Are schizophrenic men at higher risk for developmental deficits than schizophrenic women? Implications for adult neuropsychological functions.

This study tested the hypothesis that schizophrenic men would be at a greater risk than schizophrenic women for exhibiting a history of developmental problems in childhood and would exhibit more neuropsychological deficits as adults. The study was a secondary analysis of data that were collected in 1981-83. The sample consisted of 49 DSM-III schizophrenic patients (57% male/43% female), who were generally in the early stages of the disorder. All subjects received a neurodevelopmental and clinical/diagnostic interview and a neuropsychological battery of tests, including measures of intelligence, abstract reasoning, memory, sustained attention, executive function, language skills, and motor ability. Latent class analysis was used to identify gender differences in subclasses of schizophrenia. The groups were then compared on neuropsychological function. Results indicated that schizophrenics with histories of early developmental problems exhibited significantly more neuropsychological dysfunction as adults than did other schizophrenics, and they were more likely to be men. Impairment in this group was evident in the areas of verbal ability, attention, abstraction, motor function, and verbal and nonverbal learning and memory, with verbal tasks being relatively more impaired.

MR appearance of radiation hepatitis.

The histopathologic changes of radiation hepatitis have been well described. The magnetic resonance (MR) appearance, however, has been described only in two case reports. We obtained serial MR scans of patients undergoing therapeutic irradiation for Hodgkins lymphoma to determine the time course of changes in signal intensity of the liver. We found an increased signal intensity of the irradiated portion of the liver on T2-weighted images. Changes first detected at 4 weeks following 3600 cGy to the abdomen returned to normal signal intensity within 60 days following completion of radiation therapy. One patient demonstrated a subtle increase in signal intensity of the irradiated region as early as 7 days after receiving 2000 cGy. Our results suggest that MR imaging is a useful noninvasive means of tracing the course of radiation hepatitis.

Short-term immunological effects of induced emotion.

Twenty healthy volunteers (half male) recalled and relived maximally disturbing (NEG) and maximally pleasurable (POS) emotional experiences. Forty minutes of silence, then neutral conversation, preceded and followed 40 minutes of emotion elicitation (NEG and POS randomly rotated). They were under video, cardiovascular, and immunological monitoring. Subjects reported appropriate emotions and showed significant cardiovascular activation during the NEG condition. Speech alone had an independent cardiovascular activating effect. Emotion, particularly NEG, led to further activation. NEG emotion promoted significant declines in mitogenic lymphocyte reactivity, followed by return to pre-emotion levels. A similar though less extreme decline was seen in the POS condition. There was a weak trend for elevated natural killer cell activity under the NEG condition, possibly due in part to changed trafficking patterns. Correlational findings confirmed these group effects. The decline in mitogenic reactivity during POS emotion appeared to be due to subtle degrees of tension and excitement triggered by the experimental experience regardless of the exact emotions recalled. Results suggest that immunologic processes are sensitive to influence by arousal of emotion.

Effect of radiation therapy on thoracic and lumbar bone marrow: evaluation with MR imaging.

Bone marrow suppression is often the limiting factor in the use of radiation therapy. In order to determine if MR imaging can be used to quantify bone marrow changes, we performed a serial prospective study of patients with lung cancer (six cases) and lymphoma (six cases). Quantitative and qualitative assessments of T1-weighted sagittal images, 750/33 (TR/TE), obtained at 0.6 T before, during, and after radiotherapy showed increased signal intensity in the radiated portions of the spine. These changes appeared as early as 2 weeks after the beginning of radiation, continued to increase until a maximum value was attained, and then persisted during the follow-up period of 2 years. A significantly higher (p less than .04) ratio of pretreatment to maximum posttreatment signal intensity was seen in patients with lymphoma than in those with lung cancer, and pretreatment values in patients with lymphoma were significantly lower (p less than .01). The lower pretreatment values found in the patients with lymphoma may have been due to the smaller amount of yellow marrow in these patients, who were significantly younger (33 vs 62 years). The higher ratio of pre- and posttreatment signal intensity may have been related to the larger amount of hematopoietic marrow available to undergo fatty replacement. The persistence of elevated signal intensity for as long as 2 years after radiation suggests an endpoint in the process of marrow conversion, but not reversal in the form of regeneration of hematopoietic bone marrow. Quantitative MR evaluation of bone marrow may be of considerable value as a noninvasive means of monitoring the effects of radiotherapy.

Biological measures and cellular immunological function in depressed psychiatric inpatients.

Thirty depressed psychiatric inpatients, including 18 with a diagnosis of major depression, and 25 hospital staff controls were compared with respect to cellular immune function--that is, mitogen responsiveness to concanavalin A (con A), phytohemagglutinin (PHA), and pokeweed mitogen (PWM); natural killer cell (NK) activity; and T cell subsets, including helper/inducer T cells (CD4) and suppressor/cytotoxic cells (CD8). Only physically healthy subjects, who had not used psychoactive medications (except for low dose benzodiazepines) or other medications known to affect the immune system for at least 14 days, were included. Paired comparisons of the immune measures of patients with a DSM-III diagnosis of major depression (n = 18) with their controls demonstrated a statistically significant reduction of the patients' con A response. In addition, the patients with major depression had significantly lower con A and PHA responses than the combined patients with other forms of depression (atypical, dysthymic, or atypical bipolar). There was no indication that severity of depression, dexamethasone suppression test status, benzodiazepine use, or age accounted for the differences in immune function. A possibly important, unexpected finding was that antihistamine use was associated with lower immune function.

Psychotherapy of schizophrenia: an empirical investigation of the relationship of process to outcome.

The Boston Psychotherapy Study found no major differences in the effects of insight-oriented and supportive psychotherapies in the treatment of schizophrenia. The authors of the current study looked beyond the assignments to those treatment designations and used blindly rated transcripts of tape-recorded sessions to examine the relationship of therapist interventions and patient outcomes at 2 years. They found significant relationships between skillfully conducted psychodynamic exploration and greater improvements in negative symptom areas of schizophrenia. The authors note the limitations and implications of these findings for clinical practice and research.

Lateral ventricular size and social network differentiation in young, nonchronic schizophrenic patients.

The authors correlated lateral cerebral ventricular size with social network differentiation and social outcome in 15 young, nonchronic patients with schizophrenia and schizophreniform disorder. Patients with fewer social contexts, fewer types of relationships, and less independent residence had larger ventricles.

Effects of psychotherapy in schizophrenia: I. Design and implementation of a controlled study.

This article describes a 2-year, multi-hospital study on the effects of psychotherapy for nonchronic schizophrenic patients. The design and methods used to evaluate the relative benefits of exploratory, insight-oriented (EIO) psychotherapy and reality-adaptive, supportive (RAS) psychotherapy when both are provided by experienced therapists against the backdrop of good hospital and psychopharmacological management are presented. Similarities and differences between the two therapies and the therapists are outlined. Special attention is given to the problems in implementing research on long-term psychotherapy. Finally, the strengths and limitations of the present study are discussed.

Effects of psychotherapy in schizophrenia: II. Comparative outcome of two forms of treatment.

This study compares the effects of exploratory, insight-oriented (EIO) and reality-adaptive, supportive (RAS) forms of psychotherapy on a sample of 95 schizophrenic patients. Analyses of 2-year outcomes revealed a complex interaction between the type of psychotherapy provided and the domain of psychopathology affected. RAS psychotherapy exerted clear preferential effects in the areas of recidivism and role performance. The EIO psychotherapy exerted preferential, albeit more modest, action in the areas of ego functioning and cognition. Overall, however, the magnitude of the differences was low. The results highlighted the need for more focused studies of subgroups, and of process and contextual influences on outcome.

Free association as a biopsychosocial probe.

Free association was used as an experimental approach in a pilot study of four healthy subjects. Physiologically simultaneous measurement of respiratory minute volume showed a wide range of moment-to-moment values, possibly reflecting shifts in emotional state. Psychologically, subjects manifested classical resistance and transference attitudes. These psychological findings were confirmed in a second study using seven mild asthmatics and six healthy comparison subjects. The asthmatics showed significant constriction of verbal associative productivity and also significantly greater "immaturity" in drawings of two humans and of an animal, serially administered before and after three free associative sessions. A third study of associative output after stressful stimulation, using 17 asthmatics and 16 controls, confirmed the verbal constriction of the asthmatics. Free association permits study of psychosocial context and, in particular, reconstruction of important self--other relationships. These factors are important in assessing the "strain" surrounding manifest expression of emotion. Verbatim associative productions from experimental subjects and from a patient in psychoanalysis are used to form a model of emotional processes in acute bronchial asthma. This is a special case of Engel's general biopsychosocial model of disease.

Clinical measurement in psychoanalysis: an approach.

Measurement of the complex phenomena in psychoanalysis is approached by defining interrelated elements in the analytic situation and specifying the range of their variation in scales which can be both generalized and made specific for an individual patient. Using this approach in transcripts of psychoanalytic sessions, we rate painful emotion, impairment of defensive maneuvers, and activation of threatening conflictual fantasies. This preliminary study involved rating of tape-recorded sessions by psychoanalytically oriented judges. Quantitative estimates appeared to relate in many ways to qualitative fluctuations in the patient's state. Such an approach may be helpful in developing more effective clinical theory about emotions, defensive processes, and transference fantasies.

Methodology for a prospective study of suitability for psychoanalysis: the role of psychological tests.

A methodology for the use of psychological tests in the evaluation for suitability for psychoanalysis is described. Four variables--Reality Testing, Level and Quality of Object Relations, Affect Availability and Tolerance, and Motivation--were chosen for study and are discussed in detail. Data indicating a high degree of reliability between raters are presented.

A context analysis of psychological states prior to petit mal EEF paroxysms.

This is the first report in the literature of an application of the rigorous symptom-context method for determining the nature of the psychological antecedents of petit mal EEG paroxysmal activity. The activity is defined by the presence of a 3 cycle/second spike and wave on the EEG which is recorded concurrently while the patient is speaking his thoughts freely during interviews. The content of the patient's speech before each petit mal episode is compared with the content of speech during nonparoxysmal periods. Three petit mal patients were examined in this way for four sessions each. (Total petit mal EEG paroxysms for patient no. 1 were 19, patient no. 2 were 25, and patient no. 3 were 55.) For the first patient, strong psychological antecedents were found before petit mal EEG paroxysms as compared with comparison periods from the same patient. These consisted of such usual negative affects as feeling depressed and blocked. For the two other patients, only a few psychological antecedents discriminated significantly and these were not of the same type across the three patients. We conclude that the patients differ in amount and type of psychological antecedents. The differences may be attributed to differences in the type of petit mal and/or differences in the psychological component to the petit mal. The differences among the patients are probably not related to the average length of the paroxysms since we have shown that the relationships with the duration were generally silences than during the patient's speech (for two of the three patients)--talking probably requires more focused attention than silence; more focused attention or activity tends to reduce these episodes.