The biochemical high-risk paradigm: behavioral and familial correlates of low platelet monoamine oxidase activity.

A population of individuals potentially at risk for psychiatric disorders was identified by screening 375 college student volunteers for low platelet monoamine oxidase (MAO) activity levels. The lower and upper 10 per cent in MAO activity were interviewed and family history data were obtained. Low-MAO probands reported more frequent psychiatric or psychological counseling and problems with the law. Families of low MAO probands had an eightfold increase in the incidence of suicide or suicide attempts over those of high-MAO probands. This suggests that reduced MAO levels, reported previously in patients with affective disorders and chronic schizophrenia, may predict a vulnerability to psychiatric disorder.

Recorded and reported sleep in chronic primary insomnia.

Sleep polygraph and questionnaire data of 18 chronic primary insomniacs were compared with those of 18 age- and sex-matched controls. The insomniacs had significantly longer sleep latencies, less total sleep, less sleep efficiency, more terminal wake time, and less delta sleep. There were significant discrepancies between the insomniacs' and controls' subjective assessments of their sleep and the sleep-polygraph data, but in opposite directions. The insomniacs' recorded sleep also showed more night-to-night variability than that of the controls. However, the controls, in contrast to the insomniacs, reported sleeping worse in the laboratory than at home. Significant differences between insomnia subtypes validly reflected the insomniacs' subjective complaints and were generally in accord with expectations based on them.

Psychiatric vulnerability, monoamine oxidase, and the average evoked potential.

College students in two separate studies had platelet monoamine oxidase (MAO) activity determinations and average evoked potential (AEP) measurements taken. On the basis of Minnesota Muliphasic Personality Inventory (MMPI) or Research Diagnostic Criteria (RDC) evaluations, psychopathology, particularly affective disorder, was found to be more prevalent among both persons with the combination of low MAO activity and AEP augmenting and those with high MAO activity and AEP reducing. The same pattern is apparent whether students were selected for extremely high or low MAO activity (study 1) or for elevated or normal MMPI scores (study 2). Some psychiatric patient groups also show this pattern. An interactive model of sensation-seeking and sensory inhibition is presented.

Smooth pursuit eye tracking impairment: relation to other 'markers' of schizophrenia and psychologic correlates.

Smooth pursuit eye tracking impairment has been observed in the major psychoses, particularly schizophrenia. To understand better the relationship of smooth pursuit disruption to personality dispositions linked to psychiatric syndromes and to two other "marker variables" associated with psychosis (low platelet monoamine oxidase [MAO] activity and poor performance on the continuous performance task [CPT]), we studied the psychologic, biochemical, and psychophysiologic correlates of impaired smooth pursuit tracking in two nonpsychiatric patient populations. One sample consisted of 67 volunteers screened for extreme values in a distribution of platelet MAO activities, and the second included 29 volunteers screened for extreme scores on the CPT. An aggregate of about 5% of both samples showed clearly dysfunctional smooth pursuit. Eye tracking dysfunction did not seem to be related to either MAO or CPT performance in either study. Both studies were consistent in showing that subjects with impaired smooth pursuit eye tracking had a psychologic profile characterized particularly by social introversion.

Psychological characteristics corresponding to low versus high platelet monoamine oxidase activity.

From an original sample of 375 college students and employees studied for platelet MAO activity, 66 subjects representing the lower and upper deciles of the sample were contacted for further study, including administration of the booklet form of the MMPI. We analyzed what psychological characteristics might be associated with differences in MAO activity and attempted to cross-validate these characteristics by using them to predict the separability of low vs. high MAO subjects. Each subject was randomly assigned to one of two groups in which the low and high MAO subjects were balanced for sex. For 16 women in group A, a MAO scale discriminated low and high subjects with 100% accuracy. For 18 men in group A, a separate MAO scale discriminated with 94% accuracy. To cross-validate these results, the two scales were applied to another population; both discriminated low and high MAO women and men with a combined 97% accuracy. The thematic content of the two scales is discussed in the light of other reports on the psychological characteristics of low and high MAO subjects, including the apparent relationship between the scale content and the clinical features of bipolar affective disorder.

Psychobiological effects of carbohydrate- and protein-rich meals in patients with seasonal affective disorder and normal controls.

Patients with seasonal affective disorder (SAD) frequently report carbohydrate craving and note that carbohydrate ingestion energizes them. Bright artificial light has been shown to reverse the symptoms of SAD, including carbohydrate craving. In this study, 16 depressed SAD patients and 16 matched controls were fed two different isocaloric meals, one rich in protein and one rich in carbohydrates, in a crossover design. Although their biochemical response in terms of plasma large neutral amino acid concentrations was identical, SAD patients reported activation following carbohydrate ingestion, whereas normal controls reported sedation. Marked ordering effects on psychological parameters were noted, suggesting that order should be taken into account as a methodological consideration in meal studies.

Clinical, psychophysiological, and neurological characteristics of volunteers with impaired smooth pursuit eye movements.

Two hundred eighty-five volunteers from a community college were screened on campus for accuracy of their smooth pursuit eye movements (SPEM) by electrooculograph (EOG). Those volunteers with the least and the most accurate SPEM were recalled to the laboratory for a comprehensive evaluation of clinical and demographic characteristics, family history, neurological status, and psychophysiological and biological measures, including SPEM [repeat EOG test and infrared (IR) test], an electroencephalogram, auditory and visual evoked potentials, reaction time (RT), the continuous performance task (CPT), platelet monoamine oxidase (MAO), plasma amine oxidase, and dopamine-beta-hydroxylase (DBH). Low-accuracy SPEM was associated with social isolation, inadequate rapport, eccentricity, and a variety of related schizotypal or schizophrenia-like characteristics, but not with generalized psychopathology or other demographic/medical/clinical history variables. Low-accuracy SPEM also was associated with neurological and psychophysiological abnormalities frequently observed in schizophrenic patients. These results suggest that impaired SPEM may reflect an underlying central nervous system dysfunction that is specifically associated with clinical and biological characteristics related to schizophrenia, even in the absence of overt schizophrenia.

Impaired smooth pursuit eye movement: vulnerability marker for schizotypal personality disorder in a normal volunteer population.

Impaired smooth pursuit eye movement has been proposed as a possible biologic marker for schizophrenia. Preliminary studies have suggested that this impairment may be associated with social introversion and related psychopathology in a nonpsychiatric population. To evaluate the relationship between dysfunctional smooth pursuit eye movement and schizophrenia-related psychopathology, the authors screened a new, volunteer sample of 284 male college students for eye tracking accuracy. Volunteers identified as low-accuracy trackers were significantly more likely to be diagnosed (blindly) as having a schizotypal personality disorder by DSM-III criteria than those identified as high-accuracy trackers. The authors suggest that disordered smooth pursuit eye movement may reflect a vulnerability marker for schizotypal personality disorder.

Psychotherapy with persons suffering from schizophrenia: the need for a new agenda.

The success of the biological revolution in our understanding of schizophrenia, along with the lack of convincing evidence for the efficacy of global approaches to individual psychotherapy with schizophrenia, has led to the virtual disappearance of research and theory in this area. However, it seems timely to reexamine alternative approaches to psychotherapy that are based on an informed understanding of schizophrenia as a biological distortion of certain aspects of human experiencing. The purposes and unique role of psychotherapy within the broader range of treatments must be clarified, and more phenomenologically based, empirically tested problem-specific interventions developed. Three areas seem particularly suited for psychotherapy; (1) the human issues raised by having a chronic debilitating disorder that affects one's psychological experiencing, (2) attempts to help the patient manage the disorder, and (3) the normal psychological problems that persons with schizophrenia also face. Finally, suggestions are made about rethinking the therapeutic enterprise.

Individual psychotherapy and persons with serious mental illness: the clients' perspective.

The perspectives of persons with serious mental illness about their experiences with individual psychotherapy were obtained from a stratified random sample of 12 psychosocial rehabilitation centers from all centers in Maryland. Response and completion rates, test-retest reliability, and generalization data were positive. Eight areas were explored: (1) Utilization and duration: of the 212 respondents, 90 percent had been in therapy for a median of 12 months (mean = 3 years); only a third expected to end their therapy within 5 years. (2) Therapeutic effectiveness: most of the respondents (72%) reported that individual psychotherapy had brought positive changes to their lives, 14 percent reported negative changes, and 14 percent reported that therapy had had no effect. (3) Preferred interventions and parameters: sixteen percent felt that medication was most useful, 25 percent felt that talking therapy was most useful, and 60 percent endorsed a combination of the two. With respect to diagnosis and psychotherapy, 84 percent of respondents with schizophrenia preferred brief, less frequent sessions of reality-oriented therapy over longer, more frequent sessions of insight therapy. Respondents with bipolar and major depression were equally split between the two. (4) Therapeutic issues: human concerns were more frequently rated as important and were rated higher in importance than illness-specific symptoms. (5) Clients' view of illness: Only 8 percent thought their illness was a brain disease, a third thought it was a psychological problem, and a quarter thought it was a combination of both; a third answered, open quote I don't know closed quote. Almost half did not know what their therapists thought. (6) Therapeutic relationship: Friendliness was the quality most desired in a therapist. (7) Confidentiality: Most felt that therapists generally kept the clients' confidences. (8) Empowerment: Persons who felt empowered in therapy spent less time in hospitals, expected a shorter stay in therapy, and knew more about their problems. Suggestions are made about a more client-responsive model of individual psychotherapy for persons with serious mental illness.

Schizophrenia and platelet monoamine oxidase: research strategies.

The most widely replicated neurochemical finding in schizophrenia is that of lower levels of monoamine oxidase (MAO) in the platelets of chronic schizophrenics than in normal controls. Yet, the etiological role of MAO in schizophrenia remains to be demonstrated. The incidence of low MAO in other psychiatric disorders, effects of diet, hormones and drugs, and relationships of platelet MAO to brain levels and genetic mechanisms remain unclear. This article examines factors which make any biological indicator suitable for use as a diagnostic test for schizophrenia and inquires into the methodological pitfalls and unexamined assumptions of various research strategies which use this measure.

Parents of high risk subjects defined by levels of monoamine oxidase activity.

Thirty-seven parents of probands with low platelet monoamine oxidase (MAO) activity levels and 38 parents of high MAO probands were examined for MAO activity, past and present psychopathology, and reported psychopathology in other relatives. Results showed generally positive and significant correlations between parents' and children's MAO levels, significantly greater rates of "high MAO related" disorders in parents and relatives of high MAO probands and of "low MAO related" disorders and symptoms in parents and relatives of low MAO probands. Support for a two-directional monoamine hypothesis of affective disorders is suggested.

Impact of an educational support group on family participants who take care of their schizophrenic relatives.

Using a stress-coping framework, we designed a six-session educational support group offering family caretakers information about schizophrenia, training in problem-solving skills for managing patient behavior, and greater access to social support and community resources. Subjects were recruited though local community mental health centers; 24 subjects participated in one of five identically structured caretakers' groups and another 24 subjects served as matched controls. Results of the multivariate analysis of covariance indicated a significant difference between the experimental and control caretakers following the intervention. Caretakers of the educational support group reported significantly reduced anxiety and personal distress and significantly more active coping behaviors (increased use of community resources and better management of home life with their schizophrenic family member). However, no changes were reported in the frequency of their negative feelings toward their mentally ill family member or in their generalized sense of self-efficacy.

Cost-effectiveness of providing insurance benefits for posthospital psychiatric halfway house stays.

A model insurance benefit package of post hospitalization psychiatric halfway house care was developed and administered to 32 hospitalized mentally ill persons. The therapeutic and cost effectiveness of providing a 120-day benefit package was examined over a 14-month post-hospitalization period. This was compared with the effectiveness of hospitalization benefits alone for the same patients over the 42 months prior to halfway house admission. In terms of therapeutic efficacy, there was no significant deterioration after hospitalization release in either the symptom or behavioral coping scales, except for an increase in somatization. Yearly hospital recidivism rates fell from 79% to 29%, and the average yearly length of hospital stay per patient fell from 83 days to 18 days. In terms of cost-effectiveness, halfway house benefits saved the insurers 59% of their hospitalization costs. The implications of these findings are discussed.

Lateral preference and neuropsychological correlates of schizotypy.

A battery of 11 schizotypy questionnaires was administered to 316 male undergraduates. The scores of the 266 white subjects were subjected to a principal components analysis, and 73 subjects scoring at the upper and lower ends of the factor score distribution based on the first unrotated component were recalled for neuropsychological testing. The battery of neuropsychological tests consisted of four tests of motoric performance, four subtests from the Wechsler Adult Intelligence Scale-Revised, the conjugate lateral eye movement test, and a lateral preference questionnaire. Subjects high on schizotypy did not differ from low scorers on overall neuropsychological performance or performance asymmetries. High scorers did show a sinistral shift in hand and foot preference and more crossed dominance compared with controls. Asians scored significantly higher than whites on several schizotypy scales, raising the question of a possible ethnic bias in these measures.

Effects of bright light on mood in normal elderly women.

Reduced light appears to be a key factor in seasonal affective disorder (SAD). This study asks whether the reduced levels of light experienced by elderly persons might result in depression and other SAD symptoms, and how normal elderly persons might respond to bright light interventions similar to those used to treat SAD. In interviews with 140 senior citizens, we found virtually no seasonal variation in mood and behavior and very little depressed affect. Seventeen of these seniors who had good mental and physical health, with no major eye problems, participated in a crossover study of the effects of bright light on both positive and negative affect and sleep. Although sleep did not appear to be affected, the bright light intervention tended to make these normal elderly persons feel worse--more irritable, anxious, and agitated. These findings confirm earlier reports that bright light is not beneficial for normal individuals who are unaffected by seasonal changes.

Consumer perceptions of pressure and force in psychiatric treatments.

OBJECTIVE: Mental health consumers with serious mental illness were surveyed to obtain information about their experiences with and attitudes toward forced psychiatric treatment. METHODS: A 61-item survey questionnaire developed by the authors was administered by consumer volunteers to 105 persons with serious mental illness who were attending seven rehabilitation centers in Maryland. The questionnaire covered consumers' experiences and attitudes in three areas of forced treatment: medication, outpatient therapy or rehabilitation, and hospitalization. RESULTS: At some time during the course of their illness, 57 percent of the respondents reported having been pressured or forced into hospitalization. In the year before the survey, 30 percent reported being pressured or forced into taking medication and 26 percent into attending a therapy or rehabilitation program. The most common type of pressure or force was verbal persuasion. Generally, respondents reported negative effects from forced treatment, although the intensity of the negative effects varied by treatment area, and about half retrospectively felt that the forced treatment was in their best interest. Many respondents believed that pressure or force has an appropriate role in psychiatric treatment, although most wished to maintain the right to refuse treatment that they considered not in their best interest. CONCLUSIONS: Differences in patterns of response to pressure and force in the three treatment areas highlight the variety of consumer experiences and the need to know more about the role of forced or pressured treatment in their lives.

Family members' ratings of the use and value of mental health services: results of a national NAMI survey.

OBJECTIVE: Data from a 1993 survey of families in the National Alliance for the Mentally Ill (NAMI) were analyzed to examine services used by consumers and families' perceptions of the services' value. Data from 1993 and 1976 were compared to document changes. METHODS: A total of 3,099 families responded to a mailed questionnaire that was first used in a 1976 local survey of 89 NAMI members. Respondents indicated which of 11 services had been used by their ill relative in the past two years and rated the services as having "no," "some," or "considerable" value. Chi square tests examined relationships between service use and value and key variables. RESULTS: In 1993 families reported nearly universal use of medications and rated them highest in value. More than 60 percent of the ill relatives had been hospitalized in the past two years, and hospitalization was rated second highest in value. Individual therapy, used by two-thirds of the consumers, also received high ratings. Community services were used by about a third of the consumers; these services were valued less highly than office-based services and medications. Respondents in 1976 reported less use of medication and residential services, more hospitalization, and more use of individual, group, and family therapies. In 1993 all services were valued more highly than in 1976. CONCLUSIONS: The 1993 survey findings showed that more consumers used office-based services and hospitalization than community-based alternatives, and that families rated the former services more highly. Value ratings of community services rose significantly between 1976 and 1993.

A survey on issues in the lives of women with severe mental illness.

OBJECTIVE: Women with severe mental illness were surveyed to explore issues in living with mental illness, personal relationships, and professional relationships and health care. The topics were drawn from the literature on the psychology of women and from separate focus groups of therapists and mental health care consumers. The women's survey responses were compared with men's responses to an equivalent survey to determine if the issues affected women and men similarly. METHODS: A 76-item questionnaire was completed by 107 women and 59 men from ten rehabilitation centers in Maryland. RESULTS: A larger proportion of women than men cited personal relationships as their most important formative experiences, with only 32 percent of women citing severe mental illness or related issues as formative experiences. Despite acknowledging the negative impact of several mental illness on their lives, most respondents reported normal concerns rather than illness-related ones, and most were relatively satisfied with their lives. Respondents made sense of their problems in diverse ways, although most knew their diagnosis. Women reported both more and better quality personal relationships than men. However, women were more likely than men to report a history of sexual abuse. Women reported generally good relationships with providers. About one-quarter to one-third of women reported not receiving proper care for birth control and menopause and not receiving pelvic or breast examinations. CONCLUSIONS: The survey results suggested that personal relationships are central in women's lives, that women with severe mental illness do not see their mental illness as the main feature of their identities, and that women's experience of living with severe mental illness is considerably different from that of men.

Novelty-seeking, fantasy, and sensitization in chronic insomniacs.

13 chronic primary insomniacs and a matched group of normal sleepers were studied in terms of their level of novelty-seeking, ability to fantasize, and cognitive rumination. All-night electroencephalographic patterns confirmed insomniac-control sleep differences. Chronic insomniacs differed from normal sleepers on a measure of cognitive activity as a defense pattern (Byrne's Repression-Sensitization Scale) but did not differ on measures of need for cognitive stimulation (Pearson's Internal and External Cognition Scales), ability to fantasize (Betts' imagery task), or preference for fantasy (Pearson's Internal and External Sensation Scales).