Adjudicative competence in adolescent defendants: Judges' and defense attorneys' views of legal standards for adolescents in juvenile and criminal court.

Although courts have increasingly required that adolescent defendants be competent to proceed with adjudication, the legal standard for competence in juvenile court is not yet settled. As a first step toward obtaining greater clarification in legal standards, in this study the authors surveyed 338 judges and defense attorneys regarding their beliefs about competence standards. Judges and defense attorneys believe that it is particularly important for juveniles to have competence-related legal capacities, compared to adults. However, lower levels of competence were considered necessary for juveniles adjudicated in juvenile court than for juveniles adjudicated in criminal court. Developmental immaturity was seen as moderately important to juveniles' competence, although it was rated as less important than mental disorders or cognitive impairments. Furthermore, relatively few judges appear to agree that adolescents should be found incompetent on the basis of developmental immaturity alone. The implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A cooperative randomized controlled study of adjuvant chemoendocrine therapy for breast cancer in Japan

Social competence in subjects at risk for schizophrenia and affective disorder and in normal-comparison subjects was examined in childhood and adolescence. Based on interviews with the parents of the subjects and with the children and adolescents themselves, subjects at risk for schizophrenia had poorer overall social competence than subjects at risk for affective disorder and comparison subjects in early adolescence and adolescence but not in childhood. In analyses of specific aspects of social competence, the adolescents at risk for schizophrenia had significantly poorer peer relationships and decreased hobbies/interests than the adolescents at risk for affective disorder and the normal-comparison adolescents. With respect to school adjustment, however, the two groups of adolescent offspring of parents with psychiatric disorders had significantly poorer adjustment than the comparison adolescents but did not differ from each other on this measure. These results suggest that various aspects of poor social competence may precede the onset of schizophrenia and play an important role in its development.     

The competence of adolescents as trial defendants.

The significance of adolescents' capacities as defendants has increased as a consequence of new laws that promote the transfer of juveniles for trial in criminal court. Basic and applied developmental research is reviewed to examine evidence for adolescents' capacities to participate as defendants in their criminal court trials (defined in law as competence to stand trial). Research is reviewed in 4 areas: (a) adolescents' understanding of the legal process; (b) their appreciation of the significance of legal circumstances for their defense; (c) their ability to communicate information to counsel; and (d) their reasoning and judgment in making decisions as defendants. The results suggest a greater risk of impairments in trial competence abilities for adolescents than for adults. Possible ways to respond to adolescents who are less prepared to participate in trials are offered. Tentative recommendations are made for policy and law that would increase protections against trying adolescents in criminal court when their trial competence is impaired. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A study of "atypical schizophrenia". Comparison with schizophrenia and affective disorder by sex, age of admission, precipitant, outcome, and family history

Eighty-five cases of atypical schizophrenia were compared with 200 of schizophrenia, 100 of bipolar (mania), and 225 of unipolar (depression) affective disorder. Comparisons were made on the basis of sex, age at admission, precipitating factors, outcome, and a family history of schizophrenia or of affective disorder. The atypical schizophrenia differed remarkably from the schizophrenia and most closely resembled the bipolar affective disorder when allowance was made for a younger age at onset and a higher frequency of precipitants. An analysis of symptoms verified the predominance of schizophrenic features in the atypical schizophrenia, but also showed a high percentage (80%) of patients who had one or more manic symptoms at index admission. It is concluded that great care should be taken in diagnosing schizophrenia in a patient who also has manic symptoms.     

Scintigraphic assessment of the severity of inflammatory bowel disease using Tc 99m exametazime-labeled leukocytes

This study was designed to determine whether patients with schizophrenia and those with affective disorders display a common pattern of cognitive deficits. Cognitive performance was assessed with a neuropsychological test battery in consecutively admitted in-patients with schizophrenia (n=100) and affective disorders (n=100). The two groups of patients showed a similar pattern of cognitive deficits, especially in tests focusing on attentional capacities. The groups only differed significantly in their performance on the Wisconsin Card Sorting Test (WCST), with the schizophrenic patients performing less well. These results suggest that, with the exception of the deficit as measured by the WCST, similar cognitive impairments exist in schizophrenia and affective disorders, even at very early stages of the illness. Therefore, patients with schizophrenia and those with affective disorders cannot be qualitatively distinguished with sufficient reliability. We postulate that the cognitive deficit pattern represents a final common pathway disorder in the two groups of patients.     

Parental bonding as a predictive factor for the development of adult psychiatric disorders

OBJECTIVE: To asses the capacity of the Parental Bonding Instrument (PBI) to discriminate between normal subjects and clinical samples and between with different psychiatric diagnosis. DESIGN: The present paper analyzes the studies published between 1979 and 1995, which have used the PBI in normal subjects and clinical samples and have reported the respective means and standard deviations obtained on the two PBI dimensions: affection and control. Multiple comparisons were carried out between the mean scores of affection and control of: 1) samples with the same psychiatric diagnosis (intragroup comparison); 2) samples with different psychiatric diagnoses (intergroup comparison); 3) normal subjects and clinical samples. RESULTS: Of the 46 studies with normal and clinical subjects, 23 studies were selected for the analysis, reporting means and standard deviations and specifying the diagnostic criteria. Samples with the same psychiatric diagnosis had similar affection and control scores. With the exception of bipolar affective disorders and avoidant personality disorders, the prevalent parental style was for all diagnostic groups the affectionless control style. Within the affectionless control style, the PBI discriminated between panic attacks, borderline personality and drug addiction but not between schizophrenia, unipolar depression and anxiety disorder. The PBI discriminated also between normal subjects samples and samples with anxiety disorder, schizophrenia, bipolar affective disorder, personality disorder and drug addiction respectively. CONCLUSION: The results confirm previous suggestions from single studies that the perceived parental style as measured by the PBI can be considered a good predictor for the presence of psychiatric disorders excluding panic attacks, avoidant personality disorders and unipolar affective disorders. Although the different diagnostic groups do not differ in their perceived parental style (affectionless control), significant differences between some diagnostic groups within this category suggest that the PBI might have some specificity as well.     

Symptom scales of the Diagnostic Interview Schedule: Factor results in Hispanic and Anglo samples.

The Diagnostic Interview Schedule (DIS) was designed for use in large-sample surveys of mental health to produce categorical diagnoses according to criteria such as those found in the third edition of the Diagnostic and Statistical Manual of Mental Disorders, based on structured information about lifetime symptoms provided to nonclinician interviewers. Using symptom data from a probability sample of community residents in Puerto Rico who ranged in age from 18 to 64 (N?=?1,513), we examined five clusters of items (those associated with diagnoses of affective disorders, schizophrenia, phobic disorder, somatization disorder, and alcoholism) and formed quantitative measures of psychopathology from each. We checked the factor structure of these five scales in two probability samples obtained in Los Angeles, one composed of Mexican-Americans (N?=?1,113) and one of Anglo-Americans (N?=?975). Both Los Angeles samples were restricted to persons aged 18 to 64 for these analyses. Evidence of the cross-cultural stability of the DIS Affective Symptoms and Alcoholism scales was obtained. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The differences in growth of cerebellar vermis between appropriate-for-gestational-age and small-for-gestational-age newborns

Positive and negative symptoms are measurable characteristics that may represent core features of schizophrenia and offer a quantitative approach for studying the genetics of schizophrenia and related disorders. The Positive and Negative Syndrome Scale (PANSS) was used to assess 72 members of five families segregating schizophrenia. The study confirmed high internal reliability of PANSS scales in this sample with diverse lifetime diagnoses. Gender but not alcoholism affected scores. Schizophrenia/schizoaffective and schizophrenia spectrum disorder groups had higher mean scores for the positive and negative scales than other lifetime diagnostic groups, consistent with genetic transmission of these symptoms. Positive and negative symptom patterns did not subtype families. The results support the validity of positive and negative symptom measures as independent dimensions in familial schizophrenia.     

Demographics, family history, premorbid functioning, developmental characteristics, and course of patients with deteriorated affective disorder

OBJECTIVE: This exploratory study examined the characteristics of a group of unusual and previously undescribed patients with major affective disorder who not only had been continuously symptomatic for prolonged periods of time but were also so functionally impaired that they required years of continuous care in psychiatric facilities or by family members. METHOD: Twenty-seven inpatients with major mood disorders and 29 inpatients with schizophrenia were recruited from a large state hospital; 27 outpatients with major mood disorders were recruited from an affiliated outpatient facility. The research battery included the Structured Clinical Interview for DSM-III-R--Patient Version, the Premorbid Adjustment Scale, and a semistructured interview designed to assess demographic, family history, developmental, and course information. RESULTS: Inpatients with deteriorated affective disorder differed from outpatients with nondeteriorated affective disorder along several important dimensions, including family history of mental illness, birth-related problems, physical disorders in infancy, premorbid functioning, presence of mixed episodes and rapid cycling, and medication non-compliance between hospitalizations. Inpatients with deteriorated affective disorder differed from inpatients with schizophrenia on the Premorbid Adjustment Scale. Patients with bipolar affective disorder differed from those with unipolar disorder on many of the variables associated with deterioration of functioning. CONCLUSIONS: Birth-related problems, physical disorders in infancy, and poor premorbid adjustment in childhood and adolescence appear to play an important role in deterioration of functioning among patients with unipolar depression. Disruption in treatment because of medication noncompliance and the appearance of mixed episodes and rapid cycling are associated with functional decline in bipolar affective disorder. Several characteristics previously considered specific to deterioration of functioning in schizophrenia, such as a high rate of birth complications and poor premorbid adjustment, appear to be associated with functional deterioration among patients with major depression as well.     

Detecting disorder: The treatment of mental illness among jail detainees.

This article investigates the extent to which mentally ill jail detainees are treated while they are in the custody of the criminal justice system. A random sample of 728 subjects were administered the National Institute of Mental Health Diagnostic Interview Schedule (NIMH-DIS) during jail intake and then followed up throughout their stay in jail. Of those subjects who met criteria for severe mental illness (psychosis or major affective disorder), only one-third were given treatment within 1 week of intake. Log-linear analysis revealed that treatment decisions were influenced by treatment history (the strongest predictor), the type of mental disorder (schizophrenia vs. depression), type of crime, and whether symptoms were documented by jail intake personnel. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contrast enhancement in the craniopharyngioma cyst wall caused by irradiation

OBJECTIVE: To determine the outcome of DSM-III-R schizophreniform disorder with good prognostic features. METHOD: A 6-year follow-up of 20 cases was conducted with structured interviews (comprehensive assessment of symptoms and history) and assessments of functioning scales (global assessment of functioning, Strauss-Carpenter Scale). RESULTS: Thirty-five percent of the cases had major affective disorders, 35% had schizophreniform episodes and major affective disorders, 5% had schizophreniform episodes only, 10% developed schizophrenia, and 15% had no disorders. CONCLUSION: The findings suggest an association between schizophreniform disorder with good prognostic features and affective illness.     

The relationship between cognitive inhibition and psychotic symptoms.

Cognitive models of schizophrenia have highlighted deficits of inhibitory attentional processes as central to the disorder. This has been investigated using "negative priming" (S. P. Tipper, 1985), with schizophrenia patients showing a reduction of negative priming in a number of studies. This study attempted to replicate these findings, but studied psychotic symptoms rather than the broad diagnostic category of schizophrenia. Psychotic individuals exhibiting positive symptoms were compared with asymptomatic psychiatric patients and with a normal control group. As predicted, the symptomatic group failed to show the usual negative priming effect, which was present in the asymptomatic and normal groups. A modest but significant correlation was found between negative priming and delusions. Neither diagnosis, nor affective or negative symptoms, nor chronicity, nor medication, was related to negative priming. These data replicate previous findings that positive symptoms are related to a reduction in cognitive inhibition, although considerable variability was observed among the psychotic patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role play for assessing the social competence of psychiatric patients.

This study examined the validity and utility of role play for assessing social competence of chronic psychiatric patients. Demographically matched groups of patients with schizophrenia (n?=?57), schizoaffective disorder (n?=?16), major affective disorder (n?=?33), and a nonpatient control group (n?=?20) were assessed on a role-play test, interview measures of role functioning in the community, and a problem-solving discussion with a significant other. A subsample was reassessed on the same instruments 6 months later. Behavior on the role-play test discriminated the groups, was highly correlated with ratings on the other measures, and was relatively stable over the retest interval. The results were interpreted as providing strong support for the value of role play as a general measure of social functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family study of schizophrenia and personality.

The purpose of this study was to determine whether the abnormal characteristics observed in relatives of schizophrenics represent variations in normal personality. Relatives (N?=?340) of patients with schizophrenia, affective disorder, and medical or surgical conditions were personally interviewed about psychiatric symptoms and completed the Multidimensional Personality Questionnaire. Relatives who were themselves ill had elevated scores on some scales. Relatives of schizophrenics had normal scores on all personality scales, but relatives of affectively ill probands differed from other relatives on Well-Being and measures of Negative Emotionality. When schizophrenic probands were subtyped by symptoms, relatives of emotionally blunted schizophrenics were found to have slightly lower scores on Social Closeness than did relatives of controls. Overall, these results suggest that schizophrenia is unrelated to normal personality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analysis of CAG/CTG repeat size in Chinese subjects with schizophrenia and bipolar affective disorder using the repeat expansion detection method

BACKGROUND: Family studies of schizophrenia and bipolar affective disorder provide evidence for genetic anticipation, which (in common with a number of mendelian disorders), may be caused by triplet repeat expansion. This hypothesis is strengthened by evidence from repeat expansion detection (RED) analysis revealing association between the psychoses and long CAG/CTG trinucleotide repeats. METHODS: We performed RED on Han Chinese subjects with schizophrenia (82), bipolar affective disorder (43), and normal controls (61), using a CTG10 oligonucleotide. RESULTS: Comparison between cases and controls revealed no significant association between long repeats and affected status. We also found no detectable association with age at onset and repeat length in either bipolar affective disorder or schizophrenia. Overall, the size distribution of CAG/CTG repeats in Chinese subjects was not significantly different from those reported previously for Caucasian subjects. CONCLUSIONS: These findings indicate that CAG/CTG repeat expansion is not likely to be a major etiological factor for psychosis in Chinese populations.     

The role of gender differences in the reduction of etiologic heterogeneity in schizophrenia

Recent research has shown a resurgence of interest in the study of gender differences in schizophrenia. Accumulated evidence suggests that, compared with women, men have a higher incidence of schizophrenia, earlier age of onset, poorer course and medication response, poorer premorbid social and intellectual functioning, fewer affective symptoms, lower family morbid risk of schizophrenia and affective disorders, more evidence of obstetric complications in their mothers, and greater structural brain abnormalities. The roles of estrogen, neurodevelopment, and family history of affective disorder are evaluated as co-contributors to the observed gender differences in schizophrenia. Particular emphasis is given to evaluating the hypothesis that men are more prone to a hypothesized poor-prognosis, neurodevelopmental subtype of schizophrenia, for which early environmental brain insults play an important etiologic role, whereas women may be more prone to a hypothesized good-prognosis, affective subtype that is genetically related to the affective disorders. This hypothesis is evaluated in terms of (a) its ability to account for gender differences in schizophrenia, (b) its ability to link differences in clinical presentation to proposed differences in etiology; and (c) its potential to generate testable predictions for future schizophrenia research.     

Eye tracking in patients with unipolar and bipolar affective disorders in remission.

Examined patients (20–66 yrs old) with a history of recurrent affective disorder on a variety of smooth-pursuit and saccadic eye-tracking tasks and on psychomotor analogs of these tasks. The 25 unipolar and 24 bipolar Ss were compared to 24 schizophrenics; all Ss were in remission. Results indicate that the performance of the 2 affective-disorder groups was not significantly different from that of the controls on any of these tasks. Smooth-pursuit tracking error was greater for Ss receiving Li and for those with a higher frequency of prior episodes of the disorder. When the pursuit eye movements of these Ss were compared to those of the schizophrenics, the latter produced more tracking error than both affective-disorder groups but significantly so only with respect to unipolar Ss. Although findings are consistent with the interpretation that tracking dysfunction is not a trait characteristic of affective disorders, further investigations contrasting remitted patients with bipolar and schizophrenic disorders are needed to determine the specificity of deviant tracking to schizophrenia. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In experimental diabetes the decrease in the eye of lens carnitine levels is an early important and selective event

The relationship between a history of substance use disorder and the early course of psychotic illness was examined in 96 subjects with schizophrenia and 106 subjects with affective psychosis followed in the Suffolk County Mental Health Project, a longitudinal study of first-admission psychosis. Subjects received a structured diagnostic interview and clinical ratings at baseline assessment and again 6 months later. The 6-month assessment included information about treatment received during the interval. A lifetime history of substance use disorder was associated with worse clinical functioning at 6 months for schizophrenia subjects, but not for those with affective psychosis. There were no significant associations of substance use disorder with type of treatment during the interval or with self-reported compliance with medication. Schizophrenia subjects were more likely than subjects with affective psychosis to report cannabis use during the interval and to meet criteria for cannabis use disorder.     

DSM-IV intermittent explosive disorder: a report of 27 cases

BACKGROUND: The authors' objective was to provide data regarding the demographic, phenomenological, course of illness, associated psychiatric and medical comorbidity, family history, and psychiatric treatment response characteristics of rigorously diagnosed subjects who met DSM-IV criteria for intermittent explosive disorder. METHOD: Twenty-seven subjects meeting DSM-IV criteria for a current or past history of intermittent explosive disorder were given structured diagnostic interviews. The subjects' medical histories, family histories of psychiatric disorders, and responses to psychiatric treatments were also assessed. RESULTS: Most subjects described their intermittent explosive disorder symptoms as very distressing and/or highly problematic. All 27 subjects described aggressive impulses prior to their aggressive acts. Of 24 subjects who were systematically queried, 21 (88%) experienced tension with the impulses; 18 (75%), relief with the aggressive acts; and 11 (48%), pleasure with the acts. Most subjects stated that their aggressive impulses and acts were also associated with affective symptoms, particularly changes in mood and energy level. Twenty-five (93%) subjects had lifetime DSM-IV diagnoses of mood disorders; 13 (48%), substance use disorders; 13 (48%), anxiety disorders; 6 (22%), eating disorders; and 12 (44%), an impulse-control disorder other than intermittent explosive disorder. Subjects also displayed high rates of comorbid migraine headaches. First-degree relatives displayed high rates of mood, substance use, and impulse-control disorders. Twelve (60%) of 20 subjects receiving monotherapy with an antidepressant or a mood stabilizer reported moderate or marked reduction of their aggressive impulses and/or episodes. CONCLUSION: Intermittent explosive disorder appears to be a bona fide impulse-control disorder that may be related to mood disorder and may represent another form of affective spectrum disorder.