Mental disorder as a risk factor for human immunodeficiency virus infection in a sample of veterans.

People who suffer from mental disorders are at increased risk for becoming infected with HIV. There have been no studies that show whether particular psychiatric disorders present an increased risk for HIV infection in samples of nonpatients. This article uses data from the 1992 National Survey of Veterans to determine if veterans with posttraumatic stress disorder (PTSD), or with other mental or emotional problems, are at increased risk for HIV infection. The results indicate that the combination of PTSD and substance abuse increased the risk of HIV infection by almost 12 times over those without either. This is evidence of a particular psychiatric disorder increasing risk for HIV. Although cross-sectional, these data allow some conjecture about the timing of the onset of PTSD in relation to HIV infection. These results present powerful evidence that mentally ill persons such as those with PTSD, who may be underserved for health services including AIDS prevention efforts, should be targeted as an at-risk group.

Wisconsin card sorting test and work performance in schizophrenia.

Patients with schizophrenia have long been observed to perform poorly on the Wisconsin Card Sorting Test (WCST). Although numerous studies have established links between WCST performance and specific and diffuse structural brain abnormalities, little is known about its relationship to occupational functioning. The present study has investigated the relationship between behavior at a vocational work placement and performance on the WCST test for 89 subjects with schizophrenia or schizoaffective disorder. Multiple regression analyses that examined select WCST raw scores and that covaried out IQ and Digit Symbol Subtest scores found that Task Orientation at work was significantly related to WCST Trials to the First Category and Total Number Correct. Multiple regression analyses that examined standard scores, corrected for age and education, revealed that Task Orientation was related to Percent Conceptual Level and that Social Skills were related to Total Errors and Percent Conceptual Level. Results support the criterion-related validity of the WCST and have implications for understanding impairments in work function.

Insight and psychosocial treatment compliance in schizophrenia.

Research has suggested that poor insight in patients with schizophrenia is associated with poorer medication compliance and heightened levels of psychopathology. This study examined the relationship of insight to compliance with a work rehabilitation program and with levels of psychopathology and psychosocial functioning. Poor insight was found to be positively associated with fewer weeks of participation and with poorer social skills and personal presentation in the fifth week of work. Poor insight was also associated with cognitive disorganization and a lower intelligence quotient, but not with heightened levels of psychopathology. Results suggest that poor insight may predict noncompliance with psychosocial treatment and may be related to a constellation of cognitive deficits.

Concurrent validity of the cognitive component of schizophrenia: relationship of PANSS scores to neuropsychological assessments.

Cognitive symptoms of schizophrenia may represent a separate component of the disorder that is distinct from positive or negative syndromes. In a previous study, we reported a factor analysis of the Positive and Negative Syndrome Scale (PANSS) that revealed five components, one of which we labeled the Cognitive component. In the present study, we explored the validity of the PANSS Cognitive component by examining correlations between neuropsychological measures and the five factor-analytically derived PANSS scores for 147 subjects with diagnoses of schizophrenia or schizoaffective disorder. Higher scores on the PANSS Cognitive component were significantly correlated with poorer performance on all neuropsychological tests, including the Wisconsin Card Sorting Test (WCST), the Digit Symbol Substitution Task, the Slosson Intelligence Test, and the Gorham Proverbs Test. Multiple regression revealed that these test scores explained 37% of the variance in the Cognitive component score. Neuropsychological tests have very limited associations with the other PANSS components. These results suggest that the Cognitive component of the PANSS is a valid measure of cognitive deficits in schizophrenia, and they support the hypothesis that Cognitive impairment is a distinctive feature of schizophrenia independent of positive and negative syndromes.

Five-component model of schizophrenia: assessing the factorial invariance of the positive and negative syndrome scale.

A five-component model of schizophrenia has been presented by Kay and Sevy based upon an analysis of the Positive and Negative Syndrome Scale. Kay and Sevy found factorial validity for negative and positive syndromes, and they identified excitement, depressive, and cognitive components as well. They suggested that subtypes and syndromes can be mapped along dimensions presented in their model. The present study compares the five-component solution for a new sample of 146 subjects to a reanalysis of the Kay and Sevy data. Despite divergent demographic characteristics, the two samples produce similar dimensions. Correlations of component loadings and subject scores as well as confirmatory factor analysis are presented. Discussion focuses on points of agreement and important differences in the symptoms assigned to each component. How the dimensions relate to rationally derived models of positive and negative syndromes is reviewed, and implications for subtyping and other methods of examining the heterogeneity of schizophrenia are considered.

Relationship of positive and negative symptoms to cocaine abuse in schizophrenia.

The prevalence of cocaine abuse by patients with schizophrenia has led researchers to investigate features of the disorder correlated with abuse. Although abuse has been found to be more common among patients with a diagnosis of paranoid subtype and a history of earlier and more frequent hospitalizations, it is unclear if it is related to any particular pattern of negative or positive symptoms. This study examines the severity of positive and negative symptoms for patients with and without histories of cocaine abuse. Subjects with a history of at least 2 months of cocaine abuse (N = 25), no lifetime substance abuse (N = 20), and 2 months of alcohol abuse with no other substance abuse (N = 23) are compared on five-factor analytically and three rationally derived scores from the Positive and Negative Syndrome Scale (PANSS). Following a multivariate analyses of variance (p < .01), univariate analyses indicated significant differences on the negative syndrome scales, with cocaine-abusing subjects exhibiting less severe negative symptoms than subjects with no substance-abuse history. Cocaine-abusing subjects were also found to have been younger at time of first psychiatric hospitalization and more likely to qualify for a diagnosis of the paranoid subtype.

The Positive and Negative Syndrome Scale and the Brief Psychiatric Rating Scale. Reliability, comparability, and predictive validity.

In a psychiatric rehabilitation study, 154 concurrent ratings were performed using the 30-item Positive and Negative Syndrome Scale (PANSS) and the 18-item Brief Psychiatric Rating Scale (BPRS). Although both instruments had excellent interrater reliability, the PANSS was consistently better: on the 18 symptom items the two instruments share, the PANSS had higher intraclass r's on 14; for the syndromes, the PANSS was higher than the BPRS on positive, negative, and total. Weighted Kappas comparing shared items revealed that most were not interchangeable, with only three coefficients in the excellent range. However, syndrome scale scores were very highly correlated and resulted in similar classification for negative schizophrenia. Ten of the 12 items of the PANSS not included in the BPRS had low zero-order correlations with BPRS items, which suggests that they measure symptoms distinct from those measured by the BPRS and should add to clinical predictive power. This proved true in our study of rehabilitation of patients with schizophrenia. PANSS symptom ratings explained up to 55% of the variance on seven measures of work performance, whereas the BPRS had lower predictive power on six of the seven measures. We concluded that the PANSS may be superior to the BPRS in clinical research on schizophrenia and that most BPRS items are not interchangeable with identically named PANSS items.