Impaired recognition of meaningful sounds in Alzheimer's disease.

We studied recognition of meaningful nonverbal sounds using a sound-picture matching test in 18 patients with senile dementia of the Alzheimer type (SDAT) and 19 age-matched controls. A significant impairment of sound recognition was found in the SDAT group, consistent with auditory sound agnosia. Although sound recognition performance correlated significantly with auditory verbal comprehension scores, a sound recognition defect was also identifiable in the subgroup of patients with SDAT who had normal verbal comprehension. Qualitative analysis of sound recognition errors revealed that nonaphasic patients with SDAT made predominantly acoustic errors, whereas semantic errors were found almost exclusively in aphasic patients. These findings suggest that the auditory sound agnosia of patients with SDAT may be subdivided into perceptual-discriminative and semantic-associative types.

Assessment and psychotherapeutic intervention for an HIV-infected preschool child.

Pediatric acquired immunodeficiency syndrome (AIDS) is becoming more common. Moreover, human immunodeficiency virus (HIV) positive status in multiple family members is common and complicates disease management. Practitioners treating these children are often unaware of the effect of the virus on the child's psychological, cognitive, and emotional functioning. In addition, children with AIDS frequently come from families facing pressing social problems, including homelessness, poverty, and drug addiction. HIV-positive children thus confront such diverse issues as the deterioration of developmental skills, social ostracism, and the possibility of imminent death, placing them in a socioemotional crisis. This paper presents a comprehensive psychotherapeutic intervention for such children.

Post-hospitalization treatment adherence of schizophrenic patients: gender differences in skill acquisition.

A cohort of acutely ill, hospitalized patients with chronic psychotic disorders participated in a study of a manualized community reintegration skills training program. Initial data analyses revealed that skill levels improved significantly over the course of treatment, and that higher post-training skill levels were associated with better post-discharge functioning for the group as a whole. Post-discharge treatment adherence rates were dramatically better in females, and analyses were conducted to determine the role of gender. Males and females had different predictors of post-training skill level and post-discharge treatment adherence. In males, who as a group were at higher risk for poor post-discharge outcome, there was a positive association between post-training skill level and post-discharge treatment adherence. Females, on the other hand, showed good post-discharge treatment adherence regardless of post-training skill or symptom levels. This report is consistent with prior studies suggesting that male and female individuals with schizophrenia show differential patterns of social skill, skill improvement, and social adjustment.

Training hospitalized patients with schizophrenia in community reintegration skills.

OBJECTIVE: The study examined the effectiveness of the Community Re-Entry Program, a brief, time-limited skills training module designed to help acutely ill inpatients become engaged in community-based treatment programs. METHODS: Of 84 consecutive admissions to a chronic psychotic disorders unit, 44 completed assessments and attended the Community Re-Entry Program. The program consists of 16 daily small-group therapy sessions that engage the patient in efforts to define discharge readiness, identify symptoms and medication effects, and assist with discharge planning. Skill levels and positive and negative symptoms were assessed on admission and on completion of training, and a subsample of patients received two-week postdischarge follow-up assessments. RESULTS: From admission to discharge, positive symptoms diminished substantially, negative symptoms diminished to a lesser but statistically significant degree, and skill levels increased significantly. Posttraining skill level was predicted by pretraining skill level and level of participation in the skills training module. Patients' symptom levels did not predict participation in the program or skill acquisition. Skill level at discharge was also more predictive of two-week postdischarge community adjustment than were symptom levels. CONCLUSIONS: Although further controlled studies are required to fully establish the efficacy of the Community Re-Entry Program, these data suggest that brief, focused skills training may play an important role in augmenting optimal pharmacotherapy for hospitalized patients with chronic psychotic disorders.

The relationship between personality and quality of life in persons with schizoaffective disorder and schizophrenia.

The goal of this study was to examine the effects of personality traits as measured by the NEO-PI on the quality of life (QOL) of persons with schizoaffective disorder and schizophrenia. The premise of this research is that personality traits may be important in shaping one's outlook and satisfaction with life. In a prior pilot study, personality traits were measured in persons with schizoaffective disorder and schizophrenia. In this study, the relationship between QOL and specific personality domains as assessed by the NEO-PI were studied in 21 patients. Global QOL as measured by the Lehman QOL instrument was positively correlated with Extroversion (E) and Agreeableness (A), and negatively correlated with the domain of Neuroticism (N). Global satisfaction scores were not correlated with ratings of psychoticism, paranoia or depression. These data suggest that even in psychotic conditions such as schizoaffective disorder or schizophrenia, intrapsychic factors influence one's sense of QOL. In addition, these data suggest that personality variables may differentially affect patients' satisfaction and QOL with different treatment settings.

Stability of personality traits in schizophrenia and schizoaffective disorder: a pilot project.

This study was performed in an effort to begin characterization of personality traits in schizophrenia. Specific concerns included personality profiles relative to normal adults, personality profile stability over time, and trait-state issues. The authors administered the NEO Personality Inventory as well as symptom ratings at two time points to 21 patients. Patients were all stabilized outpatients attending an adult continuing day treatment program and diagnosed with either schizophrenia or schizoaffective disorder. Personality profiles were determined for all patients. Compared with a normal adult sample, this sample's scores on three out of five of the personality domains assessed were not distinguishable from normal adults. Test-retest correlations were highly significant over an average 28.2-week time interval. In general, the presence of positive symptoms did not appear related to NEO-PI stability, while negative symptoms did show a relationship to the stability of personality profiles. These data suggest that personality profiles can be looked at in schizophrenia, that these profiles do appear stable over time, and that negative symptoms have a strong influence on profile stability and appear to be "trait-like."

Axis II diagnoses and treatment refractoriness in schizophrenia.

In a previous medical record review study we identified a subset of chronic schizophrenic patients with comorbid Axis II personality disorder diagnoses, who had significantly longer lengths of inpatient stay as compared to schizophrenic patients without Axis II diagnoses. This study describes a detailed review of a subset of these records. Eighteen records of schizophrenic patients with comorbid Axis II diagnoses were matched with records of patients without comorbid diagnoses. Demographic and premorbid data revealed no differences between the groups, indicating that the Axis II diagnoses were markers for current as opposed to past psychopathology. Negative symptoms were lower in the cohort with comorbid Axis II personality disorder diagnoses on admission only, while affective symptomatology was increased in this group throughout treatment. Ratings of personality pathology showed a trend towards significance, with the comorbid group demonstrating greater amounts of maladaptive personality traits. These data support the notion that personality traits may be independent of Axis I symptomatology in chronic schizophrenia, and can influence the course of treatment.