Social context, coping strategies, and depressive symptoms: an expanded model with cardiac patients

This research broadened and refined a resources model of coping to encompass negative as well as positive aspects of social relationships and examined this expanded conceptualization in a 4-year prospective model with 183 cardiac patients (140 men and 43 women). Social support and social stressors in the family and extrafamily domains contributed significantly to a common social context latent construct. In addition, this conceptualization of social context was significantly related to depressive symptoms 4 years later. Especially important conceptually, coping strategies functioned as a mechanism through which both social support and social stressors related to subsequent depressive symptoms. Moreover, positive and negative aspects of social relationships made essentially unique contributions in predicting subsequent coping efforts.     

Attribution and expressed emotion in the relatives of patients with schizophrenia.

[Correction Notice: An erratum for this article was reported in Vol 101(2) of Journal of Abnormal Psychology (see record 2008-10481-001). An incorrect sentence was published. The sentence that ends the fourth paragraph on p. 547 ought to read: A more recent onset of illness would be expected to produce more unstable attributions, and more disturbed behavior (particularly involving violence toward the relative) would be expected to produce attributions that were more internal and personal to the patient but more external and uncontrollable as regards the relative.] Indexes of expressed emotion (EE) in 58 relatives of patients with schizophrenia were related to those relatives' spontaneously expressed causal beliefs about the illness and about related symptoms and behaviors. Relatives made attributions predominantly to factors external, universal, and uncontrollable from their own perspective, and to factors internal, universal, and uncontrollable from the patient's perspective. Low-EE relatives were similar in their attributions to emotionally overinvolved relatives. Compared with these 2 groups, critical and/or hostile relatives made more attributions to factors personal to and controllable by the patient. Subsequent analyses suggested that hostile relatives were further characterized by making more attributions to factors internal to the patient and by making attributions with fewer causal elements. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analysis of the attention deficit in schizophrenia: a study of patients and their relatives in Ireland

County Roscommon, a rural area in the western part of Ireland, was the site of a family study of schizophrenia. As part of this study, we have assessed several elements of attention, identified by principal components analysis in previous investigations, in a group of subjects with schizophrenia, first-degree relatives of subjects with schizophrenia and age- and education-matched controls. The schizophrenic subjects performed significantly more poorly than the controls; the performance of the relatives fell somewhere between the other two groups. Those relatives with a DSM-III-R diagnosis (most frequently, alcohol abuse or an affective disorder) tended to perform more poorly on some of the attention elements than relatives without a diagnosis; in contrast, control subjects with diagnoses were not distinguishable from other controls. The attention elements appeared to differ in their capacity to differentiate the groups and each seemed to have a distinctive profile. The effects of alcohol abuse were also considered. The results obtained with this cohort may provide clues concerning the pathophysiological basis of schizophrenia and the heterogeneity of its expression.     

Current treatment strategies and factors influencing outcome in patients with bacterial brain abscess

We clearly determined the key to managing patients with brain abscess by retrospectively evaluating the factors affecting poor outcome in these patients. This study included 113 patients with brain abscess diagnosed in the CT era. Basic characteristics and therapeutic parameters were estimated as independent predictors of poor outcome by using univariate and multivariate logistic regression analysis. Patients with poor outcomes more frequently had deeply-located abscesses (p < 0.02), IVROBA (intraventricular rupture of brain abscess (p < 0.001) and were in a severely deteriorated neurological state (p < 0.001) than those with good outcomes. Multiple logistic regression analysis predicted that IVROBA (ORs, 24.5; 95% CI, 3.04 to 197.9) and severely deteriorated cases (ORs, 13.7; 95% CI, 2.34 to 80.8) resulting from IVROBA increased the relative risk of poor outcome. Patients with IVROBA more frequently had also deeply-located abscesses (p < 0.005), positively immunocompromised states (p < 0.05) and were in a severely deteriorated condition (p < 0.003) than those without IVROBA. Patients with metastatic abscess had also IVROBA (p < 0.006). Multiple logistic regression analysis anticipated that deeply-located abscess (ORs, 3.90; 95% CI, 1.38 to 11.04), and metastatic abscess (ORs, 12.26; 95% CI, 1.35 to 111.2) increased the relative risk of IVROBA. Patients in an obtunded state and with marked neurological deficit had IVROBA more often than patients in an alert state and/or mild neurological deficit (ORs, 3.23; 95% CI, 1.17 to 8.86, p < 0.03) before treatment. Our findings suggest that IVROBA strongly influences poor outcome in patients with brain abscess. The key to decreasing poor outcomes may be the prevention and management of IVROBA, by evaluating intracranial pressure pathophysiology. IVROBA should be aggressively treated by aspiration methods for the abscess coupled with appropriate intravenous and intrathecial administration of antibiotics.     

Fertility and schizophrenia: evidence for increased fertility in the relatives of schizophrenic patients

BACKGROUND AND PURPOSE: We present a rare case of desmoplastic fibroma of the skull. Desmoplastic fibroma is a distinctive and rare neoplasm of bone that histologically and biologically mimics desmoid soft tissue tumor. Only 6 cases have been reported in the skull and none of these was diagnosed by MRI. CLINICAL PRESENTATION: A 64 year-old woman, operated on in June 1991 for left mastectomy due to a ductal adenocarcinoma and again in October 1994 for a left frontal metastatic adenocarcinoma, was admitted in our Department of Neurosurgery because a control cerebral MRI had detected a diploic lesion, isointense on T1-weighted images and hyperintense on T2, with moderate enhancement, localized in a right parietal site. Neurological examination was negative. The lesion was surgically removed and a cranioplasty was performed. Histological diagnosis was desmoplastic fibroma. Twelve months after treatment she has no neurological symptoms or signs of cerebral lesions (MRI) or systemic metastasis (total body CT). CONCLUSION: In the literature the number of desmoplastic fibroma is too small and the follow-up period too short to permit any conclusions regarding the aggressiveness of the tumor.     

Social and cognitive strategies for coping with accountability: Conformity, complexity, and bolstering.

This experiment tested predictions derived from a social contingency model of judgment and choice that identifies 3 distinctive strategies that people rely on in dealing with demands for accountability from important interpersonal or institutional audiences. The model predicts that (a) when people know the views of the audience and are unconstrained by past commitments, they will rely on the low-effect acceptability heuristic and simply shift their views toward those of the prospective audience, (b) when people do not know the views of the audience and are unconstrained by past commitments, they will be motivated to think in relatively flexible, multidimensional ways (preemptive self-criticism), and (c) when people are accountable for positions to which they feel committed, they will devote the majority of their mental effort to justifying those positions (defensive bolstering). The experiment yielded results supportive of these 3 predictions. The study revealed some evidence of individual differences in social and cognitive strategies for coping with accountability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Smooth pursuit eye movements to extraretinal motion signals: deficits in relatives of patients with schizophrenia

BACKGROUND: Although mounting evidence supports the idea that smooth pursuit abnormality marks the genetic liability to schizophrenia, the precise ocular motor mechanism underlying the abnormality remains unknown. Based on recent findings in schizophrenia, we hypothesize that subtle deficits in the ability to hold online and/or use extraretinal motion information underlie the pursuit abnormality in vulnerable individuals. METHODS: The hypothesis was tested in 69 first-degree, biological relatives of probands with schizophrenia; 26 relatives had schizophrenia spectrum personalities (SSP). Subjects recruited from the community (n=71; 29 with SSP), without a known family history of psychosis, constituted the comparison groups. The traditional smooth pursuit gain measure, which is a ratio of smooth pursuit eye velocity in response to both retinal and extraretinal motion signals and the target velocity, was obtained. In addition, newly developed measures of predictive smooth pursuit (ie, in the presence of only extraretinal motion signals) were obtained. The latter measures were evaluated after the current retinal motion signals were made unavailable by briefly making the target invisible. RESULTS: Relatives, particularly those with SSP, showed significantly poorer predictive pursuit response to extraretinal motion signals (F(2,136)=6.51, P<.005), compared with the community subjects. However, the traditional smooth pursuit gain in response to both retinal and extraretinal motion signals was not different between groups. CONCLUSIONS: These results suggest that relatives of patients with schizophrenia, particularly those with SSP, have specific deficits in predictive pursuit based on only extraretinal motion signals. Normal smooth pursuit gain in response to both retinal and extraretinal motion signals is likely due to compensation based on retinal motion information. The latter suggests normal retinal motion processing and smooth pursuit motor output.     

Affective reactivity of speech in schizophrenia patients and their nonschizophrenic relatives.

This study compared levels of referential communication disturbance in speech samples from 41 stable schizophrenia outpatients, 46 parents of patients, and 23 nonpsychiatric control participants in affectively positive versus affectively negative conditions. The speech of the patients and parents showed elevated frequencies of reference failures in the affectively positive condition compared with control participants; the speech of the patients became more disordered in the affectively negative condition, whereas the speech of the parents did not. These results support the idea that referential communication disturbances reflect vulnerability, as well as overt illness, but that affective reactivity of these disturbances is associated mainly with the manifest illness. These findings are consistent with biological, cognitive, and psychological theories about the processes underlying stress responsiveness of schizophrenic symptoms more generally. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Non-compliance with treatment in patients suffering from schizophrenia: a study to evaluate possible contributing factors

In the decade since the clinical arrival of laparoscopic cholecystectomy, there have been gratifying improvements in imaging technology and instrumentation, and innovative techniques have evolved. Laboratory-simulator devices are available for basic skills exercises and can at least reasonably mimic the appearance of the gallbladder and some other organs or anatomic regions. Unfortunately, there is no satisfactory method to practice dealing with certain structural abnormalities or disease processes. Because of that, some operations will be particularly difficult and the outcomes will be favorable only with careful planning and capable execution. The experiences and skill level of the surgeon can be enhanced by appropriate mental preparation. As a result, the surgeon will have the opportunity to accomplish the task, both laparoscopically and safely, under circumstances that initially were thought to be inappropriate or impossible for laparoscopy.     

Characterization of insulin autoantibodies in relatives of patients with type I diabetes

We studied in detail the anti-insulin autoantibodies in 29 nondiabetic relatives of patients with type I diabetes. The affinity of the autoantibodies for [125I]human insulin was high (1.34 x 10(9)-20.71 x 10(9) L/mol), and the capacity was low (0.84 x 10(-12)-37.80 x 10(-12) M). The product of affinity x capacity of each relative's antibodies directly correlated (r = 0.99) with the level of antibodies determined in our standard radioassay. The autoantibodies from each of the subjects studied had the same rank order of affinities for insulin from different species. Guinea pig, fish insulin, and insulin containing Trp rather than Leu in position 13 of the A-chain inhibited minimally the human insulin binding. Human proinsulin, insulin containing Gln rather than Glu in position 17 of the A-chain, and desoctapeptide insulin (des B23-30) all inhibited binding effectively. Insulin autoantibodies in relatives of patients with type I diabetes share common epitope(s), which suggests a common pathogenic mechanism for production of such antibodies. The epitopes from this initial analysis appear to include amino acids B1-B3 and A8-A13. The region recognized can be distinguished from the insulin receptor binding domain.     

Staar Collamer intraocular lens: clinical results from the phase I FDA core study

PURPOSE: To assess the early postoperative efficacy and safety of the Staar Collamer intraocular lens (IOL) in small incision cataract surgery. SETTING: Six private ophthalmology practices geographically distributed throughout the United States. METHODS: One hundred twenty-five patients with a mean age of 72.1 years were enrolled in the U.S. Food and Drug Administration (FDA) Phase 1 clinical study of the Staar Collamer IOL after having cataract removal by phacoemulsification. Of these, 107 completed 4 to 6 months of follow-up. RESULTS: At 4 to 6 months postoperatively, 97.1% of patients achieved 20/40 or better corrected visual acuity; 100% of patients without pre-existing pathology (best case) achieved the same result; both results were better than FDA grid values. No persistent sight-threatening complications were reported. Through 6 months, 4.7% of patients required a neodymium:YAG capsulotomy. No IOL dislocations or removals were reported. CONCLUSION: Results indicate that the Collamer material is safe and effective for platehaptic IOLs used in small incision cataract surgery.     

Risperidone in the treatment of schizophrenia: results of a study of patients from Germany, Austria, and Switzerland

Wound healing is a complex series of highly interdependent and overlapping stages involving a number of cellular processes. Macrophages are pivotal to the healing process, as director cells, but also functioning as phagocytes and debridement agents in addition to producing chemoattractants and growth factors which attract cells necessary for repair and control of wound healing processes. A number of other factors influence wound healing, such as oxygen, the immune system, and corticosteroids.     

Changes and results of surgical strategies for hepatocellular carcinoma: results of a 15-year study on 452 consecutive patients

In an attempt to define better surgical strategies for patients with hepatocellular carcinoma (HCC), we conducted a retrospective analysis of 452 patients who underwent hepatic resection at our institute during a period of 15 years. The patients were divided into two groups: group A, comprising 188 patients who underwent hepatic resection before 1988, and group B, comprising 264 patients after 1989. These groups were compared clinicopathologically. The percentage of patients with Child's A disease but without cirrhosis, in group A was lower. The diameter of the resected tumor was larger in group A, and major hepatic resections and curative operations were more frequently performed in group A. In group B, there was less blood loss, the specimen weighed less, and the hospital mortality was lower. Although the tumor-free survival rates were similar between the two groups, the survival rate in group B was significantly better. While even minor hepatic resection accompanied by a lower rate of surgical margin-free surgery has contributed to making hepatic resection safer, it has not improved the tumor-free survival rate. Conversely, recent advances in imaging modalities used during follow-up for the early detection of recurrence and for planning multimodality treatment have contributed to increasing the survival rate.     

Somatosensory processing in the biological relatives of schizophrenia patients: A signal detection analysis of two-point discrimination.

This study examined 2-point discrimination performance in 1st-degree biological relatives (n?=?39) of individuals with schizophrenia and normal adult control participants (n?=?30) recruited from the community. They completed an objective 2-point discrimination task, adapted for use with a signal detection approach to permit separation of discriminability (i.e., sensitivity, d') from response bias/criterion (or motivation, lnβ). Relatives revealed poorer performance on the d' index compared with controls. The 2 groups did not differ on lnβ, suggesting a genuine difference in sensitivity but not response bias. The sensitivity deficit might reflect decreased spatial acuity and/or impaired intensity cue processing of tactile stimuli. Poor performance on the d' index was most closely associated with 2 schizotypic features, namely "odd beliefs/magical thinking." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with chronic illness: A study of illness controllability and the influence of coping strategies on psychological adjustment.

Longitudinal data on the coping strategies used by 151 41–89 yr old middle-aged and older adults faced with 1 of 4 chronic illnesses were used to evaluate the role of coping in the explanation of psychological adjustment. The authors distinguished between illnesses that offer few opportunities for control (rheumatoid arthritis and cancer) and those more responsive to individual and medical efforts at control (hypertension and diabetes) and evaluated the emotional consequences of 2 coping strategies—information seeking and wish-fulfilling fantasy—expected to play different roles in adjustment. Results show that information seeking had salubrious effects on adjustment and that wish-fulfilling fantasy had deleterious consequences; contrary to expectation, neither strategy's effects were modified by illness controllability. Analyses of the direction of causation between coping and adjustment suggest that wish-fulfilling fantasy is linked to poor adjustment in a mutually reinforcing causal cycle. The modesty of the effects of coping, however, demands replication of results to confirm the conclusions drawn in the present study. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of antipsychotics on the clinical and psychosocial behavior of patients with schizophrenia

With the arrival of atypical antipsychotic drugs, questions have arisen as to their efficacy, compared with classical antipsychotics, and their impact on the clinical and psychosocial behavior of schizophrenic patients. This paper reviews the development of antipsychotic drugs from the prototype chlorpromazine in the 1950s to the atypical antipsychotics--clozapine, risperidone, olanzapinein--in the 1990s. Particular attention is given to the medications' effect on positive and negative symptoms and on patients' quality of life. Experience to date with the atypical antipsychotic drugs is that they are as effective as traditional treatments, with a possibly greater action in treating negative symptoms and with a lower extrapyramidal side effects profile. For comprehensive treatment of schizophrenia, the author advocates a polydimensional approach encompassing psychopharmacology, psychotherapy, psychosocial interventions (particularly with family members), and vocational training.     

Pursuit gain and saccadic intrusions in first-degree relatives of probands with schizophrenia.

Oculomotor functioning of 26 probands (aged 18–45 yrs) with schizophrenia, 12 spectrum and 46 nonspectrum 1st-degree relatives (aged 16–72 yrs), and 38 nonpsychiatric control Ss (aged 19–67 yrs) was evaluated. Spectrum relatives had more anticipatory saccades (ASs) and lower pursuit gain than nonspectrum relatives, who had more ASs and lower pursuit gain than control Ss. Probands also had lower pursuit gain than nonspectrum relatives and control Ss but did not differ from other groups on AS frequency. Control Ss had more globally accurate pursuit tracking (root mean square [RMS] error deviation) than both relative groups, whereas probands had the poorest RMS scores. Square wave jerk frequency did not differentiate the groups. Attention enhancement affected the frequency of ASs but did not affect either the other intrusive saccadic event or RMS scores. These results offer evidence that eye-movement dysfunction may serve as a biological marker for schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Carotid-vertebral artery blood transit time: results in healthy subjects and patients with schizophrenia and brain disease

Estimation of blood transit time in the neck and the extension of this into the head was made by a method of electrical impedance, over a wide age range, in 159 healthy subjects, 160 schizophrenic patients, and 199 patients with organic brain disease. In each case, the distance between the electrocardiogram and the next succeeding pulse-volume impedance wave was measured and averaged over 30 serial wave forms. Chronological age proved a significant variable, transit times lengthening progressively with the age, but only for measurements extending into the head. Sex and hemispheric laterality played no significant role. With age held constant, mean transit times into the head were significantly prolonged in both groups of patients as compared with controls. No significant differences were found however between means of psychiatric andneurological patients. It is suggested that these results reinforce the organic etiology of schizophrenia.