Martin Harrow

The longitudinal course of schizoaffective disorders: A prospective follow-up study

To study whether outcome of schizoaffective psychosis is more similar to that of schizophrenia, or major affective disorders, or whether it shows an intermediate pattern between these two disorders, we conducted a prospective follow-up study of 167 patients from two hospitals. Thirty-nine schizoaffective patients, 47 schizophrenic patients, 33 manic patients, and 48 patients with major depressive disorders were assessed during hospitalization and then followed up 1 year after hospital discharge. Standardized assessments were conducted of patients work functioning, social adjustment, symptom outcome, rehospitalization, treatment at follow-up, and their overall posthospital adjustment. The data indicated the following: a) On both major scales of overall outcome, schizoaffective patients posthospital adjustment was significantly poorer than that of patients with major affective disorders (p < .01), and showed a nonsignificant tendency to be better than that of schizophrenics. Only 10 per cent of the schizoaffective patients had very favorable outcomes. b) There were no significant differences in overall outcome between schizoaffective patients who were manic vs. depressed, or mainly affective vs. mainly schizophrenic (p > .20). c) Both the schizoaffective and affectively disordered patient groups had significantly better posthospital work functioning than did the schizophrenic patients (p < .05). d) However, both the schizoaffective and schizophrenic groups had significantly poorer posthospital social functioning than did the affectively disordered patients (p < .05). Overall, the data suggest that outcome of schizoaffective disorders differs in some ways from that of both schizophrenia and affective disorders. The results indicate that a larger number of schizoaffective patients than patients with schizophrenia or affective disorders show intermediate outcomes, with both good posthospital functioning in some areas and poor posthospital functioning in other areas. These results do not support the currently popular suggestion that outcome of schizoaffective disorders is similar to that of affective disorders. Four potential models which use outcome in schizoaffective disorders as one criterion for diagnostic classification were discussed.

Inter-Relationships among Three Measures of Disordered Thinking in Continuous Word Association

This report investigated the inter-relationships among three word-association indices (response commonality, degree of logical relatedness, and idiosyncratic responses) for a continuous word-association test to examine continuous-association procedures as a technique for studying associative thought disorder in schizophrenia. Results indicated high intercorrelations among all measures for both schizophrenics (n = 42) and nonschizophrenic psychiatric controls (n = 30). These data provide evidence in support of the utility of the continuous word-association test as an instrument capable of assessing associative disturbance in schizophrenia in a manner similar to the more familiar single word-association test.

Associative thinking in schizophrenia: A contextualist approach

Explored the question of whether responses that appeared to be highly pathological on the basis of the word association test did indeed reflect an underlying aberrant associative process or whether the associations actually had a greater degree of meaning than was evident from the test (N = 60). Utilizing contextualist techniques designed by the authors, which were analogous to the word association test but yet measured schizophrenic associative thinking in specific contexts that more closely approximated natural language situations, the quality and purposiveness of the schizophrenics associations were examined. The word association test technique was judged to be inadequate by itself to account for underlying associative processes involved in schizophrenic associative thought disorder. A majority of responses (70% schizophrenic, 81% nonschizophrenic) judged to be pathological on the basis of the word association test alone became meaningful in the context of a sentence created by the Ss to explain purposively their associations. The schizophrenics experience of a stimulus word and consequent associations to that word became clearer when placed within an appropriate context (i.e., a sentence), rather than examined as isolated semantic features (as in the word association test).

Auditory Misperceptions of Word-Association Stimuli in Schizophrenia

This study examined whether auditory misperception of stimulus words on a word-association test can account for idiosyncratic responses of 37 schizophrenics. Results indicated performance comparable to 19 nonschizophrenics under conditions of auditory and visual presentation, and thus did not support the position that mishearing of stimuli artifactually increased associative thought disturbance.

Early Phases of Schizophrenia and Depression: Prediction of Suicide

As prospective studies of representative samples of schizophrenics and other types of psychotic and nonpsychotic patients have increased (1–5), suicide has been recognized as a major problem which merits greater concern on the part of clinicians and policy makers alike. For mentally disturbed samples, literature reviews suggest that the suicide rate may range from 10% to 15% among the major mental disorders (1,45). For the general population, suicide is a leading cause of death among adults under forty years of age, and suicide rates have been increasing since 1955 with a slight decrease in the late 1970s (6).

Kinesthetic figural aftereffects in acute schizophrenia: a style of processing stimuli.

The Kinesthetic Figural Aftereffect test was administered to 106 psychiatric inpatients to assess styles of stimulus processing in schizophrenia. Three conditions were used: (1) standard stimulus conditions at the acute phase; (2) standard conditions, 7 wk. later, to evaluate stability over time; (3) reversed stimulus conditions to assess kinesthetic figural aftereffect generality under different stimulus conditions. Results indicated that: (1) schizophrenics reduced stimuli, but differences between patient groups were not significant. (2) Kinesthetic figural aftereffect stability over time was shown by nonschizophrenics (p < .01) but not by schizophrenic and borderline patients. (3) All diagnostic groups reversed kinesthetic figural aftereffect responses under reversed stimulus conditions, e.g., former “augmenters” tended to reduce more under augmenting conditions, suggesting the importance of the specific stimulus conditions. (4) Acute schizophrenics showed a stimulus-governed style. (5) The results raise questions about kinesthetic figural aftereffects as a measure of response style.

Word association: Multple measures and multiple meanings

Investigated the interrelationships between reaction time and three major verbal word association variables (response commonality, idiosyncratic responses, and degree of logical relatedness) in schizophrenics (N = 42) and nonschizophrenic psychiatric controls (N = 30). This study investigated the degree to which these four measures assess similar or different components of associative thought disorder in the same Ss, using both verbal associative measures and a nonverbal performance measure. Results indicated that reaction time was largely independent of all verbal measures in schizophrenics. These data were discussed in regard to the meaning and interpretation of word association test data as a function of choice of dependent variables for measuring associative thought disturbance.

Investigation of factors related to stimulus overinclusion

The investigators studied the experiential state of stimulus overinclusion (SOI) in 109 consecutive acutely hospitalized patients. This phenomenon has been cited in theoretical formulations of the schizophrenic defect. Schizophrenics did not experience significantly more SOI than other patients. Specific relationships to diagnosis, emotional states, and altered states of consciousness (particularly psychomimetics) were studied and etiological implications are discussed.

Depression and organicity

SummaryThe present paper attempts to explore the problems involved in the frequently-posed differential diagnostic question: “Is this patient depressed, or is he organic?” A number of theoretical and conceptual difficulties underlie the problem of isolating these two factors which often make such a question a less than reasonable one.n Organicity is a global concept, which does not distinguish clearly between toxic-structural, or between reversible-irreversible impairments.Depression is a construct which means many things to many clinicians. Some or all depressive illness may be in the nature of “somatic affections”. Depression in any form whatsoever does not ever rule out underlying or accompanying organic pathology; and it is difficult to conceive of an individual experiencing some loss of functioning capacity based on central nervous system impairment without being in some manner depressed about this loss. Furthermore, good external criteria are often lacking, and the relative usefulness of a number of traditional diagnostic indicators of depression and of organicity can be questioned in the light of increasingly mixed evidence concerning their accuracy as specific diagnostic signs.

Paranoid and nonparanoid schizophrenia: drive dominated thinking and thought pathology at two phases of disorder.

A sample of acutely hospitalized paranoid and nonparanoid schizophrenics and another sample of paranoid and nonparanoid schizophrenics studied at follow-up were compared on measures of cognitive functioning, disordered thinking, and drive dominated thinking using the WAIS, the Rorschach test, the object sorting test, and an overall index of outcome functioning (N = 67). Results suggested that cognitive regression is related more to acute psychological disturbance than to the presence or absence of paranoia, that the presence of socialized drive dominated thinking during the acute phase is related to better posthospital adjustment at follow-up, and that paranoid schizophrenics show better cognitive functioning after the acute phase. Results did not support the theory that suggests an etiological relation between homosexual conflict and paranoia.