ABSTRACT
The heterogeneity of schizophrenia has been acknowledged for decades because of the diverse presentation of symptoms, illness course, and treatment response noted between individuals diagnosed with the disorder. Cluster analysis has been used as a statistical method to determine whether schizophrenia subgroups might be identified based on symptom heterogeneity. However, there is very limited research examining whether heterogeneity in negative symptoms might be useful in establishing schizophrenia subtypes, particularly research examining newer models of negative symptoms based on five latent constructs including anhedonia, asociality, avolition, blunted affect, and alogia. The Brief Negative Symptom Scale was used to assess the five negative symptoms domains in a sample of 220 outpatients diagnosed with schizophrenia or schizoaffective disorder. Cluster analysis supported a four-cluster solution, comprising clusters of subjects with low negative symptoms (LNS), severe negative symptoms (SNS), and two clusters with moderate negative symptoms, one with predominantly elevated blunted affect (BA) and one with elevated avolition (AV). The LNS, SNS, BA, and AV clusters significantly differed on external validators including clinical characteristics, neurocognition, and functional outcome. Findings suggest that schizophrenia heterogeneity can be parsed according to negative symptom subtypes that have distinct clinical and neuropsychological profiles. Implications for diagnosis and treatment are discussed.
Subject(s)
Psychotic Disorders , Schizophrenia , Anhedonia , Cluster Analysis , Humans , Psychotic Disorders/diagnosis , Schizophrenia/diagnosis , Schizophrenic PsychologyABSTRACT
Neuropsychologists evaluate children and adults with ADHD to establish a diagnosis, quantify cognitive deficits associated with ADHD and other common comorbid conditions, and provide recommendations for education and vocational planning. Standardized instruments that align with DSM ADHD symptom criteria are recommended for increasing ADHD diagnostic accuracy. This study examined whether a brief DSM-based symptom rating scale would assist in differentiating subtypes of ADHD. Participants were 253 children diagnosed with ADHD-Inattentive (n = 163) or ADHD-Combined (n = 90). Parents completed the Behavior Assessment System for Children, Second Edition (BASC-2) and DSM-IV ADHD Symptom Rating Scale (SRS) as part of a comprehensive evaluation to establish ADHD diagnoses. The SRS displayed expected convergent and discriminant validity with BASC-2 subscales. The diagnostic accuracy of the SRS subscales to differentiate ADHD was also examined and compared with the BASC-2. Results indicated that SRS Impulsivity, SRS Hyperactivity, and BASC-2 Hyperactivity had significantly better classification accuracy than BASC-2 Attention Problems and SRS Inattention, although they did not differ from each other. The SRS produced symptom profiles consistent with ADHD-Inattentive and Combined subtypes with good classification accuracy when differentiating subtypes. Overall, the SRS is an economical measure that can assist in ADHD presentation differentiation when used as a component of ADHD evaluations.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Adult , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/psychology , Child , Cognition , Data Collection , Diagnostic and Statistical Manual of Mental Disorders , Humans , Impulsive Behavior , Psychiatric Status Rating ScalesABSTRACT
Objective: Despite evidence of social skill deficits in children with ADHD, there is no consensus regarding a social cognitive profile and whether these skills predict behavior. Therefore, a comprehensive battery was used to investigate the relationship between social cognition and behavioral functioning. Method: Children ages 7 to 13 with ADHD (n = 25) and controls (n = 25) completed tests assessing social cognitive domains (affect recognition and theory of mind [ToM]). Parents completed measures of social cognition (pragmatic language ability and empathy), behavioral symptoms, and adaptive functioning. Results: Children with ADHD performed significantly worse on measures of cognitive ToM and affect recognition and received lower ratings of pragmatic language and cognitive empathy than typically developing peers. These domains, particularly pragmatic language, predicted parent ratings of problematic and adaptive behaviors. Conclusion: Results establish a relationship between specific social cognitive abilities and daily functioning, which has implications for treatment.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Language Development Disorders , Theory of Mind , Adolescent , Child , Cognition , Humans , Neuropsychological Tests , Social Cognition , Social SkillsABSTRACT
The purpose of this paper is to describe the development, actions, and evaluation of a university-based, transdisciplinary coalition so that the model may be replicated in other university or multidisciplinary systems. The University of Nevada Las Vegas (UNLV) Mental and Behavioral Health Coalition addresses Nevada's workforce shortages through multi-disciplinary faculty collaboration among seven training programs at UNLV that produce mental health professionals. The coalition's collaborative approach to solution-generating work has served as a catalyst for professional integration in the community as a whole.
