ECT for lorazepam-refractory catatonia.

Catatonic syndromes are seen in diverse psychiatric and systemic illnesses, and may have varied presentations. Although reports suggest that benzodiazepines are helpful, debate persists regarding definitive treatment for catatonia. We present a case in which electroconvulsive therapy effectively resolved symptoms in an adolescent patient with catatonia who had only a transient response to lorazepam.

Clinical benefits of paid work activity in schizophrenia.

Although indirect support can be found for the clinical benefits of work, it has not been studied in randomized designs, nor have critical variables been manipulated. One such variable is pay incentive. The authors present a study of 150 subjects with schizophrenia or schizoaffective disorder who were randomized into Pay ($3.40/hour) and No-Pay conditions and offered 6-month work placements within a Department of Veterans Affairs medical center. Subjects participated in a work-related support group and were evaluated weekly on symptom measures. Results indicated that Pay subjects worked more hours and earned more money than No-Pay subjects. Pay subjects showed more total symptom improvement at followup, and more improvement, particularly on positive and emotional discomfort symptoms. They also had a significant lower rate of rehospitalization than No-Pay subjects. Participation in work activity was closely associated with symptom improvement. Participators showed more total symptom improvement at followup than partial participators or nonparticipators, and more improvement, particularly on positive, hostility, and emotional discomfort symptoms. We concluded that pay increased participation and that, in this study, participation in work activity was primarily responsible for symptom reduction.

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.

Admission decisions and performance during medical school.

This study compared a group of 24 applicants who were interviewed and accepted at the Yale University School of Medicine but went to other medical schools (AYEs) with a group of 27 applicants who attended the same schools but had been rejected at Yale following an interview and committee deliberation (NAYs). Measures of performance during medical school included scores on Parts I and II of the examinations of the National Board of Medical Examiners and evaluations from the dean's office at each student's medical school. No relationship was found between admission decisions and performance during medical school when AYEs and NAYs attending the same medical schools were compared.

Do admission decisions predict performance during medical school? A comparison of one medical school's rejected and accepted applicants who attended other schools.

The relation of one school's admission decisions to performance in medical school was examined by comparing accepted applicants who chose to attend other institutions with rejected applicants who went to those same institutions. When differences among schools were controlled, no effect of admission decisions was observed.

Prediction of screening decisions in a medical school admission process.

To study and predict a set of screening decisions in a medical school admission process, a stratified sample (n = 864) was drawn to represent the range of applicants to the Yale University School of Medicine during a single year. A smaller sample from the following year's applicants was drawn in a similar fashion for purposes of cross-validation. Prior to the prediction of screening decisions, a set of independent variables was selected by a factor analytic procedure from credentials in an applicant's admission folder. These folder variables ranged in nature from quantitative measures of academic performance to demographic information and types of extracurricular activity. Two multivariate statistical procedures, Sonquist's Automatic Interaction Detection (AID) and linear discriminant analysis (LDA), were used to predict screening decisions. Measures of academic performance and ability proved to be the most effective predictors of screening decision, as evidenced in the final AID tree and the discriminant function.