Course Of Schizophrenic Illness Research Articles

Driving skills in unmedicated first- and recurrent-episode schizophrenic patients.

The present study was designed to examine driving skills according to regulations of the German guidelines for road and traffic safety in unmedicated schizophrenic inpatients. A total of 13 first-episode (FES) and 13 recurrent-episode (RES) schizophrenic inpatients were included in the analysis and compared with a group of 20 healthy controls (HC). Data were collected with the computerised Wiener Testsystem measuring visual perception, reactivity and stress tolerance, concentration and vigilance. Analysis of data indicates that a great proportion (58%) of schizophrenic patients were impaired in psychomotor functions related to driving skills. FES and RES significantly differed with respect to driving ability with a greater proportion in the FES (38%) showing severe impairments when compared with RES (25%). Differences with respect to HC performance were most pronounced in concentration and for the FES additionally in visual perception. Analysis of our data indicates that a great proportion of schizophrenic patients are impaired in psychomotor functions related to driving skills that cannot be attributed to adverse side effects of psychopharmacological treatment. Besides, we cannot confirm a chronical decline of psychomotor functions related to driving skills at least in the early course of schizophrenic illness.

Psychopathological characteristics and treatment response of first episode compared with multiple episode schizophrenic disorders

ObjectiveThe aim was to investigate the hypothesis that patients with first episode schizophrenic disorders have a more favorable treatment response than those with multiple episodes.MethodA total of 400 inpatients from an ongoing multi-centre, follow-up program who fulfilled ICD-10 criteria for schizophrenic disorders (F2) were assessed at admission to and discharge from hospital using the Positive and Negative Syndrome Scale (PANSS).ResultsAt admission, first episode patients (n = 121) showed higher levels of positive symptoms (PANSS positive subscore) and lower ones of negative symptoms (PANSS negative subscore) than multiple episode patients (n = 279), whereas the global disease severity (PANSS total score) was comparable. Analyses of covariance revealed that treatment response (adjusted symptom levels at discharge) was more favorable in first-episode patients, with respect to both positive and negative symptoms.ConclusionThe results are compatible with the hypothesis that treatment response becomes less favorable during the course of schizophrenic illness. This finding might be associated with progressive neurobiological alterations.

0398 FAMILY PROCESSES UNDERLYING PARENTAL EXPRESSED EMOTION

This study addresses the questions if and for which patients expressed emotion (EE) has a predictive validity in an 8 year follow-up study and if this is dependent on the residential form, especially on patients and relatives living together. Eight years after a baseline examination (Camberwell Family Interviews [CFI], global assessment scale [GAS], symptom score) 69 of 99 patients were reexamined. The number and duration of rehospitalizations as well as the symptom and GAS scores were recorded. These was no difference between outcome of high and low EE patients with a duration of illness of less than 4.5 years and for those living with partners. Patients from high EE parents with a longer duration of illness (> 4.5 years) at the outset of the study were significantly more often and longer in hospital. They had significantly higher symptom and GAS scores at the outset of the study and after 8 years. The EE effect was equal in the first and second 4 years of the follow-up and was independent from patients and parents living together. The results emphasize the significance of the EE index as a long-term predictor for the course of schizophrenic illness. The independence of the prediction from living together is an argument against a simple causal interpretation of the connection between EE and the course of schizophrenia.

Spätadoleszenz und junges Erwachsenenalter - Ätiopathogenetische Bedeutung für schizophrene Psychosen

The significant upsurge of schizophrenic illness manifestations during adolescence and young adulthood is a core finding of epidemiological research in schizophrenia. The reasons are probably manifold, so far, however, not well understood. From the perspective of neurobiological maturation, processes of neuronal reorganisation in cortical and subcortical structures are hot topics. Aberrant forms of pruning, sprouting and myelinization may play a major role in the pathogenesis of a schizophrenic breakdown. The consequences for the pathophysiology of schizophrenia have to be considered. Models of neuroplasticity during adolescence can be connected with models of a neurodevelopmental vulnerability and models of neurotoxicity within an integrated aproach in order to better understand premorbid adjustment, onset, and course of schizophrenic illness. From the perspective of psychosocial development, prominent developmental tasks have to be considered, which form a major challenge to all adolescents, bearing, however, special risks for some adolescents. Patterns of psychosocial adaptation found during this developmental period must be considered in their long-term consequences. Neurobiological reorganisation and psychosocial transformation are both sides of one developmental process during adolescence and young adulthood.

Suicidal behavior in schizophrenia

There is a high prevalence of suicidal behavior in individuals suffering from schizophrenia and recent investigations substantially elucidate this problem and provide useful insights about clinical risk factors, neurobiologic underpinnings and the impact of various treatments on reducing such behavior. The risk of suicide is greatest early in the course of schizophrenic illness but continues throughout life; risk factors for suicidal behavior include psychosis, depression and substance abuse. Effectively treating positive symptoms and depression, reducing substance abuse, avoiding akathisia, addressing demoralization and instilling hope are important elements in this treatment approach. The newer generation of atypical antipsychotics (particularly clozapine) and new psychologic approaches (particularly cognitive behavioral therapy) appear to be useful in reducing suicidality in schizophrenia. The significant advances in defining the neurobiologic basis of suicidality may enable the development of more effective treatments. The renewed emphasis on resilience and recovery as desired outcomes in schizophrenia and the accompanying sense of hope encourage optimism about effectively reducing suicidality in schizophrenia. Over the past 10 years, much has been learnt and hopefully this momentum will be translated into increasingly better outcomes.

Long-term course of schizophrenic illness: Bleuler's study reconsidered.

The influential 1972 study by Manfred Bleuler on the long-term course of schizophrenic illness has been reconsidered. The authors tested the diagnosis of schizophrenia in all patients and investigated how the distribution of the types of illness course and outcome would change after exclusion of patients whose diagnosis of schizophrenia could not be confirmed by modern diagnostic standards. Clinical charts and Bleuler's research notes on the original sample were assessed, and all patients were rediagnosed with the help of DSM-IV, DSM-III-R, ICD-10, the Research Diagnostic Criteria (RDC), Schneider's criteria, and an operationalized version of the criteria of Eugen Bleuler. The diagnosis of schizophrenia was not confirmed in about 30% of the sample; the majority of these patients were rediagnosed with schizoaffective disorder. High diagnostic agreement was found between DSM-IV, DSM-III-R, ICD-10, and RDC; there was much less agreement with Bleuler's and Schneider's criteria. After exclusion of patients whose schizophrenia diagnosis was not confirmed, the proportion of patients with undulating course and recovery slightly decreased, and the proportion of patients with severe end state slightly increased. Nevertheless, the distribution of the types of long-term course did not significantly change, and even among patients with strictly defined schizophrenia, half had an undulating course with remissions and 12%-15% recovered. Schizophrenic illness remains heterogeneous with regard to illness course and outcome even when narrowly diagnosed with the help of modern operationalized diagnostic criteria. Contemporary differentiation between schizophrenic and schizoaffective disorders is prognostically valid.

The Influence of Familial Loading on the Course of Schizophrenic Symptoms and the Success of Psychoeducational Therapy

This prospective study examines the influence of familial loading on the course of schizophrenic illness and the extent to which this is modifiable by psychoeducational training as a form of psychotherapy. 182 schizophrenic patients enrolled in the study were allocated at random into four different treatment groups and one control group. 40% of the patients had mentally ill relatives, 20% with some form of schizophrenia. Patients attending the treatment group and those in the control group were examined before and immediately after psychoeducational training and at 2-year and 5-year follow-ups. Control group patients with mentally ill relatives displayed a significant increase in psychopathological symptoms and rehospitalization rate compared to those without. The psychoeducational training arrested or even improved the increase in psychopathological symptoms in patients with mentally ill relatives. Familial loading contributes substantially to a high rehospitalization rate and a poor outcome in schizophrenic patients. Psychoeducational interventions are an appropriate means of arresting this unfavorable development.

Long-term outcome of patients who receive ketamine during research

Background: To comprehend the pathophysiology of schizophrenia and to facilitate drug discovery, animal and human models of schizophrenia are necessary. Ketamine, a noncompetitive N-methyl- d-aspartate antagonist, has been used to probe glutamatergic function in normal and schizophrenic volunteers. These studies and others have provided data consistent with a putative involvement of a glutamatergic dysfunction in the pathophysiology of schizophrenia; however, these studies have also raised concerns about the distress inflicted on patients, the potential for adverse events, and the serious long-term effects that could possibly be induced by symptom-simulating action. Methods: For all patient volunteers ( n = 30) who participated in these studies, we reviewed the acute safety during and in the immediate postketamine administration. Patients available for long-term follow-up ( n = 25) were matched to a group of patients ( n = 25) who participated in research but did not receive ketamine. We compared their long-term outcome in terms of psychopathology, the need for psychiatric care, and the amount of antipsychotic medication required for optimal therapeutic response. Results: There were no serious adverse events in more than 90 ketamine interviews. Distress to patients was minimal, which is shown by the lack of anxiety ratings. Over a mean follow-up period of 8 months, we found no differences between patients who did and did not receive ketamine on any measures of psychopathology, psychiatric care, or the amount of antipsychotic medication. Conclusions: In a controlled environment and paying close attention to subject safety features, administering subanesthetic doses of ketamine causes no adverse events and little distress to schizophrenic volunteers. This study strongly indicates that administering ketamine does not change any aspect of the course of schizophrenic illness.

S53.02 Cognitive and behavioral functioning during the decade prior to first hospitalization and during early course of schizophrenic illness

S53.02 Cognitive and behavioral functioning during the decade prior to first hospitalization and during early course of schizophrenic illness

A review of expressed emotion research in health care

Much research has been carried out on the impact of family relationships on the development and course of different illnesses. Research on Expressed Emotion (EE) developed out of studies of the impact of family members on patients with schizophrenia, and has provided us with a robust measure of relatives' emotional attitudes towards patients, which has now been applied in the study of numerous psychiatric and medical illnesses. This review outlines the history of EE research in schizophrenia, and discusses the evidence for the association between family EE and the course of schizophrenic illness. Some of the factors which might moderate the association between EE and illness course are outlined and the issues of the meaning and development of EE are discussed in the light of recent theoretical advances. The application of the EE methodology in other psychiatric and medical conditions is then reviewed and conclusions are drawn about the extent to which EE predicts illness course in conditions other than schizophrenia. Consideration is given to the ways in which the application of the paradigm to a variety of illnesses or conditions with different features can enhance our understanding of the EE construct.

In conclusion: does antipsychotic treatment modify the longterm course of schizophrenic illness?

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Expressed-emotion development and course of schizophrenic illness: considerations based on results of a CFI replication.

This study examines the correlation between development of expressed emotion (EE) in relatives and course of illness of 99 DSM-III schizophrenic patients. Patients whose relatives were high EE at baseline and at the 2nd CFI approximately 20 months later had a poor prognosis at the very outset of the study and an unfavourable course of illness. They had a higher rehospitalisation rate, more symptoms, lower psychosocial assessment, and a poorer 2-year and even 8-year outcome. Patients from families with a fluctuating EE or a consistently low EE had better courses. Expressed emotion is therefore a valid predictor not only of symptomatic relapses, but also of other important aspects of schizophrenia. The connection between EE index and course of illness seems not to be simply reactive or causal, but complex and non-uniform.

Family Interaction and the Course of Schizophrenic Illness

The aim of the present study was to assess the prognostic relevance of relatives' interactive behaviour towards the patient, as covered by the Münster Family Interview (MFI), to the further course of the schizophrenic illness. The MFI is a family interview (of the whole family, including the patient) designed to record the emotional family atmosphere based on the concept of expressed emotion (EE). The ratings take place directly after the interview on five scales (criticism, hostility, overinvolvement, resignation and warmth), the resignation scale being added to the 'classic' EE scales. Ninety-nine families of outpatients diagnosed with schizophrenia according to the DSM-III were examined with the MFI during a home visit. The patients were seen 1 and 2 years after the first examination. The target criteria selected for the prognostic significance of the interaction measurements were: rehospitalisation within 2 years; extent of symptoms after 1 year, and psychosocial skills after 1 year. The significance of the interaction dimensions was verified in regression models. The control variable used in the regression models was the Strauss-Carpenter scale. Regression models were produced for the total group and for a subgroup of moderately ill patients. All target criteria yielded serviceable prediction models. The most important variable for prediction was the control variable, the Strauss-Carpenter scale. However the interaction variables made additional contributions to the prognosis, especially in the subgroup of moderately ill patients. The best MFI scale for all the outcome criteria was resignation; criticism predicted only the symptomatology, and emotional overinvolvement the level of social functioning after 1 year. In conclusion, practical work with families of schizophrenic patients should emphasise the protective function of relatives towards patients more strongly.

Expressed emotion in an 8 year follow-up

This study addresses the questions if and for which patients expressed emotion (EE) has a predictive validity in an 8 year follow-up study and if this is dependent on the residential form, especially on patients and relatives living together. Eight years after a baseline examination (Camberwell Family Interviews [CFI], global assessment scale [GAS], symptom score) 69 of 99 patients were reexamined. The number and duration of rehospitalizations as well as the symptom and GAS scores were recorded. These was no difference between outcome of high and low EE patients with a duration of illness of less than 4.5 years and for those living with partners. Patients from high EE parents with a longer duration of illness (> 4.5 years) at the outset of the study were significantly more often and longer in hospital. They had significantly higher symptom and GAS scores at the outset of the study and after 8 years. The EE effect was equal in the first and second 4 years of the follow-up and was independent from patients and parents living together. The results emphasize the significance of the EE index as a long-term predictor for the course of schizophrenic illness. The independence of the prediction from living together is an argument against a simple causal interpretation of the connection between EE and the course of schizophrenia.

S-67-3 - Natural course of schizophrenic illness: Deterioration versus continuation of premorbid function

S-67-3 - Natural course of schizophrenic illness: Deterioration versus continuation of premorbid function

The effect of typical and atypical antipsychotics on the course of schizophrenic illness

The effect of typical and atypical antipsychotics on the course of schizophrenic illness

The effects of EE on the long term course of schizophrenic illness—results of an 8 years follow-up

Prevailing models of the association between expressed emotion (EE) and relapse conceptualize EE as a form of stress for patients. In eating disorders (ED), there is no research addressed to evaluate the degree to which patients feel stress due to their relatives’ EE. It has been neither investigated how the EE and the subsequent stress relate to disordered behaviours and attitudes neither. Using a sample of 77 inpatients with ED, this study aimed to: (1) evaluate patients’ reported level of stress as it relates to their caregivers’ EE, particularly as associated with carer's criticism, emotional overinvolvement and warmth; (2) examine the associations of stress with the patients’ perceptions (self-reported) and the caregivers’ perspective (assessed by the Camberwell Family Interview) of the EE; and (3) study how the two views of EE (patients’ and caregivers’) and the stress due to EE relate to the ED symptoms. The findings indicate that patients judged their carers’ critical stance as the most stressful, followed by emotional overinvolvement. Secondly, patients’ perceptions of EE, whereas none of the interview indices focused on the caregivers’ perspective, were associated to the stress and to the ED symptomatology. Additionally, the patients’ stress due to criticism was positively related to the ED symptoms, while the stress associated with emotional overinvolvement and warmth was not. Clinical and research implications are discussed. Findings suggest attention to the ED patients’ view of their family environment and support the utility of assessing their appraisals of EE.

Schizophrenic patients' perceptions of their relatives' attitudes

Although the attitudes of family members as revealed by measures of expressed emotion (EE) have been shown to be associated with the course of schizophrenic illness, little is known about how patients perceive these attitudes. A detailed interview was used to assess patients' perceptions of their family members' behaviors toward them. Family members' EE was assessed with the Five-Minute Speech Sample (FMSS). Overall, patients' perceptions of criticism were congruent with a component of the FMSS-EE that measures criticism. Results indicated that when family members had high EE/critical scores, patients perceived them as displaying more instances of critical behavior. All cases in which patients' perceptions of criticism were incongruent with measures of FMSS-EE occurred among ethnic minority group members. Although the FMSS-EE did not predict outcome in this study, patients who perceived their relatives as higher in criticism had more negative outcomes at 1 year. These findings suggest that when family environments are examined in patients from ethnic minority groups, the patient's perspective may be a more potent predictor of outcome than traditional measures of EE.

VBR and premorbid status in schizophrenia

Ventricular enlargement is a consistently documented abnormality in schizophrenia, seen in one third to one half of patients; ventricle-brain ratio (VBR) is the most frequently used index of ventricle enlargement. The precise timing of this abnormality in the course of schizophrenic illness and its relationship to neuropsychological dysfunction and premorbid adjustment remains unclear. We have previously shown that VBR could be used to dichotomize a sample of schizophrenics and generate hypotheses regarding premorbid ability and development: 1) childhood onset associated with poor premorbid function, low educational achievement, lower IQ, and lower VBR; and 2) later onset with relatively normal childhood function, higher academic achievement and IQ, and increased VBR. To re-examine these questions, we investigated the relationship between VBR, premorbid psychosocial and cognitive ability, and neurnpsychological function in another sample of 55 DSM-III-R schizophrenic inpatients. Each was rated on BPRS and SANS at baseline and after 4 weeks of antipsychotic treatment. VBR was determined from MRI scans via computerized planimetry. Neuropsychological testing was used to gauge current functioning and to estimate premorbid cognitive ability; the Premorbid Adjustment Scale was used to estimate premorbid psychosocial functioning. Unlike our previous study, VBR was not associated with premorbid cognitive or psychosocial functioning, decline in premorbid ability, or symptom status. Our failure to replicate our own previous findings is another example of the difficulty in obtaining consistently replicable findings in schizophrenia. In part, the discrepant findings may be related to limitations in current methods of image acquisition and analysis. More precise and comprehensive techniques such as shape analysis and image averaging may help to clarify these important issues involved in understanding the development and pathophysiology of schizophrenia.

Effects of alcohol on symptoms in alcoholic and nonalcoholic patients with schizophrenia.

Alcohol abuse and dependence are common among patients with schizophrenia. The Epidemiologic Catchment Area (ECA) study found that 34 percent of patients with schizophrenia met criteria for an alcohol use disorder, a higher percentage than in the general population (1). However, the findings in other literature on this matter are inconsistent, with reported rates of alcohol problems among patients with schizophrenia ranging from 6 percent to 60 percent (2-5). The eff cts of alcohol use on psychopathology and on the course of schizophrenic illness are complex. Some studies have implied that patients with schizophrenia use alcohol to reduce theirpsychiatnic symptoms and that alcohol has very little effect on overall prognosis (6,7). Other investigators have suggested that alcohol use may exacerbate psychotic symptoms and depression, increase impulsiveness and suicide attempts, and, in general, worsen the course of the illness (2,4,5). From the varying