational level. Theories describing the expected effects of job demands and working conditions on wages are described. Results suggest that higher levels of emotional labor demands are associated with lower wage rates for jobs low in cognitive demands and with higher wage rates for jobs high in cognitive demands. Implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Familial subtypes of depression: a clinical view

The clinical workup of 238 unipolar depressives were subdivided according to immediate family history. Pure depressives (with only depression in the family) typically have an illness involving more endogenous features and chronicity. Depression spectrum patients (with only alcoholism or sociopathy in first-degree relatives) have the mildest illness. Sporadic depression (with a negative family history) is associated with an intermediate severity. Premorbid unstable personality characteristics are more common to the spectrum patients. Sporadic patients have the least personality difficulties. While these differences are definite, they are not large enough to justify separation of unipolar depression into subsyndromes dependent on symptom differences. Rather, family history seems to exert its effect most strongly on the distinctive premorbid personality characteristics of the 3 groups.     

Group programmes for recovery from early psychosis

BACKGROUND: We evaluate the impact of a group-based, transitional, psychosocial programme, within a comprehensive service (the Early Psychosis Prevention and Intervention Centre, EPPIC), on recovery from first-episode psychosis. METHOD: Individuals using the service (and meeting study criteria) were assessed on a range of symptom and functioning instruments at entry, after 6 weeks and 6 months. Participants received comprehensive case management and services according to their identified needs. Thirty-four people who had attended the group programme were compared at 6 month follow-up with 61 EPPIC patients who had not attended. RESULTS: The people attending the group programme had a lower level of premorbid adjustment than the comparison group, and a trend towards exhibiting a higher level of negative symptoms, prior to commencing the group programme. However, at 6 month follow-up, no significant differences were found between the groups. CONCLUSIONS: Involvement in the group programme may have had a positive impact on a subgroup of EPPIC subjects with poor level of premorbid adjustment, by providing a 'holding pattern' in the critical period following the emergence of first-onset psychosis, and thus prevented deterioration and the development of disability.     

Admission to hospitals with on-site cardiac catheterization facilities :impact on long-term costs and outcomes

BACKGROUND: Admission to a hospital with a capability for cardiac procedures is associated with a higher likelihood of referral for a cardiac procedure but not with a better short-term clinical outcome. Whether there are differences in long-term mortality and resource consumption is not clear. We sought to determine whether elderly Medicare patients with acute myocardial infarction admitted to hospitals with on-site cardiac catheterization facilities have lower long-term hospital costs and better outcomes than patients admitted to hospitals without such facilities. METHODS AND RESULTS: As part of the Cooperative Cardiovascular Project pilot in Connecticut, we conducted a retrospective cohort study using data from medical charts and administrative files. The study sample included 2521 patients with acute myocardial infarction covered by Medicare from 1992 to 1993. The cardiac catheterization rate was higher in the hospitals with facilities (38.6% versus 26.9%; P<0.001), but the revascularization rate was similar (20.5% versus 19.5%) during the initial episode of care and at 3 years (29.7% versus 29.7%). Mortality rates were similar for patients admitted to the 2 types of hospitals at 30 days (OR, 1.08; 95% CI, 0.83 to 1.42) and at 3 years (OR, 1.02; 95% CI, 0.83 to 1.26). The adjusted readmission rates were significantly lower among patients admitted to hospitals with cardiac catheterization facilities (OR, 0.76; 95% CI, 0.61 to 0.94). However, the overall mean days in the hospital for the 3 years after admission was 25.9 for patients admitted to hospitals with facilities and 24.6 for the other patients (P=0.234). Adjusting for baseline patient characteristics, there was no significant difference in the 3-year costs between patients admitted to the 2 types of hospitals. CONCLUSIONS: With higher rates of cardiac catheterization and lower readmission rates, patients admitted to hospitals with on-site cardiac catheterization facilities did not have significantly different hospital costs compared with patients admitted to hospitals without these facilities. There was also no significant difference in short- or long-term mortality rates.     

Antibiotic optimization. An evaluation of patient safety and economic outcomes

BACKGROUND: Although numerous reports have described interventions designed to influence antibiotic utilization, to our knowledge none have been evaluated in a randomized study. METHODS: Adult inpatients receiving 1 or more of 10 designated parenteral antibiotics for 3 or more days during a 3-month period were randomized to an intervention (n = 141) and a control (n = 111) group using an unblocked, computer-generated random number table. Obstetric patients and those seen in infectious disease consultation were excluded. The intervention group received antibiotic-related suggestions from a team consisting of an infectious disease fellow and a clinical pharmacist. Both groups were evaluated for clinical and microbiological outcomes as well as antibiotic utilization via prospective chart reviews and analysis of the hospital's administrative database. RESULTS: Sixty-two (49%) of the intervention group patients received a total of 74 suggestions. Sixty-three (84%) of these suggestions were implemented; the majority involved changes in antibiotic choice, dosing regimen, or route of administration. Per patient antibiotic charges were nearly $400 less in the intervention group vs controls (P = .05). Almost all the savings were related to lower intravenous antibiotic charges. Clinical and microbiological response, antibiotic-associated toxic effects, in-hospital mortality, and readmission rates were similar for both groups. Multiple linear regression analysis identified randomization to the intervention group and female sex as the sole predictors of lower antibiotic charges. There was a trend toward a shorter length of stay for the intervention group (20 vs 24.7 days, P = .11). CONCLUSIONS: This is the first randomized study to evaluate whether antibiotic choices can be influenced in a cost-effective fashion without sacrificing patient safety. We demonstrate that 50% of patients initially treated with expensive parenteral antibiotics can have their regimens refined after 3 days of therapy and that these modifications result in good clinical outcomes with a substantial reduction in antibiotic expense.     

Self-handicapping and defensive pessimism: Exploring a model of predictors and outcomes from a self-protection perspective.

The present study is centrally concerned with self-handicapping and defensive pessimism (comprising defensive expectations and reflectivity), the factors that predict these strategies, and the associations between these strategies and a variety of academic outcomes. Major findings are that task orientation negatively predicts both self-handicapping and defensive expectations and positively predicts reflectivity; uncertain personal control positively predicts defensive expectations, and to a lesser extent, self-handicapping; and an external attributional orientation is positively associated with self-handicapping, and to a lesser extent, defensive expectations. Both self-handicapping and defensive expectations are negatively associated with self-regulation and persistence, whereas reflectivity is positively associated with these outcomes. Students high in self-handicapping received lower end-of-year grades than did students low in self-handicapping and were less likely to be in attendance 1 year later. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Children's attachment representations: Longitudinal relations to school behavior and academic competency in middle childhood and adolescence.

A longitudinal study examined children's (N?=?108) attachment representations in relation to behavior and academic competency at school during middle childhood and adolescence. Attachment representations were assessed from children's responses to a separation story at age 7 years. At ages 9, 12, and 15, teachers rated children on four dimensions of school behavior: attention–participation, extroversion, disruptive behavior, and insecurity about self. Children's grade point average (GPA) in school was also examined. Children's attachment representations (secure vs. insecure) did not predict either disruptive behavior or extroversion, but they were significantly linked to attention–participation, insecurity about self, and GPA, with secure representations being associated with more favorable outcomes. The study controlled for social class, gender, IQ, perspective-taking ability, and prior competency. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical anhedonia and schizophrenia.

Assessed the relation of anhedonia to schizophrenia using 69 schizophrenics and 54 psychiatric control outpatients from 3 mental health centers. In addition to indexes of schizophrenia, each S was given the Physical Anhedonia Scale, a measure of premorbidity, and a vocabulary test. Measures of chronicity and education were also included. ANOVAs indicated no significant differences in anhedonia among 4 diagnostic groups: paranoid schizophrenics, nonparanoid schizophrenics, unipolar affective psychiatric control Ss, and other psychiatric control Ss. Intercorrelations showed that anhedonia was negatively related to premorbid social status, years of education and vocabulary, but it was not significantly related to hospitalization. Data do not support the hypothesis that anhedonia is a consistent sign of schizophrenia but are compatible with the notion that anhedonia is the consequence of such liabilities as psychiatric disturbance, poor premorbid status, low educational level, and low verbal ability. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current state of standardization adherence: A reflection of competency in psychological assessment.

Identification of competencies to be mastered during training and maintained through lifelong learning has recently received considerable attention. This study investigated a single, commonly identified core assessment skill competency, adherence to standardized administration procedures, to establish a current appreciation of baseline competency in the profession. Standardization adherence among 150 professionals averaged 70% and was not significantly related to level of education or the time elapsed since degree attainment. Contrary to expectations, adherence was significantly higher for less frequently administered tests than for those more commonly administered. Accessibility to procedural instructions (e.g., embedded within stimuli) was unrelated to levels of adherence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expressed emotion and the course of late-life depression

This study examined rates of expressed emotion (EE) indexed by the Five Minute Speech Sample (FMSS; A. B. Magana et al., 1986) in adult children or spouses of 54 elderly patients hospitalized for major depressive disorder. It also examined whether EE was related to course of psychiatric illness in these elderly patients over 1 year. Among the family members, 40% were classified as high EE. EE was not significantly related to relapse in the total sample. However, there was an interaction between EE and relationship to the patient (i.e., spouse or adult child) on 1-year clinical outcomes of the elderly. Among adult children caring for older patients, high-EE status predicted higher rates of patient relapse and lower rates of complete and sustained recovery from depression than low EE. In contrast, there was a trend association among spouses between high EE and lower rates of relapse as well as higher rates of complete and sustained recovery.     

Premorbid competence, role orientation, and gender differences in DSM-II versus DSM-III schizophrenic patients.

The study compared 71 patients diagnosed as schizophrenic or within the schizophrenia spectrum according to Diagnostic and Statistical Manual of Mental Disorders (DSM-II) with 66 patients who received similar diagnoses according to DSM-III. On measures of premorbid competence and role orientation, DSM-II and DSM-III schizophrenic patients obtained comparable scores. The DSM-III patients with schizophrenic versus schizophrenia spectrum diagnoses also obtained comparable scores on these measures. The gender differences in premorbid competence and role orientation that have consistently characterized DSM-II schizophrenics continued to characterize DSM-III schizophrenic and schizophrenia spectrum patients. The results suggest that findings previously obtained with DSM-II schizophrenics concerning premorbid competence and role orientation can be generalized to DSM-III schizophrenics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)