Positive and negative symptoms and and adjustment in severely mentally ill outpatients.

Studying the relationships among clinical symptoms and adjustment can clarify prognostic factors in severe mental disorders, highlight syndromes that may be the focus of different treatments, and illuminate causal relationships connecting premorbid, 'acute', and long-term psychopathological features. This article examines the relationship between positive and negative symptoms and community adjustment in 398 community mental health center outpatients maintained on neuroleptic medication. Outcome measures include psychiatric hospitalization, employment, and social involvement. Affective symptomatology, premorbid social competence, and three neuropsychological measures are additional independent variables. Positive and negative symptoms are significantly correlated with separate aspects of contemporaneous adjustment, as well as with subsequent hospitalization. Negative symptoms are predominantly related to prior hospitalization, employment, and social interactions; positive symptoms are primarily related to subsequent hospitalization. Disordered attention is most related to global neuropsychological impairment; avolition is mainly associated with degree of employment. Findings are separable from the effects of schizophrenic vs. non-schizophrenic diagnosis. Special attention is paid to a central group of negative symptoms, to separating negative symptoms from neuropsychological deficits, and to distinguishing premorbid from current social functioning.

Social processing correlates of nonverbal social perception in schizophrenia.

This study examines the relationship of nonverbal social perception to other areas of social functioning in schizophrenia. One model of interpersonal problem-solving skills presents a sequence of receiving, processing, and sending skills. Social perception skills best fit the first stage in this model: receiving skills. As expected, schizophrenic subjects (N = 29) were less skillful than normal subjects (N = 15) on measures of social problem solving, understanding of social sequences, and social judgment. In addition, performance on these tasks was significantly related to nonverbal social perception, but only for the schizophrenic group. Thus, deficits in nonverbal social perception are related to other measures of social functioning in schizophrenia. Implications of these findings for understanding and treating social deficits in schizophrenia are discussed.

Stress, coping, and social support in hypothetically psychosis-prone subjects.

This paper examined stress processes in hypothetically psychosis-prone individuals. Subjects scoring high on Perceptual Aberration/Magical Ideation (Per-Mag subjects), Anhedonia, and low-scoring control subjects were compared for scores on Hassles and Uplifts, cognitive appraisal, coping strategies, emotions in two stressful situations, and on perceived social support. The groups differed in their experiences of minor life events and Secondary Appraisal but not in Primary Appraisal or emotions. There were notable differences in coping patterns and perceptions of social support. Per-Mag subjects contrasted with controls in using more coping by Escape-avoidance and Accepting responsibility, and reported less social support. Anhedonic subjects differed in their experience of minor life events and coped less through Positive reappraisal and Seeking social support. Per-Mag subjects are mainly distinguished by their coping processes. Anhedonic subjects are also sensitive to the incidence of minor life events. The results indicate that risk factors, stress, and coping interact in the absence of mental disorder.

Recognition and judgment of facial stimuli in schizotypal subjects.

Affect recognition abilities, an important component of successful social functioning, were examined in two groups of schizotypal subjects who were identified by the Perceptual Aberration/Magical Ideation and Physical Anhedonia Scales (PABS, MIS, PAS). Prior research has demonstrated social impairments in subjects identified by these scales and in schizophrenics. Although research has shown schizophrenic subjects to have facial affect recognition deficits, the present results did not support the hypothesis that such impairments would appear in subjects exhibiting similar symptoms, but to a less severe degree, when compared with controls. The results suggest that deficits in emotional decoding may appear at a relatively late stage in the developmental course of mental disorder, or may only be associated with more severe levels of schizophrenia-spectrum symptomatology. The paper discusses theoretical and methodological implications for research on the components and development of social deficits in the schizophrenia-spectrum disorders.

Positive and negative symptom course in chronic community-based patients. A two-year prospective study.

BACKGROUND: The long-term symptom profile of chronic out-patients was studied. METHOD: 242 out-patients receiving neuroleptic medications (109 with schizophrenia and 133 non-schizophrenics), were studied for positive (SAPS) and negative (SANS) symptoms at baseline and at 24 months to investigate whether these symptom groups changed over outpatient maintenance treatment. RESULTS: Overall and within groups, negative symptoms decreased and positive symptoms increased. While the sums of the SANS scores for the schizophrenic patients were initially higher, their mean SANS score dropped more over time (P < 0.001), to show no difference from non-schizophrenics at follow-up. Positive symptoms increased in both groups, although schizophrenics were higher at both times; sub-scales within the SANS showed different patterns of change. CONCLUSION: Support is found for a multidimensional view of both positive and negative symptoms and for a reconsideration of the notion of 'progressive downward course' in schizophrenia.

Anhedonia and the intentional communication of emotion.

This study evaluated the accuracy and expressiveness of emotional communication by college students identified as anhedonic or control (ns = 24), based on their scores on the Physical Anhedonia Scale, using an emotional communication task and self-report indices of emotional expressiveness and self-monitoring. As expected, the anhedonic group reported significantly less emotional expressiveness in real-life social situations. However, contrary to the hypotheses, they did not differ from controls on measures from a laboratory communication task or on self-monitoring.

Personal resourcefulness: positive aspects of functioning in high-risk research.

This paper discusses theoretical and measurement issues involved in attaining a differentiated picture of the distribution of outcomes in subjects selected for their elevated risk for psychosis; these outcomes include positive adaptations as well as subtle expressions of psychopathology. Many at-risk subjects either do not break down or actually "prosper" in the face of risk factors, a problem that persists even when risk groups are defined with increasing selectivity. Although this phenomenon is often referred to as the problem of "false positives" in risk research, its implications are more far-reaching than simply defining a problem of low yield in prospective studies.

Ego-strength revised: a comparison of the MMPI-2 and MMPI-1 versions of the Barron Ego-strength scale.

This study evaluated the equivalence of the original MMPI and the shortened MMPI-2 versions of the Barron (1953) Ego-strength scale, an important research scale. Three hundred fifty-five subjects took the MMPI-2 and the 16 MMPI-1 items dropped from the original scale. The omitted items appear to contribute little to the original scale. The revised version compares favorably with the old in terms of internal consistency, and the two versions are highly intercorrelated. Confirmatory Factor Analysis indicates that four of Stein and Chu's (1967) five groupings of the original items provide a reasonably good fit for the MMPI-2 as well. Compared to the original, the new version was slightly more correlated with other paper-and-pencil measures of psychological health and well-being.

Positive thought disorder in a hypothetically psychosis-prone population.

Proverb interpretations of subjects who scored high on the Perceptual Aberration-Magical Ideation Scale (Chapman & Chapman, 1985) were compared with those of low-scoring controls. Responses to 10 familiar and 3 unfamiliar proverbs were scored for Bizarre-idiosyncratic thinking (Marengo, Harrow, Lanin-Kettering, & Wilson, 1986) and literalness (Hertler, Chapman, & Chapman, 1978). A Group by Type of Proverb (familiar versus unfamiliar) interaction was found for bizarre-idiosyncratic scores; (Per-Mags) scored higher than controls on unfamiliar, but not familiar proverbs. The Group X Familiarity interaction for bizarre-idiosyncratic scores indicates that the Per-Mag group displayed a subclinical, positive-thought disorder that is affected by the familiarity of the proverbs.

Creativity and schizotypal traits. Creativity test scores and perceptual aberration, magical ideation, and impulsive nonconformity.

Using a nonclinical and noneminent population, this study demonstrates an overlap in creative and schizotypal traits in the areas of perceptual functioning, behavioral and personality styles, and interests. No such overlap is observed in the area of divergent thinking. A battery containing five creativity measures was administered to a group of college student subjects scoring high on either the Perceptual Aberration Scale or the Magical Ideation Scale (N = 52) and to a group of control subjects (N = 65). A multivariate analysis of variance indicated that subjects high on the schizotypal traits of Perceptual Aberration or Magical Ideation (Per-Mag subjects) differed significantly from control subjects on the five creativity tests. Per-Mag subjects scored significantly higher than control subjects on the Barron-Welsh Revised Art Scale, a measure of preferences for figures, and the How Do You Think, a biographical and personality measure. There was a tendency for female Per-Mag subjects to score higher than female control subjects on the Domino Creativity Scale of the Adjective Check List. Per-Mag and control subjects did not differ on the Gough Creative Personality Scale of the Adjective Check List or on the Alternate Uses test, a test of divergent thinking. Per-Mag subjects who scored above the median for their group and gender on the Impulsive Nonconformity Scale received the highest creativity scores on the Barron-Welsh Revised Art Scale and the How Do You Think, although these results only approached significance. These findings argue for the specificity of areas of similarity and difference in schizotypy and creativity.

Mental health training and the hospice community: a national survey.

This article summarizes a national survey of the hospice community. Respondents provided detailed information in the following areas: (a) What formal mental health training is provided for staff members? (b) Who conducts this training? (c) What areas are covered and where would more training be useful? (d) How is the training conducted--what formats and teaching materials are used? and (e) How much training do staff members receive? The results of the survey indicate that the hospice community is making a concerted effort to meet the mental health training needs of its paid staff members and volunteers. However, more than half of the hospices surveyed expressed a need for further training in 26 of the 33 issues and skills covered in the questionnaire, and many reported a need for a more systematic and comprehensive mental health curriculum. The findings point to several areas of particularly great need and provide a basis for the development of future mental health training in the hospice community.