Faculty Bibliography

In a prospective 2-year follow-up of 37 young acute schizophrenics, we examined the predictive significance and relative contribution of historical, genealogical, course, and clinical dimensions. Patients were evaluated multidimensionally at index admission and after 21 to 33 months, at which time 19 cooperated in follow-up involving clinical, functional, psychometric, and objective outcome measures. Multiple regression analysis found that combinations of 3 to 4 index variables significantly predicted 13 of 14 outcome measures, yielding multiple R values between .63 and .93 (X = .78). In total, a set of eight parameters contributed in explaining the outcome variance. The strongest overall predictor of favorable outcome was baseline negative syndrome. Other significant predictors were good premorbid school functioning, favorable prior disposition, sudden onset of illness, nonparanoid subdiagnosis, family history of alcoholism, psychomotor retardation, and depression. Accordingly, a patient's premorbid adjustment, course of illness, and presenting clinical profile provided nonoverlapping sources of outcome prediction. Of these three dimensions, it was proposed that the prognostic significance of the clinical profile may be phase specific, carrying different implications when assessed in the acute vs. chronic stage of illness.

In order to investigate the structure, longitudinal course, and significance of affect impairments in young acute schizophrenics, we prospectively studied a group of 37 consecutively admitted acute inpatients at baseline and 26 months later (n = 19). They were evaluated at both points on a multidimensional affect rating scale, psychopathology rating scales, and tests of attention and motorium. Additionally, they were assessed on historical and subdiagnostic variables at baseline and on level of functioning at follow-up. Factor analysis revealed three reliably measured affect components: emotional unrelatedness, expressive immobility, and inappropriateness of affect. The first two factors were strongly interrelated and associated also with the BPRS depression factor at baseline. All four affective dimensions proved unstable over the course of 2 years and produced different sets of correlates at the two points of time. In the acute phase, only the depression factor carried favorable prognostic import (r = 0.52, P less than 0.05). Emotional unrelatedness and expressive immobility were of unfavorable consequence only when observed in the follow-up stage. Thus, the affect profile seemed to be an evolving rather than a static phenomenon, precluding generalizations across the early course of schizophrenia. Possible interpretations of the baseline overlap between affect deficits and depression were discussed as well as their different prognostic implications

The construct validity and extended stability of positive and negative syndromes were studied via multidimensional cross-sectional assessment of 134 schizophrenics in the acute, chronic, and long-term chronic stages. For all groups the syndromes were internally reliable, not significantly intercorrelated, and of similar severity. The syndromal correlates with clinical, motor, historical, and genealogical dimensions, however, differed as a function of chronicity. In acute schizophrenics, a negative syndrome was associated with clinical and genealogical indicators of good prognosis, whereas the converse obtained for a positive syndrome in the acute stage and a negative syndrome in the chronic stage. The relationship of education, marital status, and attention disorder to the positive-negative distinction also varied according to length of illness. Its meaning, therefore, appeared phase-specific and subject to evolution, obviating generalizations across all phases. Implications for theory, prognosis, current research, and future study are presented

This study considered whether chronic schizophrenics with positive and negative syndromes represent distinct subtypes. From a survey of 47 schizophrenic inpatients, 18 showed preponderance of productive or deficit features, and four were mixed. The discrete groups were compared on clinical symptoms, cognitive tests, demographic and historical data, and drug side effects. They were significantly distinguished on most criterion symptoms and affect scales but, otherwise, essentially comparable in psychopathology and extrapyramidal symptoms. The tests revealed similar levels of intellectual impairment and visual-motor deficit, yet the negative patients displayed more primitive cognitive mode and greater psychomotor retardation. They also proved older, less educated, more often born in winter-time, hospitalized later in life, and less heavily medicated. The results supported the validity of the positive-negative dimension for identifying schizophrenic subtypes and suggested etiological implications regarding developmental deficiency

Radioreceptor assay, a promising new tool for studying serum levels of neuroleptics and their biologically active metabolites, was used to elucidate the role of neuroleptic plasma levels in 24 chronic schizophrenic patients with a poor clinical response to standard treatment. Most of these 24 patients attained serum levels reportedly associated with improvement in more acute patients, suggesting that their lack of response was not due to relative absence of drug in serum. Alternative reasons for lack of response despite adequate plasma levels are discussed.

Toxic psychosis due to quinacrine treatment represents an infrequent, but serious psychiatric complication. Psychiatrists should be familiar with this side effect as quinacrine continues to be used as an antimalarial, as an antihelmintic and as an antineoplastic agent. A case of a young male is presented who developed an acute toxic psychosis which necessitated psychiatric hospitalization. The case is discussed in light of previously published clinical reports and experimental studies. It appears that quinacrine acts as a cortical stimulant, but the exact mechanism of its action on the CNS is not clear at this point