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Biomedical subjects

D V Jeste

Publications and source records attributed to D V Jeste.

At least 91 records · Page 5Linked to original sources
PubMed1997

Effects of schizophrenia and aging on pupillographic measures of working memory.

The amount of cognitive resources used to perform a task can be indexed as changes in pupil size. In a previous study, we examined pupillary response measures of slave store and central executive cognitive resources during a working memory task and found abnormally reduced utilization of these resources in schizophrenia. In the present study, multiple regression analyses were performed to examine the independent and combined effects of aging and schizophrenia on pupillary response and recall measures in a larger sample of community-dwelling schizophrenia patients. Schizophrenia was associated with a significant decline in working memory capacity, and an additional moderate decline was associated with aging, but these two factors did not interact. Baseline pupil size was significantly correlated with symptom severity, independent of medication. However, pupillary responses evoked by the working memory task and recall scores were not related to symptom severity. Results were consistent with an additive, rather than a synergistic, relationship between aging and schizophrenia, and suggested that working memory impairment in noninstitutionalized outpatients with schizophrenia may remain stable across symptom status and across the life span.

Adult↗
PubMed1997

Validity of specific subscales of the positive and negative symptom scales in older schizophrenia outpatients.

We investigated the construct validity of subscales of the Scale for the Assessment of Positive Symptoms (SAPS) and the Scale for the Assessment of Negative Symptoms (SANS) along with other measures of psychopathology in 109 schizophrenia outpatients aged 45-84 years. Scores on subscales of the SAPS, SANS and Brief Psychiatric Rating Scale (BPRS) and on the Hamilton Depression Scale (HAM-D) were subjected to a principal components analysis and orthogonal rotation followed by an extension analysis. In both analyses, three of four SAPS subscales had their highest loading on the positive symptom factor and four of five SANS subscales had their highest factor loading on the negative symptom factor. The SAPS bizarre behavior subscale, however, had a much higher loading on the depressive symptom factor than on the positive symptom factor, and the SANS avolition-apathy subscale had moderate loadings on both the negative symptom factor and the depressive symptom factor. The use of SAPS and SANS subscales to represent two constructs was largely (but not entirely) validated among middle-aged and elderly schizophrenia outpatients. The SAPS bizarre behavior subscale and, to a lesser extent, the SANS avolition-apathy subscale appear to represent in this older population a separate construct which may be related to depressive symptoms.

Age Factors↗
PubMed1997

Cellular and molecular neuropathology of schizophrenia: new directions from developmental neurobiology.

Schizophrenia is in essence a developmental disorder, but an unusual one in that the onset of symptoms is markedly delayed. Neuropathologic studies of the brain in schizophrenia have revealed subtle abnormalities that may reflect abnormal neuronal development. A more detailed examination of the cellular and molecular pathology of schizophrenia has been limited by the lack of informative markers that might allow a more complete understanding of the brain defects that characterize this disorder. Recent advances in molecular biology have made available a growing number of probes for examining the expression of specific gene products in brain tissue by using in situ hybridization and immunohistochemistry using antibodies to recombinant antigens. Several recently cloned neural genes are expressed in the forebrain regions which have been implicated in schizophrenia, and may have significant roles in brain development or function. Selected neurotransmitter receptors, neurotrophins and their receptors, and transcription factors of the POU and MADS families are promising candidates for future studies of the cellular and molecular neuropathology of schizophrenia.

Biomarkers↗
PubMed1997

Self-reported social functioning among older patients with schizophrenia.

The purpose of this study was to evaluate the utility of a self-report measure of social functioning as an outcome measure for older schizophrenia patients. Sixty-five schizophrenia patients and 39 healthy controls, ranging in age from 45 to 81 years, were evaluated using a modified Social Adjustment Scale (SAS-M), Scales for Assessment of Positive and Negative Symptoms, Depression Subscale of the Brief Symptom Inventory, Mini-Mental State Examination, Dementia Rating Scale, measures of social support, and measures of background variables. Compared with controls, fewer patients with schizophrenia engaged in social roles, were married, were parents, or held jobs. Moreover, patients were more impaired in overall functioning, specifically in the domains of social/leisure, extended family, and marital roles than controls. Impairments in most roles were correlated with greater severity of symptoms, but not with degree of cognitive impairment, social environment, or background characteristics. The SAS-M is a useful addition to psychosocial batteries; however, the self-report format may not reflect others' perception of functioning.

Activities of Daily Living↗
PubMed1997

N400 abnormalities in late life schizophrenia and related psychoses.

The N400, an event-related brain potential (ERP) sensitive to semantic congruity, has been reported to have increased latency and/or reduced amplitude in young adults with schizophrenia. Little is known, however, regarding the N400 in older schizophrenia patients, especially those with late onset. We studied 18 middle-aged and elderly patients with schizophrenia and related psychoses (nine with early-onset psychosis (EOP) and nine with late-onset psychosis (LOP)), and nine normal comparison (NC) subjects. Subjects read words which were semantically incongruent (50%) or congruent (50%) with a preceding spoken phrase which defined either an antonymic or categorical relationship. The LOP group had a significantly later peak latency of the N400 congruity effect compared to the NC group. Seven of 18 psychosis patients, but none (0/9) of the normal subjects, had an abnormal latency or amplitude (p = 0.04), measured at T6 (right temporal). Smaller amplitudes were associated with more severe negative symptoms (rp = 0.58; p = 0.01). N400 abnormalities in older schizophrenia patients likely reflect abnormal processing of semantic information.

Adult↗
PubMed1997

Health-related quality of life in older patients with schizophrenia and other psychoses: relationships among psychosocial and psychiatric factors.

OBJECTIVE: Few multivariate studies relating psychosocial factors to symptoms of psychosis among older patients exist. We assessed environmental stressors, satisfaction with emotional support, coping responses and psychiatric symptoms, and sought to relate these factors to quality of well-being among older patients with schizophrenia and other psychoses. METHOD: Subjects were 70 psychosis patients with a mean age of 58. Predictors included measures of stressors (number of negative life events), satisfaction with emotional support, coping responses, positive and negative symptoms, depressive symptoms, social adjustment and a general quality of well-being (QWB) score. RESULTS: A conceptual model was tested and modified using path analytic techniques. Preliminary analyses suggested that psychosocial environment (life events, coping and emotional support) was primarily a product of psychiatric symptoms. Therefore, psychiatric symptoms preceded psychosocial environment variables in the proposed model. Further results suggested that depression mediated all of the effects of psychotic symptoms on social maladjustment, but not all of their effects on well-being. CONCLUSIONS: In older patients with schizophrenia and other psychoses, health-related quality of well-being is influenced by symptoms of psychoses, psychosocial factors and social maladjustment.

Adaptation, Psychological↗
PubMed1997

Treatment of schizophrenia and delusional disorder in the elderly.

With increasing longevity, greater numbers of patients with schizophrenia and delusional disorder will be surviving into advanced age. Antipsychotics form the core of the treatment for both of these psychotic disorders. Treatment of elderly patients with antipsychotics is, however, complicated by a much higher risk of adverse effects such as tardive dyskinesia. More is known about treating patients with schizophrenia than those with delusional disorder. The introduction of newer atypical antipsychotics may herald a new era in the pharmacotherapy of elderly psychotic patients. Nonetheless, judicious dosing is essential in the geriatric population. We discuss the benefits and limitations of the main forms of treatment.

Aged↗
PubMed1997

A clinical evaluation of risperidone in the treatment of schizophrenia: a 10-week, open-label, multicenter trial. ARCS Study Group. Assessment of Risperdal in a Clinical Setting.

The efficacy and safety of risperidone have previously been demonstrated in controlled clinical trials in hospitalized chronic schizophrenia patients who met strict research criteria. The present study was designed to evaluate the efficacy and safety of risperidone in a heterogeneous patient population. Patients were enrolled in the study if they had a diagnosis of schizophrenia (DSM-III-R) with or without acute exacerbation. Of the 945 patients from 158 psychiatric centers who entered this phase IV study, 558 completed the 10-week trial. During week 1, the dose of risperidone was titrated to 6 mg/day, maintained there for 1 week, and then adjusted over a 4-week period as clinically necessary; the dose was then fixed for the final 4-week period. The mean dose of risperidone at endpoint was 5.9 mg/day. Patients were evaluated at baseline and at weeks 2, 6, and 10, using Clinical Global Impression scale, Psychotic Symptoms Assessment scale, and Global Assessment of Functioning scale. Significant improvement in mean scores was found on each of these measures at endpoint. Comparable results were obtained at week 10 in treatment-resistant and non-treatment-resistant patients. Risperidone was generally well tolerated and the severity of extrapyramidal symptoms was significantly reduced at endpoint.

Adult↗
PubMed1997

Anxiety disorders in the elderly: DSM-IV and other barriers to diagnosis and treatment.

Traditional lore suggests that anxiety disorders are less prevalent in elderly than in younger adults, and late-onset anxiety disorders are especially rare. We question these assumptions, and suggest that these conditions are underdiagnosed in late life. A common problem in the literature is the application of DSM-IV-like criteria developed from studies of younger adults to geriatric samples without regard for atypical symptom presentations, high occurrence of depressive and medical co-morbidity, and influence of aging-related psychosocial changes on the clinical picture. Diagnostic problems are further compounded by therapeutic ones. Clinicians are often forced to make treatment decisions for their elderly patients based on uncontrolled clinical observations or questionable extrapolation of treatment data in younger adults. An open-minded approach unhinged by 'conventional wisdom' is warranted.

Adult↗
PubMed1997

Geriatric psychosis.

This article reviews diagnostic and treatment issues which merit special consideration in the elderly psychotic patient. Psychoses are serious psychiatric disorders and can present in different forms in the elderly. The important ones include schizophrenia, psychosis in patients with dementia, psychosis in patients with depression and delusional disorder. Typical and atypical antipsychotic medications remain the treatment of choice for psychotic disorders but special considerations are warranted when prescribed to elderly patients. We have highlighted differences between younger and older adults in terms of clinical characteristics and treatment of psychotic disorders.

Age of Onset↗
PubMed1997

Pupillary responses index overload of working memory resources in schizophrenia.

The authors examined the hypothesis that schizophrenia patients have reduced availability of working memory resources by using pupillary responses as an index of resource overload. Pupillary responses were recorded during a verbal working memory task (digit recall) in 24 schizophrenia patients and 32 normal controls. Pupil size increased with increased processing load (digit-span length) but changed little or declined when processing demands exceeded available resources (overload). The schizophrenia patients showed impaired digit recall and abnormally small pupillary responses during digit presentation only in the higher processing load conditions, but they showed abnormally small pupillary responses during digit retrieval in all processing load conditions. The results suggest reduced availability of slave store and central executive working memory resources in schizophrenia. This study serves as an example of how pupillography methods can be used to test current hypotheses regarding overload of cognitive capacities in schizophrenia patients.

Adult↗
PubMed1997

Is it possible to be schizophrenic yet neuropsychologically normal?

This study identified and characterized a group of schizophrenic patients without neuropsychological (NP) impairment. A comprehensive NP battery was administered to 171 schizophrenic outpatients and 63 normal comparison participants. Each participant's NP status was classified through blind clinical ratings by 2 experienced neuropsychologists; 27% of the schizophrenics were classified as NP normal. The NP-normal and NP-impaired schizophrenics were similar in terms of most demographic, psychiatric, and functional characteristics, except that NP-normal patients had less negative and extrapyramidal symptoms, were on less anticholinergic medication, socialized more frequently, and were less likely to have had a recent psychiatric hospitalization. The existence of NP-normal schizophrenics suggests that the pathophysiology underlying the cognitive deficits often associated with schizophrenia may be distinct from that causing some of its core psychiatric features.

Adult↗
PubMed1997

The first Summer Research Institute in Geriatric Psychiatry.

In July 1995, the American Association for Geriatric Psychiatry (AAGP) sponsored the first annual week-long Summer Research Institute (SRI) in Geriatric Psychiatry, at the University of California, San Diego. The NIMH-funded SRI was intended for promising postresidency and postdoctoral fellows, as well as junior faculty persons interested in research careers in geriatric psychiatry. The SRI focused on the tools needed to begin, maintain, and succeed on that career path and has been followed by continued communication between trainees and faculty. The SRI was highly successful, judging from the participants' evaluations, as well as the trainees' accomplishments in terms of publications and research funding during 1 year of follow-up. The SRI provides a useful model for an approach to bridging and shortening the transition period from fellowship to first research funding and of ensuring a continued flow of new investigators in geriatric psychiatry.

Academies and Institutes↗
PubMed1997

Nondementia nonpraecox dementia praecox? Late-onset schizophrenia.

Schizophrenia has traditionally been viewed as a psychotic disorder with onset in adolescence or early adulthood and a deteriorating course. Over the past decade, the authors have been studying patients meeting DSM-III-R as well as specified research criteria for late-onset schizophrenia (onset after age 45) and several comparison groups with psychiatric, neurologic, neuropsychologic, brain-imaging, psychophysiological, and psychosocial assessments. Results to date suggest a number of similarities and differences between late-onset schizophrenia and comparison groups of other older patients with psychoses (including earlier-onset schizophrenia). Later-onset schizophrenia is probably a neurobiologically distinct subtype of schizophrenia. Differential involvement of cortico-striato-pallido-thalamic circuitry may explain differences in age at onset. The authors propose a new conceptual model for level of functioning at different stages of life in late-onset schizophrenia.

Adult↗
PubMed1997

Direct assessment of functional status in older patients with schizophrenia.

OBJECTIVE: There has been a growing trend in medicine to evaluate the impact of illness on functional abilities. Such studies typically rely on the patient's or caregiver's report. The goal of this study was to assess directly the functional capacity of psychiatric patients, especially older ones. METHOD: The subjects were 55 outpatients with schizophrenia and 72 normal persons ranging in age from 45 to 86 years. The subjects were administered the Direct Assessment of Functional Status Scale, which assess behaviour during simulated daily activity tasks in the areas of time orientation, communication, transportation, finance, shopping, grooming, and eating. RESULTS: The patients with schizophrenia had significantly greater disability than the normal subjects according to total scale scores as well as the communication, transportation, finance, and shopping subscale scores. Global cognitive status was the best predictor of total scale score. CONCLUSIONS: The Direct Assessment of Functional Status Scale is a promising instrument for functional assessment in outpatients with schizophrenia.

Activities of Daily Living↗