Biomedical subjects
R H Dworkin
Publications and source records attributed to R H Dworkin.
Proposed classification of herpes zoster pain.
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Pain insensitivity in schizophrenia: a neglected phenomenon and some implications.
The literature on insensitivity to pain in schizophrenia is reviewed. Numerous reports indicate that, relative to normals, individuals with schizophrenia are insensitive to physical pain associated with illness and injury. In addition, insensitivity to pain of various sorts administered in experimental studies has been reported frequently in this population. This extensive and diverse literature of clinical and experimental reports suggests that many individuals with schizophrenia are less sensitive to pain than normal individuals. However, because the experimental studies--almost all of which were conducted before 1980--suffer from a variety of methodological limitations, this research provides neither a satisfactory characterization nor an adequate explanation of pain insensitivity in schizophrenia. It is argued that this widely reported but currently neglected phenomenon has important implications for physical health, self-mutilation, homelessness, premorbid development, and affective flattening in individuals with schizophrenia.
Social competence deficits in adolescents at risk for schizophrenia.
Social competence in subjects at risk for schizophrenia and affective disorder and in normal-comparison subjects was examined in childhood and adolescence. Based on interviews with the parents of the subjects and with the children and adolescents themselves, subjects at risk for schizophrenia had poorer overall social competence than subjects at risk for affective disorder and comparison subjects in early adolescence and adolescence but not in childhood. In analyses of specific aspects of social competence, the adolescents at risk for schizophrenia had significantly poorer peer relationships and decreased hobbies/interests than the adolescents at risk for affective disorder and the normal-comparison adolescents. With respect to school adjustment, however, the two groups of adolescent offspring of parents with psychiatric disorders had significantly poorer adjustment than the comparison adolescents but did not differ from each other on this measure. These results suggest that various aspects of poor social competence may precede the onset of schizophrenia and play an important role in its development.
Childhood precursors of affective vs. social deficits in adolescents at risk for schizophrenia.
Childhood attentional and neuromotor precursors of social competence and affective deficits in adolescents at risk for schizophrenia, adolescents at risk for affective disorder, and matched comparison adolescents were examined. The subjects were offspring of parents with schizophrenia or affective disorder and of normal parents matched on age, sex, and socioeconomic status from the New York High-Risk Project (Sample B). On the basis of interviews conducted when the subjects were children and adolescents, social competence was rated from child reports and parent reports, affective deficits were assessed by affective flattening ratings, and smiling was assessed by counting broad smiles. Adolescents at risk for schizophrenia had significantly greater social and affective deficits than adolescents at risk for affective disorder and comparison adolescents. In subjects at risk for schizophrenia, childhood neuromotor dysfunction predicted adolescent affective flattening, and childhood attentional dysfunction predicted adolescent social deficits. The results suggest that affective and social deficits in schizophrenia have different childhood precursors.
A high-risk method for studying psychosocial antecedents of chronic pain: the prospective investigation of herpes zoster.
Although patients with chronic pain are often psychologically distressed, it has been difficult to determine whether this distress is an antecedent of chronic pain or whether it is caused by the experience of living with chronic pain. The aim of this investigation was to develop a method that would allow individuals who are at risk for the development of chronic pain to be studied before their pain has become chronic. Patients with acute herpes zoster were assessed with demographic, medical, pain, and psychosocial measures. Pain was assessed in follow-up interviews at 6 weeks and 3, 5, 8, and 12 months after these initial assessments. There were no significant differences between patients who developed short-term herpes zoster pain and patients who did not develop short-term pain for any of the measures at the initial assessment, except for one measure of pain intensity. Patients who developed chronic herpes zoster pain, however, had significantly greater pain intensity, higher state and trait anxiety, greater depression, lower life satisfaction, and greater disease conviction at the initial assessment than patients who did not develop chronic pain. In discriminant analyses, disease conviction, pain intensity, and state anxiety each made a unique contribution to discriminating patients who did and who did not develop chronic pain. This study demonstrates the feasibility of investigating psychosocial antecedents of the development of chronic pain by prospectively examining the longitudinal course of herpes zoster.
Affective deficits and social deficits in schizophrenia: what's what?
Affective deficits and social deficits have played an important role in theory and research on schizophrenia, and it has generally been assumed that these are two different types of symptoms. The aim of these comments is to argue that the distinction between these symptoms is not straightforward and that the apparent differences between affective and social deficits virtually disappear when current approaches to their definition and measurement are considered. The implications of this point with regard to theory and research on the etiology and treatment of schizophrenia are discussed, and an approach that has the potential to reveal whether specific schizophrenic symptoms are more closely associated with affective deficits or with social deficits is described.
Simple schizophrenia: an investigation of Bleuler's criteria based on the major twin studies of schizophrenia.
Schizophrenics fulfilling Bleuler's criteria for simple schizophrenia--no evidence of hallucinations, delusions, and catatonic behavior--were similar to schizophrenics with more typical forms of the disorder with respect to negative symptoms, premorbid social adjustment, and age at onset. These results support the validity of the simple schizophrenia subtype by providing evidence that schizophrenics without conspicuous positive symptoms are similar to those with such symptoms on these core features of the disorder.
Simple schizophrenia, negative symptoms, and prefrontal hypodopaminergia.
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Childhood attentional dysfunctions predict social deficits in unaffected adults at risk for schizophrenia.
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Examining the underlying structure of schizophrenic phenomenology: evidence for a three-process model.
The present report examined the latent structure of schizophrenic phenomenology. Schizophrenic patient case histories (n = 192) were rated for positive symptoms, negative symptoms, and premorbid social adjustment and the observed covariation among these clinical features was evaluated using a model-based confirmatory factor analytic approach. Our results indicated that schizophrenic phenomenology was best characterized by three distinct underlying structures. These data provide empirical support for Strauss et al.'s (1974) three-process model, which suggests that positive symptoms, negative symptoms, and disordered premorbid personal-social relationships are three distinct classes of phenomenology possibly reflective of three relatively independent pathological processes in schizophrenia. The data are also consistent with Crow's (1980, 1985, 1987) model of schizophrenic symptomatology, differentiating social impairment from both positive and negative symptoms. The heuristic implications of these data for the development of schizophrenia are discussed and the utility of a replication of the present study is noted.
Clinical aspects of depression in chronic pain patients.
It has been widely recognized that an appreciable proportion of chronic pain patients have depressive disorders. Although numerous studies and several literature reviews have examined the relationship between chronic pain and depression, disorders of mood come in many forms, and little attention has been paid to the different types of depressive disorders found among patients with chronic pain. In this article, the different ways in which a chronic pain patient may manifest depression are discussed. Diagnostic criteria for major depression, dysthymia, and atypical depression are described, and the relevance of these disorders and of masked depression to chronic pain is discussed. The medical illnesses and medications that can cause symptoms of depressive disorders are also briefly described. Depressive disorders and their concomitants are an integral part of the experience of chronic pain and are important in developing an optimal treatment plan. For these reasons, they should be carefully evaluated in all patients with chronic pain.
Social competence and positive and negative symptoms: a longitudinal study of children and adolescents at risk for schizophrenia and affective disorder.
OBJECTIVE: The authors longitudinally examined social competence and positive and negative symptoms in children at risk for schizophrenia, children at risk for affective disorder, and matched normal subjects. METHOD: The subjects were offspring of parents with schizophrenia or affective disorder and normal comparison subjects matched on age, sex, and socioeconomic status. Ratings of social competence (Premorbid Adjustment Scale), affective flattening and poverty of speech (Scale for the Assessment of Negative Symptoms), and positive formal thought disorder (Scale for the Assessment of Positive Symptoms) were based on videotaped psychiatric interviews conducted in childhood (N = 144), early adolescence (N = 127), and adolescence (N = 106). RESULTS: In childhood, there were no significant group differences. In early adolescence, the subjects at risk for schizophrenia had poorer social competence than those at risk for affective disorder and the normal subjects. In early adolescence, the subjects at risk for schizophrenia also had greater positive thought disorder than those at risk for affective disorder but did not differ significantly from the normal subjects; there were no differences in negative symptoms. In adolescence, the subjects at risk for schizophrenia had poorer social competence and greater positive and negative symptoms than the adolescents at risk for affective disorder and the normal subjects. CONCLUSIONS: During early adolescence and adolescence, poor social competence may be more characteristic of children at risk for schizophrenia than those at risk for affective disorder. Higher levels of positive and negative symptoms may also be specific to subjects at risk for schizophrenia, but only during adolescence.
Patterns of sex differences in negative symptoms and social functioning consistent with separate dimensions of schizophrenic psychopathology.
In 220 schizophrenic twins, men had greater asociality-withdrawal and poorer premorbid social competence than women but there were no sex differences in symptoms, suggesting that negative symptoms and social functioning reflect different processes in the development and manifestation of schizophrenia and that they should be examined separately.
Positive and negative symptoms and social competence in adolescents at risk for schizophrenia and affective disorder.
The authors compared adolescents at risk for schizophrenia and affective disorder and normal adolescents. The subjects at risk for schizophrenia had significantly poorer social competence, and formal thought disorder was greater in both high-risk groups. There were no group differences in negative symptoms.
Models of positive and negative symptoms in schizophrenia: an empirical evaluation of latent structures.
The present investigation empirically evaluated three competing models of the relations between positive and negative symptoms in schizophrenia, namely the severity-liability model (Gottesman, McGuffin, & Farmer, 1987), Andreasen's unidimensional bipolar model (Andreasen & Olsen, 1982), and Crow's independent dual-process model (Crow, 1980a, 1980b). Using positive and negative symptom ratings based on 220 schizophrenic subjects, the results of a LISREL VI (Joreskog & Sorbom, 1984) confirmatory factor analysis revealed that Crow's model of positive and negative symptoms provided the best fit to the observed data among the three models. The severity-liability model provided a modest fit to observed data, and Andreasen's model fit the data poorly. Results are interpreted as supporting the validity of the positive and negative symptom distinction in schizophrenia and as providing substantive empirical support for Crow's independent dual-process model. The methodological advantages of confirmatory factor analysis in the specification and evaluation of theoretical models in experimental and developmental psychopathology are discussed.
Psychiatric diagnosis and chronic pain: DSM-III-R and beyond.
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A multidimensional approach to the genetics of schizophrenia.
To determine which dimensions of psychopathology are associated with a greater liability to develop schizophrenia, the authors examined the case histories of 151 monozygotic probands from five twin studies. Proband twins from pairs concordant for schizophrenia had greater numbers of negative symptoms, poorer premorbid adjustment, fewer paranoid symptoms, and earlier ages at onset than probands from discordant pairs. In discriminant analyses, negative symptoms, premorbid social competence, and paranoid symptoms each contributed to the discrimination between concordant and discordant pairs. These results provide support for Strauss et al.'s suggestion that these three types of symptoms reflect three different functional processes in the development of schizophrenia.