Does religious belief enable positive interpretation of auditory hallucinations?: a comparison of religious voice hearers with and without psychosis.

Introduction. Hearing voices occurs in people without psychosis. Why hearing voices is such a key pathological feature of psychosis whilst remaining a manageable experience in nonpsychotic people is yet to be understood. We hypothesised that religious voice hearers would interpret voices in accordance with their beliefs and therefore experience less distress. Methods. Three voice hearing groups, which comprised: 20 mentally healthy Christians, 15 Christian patients with psychosis, and 14 nonreligious patients with psychosis. All completed (1) questionnaires with rating scales measuring the perceptual and emotional aspects of hallucinated voices, and (2) a semistructured interview to explore whether religious belief is used to make sense of the voice hearing experience. Results. The three groups had perceptually similar experiences when hearing the voices. Mentally healthy Christians appeared to assimilate the experience with their religious beliefs (schematic processing) resulting in positive interpretations. Christian patients tended not to assimilate the experience with their religious beliefs, frequently reporting nonreligious interpretations that were predominantly negative. Nearly all participants experienced voices as powerful, but mentally healthy Christians reported the power of voices positively. Conclusion. Religious belief appeared to have a profound, beneficial influence on the mentally healthy Christians' interpretation of hearing voices, but had little or no influence in the case of Christian patients.

Is semantic memory impaired in schizophrenia? A systematic review and meta-analysis of 91 studies.

INTRODUCTION: Semantic memory impairments in schizophrenia have been reported across a wide range of neuropsychological tests. Set against a backdrop of fairly widespread cognitive impairments, it is difficult to know whether there is a primary, or secondary, impairment of semantic memory in schizophrenia. Also, whether there is a profile of differential impairment across the range of neuropsychological tests. METHODS: Employing a systematic search strategy, 91 papers were identified which have assessed participants with schizophrenia on a measure of semantic memory. A series of meta-analyses were then conducted which provided combined weighted means for performance on tasks of naming, word-picture matching, verbal fluency, priming, and categorisation. RESULTS: An uneven profile of impairment is reported with large effect sizes for tests of naming and verbal fluency, medium effect sizes for word-picture matching and association and small effect sizes for categorisation and priming tests. CONCLUSIONS: This uneven profile supports the claim that a degradation of semantic knowledge may not be adequate in explaining the semantic memory impairment in schizophrenia. This conclusion is supported by the data which report a relationship between an executive dysfunction and poor priming and fluency performance particularly. The data support a link between Formal Thought Disorder and semantic memory impairments on tests of naming and verbal fluency but on other tests evidence is equivocal.

Beyond symptom dimensions: schizophrenia risk factors for patient groups derived by latent class analysis.

INTRODUCTION: Patients grouped by latent class analysis of symptoms show some consensus between studies, and may be less etiologically heterogeneous than current diagnoses. If so, the effect size of 'neurodevelopmental' risk factors may be greater than in equivalent DSMIV diagnostic groups. METHOD: Two hundred fifty six individuals with neurodevelopmental risk factors recorded in the National Child Development Study (1958) UK birth cohort were grouped by data-driven illness subtypes, derived previously in over 1000 individuals. The effect sizes of these risks were compared between data-derived and DSMIV schizophrenia (295.x) groups. RESULTS: Compared to DSMIV schizophrenia, the data-driven subtype broadly characterized by the presence of psychotic symptoms in the absence of affective symptoms showed significantly greater effect sizes in eight out of thirteen continuously-rated risk factors: birth weight, cognition, childhood behavioural problems, and neurological softsigns including handedness. CONCLUSION: A data-driven subgroup of schizophrenia patients, characterized as lacking co-morbid depressive symptoms, is less heterogeneous with respect to neurodevelopmental etiology.

Semantic memory impairment in schizophrenia--deficit in storage or access of knowledge?

This study evaluates whether patients with schizophrenia have a degraded memory store for semantic knowledge. 20 patients with a chronic history of schizophrenia and evidence of cognitive impairment were selected, since the literature indicates that this subgroup is most likely to manifest a degraded semantic knowledge store. Their profile of semantic memory impairments was compared to that of a group of Alzheimer's Dementia (AD) patients (n=22), who met neuropsychological criteria for degraded semantic store. Both groups were matched for Performance IQ. 15 elderly healthy controls were also included in the study. The AD and schizophrenia groups produced substantially different profiles of semantic memory impairment. This is interpreted as indicating that the semantic impairments in this subgroup of patients with schizophrenia do not result from a degraded store. This is corroborated by an analysis of the data using other neuropsychological criteria for determining degraded store. We conclude that there is little evidence for a classic degradation of semantic knowledge in schizophrenia, and it appears that impairments result from an inability to use semantic knowledge appropriately, particularly when selection of salient semantic relations is required.

Body image, mood and quality of life in young burn survivors.

This study looks at the body image, mood and quality of life of a group of 36 young people aged between 11 and 19 years who had burns as children, compared with an age-matched control group of 41 young people who had not had these injuries. Participants completed the Body Esteem Scale (BES), the Satisfaction With Appearance Scale (SWAP), the Beck Depression Inventory-II (BDI-II) and the Youth Quality of Life Questionnaire (YQOL). It was hypothesised that young burn survivors would report more dissatisfaction with their appearance, a lower mood and a lower quality of life compared with non-injured controls. However, young burn survivors reported significantly more positive evaluations of how others view their appearance (p=0.018), more positive weight satisfaction (p=0.001) and a higher quality of life (p=0.005) than the control group. They also reported more positive general feelings about their appearance, although this was just below the level for statistical significance (p=0.067) and a similar mood to the school sample (p=0.824). The data suggest that young burn survivors appear to be coping well in comparison to their peers, and in some areas may be coping better, in spite of living with the physical, psychological and social consequences of burns.

Do overinclusion and distorted semantic category boundaries in schizophrenia arise from executive dysfunction?

Semantic memory impairments have been reported extensively in people with schizophrenia. Inefficient search and retrieval strategies, due to an executive dysfunction, rather than a primary loss of semantic knowledge are a primary candidate for such impairments. In order to test this hypothesis we compared the performance of 20 patients meeting DSM-IV-TR criteria for schizophrenia with that of 20 healthy controls and 10 patients with acquired brain injury (ABI) with a dysexecutive syndrome. Seventy percent of the people with schizophrenia and 100% of the ABI patients in this study met criteria for executive impairment. However, the two groups performed significantly differently on a range of semantic memory tests. Whereas 45% of the patients with schizophrenia met criteria for distorted semantic category boundaries (n.b. overinclusion), this was true for only 10% of the ABI patients. In addition, no correlation was found between severity of executive dysfunction and tendency to overinclude in the schizophrenia group. This pattern of neuropsychological findings suggests that overinclusion, or disorganized semantic categorization procedures, in schizophrenia does not result from a classical executive dysfunction. Alternative explanations are discussed.

Randomized controlled trial of assertive community treatment in intellectual disability: the TACTILD study.

BACKGROUND: There has been a policy shift away from hospital to community in the services of all those with psychiatric disorders, including those with intellectual disability (ID), in the last 50 years. This has been accompanied recently by the growth of assertive outreach services, but these have not been evaluated in ID services. METHOD: In a randomized controlled trial we compared assertive outreach with 'standard' community care, using global assessment of function (GAF) as the primary outcome measure, and burden and quality of life as secondary measures. RESULTS: We recruited 30 patients, considerably less than expected; no significant differences were found between the primary and secondary outcomes in the two groups. The differences were so small that a Type II error was unlikely. CONCLUSIONS: Reasons for this lack of specific efficacy of the assertive approach are discussed and it is suggested that there is a blurring of the differences between standard and assertive approaches in practice.

Can disorganisation of semantic memory account for the abnormalities of thought in schizophrenia-a controlled experimental study.

BACKGROUND: Disorganisation of semantic memory could provide a cognitive explanation for the disturbances of thinking and reasoning in schizophrenia. In this study, we directly test this explanation by identifying patients with disorganised semantic categories and then examine how they use their knowledge about these same categories in an inductive reasoning task. METHOD: Experiment 1 utilised a semantic category-sorting task to identify patients with disorganisation of semantic memory. In Experiment 2, the patients with disorganised categories carried out a category-based inductive reasoning task. Accurate performance on this task requires access to well-organised semantic knowledge about the objects and categories used in Experiment 1. RESULTS: Patients with disorganised semantic categories in Experiment 1 did not demonstrate any difficulties or unusual responses when reasoning about the same categories in Experiment 2. CONCLUSION: Disorganisation of semantic memory may not be the primary cause of disturbed reasoning or thought in schizophrenia. Patients with schizophrenia tend to generate ad hoc categories, which are unsuited to the current context. Impaired performance on semantic memory tasks can arise from a misunderstanding of social context.

Adult psychosis, common childhood infections and neurological soft signs in a national birth cohort.

BACKGROUND: Neurological soft signs preceding adult-onset schizophrenia suggest a neurodevelopmental origin and could reflect physical illness in childhood. AIMS: To investigate possible associations of adult-onset psychosis with neurological soft signs and common infectious illnesses in childhood. METHOD: Using data from the UK National Child Development Study, a longitudinal general population sample, odds ratios were calculated for clinical diagnoses of common childhood viral illnesses and later adult psychotic illness, childhood epilepsy and a range of neurological soft signs. RESULTS: The number of illnesses per individual did not relate either to the number of soft signs, or to any particular adult outcome. Schizophrenia, affective psychosis and epilepsy were not associated with common childhood illness but were associated with neurological soft signs and an increased, but small, frequency of previous meningitis and tuberculosis. CONCLUSIONS: Overall the data support the notion of neurological soft signs as markers of disordered neurodevelopment in schizophrenia (but the early neurological abnormalities are not caused by infectious illness) and an association between meningitis or tuberculosis in childhood and a small proportion of cases of epilepsy, affective psychosis and schizophrenia.

Training in communication skills for informal carers of people suffering from dementia: a cluster randomized clinical trial comparing a therapist led workshop and a booklet.

The objective of the study was to evaluate whether a short training workshop in communication techniques is more effective than an information booklet for improving communication skills in informal carers of people suffering from dementia. 30 informal carers were allocated to the workshop sessions and 15 to the booklet. Outcome measures included awareness of communication strategies; perceived frequency of communication breakdown at home, and the associated level of distress; general stress; and consumer satisfaction. At six week follow-up, the workshop group demonstrated a significantly greater awareness of communication strategies than the booklet-only group. Both groups reported some reduction in the frequency of communication problems at home, and a reduction in the associated level of distress. The frequency of other problem behaviours remained stable. Satisfaction with the workshop indicated that training was helpful but depended on the stage of illness of the partner.

Visual crowding and category specific deficits for pictorial stimuli: A neural network model.

This paper describes a series of modular neural network simulations of visual object processing. In a departure from much previous work in this domain, the model described here comprises both supervised and unsupervised modules and processes real pictorial representations of items from different object categories. The unsupervised module carries out bottom-up encoding of visual stimuli, thereby developing a "perceptual" representation of each presented picture. The supervised component then classifies each perceptual representation according to a target semantic category. Model performance was assessed (1) during learning, (2) under generalisation to novel instances, and (3) after lesion damage at different stages of processing. Strong category effects were observed throughout the different experiments, with living things and musical instruments eliciting greater recognition failures relative to other categories. This pattern derives from within-category similarity effects at the level of perceptual representation and our data support the view that visual crowding can be a potentially important factor in the emergence of some category-specific impairments. The data also accord with the cascade model of object recognition, since increased competition between perceptual representations resulted in category-specific impairments even when the locus of damage was within the semantic component of the model. Some strengths and limitations of this modelling approach are discussed and the results are evaluated against some other accounts of category-specific recognition failure.

No association between breast-feeding and adult psychosis in two national birth cohorts.

BACKGROUND: It has been proposed that breast-feeding might have a protective effect against the development of adult schizophrenia. AIMS: To test this hypothesis. METHOD: Using prospective data from two UK national birth cohorts, the feeding histories of those who later developed schizophrenia were compared with the remaining population at risk. Analyses in each cohort were considered to be independent tests of the hypothesis. RESULTS: There were no differences in feeding histories. In the 1946 birth cohort (n = 4447) 30 cases of DSM-III-R schizophrenia arose by age 43; 24.1% of cases v. 23.6% of controls were entirely bottle-fed; 17.3% v. 12.3% were breast-fed for under 1 month; 58.6% v. 64.1% were breast-fed beyond 1 month. In the 1958 cohort (n = 18,856), 40 cases of CATEGO nuclear schizophrenia arose by age 28; 24.1% of cases v. 31.7% of controls were entirely bottle-fed; 27.6% v. 24.9% were breast-fed for under 1 month; 48.3% v. 43.4% were breast-fed beyond 1 month. CONCLUSIONS: These findings provide no evidence of any effect of breast-feeding in protecting against the risk of later schizophrenia.

Investigating visual knowledge in dementia of the Alzheimer type (DAT): evidence for a structured organization.

Given that certain types of semantic dysfunction in DAT have been attributed to difficulties in accessing visual knowledge, the issues of integrity of access to, and format of storage, within the "visual store" are particularly important. In these experiments, we tested 10 DAT patients and matched controls on the reality decision and part-whole matching tasks. Visual knowledge was found to be significantly impaired in the DAT group. Moreover, DAT patients displayed disproportionate deficits in accessing visual knowledge of items from nonliving categories. Results are interpreted within a framework of differential hierarchical access to visual representations of perceptually similar and perceptually distinct categories of items.

Relative hand skill predicts academic ability: global deficits at the point of hemispheric indecision.

Population variation in handedness (a correlate of cerebral dominance for language) is in part genetic and, it has been suggested, its persistence represents a balanced polymorphism with respect to cognitive ability. This hypothesis was tested in a sample of 12,770 individuals in a UK national cohort (the National Child Development Study) by assessing relative hand skill (in a square checking task) as a predictor of verbal, non-verbal, and mathematical ability and reading comprehension at the age of 11 years. Whereas some modest decrements were present in extreme right handers the most substantial deficits in ability were seen close to the point of equal hand skill ('hemispheric indecision'). For verbal ability females performed better than males, but the relationship to relative hand skill was closely similar for the two sexes; for reading comprehension males close to the point of equal hand skill showed greater impairments than females. Analysed by writing hand the relationship of ability to hand skill appeared symmetrical about the point of 'hemispheric indecision'. The variation associated with degrees of dominance may reflect the operation of continuing selection on the gene (postulated to be X-Y linked) by which language evolved and speciation occurred.

Linguistic performance in children who develop schizophrenia in adult life. Evidence for normal syntactic ability.

BACKGROUND: Less syntactically complex speech in patients with schizophrenia has been thought to represent a premorbid dysfunction, of possible prognostic value and indicative of a neurodevelopmental origin for schizophrenia. METHOD: Narratives written at age 11 by children who then developed psychiatric disorders in adult life (using PSE CATEGO diagnoses), especially schizophrenia, were compared with matched controls on syntactic complexity, syntactic maturity, grammatical deviance and spelling ability. RESULTS: Children who later developed either schizophrenia, affective psychosis or a neurotic type of disorder in adulthood did not differ from normal controls on any of the measures of syntactic production, grammatical errors or spelling. CONCLUSIONS: It is probable that previous reports of reduced syntactic complexity in schizophrenic speech are a consequence of being in a psychotic state and do not represent a premorbid deficit.

Cerebral lateralization is delayed in children who later develop schizophrenia.

The origins of schizophrenia are obscure. One suggestion is that it represents a component of the genetic variation associated with the establishment of dominance in one or other cerebral hemisphere, a mechanism that has been crucial in the evolution of language. Indices of cerebral hemispheric dominance (hand, foot and eye preference, speed of checking squares) recorded on the 16,980 children in the UK National Child Development Study cohort were examined in relation to psychiatric admission by the age of 28 years. Diagnoses were established by the application of Present State Examination criteria to case notes. Pre-schizophrenic children (n = 34-36) were more likely (p < 0.0003) to be rated by their mothers as ambidextrous at the age of 7 years, and at 11 years were less (p < 0.01) strongly right-handed than their peers in the cohort population on a test of relative hand skill: children who later developed affective psychosis (n = 25) or neurosis (n = 60) did not differ significantly from controls. Delay in establishing dominance in one hemisphere could be the critical factor that predisposes to schizophrenia.

Obstetric complications in children born to parents with schizophrenia: a meta-analysis of case-control studies.

On the basis of previous findings, we used meta-analyses to consider whether births to parents with schizophrenia have an increased risk of obstetric complications. Meta-analyses were based on published studies satisfying the following selection criteria. The schizophrenic diagnosis could apply to either parent: parents with non-schizophrenic psychoses were not included: only normal controls were accepted. In all, 14 studies provided effect sizes or data from which these could be derived. Studies were identified by data searches through MEDLINE, PSYCLIT and through references of papers relating to the subject. Births to individuals with schizophrenia incur an increased risk of pregnancy and birth complications, low birthweight and poor neonatal condition. However, in each case the effect size is small (mean r = 0.155; 95% CI = 0.057). The risk is greater for mothers with schizophrenia and is not confined to mothers with onset pre-delivery or to the births of the children who become schizophrenic themselves.

Antecedents of schizophrenia and affective illness. Obstetric complications.

BACKGROUND: This exploratory study seeks to generate new hypotheses about the relationship between obstetric complications and schizophrenia. METHOD: The British Perinatal Mortality Survey represents 98% of all births during one week in March 1958 in Great Britain. Present State Examination (PSE), Catego diagnoses of narrowly defined schizophrenia (n = 49), broadly defined schizophrenia (n = 79), affective psychosis (n = 44) and neurosis (n = 93) were derived from case notes for all cohort members. The remainder of the cohort, surviving the perinatal period, acted as controls (n = 16 812). Variables in the British Perinatal Mortality Survey were grouped into five categories: the physique/lifestyle of the mother (including demographic characteristics), her obstetric history, the current pregnancy, the delivery and the condition of the baby. RESULTS: There were 7/17 significant differences in maternal physique/lifestyle and obstetric history between the births of schizophrenics and controls, compared to 4/40 comparisons of somatic variables relating to pregnancy, birth and the condition of the baby. This compares with 4/17 and 7/40 for affective psychotics and a total of 4/57 differences for all categories of variables when neurotics were contrasted with controls. CONCLUSIONS: The purported increased risk of obstetric complications in schizophrenics may result from the physique/lifestyle of their mothers.

Childhood precursors of psychosis as clues to its evolutionary origins.

Those who as adults will be admitted to a psychiatric ward with a psychotic illness can be distinguished (on the basis of group differences) from others by their behaviour and academic performance at the ages of 7 and 11 years. Pre-schizophrenic boys are anxious and hostile towards adults and peers at the age of 7 years and show poor concentration. By age 11 years these boys are also rated as depressed, and pre-schizophrenic girls as depressed and withdrawn. Pre-affective psychotic boys show minor changes (for example an increase in hostility and restlessness) at age 7 years, although these features are not obvious at age 11 years. Abnormalities that in some respects resemble those in pre-schizophrenic boys are present at age 11 years in a group of females who will be admitted to psychiatric units with non-psychotic diagnoses by the age of 28 years. Academic impairments (including speech and reading difficulties) at ages 7, 11 and 16 years are more severe in pre-schizophrenics than in the other groups. Schizophrenics-to-be are slow to develop continence and show poor coordination and vision at age 7 years, and are rated clumsy at age 16 years. Psychosis reflects a disturbance of aspects of central nervous system function that are time-dependent and in certain respects gender specific. It is argued that the psychoses represent extremes of variation in a gene (or genes) that differs between sexes and controls the timing of development of the two cerebral hemispheres.(ABSTRACT TRUNCATED AT 250 WORDS)

Childhood antecedents of schizophrenia and affective illness: social adjustment at ages 7 and 11.

OBJECTIVE: To investigate the social adjustment in childhood of people who as adults have psychiatric disorders. DESIGN: Subjects in a prospectively followed up cohort (the national child development study) who had been admitted as adults to psychiatric hospitals were compared with the rest of the cohort on ratings of social behaviour made by teachers at the ages of 7 and 11 years. SUBJECTS: 40 adult patients with schizophrenic illnesses, 35 with affective psychoses, and 79 with neurotic illness who had been admitted for psychiatric reasons by the age of 28. 1914 randomly selected members of the cohort who had never been admitted for psychiatric treatment. MAIN OUTCOME MEASURES: Overall scores and scores for overreaction (externalising behaviour) and underreaction (internalising behaviour) with the Bristol social adjustment guide at ages 7 and 11. RESULTS: At the age of 7 children who developed schizophrenia were rated by their teachers as manifesting more social maladjustment than controls (overall score 4.3 (SD 2.4) v 3.1 (2.0); P < 0.01). This was more apparent in the boys (5 (2.6)) than the girls (3.4 (1.8)) and related to overreactive rather than underreactive behaviour. At both ages prepsychotic (affective) children differed little from normal controls. By the age of 11 preneurotic children, particularly the girls, had an increased rating of maladjustment (including overreactions and underreactions). CONCLUSION: Abnormalities of social adjustment are detectable in childhood in some people who develop psychotic illness. Sex and the rate of development of different components of the capacity for social interaction are important determinants of the risk of psychosis and other psychiatric disorders in adulthood.