Edward Kaplan

Insight and interpersonal function in schizophrenia.

Research has linked impaired insight in schizophrenia to poorer medication compliance and treatment outcome. It is unclear, however, whether poorer interpersonal function is also associated with impaired insight. To examine this question, subjects with schizophrenia or schizoaffective disorder were classified as having unimpaired (N = 44) or impaired (N = 57) insight, and their scores on Heinrichs et al.s Quality of Life (QOL) Scale were compared. Multiple regressions were conducted to determine the relationship between individual components and social function. Results indicate that subjects with impaired insight had significantly poorer QOL interpersonal relation and intrapsychic foundation scores than unimpaired subjects, despite having equivalent deficit symptoms. Unawareness of the social consequences of illness was found to be the component of insight more closely linked to social dysfunction. This suggests that impairments in insight may be uniquely associated with social dysfunction.

Neurocognitive function and insight in schizophrenia: support for an association with impairments in executive function but not with impairments in global function

It remains unclear how impaired insight and neurocognitive impairment are related to one another in schizophrenia. In order to examine this relationship, subjects with schizophrenia or schizoaffective disorder were classified as having‘impaired’(n=38) or‘unimpaired’(n=43) insight based on their insight rating on the Positive and Negative Syndrome Scale (PANSS). Their performance on neuropsychological tests of global function, executive function, memory and vigilance was then compared. Multivariate analyses followed by Scheffe tests indicated that subjects with impaired insight performed less well on the Wisconsin Card Sorting Test, demonstrating poorer abstract flexibility and heightened perseveration. No differences were found between the groups with regard to global cognitive function, memory or vigilance. This suggests that insight is closely linked to deficits in executive function, and that it may be associated with the compromise of frontal lobe function.

Personality and psychopathology in schizophrenia: The association between personality traits and symptoms

Research has indicated that stable individual differences in personality exist among persons with schizophrenia, and that they likely predate the onset of illness. Little is known, however, about whether individual differences in personality are related to levels of psychopathology. This study tested the hypotheses that levels of Extroversion, Neuroticism, and Psychoticism are associated with symptomatology. Accordingly, measures of these dimensions of personality and of symptomatology were obtained simultaneously for 113 male subjects with schizophrenia or schizoaffective disorder. Next, subjects were characterized as having high or low levels on each personality dimension and their scores on the five components of the Positive Negative Syndrome Scale were compared using multivariate and univariate procedures. Results indicate that extroverted subjects had lower levels of Positive, Negative, and Emotional Discomfort symptoms, and higher levels of Excitement symptoms than introverted subjects. Subjects with higher levels of Neuroticism had higher levels of Positive and Emotional Discomfort symptoms than subjects with lower levels of Neuroticism. No differences in symptoms were found among subjects with higher versus lower levels of Psychoticism. Results suggest individual differences in personality are associated with psychopathology in schizophrenia and may help further explain the heterogeneity widely observed in this disorder.

The functional consequences of memory impairments on initial work performance in people with schizophrenia.

Exploring the link between cognitive impairments and domains of function is a new trend in schizophrenia research. This study reports on the association of verbal memory impairment and initial work function for a group of 87 individuals diagnosed with either schizophrenia or schizoaffective disorder. Multiple regression analyses were used to predict the degree of association between verbal memory variables and ratings on the Work Behavior Inventory (WBI) in the initial week of a vocational rehabilitation program. Results indicated that verbal memory scores predicted 20% of the WBI total score. Results also indicated strong relationships with the individual work domains of work habits and work quality and weaker relationships with the domains of cooperativeness and personal presentation. No significant relationship was found between verbal memory variables and social skills at the job site. Verbal memory impairment is discussed as a rate limiting factor in rehabilitation.

Internal consistency, temporal stability and neuropsychological correlates of three cognitive components of the Positive and Negative Syndrome Scale (PANSS)

Comprehensive models of schizophrenia have increasingly included symptoms of cognitive dysfunction as an important feature of schizophrenia. Factor analytic studies of the Positive and Negative Syndrome Scale (PANSS) have consistently established cognitively disorganized symptoms as a separate domain from positive and negative symptoms. However, the individual symptom composition of the cognitive domain varies from model to model. The present study explores the temporal stability, internal consistency, concurrent validity, and discriminant validity for three published PANSS factor analytically derived cognitive components (Bell et al., 1994a, Psychiatry Res., 52, 295-303; Dollfus et al., 1991. Eur. Psychiatry, 6, 251-259; Kay and Sevy, 1990. Schizophr. Bull., 16, 537-544). Analyses were conducted using PANSS data from 120 patients with DSM-IV diagnoses of schizophrenia or schizoaffective disorder. Results indicate that the Bell et al. and Kay and Sevy models have similar psychometric properties including adequate temporal stability, internal consistency, and discriminant validity. The Kay model demonstrated somewhat better concurrent validity with cognitive test measures, while the Dollfus model demonstrated relatively poor psychometrics. The symptom composition of a narrowly defined cognitively disorganized subtype and a more broadly defined cognitively impaired subtype are discussed in terms of their value for schizophrenia research.

Personality and psychosocial dysfunction in schizophrenia: the association of extraversion and neuroticism to deficits in work performance

Research on vocational dysfunction in schizophrenia has as yet only examined associated features of illness. We hypothesized that personality variables may be also associated with work function. We reasoned that higher levels of extraversion and neuroticism would predict poor function by virtue of the social support seeking and passive/avoidant coping styles associated with each. To test this, multiple regressions were conducted in which measures of extraversion and neuroticism predicted work performance among 43 subjects with schizophrenia or schizoaffective disorder. Higher levels of extraversion and neuroticism significantly predicted poorer function, accounting for between 7% and 27% of the variance in global cooperativeness, work quality, work habits and personal presentation measures of work behavior. The potential importance of assessing personality in rehabilitation is discussed.

Affect recognition in deficit syndrome schizophrenia

This study has three aims: (1) to compare a deficit syndrome schizophrenia sample (n=19) with a non-deficit sample (n=50) on affect recognition; (2) to determine the association between individual deficit criteria and affect recognition performance in the deficit sample; and (3) to compare the deficit syndrome and negative syndrome samples with respect to affect recognition test performance. Results revealed that the deficit sample had significantly lower adjusted mean affect recognition scores than the non-deficit sample. In addition, 17 of the 19 subjects with deficit syndrome had impairments in affect recognition, whereas, non-deficit subjects were only slightly more likely to score in the impaired range than the unimpaired range. Within the deficit sample Diminished Sense of Purpose was the criterion most strongly associated with affect recognition impairment. Finally, a group of subjects classified as having prominent negative symptoms did not demonstrate the same pattern of impairment as shown by the deficit syndrome sample. The relationship between affect recognition, information processing and the deficit syndrome is discussed along with implications for classification in schizophrenia.

Wisconsin card sorting test dimensions in schizophrenia: Factorial, predictive, and divergent validity

This study explored the factor structure of the Wisconsin Card Sorting Test (WCST). Scores from 197 participants with schizophrenia or schizoaffective disorder were subjected to an exploratory factor analysis that yielded three factors: Perseveration, Nonperseverative Error, and Inefficient Sorting. Comparison with two previous factor analyses revealed remarkable factorial invariance. Correlations with subject and illness characteristics, symptom dimensions, and work performance demonstrated predictive and divergent validity for the three factors. However, a representative item from each factor yielded similar correlations with very little loss of power suggesting that the factors are composed of highly redundant items. When data reduction is necessary, schizophrenia researchers are justified in using three variables: perseverative error, nonperseverative error, and failure to maintain set, to represent WCST performance.

Object relations and reality testing in early- and late-onset schizophrenia

One hundred fifty-seven U.S. military veterans with schizophrenia were divided into early-onset (i.e., onset at age 20 or before, n = 36) and late-onset (i.e., onset after age 30, n = 28) groups and completed the Bell Object Relations and Reality Testing Inventory (BORRTI), the Positive and Negative Syndrome Scale, and several representative neuropsychological instruments. Participants were compared on background characteristics and test measures. The early-onset group demonstrated significantly more object-relations and reality-testing deficits than the late-onset group. In contrast, no significant group differences were found on symptom or neuropsychological variables. An a posteriori three-group analysis that included the middle age of onset group (i.e., ages 21 to 30) found that the middle group had mean values that fell between early- and late-onset groups on most variables. No distinct patterns of BORRTI subscale scores distinguished the middle group. The finding that object-relations and reality-testing deficits are more pronounced in early-onset schizophrenia has implications for the treatment and rehabilitation of schizophrenia.