Comparison of Black and White participants with severe mental illness in response to cognitive remediation as an augmentation of vocational rehabilitation.

PURPOSE: Despite evidence that cognitive remediation improves cognitive and employment outcomes in persons with severe mental illnesses (SMI), its effects have not been systematically compared between Black and White participants. Considering that Black adults have more negative experiences receiving mental health treatment, providers may have greater difficulty engaging and retaining Black Americans in cognitive remediation. Due to the effects of structural racism on reducing employment opportunities for Black Americans, it is unclear whether Black participants will reap the same benefits of cognitive remediation on work outcomes as White Americans. This paper addressed this question. METHODS: A secondary analysis was conducted of five randomized controlled trials comparing cognitive remediation (the Thinking Skills for Work program: TSW) and vocational rehabilitation vs. vocational rehabilitation only in 137 Black and 147 White Americans (64.2% schizophrenia-schizoaffective disorder) who were followed up for two years. RESULTS: Comparable proportions of Black and White participants were engaged and retained in TSW (>75%). Participants who received TSW improved significantly more in cognition than those receiving vocational services alone, with no racial differences in benefit. Participants in TSW obtained more work, earned more wages, and worked more weeks than those receiving vocational services alone, with no differences between the races. CONCLUSIONS: The findings indicate that Black Americans with SMI receiving vocational services could be successfully engaged in and benefit from cognitive remediation, highlighting the vital role of healthcare service systems in giving credence to structural racism to more effectively mitigate racial disparities in treatment outcomes.

Radiographic and functional outcome of posterolateral lumbosacral fusion for low grade isthmic spondylolisthesis in children and adolescents.

AIMS: We reviewed 34 consecutive patients (18 female-16 male) with isthmic spondylolysis and grade I to II lumbosacral spondylolisthesis who underwent in situ posterolateral arthodesis between the L5 transverse processes and the sacral ala with the use of iliac crest autograft. Ten patients had an associated scoliosis which required surgical correction at a later stage only in two patients with idiopathic curves unrelated to the spondylolisthesis. METHODS: No patient underwent spinal decompression or instrumentation placement. Mean surgical time was 1.5 hours (1 to 1.8) and intra-operative blood loss 200 ml (150 to 340). There was one wound infection treated with antibiotics but no other complication. Radiological assessment included standing posteroanterior and lateral, Ferguson and lateral flexion/extension views, as well as CT scans. RESULTS: A solid posterolateral fusion was confirmed in all patients at mean latest follow-up of 4.7 years (3.4 to 9.8) beyond skeletal maturity into early adult life. Fusion of the isthmic lesion was documented in nine patients bilaterally and eight patients unilaterally. The poor fusion rate across the spondylolysis has not affected the excellent functional results of the procedure, which in our series depended on achieving a stable lumbosacral junction. CONCLUSION: Quality of life assessment demonstrated significant improvement in all functional scores and high patient satisfaction with 28 patients returning to previous sports activities at an elite competitive level. TAKE HOME MESSAGE: Posterolateral arthrodesis in situ with autologous iliac crest bone without instrumentation has achieved a solid fusion between the L5 transverse processes and the sacral ala in patients with grade I to II isthmic lumbosacral spondylolisthesis and this has produced excellent clinical outcomes and high patient satisfaction.

Supported employment for persons with serious mental illness: current status and future directions.

The individual placement and supported (IPS) model of supported employment is the most empirically validated model of vocational rehabilitation for persons with schizophrenia or another serious mental illness. Over 18 randomized controlled trials have been conducted throughout the world demonstrating the effectiveness of supported employment at improving competitive work compared to other vocational programs: IPS supported employment is defined by the following principles: 1) inclusion of all clients who want to work; 2) integration of vocational and clinical services; 3) focus on competitive employment; 4) rapid job search and no required prevocational skills training; 5) job development by the employment specialist; 6) attention to client preferences about desired work and disclosure of mental illness to prospective employers; 7) benefits counseling; and 8) follow-along supports after a job is obtained. Supported employment has been successfully implemented in a wide range of cultural and clinical populations, although challenges to implementation are also encountered. Common challenges are related to problems such as the failure to access technical assistance, system issues, negative beliefs and attitudes of providers, funding restrictions, and poor leadership. These challenges can be overcome by tapping expertise in IPS supported employment, including standardized and tested models of training and consultation. Efforts are underway to increase the efficiency of training methods for supported employment and the overall program, and to improve its effectiveness for those clients who do not benefit. Progress in IPS supported employment offers people with a serious mental illness realistic hope for achieving their work goals, and taking greater control over their lives.

Parity-dependent oscillations in collisional polarization transfer: CN(A²Π, v = 4) + Ar.

We report the first systematic experimental and theoretical study of the state-to-state transfer of rotational angular momentum orientation in a (2)Π-rare gas system. CN(X(2)Σ(+)) was produced by pulsed 266 nm photolysis of ICN in a thermal bath (296 K) of Ar collider gas. A pulsed circularly polarized tunable dye laser prepared CN(A(2)Π, v = 4) in two fully state-selected initial levels, j = 6.5 F1e and j = 10.5 F2f, with a known laboratory-frame orientation. Both the prepared levels and a range of product levels, j' F1e and j' F2f, were monitored using the circular polarized output of a tunable diode laser via cw frequency-modulated (FM) spectroscopy in stimulated emission on the CN(A-X) (4,2) band. The FM Doppler lineshapes for co-rotating and counter-rotating pump-and-probe geometries reveal the time-dependence of the populations and orientations. Kinetic fitting was used to extract the state-to-state population transfer rate constants and orientation multipole transfer efficiencies (MTEs), which quantify the degree of conservation of initially prepared orientation in the product level. Complementary full quantum scattering (QS) calculations were carried out on recently computed ab initio potential energy surfaces. Collision-energy-dependent tensor cross sections for ranks K = 0 and 1 were computed for transitions from both initial levels to all final levels. These quantities were integrated over the thermal collision energy distribution to yield predictions of the experimentally observed state-to-state population transfer rate constants and MTEs. Excellent agreement between experiment and theory is observed for both measured quantities. Dramatic oscillations in the MTEs are observed, up to and including changes in the sign of the orientation, as a function of even/odd Δj within a particular spin-orbit and e/f manifold. These oscillations, along with those also observed in the state-to-state rate constants, reflect the rotational parity of the final level. In general, parity-conserving collisions conserve rotational orientation, while parity-changing collisions result in large changes in the orientation. The QS calculations show that the dynamics of the collisions leading to these different outcomes are fundamentally different. We propose that the origin of this behavior lies in interferences between collisions that sample the even and odd-λ terms in the angular expansions of the PESs.

Thrombus load and acute right ventricular failure in pulmonary embolism: correlation and demonstration of a "tipping point" on CT pulmonary angiography.

OBJECTIVES: The aim of this study was to determine the correlation between increasing pulmonary embolism thrombus load and right ventricular (RV) dilatation as demonstrated by CT pulmonary angiography (CTPA) and to assess the thrombus load threshold which indicates impending RV decompensation. METHODS: 2425 consecutive CTPAs were retrospectively analysed. Thrombus load using a modified Miller score (MMS), RV to left ventricular (RV:LV) ratio, presence of septal shift, and pulmonary artery and aorta size were analysed in 504 positive CTPA scans and a representative cohort of 100 negative scans. Results were correlated using non-parametric analysis (two-tailed t-test or χ(2) test) and Pearson's rank correlation. RESULTS: Increasing thrombus load correlated with a higher RV:LV ratio, with a statistically significant difference in RV:LV ratios between the negative and positive pulmonary embolism (PE) cohorts. Larger thrombus loads (MMS ≥12 vs MMS <12) were strongly correlated with RV strain (mean RV:LV ratio, 1.323 vs 0.930; p<0.0001). Smaller thrombus loads had no significant influence on RV strain. Septal shift was also more likely with an MMS of ≥12, as was an increase in pulmonary artery diameter (r=0.221, p<0.001). CONCLUSION: With increasing thrombus load in PE, there is CTPA evidence of RV decompensation with an MMS threshold of 12. This suggests a "tipping point" beyond which RV decompensation is more likely to occur. This is the first study to describe this tipping point between a thrombus load of MMS >12 and an increase in RV:LV ratio. This finding may help to improve risk stratification in patients with acute PE diagnosed by CTPA.

Depolarization of rotational angular momentum in CN(A2Π, v = 4) + Ar collisions.

Angular momentum depolarization and population transfer in CN(A(2)Π, v = 4, j, F(1)e) + Ar collisions have been investigated both experimentally and theoretically. Ground-state CN(X(2)Σ(+)) molecules were generated by pulsed 266-nm laser photolysis of ICN in a thermal (nominally 298 K) bath of the Ar collision partner at a range of pressures. The translationally thermalized CN(X) radicals were optically pumped to selected unique CN(A(2)Π, v = 4, j = 2.5, 3.5, 6.5, 11.5, 13.5, and 18.5, F(1)e) levels on the A-X (4,0) band by a pulsed tunable dye laser. The prepared level was monitored in a collinear geometry by cw frequency-modulated (FM) spectroscopy in stimulated emission on the CN(A-X) (4,2) band. The FM lineshapes for co- and counter-rotating circular pump and probe polarizations were analyzed to extract the time dependence of the population and (to a good approximation) orientation (tensor rank K = 1 polarization). The corresponding parallel and perpendicular linear polarizations yielded population and alignment (K = 2). The combined population and polarization measurements at each Ar pressure were fitted to a 3-level kinetic model, the minimum complexity necessary to reproduce the qualitative features of the data. Rate constants were extracted for the total loss of population and of elastic depolarization of ranks K = 1 and 2. Elastic depolarization is concluded to be a relatively minor process in this system. Complementary full quantum scattering (QS) calculations were carried out on the best previous and a new set of ab initio potential energy surfaces for CN(A)-Ar. Collision-energy-dependent elastic tensor and depolarization cross sections for ranks K = 1 and 2 were computed for CN(A(2)Π, v = 4, j = 1.5-10.5, F(1)e) rotational/fine-structure levels. In addition, integral cross sections for rotationally inelastic transitions out of these levels were computed and summed to yield total population transfer cross sections. These quantities were integrated over a thermal collision-energy distribution to yield the corresponding rate constants. A complete master-equation simulation using the QS results for the selected initial level j = 6.5 gave close, but not perfect, agreement with the near-exponential experimental population decays, and successfully reproduced the observed multimodal character of the polarization decays. On average, the QS population removal rate constants were consistently 10%-15% higher than those derived from the 3-level fit to the experimental data. The QS and experimental depolarization rate constants agree within the experimental uncertainties at low j, but the QS predictions decline more rapidly with j than the observations. In addition to providing a sensitive test of the achievable level of agreement between state-of-the art experiment and theory, these results highlight the importance of multiple collisions in contributing to phenomenological depolarization using any method sensitive to both polarized and unpolarized molecules in the observed level.

Magnetic resonance follow-through imaging for evaluation of disease activity in ileal Crohn's disease: an observational, retrospective cohort study.

BACKGROUND: Magnetic resonance follow-through (MRFT) is a new cross-sectional imaging modality with the potential to accurately stage ileal Crohn's disease (CD), while avoiding ionizing radiation and the discomfort associated with enteroclysis. We aimed to assess the reliability of this technique in assessing the extent and activity of ileal CD, and to assess its influence on subsequent management. METHODS: Out of a total of 342 patients undergoing MRFT between 2004 and 2008, 221 were performed in 191 patients with confirmed CD. Case notes were reviewed in detail with documentation of all investigations pre- and post-MRFT. Agreement between inflammatory markers, histopathology, and MRFT findings was determined. RESULTS: Overall, 116/221 (52.5%) of MRFTs showed active ileal CD, and 76/221 (34.4%) quiescent CD, while 29/221 (13.1%) were suboptimal. Overall, 66 strictures and 18 fistulae were identified. There was substantial agreement between active ileal CD on MRFT and histopathology (n = 59; kappa = 0.66; P = 0.0006; sensitivity 85.1%, specificity 85.7%) and fecal calprotectin (n = 14; kappa = 0.72; P = 0.047), while C-reactive protein (CRP) showed moderate agreement (n = 107; kappa = 0.402; P = 0.00028). Management was influenced by MRFT reports following active (52/84, 62% treated medically) or quiescent (48/62, 77.4% managed conservatively) disease. Fibrotic strictures were predominantly treated surgically (7/14, 50%). In all, 13/32 (40.6%) patients with inflammatory ileal strictures required surgery, mostly due to steroid-resistant disease. Overall, 75 MR findings were documented in 221 MRFTs, including 1 renal cancer. CONCLUSIONS: MRFT provides accurate information on ileal CD activity, with close agreement to inflammatory markers and histopathology. It represents a substantial advance in the staging of CD, while avoiding painful enteroclysis and radiation exposure in young patients.

The effect of voice recognition software on comparative error rates in radiology reports.

This study sought to confirm whether reports generated in a department of radiology contain more errors if generated using voice recognition (VR) software than if traditional dictation-transcription (DT) is used. All radiology reports generated over a 1-week period in a British teaching hospital were assessed. The presence of errors and their impact on the report were assessed. Data collected included the type of report, site of dictation, the experience of the operator, and whether English was the first language of the operator. 1887 reports were reviewed. 1160 (61.5%) were dictated using VR and 727 reports (38.5%) were generated by DT. 71 errors (3.8% of all reports) were identified. 56 errors were made using VR (4.8% of VR reports), whereas 15 errors were identified in DT reports (2.1% of transcribed reports). The difference in report errors between these two dictation methods was statistically significant (p = 0.002). Of the 71 reports containing errors, 37 (52.1%) had errors that affecting understanding. Other factors were also identified that significantly increased the likelihood of errors in a VR-generated report, such as working in a busy inpatient environment (p<0.001) and having a language other than English as a first language (p = 0.034). Operator grade was not significantly associated with increased errors. In conclusion, using VR significantly increases the number of reports containing errors. Errors using VR are significantly more likely to occur in noisy areas with a high workload and are more likely to be made by radiologists for whom English is not their first language.

Performance of subjects with and without severe mental illness on a clinical test of problem solving.

Severe mental illness is associated with impairments in executive functions, such as conceptual reasoning, planning, and strategic thinking all of which impact problem solving. The present study examined the utility of a novel assessment tool for problem solving, the Rapid Assessment of Problem Solving Test (RAPS) in persons with severe mental illness. Subjects were 47 outpatients with severe mental illness and an equal number healthy controls matched for age and gender. Results confirmed all hypotheses with respect to how subjects with severe mental illness would perform on the RAPS. Specifically, the severely mentally ill subjects (1) solved fewer problems on the RAPS, (2) when they did solve problems on the test, they did so far less efficiently than their healthy counterparts, and (3) the two groups differed markedly in the types of questions asked on the RAPS. The healthy control subjects tended to take a systematic, organized, but not always optimal approach to solving problems on the RAPS. The subjects with severe mental illness used some of the problem solving strategies of the healthy controls, but their performance was less consistent and tended to deteriorate when the complexity of the problem solving task increased. This was reflected by a high degree of guessing in lieu of asking constraint questions, particularly if a category-limited question was insufficient to continue the problem solving effort.

Ligand-dependent activation of the melanocortin 5 receptor: cAMP production and ryanodine receptor-dependent elevations of [Ca(2+)](I).

The melanocortins are involved in the regulation of various cognitive and physiological processes such as learning, feeding, immune suppression, pigmentation, and sebum production. Five melanocortin receptors have been identified, of which the melanocortin 5 receptor (MC5R) has the most widespread distribution. This subtype is found in the brain, and at numerous peripheral sites including the skin where it is expressed in the sebaceous glands. The purpose of this study was to identify the peptide that functions as a natural ligand at the MC5R in the skin. alpha-MSH, ACTH1-39, ACTH1-17, ACTH1-10, and ACTH4-10 all increased the production of cAMP in HEK293 cells transfected with the mouse MC5R. alpha-MSH and ACTH1-17 were the most potent in this respect. In addition, all peptides stimulated a rapid and transient increase in [Ca(2+)](i), and, ACTH1-10 was the most potent. The increases in [Ca(2+)](i) were of intracellular origin, but not associated with inositol phosphate production. The elevations in [Ca(2+)](i) were reduced by ruthenium red and procaine and it is therefore possible that they were mediated via ryanodine receptors.

The convergence of neuropsychological testing and clinical ratings of cognitive impairment in patients with schizophrenia.

This study examined the relationship between clinical rating of cognitive symptoms and performance on neuropsychological tests in acute and chronic samples of patients with schizophrenia. Two separate studies examined patients who varied widely in their lifetime functional outcome, including 263 elderly poor-outcome inpatients and 20 acutely admitted patients. In the first study, six cognitive performance measures were collected, and in the second study, five different measures were collected. Correlations with different symptom models of cognitive and negative symptoms were examined. In both samples, cognitive symptoms were never more highly correlated with cognitive test performance than with negative symptoms. When cognitive and negative symptom ratings were combined, they never accounted for as much as half of the variance in performance on the cognitive tests in both samples. These data suggest that clinical assessment of symptoms is not a viable alternative to neuropsychological testing to obtain information about cognitive functioning in schizophrenia. These results may also be specific to the clinical rating scale used, the Positive and Negative Syndrome Scale (PANSS).

A double-blind placebo-controlled case study of the use of donepezil to improve cognition in a schizoaffective disorder patient: functional MRI correlates.

Cognitive impairment in multiple domains is common in patients with schizophrenia and may be a powerful determinant of poor functional ability and quality of life. We report a double-blind, placebo-controlled, cross-over study of donepezil augmentation in a schizoaffective disorder patient stabilized on olanzapine pharmacotherapy. The patient showed significant improvements in several cognitive measures and increased activation of prefrontal cortex and basal ganglia on functional MRI during the donepezil augmentation. In addition, the donepezil augmentation resulted in a reduction of depressive symptoms and in significant improvements in functional abilities and quality of life. Further studies of donepezil augmentation of neuroleptics in schizophrenia are warranted.

The role of cognition in vocational functioning in schizophrenia.

Schizophrenia is associated with long-term unemployment. Cognitive dysfunction, rather than clinical symptoms, may be the most important factor in the ability to work for patients with this disorder. To evaluate the relationship of clinical symptoms and cognitive functioning to work status, thirty patients with schizophrenia, who were participants in a vocational rehabilitation program, were evaluated with a comprehensive neuropsychological battery and assessment of psychopathology. Subjects were classified as being in stable full-time, part-time or unemployed work status for at least a year. Univariate analysis indicated that patients who were working full-time were significantly better educated, more likely to be treatment-resistant, more likely to be treated with an atypical antipsychotic medication, had more positive symptoms, and were engaged in work tasks which were more cognitively complex than the part-time employed and unemployed work groups. An ANCOVA controlling for education demonstrated that the full-time employed group performed significantly better than the unemployed group on measures of executive functioning, working memory and vigilance; and significantly better than the part-time group on measures of vigilance and executive functioning. Although negative symptoms did not significantly relate to work status in the univariate analysis, a multiple regression indicated that negative symptoms, level of education, and executive functioning differentiated the work groups. These results suggest that poor premorbid function, negative symptoms and cognitive dysfunction are significantly associated with unemployment in schizophrenia.

Relationship of cognitive functioning, adaptive life skills, and negative symptom severity in poor-outcome geriatric schizophrenia patients.

The authors assessed whether cognitive functioning and negative symptoms are related to functional outcome across severity of negative symptoms and examined relationships between symptom domains in patients with high versus low negative symptom severity. The interrelationships between cognitive functioning and functional skills in poor-outcome geriatric schizophrenic patients were compared between those who were in the first (n = 81) and the fourth quartiles (n = 127) of negative symptom severity based on the normative data in the Positive and Negative Syndrome Scale. It was found that negative symptoms and cognitive functioning were the strongest correlates of functional status in geriatric poor-outcome schizophrenic patients--regardless of negative symptom severity. Interestingly, the greater the severity of negative symptoms, the less strongly negative symptoms were related to functional outcome. The present findings demonstrate that the relationship of cognitive functioning to social and adaptive functioning remains significant despite differing levels of negative symptom severity.

Atomic force microscopy of gastric mucin and chitosan mucoadhesive systems.

Atomic force microscopy has been utilized to probe, at a molecular level, the interaction between purified pig gastric mucin (PGM) and a mucoadhesive cationic polymer, chitosan (sea cure 210+), with a low degree (approx. 11%) of acetylation. Images were produced detailing the structures of both PGM and chitosan in 0.1 M acetate buffer (pH 4.5), followed by the complex of the two structures in the same buffer. PGM in 0.1 M acetate buffer revealed long linear filamentous structures, consistent with earlier electron microscopy and scanning tunnelling micoscopy studies. The chitosan molecules also adopted a linear conformation in the same buffer, although with a smaller average length and diameter. They appeared to adopt a stiff-coil conformation consistent with earlier hydrodynamic measurements. The complexes formed after mixing PGM and chitosan together revealed large aggregates. In 0.1 M ionic strength buffer they were of the order of 0.7 microm in diameter, consistent with previous electron microscopy studies. The effect of ionic strength of the buffer on the structure of the complex was also studied and, together with molecular hydrodynamic data, demonstrates that the interaction is principally electrostatic in nature.

The longitudinal relationship of clinical symptoms, cognitive functioning, and adaptive life in geriatric schizophrenia.

Cognitive dysfunction is increasingly being recognized as a major contributor to the adaptive impairment seen in most patients with schizophrenia. Reported here is a prospective longitudinal evaluation of the relationship between cognitive and adaptive functioning in elderly patients with schizophrenia. It was hypothesized that baseline cognitive and negative, but not positive symptoms, would be predictive of cross-sectional impairment and longitudinal outcome. Subjects were 168 elderly patients with schizophrenia, free of major neurological disorders, who were residents of a long-term psychiatric facility. Subjects were assessed at baseline and again an average of 15months later. The PANSS was used to assess the severity of symptoms of schizophrenia. Cognitive symptoms were assessed using the components of the CERAD cognitive battery. Social and adaptive functioning was assessed using the SAFE scale. Spearman correlations were determined among clinical variables, and the rank ordering of prediction of SAFE scale scores at follow-up was determined using a stepwise regression procedure. At follow-up, adaptive life skills correlated with cognitive performance and negative symptoms (Spearman rho values 0. 41-0.57, all p values <0.0001), but not positive symptoms (r=0.09, n. s.). Among cognitive tasks, verbal learning and memory were most highly correlated with adaptive skills at follow-up. These results confirm and extend previous studies that indicate that cognitive impairments are predictive, both cross-sectionally and longitudinally, of adaptive life skills in persons with schizophrenia. Negative symptoms, but not positive symptoms, were correlated with impaired adaptive skills. Taken together, these results underscore the need to develop more effective treatments for cognitive and negative symptoms in schizophrenia.

Nicotine impairs spatial working memory while leaving spatial attention intact.

We investigated the effects of nicotine on spatial working memory and spatial selective attention in young, healthy smokers. Spatial working memory was assessed by a delayed response task. Delayed response performance is associated with the integrity of the dorsolateral prefrontal cortex. Spatial interference and negative priming tasks were used to assess spatial selective attention. Nicotine impaired spatial working memory in smokers but it did not affect spatial selective attention. This result suggests that nicotine may impair dorsolateral prefrontal function, as assessed by the spatial working memory task in young smokers and that this deficit does not stem from impairments in spatial selective attention. However, the effects of nicotine on working memory and selective attention in nonsmokers or in psychiatric population with suspected nicotinic receptor abnormalities (e.g., schizophrenia patients) cannot be deduced from the present study.

Neurocognition as a determinant of employment status in schizophrenia.

Chronic unemployment is a major problem faced by many persons with schizophrenia. In this article, the author first reviews reasons why employment is an important goal for patients with schizophrenia. Employment appears to improve the clinical symptoms of schizophrenia. Employment also reduces the economic costs of the illness to society. The author then discusses predictors of positive employment outcomes in schizophrenia. Clinical symptoms, especially positive symptoms, do not appear to play a large role in predicting occupational functioning in schizophrenia. The author than reviews the evidence for the role of cognitive impairment in unemployment in patients with schizophrenia. In seven of the eight studies reviewed, significant relationships between cognitive functioning and work status/work behaviors were reported. These studies provide the basis for identifying those patients most at risk for the poorest occupational outcomes as well as those most likely to benefit from focused intervention.

Risperidone versus haloperidol on secondary memory: can newer medications aid learning?

The introduction of the new generation of antipsychotic medications for the treatment of schizophrenia has been accompanied by a growing interest in the neurocognitive effects of these drugs. The present study compared the effects of risperidone and haloperidol on secondary memory in a group of treatment-resistant schizophrenia patients. The study design included a baseline phase and two double-blind phases in which patients were randomly assigned to medication under two different dose conditions (fixed dose and flexible dose). Secondary memory was assessed at baseline, fixed-dose, and flexible-dose phases, using the California Verbal Learning Test (CVLT). Six measures were selected, which formed three factors (general verbal learning ability, retention, and learning strategy). Risperidone-treated patients showed greater improvement than haloperidol-treated patients in general verbal learning ability, a finding characterized by significant treatment effects on CVLT measures of learning acquisition, recall consistency, and recognition memory. After controlling for benztropine status, differences on the measures of learning acquisition and recall consistency remained significant, and differences in recognition memory weakened slightly (p = 0.07). No significant treatment effects were noted on retention or learning strategy. These findings suggest that risperidone may exert a facilitating effect on the acquisition of new verbal information, an effect that does not appear to be due to the activation of semantic encoding strategies.