Janet E. True

Validity of the Alien Cognitive Levels Assessment: A tri-ethnic comparison

Schizophrenia is a mental illness which is characterized by severe cognitive deficits and impairments in adaptive functioning. The Allen Cognitive Levels (ACL) Assessment is a screening instrument designed to assess cognitive functioning and to aid clinicians in making judgments about how a patient will be able to perform basic activities of daily living. While the ACL has been widely used, the validity of ACL scores for predicting concurrent adaptive functioning has not been established empirically. The present study examined ACL scores in 110 schizophrenic patients. Scores on the ACL were found to be highly related to scores on the Functional Needs Assessment (r = 0.66), which measures a patients ability to perform basic activities of daily living. Findings provided some of the first strong evidence that ACL scores reflect adaptive functioning. Correlations between the ACL and the Functional Needs Assessment were equally strong in non-Hispanic whites (n = 31, r = 0.67), Mexican-Americans (n = 58, r = 0.60), and African-Americans (n = 21, r = 0.46). Mean scores did not differ between patients from different ethnic groups. In addition, there was no relationship between ACL scores and level of acculturation within the Mexican-American group. Our data strongly support the hypothesis that the ACL provides a valid and culturally unbiased measure of cognitive functioning that can be helpful in determining how a patient is likely to perform activities of daily living.

A comparison of instrument sensitivity to negative symptom change

Accurate assessment of negative symptom changes in schizophrenic patients is crucial to determining the efficacy of new treatments. The present study examined the sensitivity to change over the course of hospitalization in negative symptomatology assessed by the Scale for the Assessment of Negative Symptoms (SANS), the Negative Symptom Assessment (NSA), and an expanded version of the Brief Psychiatric Rating Scale (BPRS) in a sample of 60 schizophrenic patients. Symptoms were assessed when the patients were acutely ill and again when they were stabilized. Effect sizes were compared across all three rating scales. The retardation factor of the BPRS had a relatively small effect size (0.32). Effect size for the total NSA was 0.78 and ranged from 0.38 to 0.87 for the SANS. Individual factors had moderate to large effect sizes that ranged from 0.18 to 0.91 for both scales. Separate analyses were performed to calculate effect sizes for a five-factor version of the NSA and to examine only those symptoms specified in DSM-IV (alogia, affective flattening, and avolition). Effect sizes relatively comparable to those found for the entire SANS and NSA scales were found for the separate calculations. Results indicate that the addition of a negative symptom assessment instrument to research protocols increases the ability to detect changes in negative symptoms with substantially fewer subjects than would be required with the BPRS retardation factor alone.

Acute effects of neuroleptics on unmedicated schizophrenic patients and controls.

Acute administration of haloperidol (0.2 mg/kg) produced many more side effects in normal controls than in unmedicated schizophrenic patients. Prior to the neuroleptic challenge, both groups were on the peripheral monoamine oxidase inhibitor, debrisoquin, for at least 1 week, in order to enhance the relative contribution of CNS catecholamine metabolites to those measured in both plasma and urine. The patient group had higher plasma levels of methoxyhydroxyphenylglycol (MHPG) and homovanillic acid (HVA) and higher urinary MHPG output than controls, but there were no effects of haloperidol challenge, compared to placebo challenge. In both groups there were significant declines in plasma HVA levels from 8:30 AM to 12 NOON. These declines were unaffected by the haloperidol challenge. Explanations for the marked differences in behavioral effects of haloperidol on patients and controls include the possibility that dopamine receptor numbers were increased in the brains of the schizophrenic patients.

Clonidine plus haloperidol in the treatment of schizophrenia/psychosis.

Because of the evidence for increased norepinephrine (NE) production in psychotic patients, we studied the effects of combining the alpha 2-adrenergic agonist clonidine with haloperidol for the treatment of schizophrenic psychosis. Twelve hospitalized schizophrenic patients were taken off their antipsychotic medication for 2 to 4 weeks before double-blind treatment with haloperidol (20 mg/day) combined with either clonidine or placebo. The group receiving clonidine was significantly more improved on the thought disorder subscale of the Brief Psychiatric Rating Scale (p = 0.02). The groups differed initially in the level of negative symptoms, but not controlling for this difference statistically by analysis of covariance did not change the finding with regard to the superiority of combining clonidine with haloperidol. We conclude that larger treatment trials of combining haloperidol with clonidine are warranted.

An investigation of instruments used to assess negative symptoms in patients with schizophrenia

Accurate assessment of changes in negative symptoms is necessary to evaluate new treatments for patients with schizophrenia. In an investigation of instrument sensitivity, Eckert et al., (1996) found the Negative Symptom Assessment (NSA) to be very effective in detecting negative symptom changes in patients with schizophrenia. The efficacy of the Positive and Negative Syndrome Scale (PANSS) was not examined. The current research replicates the finding that the NSA is sensitive to changes in negative symptomatology from initial assessment to ratings at discharge with 23 schizophrenic patients (effect size (ES) 1.2). PANSS and NSA ratings were available at the beginning and end of medication study. Some patients would ha ve been on standard medications, some on placebo and some on investigational medications. For this time period, the ES for the PANSS Negative factor was 0.51 while the NSA ES was very small ES (0.10) despite the fact that the NSA ES from the beginning of study to discharge was quite large ES (1.20) . This suggests that both the NSA and PANSS are sensitive to changes over time, however the Negative factor on the PANSS is assessing something different from the NSA. Further analyses indicated that some negative symptoms as measured by the NSA improved from initial assessment to the end of the medication study, while others worsened. Whereas, all negative symptoms assessed by the PANSS improved during the study period. Examining relationships between PANSS negative symptom items and NSA factors indicated that many PANSS negative items significantlycorrelate with multiple NSA factors. Attention was focused in particular on the 3 NSA factors that measure the negative symptoms listed as DSM IV diagnostic criteria. A potential explanation for this interesting finding is that the NSA items assess specific negative symptoms which can vary independently; while the PANSS negative symptom items measure a more general negative factor. Suggestionsare made for further examination to clarify the utility of the PANSS and NSA in detecting changes in negative symptoms.