Marion Glick

Thought Disorder in High-Functioning Autistic Adults.

Examined thought disorder in a sample (n = 11) of high- functioning autistic young adults and older adolescents (mean IQ = 83) utilizing objective ratings from the Thought, Language and Communication Disorder Scale (TLC Scale) and projective data from the Rorschach inkblots. Results from the TLC Scale pointed to negative features of thought disorder in this sample (e.g., Poverty of Speech). Rorschach protocols revealed poor reality testing and perceptual distortions in every autistic subject, and also identified several areas of cognitive slippage (e.g., Incongruous Combinations, Fabulized Combinations, Deviant Responses, Inappropriate Logic). Comparing TLC Scale and Rorschach results to schizophrenic reference groups, autistic subjects demonstrated significantly more Poverty of Speech and less Illogically on the TLC Scale, and on the Rorschach they evidenced features of thought disorder that are encountered also in schizophrenia. Results are discussed in relation to the measures employed, and to areas of similarity and difference between autism and schizophrenia.

Premorbid social competence and outcome among schizophrenic and nonschizophrenic patients.

The relation between premorbid social competence and outcome was examined with 381 male state hospital patients in four diagnostic categories: schizophrenia, affective reaction, psychoneurotic disorder, and personality disorder. Outcome was assessed using the measures of length of initial hospitalization, total length of rehospitalization, and number of readmissions. The follow-up period was 3 years after discharge from the first hospitalization. On all outcome measures, higher social competence was significantly related to favorable outcome. The four diagnostic groups differed significantly in social competence level, but no evidence was found to indicate that the social competenceoutcome relation was influenced by diagnosis. Results were interpreted as consistent with a developmental formulation and as indicating that the relation between premorbid social competence and outcome is not unique to schizophrenia but obtains over a broad range of diagnoses.

Social Competence among Cocaine Abusers: Moderating Effects of Comorbid Diagnoses and Gender

Levels of social competence and maladaptive behaviors were examined among 184 male and 85 female treatment-seeking cocaine abusers. Social competence was assessed based on indices of functioning at work and in relationships, maladaptive behaviors included severity of drug and legal problems, and difficulties in interpersonal relationships. Consistent with developmental interpretations, results indicated that addicts with comorbid depression had higher social competence than those with comorbid antisocial personality disorders. In contrast with research on other psychiatric groups, female addicts had lower social competence than males; however, they also had lower levels of maladaptive behaviors. Findings are discussed in terms of implications for preventive interventions and treatment for drug abusers.

Developmental correlates of age at first hospitalization in nonschizophrenic psychiatric patients.

Age at first hospitalization, premorbid social competence, and developmental categorizations of symptomatology were examined in 228 male and 220 female patients in three diagnostic categories: major affective disorder, neuroses, and personality disorder. High social competence patients were older at first hospitalization than low competence individuals. Younger first admission patients showed more symptoms in the action category and in the role orientation of turning against others. Older patients more frequently displayed symptoms of the thought variety and of turning against the self. Gender differences in age at first hospitalization were not found. With respect to all developmental variables examined, the results suggest that a broader view of prognosis proposed in research with schizophrenic patients is applicable to nonschizophrenic groups.

PARANOID SCHIZOPHRENIA: An Unorthodox View

Most paranoid patients have traditionally been diagnosed as schizophrenic, although considerable evidence points to the dissimilarities between paranoid and nonparanoid schizophrenic patients and to commonalities between paranoid and affective disorder groups. Based on a review of research, it is suggested that paranoid schizophrenia, at least in some of its varieties, may more fruitfully be conceptualized as a phenotypic expression of an underlying depressive mode than as a schizophrenic form. This formulation is presented within the framework of a broad examination of diagnostic issues.

Premorbid social competence and the revolving door phenomenon in psychiatric hospitalization.

The relation between premorbid social competence and length of initial hospitalization was examined in 381 male state hospital patients in four diagnostic categories: schizophrenic, affective reaction, psychoneurotic, and personality disorder. A significant relation was discovered between diagnosis and outcome, with schizophrenic patients having the longest and personality disorder patients the shortest lengths of initial hospitalization. Premorbid social competence was related to outcome, as assessed both by length of initial hospitalization, and by whether the patient was rehospitalized. These two outcome measures were found to be positively related, thus supporting the developmental formulation that premorbid social competence is indicative generally of prognosis. The findings were employed to generate the inference that patients at differing levels of premorbid social competence require different treatment modalities.

Premorbid Social Competence and the Effectiveness of Early Neuroleptic Treatment

The relationship of premorbid social competence to early psychotic symptom resolution was examined in 84 (44 male, 40 female) acutely psychotic inpatients given fixed-dose neuroleptic treatment. Patients with a substantial reduction in psychotic symptomatology at 10 days had higher overall social competence scores and higher scores on the indices of occupation, marital status, age, and employment history than did patients with little symptom resolution. Sex and diagnosis were not related to degree of psychotic symptom resolution. The results suggest that early symptom resolution with neuroleptic treatment represents yet another instance of outcome being related to premorbid social competence. The findings likewise accord with the view that social competence reflects underlying developmental differences.

Inter-relationships among hospitalization measures of psychiatric outcome.

In a diagnostically heterogeneous sample of 381 first admission male state hospital patients, no consistent correlations appeared among three commonly employed hospitalization measures of outcome. The possibility that psychiatric hospitalization may be a multidimensional criterion is considered and the implications for outcome research are discussed.

Werner’s Developmental Thought in the Study of Adult Psychopathology

The developmental approaches to psychopathology and self-image reviewed in this article as well as Zigler’s broad body of research on mental retardation owe a primary theoretical debt to organismic developmental theory (e.g., Werner, 1948; 1957; Werner & Kaplan, 1963). The research and the formulations of the developmental approach to adult psychopathology that unfolded over the course of more than 40 years demonstrate the power of organismic-developmental theory for understanding and interrelating many major variables in psychopathology. The application of developmental theory has enabled the generation and testing of hypotheses about premorbid social competence, symptomatology, diagnosis, paranoid-nonparanoid status in schizophrenia, prognosis, outcome, and self-images as personality variables. This has created a broad body of data through which these diverse phenomena can be integrated and understood in relation to each other. With respect to psychopathology as well as other aspects of behavior, the developmental framework has allowed the functioning of people with mental retardation to be understood and integrated with the broad body of knowledge about the functioning of people without mental retardation.