Validity of self-reports about quality of life among patients with schizophrenia.

Lehman's Quality of Life Interview was administered to 22 patients with schizophrenia and their proxies and to 15 patients with cancer and their proxies. The results indicated that there was a discrepancy between responses on global objective and subjective measures for patients with schizophrenia but not for patients with cancer. A discrepancy was also found for the proxies of the patients with schizophrenia but not for the proxies of the patients with cancer. These findings suggest that the discrepancy between subjective and objective indicators of quality of life of patients with schizophrenia signifies a genuine difference rather than an anomaly related to the patient's psychiatric condition.

Anhedonia in depression and schizophrenia: a reexamination.

The purpose of this study was to utilize factor analysis to help determine whether anhedonia is a symptom of both depression and schizophrenia. Measures of depression, positive and negative symptoms of schizophrenia, and anhedonia were administered to a group of schizophrenic patients (N = 54) and to a group of patients with major depressive disorder (N = 27). The correlation matrix among the various scales was subjected to an oblique exploratory factor analysis. Three factors were extracted, accounting for three quarters of the variance. The first measured depression, the second measured positive symptoms, and the third measured negative symptoms. Anhedonia loaded significantly on the first factor but not on the third, suggesting that it is a symptom of depression rather than schizophrenia. These results were corroborated by means of confirmatory factor analysis. We conclude that anhedonia is a symptom of depression and that it only appears to be a symptom of schizophrenia because it is a component of emotional blunting which is indeed a negative symptom of schizophrenia.

Hemispheric processing deficits in patients with paranoid schizophrenia.

The purpose of the present study was to investigate hemispheric deficits in individuals with paranoid schizophrenia on four kinds of tasks: dichoptic viewing tasks involving verbal and nonverbal visual stimuli, and dichotic listening tasks involving verbal and nonverbal auditory stimuli. As dependent measures, both accuracy and speed of (correct) responding were measured. The sample recruited for this study consisted of 18 patients with paranoid schizophrenia, 15 outpatients with anxiety disorders, and 20 controls with no history of psychiatric disorders. Results indicated that, relative to the controls, the paranoid schizophrenic patients were less accurate and less efficient on auditory-verbal tasks requiring right hemisphere processing. Unlike the controls the paranoid schizophrenic patients manifested a lateralized left hemisphere advantage.

A re-examination of the relationship between shyness, attributional style, and depression.

Alfano, Joiner, and Perry (1994) used analysis of variance and analysis of covariance in a sample of college students to demonstrate that attributional style mediates between shyness and depression, as opposed to depression mediating between shyness and attributional style. They suggested, however, the hypothetical possibility of a third model, in which negative attributional style, rather than shyness, is the independent variable, and shyness serves as a mediator between attributional style and depression. In the current study, this alternative model was tested by using LISREL to reanalyze the Alfano et al. data. Results showed that this third model, with shyness as the mediating variable, fit the model quite poorly, in contrast to the preferred model of Alfano et al., which fit quite well. However, variants of this model, in which shyness functionally precedes both attributional style and depression, fit the data better. The substantive implications of this model for counseling practice and the methodological cautions about interpreting cross-sectional data for temporal sequences are discussed.

The structure of empathy during middle childhood and its relationship to prosocial behavior.

This study was an investigation of the structure and development of dispositional empathy during middle childhood and its relationship to altruism. A sample of 478 students from 2nd, 4th, and 6th grades completed an altruism questionnaire and a social desirability scale, both created for this study, and the Interpersonal Reactivity Index (Davis, 1980), adapted for this study. Teachers also rated the students on prosocial behaviors, such as sharing. In addition, as an experimental part of the study, the children could make monetary donations and volunteer time to raise funds. Results of a confirmatory factor analysis on the Interpersonal Reactivity Index supported Davis's (1980) findings that empathy comprises four components: perspective taking, fantasy, empathic concern, and personal distress. Factor intercorrelations, however, were not the same as those reported by Davis. MANOVAs were used to examine gender and age effects on empathy. Girls were more empathic in general than boys, and older children showed more empathic concern than younger children. Only empathic concern and perspective taking were significant predictors of prosocial behavior.

Toward a general model of health-related quality of life.

A health-related quality of life (HRQOL) model that fitted data collected in previous studies from two separate samples--patients with chronic physical illness and patients with chronic mental illness--was adapted and tested on a representative sample drawn from the normal population. This model, which implied that both physical and mental health influenced number of friendships, personal growth, and job satisfaction, fitted the data very well. However, an alternative model reversing the directions of the pathways so that friendships, personal growth, and job satisfaction affected physical health and mental health, with the latter two having a mutual effect on each other, fitted the data even better. This suggests that, although a medical model of HRQOL may be more important when it comes to alleviating illness, a psychosocial model of HRQOL may be more important when it comes to maintaining health and preventing illness. Moreover, the fact that essentially the same five-factor structural model fits three distinct populations, healthy and unhealthy, suggests that there may be a general model of quality of life applicable to all populations. The implications of these findings for clinical theory, policy, and practice are discussed.

Psychosocial functioning and subjective experience in schizophrenia: a reanalysis.

Data collected by Brekke et al. (1993) on the symptomatology, psychosocial functioning, and subjective experience of schizophrenia outpatients were reanalyzed using LISREL to elucidate a causal model that would depict the functional relationships between the variables. The model that best fit the data parallels another model tested previously on cardiac patients and shows that subjective experience is much more influenced by symptomatology than by social functioning. This confirms Brekke et al.'s main finding. The implications of these results for intervention and for future research are considered.

Cross-validating a causal model relating attributional style, self-esteem, and depression: an heuristic study.

Pillow, West, and Reich, using path analysis in 1991, were unable to confirm the causal model predicted from the reformulated learned helplessness theory of Abramson, Seligman, and Teasdale which links the dimensions of attributional style with self-esteem and depression. Because their failure to confirm the model may have been due to their using normal subjects instead of psychiatric patients, the model was retested in the present study on psychiatric patients, many of whom had been diagnosed as depressed. Although the Abramson, et al. model was once again not confirmed, neither was the alternative model proposed by Pillow, et al. The model that fitted the data best in this study differed from both of these models and indicated that all three attributional dimensions affect depression solely through the mediation of self-esteem.

MMPI validity measures: a comparative study of original with alternative indices.

A comparison was made of the original MMPI validity scales (L,F,K,F - K) with validity scales devised subsequently (TR, Ca, Ds, Mp, Ws - Wo) to determine which scales, the older or newer, were better, either alone or combined, in detecting fake-good, fake-bad, and careless responding. This was accomplished by having groups of subjects answer the MMPI first under standard conditions and then, 1 week later, under one of the falsifying conditions. A group of 40 psychiatric patients responded under standard and then fake-good conditions; a group of 40 university students responded under standard and then fake-bad conditions; and a group of 20 students responded under standard and then fake-careless conditions. Results indicate that both the traditional and newer validity indices were equally good at detecting fake-good responding. None of the indices was adequate in detecting careless responses. We conclude, as a consequence of this study, that the newer scales perform a clinically useful function when faking good is suspected on the MMPI.

A comparison of medicated and nonmedicated attention-deficit disordered hyperactive boys.

Sixty boys diagnosed as having attention-deficit disorder with hyperactivity were divided into two equal groups, depending on whether or not they were taking medication for their disorder. These two groups were subdivided equally into younger and older groups, the cutoff being 11.5 years. All subjects were given the Children's Depression Inventory, the Coopersmith Self Esteem Inventory and the Children's Attributional Style Questionnaire. Teachers completed the Child Behaviour Checklist and Conners' Teacher Rating Scale. The results indicated that in the older subjects, the medicated group had lower social self-esteem than the nonmedicated group and in younger subjects the medicated group had higher academic self-esteem than the nonmedicated group. There were no significant differences among the groups with respect to depression; all four groups of subjects were mildly depressed. The younger subjects in general were more inattentive, nervous, impulsive and aggressive; and teachers did not report any less externalising behaviour in those subjects who were on medication. These results were interpreted in the light of findings from previous studies, and the lack of drug effect on externalising behaviour is discussed. Clinical recommendations are made for alleviating depression and improving self-concept by means of cognitive therapy, especially for older medicated ADDH children.

Attributional style in paranoid vs. depressed patients.

The Attributional Style Questionnaire was given to three groups of 15 adult patients: a group of paranoid patients who were not depressed, a group of depressed patients who were not paranoid, and a group of patients who were both paranoid and depressed. As predicted, the paranoid patients manifested an attributional style opposite to that of the depressed patients: that is, they tended to attribute good events to themselves and bad events to others or to chance, whereas the depressed patients tended to attribute bad events to themselves and good events to others or to chance. These findings confirm those of Kaney & Bentall (1989). The patients who were both paranoid and depressed fell in between the two other groups with respect to their attributions of good events but did not differ from the paranoid group in their attributions of bad events. In addition, differences among groups were manifest with respect to self-esteem, delusional content and suicidal ideation. The implications of these findings for therapy are discussed.

Thought disorder in the relatives of schizophrenics. A meta-analytic review of selected published studies.

Selected published studies investigating the existence of thought disorder in close relatives were re-examined in response to the conclusion by Saccuzzo, Callahan, and Madsen (J Nerv Ment Dis 176:368-371, 1988) that "the evidence for thought disorder in the families of schizophrenics is weak and inconclusive." A meta-analysis was performed on a subset of these studies to determine the (weighted) average effect size and its variability. The results indicated that the effect size was significant, i.e., there is a definite association between being related to a schizophrenic and manifesting (subclinical) thought disorder. Moreover, the variability of effect sizes among studies was not entirely due to sampling error and needs to be explained in terms of moderator variables.

Treatment of nonseptic olecranon bursitis. A controlled, blinded prospective trial.

We enrolled 42 patients with nonseptic olecranon bursitis in a double-blind prospective treatment trial to compare the efficacy of an intrabursal steroid preparation with that of an oral anti-inflammatory agent. Patients were randomized into one of four treatment regimens: (1) methylprednisolone acetate (20 mg) intrabursal injection and oral naproxen (1 g/d for 10 days), (2) methylprednisolone acetate (20 mg) intrabursal injection and oral placebo for 10 days, (3) oral naproxen (1 g/d for 10 days), and (4) oral placebo for 10 days. The degree of swelling in millimeters was assessed at study introduction and at 1, 3, and 6 weeks. At 6 months, the number of patients requiring reaspiration for bursitis recurrence was tabulated. Data at 1 week indicated that patients treated with an intrabursal methylprednisolone acetate injection (20 mg) demonstrated the most rapid decrease in swelling. At 6 weeks, the methylprednisolone-treated groups demonstrated sustained improvement. At 6 months, the mean number of reaspirations per patient for reaccumulation of bursal fluid was higher in groups 3 (1.0 +/- 1.2) and 4 (0.4 +/- 0.7). An intrabursal methylprednisolone acetate 20-mg injection seems to be the most effective treatment regimen for nonseptic olecranon bursitis.

Septic and nonseptic olecranon bursitis. Utility of the surface temperature probe in the early differentiation of septic and nonseptic cases.

Forty-six consecutive cases of olecranon bursitis were prospectively analyzed during a 1-year period. Eleven cases were septic; 35 cases were nonseptic. In addition to bursal fluid analysis, the surface temperature over the involved olecranon bursa and the contralateral (control) olecranon process was obtained by using a surface temperature probe. We compared the temperature difference between the involved and control sides in all septic and nonseptic cases. In nonseptic cases, the mean surface temperature difference was 0.7 degree C vs 3.7 degrees C in septic cases. In all septic cases, the temperature difference was 2.2 degrees C or greater (range, 2.2 degrees C to 5.1 degrees C; SD, 1.1). Use of the surface probe temperature difference proved 100% sensitive and 94% specific in discriminating septic from nonseptic cases. It seems to be more helpful than the bursal fluid leukocyte count, the predominant cell type, or Gram's stain in the early differentiation of septic and nonseptic olecranon bursitis.

Synchrony and desynchrony in high and low arousal subjects undergoing therapeutic exposure.

A comparison of synchrony and desynchrony was made among phobic patients exposed to imaginal flooding under conditions of high and low arousal, respectively. Subjective anxiety (SUDs) and skin conductance (SC) were recorded at five minute intervals during three separate sessions. Results showed some degree of synchrony (small positive relationship) between the two measures for the high arousal group and desynchrony (no relationship) between these measures for the low arousal group. However, with the exception of two cases, one from each group, the findings were by no means clear-cut, suggesting that other factors besides level of arousal may be responsible for individual differences in synchrony.

Thought disorder among the relatives of schizophrenics. A reaction to Callahan and Saccuzzo.

Callahan and Saccuzzo (J Nerv Ment Dis 174:240-242, 1986) claim that there has been no published research on thought disorder (associative cognitive dysfunction) in the first-degree relatives of schizophrenics and interpret the results of their preliminary study as indicative of familial psychopathology. In fact, there have already been numerous published studies on this topic drawing the same broad conclusion. Attention is drawn to these studies, and their findings are described. A fresh approach to research in this area is called for.

A retrospective study of dropout rates from a community mental health centre and associated factors.

To ascertain if decentralization of mental health services, making them more accessible to the public, would be reflected in a decrease in the dropout rate, a comparison was made between dropout rates just prior to and immediately following decentralization. This involved examining 1350 closed files representing cases seen during a three-year period after decentralization and comparing the findings with those of a previous study of files of 588 cases seen during a year before decentralization. The dropout rate decreased from 46% to 43%; while statistically significant, this change was too small to be of any practical importance. However, analysis of demographic and clinical variables in the post-decentralization sample proved most interesting. On the whole, it confirmed the findings from previous investigations, i.e. dropouts tended to be younger, less well-educated, of low socioeconomic status (SES), and were most commonly diagnosed as having a personality disorder. Although some therapists had a comparatively large proportion of dropouts, this discrepancy may reflect the distribution of difficult cases rather than the effectiveness of the therapists.

A simplex model of the paranoid process: implications for diagnosis and prognosis.

The theory that the paranoid process is gradual and insidious was tested quantitatively by means of LISREL, a computer program designed to trace causal pathways between latent variables. The results clearly confirmed Lorr's simplex model which depicts a progressive sequence of six stages, beginning with hostile attitude and ending with delusions of influence. The model suggests that it is artificial to distinguish paranoid personality, paranoia and paranoid schizophrenia as separate diagnostic entities. Instead, paranoid schizophrenia should be regarded as a more severe form of paranoia which in turn is a more severe form of paranoid personality. The implications of this model for prognosis are also discussed.

Hospital staff's perceptions of the alcoholic.

Hospital staff's perceptions of the characteristics of alcoholics were investigated by means of a questionnaire containing a set of 23 semantic differential scales on which they rated four types of patient: "the Alcoholic," "the Nondrinker," "the Drug Addict," and "the Heavy Drinker." Factor analysis of the responses showed that types of patients were perceived in terms of three dimensions. Stability, Dangerousness, and Self-Assertiveness. In comparison with heavy drinkers, alcoholics were perceived by hospital staff in general as unstable, harmless, and self-effacing, though clerks tended to see them as more dangerous than did professionals. These perceptions are considered in relation to the respondent's own frequency of drinking. Finally, the explanation of these findings and their implications for clinical education and policy are discussed.