The functional relevance of affect recognition errors in schizophrenia.

To evaluate the clinical and ecological validity of affect recognition (AR) measures in a sample of community-dwelling schizophrenic outpatients (N = 40), we analyzed the relation of facial and vocal AR to intellectual, symptomatic, and quality-of-life criteria. Facial and vocal AR showed virtually identical patterns of association with these criteria, suggesting that both modalities of AR draw on the same underlying heteromodal capacity. Specifically, AR was correlated with a subset of intellectual abilities (verbal-semantic, executive-attentional), but was unrelated to age, education, or neuroleptic dose. In terms of clinical and ecological criteria, AR errors correlated with more severe psychotic symptoms (positive and disorganized) and with lower quality of life (relationships, community participation, and richness of intrapsychic experience). Even after controlling for subjects' intellectual abilities and illness severity, inaccurate AR was associated with bizarre behaviors (involving sociosexual interactions, clothing, appearance) and with impoverished interpersonal relations. Thus, while difficulty identifying basic affective cues is related to general cognitive and illness-severity factors, it appears to have specific functional implications that do not depend on generalized impairment. Assessment of AR may identify a subgroup of schizophrenic patients who have a central defect in the heteromodal monitoring of emotional-social displays, associated with dysregulation of social behaviors and disruption of interpersonal relations.

Independent frontal-system deficits in schizophrenia: cognitive, clinical, and adaptive implications.

This study examined whether frontal-system impairments in schizophrenia occur independently of one another and whether they have distinct implications for information processing, symptom severity, and adaptive functioning. We assessed 26 medication-free schizophrenic outpatients and 18 normal control subjects on eight frontally mediated tasks, semantic information processing, IQ, the BPRS, and long-term psychosocial adaptation. Schizophrenic subjects showed three types of deficits, which were uncorrelated with one another: (1) Executive dysfunction (inflexible problem solving) was related to decreased use of expectancy during controlled semantic priming, lower intelligence, more severe negative symptoms and stereotyped mannerisms. (2) Disinhibition of responses (to irrelevant stimuli) was associated with increased automatic priming, a trend for more severe hallucinations, and was unrelated to intelligence. (3) Motor dyscoordination (inaccurate, dysfluent motor sequencing) was not related to semantic processing, intelligence, or symptoms. Furthermore, all three impairments were unrelated to generalized slowness, age, sex, illness length, or pre-washout neuroleptic dose. Two deficits accounted for aspects of long-term psychosocial adaptation, even after statistical correction for IQ: Executive dysfunction was associated with younger illness onset, poor purposefulness and planning, impaired social relations, and lower global functioning. Motor dyscoordination was associated with poor treatment outcome and restricted educational advancement. Furthermore, executive and motor deficits interacted significantly; subjects who had both deficits showed the least favorable treatment outcome. These findings are neither consistent with generalized impairment nor with a unitary 'frontal syndrome' in schizophrenia. They provide preliminary evidence for at least three frontal-system deficits (dorsolateral, orbital, and premotor), which are dissociable from one another, can occur without general intellectual impairment, and have distinct implications for long-term adaptive functioning.

Acute renal failure in pregnancy.

Acute renal failure (ARF) during pregnancy is a rare event. However, the care of the woman diagnosed with ARF is a challenge for the perinatal care team. The physiologic hydronephrosis and hydroureter of pregnancy alters clinical parameters for assessing the woman diagnosed with ARF. Urinary stasis and enhanced filtration predisposes to alterations in 24-hour urine evaluations, increased urinary creatinine excretion, and lower BUN and serum creatinine values. If the renal system becomes compromised, the woman is at risk for acidemia, fluid and electrolyte imbalances, and pregnancy compromise. The perinatal nurse must have an understanding of normal pregnancy physiology and an appreciation for how pregnancy physiology may alter renal assessments. Furthermore, the nurse must know the impact that ARF can have on maternal status and fetal well-being. Astute, continuous assessments of maternal and fetal status are required to detect subtle changes. While maternal status is the primary concern, it must not be forgotten that a change in fetal status may be the first indication of underlying maternal compromise.

Slower and more variable reaction times in schizophrenia: what do they signify?

Extensive research has demonstrated that schizophrenic subjects are slower than normal comparison subjects on a range of reaction-time tasks. Some investigators have also observed that schizophrenic patients exhibit larger intraindividual variability in reaction times when performing these tasks than do normal comparison subjects. This study, using a lexical decision choice reaction time (CRT) task, explored the relation of mean CRT and it intra-individual variability (CRT-SD) to psychiatric symptoms and to performance on executive-motor tasks in 26 medication-free schizophrenic out-patients and 17 normal comparison subjects. Schizophrenic subjects had both significantly slower and more variable CRTs which were unrelated to general intellectual abilities (IQ). Among schizophrenic subjects, both CRT and CRT-SD were significantly related to severity of psychotic symptoms, failure to maintain cognitive set, and poorer motor coordination and global functioning. After controlling for mean CRT, CRT-SD showed unique covariation with clinical symptoms (positive, disorganized and tension/hostility). Conversely, mean CRT showed unique covariation with the failure to maintain cognitive set and with stereotypic mannerisms, independent of CRT-SD. These results suggest that slower CRT and increased intra-individual variability in CRT, while not fully independent of one another, may reflect separate aspects of symptomatic and cognitive dysfunction in schizophrenia.

Liver transplant and pregnancy.

Advances in transplantation medicine present the perinatal health care provider with a unique challenge: care of the woman during pregnancy after organ transplantation. Pregnancy in liver transplant recipients is complicated by hypertension, preeclampsia, anemia, and preterm birth. Neonates born to women after liver transplant are not at increased risk for congenital anomalies. Evidence to date supports that pregnancy does not have a deleterious effect on hepatic graft function or survival if the woman has stable hepatic function before pregnancy. The article focuses on the issues involved with perinatal management of the woman who is a liver transplant recipient.

Aggressive management of HELLP syndrome and eclampsia.

The nursing care of women critically ill during pregnancy is an ever-changing specialty that presents unique clinical problems and issues. The woman and the fetus can be profoundly affected by the hypertensive disorders of pregnancy. The underlying pathology must be identified in relation to its effects on the pregnancy, the effects of the pregnancy on the disease, and the implications for the woman and the fetus. Severe preeclampsia, the HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), and eclampsia present such challenges and management problems. This article discusses the pathophysiology and management implications of severe preeclampsia, the HELLP syndrome, and eclampsia.

Clinical and neurocognitive aspects of source monitoring errors in schizophrenia.

OBJECTIVE: Source monitoring, an aspect of memory that involves judgments about the origin of information, has been found to be more prone to errors in schizophrenic subjects than in normal persons. To examine the precise nature of such errors and their relationship to clinical and neurocognitive variables, the authors compared schizophrenic and normal subjects. METHOD: Schizophrenic subjects who had been medication free for 1 week (N = 26) and demographically matched normal subjects (N = 21) performed a source monitoring task and were assessed on current psychiatric symptoms, IQ, and frontal lobe functioning. RESULTS: The schizophrenic subjects had normal recognition memory of target words (recognition hits) and a normal generation effect but made more errors than the comparison subjects in identifying the source of target words. Specifically, the schizophrenic subjects made more errors in remembering the source of new and self-generated items, and they tended to attribute items to an external source. In 11 retested subjects, these errors were stable and independent from medication status after a 2-year interval. Secondary analyses suggested that certain source monitoring errors may be associated with hostility and lower IQ. When the effect of IQ was controlled, correlations with frontal dysfunction were not significant. CONCLUSIONS: Schizophrenic subjects make significantly more source monitoring errors than normal subjects, but not because of problems with recognition memory hits or with the generation effect. This tendency may be trait like and may be related to hostility. Lower IQ in schizophrenia plays a partial role in these errors, but frontal dysfunction does not.

Negative symptoms in schizophrenia and nailfold plexus visibility.

Visibility of the nailfold vascular plexus has shown promise as a genetically transmitted marker for liability to schizophrenia. To assess whether this marker is specifically associated with negative or positive symptoms of schizophrenia, we reanalyzed patient data collected 20 years ago, well before interest in the negative/positive symptom distinction. Eighty-four patients, who retrospectively met DSM-III-R criteria for schizophrenia, had been rated for plexus visualization score (PVS) and independently interviewed using the Mental Status Schedule (MSS). Content scales were derived from the MSS to assess negative, positive, and affective symptoms. There was a highly significant correlation between PVS and negative symptoms (including verbal, motor, cognitive and motivational deficits), but not between PVS and positive or affective symptoms. These findings indicate that the negative symptoms of schizophrenia are due to a disease process biologically distinguishable from those causing positive symptoms and that plexus visibility is a risk marker for this pathology.

Attention deficit disorder and the mediating effect of age on academic and behavioral variables.

Seventy-nine children, independently diagnosed as having attention deficit disorder (ADD) with or without hyperactivity and ranging in age from 6 years, 0 months, to 12 years, 11 months, were administered the Wechsler Intelligence Scale for Children-Revised (WISC-R), the Wide Range Achievement Test (WRAT), and the Child Behavior Checklist (CBC). Multiple regression analyses indicated a significant multiple correlation between age and achievement variables (R = 0.42, p = 0.003) and age and behavioral (CBC) variables (R = 0.55, p = 0.01). Post hoc analyses indicated that much of this variance was accounted for by a significant negative association between age and Full Scale IQ-WRAT Arithmetic difference scores, and significant positive correlations between age and scores on the Social Withdrawal and Uncommunicative scales from the CBC. A nonparametric chi-square analysis indicated that older children with ADD are significantly more likely (p = 0.037) than younger ADD children to have a discrepancy of 15 or more points between IQ and math achievement scores. Results suggest that older ADD children are more likely than younger ADD children to experience academic and socioemotional difficulties.

Musth and urinary testosterone concentrations in the African elephant (Loxodonta africana).

Urine samples were obtained from free-ranging African elephants that were considered to be in and out of musth. Testosterone concentrations, measured by radioimmunoassay were significantly greater in males that were in or around the time of behavioural musth. This study supports a correlation between the observed behavioural characteristics of musth and urinary testosterone levels.