Search PubMed⌕ Search

Biomedical subjects

M Alpert

Publications and source records attributed to M Alpert.

At least 37 records · Page 2Linked to original sources
PubMed1999

Neuroleptic malignant syndrome in children and adolescents.

OBJECTIVE: Neuroleptic malignant syndrome (NMS) is a serious iatrogenic condition. This report reviews the world literature to characterize the syndrome and evaluate factors that promote early detection and effective intervention. METHOD: The review identified 77 NMS cases (49 males, 27 females, 1 gender unknown); ages ranged from 0.9 to 18 years (mean 14.8 +/- 3.96). Univariate and multiple regression analyses were applied to 38 variables to identify early signs of the disorder, to identify correlates of outcome, and to evaluate treatments. RESULTS: The duration of NMS spanned from 1 to 119 days. Nine percent of patients died and 20% resolved with serious sequelae. Patients receiving low-potency neuroleptics had a poorer outcome (p = .01). Fever was related to longer duration of illness (p = .03). Anticholinergics and bromocriptine were effective and without fatalities, but dantrolene was not useful in this sample of children and adolescents. CONCLUSIONS: Early detection and appropriate interventions appear important in moderating the course and outcome of NMS.

Adolescent↗
PubMed1999

Lateralization of facial emotional expression in schizophrenic and depressed patients.

This study examined facial emotional expressions produced by schizophrenic (SZ), unipolar depressed (UD), and normal control (NC) righthanded adults. Hypotheses regarding right-hemisphere activation in UD and suppression in SZ were addressed, as well as hypotheses about emotion and laterality. Subjects were videotaped while posing positive, neutral, and negative facial expressions to verbal command and to visual imitation. Naive judges rated hemiface stimuli for intensity in original and mirror-reversed orientations. Overall, SZs produced expressions with diminished intensity relative to UDs and NCs. Across subject groups, expressions were more intense in the visual than the verbal condition. In general, approach expressions were produced with greater right-hemiface intensity, and withdrawal expressions with greater left-hemiface intensity. UDs showed more pronounced facial asymmetry than SZs or NCs. An unanticipated right-hemispace perceptual bias among the judges may reflect the analytical, detailed rating procedure used and the presumably greater reliance by the judges on left-than right-hemisphere strategies.

Adult↗
PubMed1998

Acoustic distinctions in the speech of male psychopaths.

A key feature of psychopathy is the ability to deceive, manipulate, and con the unwary, while seeming to be perfectly sincere. Is this impression of sincerity achieved solely through body gestures and facial expression, or is there also something different about the voice quality of psychopaths? We analyzed the acoustic characteristics of speech in 20 male offenders (10 psychopaths and 10 nonpsychopaths), assessed with the Psychopathy Checklist--Revised (Hare, 1991). We used a computer program developed by Alpert, Merewether, Homel, Martz, and Lomask (1986) to measure variations in amplitude and prosody. Results indicated that psychopaths spoke more quietly than controls and did not differentiate, in voice emphasis, between neutral and affective words. These findings are consistent with the developing view that psychopaths are insensitive to the emotional connotations of language. In addition, their vocal characteristics may be part of a self-presentation mode designed to manipulate and control interpersonal interactions.

Adult↗
PubMed1998

Intensive day program for psychiatrically disturbed truant adolescents.

Results of a day treatment program tailored to psychiatrically disturbed truant adolescents were compared to those of traditional outpatient treatment for effects on truancy, psychiatric symptoms, global improvement, and global functioning. Significantly greater reductions of truancy were found in the day treatment program, along with significantly greater improvement in the other factors measured.

Absenteeism↗
PubMed1998

The relationship between negative symptoms of schizophrenia and extrapyramidal side effects with haloperidol and olanzapine.

Atypical neuroleptics present a unique opportunity to examine confounding by neuroleptic-induced extrapyramidal symptoms (EPS) in the assessment of negative signs of schizophrenia. EPS, such as facial bradykinesia and akinesia, involve some of the same response systems and phenomena as emotional display channels. EPS are attributed to the blockade of dopamine receptors in the striatum by traditional neuroleptics. Newer atypical neuroleptics target primarily mesolimbic and mesocortical areas, and receptors for other transmitters such as serotonin. Olanzapine has been reported as less likely to cause EPS and may improve some negative signs. We investigated the relationship between measures of EPS and negative symptoms in patients with schizophrenia treated with haloperidol or olanzapine. Patients were rated with the Positive and Negative Syndrome Scale (PANSS) and the Simpson-Angus Scale EPS scale. Results show that the two agents have comparable efficacy but different safety outcomes. A positive correlation between EPS and PANSS negative score was detected in the haloperidol group only. Stepwise multiple regression analysis shows that a big proportion of variability in PANSS negative symptoms is predicted by EPS in the haloperidol group, but not in the olanzapine group, even though EPS increased in patients treated with haloperidol but not in olanzapine patients.

Adult↗
PubMed1997

At issue: speech fluency and schizophrenic negative signs.

The spontaneous speech of negative-syndrome schizophrenia patients is underproductive and contains many hesitations and pauses. Acoustic analysis of the patient's speech during interview reveals that the duration of pauses, independent of other linguistic or paralinguistic measures, correlates strongly with the clinician's impressions of the patient's flat affect and alogia. Pausing is less related to associality and other aspects of the negative syndrome. The hesitations appear to reflect a word-finding difficulty that, together with neuropsychological evidence of compromised performance on word fluency tasks, suggests a specific speech generation difficulty. The significant relationship between pausing and both flat affect and alogia suggests that the two negative signs share phenomenal and psychometric properties. The examination of speech generation mechanisms may provide an informative avenue for study of schizophrenic psychopathology. Acoustic analysis reveals processes that are not apparent to the clinician and may provide a useful basis for clinical assessments and research.

Affect↗
PubMed1996

Focal cerebral perfusion defects demonstrated by 99mTc-hexamethylpropyleneamine oxime SPECT in elderly depressed patients.

High resolution single photon emission computed tomography (SPECT) was used to evaluate regional cerebral blood flow (rCBF) in 14 acutely depressed elderly patients and 29 normal subjects. SPECT images of the two groups were randomized and blindly read. Foci of decreased radionuclide uptake were assessed by number and location. The total number of rCBF defects per whole brain study was significantly greater in the depressed patients than in the normal subjects. A significantly greater number of rCBF defects was found most strikingly in the lateral frontal and less prominently in the lateral and medial temporal brain regions of the depressed patients.

Aged↗
PubMed1996

Carbamazepine use in children and adolescents with features of attention-deficit hyperactivity disorder: a meta-analysis.

OBJECTIVE: In the United States approximately 750,000 children receive psychostimulants to treat attention-deficit hyperactivity disorder (ADHD); up to 25% may not respond. The purpose of this study was to evaluate the reports in the international literature concerning the efficacy of carbamazepine (CBZ) in children with ADHD features by means of meta-analysis. METHOD: A review of the world literature located 29 reports that dealt with behavior problems, activity levels, and CBZ in children. Of these, only 10 reports provided sufficient or pertinent information for the meta-analysis. RESULTS: In all seven open studies, therapeutic responses were significant (ranging from p = .05 to .0001, two-tailed t test). Meta-analysis using weighted variables revealed a significant positive correlation (r = .88; p < .02) between duration of treatment and positive outcome. In three double-blind placebo-controlled studies, treatment effects for CBZ's superiority over placebo ranged from p = .07 to .0001. A meta-analysis of these three studies revealed that CBZ was significantly (p = .018) more effective than placebo at controlling target symptoms. CONCLUSIONS: Despite the general lack of attention that CBZ has received for treating ADHD, there is preliminary evidence that CBZ may be an effective alternate treatment in children with features of ADHD.

Anticonvulsants↗
PubMed1996

Constricted expressiveness and psychophysiological reactivity in schizophrenia.

The present study investigated flat affect in schizophrenia within a multicomponent model of emotions in which affects were identified with the expression or display of feelings. Display, as well as other components of emotion, such as subjective experience and psychophysiological reactivity, were examined as 24 schizophrenic inpatients (12 with flat affect) and 12 depressed inpatients were guided through imagery of personal emotional experiences. It was hypothesized that display variables would show a relationship with flat affect, whereas physiological and subjective variables would not. Increased flatness of affect was associated with longer pauses and reduced dyadic interaction and less zygomatic (cheek) electromyogram activity. The flat affect patients unexpectedly showed more corrugator (brow) electromyogram activity compared with the depressed group, which perhaps reflects difficulty in self-expression. The flat affect group had faster heart rates at baseline. The groups did not, however, differ in self-report of the intensity of experienced emotion. These results support the view that flat affect patients show a reduction in emotional display, whereas other subsystems of emotion processing appear normally engaged.

Adult↗
PubMed1996

Adjunctive nadolol in the treatment of acutely aggressive schizophrenic patients.

BACKGROUND: This study assessed the safety and efficacy of nadolol 120 mg/day compared with placebo, when administered adjunctively to neuroleptic in a group of acutely aggressive schizophrenic patients. METHOD: Thirty-four male patients enrolled in this double-blind, placebo-controlled trial. The subjects were evaluated with the Brief Psychiatric Rating Scale (BPRS) and the Simpson Angus Neurologic Rating Scale for extrapyramidal effects. The total BPRS score as well as three factors, thought disturbance, hostility, and activation, was analyzed. RESULTS: Compared with those who received placebo, the patients taking nadolol showed significant improvement on total BPRS score, particularly on the thought disturbance and activation factors, after the first treatment week (p = .05). By the end of the second treatment week, the patients taking placebo also began to show improvement, and the group differences were no longer significant. The patients treated with nadolol showed significantly more improvement on Simpson-Angus scores than those who received placebo (p = .03). However, there was no significant correlation between BPRS and Simpson-Angus changes. In the nadolol group, patients with and without akathisia showed no significant difference in their BPRS scores. CONCLUSION: These findings suggest that adjunctive nadolol may be useful in the treatment of acutely aggressive schizophrenic patients by inducing a more rapid and consistent decrease of overall psychiatric symptoms and by reducing the extrapyramidal effects. Our results raise the possibility that the mechanism of action of nadolol on psychiatric symptoms in schizophrenic patients may be different from the mechanism of improvement of neuroleptic-induced extrapyramidal symptoms and akathisia. Nadolol may be a helpful adjunctive treatment for schizophrenic patients in general and not just for those with a high hostility level.

Acute Disease↗
PubMed1995

Clinical effects of recent cocaine use on patients with acute schizophrenia.

OBJECTIVE: Dopamine function has been hypothesized to be involved in both producing schizophrenic symptoms and mediating cocaine's reinforcing properties. As a result, cocaine abuse in schizophrenic patients may be seen as a natural experiment that may alter the phenomenology and neurobiology of schizophrenia. This report concerns the clinical effects of cocaine abuse and cessation in schizophrenic patients at two times: when patients presented to the psychiatric emergency service and again after 4 weeks of hospitalization. METHOD: The subjects were 15 cocaine-abusing and 22 cocaine-abstaining schizophrenic patients. Diagnostic assessments were performed with the Structured Clinical Interview for DSM-III-R--Patient Version, which uses DSM-III-R criteria. All of the patients were assessed at both times with the Brief Psychiatric Rating Scale, the Scale for the Assessment of Positive Symptoms, and the Scale for the Assessment of Negative Symptoms. RESULTS: Cocaine-abusing schizophrenic patients showed fewer negative signs and more anxiety/depression at the hospital-admission assessment than their nonabusing counterparts. At retest, no group differences were detected in patients' negative signs or mood symptoms. Severity of positive symptoms was equal at both testing sessions. CONCLUSIONS: The significant difference in negative signs and mood symptoms at admission assessment was attributed to the neurobiological impact of cocaine. The role of psychostimulants in schizophrenic patients is discussed.

Acute Disease↗
PubMed1995

Clinical and acoustic measures of the negative syndrome.

We studied 12 male schizophrenia patients in a 6-week treatment trial comparing two neuroleptics and placebo. Efficacy in regard to negative symptoms was of interest, and Alphs' Negative Symptom Assessment (NSA) was included. The NSA includes behaviorally anchored ratings such as "prolonged time to response" and "restricted speech output." Audio recordings of interviews with the patients were analyzed acoustically. In general, the behavioral anchors did not prevent the ratings from being influenced by global impressions. There was a strong correlation between each item and the total of other items, but a modest correlation with the relevant behavioral measure. Results suggest that, even with specific and behaviorally anchored items, the clinician's assessment is confounded by global impressions. Treatment effects were greater for the acoustic measures than for the clinical measures.

Acoustics↗
PubMed1995

Cues to the assessment of affects and moods: speech fluency and pausing.

Clinicians' rating of the negative syndrome of schizophrenia are highly correlated with the rate and duration of the patient's pauses. To test the degree to which pausing provides the cue for clinicians' impressions we selected audio recordings of interviews with schizophrenic patients who showed moderate levels of negative signs and, through the use of a computerized digital editor, transformed the recordings by either doubling or halving the duration of all of the patient's pauses. Other aspects of the patients' speech were unchanged. Ratings of flat affect were changed by the editing: reduced pause samples were seen as less flat and increased pause samples as flatter. Ratings of mood were not significantly changed. These results suggest that neuropsychological factors that interfere with fluent speech may play a role in the pathogenesis of the negative syndrome. In addition, the edited tapes provide helpful materials for training clinicians to assess moods and affects.

Adult↗
PubMed1994

Medication effects on referent communication in schizophrenic patients: an evaluation with a structured task.

Objective measures of communication efficiency were collected twice on 10 schizophrenic patients while they participated in a structured interactive task which has seen considerable use in developmental studies of communication skills. Referential communication and thought disorder were assessed while patients were off and then on neuroleptic medication. While medicated, subjects produced more informative task-related responses. Drug-free subjects produced more unclear references and episodes of bizarre speech. These "interruptive" tendencies appeared to be a problem of dialogue maintenance and attentional focus, which improved with medication.

Adult↗
PubMed1994

A multimethod, multichannel assessment of affective flattening in schizophrenia.

Flat affect was examined across multiple contexts (during interviews and emotional films), multiple channels of expression (facial and vocal), and different assessment techniques (clinical ratings, observational ratings of facial expression, and acoustic analyses) in 23 medication-free schizophrenic patients. Patients participated in three different interviews during which either clinical ratings were made or their voices were audiotaped for later acoustic analyses. Patients were also videotaped while they viewed positive and negative emotional films. The videotapes were then coded for the frequency, intensity, and duration of positive and negative facial expressions. Results indicated that general clinical ratings were related across different interviews. However, only those items specific to affective flattening bore significant relationships to vocal and facial expressiveness. Vocal expressiveness and negative facial expressiveness were related, but vocal expressiveness was not related to positive facial expressiveness.

Adult↗
PubMed1994

The syntactic role of pauses in the speech of schizophrenic patients with alogia.

This study examines the relation between alogia and pausing. The authors analyzed the flow of speech of 17 male schizophrenic patients during an interview, particularly the pauses that occurred within and between syntactic clauses and those that occurred as the turn switched from the interviewer's question to the patient's response. The strongest predictor of alogia ratings was the duration of switching pauses; the frequency of long within-clause pauses was also significantly related to alogia, but the frequency of between-clause pauses showed a trend toward a negative relation with alogia. Words following within-clause pauses were more likely to be content words than function words, and the content words were less frequent in the English language than the speaker's other words. This suggests that alogic patients have difficulty in word finding and in thought formulation, as well as a general increase in the duration of all pauses.

Adult↗