Self-monitoring of reexperiencing symptoms: a randomized trial.

The efficacy of a brief intervention to self-monitor reexperiencing symptoms was evaluated in 137 U.S. combat veterans with PTSD who were enrolled in 5-week psychoeducation groups at a large Veterans Affairs Medical Center. Groups were randomized to psychoeducation alone (Education Control, n = 50) or psychoeducation plus intrusion monitoring (Education + Monitoring, n = 87). Education + Monitoring participants were asked to make a daily record of the number and content of nightmares, flashbacks, intrusive trauma-related thoughts, and physiological and emotional reactions to triggers. Avoidance symptoms were reduced in both conditions (η(2)  = .093), with no additional benefit from intrusion monitoring (η(2)  = .001). Compliance with intrusion monitoring was markedly low, which complicated the interpretation of the study findings. Even though intrusion monitoring has a strong theoretical foundation and may be an efficient and cost-effective alternative to more structured treatments for PTSD, the effect of intrusion monitoring will not be clearly understood until higher compliance can be achieved. Future work in this area should address barriers to compliance and investigate strategies for enhancing motivation to engage in self-monitoring.

Associations between past alcohol, cannabis, and cocaine use and current schizotypy among first-degree relatives of patients with schizophrenia and non-psychiatric controls.

Associations between past use of alcohol, cannabis, and cocaine and various domains of schizotypy were examined in first-degree relatives of patients with schizophrenia and non-psychiatric controls. Substance use was operationalized in three ways: (1) having ever used the substance, (2) age at first use, and (3) past frequency/amount of use during three time periods in late adolescence/early adulthood. Schizotypy was assessed using the Schizotypal Personality Questionnaire (SPQ). Participants who had ever used cannabis had significantly higher cognitive-perceptual, interpersonal, and total schizotypy scores compared to those who had not. Younger age of alcohol use onset was associated with more schizotypy in adulthood, and younger age of first cannabis use was related to more interpersonal schizotypy. More frequent/heavier use of alcohol in the 25-29 age-range, and cannabis in early adulthood, were associated with more schizotypy. The use of addictive substances, particularly cannabis, is related to schizotypy in complex ways.

Lack of support for the inability to taste phenylthiocarbamide as an endophenotypic marker in patients with schizophrenia and their first-degree relatives.

OBJECTIVE: This study sought to replicate recent findings that both patients and relatives are significantly more likely to be phenylthiocarbamide (PTC) nontasters than healthy controls, and that within the patient group, nontasters have more severe positive and/or negative symptoms than tasters. Associations between PTC-tasting status and olfactory identification scores also were examined. METHOD: PTC perception and olfactory identification were assessed in 48 patients with schizophrenia or schizoaffective disorder, 28 first-degree relatives, and 32 healthy volunteers. RESULTS: The three groups did not differ in PTC taste sensitivity. Findings did not change after: a sensitivity analysis that re-categorized participants who "possibly" tasted PTC, excluding Caucasian participants, or restricting the sample of patients to only those with schizophrenia. Among the patients, tasters and nontasters did not differ with regard to positive, negative, or general psychopathology symptoms. In the combined sample and the three groups separately, there were no associations between PTC-tasting status and olfactory identification scores. CONCLUSIONS: This study, conducted specifically as an attempt to replicate previously reported findings, failed to provide support for PTC perception as an endophenotypic marker for schizophrenia. Further research is warranted.

Neurological soft signs and minor physical anomalies in patients with schizophrenia and related disorders, their first-degree biological relatives, and non-psychiatric controls.

BACKGROUND: Subtle neurological impairments and inconsequential minor anomalies of the face and limbs are manifestations of neurodevelopmental and ontogenic abnormalities that are consistently found at higher rates in individuals with schizophrenia compared to healthy controls. Limited research has been conducted on these traits among biological relatives of patients with schizophrenia. This study hypothesized that the mean NSS score and the mean MPA score would be greater in patients than controls and that first-degree relatives would have intermediate scores. Furthermore, it was hypothesized that NSS scores and MPA scores would not be correlated. This study also explored correlations between patients' NSS and MPA scores and their relatives' respective scores and sought to replicate the finding that NSS are associated with negative and disorganized symptoms of schizophrenia, whereas MPAs are not. METHODS: Patients with schizophrenia and related psychotic disorders (n=73), first-degree relatives (n=44), and non-psychiatric controls (n=54) were assessed. Measures included the Neurological Evaluation Scale, a structured examination for MPAs, and the Positive and Negative Syndrome Scale in patients. Analyses accounted for clustering within families. RESULTS: Both NSS and MPAs were greater in patients than controls, and first-degree relatives had intermediate scores. Furthermore, NSS and MPA scores were independent in all three groups. Correlations were found between patients' and their relatives' scores on one NES subscale (sensory integration) and total MPA score and several MPA regions (eyes, ears, and hands). This study replicated previous findings that in patients with schizophrenia, NSS are associated with negative, disorganized, and other domains of symptoms. Associations between MPAs and symptoms were sparse and inconsistent. CONCLUSION: These findings suggest that NSS and MPAs represent two quite distinct markers of risk for schizophrenia that may stem from genetic factors, as well as from environmental/developmental influences. Future research on multivariable risk prediction models may benefit from the use of somewhat independent risk markers or endophenotypes.

Facial measurement differences between patients with schizophrenia and non-psychiatric controls.

OBJECTIVE: Several previous reports suggest that facial measurements in patients with schizophrenia differ from those of non-psychiatric controls. Because the face and brain develop in concert from the same ectodermal tissue, the study of quantitative craniofacial abnormalities may give clues to genetic and/or environmental factors predisposing to schizophrenia. Using a predominantly African American sample, the present research question was two-fold: (1) Do patients differ from controls in terms of a number of specific facial measurements?, and (2) Does cluster analysis based on these facial measurements reveal distinct facial morphologies that significantly discriminate patients from controls? METHOD: Facial dimensions were measured in 73 patients with schizophrenia and related psychotic disorders (42 males and 31 females) and 69 non-psychiatric controls (35 males and 34 females) using a 25-cm head and neck caliper. Due to differences in facial dimensions by gender, separate independent samples Student's t-tests and logistic regression analyses were employed to discern differences in facial measures between the patient and control groups in women and men. Findings were further explored using cluster analysis. Given an association between age and some facial dimensions, the effect of age was controlled. RESULTS: In unadjusted bivariate tests, female patients differed from female controls on several facial dimensions, though male patients did not differ significantly from male controls for any facial measure. Controlling for age using logistic regression, female patients had a greater mid-facial depth (tragus-subnasale) compared to female controls; male patients had lesser upper facial (trichion-glabella) and lower facial (subnasale-gnathion) heights compared to male controls. Among females, cluster analysis revealed two facial morphologies that significantly discriminated patients from controls, though this finding was not evident when employing further cluster analyses using secondary distance measures. When the sample was restricted to African Americans, results were similar and consistent. CONCLUSIONS: These findings indicate that, in a predominantly African American sample, some facial measurements differ between patients with schizophrenia and non-psychiatric controls, and these differences appear to be gender-specific. Further research on gender-specific quantitative craniofacial measurement differences between cases and controls could suggest gender-specific differences in embryologic/fetal neurodevelopmental processes underpinning schizophrenia.

Associations between schizotypal features and indicators of neurological and morphological abnormalities.

OBJECTIVE: Limited research suggests that subtle neurological and morphological abnormalities that have been documented in patients with schizophrenia also may be associated with schizotypal traits in non-psychiatric samples. Based on the notion that neurological soft signs (NSS) may mark a genetic diathesis, this study hypothesized that NSS scores would be related to the level of schizotypy in relatives of schizophrenia patients and in controls. Additionally, associations between MPA scores and schizotypy were explored in these two groups. METHOD: Twenty-six first-degree relatives of schizophrenia patients and 38 controls with no personal or family history of psychosis were assessed for schizotypy using the Structured Clinical Interview for DSM-IV Axis II Disorders schizotypal personality disorder module, as well as the self-administered Schizotypal Personality Questionnaire. The Neurological Evaluation Scale and a structured examination for MPAs also were administered. RESULTS: Mean schizotypy scores did not differ between relatives and controls. Both NSS and MPAs were associated with the level of interviewer-assessed schizotypal features in controls but not in relatives of patients with schizophrenia. NSS and MPAs were not associated with self-reported schizotypy in either group. CONCLUSIONS: These findings demonstrate that both NSS and MPAs are associated with interview-based schizotypal traits, at least in non-psychiatric participants. Future research should seek to replicate these results in other samples of relatives and controls.

Psychometric properties of the Brief Version of the Schizotypal Personality Questionnaire in relatives of patients with schizophrenia-spectrum disorders and non-psychiatric controls.

The Schizotypal Personality Questionnaire-Brief Version (SPQ-B), which includes cognitive-perceptual, interpersonal, and disorganized domains, was developed as a concise, self-report measure of schizotypy. This analysis was conducted to: (1) determine the internal consistency reliability of SPQ-B total and subscale scores, (2) use confirmatory factor analysis to assess the three-factor model as well as a single-factor solution, and (3) examine a measure of concurrent criterion validity of SPQ-B scores. The study was conducted at a large, urban, university-affiliated, public-sector health system in the southeastern United States. Data were obtained from 118 participants, including 61 biological relatives of patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder, and 57 non-psychiatric controls. Relatives and controls did not differ significantly on SPQ-B total or subscale scores (or on the full 74-item SPQ total or subscale scores). Internal consistency reliability was adequate for the total SPQ-B score and the interpersonal subscale but was less than ideal for the cognitive-perceptual and disorganized subscales. Regarding the confirmatory factor analysis, though the three-factor solution yielded reasonably good fit to the data, the single-factor solution provided equal fit. Correlations between the three subscales ranged from .63 to .74. With regard to criterion validity, correlations between the SPQ-B total and subscale scores and schizotypy scores derived from a semi-structured, interview-based assessment revealed correlations generally ranging from .40 to .60. The SPQ-B may be a useful brief screening measure of schizotypy, though some limitations in its psychometric properties were evident in this sample. It may be advisable to use total SPQ-B scores rather than subscale scores in some situations, or to use factor analytic techniques to study the instrument's latent structure in specific samples.

Medication status affects the relationship of symptoms to prepulse inhibition of acoustic startle in schizophrenia.

Inhibition of the acoustic startle response by a smaller preliminary nonstartling stimulus is termed prepulse inhibition (PPI). Schizophrenia patients have impairments in PPI that may not fully normalize even when they are clinically stable on medication, particularly typical antipsychotics. There is evidence that more severe symptoms are associated with more severe PPI abnormalities, but the effect of antipsychotics on this relationship is not clear. Seventy-three male schizophrenia patients underwent acoustic startle and PPI testing. Symptom ratings were performed using the Brief Psychiatric Rating Scale (BPRS) and its subscales. Fifty-two subjects were treated with antipsychotic medication at time of testing; 21 were unmedicated. For all subjects, PPI was negatively correlated with the BPRS psychological discomfort subscale but not with BPRS total symptoms, BPRS positive symptoms or BPRS negative symptoms. For medicated subjects analyzed separately, there were no correlations with BPRS total scores or any subscales. For the unmedicated subjects analyzed separately, there were significant correlations of lower PPI with greater severity of BPRS total symptoms, positive symptoms and the psychological discomfort subscale. These data indicate that more severe symptoms are associated with lower PPI, but that medication status is an important factor in the relationship between symptom severity and sensorimotor gating.

Factor structure of the Neurological Evaluation Scale in a predominantly African American sample of patients with schizophrenia, unaffected relatives, and non-psychiatric controls.

OBJECTIVE: This study aimed to identify latent factors of the most widely used scale to measure neurological soft signs, the Neurological Evaluation Scale (NES), in a sample of schizophrenia patients, their relatives, and non-psychiatric controls. METHOD: The NES was administered following the format and instructions of the original scale [Buchanan, R.W., Heinrichs, D.W., 1989. The Neurological Evaluation Scale (NES): a structured instrument for the assessment of neurological signs in schizophrenia. Psychiatry Res. 27, 335-350]. Three factor analyses were conducted using: (1) 23 items of the scale, (2) these 23 items in a sample restricted to African American participants, and (3) 12 items previously recommended based on adequate inter-rater reliability [Sanders, R.D., Forman, S.D., Pierri, J.N., Baker, R.W., Kelley, M.E., van Kammen, D.P., Keshavan, M.S., 1998. Inter-rater reliability of the neurological examination in schizophrenia. Schizophr. Res. 29, 287-292]. RESULTS: Exploratory factor analysis in the overall sample (n = 110) revealed three factors of interest: a "coordination/Romberg" factor (which included the fist-edge-palm test, finger-thumb opposition, rapid alternating movements, and the Romberg test), a "sensory integration" factor (which included synkinesis, extinction, stereognosis, and audio-visual integration), and an "eye movements/tandem walk/overflow movements" factor (which included convergence, gaze impersistence, tandem walk, and adventitious overflow). Minimal differences were apparent when comparing these results with those obtained from an analysis including only African American participants (n = 99). Restricting the analysis to only 12 items resulted in two factors (with poor discriminant validity and internal consistency), which showed few similarities with previously reported exploratory factor analysis results. CONCLUSIONS: This study shows that results of empirically-derived factors of the NES vary substantially across study samples and research groups, though there appear to be at least two consistent latent variables, one related to the repetition of motor tasks and another tapping the processing of sensory stimuli. The factors demonstrated in the present study are more consistent with the original conceptually-derived subscales than prior factor analyses. Thus, until further research replicates consistent subscales of subtle neurological impairment in a variety of settings and samples, the total NES score may be more useful when comparing results across studies. Further research on latent neurological factors is needed.

The influence of perceived control and locus of control on the cortisol and subjective responses to stress.

Stress has been implicated in the etiology of numerous mental and physical illnesses. Thus, it is important to identify factors that buffer individuals against stress. The purpose of this study was to examine the influence of perceived control (PC) on the biological and subjective stress responses, and to investigate the potential moderating effect of locus of control (LOC) on this relationship. Stress was induced with a noise-cognitive paradigm, and PC was manipulated by offering the option of manual control over noise intensity. Saliva cortisol and subjective stress were measured. There was no main effect of control on cortisol. However, LOC moderated the relation between control and cortisol; participants with more internal LOC, who also perceived themselves to have control over the stressor, showed a reduced cortisol response in the PC condition. The results are discussed in light of their implications for elucidating the determinants of the effects of perceived control on stress.

Schizophrenia: etiology and course.

Decades of research on schizophrenia have not produced major breakthroughs, but gradual progress has been made in identifying risk factors and clarifying the nature of the etiologic process. This article provides an overview of trends in research findings as well as current assumptions about the interplay between environmental and genetic factors in the etiology of schizophrenia. Based on the cumulative findings, it appears that both genetic and prenatal factors can give rise to constitutional vulnerability. Subsequent neuromaturational processes, especially those that occur during adolescence, and exposure to stressful events can trigger the behavioral expression of this vulnerability.