New Measures for Research on Men Who Have Sex with Men and for At-Risk Heterosexuals: Tools to Study Links Between Structural Interventions or Large-Scale Social Change and HIV Risk Behaviors, Service Use, and Infection.

Large-scale structural interventions and "Big Events" like revolutions, wars and major disasters can affect HIV transmission by changing the sizes of at-risk populations, making high-risk behaviors more or less likely, or changing contexts in which risk occurs. This paper describes new measures to investigate hypothesized pathways that could connect macro-social changes to subsequent HIV transmission. We developed a "menu" of novel scales and indexes on topics including norms about sex and drug injecting under different conditions, experiencing denial of dignity, agreement with cultural themes about what actions are needed for survival or resistance, solidarity and other issues. We interviewed 298 at-risk heterosexuals and 256 men who have sex with men in New York City about these measures and possible validators for them. Most measures showed evidence of criterion validity (absolute magnitude of Pearson's r ≥ 0.20) and reliability (Cronbach's alpha ≥ 0.70). These measures can be (cautiously) used to understand how macro-changes affect HIV and other risk. Many can also be used to understand risk contexts and dynamics in more normal situations. Additional efforts to improve and to replicate the validation of these measures should be conducted.

Injection risk norms and practices among migrant Puerto Rican people who inject drugs in New York City: The limits of acculturation theory.

BACKGROUND: Among people who inject drugs (PWID) in New York City (NYC), racial minorities are disproportionately infected with HIV and hepatitis C (HCV). Prior research has shown that PWID who started injecting drugs in Puerto Rico (P.R.) tend to maintain the risky injection behaviors learned there. This study identifies the P.R.-native norms supporting the continued injection risk behavior of migrant Puerto Rican PWID in NYC to inform a culturally appropriate risk-reduction intervention. METHODS: 40 migrant Puerto Rican PWID were recruited in NYC for a longitudinal qualitative study. The sample was stratified to include 20 migrants with <3 years in NYC and 20 migrants with >3-6 years in NYC. Time-location sampling was used to curb possible network bias in recruitment. Over 12 months, migrants completed semi-structured interviews at baseline, monthly follow-ups, and study exit. Analyses were guided by grounded theory. RESULTS: Most participants (90%) reported having had chronic HCV, and 22.5% reported being HIV-positive. Syringe- and cooker-/cotton-sharing were widespread in both P.R. and NYC. The ubiquitous practice of cleaning used syringes by "water-rinsing and air-blowing" was guided by a normative belief, learned in P.R., that "water and air kill HIV." Sterile syringe use was not a priority. HCV was not a concern. P.R.-native abstinence-only narratives discouraged opioid agonist treatment (OAT) enrollment among recent migrants (≤3 years). Experiences with drug dealers, prison-power groups, and injection doctors ("Gancheros") in P.R. influenced migrants' injection risk behavior in NYC. Those who were Gancheros in P.R. continued working as Gancheros in NYC. CONCLUSIONS: Injection risks make migrant Puerto Rican PWID in NYC vulnerable to HIV/HCV. Harm reduction programs should pay closer attention to the rationales behind these injection risks. A risk-reduction intervention that incorporates the Ganchero figure may be a credible way to help migrants reduce injection risk and accept OAT and syringe exchange programs (SEP).

Reflections of depression in acoustic measures of the patient's speech.

BACKGROUND: The literature on acoustic measures of voice in depression is reviewed. Authors have separated results derived from studies of automatic speech, such as counting or reading, from free speech. Free speech requires cognitive activity such as word finding and discourse planning in addition to the motor activity of automatic speech. Also, results have been less ambiguous if homogeneous groups of agitated or retarded depressed patients were examined. METHODS: These distinctions are applied to the results of a 12-week double-blind treatment trial that compared response to nortriptyline (25-100 mg/day) with sertraline (50-150 mg/day). Twelve male and ten female elderly depressed patients and an age-matched normal control group (n=19) were studied. Patients were divided into retarded or agitated groups on the basis of ratings. Results from measures of fluency (speech productivity and pausing) and prosody (emphasis and inflection) are described. RESULTS: Depressed patients showed less prosody than the normal subjects. Improvement in the retarded group was reflected in briefer pauses but not longer utterances. There was a trend in the agitated group for improvement to be reflected in the utterance but not the pause measure. CONCLUSIONS: Clinical impressions are substantially related to acoustic parameters. Temporal changes associated with depression appear to reflect the depressed state whereas prosodic features seem to reflect a depressed trait. Acoustic measures of the patient's speech may provide objective procedures to aid in the evaluation of depression. Limitations of the study are discussed.

Prosody and lexical accuracy in flat affect schizophrenia.

To test the hypothesis that flat affect in schizophrenia involves a motor-expressive deficiency, but not an emotional deficiency, we compared the acoustic properties of speech that are used to express emotion with the emotional content of the words. DSM-III-R schizophrenic patients were divided into flat (N=20) and non-flat affect (N=26) groups on the basis of rating-scale scores. Twenty normal subjects also were included. Subjects were recorded on audio tape as they described a happy and a sad experience for about 10 min. The recordings were analyzed acoustically for fluency and for two types of prosody: inflection and emphasis. Words from transcriptions of the recordings were sorted by content analysis software into psychologically meaningful categories; we compared 'pleasure' and 'distress' word categories. Patients with flat affect spoke with less inflection, and were less fluent. However, they were similar to the other groups in the rate at which they used 'pleasure' words to describe happy experiences and 'distress' words to describe sad experiences. The behavioral deficiency in flat affect appears to be restricted to reduced activity in communicative motor channels. Other aspects of emotion processing seem intact.

The relationship between affect expression and affect recognition in schizophrenia.

To examine the relationship between affect expression and affect recognition, we assessed 30 clinically stable, medicated schizophrenic inpatients. Affect expression was assessed using both a standard clinical rating scale (SANS) and a computerized acoustic voice analysis (VOXCOM). Affect recognition was assessed using the Florida Affect Battery (FAB). The schizophrenics' performance on the FAB was impaired, indicating broad deficits in affect recognition (p<0.05). There were no significant correlations between measures of affect expression and affect recognition, suggesting that the expressive impairment in schizophrenia is not related to their ability to discern emotions in others. SANS Inappropriate Affect, however, was negatively correlated with facial affect recognition (p = 0.001), suggesting that raters' impression of inappropriate affect may indicate a failure in the process of affect attunement.

Acoustic distinctions in the speech of male psychopaths.

A key feature of psychopathy is the ability to deceive, manipulate, and con the unwary, while seeming to be perfectly sincere. Is this impression of sincerity achieved solely through body gestures and facial expression, or is there also something different about the voice quality of psychopaths? We analyzed the acoustic characteristics of speech in 20 male offenders (10 psychopaths and 10 nonpsychopaths), assessed with the Psychopathy Checklist--Revised (Hare, 1991). We used a computer program developed by Alpert, Merewether, Homel, Martz, and Lomask (1986) to measure variations in amplitude and prosody. Results indicated that psychopaths spoke more quietly than controls and did not differentiate, in voice emphasis, between neutral and affective words. These findings are consistent with the developing view that psychopaths are insensitive to the emotional connotations of language. In addition, their vocal characteristics may be part of a self-presentation mode designed to manipulate and control interpersonal interactions.

At issue: speech fluency and schizophrenic negative signs.

The spontaneous speech of negative-syndrome schizophrenia patients is underproductive and contains many hesitations and pauses. Acoustic analysis of the patient's speech during interview reveals that the duration of pauses, independent of other linguistic or paralinguistic measures, correlates strongly with the clinician's impressions of the patient's flat affect and alogia. Pausing is less related to associality and other aspects of the negative syndrome. The hesitations appear to reflect a word-finding difficulty that, together with neuropsychological evidence of compromised performance on word fluency tasks, suggests a specific speech generation difficulty. The significant relationship between pausing and both flat affect and alogia suggests that the two negative signs share phenomenal and psychometric properties. The examination of speech generation mechanisms may provide an informative avenue for study of schizophrenic psychopathology. Acoustic analysis reveals processes that are not apparent to the clinician and may provide a useful basis for clinical assessments and research.

Clinical and acoustic measures of the negative syndrome.

We studied 12 male schizophrenia patients in a 6-week treatment trial comparing two neuroleptics and placebo. Efficacy in regard to negative symptoms was of interest, and Alphs' Negative Symptom Assessment (NSA) was included. The NSA includes behaviorally anchored ratings such as "prolonged time to response" and "restricted speech output." Audio recordings of interviews with the patients were analyzed acoustically. In general, the behavioral anchors did not prevent the ratings from being influenced by global impressions. There was a strong correlation between each item and the total of other items, but a modest correlation with the relevant behavioral measure. Results suggest that, even with specific and behaviorally anchored items, the clinician's assessment is confounded by global impressions. Treatment effects were greater for the acoustic measures than for the clinical measures.

Cues to the assessment of affects and moods: speech fluency and pausing.

Clinicians' rating of the negative syndrome of schizophrenia are highly correlated with the rate and duration of the patient's pauses. To test the degree to which pausing provides the cue for clinicians' impressions we selected audio recordings of interviews with schizophrenic patients who showed moderate levels of negative signs and, through the use of a computerized digital editor, transformed the recordings by either doubling or halving the duration of all of the patient's pauses. Other aspects of the patients' speech were unchanged. Ratings of flat affect were changed by the editing: reduced pause samples were seen as less flat and increased pause samples as flatter. Ratings of mood were not significantly changed. These results suggest that neuropsychological factors that interfere with fluent speech may play a role in the pathogenesis of the negative syndrome. In addition, the edited tapes provide helpful materials for training clinicians to assess moods and affects.

The syntactic role of pauses in the speech of schizophrenic patients with alogia.

This study examines the relation between alogia and pausing. The authors analyzed the flow of speech of 17 male schizophrenic patients during an interview, particularly the pauses that occurred within and between syntactic clauses and those that occurred as the turn switched from the interviewer's question to the patient's response. The strongest predictor of alogia ratings was the duration of switching pauses; the frequency of long within-clause pauses was also significantly related to alogia, but the frequency of between-clause pauses showed a trend toward a negative relation with alogia. Words following within-clause pauses were more likely to be content words than function words, and the content words were less frequent in the English language than the speaker's other words. This suggests that alogic patients have difficulty in word finding and in thought formulation, as well as a general increase in the duration of all pauses.

Scales for the assessment of neuroleptic response in schizophrenic children: specific measures derived from the CPRS.

This article reports the psychometric properties of two scales for rating positive and negative schizophrenic signs and symptoms. These Positive and Negative Syndrome Scales consist of items selected from the Children's Psychiatric Rating Scale (CPRS), which contains items covering a wide range of childhood psychopathology. CPRS rating data were analyzed for 19 schizophrenic children, 16 males and 3 females, mean age 8.9 years (range 5.5-11.7), evaluated in a double-blind, placebo-controlled crossover study of haloperidol. We describe the item composition and coherence of each scale, the interrater reliabilities of clinicians using the scales, and the sensitivity of the scales for resolving treatment response. Schizophrenic children showed both positive and negative signs and symptoms, and both improved with neuroleptic treatment.

A new pictorial instrument for child and adolescent psychiatry: a pilot study.

A pictorial instrument was developed to assess psychopathology in children aged 6 to 16 years. Symptom pictures (n = 137) representing DSM-III-R criteria were organized into seven diagnostic subscales. Clarity of the pictures was assessed in 31 normal children. Fifty-one psychiatric inpatient children completed the instrument using a 6-point visual analogue scale. Sensitivity to change was assessed in 15 children. The subscales' internal consistencies (Cronbach's alpha) ranged from 0.54 to 0.86. A canonical discriminant analysis among four diagnostic groups achieved a Wilks' lambda of 0.67 (p = 0.02). This instrument may be a valuable adjunct to psychiatric interviews in children.

Mapping schizophrenic negative symptoms onto measures of the patient's speech: set correlational analysis.

We describe a system designed to assess the speech behaviors that inform clinicians about their patients' negative symptoms. Measures are formed into scales to reflect the patient's Pausing, Speech Rate, and Dyadic Interaction with the interviewer. Using set correlation, we examined the associations between the acoustic scales and the clinician's ratings of Flat Affect, Alogia, and Asociality. Over half of the multivariance in the clinical scales was accounted for by the acoustic scales. Unique isomorphisms between the acoustic and rating scales were found for: Dyadic Interaction with Flat Affect; Pause Production with Alogia; and Rate with Asociality.