ROUNDS, a new time-sampling methodology for the quantitative behavioral assessment of schizophrenic withdrawal. Reliability and validity.

Negative symptoms in schizophrenia have been the subject of much research interest. However, there has been a need for a way to measure withdrawal behavior quantitatively over time. We have developed a behavioral time-sampling methodology performed by nursing staff on a schizophrenia inpatient unit. Called ROUNDS, it gathers reliable and valid quantitative data about specific withdrawal behaviors such as posture, daytime sleep and levels of social interaction and activity. This paper describes the development of the method, its implementation, the statistical analysis of its reliability and validity, and the degree to which the data can be replicated with different sampling frequencies. We contend that this method can be applied to the analysis of a wide variety of questions about the nature and treatment response of schizophrenic withdrawal in an inpatient setting.

Neurocognitive deficits and social functioning in outpatients with schizophrenia.

Previous studies suggest that neurocognitive factors may contribute to the reduced social functioning of patients with schizophrenia. To assess this relationship, we administered a battery of neurocognitive tests and independently assessed symptoms (PANSS) and social functioning (SFS) in 88 stable outpatients with schizophrenia. We found a significant correlation between neurocognitive and social functioning variables. Patients' performance on aphasia, spatial organization and visual spatial tasks was correlated with their competence at activities of daily living, frequency of social activities and total social functioning. Regression analyses of each social functioning scale revealed different symptom and neurocognitive predictors. Patients' overall social functioning was best predicted by a combination of negative symptoms and aphasia. The results support the potential use of interventions to reduce patients' cognitive deficits as a means to improve their social outcomes.

Social functioning and neurocognitive deficits in outpatients with schizophrenia: a 2-year follow-up.

Neurocognitive deficits have been associated with the social functioning impairments of patients with schizophrenia. More information is needed about how cognitive status and other variables predict social functioning over defined periods of time. In this study, 72 relatively stable outpatients with schizophrenia were compared between baseline and a 2-year follow-up on measures of social functioning. Patients were also assessed with a battery of neurocognitive tests and the Positive and Negative Syndrome Scale. Results were compared by univariate and multivariate analyses. A total of four out of seven subscales of the Social Functioning Scale (SFS) and the total SFS score did not show a significant change over the 2-year period. On the three SFS subscales that did show a significant change, residual change scores were correlated with better neurocognitive performance at baseline, younger age, and shorter illness duration. For the Multnomah Community Ability Scale, 48.9% of the total score at follow-up was predicted by initial negative symptoms and scores on the Aphasia Screening Test. These results document the independent contribution of demographic variables, negative symptoms, and neurocognitive deficits to the social functioning impairments of individuals with schizophrenia.

Dextro-amphetamine diminishes negative symptoms in schizophrenia.

Thirty schizophrenic patients received intravenous dextro-amphetamine while on and off pimozide. The results provide evidence that negative symptoms and depressed mood in schizophrenia respond in part to intravenous challenges of dextro-amphetamine. Improvement in negative symptoms while on d-amphetamine correlated significantly with subsequent improvement in the same negative symptoms while on pimozide. These results do not support the Type II model of irreversible negative symptoms in schizophrenia in our patient sample. Changes in negative symptoms may be related to state dependent changes in the dopamine system, but noradrenergic mechanisms cannot be excluded either.

Lack of insight among outpatients with schizophrenia.

OBJECTIVE: This study investigated the prevalence of lack of insight among outpatients with schizophrenia and the relationship between lack of insight and other variables, including whether patients received professional residential supervision. METHODS: A total of 87 stable outpatients with schizophrenia were drawn from community programs in a public-private mental health system. Subjects' clinical symptoms and insight about their illness were assessed using the Positive and Negative Syndrome Scale, a battery of neuropsychological tests, and the Social Functioning Scale. RESULTS: The illness insight of 43 subjects, or 49.5 percent, was at least moderately impaired. Twenty-one subjects, or 25 percent, had severe insight deficits. In a multiple regression analysis, 40 percent of the variance in lack of insight was predicted by ratings of the severity of delusions, difficulty with abstract thinking, lack of social activities, and absence of anxiety. Patients who received professional residential supervision had more impaired insight than those living independently or with family. CONCLUSIONS: Insight deficits are common among stable outpatients engaged in community-based care. These deficits have implications for patients' use of limited services such as residential supervision.

Neuropsychological deficits in chronic schizophrenics. Relationship with symptoms and behavior.

Thirty-nine hospitalized chronic schizophrenics were administered the Luria-Nebraska Neuropsychological Battery (LNNB) and the Weschler Adult Intelligence Scale-Revised when they were clinically stable. Test variables were related to Brief Psychiatric Rating Scale ratings and two behavioral measures of ward functioning, points and activities. Spearman correlations of test variables with the symptom and behavioral measures were entered into a series of median polish analyses. There was an overall significant relationship between the two sets of variables. Neuropsychological test variables that were most highly correlated with symptom/behavioral measures were LNNB Left Frontal, Memory, and Intellectual Processes scales. The positive symptoms of thought disorder and hallucinations were most consistently related to neuropsychological variables. In contrast with other findings in the literature, negative symptoms were not significantly correlated with neuropsychological performance.