Outpatients with schizophrenia and bipolar I disorder: Do they differ in their cognitive and social functioning?

The authors used a battery of cognitive and social functioning measures to evaluate stable outpatients with schizophrenia (n=74) and bipolar I disorder (n=26) who were receiving care at community and rehabilitation programs. The groups did not differ significantly on 36 of 41 measures. For most variables, comparisons between groups yielded effect sizes of <0.5. These results suggest that individuals with bipolar I disorder receiving community and rehabilitation services have many social and cognitive deficits that are as severe as those in schizophrenia.

The relationship among three measures of social functioning in outpatients with schizophrenia.

Deficits in social functioning are a defining characteristic of schizophrenia. Several instruments have been developed to measure social functioning in this population, but there has been little study of the correlation among different instruments. We used the Social Functioning Scale (SFS), the Multnomah Community Ability Scale (MCAS), and the Quality of Life Interview (QOLI) to evaluate 72 stable outpatients with schizophrenia. Results of canonical analyses indicate a significant but limited relationship between each set of measures. The largest overlap was between the QOLI and the SFS (R2c = .597) with less shared variance found between the SFS and the MCAS (R2c = .520) and between the MCAS and the QOLI (R2c = .335). Although the instruments share some common content. the instruments measure different aspects of social functioning. A consensus is needed about how to define and measure social functioning in this population.

Social functioning and neurocognitive deficits in outpatients with schizophrenia: a 2-year follow-up.

Neurocognitive deficits have been associated with the social functioning impairments of patients with schizophrenia. More information is needed about how cognitive status and other variables predict social functioning over defined periods of time. In this study, 72 relatively stable outpatients with schizophrenia were compared between baseline and a 2-year follow-up on measures of social functioning. Patients were also assessed with a battery of neurocognitive tests and the Positive and Negative Syndrome Scale. Results were compared by univariate and multivariate analyses. A total of four out of seven subscales of the Social Functioning Scale (SFS) and the total SFS score did not show a significant change over the 2-year period. On the three SFS subscales that did show a significant change, residual change scores were correlated with better neurocognitive performance at baseline, younger age, and shorter illness duration. For the Multnomah Community Ability Scale, 48.9% of the total score at follow-up was predicted by initial negative symptoms and scores on the Aphasia Screening Test. These results document the independent contribution of demographic variables, negative symptoms, and neurocognitive deficits to the social functioning impairments of individuals with schizophrenia.

Predictors of residential independence among outpatients with schizophrenia.

OBJECTIVE: Many outpatients with schizophrenia receive support or supervision in their place of residence, but the predictors of residential independence are not clearly understood. The purpose of this study was to identify factors that predict the degree of residential independence among outpatients with schizophrenia. METHODS: Seventy-two outpatients with schizophrenia were assigned to three groups based on their degree of residential independence. The three groups were compared on three measures of social functioning, on the Positive and Negative Syndrome Scale, and on a battery of neuropsychological tests. RESULTS: Patients' degree of residential independence was related to their frequency of family contact, hygiene skills, relative absence of negative symptoms, and participation in social activities. In a discriminant function analysis, the residential status of 78 percent of the patients was correctly classified. CONCLUSIONS: Aspects of social functioning are significantly associated with patients' independent living status. Future research is needed to determine how family contact, social activities, and hygiene skills may increase patients' degree of residential independence.

Subjective quality of life in out-patients with schizophrenia: clinical and utilization correlates.

The relationship between subjective quality of life (QOL), clinical measures, and service utilization was measured in out-patients with schizophrenia. A total of 72 subjects completed the Quality of Life Interview and were also assessed by means of the Positive and Negative Syndrome Scale, a battery of neuropsychological tests, and two measures of social functioning. Use of psychiatric services over a 2-year period was ascertained from comprehensive records. Global subjective QOL was lower than patients' satisfaction with specific life domains. There were few significant correlations between satisfaction with, and objective measures of, specific life areas. In a multiple regression, patients' global subjective QOL was inversely related to their scores on the PANSS depression factor, and to the number of psychiatrist out-patient visits.

Lack of insight among outpatients with schizophrenia.

OBJECTIVE: This study investigated the prevalence of lack of insight among outpatients with schizophrenia and the relationship between lack of insight and other variables, including whether patients received professional residential supervision. METHODS: A total of 87 stable outpatients with schizophrenia were drawn from community programs in a public-private mental health system. Subjects' clinical symptoms and insight about their illness were assessed using the Positive and Negative Syndrome Scale, a battery of neuropsychological tests, and the Social Functioning Scale. RESULTS: The illness insight of 43 subjects, or 49.5 percent, was at least moderately impaired. Twenty-one subjects, or 25 percent, had severe insight deficits. In a multiple regression analysis, 40 percent of the variance in lack of insight was predicted by ratings of the severity of delusions, difficulty with abstract thinking, lack of social activities, and absence of anxiety. Patients who received professional residential supervision had more impaired insight than those living independently or with family. CONCLUSIONS: Insight deficits are common among stable outpatients engaged in community-based care. These deficits have implications for patients' use of limited services such as residential supervision.

Neurocognitive deficits and social functioning in outpatients with schizophrenia.

Previous studies suggest that neurocognitive factors may contribute to the reduced social functioning of patients with schizophrenia. To assess this relationship, we administered a battery of neurocognitive tests and independently assessed symptoms (PANSS) and social functioning (SFS) in 88 stable outpatients with schizophrenia. We found a significant correlation between neurocognitive and social functioning variables. Patients' performance on aphasia, spatial organization and visual spatial tasks was correlated with their competence at activities of daily living, frequency of social activities and total social functioning. Regression analyses of each social functioning scale revealed different symptom and neurocognitive predictors. Patients' overall social functioning was best predicted by a combination of negative symptoms and aphasia. The results support the potential use of interventions to reduce patients' cognitive deficits as a means to improve their social outcomes.

Neuropsychological deficits in chronic schizophrenics. Relationship with symptoms and behavior.

Thirty-nine hospitalized chronic schizophrenics were administered the Luria-Nebraska Neuropsychological Battery (LNNB) and the Weschler Adult Intelligence Scale-Revised when they were clinically stable. Test variables were related to Brief Psychiatric Rating Scale ratings and two behavioral measures of ward functioning, points and activities. Spearman correlations of test variables with the symptom and behavioral measures were entered into a series of median polish analyses. There was an overall significant relationship between the two sets of variables. Neuropsychological test variables that were most highly correlated with symptom/behavioral measures were LNNB Left Frontal, Memory, and Intellectual Processes scales. The positive symptoms of thought disorder and hallucinations were most consistently related to neuropsychological variables. In contrast with other findings in the literature, negative symptoms were not significantly correlated with neuropsychological performance.

ROUNDS, a new time-sampling methodology for the quantitative behavioral assessment of schizophrenic withdrawal. Reliability and validity.

Negative symptoms in schizophrenia have been the subject of much research interest. However, there has been a need for a way to measure withdrawal behavior quantitatively over time. We have developed a behavioral time-sampling methodology performed by nursing staff on a schizophrenia inpatient unit. Called ROUNDS, it gathers reliable and valid quantitative data about specific withdrawal behaviors such as posture, daytime sleep and levels of social interaction and activity. This paper describes the development of the method, its implementation, the statistical analysis of its reliability and validity, and the degree to which the data can be replicated with different sampling frequencies. We contend that this method can be applied to the analysis of a wide variety of questions about the nature and treatment response of schizophrenic withdrawal in an inpatient setting.

Expressive vocal behavior and the severity of coronary artery disease.

This study sought to ascertain the relationship of expressive vocal behavior in a structured interview and the severity of coronary artery disease in a group of 79 patients referred for coronary angiography. One half of the structured interview was administered in a nonchallenging manner, the other half in a moderately challenging manner. In patients age 60 and younger, two speech measures derived from the nonchallenging interview, a computer-scored index of the frequency of simultaneous speech and judged loudness level, accounted for 38% of the variance in the patients' severity of stenosis scores, when the latter was indexed by the Gensini method. The same speech indices derived from the challenging interview segment accounted for only 18% of the variance on the patients' Gensini scores. In the older patient group, only one speech variable, speech rate in the nonchallenging interview segment, contributed to the patients' Gensini scores. The findings suggest a) that in younger patients objective, computer-scorable, speech variables correlate significantly with severity of coronary occlusion, and b) that is not essential that these speech indices be derived from a structured interview that is administered in a challenging and provocative manner. In the present study, there were no significant correlations between the participants' global TABP scores and their occlusion scores.

Components of hostility and the severity of coronary artery disease.

Previous research has linked various measures of hostility to the prevalence and incidence of coronary heart disease (CHD). The present study sought to determine whether some dimensions of hostility are differentially related to angiographically documented severity of coronary artery disease (CAD). Specifically, a hostility measure that correlates with indices of neuroticism was compared with a hostility measure unrelated to neurotic tendencies. For patients 60 years and younger, results were significant, revealing that neurotic hostility was inversely associated with severity of CAD whereas nonneurotic hostility scores were positively related to extent of disease. Overall hostility scores derived from the combination of the two kinds of hostility measures were unrelated to CAD severity. Results suggest that the multidimensional nature of the hostility construct should be appreciated in attempts to associate measures of hostility with manifestations of CHD.

A mental health center's influence in a county jail.

A case study that describes the process of establishing mental health services in the medium-sized Howard County (Maryland) jail is presented. Built in 1878, the county jail provided virtually no rehabilitative services to its inmates until 1972. At that time, personnel from the Howard County Bureau of Mental Health began to gain access to the jail, establish rapport with the jail staff, assess the mental health needs of the inmates, and implement various programs to meet these needs. Implementation and development of services are described for the 12-year span between 1972 and 1984. The concept of providing community-based services has been accepted and incorporated into the value system and structure of the jail. It is concluded that the viability of programs depended upon interactions among continuation of strong leadership for each component of the rehabilitation program, acceptance of the value of these services by the jail administration and staff, and availability of community resources. The linkage between the jail and community agencies is discussed.