Thomas J. Dinzeo

Oil and Water or Oil and Vinegar? Evidence-Based Medicine Meets Recovery

With the increasing prominence of the notions of “recovery” and “recovery-oriented practice,” practitioners, program managers, and system leaders are increasingly asking about the relationship between “evidence-based practices” and recovery. After reviewing the concepts of recovery from mental illness, being in recovery with a mental illness, recovery-oriented care, and evidence-based medicine, the authors argue for a complementary relationship between recovery and evidence-based practices. This relationship is neither simple nor straightforward, but results in a whole that is greater than the sum of its parts through which each element benefits from the influence of the other.

Stability of formal thought disorder and referential communication disturbances in schizophrenia.

This study examined the degree to which different types of communication disturbances in the speech of 48 schizophrenia patients and 28 controls were variable and state related versus stable and traitlike. Clinically rated formal thought disorder and 5 types of referential disturbance showed substantial stability within participants over time. The sixth type of referential disturbance, the vague reference, was not stable over time. Formal thought disorder was associated with the severity of core psychotic symptoms in patients. whereas referential disturbances showed little or no association with positive or negative symptom severity. Furthermore, changes in psychotic symptoms over time were accompanied by corresponding changes in formal thought disorder but not referential disturbances. These results support the idea that some types of referential disturbances are traitlike and may be reflective of vulnerability as well as manifest illness.

Recognition memory for faces in schizophrenia patients and their first-degree relatives.

It has consistently been shown that schizophrenia patients are impaired in recognition memory for faces. However, studies have not examined the specificity of this deficit relative to other cognitive functions nor the relationship between this deficit and particular schizophrenia symptoms. In addition, no studies have examined recognition memory for faces in unaffected biological relatives of schizophrenia patients who likely share some of the genetic diathesis for this disorder without presenting the potential confounds of mentally ill study samples. The Faces subtests from the Wechsler Memory Scale-Third Edition were used to evaluate recognition memory for faces in 39 schizophrenia patients, 33 of their first-degree relatives and 56 normal controls. Both schizophrenia patients and their relatives were impaired, relative to control participants, in recognition memory for faces after partialing out group differences in spatial attention or verbal memory. Further, recognition memory for faces was associated with positive symptoms in the schizophrenia group and schizotypal personality traits in the relative group. These findings may have important implications for reducing etiological heterogeneity among schizophrenia populations, identifying disorder susceptibility among their relatives and furthering understanding of disorder etiology.

Attentional Dysfunction, Social Perception, and Social Competence: What Is the Nature of the Relationship?

The aim of this study was to examine the nature of the relationship between attentional dysfunction and social competence deficits in patients with schizophrenia. Attentional functioning, social perception, and social competence were assessed in 56 inpatients. Measures of vigilance and span of apprehension were administered to assess attentional functioning. Social perception was assessed with an audiovisual measure of affect recognition. Social competence was rated from a role-play task. Span of apprehension and auditory vigilance emerged as specific predictors of social competence. Affect recognition was tested as a mediator and a moderator of the relationship between attentional dysfunction and social competence. Affect recognition was found to moderate the relationship between span of apprehension and social competence.

Normal personality characteristics in schizophrenia: a review of the literature involving the FFM.

Schizophrenia is generally viewed as a disruption of normal functioning because of an underlying core illness. A number of theorists have speculated that this core illness may unilaterally disrupt normal personality functioning. However, recent data suggests that the relationship may be more complex and reciprocal than previously conceptualized. Furthermore, basic personality characteristics appear to be associated with numerous clinical phenomena. This article reviews the empirical literature pertaining to normal personality characteristics [structured around the five-factor model (FFM) of personality] in individuals with schizophrenia. Evidence suggests that certain personality characteristics may be uniquely related to the etiology of psychosis, as well as symptom severity, occupational functioning, cigarette smoking, substance use and violent behavior, social isolation, and suicidality in patients with schizophrenia. The implications of these findings and suggestions for future research are discussed.

Stress and arousability in schizophrenia

This paper examines trait arousability (TA), a temperament characteristic, in 47 stable outpatients with schizophrenia and 50 non-psychiatric controls. Self-reported levels of stress were obtained during a negative and positive memory speech task. Levels of TA, and the association of TA scores with reported stress during the speech tasks, were examined both between and within groups. In addition, TA scores were examined in relation to symptom presentation in the patient group. Patients reported higher levels of trait arousability and higher levels of stress than controls. Trait arousability scores were significantly associated with reported stress in one of the speech condition in patients, and with the severity of positive and affective symptoms. These results suggest that temperament characteristics of an individual with schizophrenia may be related to stress responsiveness and symptom presentation.

A clinical trial of peer-based culturally responsive person-centered care for psychosis for African Americans and Latinos.

Background Providing culturally competent and person-centered care is at the forefront of changing practices in behavioral health. Significant health disparities remain between people of color and whites in terms of care received in the mental health system. Peer services, or support provided by others who have experience in the behavioral health system, is a promising new avenue for helping those with behavioral health concerns move forward in their lives. Purpose We describe a model of peer-based culturally competent person-centered care and treatment planning, informed by longstanding research on recovery from serious mental illness used in a randomized clinical trial conducted at two community mental health centers. Methods Participants all were Latino or African American with a current or past diagnosis within the psychotic disorders spectrum as this population is often underserved with limited access to culturally responsive, person-centered services. Study interventions were carried out in both an English-speaking and a Spanish-speaking outpatient program at each study center. Interventions included connecting individuals to their communities of choice and providing assistance in preparing for treatment planning meetings, all delivered by peer-service providers. Three points of evaluation, at baseline, 6 and 18 months, explored the impact of the interventions on areas such as community engagement, satisfaction with treatment, symptom distress, ethnic identity, personal empowerment, and quality of life. Conclusions Lessons learned from implementation include making cultural modifications, the need for a longer engagement period with participants, and the tension between maintaining strict interventions while addressing the individual needs of participants in line with person-centered principles. The study is one of the first to rigorously test peer-supported interventions in implementing person-centered care within the context of public mental health systems. Clinical Trials 2010; 7: 368—379. http://ctj.sagepub.com

Schizotypal Personality Questionnaire—Brief Revised: Psychometric replication and extension.

The psychometric screening and detection of schizotypy through the use of concise self-report assessment instruments such as the Schizotypal Personality Questionnaire-Brief Revised (SPQ-BR; Cohen, Matthews, Najolia, & Brown, 2010) enables an expeditious identification of individuals at putatively elevated risk to develop schizophrenia-spectrum disorders. Using 2 large, culturally diverse, independent samples, this study expanded the psychometric evaluation of this instrument by presenting a series of confirmatory factor analyses; reviewing internal consistency reliabilities; and evaluating the construct validity of the scale by way of examining group differences in SPQ-BR scores between individuals with and without self-reported family histories of schizophrenia. The results indicate a 2-tier factor solution of the measure and indicate strong internal reliability for the scale. Findings regarding construct validity of the SPQ-BR are more variable with the Cognitive-Perceptual Deficits superordinate factor receiving the strongest evidentiary support. Limitations of this study and directions for future research are discussed.

On the boundaries of blunt affect/alogia across severe mental illness: Implications for Research Domain Criteria

There is growing awareness that reduced expressive behaviors (e.g., blunt affect, alogia, psychomotor retardation) are characteristic of a range of psychiatric conditions, including mood and schizophrenia-spectrum disorders. From a Research Domain Criteria (RDoC) perspective, it would be critical to determine whether these symptoms manifest similarly across diagnostic groups--as they may share common pathophysiological underpinnings. The present study employed computerized acoustic analysis of speech produced in reaction to a range of visual stimuli in 48 stable outpatients with schizophrenia and mood disorders to offer preliminary understanding of this issue. Speaking assessments were administered 1 week-apart to examine how temporal stability might vary as a function of clinical diagnosis and symptom severity. Speech characteristics generally did not differ between groups and were similarly, and for the most part, highly stable over time. Aspects of speech were significantly associated with severity of psychosis and negative symptoms, but not with clinical depression/anxiety severity. Moreover, stability of speech characteristics generally did not vary as a function of diagnostic group or clinical severity. The magnitudes of group differences were almost exclusively in the negligible to small range. Speech production was associated with social functioning deficits. In sum, these preliminary data suggest that speech variables tap a stable and clinically important facet of psychopathology that cut across diagnostic categories. Computerized acoustic analysis of speech appears to be a promising method for understanding the pathological manifestation of these variables.

Citizenship, Community, and Recovery: A Group- and Peer-Based Intervention for Persons With Co-Occurring Disorders and Criminal Justice Histories

Group interventions for persons with co-occurring disorders of serious mental illness (SMI) and alcohol or other substance use disorders may positively affect participants’ substance use, criminal justice contacts, and transition to community supports and community living. We report on a group intervention with wraparound peer support that, in earlier research, has shown promise regarding these domains. We provide a detailed description and discussion of the intervention, including case vignettes. We also discuss future research on this intervention and offer recommendations for additional research in this area and with this target population.