Depressed patients with schizophrenic or paranoid symptoms

Family history, response to treatment and outcome are reported in a series of 76 patients presenting with both depression and schizophrenic or paranoid symptoms. About 10% of psychotic admissions to the Maudsley and Bethlem Royal Hospitals met a study definition of "schizodepressive" illness. The patients were highly heterogeneous in history, clinical picture and outcome. Many followed a typical schizophrenic course, and others a typical course for effective disorders, but only 4 were given a final diagnosis of manic depressive disease. The best predictors of poor outcome were a mode of onset as an exacerbation of previous psychotic symptoms and the presence of schizophrenic symptoms at some time without depression. The best predictors of good outcome were Stephens' criteria of good prognosis schizophrenia and Kasanin's concept of "acute schizo-affective psychosis". These findings are not easily reconciled with Kraepelin's two entities principle but suggest a continuum of outcome between schizophrenia and unipolar depressive psychosis.     

MMPI profiles of brain-damaged and schizophrenic subjects

MMPI mean profiles for matched groups of 50 brain-damaged and 50 schizophrenic Ss from a short-term hospital were compared. The profiles are quite different. F tests demonstrated that the Sc scale best differentiated the two groups at far beyond the .01 level, and scales F, PA and PT also differentiated the two groups beyond the .01 level. A cut-off point of 80 on the SC scale correctly classified 78% of the two groups. Neither the 2-9 nor the 1-3-9 profile occurred a sufficient number of times in either group to be of any help in diagnosis.     

Neuropsychological test performances of young depressed outpatient women. An examination of executive functions.

Thirty young, unmedicated, outpatient, depressed women were compared to an equal number of matching controls on a series of neuropsychological tests purported to be sensitive to the executive functions. Specifically, the measures included the Design Fluency Test, Hand Dynamometer tasks of grip strength, perseveration, and fatigue, the FAS Verbal Fluency Test, the Stroop Color and Word Test, and the Trail Making Test (Parts A and B). Despite past research which has indicated anterior hemispheric asymmetries and impaired neurocognitive performances in depressives, this research failed to identify any reliable differences between depressed and nondepressed women on any of the neuropsychological measures. These results argue against the frequently held stereotype that depressed individuals typically display impaired performances on neurocognitive tasks. Furthermore, since the profile of the depressed sample appeared to differ significantly from past studies, a discussion is provided as to how the characteristics of this group may have impacted the results. Implications of these findings for clinical practice and future research are also provided.     

A process approach to the Bender-Gestalt test and its use in differentiating schizophrenic, brain-damaged, and medical patients

Developed a processing model that would account for the shifting of attention that occurs as individuals copy Bender-Gestalt designs. Process-oriented variations of the Bender-Gestalt test were designed that emphasized each of the three processes hypothesized to contribute to Bender-Gestalt performance: Perceptual-motor integration, attentional factors, and short-term memory. A standard Bender-Gestalt and the three variations were administered to 24 schizophrenics, 24 brain-damaged patients, and 24 medical patients, matched for intelligence and sex. Protocols were scored blindly by the Pascal-Suttell and Hain methods. Discriminant function analysis based upon the four versions of the Bender-Gestalt test classified patients as schizophrenic or brain-damaged at a significantly higher rate than the standard Bender-Gestalt scored by either the Pascal-Suttell or Hain system.     

Depression in paranoid and nonparanoid schizophrenic patients compared with major depressive disorder

Background: Depression occurring in schizophrenia is a common problem; however, investigators have typically not studied it with the paranoid/nonparanoid dichotomy in mind. This study examines the quality as well as the severity of depression in three psychiatric groups: paranoid schizophrenia patients, nonparanoid schizophrenia patients, and nonpsychotic major depression patients. Method: Clinical and sociodemographic data were collected on 27 paranoid and 27 nonparanoid schizophrenia patients during their postpsychotic phase while they were at least mildly depressed, and a comparison group of 27 nonpsychotic patients diagnosed with major depressive disorder. The three groups were then assessed on various psychometric scales for severity of depression, profile of symptoms, suicidal risk, and anhedonia. Results: The paranoid schizophrenia patients were more depressed and more at risk for suicide than the nonparanoid schizophrenia patients, yet their depressive profiles and levels of anhedonia were similar. Conclusions: Depressed mood and anhedonia constitute serious problems for schizophrenia patients, but particularly for paranoid schizophrenia patients during the postpsychotic phase of their illnesses. Clinical implications: Schizophrenia patients, especially those with the paranoid features, should be routinely evaluated and monitored for depression. Apart from treatment with drugs, cognitive therapy may be considered a viable option, particularly for paranoid schizophrenia patients. Limitations: Gender was not matched for the two schizophrenia groups and extrapyramidal side effects were not measured.     

A comparison of the effectiveness of MMPI indices in the discrimination of brain-damaged and schizophrenic patients

Assessed the effectiveness of 22 published MMPI procedures to differentiate organic brain syndrome (OBS) from schizophrenic (Sc) patients. Generally, each procedure previously has been suggested to have some effectiveness in making this differentiation. When assessed across studies, however, the S groups have differed on so many relevant variables (age, sex, clinical setting, etc.) that direct comparisons of their relative effectiveness cannot be made. In the current study the accuracy rates are presented for each of the 22 discrimination procedures with a sample matched on age, education, and IQ and also with an unmatched sample, all selected from the patient population at a neuropsychiatric setting. With the matched sample the Hs-Pt Index (Watson, Plemel , & Jacobs, 1978) and the Sc-O Scale, Unweighted Long form (Watson, 1971) reached statistical significance (p less than .10). With the unmatched sample both of the above procedures plus the OBS Signs procedure ( Markowitz , 1973) and P-O Scale (Watson & Plemel , 1978) reached statistical significance (p less than .10). Overall accuracy rates of those procedures found to be statistically significant ranged from 61.5 to 70.0%. These accuracy rates compare favorably to those obtained with more complex and time-consuming neuropsychiatric batteries.     

Investigation of serum cytokine levels and cytokine production in whole blood cultures of paranoid schizophrenic patients

There is some evidence that the pathophysiology of schizophrenia is related to changes in the innate and adaptive immune systems. In an attempt to define a potential immunological dysfunction in schizophrenia, we measured the serum levels of several cytokines in the sera of 24 patients with paranoid schizophrenia and investigated the cytokine production in whole blood assays after stimulation in vitro with virus (Newcastle disease), phytohemagglutinin (PHA) or bacterial lipopolysaccharide (LPS) and compared them with healthy, normal controls. A significant increase of interleukin 6 (IL-6), IL-8 and interferon gamma (IFN-gamma) levels, but a decreased L-10 level were observed in the sera of patients with schizophrenia. No significant changes in the serum levels of IL-2, IL-4, IFN-alpha and tumor necrosis factor alpha (TNF-alpha) were detected in these patients. When cytokine production in vitro was examined, a significant defect in PHA-induced IL-2, L-4 and IFN-gamma, and in virus-induced IFN-alpha production, but no significant alterations in LPS-induced IL-6, IL- 10 and TNF-alpha production were observed. In summary, increased serum levels of some cytokines such as IL-6, IL-8 and IFN-gamma indicate an activation of the inflammatory response in schizophrenia, while the in vitro assay indicates significant changes in the Th1 (decreased production of 1L-2 and IFN-gamma) and Th2 (decreased production of IL-4) cell system responses. The role of the defective EFN-alpha production in the regulation of the imbalance between Th1 and Th2 cell system responses is suggested.     

Further evidence that concerns the validity of an MMPI key for separation of brain-damaged and schizophrenic patients

This study attempted to cross-validate an MMPI Key for the separation of brain-damaged and schizophrenic inpatients. MMPI profiles generated by 20 males with a variety of documented brain dysfunctions were compared to those of 20 heterogenous male schizophrenics. The groups were matched on the variables of age and education. The procedure provided 82.5% correct classification, which included 85% correct schizophrenic identification and 80% correct brain-damage identification. The Key was recommended for use as a rough screening device or as a supplement to appropriate neuropsychological procedures.     

Neuropsychological test performance in illiterate subjects.

The purpose of this study was to further analyze the effects of education across different age ranges on neuropsychological test performance. Two different analyses were performed. The first analysis was conducted in order to pinpoint the impact of school attendance on neuropsychological testing. A group of 64 illiterate normal subjects was selected in the Mexican Republic. Their performance was compared with two barely schooled control groups (1-2 and 3-4 years of schooling). The subjects' ages ranged from 16 to 85 years. In the second analysis, the illiterate subjects were further matched by age and sex with individuals with 1 to 4, 5 to 9, and 10 to 19 years of formal education. The Spanish version of the NEUROPSI neuropsychological test battery (Ostrosky, Ardila, & Rosselli, 1997) was used. Results indicated a significant educational effect on most of the tests. Largest educational effect was noted in constructional abilities (copying of a figure), language (comprehension), phonological verbal fluency, and conceptual functions (similarities, calculation abilities, and sequences). Aging effect was noted in visuoperceptual (visual detection) and memory scores. In the first subject sample, it was evident that, despite using such limited educational range (from 0-4 years of formal education), and such a wide age range (from 16-85 years), schooling represented a stronger variable than age. It is proposed that education effect on neuropsychological test performance represents a negatively accelerated curve, tending to a plateau.     

Relative efficacy of the Sc-O, P-O, P-N, and Sc MMPI scales in differentiating brain-damaged, brain-damaged schizophrenic, schizophrenic, and somatoform disorders in an outpatient setting

This study examined the efficacy of the Schizophrenic-Organicity (Sc-O), Psychiatric-Organic (P-O), the Pseudo-Neurological (P-N), and the Schizophrenia (Sc) MMPI subscales in differentiating the following four groups of outpatients: brain-damaged (n = 35), brain-damaged schizophrenics (n = 10), non-brain-damaged schizophrenics (n = 15), and somatoform disorders (n = 45). Both unmatched and matched samples were used in the analysis, and cut-off scores were obtained. In an unmatched sample, results suggested that the Sc scale was useful in differentiating brain-damaged schizophrenics from brain-damaged and somatoform disorders. With matched samples, the Sc differentiated brain-damaged schizophrenics well from other clinical groups, while the P-O scale differentiated the non-brain-damaged schizophrenics from brain-damaged and somatoform disorders. Furthermore, the P-N scale discriminated brain-damaged schizophrenics from non-brain-damaged schizophrenics, while the Sc-O scale was no longer significant. Results suggest that caution should be used in generalizing from previous studies (which used inpatient samples) to outpatient populations.     

Neuropsychological test development and normative data on Hispanics.

The development of culturally relevant psychological assessment tools and intervention procedures has not been commensurate with the rate of Hispanic population growth in the United States. The development of valid and reliable test measures for the assessment of this population must be based on empirical investigations. In this article, we present normative data on multiple measures from the Benton Laboratory and the Wisconsin Card Sorting Test. Results revealed equivalent findings for our Hispanic subjects and the English-speaking samples utilized in the original normative studies within the United States. We additionally review current trends and specific problems encountered in neuropsychological research with Hispanics, and suggest guidelines and directions for future research.