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Biomedical subjects

M Harrow

Publications and source records attributed to M Harrow.

At least 37 records · Page 2Linked to original sources
PubMed1986

Schizophrenic thought disorder at followup: its persistence and prognostic significance.

To assess the prominence, persistence, and prognostic significance of positive thought disorder in schizophrenia, we studied a large sample of psychiatric inpatients at the acute phase and then followed them up twice--1 1/2-2 years and 4 years after hospital discharge. Positive thought disorder was more prominent at the acute phase in schizophrenic and manic patients than in other types of psychotic and nonpsychotic disorders. At followup, positive thought disorder did not persist for all schizophrenics, but a significantly larger percentage of schizophrenic than other psychotic and nonpsychotic patients followed a course in which positive thought disorder was either persistently or episodically present. Positive thought disorder, when seen after the acute phase, was related to concurrent functioning, and predicted subsequent poorer outcome and functioning for both schizophrenic and nonschizophrenic patients. Positive thought disorder was one of several central features of the active schizophrenic disorder. Among schizophrenics, it was related to other major types of psychopathology, especially delusions, another positive symptom with cognitive-ideational elements. Severe positive thought disorder after the acute phase indicated a sustained episode, and suggested a more severe type of schizophrenia with a poorer prognosis.

Acute Disease↗
PubMed1986

Evaluating bizarre-idiosyncratic thinking: a comprehensive index of positive thought disorder.

A summary of our method of assessing positive thought disorder, or bizarre-idiosyncratic thinking, from two short verbal tests is presented. This measure provides for standardized thought disorder assessments of: the overall presence and severity of thought disorder, and the type of disordered thinking shown. A definition and examples of bizarre-idiosyncratic thinking are provided, along with information on the reliability and validity of the scoring system. A method of establishing subject groups based on the severity of positive thought disorder also is presented--ranging from no thought disorder, to abnormal thinking, to severe formal thought disorder. This measure has been used to assess longitudinal changes in thought disorder symptoms over time and to evaluate relationships between thought disorder, other aspects of psychopathology (such as delusions), and adjustment in other areas of functioning across diagnostic groups.

Humans↗
PubMed1986

Features associated with thought disorder in manic patients at 2-4-year follow-up.

The authors assessed 47 formerly hospitalized manic patients for thought disorder 2-4 years after discharge and studied the relationship between thought disorder and other major clinical variables. Fourteen (30%) of the manic patients showed severe positive thought disorder 2-4 years after hospitalization. Partial correlations and multiple regression analyses indicated that thought disorder at follow-up was most closely related to the presence of manic behavior and psychosis. It was also more frequent in manic patients with poor posthospital functioning and in manic patients with multiple previous manic episodes or a more chronic course of illness.

Adolescent↗
PubMed1985

Paranoid and nonparanoid schizophrenia: drive dominated thinking and thought pathology at two phases of disorder.

A sample of acutely hospitalized paranoid and nonparanoid schizophrenics and another sample of paranoid and nonparanoid schizophrenics studied at follow-up were compared on measures of cognitive functioning, disordered thinking, and drive dominated thinking using the WAIS, the Rorschach test, the object sorting test, and an overall index of outcome functioning (N = 67). Results suggested that cognitive regression is related more to acute psychological disturbance than to the presence or absence of paranoia, that the presence of socialized drive dominated thinking during the acute phase is related to better posthospital adjustment at follow-up, and that paranoid schizophrenics show better cognitive functioning after the acute phase. Results did not support the theory that suggests an etiological relation between homosexual conflict and paranoia.

Adult↗
PubMed1985

The thought behind the words: a view of schizophrenic speech and thinking disorders.

Chaika (1982) has proposed that what is frequently viewed as a schizophrenic thought disorder should more precisely be regarded as a speech disorder. We suggest, however, that one should emphasize constructs concerning disordered schizophrenic thinking. We support this position since the schizophrenic's strange speech can fit into a larger view about his disordered thinking which is grounded in a nomological net involving various different types of strange behavior. Other support comes from (1) the use of tests assessing disordered nonverbal behavior, (2) evidence that schizophrenics intermingle personal concerns (ideas) into their verbalizations, (3) bizarre schizophrenic behavior, and (4) the very large percent of schizophrenics with delusions. There is an intricate link between language--which includes a system of symbols, words, and meanings--and thinking. Thus, we have proposed that the disturbance most frequently observed in schizophrenic verbalizations be viewed as involving conceptual-linguistic activity, and not just a problem of speech activity.

Cognition Disorders↗
PubMed1985

Negative symptoms in schizophrenia: their longitudinal course and prognostic importance.

Negative and positive symptoms were investigated longitudinally in 39 young schizophrenic patients at two followup assessments approximately 2.5 and 5 years after hospital discharge. Negative symptoms, such as flat affect and poverty of speech, which were assessed at the first followup, were found to be effective prognostic signs in schizophrenic patients for predicting later poor role functioning at the second followup. The prognostic importance of negative symptoms was predominantly due to their tendency to occur in patients who were already functioning poorly in social and instrumental areas at the first followup, and who tended to continue doing poorly at the second followup. Contrary to some current hypotheses, positive symptoms, such as delusions and hallucinations, were also found to be prognostic of later deficits in role functioning at the second followup. Negative symptoms appeared to be generally persistent over time, although there was some tendency toward remission. Potential models of the etiology of negative symptoms and their role in schizophrenia are proposed.

Adolescent↗
PubMed1985

The course of psychosis in early phases of schizophrenia.

To study the course of psychosis in early schizophrenia, the authors assessed 111 patients at hospitalization and at one or two follow-ups. The course of psychosis was analyzed separately for broad (DSM-II) and narrow (DSM-III) concepts of schizophrenia. The patients diagnosed with DSM-II improved in psychosis between the first and second follow-ups. Those also diagnosed with DSM-III showed more persistent psychosis; 40% were psychotic at both follow-ups. A subgroup of patients showed improvement in psychosis even after several years of sustained symptoms. The authors discuss the implications of the data for views about the persistence of psychotic symptoms.

Adult↗
PubMed1985

Thought disorder. A function of schizophrenia, mania, or psychosis?

Does thought disorder emerge solely as a function of psychosis, or is it a function of diagnosis? The present research investigated whether thought disorder is more frequent in specific diagnostic groups, such as schizophrenia and mania, than in other types of psychotic disorders. The frequency and severity of positive thought disorder was assessed in 324 Research Diagnostic Criteria and DSM-III schizophrenics, manics, other psychotic patients, and nonpsychotic patients, and a normal comparison group. Fifty-seven percent of the sample were first hospital admissions. Patients were tested at the acute phase of their disorder, within the first 2 weeks of hospitalization, with three cognitive tests. Scores from these three tests were scaled to obtain a composite index of the severity of positive thought disorder. Diagnostic factors were more salient to the severity of disordered thinking than was psychosis. Thought disorder was significantly more frequent in schizophrenia and mania than in other psychotic disorders (p less than .05). The frequency of patients with severe thought disorder was reduced as one moved down the hierarchy of manic, schizophrenic, schizoaffective, and depressed psychotic disturbances (p less than .001). Rather surprisingly, the current research suggests that nonpsychotic manic patients may be as thought disordered as psychotic manic patients at acute phases of disturbance. This would indicate that the presence of positive thought disorder in mania is not primarily a function of most of these patients' being psychotic at the acute phase of disturbance. Thought disorder was not simply a function of psychosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1984

Outcome in schizoaffective disorders: a critical review and reevaluation of the literature.

A review of a number of major studies of the outcome of schizoaffective disorders, focusing on how schizoaffective disorders should be viewed diagnostically, is presented. An analysis is made of various research methods used, including prospective, retrospective, and prognostic approaches. Results of the analysis suggest that prospective studies are more valuable. The research results on outcome question the thesis that schizoaffective disorders are only affective disorders. Overall, the mixed results reveal that the outcome of schizoaffective disorders is poorer than that of affective disorders and better than that of schizophrenia. Since outcome is one type of validating criterion which can be used for establishing diagnostic categories, the results question aspects of the DSM-III system of categorizing schizoaffective disorders. We suggest that mood-incongruent psychotic symptoms either influence outcome negatively or are associated with other features which influence outcome negatively.

Bipolar Disorder↗
PubMed1984

Negative and positive symptoms in schizophrenia and depression: a followup.

Negative and positive symptoms were investigated in a sample of 72 young schizophrenic and depressed patients at followup approximately 1 1/2 years after hospital discharge. Flat affect, poverty of speech, and psychomotor retardation were included as negative symptoms, and delusions, hallucinations, and florid thought disorder as positive symptoms. Marked negative symptoms were found to occur in a subgroup of schizophrenic subjects at followup, but were infrequent in depressed subjects. Educational difficulties and poor social functioning before initial hospitalization were associated with later negative symptoms at followup for schizophrenic subjects. Negative symptoms were also related to concurrent outcome measures of instrumental and social functioning at followup. Contrary to some hypotheses, negative and positive symptoms, when assessed concurrently, were not at opposite ends of a bipolar continuum. Rather, they appeared to be independent phenomena in schizophrenia during the early posthospital phase. Overall, these results suggest that negative symptoms are important for a subgroup of schizophrenic patients during the early course of their disorder and that they have important correlates with specific aspects of role functioning.

Adolescent↗
PubMed1984

Prognosis and outcome using broad (DSM-II) and narrow (DSM-III) concepts of schizophrenia.

The classical prognostic indicators of Vaillant and Stephens, the acute onset of psychotic symptoms, and key demographic factors were investigated as predictors of outcome in a prospective study of 153 schizophrenic patients defined using broad (DSM-II) and narrow (DSM-III) concepts of schizophrenia. Findings indicate: Several established prognostic items did not show strong predictive utility in DSM-II or DSM-III schizophrenia when young, nonchronic patients were studied. For both DSM-II and DSM-III schizophrenic patients, longitudinal assessments of psychotic symptoms, work history, and social functioning predicted their respective assessments at followup. However, the predictive utility of some key prognostic indicators shifted for narrow vs. broad concepts of schizophrenia. Most importantly, sex, which was the most powerful predictor of overall outcome among patients with DSM-II schizophrenia, failed to predict outcome among patients with DSM-III schizophrenia, primarily because many women with favorable outcome did not meet the DSM-III criteria for schizophrenia. DSM-III schizophrenia comprises a more homogeneous group of poor prognosis patients in comparison to DSM-II schizophrenia. Educational level, age at first hospitalization, and work history were successful predictors of outcome (p less than .01) when a new, narrow concept of schizophrenia was used.

Acute Disease↗
PubMed1984

The longitudinal course of schizoaffective disorders. A prospective follow-up study.

To study whether outcome of schizoaffective psychosis is more similar to that of schizophrenia, or major affective disorders, or whether it shows an intermediate pattern between these two disorders, we conducted a prospective follow-up study of 167 patients from two hospitals. Thirty-nine schizoaffective patients, 47 schizophrenic patients, 33 manic patients, and 48 patients with major depressive disorders were assessed during hospitalization and then followed up 1 year after hospital discharge. Standardized assessments were conducted of patients' work functioning, social adjustment, symptom outcome, rehospitalization, treatment at follow-up, and their overall posthospital adjustment. The data indicated the following: a) On both major scales of overall outcome, schizoaffective patients' posthospital adjustment was significantly poorer than that of patients with major affective disorders (p less than .01), and showed a nonsignificant tendency to be better than that of schizophrenics. Only 10 per cent of the schizoaffective patients had very favorable outcomes. b) There were no significant differences in overall outcome between schizoaffective patients who were manic vs. depressed, or mainly affective vs. mainly schizophrenic (p greater than .20). c) Both the schizoaffective and affectively disordered patient groups had significantly better posthospital work functioning than did the schizophrenic patients (p less than .05). d) However, both the schizoaffective and schizophrenic groups had significantly poorer posthospital social functioning than did the affectively disordered patients. Overall, the data suggest that outcome of schizoaffective disorders differs in some ways from that of both schizophrenia and affective disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

State dependence of noradrenergic activity in a rapidly cycling bipolar patient.

Plasma levels of the major norepinephrine (NE) metabolite, 3-methoxy-4-hydroxyphenylglycol (MHPG), were measured in a rapidly cycling bipolar patient and her first-degree relatives. The mood state dependence and the reciprocal relationship between noradrenergic and cholinergic activity were investigated by assessing mood, thought disorder, and plasma MHPG following the infusion of physostigmine. A correlation was found between plasma MHPG and mood states, with exceedingly high levels during mania and hypomania. Levels were significantly decreased by ECT or combined lithium and chlorpromazine administration. A pathologic diurnal MHPG pattern was detected during periods of abnormal mood changes. Infusion of physostigmine led to a prompt reduction in MHPG release and a marked decline in mood-state measurements and the overall level of thought disorder. Muscarinic receptors exerting negative feedback control over the synthesis and/or release of NE may have become supersensitive as a consequence of alpha 2-adrenoceptor densensitization.

Adolescent↗
PubMed1983

Disordered thinking.

To evaluate formulations that thought disorder at the posthospital phase identifies a subgroup of nuclear schizophrenics with poor outcomes, 77 patients from a longitudinal project were followed up on major dimensions of psychopathology linked to nuclear schizophrenia. The data indicate that (1) schizophrenics were more thought disordered than were nonschizophrenics at the posthospital phase; (2) thought-disordered schizophrenics had only slightly poorer scores on classic prognostic indicators associated with poor outcomes; (3) a subgroup of early chronic schizophrenics were not severely thought disordered; (4) almost all severely thought-disordered schizophrenics demonstrated clear evidence of delusional activity at follow-up; and (5) thought-disordered schizophrenics had poorer outcomes. The overall results fit in with formulations that a severe thought disorder is one of several major features of schizophrenia. The data suggest that posthospital thought disorder identifies a subgroup of poor-outcome schizophrenics, although some non-thought-disordered schizophrenics also show poor outcomes.

Adult↗
PubMed1983

Word association: multiple measures and multiple meanings.

Investigated the interrelationships between reaction time and three major verbal word association variables (response commonality, idiosyncratic responses, and degree of logical relatedness) in schizophrenics (N = 42) and nonschizophrenic psychiatric controls (N = 30). This study investigated the degree to which these four measures assess similar or different components of associative thought disorder in the same Ss, using both verbal associative measures and a nonverbal performance measure. Results indicated that reaction time was largely independent of all verbal measures in schizophrenics. These data were discussed in regard to the meaning and interpretation of word association test data as a function of choice of dependent variables for measuring associative thought disturbance.

Humans↗
PubMed1983

Disordered thinking in schizophrenia: intermingling and loss of set.

In a study of schizophrenic thought pathology, potential loss of set and intermingling were examined. The responses of 36 acute psychiatric patients who showed intermingling were analyzed. Intermingling, frequently seen in the speech and thinking of schizophrenic patients, involves the blending of personal material from one's experiences into one's thinking and communication, leading to bizarre and inappropriate speech. The results indicated that intermingling frequently leads to some loss of goal-directed thinking, but not usually to complete loss of set. Patients adopt new sets based partly on the original topic and partly on their own personal idiosyncratic concerns. The apparent "looseness" of schizophrenic patients is based on thematic shifts to idiosyncratic ideas, often from the beginning of their responses, rather than on word-to-word associative looseness. Intermingling of personal concerns typically occurs in a nonfragmented fashion. Schizophrenics and other psychotic patients show significantly more intermingling of personal material in open and undisguised fashion, as though they do not recognize how inappropriate their intermingling appears. The results suggest that although the intrusion of personal material is task inappropriate, it still represents a form of systematic, goal-oriented thinking.

Adult↗
PubMed1983

Neurotic symptoms in the postacute phase of schizophrenia.

To assess the presence and importance of neurotic and depressive symptoms in the posthospital phase of schizophrenia, two samples of schizophrenic and nonschizophrenic patients were studied. The first sample consisted of 278 chronic patients and the second sample consisted of 284 relatively early phase, less chronic, patients. The following results emerged. a) Surprisingly high levels of neurotic/depressive symptoms are found in both schizophrenic and nonschizophrenic patients during the posthospital phase. b) Nonschizophrenic patients experience an equal or greater degree of neurotic symptom discomfort than schizophrenics, and any differences do not reach statistically significant levels. c) Neurotic/depressive symptoms seems to be one key area in which schizophrenics do not function more poorly during the posthospital phase than nonschizophrenic patients. d) The results cut across different social classes, different institutional settings, and different levels of chronicity. These data suggest that neurotic and depressive symptoms may play a greater role in the posthospital functioning of both chronic and nonchronic psychiatric patients than has heretofore been recognized.

Adult↗