Expressed emotion and subclinical psychopathology observable within the transactions between schizophrenic patients and their family members.

The authors examined whether young, recently discharged schizophrenic patients from high (n?=?34) and low (n?=?14) expressed emotion (EE) families differ in their level of subclinical symptomatology during a direct interaction task. Compared with patients from low-EE homes, patients from high-EE homes showed significantly more odd and disruptive behavior with family members. High-EE relatives were more likely than low-EE relatives to respond with criticism to the first unusual thought verbalized by the patient; when this occurred, the probability of a second unusual thought was augmented. Results suggest that high-EE family members may display negative attitudes toward patients in part because they are exposed to higher levels of unusual or disruptive behavior than low-EE relatives. The data also support a bidirectional, transactional model of the relationship between relatives' EE and patient psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prodromal signs and symptoms of schizophrenic relapse.

Six-week periods prior to 17 psychotic relapses and to 10 relapses characterized by depression and/or hostility were examined for 23 recent-onset schizophrenic outpatients. These prodromal periods were compared with periods that did not precede relapse for the same patients and for 27 schizophrenic patients who did not relapse. The Brief Psychiatric Rating Scale (BPRS) was used to assess symptomatology. Psychotic relapse was defined as an elevation to severe or extremely severe from nonpathological levels on one or more of BPRS items: Hallucinations, Unusual Thought Content, and Conceptual Disorganization. Nonpsychotic relapses were similarly defined using the Depression and Hostility items of the BPRS. Even small elevations in odd thought content, unusual perceptual experiences, depression, somatic concern, and guilt above the levels usually present for a given patient may presage psychotic relapse during the 6 to 8 weeks prior to its occurrence. When compared with nonprodromal periods of other patients, periods before relapse were found to show significantly higher levels of hostility and grandiosity in addition to higher levels of unusual thought content and perceptual abnormalities. For relapses characterized by depression and hostility, an elevation of activation was found in the prodromal period. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Norman Garmezy (1918–2009).

Norman Garmezy, a pioneer in research on risk and resilience, died in Nashville, Tennessee, on November 21, 2009, at the age of 91. He was a legendary mentor as well as an eminent scientist in clinical psychology. Norm was born on June 18, 1918, in New York City and grew up in the Bronx in a Jewish neighborhood where educational attainment was highly valued. The scientific study of resilience as conceived by Norman Garmezy, his peers, and students has transformed the science and practice of multiple disciplines, from the molecular level to the global ecosystem, infusing a strength-based and recovery-oriented approach into psychology, education, social work, and psychiatry. Current research on resilience ranges from studies of plasticity in brain development to effective planning for resilience in the context of disaster. Norm’s influential ideas and research earned him international acclaim and many honors for lifetime achievements in science. Throughout his career, Norm held many leadership roles. Throughout his life, Norm spoke with great love about his wife of 63 years, Edie Garmezy (who died just months before him in 2009), and their children. In addition to his work and his family, Norm had three abiding passions—theater, movies, and politics. During the last two decades of his life, Norm and those who loved him endured his long decline from Alzheimer’s, which slowly stole his brilliant mind and hilarious sense of humor. Nonetheless, the incredible spirit and humanity of this giant scholar continued to shine through this terrible disease. To the end of his life, Norm’s face would light up with a smile as he greeted the people he loved, and he would often exclaim, “Wonderful!” Norman Garmezy was a remarkable person and scholar who left an extraordinary legacy of love and work to inspire future generations in their efforts to understand and promote the human capacity for competence and resilience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A prospective study of stressful life events and schizophrenic relapse.

In this prospective, longitudinal study, 11 recent-onset schizophrenic outpatients who met criteria for psychotic relapse or significant psychotic exacerbation during a 1-year period of standardized maintenance medication, and 19 patients who did not relapse during this follow-up period, were interviewed monthly regarding life events. As hypothesized, for relapsing patients, a significantly higher number of independent life events (those not the result of symptomatology or personal influence) occurred in the month preceding relapse. This increase was apparent relative to either the analogous month of a "nonrelapse" period in the same patient or the average number of independent events per month during a 1-year standardized medication period for nonrelapsing patients. The methodological advances of this design as well as the consistency of these findings with those of previous retrospective studies supports the hypothesis that life events may sometimes "trigger" schizophrenic episodes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Controllability perceptions and reactions to symptoms of schizophrenia: A within-family comparison of relatives with high and low expressed emotion.

In a sample of 35 family members of patients with recent-onset schizophrenia, attributions of control and the content of critical comments were compared for 2 relatives of the same household who held discrepant expressed emotion (EE) attitudes (1 high and 1 low) toward their mentally ill family member. Attributions and the content of critical comments were also compared for low-EE relatives from low-EE homes versus low-EE relatives from high-EE homes. Our results indicate that high-EE relatives tend to attribute more control over behavior to patients than do low-EE relatives of the same patient. In addition, low-EE relatives from high-EE homes attribute more behavioral control to patients than do low-EE relatives from low-EE homes. These findings suggest that EE status is linked to attributions of control over behaviors, but additional patient factors or influences among family members may also affect EE attitudes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Verbal interactions in the families of schizophrenic and bipolar affective patients.

Do verbal interactions between psychiatric patients and family members covary with the diagnosis of the patient? This study compared relatives (usually parents) of schizophrenic (n?=?42) and bipolar (n?=?22) patients on affective style (AS) or emotional-verbal behavior toward patients in family interaction. Patients were compared on coping style or verbal interactional behavior toward relatives. Relatives of schizophrenic patients made more negative AS (particularly intrusive) statements to patients than relatives of bipolar patients. Schizophrenic patients made fewer supportive statements and more self-denigrating statements to relatives than bipolar patients. Among families of bipolar patients, negative AS in relatives was associated with oppositional, "refusing" styles in patients. Implications for psychosocial interventions with these disorders are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

P50 suppression in recent-onset schizophrenia: Clinical correlates and risperidone effects.

Chronic schizophrenic patients often do not suppress the auditory P50 component of the event-related potential to the second of 2 clicks, presented 500 ms apart, suggesting a loss of normal inhibition. This study attempted to replicate the P50 suppression deficit in patients with recent-onset schizophrenia and to examine whether P50 is related to clinical symptoms or is affected by an atypical antipsychotic medication. Data from 22 recent-onset schizophrenia patients and 11 normal controls revealed that disruption in P50 suppression is present during the early stages of illness. In addition, impaired P50 suppression covaried with clinical ratings of anxiety, depression, and anergia; results also suggested that the P50 inhibitory deficit may be related to the degree of patients' attentional impairment. Finally, risperidone, compared with a typical antipsychotic medication, improved inhibition of P50 to the second click. These results support P50 suppression as a measure of disordered neurocognition in schizophrenia. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Signal detection in vigilance tasks and behavioral attributes among offspring of schizophrenic mothers and among hyperactive children.

24 children of schizophrenic mothers, 20 children of mothers with nonpsychotic psychiatric disorders falling outside the schizophrenia spectrum, and 14 hyperactive children were examined relative to groups of individually matched comparison children and to a representatively stratified group of 67 normal children. Ss were 9–16 yrs of age. Children of schizophrenic mothers showed lower mean perceptual sensitivity (PS) than matched and stratified normal children and included an excessive number of extremely poor scorers. Neither children of mothers with nonpsychotic disorders outside the schizophrenia spectrum nor hyperactive children displayed a significant deficit in PS. Hyperactive children scored lower on a beta response criterion factor across vigilance tasks and were rated as higher on an Emotionality factor and lower on a Fearful Inhibition factor than their normal peers. The perceptual sensitivity deficit among children of schizophrenic mothers was found across motivational feedback conditions and was evident throughout the vigilance period. (3? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attentional modulation of the P50 suppression deficit in recent-onset and chronic schizophrenia.

Schizophrenia is associated with deficits in P50 suppression to the second stimulus in a pair, a process often conceptualized as a preattentive index of sensory gating. This study assessed the malleability of the deficit by determining whether early attentional control can influence P50 gating across different phases of schizophrenia. Participants included 28 patients in the recent-onset (n = 16) or chronic (n = 12) phase of illness and 28 healthy comparison subjects. During the standard paradigm, chronic schizophrenia patients exhibited impaired P50 suppression relative to healthy subjects, whereas recent-onset schizophrenia patients were intermediate. Directing voluntary attention toward the initial stimulus yielded substantial improvements in the P50 ratio; recent-onset schizophrenia patients achieved ratio scores comparable to those of healthy participants, whereas chronic patients also improved and could no longer be distinguished clearly from the healthy comparison sample. Directing attention toward the second stimulus enhanced P50 amplitude to the second stimulus across groups, possibly because activation of the inhibitory mechanism was overridden or circumvented by task demands. Thus, P50 suppression may be primarily preattentive under standard conditions, but manipulation of early attention can exert a modulatory influence on P50, indicating that the suppression deficit is malleable in schizophrenia without pharmacological agents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrity of emotional and motivational states during the prodromal, first-episode, and chronic phases of schizophrenia.

Emotional and motivational dysfunction is fundamental to schizophrenia, and yet, the nature and scope of associated deficits are not well understood. This study assessed the integrity of emotional responding from the perspective of its underlying motivational systems during different phases of schizophrenia. Evaluative, somatic, and autonomic responses were measured during viewing of pictures categorized by emotional content, including threat, mutilation, contamination, illness, pollution, mild erotica, families, food, and nature. Participants were 13 patients at ultra high risk or prodromal for psychosis, 40 first-episode schizophrenia patients, 37 chronic schizophrenia patients, and 74 healthy comparison subjects. Irrespective of phase of illness, schizophrenia patients showed a robust and normal pattern of response across multiple systems, with differential engagement of the defensive and appetitive systems as a function of the motivational significance assigned to specific emotional contexts. Although the integrity of core motivational states also appeared to be intact in prodromal patients, a less consistent pattern of response was observed. As continuing efforts are made to identify emotional and motivational abnormalities in schizophrenia, identified deficits will likely be independent of a fundamental dysfunction in basic emotion and motivation response systems and involve integration with higher order processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)