William D. Spaulding

Histories of childhood maltreatment in schizophrenia: Relationships with premorbid functioning, symptomatology, and cognitive deficits.

A number of studies have demonstrated an increased rate of histories of childhood maltreatment among adults with serious mental illness. The present investigation documented the presence of childhood maltreatment in a sample of 40 psychiatric inpatients with schizophrenia spectrum disorders. The type (neglect, physical abuse, sexual abuse), duration, and severity of childhood maltreatment was examined along with measures of premorbid functioning, current symptomatology, and cognitive functioning. Participants with histories of maltreatment were significantly more likely to have poorer peer relationships in childhood, more difficulty in school, an earlier age at first hospitalization, more previous hospitalizations, elevated symptoms of anxiety, depression, and suicidality on the Brief Psychiatric Rating Scale (BPRS), and more impaired performance on a task of visual-perceptual organization. Severity and frequency of childhood maltreatment were both positively correlated with hallucinations and delusions on the BPRS. Linear trend analysis indicated a pattern of more severe impairment as the number of types of maltreatment increased. No relationships were found between maltreatment and measures of executive functioning, verbal fluency, or verbal processing speed. A history of childhood maltreatment appears to be a significant determinant of premorbid functioning, illness-related symptom expression, and specific forms of cognitive dysfunction.

The relationship of social cognition to ward behavior in chronic schizophrenia.

The relationship between social cognition (i.e., cognition for social stimuli) and ward behavior among individuals with chronic schizophrenia was investigated. Twenty-seven inpatients completed a battery of cognitive and social-cognitive tasks and were rated by staff on various indices of ward behavior. Overall, there was a relationship between the measures of social cognition and behavior on the ward. Social cognition contributed unique variance beyond cognition to maladaptive behavior on the ward (i.e., irritability). Implications for assessment and future research are discussed.

Thinking About the Future Cognitive Remediation Therapy—What Works and Could We Do Better?

This article reviews progress in the development of effective cognitive remediation therapy (CRT) and its translational process. There is now enough evidence that cognitive difficulties experienced by people with schizophrenia can change and that the agenda for the next generation of studies is to increase these effects systematically through cognitive remediation. We examine the necessary steps and challenges of moving CRT to treatment dissemination. Theories which have been designed to explain the effects of cognitive remediation, are important but we conclude that they are not essential for dissemination which could progress in an empirical fashion. One apparent barrier is that cognitive remediation therapies look different on the surface. However, they still tend to use many of the same training procedures. The only important marker for outcome identified in the current studies seems to be the training emphasis. Some therapies concentrate on massed practice of cognitive functions, whereas others also use direct training of strategies. These may produce differing effects as noted in the most recent meta-analyses. We recommend attention to several critical issues in the next generation of empirical studies. These include developing more complex models of the therapy effects that take into account participant characteristics, specific and broad cognitive outcomes, the study design, as well as the specific and nonspecific effects of treatment, which have rarely been investigated in this empirical programme.

Social anxiety in schizophrenia

The relationship between social anxiety and positive and negative symptomatology in schizophrenia was investigated. Thirty eight inpatients with schizophrenia completed a battery of self-report measures of anxiety, a modified Stroop task, and an unstructured role play. Positive symptoms were related to fear in a number of self-report domains (i.e., social and agoraphobic). Negative symptoms were related to global observational ratings of anxiety during the role play as well as specific behaviors associated with self-reported social anxiety (i.e., speech rate and fluency). Positive symptoms generally were not associated with role play ratings. Thus, specific behaviors related to social anxiety appear to be associated with negative symptoms, while self-report is associated with positive symptoms. Problems in the assessment of social anxiety in individuals with schizophrenia and implications of these findings for social skills training in this population are discussed.

Individual cognitive-behavior therapy in the treatment of hallucinations and delusions: A review

The limitations of biochemical treatments in reducing the severity of hallucinations and delusions has led to an increased interest in the investigation of psychological treatments for these symptoms. These investigations have spanned the last 4 decades and have covered a range of psychological approaches from psychoanalytically oriented psychotherapy to behavioral approaches. More recently, findings that some psychotherapies are not effective treatments for psychosis and that cognitive-behavior therapy can be an effective treatment for neurotic disorders have led to increasing interest in the investigation of the effectiveness of cognitive-behavior therapy for psychosis. This review describes and evaluates the research on the cognitive-behavioral treatment of hallucinations and delusions and describes the cognitive models from which the treatments have developed. The conclusion is that, on the whole, the literature provides fairly strong evidence for the efficacy of cognitive-behavioral approaches in the management of chronic psychotic disorders and associated symptoms, although there are a number of areas where further development is necessary.

Cognitive abnormalities in schizophrenic patients and schizotypal college students.

Twenty schizotypal college students, identified by the MMPI-168, were compared with 127 institutionalized or postinstitutional psychiatric patients with chronic schizophrenia, 140 normal control subjects, and 19 students with nonschizotypal MMPI elevations. The comparison measures were indices of cognition derived from COGLAB, a multiparadigmatic cognitive test battery. COGLAB includes measures of preattentional, attentional, conceptual, and psychomotor performance. As expected, the patients were deficient on all but one of the measures. The nonschizotypic elevation group was not different from the normal control group. Schizotypal subjects were found to have deficits in three areas of information processing: preattentional processing, response biasing, and concept attainment and manipulation. However, their performance was just as good as and less variable than that of normal subjects on psychomotor and attentional tasks. The results do not support the hypothesis that schizotypy is characterized by pervasive cognitive deficits which are simply less severe than those of other psychiatric groups. Rather, there are discrete deficits in specific areas and possibly compensatory abnormalities associated with primary deficits. The results are further discussed with regard to the hypothesis that schizotypy shares a common neurophysiological and/or developmental substrate with more severe psychiatric disorders.

Insight in schizophrenia: Its relationship to measures of executive functions

Lack of awareness of specific symptoms among persons with schizophrenia has not been adequately studied in the context of neuropsychological function. The purpose of this study is to investigate whether poor insight as measured by the Scale to Assess Unawareness of Mental Disorder is empirically related to performance measures having a known association with executive functions in a group of individuals with chronic schizophrenia. The results showed that unawareness and misattribution of negative symptoms are significantly associated with deficits in some aspects of executive functioning even after a test of general intelligence had been partialed from the analyses. We conclude that unawareness of negative symptoms is associated with executive functioning in individuals with chronic schizophrenia. Unawareness of other symptoms (i.e., positive symptoms) may reflect dysfunction in other types of neuropsychological processes, or it may reflect motivation to deceive oneself or others.

Towards Missing Data Imputation: A Study of Fuzzy K-means Clustering Method

In this paper, we present a missing data imputation method based on one of the most popular techniques in Knowledge Discovery in Databases (KDD), i.e. clustering technique. We combine the clustering method with soft computing, which tends to be more tolerant of imprecision and uncertainty, and apply a fuzzy clustering algorithm to deal with incomplete data. Our experiments show that the fuzzy imputation algorithm presents better performance than the basic clustering algorithm.

Cognition and social functioning in schizophrenia

This article reviews three studies investigating the relationship between information processing and social functioning in schizophrenia. The most consistent finding is the association between vigilance performance on a hybrid continuous performance/span of apprehension task and various indices of social functioning (e.g., ward behavior). However, the nature of the information processing-social functioning relationships is mutable and appears dependent on a number of factors (e.g., cross-sectional versus longitudinal designs). This article concludes with a discussion of treatment implications and future research directions.

Information processing, social skill, and gender in schizophrenia

The relationships among information processing, social skill, and gender in individuals with chronic schizophrenia were investigated. Although there were no gender differences in information processing, social skill, or negative symptoms, performance on information-processing tasks was related to various indices of social skill (e.g., paralinguistic skill) for female, but not male, inpatients. This pattern of results remained after statistical controls were applied for age, illness chronicity, and positive symptoms.