Neurocognitive vulnerability, interpersonal criticism, and the emergence of unusual thinking by schizophrenic patients during family transactions.

BACKGROUND: This study examined whether the combination of patients' neurocognitive deficits and criticism by others would predict the emergence of patients' unusual thinking during stressful family transactions. METHODS: When clinically stable, 41 patients with recent-onset schizophrenia completed 2 versions of a visual vigilance task, the Continuous Performance Test (CPT). One CPT emphasized early perceptual processing, while the other stressed immediate, working memory. On a separate occasion, patients and family members participated in a 20-minute interaction in which the number of relatives' criticisms and patients' unusual thoughts was assessed. RESULTS: In a hierarchical regression model, after entering performance on the CPT demanding immediate, working memory, and the number of criticisms by family members, the interaction of CPT performance and criticism significantly predicted the number of patients' unusual thoughts during the family session (r(2) change = 0.09; P =.03). Post hoc analyses revealed that the number of criticisms and odd thoughts correlated significantly (r = 0.59, P =. 03) for patients who had poor memory-load CPT performance, but were unrelated (r = -0.07) for patients who did well on the memory-load CPT. The CPT emphasizing early visual processing, either alone or in combination with interpersonal criticism, did not predict the number of patients' unusual thoughts during the interaction. CONCLUSION: The results suggest that the combination of patients' working memory deficits and interpersonal criticism jointly predicts psychotic thinking, consistent with a model of schizophrenia that emphasizes the interaction of neurocognitive vulnerability and psychosocial stress factors. Arch Gen Psychiatry. 2000;57:1174-1179.

Perceptions of parental and peer attachments by women with mood disorders.

The relationship between perceptions of parental and peer attachments at various ages and adult mood disorders was examined in 156 women classified as having bipolar disorder or unipolar depression or as nonpsychiatric controls. Nonpsychiatric controls reported a decreased attachment to their parents over time, but they also reported an increased closeness to their mothers in adulthood following a distant adolescence. Never hospitalized, moderately depressed subjects showed a similar trend toward decreased relatedness, but moderately depressed subjects did not report reestablishment of a close relationship with their mothers after adolescence. Severely depressed and bipolar subjects reported little attachment to their mother at all ages. Bipolar subjects also reported little connectedness to their fathers throughout their lifespan and severely depressed women felt less attached than nonpsychiatric controls to peers during development. None of the psychiatric groups reported difficulties with parental overcontrol.

Dependency, self-criticism, and perceptions of socialization experiences.

This study explored the relationship of dependency and self-criticism to perceptions of socialization experiences using 132 bipolar, nonbipolar depressed, and nonpsychiatric control female subjects. After controlling for level of depression and diagnosis, dependency was related to a distant relationship with fathers during development and was marginally related to perceptions of increased parental attention and overindulgence. Self-criticism was related to perceptions of difficulties in the quality of affective bonds with fathers and peers during childhood and was related marginally to perceptions of increased paternal power and control during development. No unique socialization experiences were associated with high dependency and self-criticism jointly, but women with both dispositional tendencies were likely to be severely depressed.

Expressed emotion and subclinical psychopathology observable within the transactions between schizophrenic patients and their family members.

The authors examined whether young, recently discharged schizophrenic patients from high (n = 34) and low (n = 14) expressed emotion (EE) families differ in their level of subclinical symptomatology during a direct interaction task. Compared with patients from low-EE homes, patients from high-EE home showed significantly more odd and disruptive behavior with family members. High-EE relatives were more likely than low-EE relatives to respond with criticism to the first unusual thought verbalized by the patient; when this occurred, the probability of a second unusual thought was augmented. Results suggest that high-EE family members may display negative attitudes toward patients in part because they are exposed to higher levels of unusual or disruptive behavior than low-EE relatives. The data also support a bidirectional, transactional model of the relationship between relatives' EE and patients psychopathology.

Effects of changing contingencies on the behavior of depressed and nondepressed individuals.

The effects of rules versus shaping on the behavior of depressed and nondepressed individuals were compared. Extending the findings in the depressive realism literature to a learning paradigm, the behavior of depressed individuals was more sensitive to changing contingencies than was the behavior of nondepressed individuals. Contrary to hypotheses, however, this effect appeared due primarily to the nondepressive Ss' strategy of continuing to follow an experimenter's inaccurate rules. Results suggest the relative absence of self-presentational concerns may lead depressed individuals to be more accurate in judging environmental contingencies.

Dependency and self-criticism in bipolar and unipolar depressed women.

OBJECTIVES: The dependency and self-criticism scores of women with histories of either unipolar disorder (N = 74) or bipolar disorder (N = 20) or no psychiatric history (N = 24) were compared to determine the influence of state depression on these personality dimensions. DESIGN: All women completed the Depressive Experiences Questionnaire and the Beck Depression Inventory. Patients were divided into currently depressed and remitted groups. RESULTS: Currently depressed women with unipolar disorder were more self-critical and dependent than non-psychiatric controls; women with unipolar disorder whose depression remitted were more self-critical only. Women in both the depressed and remitted bipolar groups were more self-critical than controls. Depressed bipolar patients did not differ from the controls in their level of dependency; remitted bipolar patients were significantly less dependent than controls. CONCLUSIONS: Dependency needs in depressed women are heavily influenced by mood state. Self-criticism appears to be a-characterological trait in both major depression and bipolar disorder. Women with bipolar disorder in remission report fewer dependency needs than women with no history of psychiatric disorder. The data provide partial support for Blatt's (1974) hypothesis that dependency and self-criticism reflect relatively stable personality dimensions in patients with a mood disorder.

Effects of self-generated rules on the development of schedule-controlled behavior.

College students responded under a multiple differential-reinforcement-of-low-rate 5-s fixed-ratio 8 schedule, with components alternating every 2 min. After 40 programmed minutes of acquisition and 12 min of maintenance, without notice, both schedules changed to extinction for 28 min. During acquisition, between alternations of the multiple schedule, some subjects were asked to develop rules describing the schedule contingencies. Other subjects were given these same rules between alternations, and a third group neither received nor were asked to develop rules. By the end of the acquisition phase, self-generated-rule subjects were more likely to show schedule-typical behavior than were subjects not asked to generate rules. The behavior of those given rules was similar to those asked to generate rules at the end of acquisition, but yoked-rule subjects acquired schedule-typical behavior at a quicker rate. By the end of extinction, during the period corresponding to the previous fixed-ratio interval, all no-rule subjects who had earned points during acquisition and maintenance were responding at a rate of less than 30 responses per minute. Only 3 of the 9 self-generated-rule subjects and 2 of the 5 yoked-rule subjects were similarly responding at this low rate. Results suggest that asking subjects to develop self-rules facilitates acquisition, but can retard extinction. Results also suggest that self-generated rules function similarly to external rules.

Cognitive and affective responses to successful coping during smoking cessation.

Based on Marlatt's relapse model, this study examined the previously unexplored role of cognitive and affective responses that follow successful coping experiences during smoking cessation. Twenty-six smokers completed self-report measures of attribution, efficacy, and affect in response to smoking cessation behaviors during treatment and at 2-, 4-, and 8-week follow-ups. Subjects abstinent at 3-month follow-up were more likely to attribute their successful quitting behaviors to more internal, stable, and controllable factors, and they reported enhanced self-efficacy, compared with smokers. Differences in affective responses to successful coping by quitters and smokers were not significant. Implications of the findings with respect to relapse theory and relapse prevention treatment are discussed.

Family transactions and relapse in bipolar disorder.

This study examined whether patient symptoms and relatives' affective behavior, when expressed during directly observed family interactions, are associated with the short-term course of bipolar disorder. Twenty-seven bipolar patients and their relatives participated in two 10-minute family interactions when patients were discharged after a manic episode. Results indicated that patients who showed high levels of odd and grandiose thinking during the interactions were more likely to relapse during a 9-month followup period than patients who did not show these symptoms during the family discussions. Relapse was also associated with high rates of harshly critical and directly supportive statements by relatives. Patients' odd thinking and relatives' harsh criticism were significantly more likely to be correlated when patients relapsed (r = .53) than when they did not relapse (r = .12). Results suggest that bipolar patients who show increased signs of residual symptomatology during family transactions during the post-hospital period are at increased relapse risk. The data also suggest that relatives of relapsing patients cope with these symptoms by increasing both positive and negative affective behaviors. Moreover, a bidirectional, interactional relationship between patients' symptoms and relatives' coping style seems to capture best the role of the family in predicting relapse in bipolar disorder.