Assessment of premorbid social competence in schizophrenia: A methodological note.

The developmental theory underlying the Zigler-Phillips Social Competence Scale ({ZPSCS}; Zigler & Phillips, 1961) has important implications for using the scale to assess premorbid adjustment in schizophrenia. Many studies using the {ZPSCS} have scored the scale in an inconsistent manner or have not clearly limited the premorbid period to that prior to the onset of illness. {ZPSCS} ratings of social competence change over time, therefore studies using the {ZPSCS} should attend closely to the definition of the premorbid period and indicate whether premorbid or current adult social competence is being assessed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social competence and posthospital outcome among schizophrenic and nonschizophrenic psychiatric patients.

Although E. Zigler and L. Phillips (see 37:1 and 38:6) contend that an identical relationship between premorbid social competence and prognosis is found in both a schizophrenic and nonschizophrenic hospital population, supporting data are not presented. To test this hypothesis, the 3-yr posthospital outcomes of 81 schizophrenic and 85 nonschizophrenic previously hospitalized patients were separately related to the Zigler and Phillips' Social Competence Scale. The results indicate that among schizophrenics social competence is positively related to 2 out of 5 indexes of posthospital outcome: incidence (p     

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.     

Premorbid adjustment as predictor of outcome in schizophrenia: results of a prospective study

The present prospective follow-up study of 163 schizophrenic patients admitted to hospital for the first time examined the relationship between premorbid adjustment and different measures of the 3-year course and outcome. The same instruments had been used in all phases of the study. The Premorbid Adjustment Scale was used to assess premorbid social functioning. Outcome measures were positive symptoms, negative symptoms, social disability and number of rehospitalizations. The results of the multiple regression analyses showed that premorbid adjustment was the strongest overall predictor of outcome. Premorbid adjustment was significantly associated with negative symptoms and social disability over the 3-year course of illness. In a further step, we examined the relationship between good, moderate and poor premorbid adjustment and the course of positive symptoms, negative symptoms and social disability within the first 3 years after index admission. The most important finding was that premorbid functioning showed a stronger correlation with the course of negative symptoms and social disability than with the course of positive symptoms. Poor premorbid social functioning implies a poor social course of the illness. Female subjects showed better premorbid functioning than male subjects. Good premorbid adjustment was strongly associated with an acute onset of the illness, and poor premorbid adjustment with an insidious onset.     

The role of physical attractiveness in the readjustment of discharged psychiatric patients.

27 female and 22 male psychiatric inpatients (aged 18–56 yrs) about to be discharged to the community were rated for physical attractiveness, and their adjustment was assessed 6 mo after discharge. Before discharge, Ss' premorbid adjustment, physical attractiveness, adequacy of present interpersonal behavior, and present hospital adjustment were assessed. Six months after discharge, Ss were interviewed, and time out of the hospital, social competence, and a friend's or relative's ratings of the Ss were measured. Findings show that Ss who were more physically attractive stayed out of the hospital longer than the less attractive ones. Females who were relatively more attractive were perceived as being better adjusted by the friend or relative; this relationship was not present for males. Implications for the role of physical attractiveness in the etiology and maintenance of mental disorders are discussed. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting outcome in schizophrenia.

Schizophrenic patients leaving a VA hospital for independent life in the community were followed up for a year after departure. They had been rated on ward and at activities, had been interviewed, and had been extensively tested. By 1 year 33 of 78 had returned, but there was little difference in the predeparture measures or in a 1-month home visit between these and those who stayed out. For those staying out, 35 of 111 predictors correlated significantly with at least 1 of 2 year-end adjustment criteria. Social assets predicted no better positively (and may have predicted worse), than psychopathology predicted negatively. Demographic variables, such as time since 1st mental hospitalization, predicted at least as well as tests; and factorially pure test scales predicted no better than empirical scales. (33 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adjustment to infertility.

Psychological adjustment to the threat of being unable to bear children was investigated for 62 women and 45 men. Approximately 37% of women and 1% of men of infertile marriages showed psychological disturbance. Because of the small number of men, the predictors of adjustment for women only were examined by regression analyses. Both event characteristics (medical factors) and subjective variables (cognitive factors) were found to contribute significantly to adjustment. Younger women and women who had not received a diagnosis were more distressed than patients who had. Women who felt responsible for their infertility showed poorer adjustment, and this was most evident when the cause of infertility was not due to male factors. Also, women who believed that their chances of conceiving were lower than the actual medical prognosis were more distressed. Finally, women who were affiliated with Protestant religions showed better adjustment than women of other faiths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Premorbid competence in schizophrenia: What is being measured?

Examined whether the premorbid social competence scale of E. Zigler and L. Phillips (1960) assesses one or several dimensions in patient groups differing in regard to gender and type of hospital. Three groups of schizophrenics were studied: 295 VA hospital males, 300 state hospital males, and 300 state hospital females. For all groups, the competence scores reflected 3 orthogonal factors, but the factorial structure differed as a function of gender and type of hospital. One factor in all groups was defined by the usual socioeconomic variables of education and occupation. Each of the 5 scale indices made an independent contribution to the variance of the overall competence score, but the education index had a smaller role than the other 4 measures. Females had higher competence scores than state hospital males, a difference that was not due to the marital status variable alone. Possible explanations for this finding are discussed, and suggestions are made for refinement and further development of the scale. (62 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Nonspecific" chest pain associated with high long-term mortality: results from the primary prevention study in G?teborg, Sweden

BACKGROUND: The syndrome angina pectoris with effort-related chest pain or discomfort is usually easy to recognize. However, vague and nonspecific symptoms may cause little reason for extensive evaluation. The prognosis of such patients in the general population has so far not been well described. HYPOTHESIS: The study was undertaken to investigate long-term prognosis in men with chest pain considered to be nonspecific in comparison with men with typical angina pectoris (AP) or prior myocardial infarction (MI), and men without chest pain. METHODS: At the second screening of the G?teborg Primary Prevention Study in 1974-1977, 6,488 men aged 51 to 59 years at baseline were available for the present analysis. Men who had responded positively to a postal questionnaire about chest pain during exercise or at rest were interviewed by a physician according to a Rose questionnaire at the screening examination. Those with typical or probable AP were further examined by single experienced physician. The following four groups were formed: Group 1: men who did not complain of chest pain (n = 5,545). Group 2: men who had not consulted any doctor because of chest pain, but who had chest pain according to a questionnaire (n = 441); these men were not considered to have AP according to a three-step examination by experienced physicians. Group 3: typical AP (n = 232). Group 4: men who had suffered an MI (n = 134). RESULTS: During 16 years of follow-up, coronary heart disease (CHD) mortality for Groups 1-4 was 8.0, 19.5, 24.8, and 48.5%, respectively. Mortality from all cardiovascular diseases was 11.5, 24.5, 31.2, and 59.0%, respectively. Noncardiovascular disease mortality was 14.1, 17.7, 14.3, and 8.7%, respectively. Thus, the relative risk (RR) for CHD mortality among men with nonspecific chest pain (Group 2) was 2.77 [95% confidence interval (CI) 2.20, 3.50], for all cardiovascular disease mortality 2.46 (95% CI 2.00, 3.02), and for noncardiovascular disease mortality 1.60 (95% CI 1.28, 2.00). Total mortality in this group was as high (44%) as among those with typical AP (45%), but the highest mortality was found among men with a previous MI (68%). In men without chest pain it was 26%. Patients of Groups 2-4 had higher levels of cardiovascular risk factors than those in Group 1. Neither any specific questions in the Rose questionnaire, nor electrocardiographic changes at rest (uncommon) were of prognostic significance. Serum cholesterol, systolic blood pressure, diabetes, and smoking were significant predictors of outcome, both with respect to fatal CHD and to total mortality during the 16-year follow-up. CONCLUSION: We found a high cardiovascular as well as noncardiovascular mortality among patients with chest pain who had not been considered to have AP at a three-step examination procedure. It is important to be suspicious of early CHD symptoms in men (and women?) with "nonspecific" chest symptoms and to analyze their cardiovascular risk factor pattern further because they are at considerably higher risk for future events than those in whom CHD is not suspected.     

Abstraction on proverbs in process-reactive schizophrenia.

Administered the Phillips Prognostic Rating Scale (PRS) and the Benjamin Proverb Test to 51 consecutive, drug-free, males with a diagnosis of schizophrenia, shortly after entering the hospital. There was no relationship between classification by PRS and abstraction when drug effects and duration of current hospital stay were controlled. Using only those cases who had no previous history of psychiatric hospitalization, thereby controlling for previous and current hospitalization, still failed to produce a significant relationship. The suggestion of a racial effect emerged. This is discussed along with certain theoretical implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Weight suppression is a robust predictor of outcome in the cognitive-behavioral treatment of bulimia nervosa.

This study examined weight suppression (difference between highest premorbid weight and pretreatment weight) as a predictor of outcome in 188 outpatients with bulimia nervosa enrolled in a cognitive- behavioral therapy intervention. Participants who dropped out of treatment had significantly higher levels of weight suppression than treatment completers. Of participants who completed treatment, those who continued to engage in binge eating or purging had significantly higher levels of weight suppression than those who were abstinent from bingeing and purging. Results did not change when body mass index, dietary restraint, weight and shape concerns, or other relevant variables were controlled. Relinquishing bulimic behaviors and adopting normal eating patterns may be most feasible for patients who are closest to their highest premorbid weights. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social competence: The action-thought parameter and vicariousness in normal and pathological behavior.

A developmental conceptualization of behavior suggests that as maturation proceeds there follows a shift from action to thought. This action-thought dimension was hypothesized to be reflected in an individual's occupational choice as well as in his symptom formation and in premorbid level of adjustment (as measured by a "social competence" index [Zigler and Phillips, 1960]). Patients with symptoms in the ideational an verbal sphere were found to have a better premorbid level of adjustment and a higher level of vocational status. Atypical patterns of behavioral orientation and vocational and social adjustment were also explored. The findings are related to concepts within a developmental psychology content. From Psyc Abstracts 36:04:4JP37P. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factorial structure and prognostic significance of premorbid adjustment in schizophrenia.

A sample of 291 resident male schizophrenic patients were rated on the Becker revision of the Elgin Prognostic Scale and on the Phillips Prognostic Rating Scale. 28 items drawn from both scales were factor analyzed. The factors were rotated to both varimax orthogonal solution and to biquartimin oblique solution. The 2 methods yielded a high degree of factorial similarity. 7 factors were: I, Social Withdrawal, Few Interests; II, Inadequate Heterosexual Relationships; III, Socially Undesirable Ward Behavior; IV, Rigid, Flat Affect. and Apathy; V, Insidious Onset; VI, Stubborn and Egocentric; and VII, Chronic Poor Physical Health. Correlations with a measure of chronicity (for 3 social class groupings) indicated that Factors I, II, III, and V have important prognostic power. These findings emphasize the need for a multivariate research approach to premorbid adjustment and the inclusion of the new and prognostically significant Factor III (Socially Undesirable Ward Behavior). (27 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A controlled study of variables related to counseling center use.

Investigated the utility of several variables in discriminating between students who sought help at a university counseling center (seekers) and those who did not (nonseekers), when level of personal adjustment was controlled. Interactions between Ss' level of personal adjustment and help-seeking status were also examined. 40 female undergraduates who reported no previous history of formal counseling or psychotherapy were administered several tests including the College Maladjustment Scale. Three variables—alternate sources of help, counseling usefulness, and perceived severity of help-seeker pathology—significantly discriminated seeker from nonseeker Ss. It is suggested that level of Ss' adjustment is an important variable to control in research on the decision to seek help. Attitudinal variables were not powerful predictors of help-seeking behavior. Implications for the delivery of mental health services on the university campus are discussed. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological adjustment to survival from Hodgkin's disease.

Compared the psychological adjustment of 60 male Hodgkin's disease survivors, aged 20–47 yrs, with an age-matched sample of 20 physically healthy men. Assessment included objective self-report, projective testing, observer rating, and interview. Measures included the Global Assessment Scale, Rosenberg Self-Esteem Scale, and Thematic Apperception Test (TAT). All Ss had received no treatment and had shown no evidence of disease for the previous 6–240 mo (median 2 yrs). On most measures, no differences were found between cancer survivors and healthy controls. However, the hypothesis of greater psychosocial dysfunction in the cancer sample overall was partially confirmed by significantly lowered intimacy motivation, increased avoidant thinking about illness, prolonged difficulty in returning to premorbid work status, and illness-related concerns. Conversely, patients were significantly more appreciative of life than nonpatients. Within the patient group, late stage (aggressively treated) Ss were at highest risk for psychological distress and psychosocial disruption during the 1st 2 yrs off treatment. (52 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An assessment of physical and psychological stress of patients with facial paralysis

The purpose of this study was to determine if there is a relationship between the appearance of facial paralysis and physical or psychological stress. Subjects were 55 patients (23 men, 32 women) with facial paralysis (32 with Bell's palsy, 23 with Ramsay Hunt syndrome) who visited the Department of Otolaryngology, Nihon University Itabashi Hospital, from August 1994 to March 1996. At the time of the initial visit, patients were asked if they had any physical or psychological stress one week before the occurrence of facial paralysis. The degree of psychological stress was rated by Niina's Psychological Stress Response Scale 50 Items Revised (PSRS-50R). Answers were obtained from 52 of the 55 subjects. Forty patients (76.9%) reported that they had felt physically fatigued, suggesting some type of relationship between the occurrence of facial paralysis and physical stress. Twenty-seven patients (51.9%) reported the existence of psychological stress. However, the evaluation of psychological stress by PSRS-50R did not reveal a high level of psychological stress in any patient, indicating lack of a strong relationship between the occurrence of facial paralysis and psychological stress. Stepwise regression analyses were made to study the relationship between the degree of paralysis at the time of the initial visit and factors which affect the prognosis of the paralysis. Those patients who reported physical fatigue before the appearance of facial paralysis had more abnormal values on the nerve excitability test than those who did not report such fatigue.     

Exercise as a mediator of psychological and nutritional effects of testosterone therapy in HIV+ men

PURPOSE: The purpose of this study was to determine whether exercise mediates the psychological and nutritional effects of testosterone therapy in men with symptomatic HIV illness, low serum testosterone, and clinical symptoms of hypogonadism. METHODS: A 12-wk open trial of biweekly intramuscular testosterone injections was conducted, with 54 men completing the trial and exercise assessments. Most (71%) men were diagnosed with AIDS; 41% had a CD4 < 50. One-third of the men were diagnosed with major depression, and nearly half had some evidence of wasting. Twenty-nine men (54%) engaged in exercise (predominantly resistance training) during the trial. Exercisers did not differ from nonexercisers on any measure of psychological well being or nutritional status at baseline. RESULTS: After 12 wk of testosterone treatment, those who exercised showed significant improvement in mood (Hamilton Rating Scale for Depression; HAM-D) and overall distress (Brief Symptom Inventory; BSI) (P < 0.000 for both), as well as a significant increase in body cell mass (P < 0.01) and lean body mass (mean increase of 2.6 kg; P < 0.000) as measured by bioelectric impedance analysis. In contrast, nonexercisers showed improvement on the HAM-D (P < 0.000), but not the BSI or measures of nutritional status. CONCLUSION: These findings indicate that exercise may be an important adjunct to testosterone therapy in the treatment of psychological distress and wasting symptoms in men with symptomatic HIV illness.     

Meaning dimensions and male-female voice perception in schizophrenics with good and poor premorbid adjustment.

This study explored certain aspects of perceptual distortion in schizophrenia. Among schizophrenics with a good premorbid adjustment, schizophrenics with a poor premorbid adjustment, and normals, auditory perception of spoken material was compared as a function of (a) sex of voice and (b) dimensions of meaning. The Ss listened to successive presentations of a recorded spoken word, mixed with decreasing amounts of masking noise, until their recognition threshold were established. Schizophrenics with poor premorbid adjustment responding to the female voice had significantly higher thresholds than those responding to the male voice. This finding did not occur in schizophrenics with good premorbid adjustment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential recovery of intellectual, associational, and psychophysiological functioning in withdrawn and active schizophrenics.

Recent research indicates that activity level in schizophrenics is related to probability of cerebral damage, neurophysiological functioning, severity of the schizophrenic episode, and level of premorbid adjustment. Withdrawn patients consistently appear more disturbed than active patients on these variables. The present study examined 15 withdrawn chronic schizophrenics (mean age 37.8 yrs) and 15 active chronic schizophrenics (mean age 40.2 yrs) who were evaluated on the Venables Activity–Withdrawal Scale within their 1st wk of hospitalization. Withdrawns recovered more slowly than actives across the 1st 5 wks of hospitalization in terms of intellectual, associational, and psychophysiological measures. The interaction of these various areas of functioning and their implications for clinical practice are discussed. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)