Frederic Kass

Symptom profiles and homelessness in schizophrenia

One hundred homeless schizophrenic men and 100 never homeless schizophrenic men were compared in terms of symptom ratings on the Positive and Negative Syndrome Scale (PANSS), which yields a positive, negative, and general psychopathology scale score, as well as evaluated on a number of other variables. The homeless group obtained significantly higher ratings on the PANSS positive and general psychopathology scales, but the two groups did not differ on the PANSS negative scale score. When symptom patterns for subsets of patients who did not abuse illicit substances or alcohol (N=23 for homeless, N=56 for nonhomeless) and who were compliant with medication (N=63 for homeless, N=82 for nonhomeless) were examined, the higher ratings on the positive and general psychopathology scales failed to achieve statistical significance, while the absence of between-group differences on the negative scale was maintained. Our results suggest that severity of positive and general psychopathology symptoms, but not of negative symptoms, predicts homelessness in schizophrenia and that illicit substance abuse and neuroleptic noncompliance contributed, at least in part, to our higher positive and general psychopathology symptom ratings in the homeless sample. Our findings underscore the need to undertake prospective longitudinal studies to unravel the multifactorial etiology of homelessness in schizophrenia.

CRISIS IN PSYCHOTHERAPY: Principles of Emergency Consultation and Intervention

A surprisingly large number of visits to a crisis intervention service are made by patients engaged in ongoing psychotherapy elsewhere. Data are presented from patients and their therapists that support the concept of a psychotherapy crisis as a major precipient of such visits. A typology for the therapy crisis is elaborated, and guidelines for the crisis workers assessment and intervention are suggested.

Common Mistakes Made in Psychiatric Evaluation by Beginning Therapists

As part of their clinical experience in hospital outpatient clinics, residents and medical students are often required to evaluate new psychiatric patients for eventual treatment or referral. This is a difficult assignment. The present study attempts both to improve our understanding of the factors which are most troublesome for trainees, and to alert those who supervise their training.