Gender differences in poor outcome patients with lifelong schizophrenia.

Gender effects have been reported quite consistently in schizophrenia, with male patients having an earlier age of onset, poorer functional outcome, greater negative symptoms and cognitive impairment, and less severe positive symptoms. Because age of onset, cognitive impairments, and negative symptoms are all correlated with poorer functional status, it is not clear if previously reported gender differences in symptoms are just recapturing gender differences in functional outcome. In this study, 205 geriatric patients with lifelong poor-outcome schizophrenia (43% male) were examined for the severity of schizophrenic symptoms, cognitive impairments, and specific deficits in adaptive skills, as well as for demographic differences such as age at first psychiatric admission, premorbid education, and current treatment status. Previously reported gender differences were replicated in these patients with a uniformly poor functional outcome, with male patients having more severe negative symptoms and an earlier age of first psychiatric admission. No differences in cognitive functioning or specific functional deficits were found, however. These findings suggest that negative symptom severity is greater in male patients regardless of functional outcome and that the association of cognitive deficits with gender may be found only in patients with better functional outcome. The study of gender-related differences in brain structure or function and their interaction with overall course of illness might help understand these differences in symptom presentation.

Practice-related improvement in information processing with novel antipsychotic treatment.

BACKGROUND: Attentional deficits are prominent in schizophrenia, and skill learning is impaired. Novel antipsychotic treatment has been reported to improve certain cognitive skills in schizophrenic patients, but no information is yet available about the effect of newer medications on skill learning. METHODS: Clinically stable patients with schizophrenia (n=16) and chronically hospitalized inpatients (n=8) were recruited while receiving conventional antipsychotic treatment. Subjects were tested at baseline on a visual continuous performance test (CPT), performed alone and simultaneously with an auditory CPT. Normal controls (n=8) were also tested at baseline. The inpatients and half of the outpatients were switched to treatment with risperidone. All patients then performed the visual CPT on a daily basis and performed the dual tasks once per week, for 4weeks. RESULTS: Patients who remained on conventional medications did not improve in their performance despite the extensive practice on the test. Both chronic and stable patients receiving risperidone treatment manifested a statistically significant (P<0.05) improvement from baseline on both single and dual-task visual CPT. Stable outpatients performed significantly better at the end of the protocol than the normal controls performance at baseline (P<0.05). IMPLICATIONS: These results suggest that practice-related improvements in the performance of information processing tests are enhanced by novel antipsychotic medications. Although the specific biological mechanism of this effect is not yet known, the results may suggest that use of newer medications will enhance skill development and perhaps facilitate rehabilitation of patients with schizophrenia.

Open trial of fluoxetine in children and adolescents with dysthymic disorder or double depression.

BACKGROUND: Chronic depressions commonly present in youth and cause significant morbidity. No treatment studies in this age group are currently available. METHODS: 19 pediatric subjects with dysthymic disorder or 'double depression' were recruited. After four weeks of psychosocial treatment, subjects failing to improve began open treatment with fluoxetine (20 mg) for eight weeks. Subjects were then reassessed for treatment response. RESULTS: Fifteen subjects entered the medication phase, and eleven (73%) no longer met criteria for dysthymic disorder or Major Depression at final assessment. CONCLUSIONS: Fluoxetine shows promise as a safe and effective treatment for youth with chronic depressions. Controlled trials are indicated. LIMITATIONS: Open label design, no comparison treatment condition. CLINICAL RELEVANCE: As in adults, treatment with antidepressants may prove to be a useful intervention with children and adolescents with chronic forms of depression.

Effects of run-training and swim-training at similar absolute intensities on treadmill VO2max.

Thirty-seven sedentary males, aged 28-35 yr, were either run-trained, swim-trained, or served as controls in an 11 1/2-wk training study. Runners and swimmers exercised once a d, 3 d.wk, at a heart rate (HR) intensity equivalent to 75% of their treadmill VO2max. Treadmill maximal oxygen consumption (VO2max), submaximal cardiorespiratory response, and body composition parameters were measured before and following the training period. Runners, swimmers, and controls experienced a significant increase in treadmill VO2max over the 11 1/2-wk study period. The 28 and 25% increases observed for the runners and swimmers, respectively, were significantly greater than the 5% increase observed for the controls (P less than 0.0001). Runners and swimmers did not differ significantly from each other with respect to this increase in VO2max; nor did they demonstrate significant changes in respiratory exchange ratio (RER) at VO2max between tests. The run-trained and swim-trained groups both experienced a decrease in HR at a standard submaximal walking workload but did not differ significantly from each other. Controls showed no significant change in submaximal exercise response. A significant difference was observed among groups (P less than 0.01) for change in percent body fat. Changes in lean and fat weight over the training period were significant for both the runners (P less than 0.002) and swimmers (P less than 0.03) but not for the controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Parental focus of attention in a videotape feedback task as a function of hypothesized risk for offspring schizophrenia.

The families of 29 disturbed but nonpsychotic adolescents were observed in a structured task in which they discussed their reactions to viewing themselves interacting on videotape. Measures derived from the Singer-Wynne concenpt of transactional style deviance were applied to the parental behaviors and related to prior assessments of parental communication disorder based on individual parental TAT protocols. The results confirm the Singer-Wynne hypothesis of the cross-situational stability of transactional style deviance. The most striking finding, however, is that an index of positive focusing behavior differentiates more strongly parents of adolescents hypothesized to be at varying leves of risk for schizophrenia than does the measure of transactional style deviance.