Biomedical subjects

Alan S Bellack

Publications and source records attributed to Alan S Bellack.

At least 19 recordsLinked to original sources

PubMed2006

Scientific and consumer models of recovery in schizophrenia: concordance, contrasts, and implications.

Schizophrenia has traditionally been viewed as a chronic condition with a very pessimistic outlook, but that assumption may not be valid. There has been a growing consumer movement among people with schizophrenia that has challenged both the traditional perspective on the course of illness and the associated assumptions about the possibility of people with the illness living a productive and satisfying life. This new conception of the illness is supported by long-term studies that suggest that as much as 50% of people with the illness have good outcomes. There has also been a change in political and public health perspectives of the illness, stimulated in part by the President's New Freedom Commission on Mental Health. The purpose of this article is to provide an overview of some key themes about the recovery concept, as applied to schizophrenia. The article will address 3 questions: (1) What is recovery? (2) Is recovery possible? and (3) What are the implications of a recovery model for a scientific approach to treatment (ie, the use of evidence-based practices)? Scientific and consumer models of recovery are described, and commonalities and differences are discussed. Priorities for future research are suggested.

Convalescence↗

PubMed2006

A randomized clinical trial of a new behavioral treatment for drug abuse in people with severe and persistent mental illness.

CONTEXT: Drug abuse by people with severe mental disorder is a significant public health problem for which there is no empirically validated treatment. OBJECTIVE: To evaluate the efficacy of a new behavioral treatment for drug abuse in this population: Behavioral Treatment for Substance Abuse in Severe and Persistent Mental Illness (BTSAS). DESIGN: Participants were randomly assigned to 6 months of treatment in either BTSAS or a manualized control condition: Supportive Treatment for Addiction Recovery (STAR). SETTING: Treatment was conducted in community-based outpatient clinics and a Veterans Affairs medical center in Baltimore, Md. PARTICIPANTS: Participants were 129 stabilized outpatients meeting DSM criteria for drug dependence (cocaine, heroin, or cannabis) and serious mental illness: 39.5% met DSM-IV criteria for schizophrenia or schizoaffective disorder; 55.8%, for major affective disorders; and the remainder met criteria for severe and persistent mental illness and other Axis I disorders. INTERVENTIONS: Both treatments were administered by trained health care professionals in small groups, twice a week for 6 months. The BTSAS program is a social learning intervention that includes motivational interviewing, a urinalysis contingency, and social skills training. The control condition, STAR, is a supportive group discussion treatment. Main Outcome Measure The primary outcome measure was urinalysis results from twice-weekly treatment sessions. RESULTS: The BTSAS program was significantly more effective than STAR in percentage of clean urine test results, survival in treatment, and attendance at sessions. The BTSAS program also had significant effects on important community-functioning variables, including hospitalization; money available for living expenses; and quality of life. CONCLUSIONS: The BTSAS program is an efficacious treatment. Further work needs to be done to increase the proportion of eligible patients who are able to become engaged in treatment.

Ambulatory Care↗

PubMed2006

Family interactions and the course of schizophrenia in African American and White patients.

Relatives' critical and intrusive behavior with patients, patients' odd or unusual thinking with relatives, and the course of schizophrenia were examined. Seventy-one African American and White patients (each with 1 relative) completed 2 problem-solving discussions. Relatives' critical and intrusive behavior with patients and patients' odd or unusual thinking with relatives were assessed, and patients were followed for 2 years. For African American patients, high levels of relatives' critical and intrusive behavior were associated with better outcome. For White patients, low levels of both relatives' critical and intrusive behavior and patients' odd or unusual thinking with relatives were associated with better outcome. The results suggest that during family interactions, seemingly negative behaviors may be perceived as a sign of caring and concern by African Americans. For Whites, the combination of patients' odd or unusual thinking with relatives and relatives' critical and intrusive behavior toward patients may be especially predictive of an adverse course.

Adolescent↗

PubMed2006

A sociocultural stress, appraisal, and coping model of subjective burden and family attitudes toward patients with schizophrenia.

A sociocultural stress, appraisal, and coping model was developed to understand relatives' burden of care and negative affective attitudes toward patients with schizophrenia. Ninety-two African American and 79 White patients and a significant other (80% mothers) completed 2 10-min family problem-solving discussions. In addition, the Kreisman Rejection Scale and a global self-report rating of family burden were administered to relatives, and a self-report rating of substance use was administered to patients. Results indicated that subjective burden of care and patients' odd and unusual thinking during the family discussion each independently predicted relatives' attitudes toward patients, suggesting that negative attitudes are based in part on both patients' symptoms and perceived burden of care. African American relatives' perceived burden was also predicted by patients' substance abuse. Finally, White family members were significantly more likely than African Americans to feel burdened by and have rejecting attitudes toward their schizophrenic relative suggesting that cultural factors play an important role in determining both perceived burden and relatives' attitudes toward patients.

Adaptation, Psychological↗

PubMed2005

The development of a computer-assisted cognitive remediation program for patients with schizophrenia.

In the last decade, impairments in several cognitive domains have been recognized as a central feature of schizophrenia. Consistent evidence has accumulated that documents the contribution of these deficits to poor outcome in social and occupational functioning, and thus they are important targets for psychosocial as well as pharmacological intervention. After reviewing the literature on cognitive remediation for brain injury as well as schizophrenia patients, consulting with research groups which have implemented cognitive remediation programs for schizophrenia, and conducting pilot work with patients, our group has developed a broadly-targeted computer-based remediation intervention that is based on using exercises that engage several cognitive capacities simultaneously, teaching of a set of cognitive strategies by a supportive therapist in a one-on-one setting, and addressing many of the treatment issues that are specific to schizophrenia. The strategies that are emphasized in the intervention are derived from the learning and remediation literatures and include the following: 1) Verbalization to enhance encoding and recall of stimuli; 2) Breaking problems down to promote organized problem solving; 3) Articulation of problem solving to encourage deliberate responding and self-monitoring; 4) Self-checking of performance and adjustment as necessary; 5) Strategic probe questions to prompt participants to monitor their work and make planful responses; 6) Scaffolding aids to provide ongoing support as needed. We are currently conducting a randomized trial of the intervention in which patients complete 24 sessions of remediation or an equivalent number of sessions with a therapist using computer games that have minimal cognitive demand. Our initial experience with the intervention is encouraging and suggests that it is feasible, the tasks are extremely well-received and patients are willing to come to the clinic several times per week to work on them. It is premature to assess whether participation in cognitive remediation is effective in improving cognition, but patients have thus far demonstrated improvement on trained computer exercises. The potential of psychosocial and pharmacological interventions, alone and in combination, for cognitive impairment in schizophrenia is a promising research issue.

Cognitive Behavioral Therapy↗

PubMed2004

Affectivity in the problem-solving interactions of schizophrenia patients and their family members.

This study sought to examine the relationship between symptomatology and the affect expressed between individuals with schizophrenia and their family members. It was hypothesized that, because of their impact on patient social behavior and potential burden on relatives, greater negative symptoms would be associated with less emotional expression in patients but would be related to the greater expression of negative emotions in their relatives within a problem-solving discussion. Informed by research on the structure of emotion, a broad assessment of affect, including Negativity, Positivity, and Disengagement, was utilized to examine affect expressed by patients with schizophrenic disorders (N=91) and their family members during videotaped problem-solving discussions. Although individuals with schizophrenia were comparable to their family members in displays of Negativity, patients displayed less Positivity and greater Disengagement. Greater negative symptoms (in particular blunted or flat affect) were related to a general diminution of affective expression in the schizophrenia group. However, negative symptoms were unrelated to the emotional expression of family members. Other symptoms such as thought disorder and mood symptoms of anxiety, depression, and hostility were not related to displays of affect by either patients or their family members. The findings indicate the importance of examining domains of affect other than negativity and demonstrate that negative symptoms are related to interpersonal displays of affect in schizophrenia. Additionally, these results suggest that schizophrenic symptoms, by themselves, may contribute little to the conflict between patients and their family members.

Adult↗

PubMed2004

Behavioral consequences of methyllycaconitine in mice: a model of alpha7 nicotinic acetylcholine receptor deficiency.

Diminished expression of the alpha(7) nicotinic acetylcholine receptor occurs in selected brain regions of patients with schizophrenia, which may account for pathophysiological abnormalities and some of the deficits in attention and information processing. In view of this neurotransmitter receptor deficit, we wished to characterize the behavioral consequences associated with the administration of methyllycaconitine (MLA), a competitive alpha(7) nicotinic acetylcholine receptor antagonist, in mice. In this study, we injected groups of 12 outbred NIH Swiss male mice intraperitoneally with MLA (1.0, 3.2 and 10.0 mg/kg) and its saline vehicle. Thereafter, individual mice were observed over a one-hour interval and the intensity of a variety of behaviors were rated on a 4-point scale. The observed behaviors included: gnawing/chewing, rearing, grooming, sniffing, climbing, Straub tail, locomotion and ataxia. MLA produced statistically significant changes in the following observed behaviors: rearing, sniffing, climbing, and locomotion. A profile of the behavioral changes related to MLA administration in mice could lead to the development of a screening paradigm for alpha(7) nicotinic acetylcholine receptor agonist interventions. Ideally, an effective alpha(7) nicotinic acetylcholine receptor agonist intervention would target domains of psychopathology, especially cognitive symptoms that contribute to the profound functional disability that is often associated with schizophrenia.

Aconitine↗

PubMed2004

Race, family interactions, and patient stabilization in schizophrenia.

This study examined family interactions associated with a failure to stabilize in schizophrenia. Fifty-eight patient and parent dyads completed a problem-solving task soon after an acute episode. Stabilization was assessed over the following 6 months. African American patients' self-initiated discussions of substance use and increased anxiety during the interaction were associated with a failure to stabilize. Nonstabilization in White patients was associated with high levels of both the patients' odd thinking and the parents' criticism. White patients who were depressed during the interaction were also less likely to stabilize. Findings suggest that family relationships may play in important role in determining whether patients stabilize after an acute episode. Results also point to the importance of cultural factors in predicting patient stabilization.

Adolescent↗

PubMed2004

Preliminary reliability and validity of the Clinician-Administered PTSD Scale for schizophrenia.

This study provides preliminary psychometric support for a version of the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale (CAPS; D. D. Blake et al., 1990) adapted for use with patients with schizophrenia (CAPS-S; J. S. Gearon. S. Thomas-Lohrman, & A. S. Bellack, 2001). Nineteen women with schizophrenia and co-occurring illicit drug use disorders were administered the CAPS-S, the Structured Clinical Interview for DSM-IV diagnoses (SCID). and scales measuring trauma-related psychopathology. The results indicate that the CAPS-S can distinguish between those with and without PTSD and that the symptom clusters measure unified constructs. Interrater and test-retest reliability were high for PTSD diagnosis and symptom clusters. Solid convergent validity was demonstrated between the CAPS-S and SCID-based PTSD diagnoses and the Impact of Event Scale. There is also preliminary evidence of discriminant validity. These results support the use of the CAPS-S in women with schizophrenia.

Adult↗

PubMed2004

Do clozapine and risperidone affect social competence and problem solving?

OBJECTIVE: The purpose of this investigation was to evaluate the effects of clozapine and risperidone on social skill and problem solving in patients with schizophrenia. METHOD: The Wisconsin Card Sorting Test and the Maryland Assessment of Social Competence were administered at baseline, week 17, and week 29 of a multisite clinical trial. RESULTS: Despite evidence of clinical improvement with both medications, there was virtually no medication effect on either social competence or problem solving. CONCLUSIONS: These findings underscore the circumscribed nature of symptomatic improvement in the broader spectrum of clinical outcomes and suggest that new-generation medications may not be expected to produce substantial changes in social role functioning or social problem-solving capacity in the community. The generalizability of the findings should be viewed cautiously because of the low power of this trial, and replication is warranted.

Adult↗

PubMed2004

Skills training for people with severe mental illness.

There is a growing empirical literature on psychosocial rehabilitation strategies for schizophrenia and other severe mental illnesses. Three of the best-supported and most promising approaches were reviewed: social skills training (SST), cognitive behavior therapy (CBT), and cognitive remediation (CR). Of the three, SST has the strongest empirical support and can be considered an evidence-based treatment. However, it is appropriate as a targeted treatment for social impairment, not as a broad based treatment for schizophrenia. CBT has only recently been applied to patients with psychotic disorders and the preliminary results are promising for reducing distress associated with residual psychotic symptoms. All but a handful of trials have been carried out in the context of the public health system in the UK with specially selected patients. Consequently, it is not yet clear if it would be effective in public health systems in the US, with highly impaired patients, or for patients with comorbid substance abuse. There is an extensive literature documenting that a variety of training techniques can improve performance on neuropsychological tests, and there is a growing literature of more clinically relevant CR trials that have produced small to medium effect sizes. No studies have yet demonstrated a clinically significant effect on community functioning. This is a promising area for further research, but CR, like CBT, does not have a sufficient evidentiary base for widespread dissemination to the public mental health system at this time.

Aptitude↗

PubMed2003

Modulation of MK-801-elicited mouse popping behavior by galantamine is complex and dose-dependent.

The ability of phencyclidine (PCP), a noncompetitive antagonist of NMDA receptor-mediated neurotransmission, to precipitate a schizophreniform psychosis in susceptible individuals is consistent with the hypothesized pathologic occurrence of NMDA receptor hypofunction in this disorder. Because the psychosis caused by PCP resembles schizophrenia in all of the relevant domains of psychopathology, investigators have sought to characterize animal models of NMDA receptor hypofunction. MK-801 (dizocilpine) binds to the same hydrophobic channel domain in the NMDA receptor-associated ionophore as PCP, and has been shown to elicit intense irregular episodes of jumping behavior in mice, termed "popping." MK-801-elicited mouse popping is an animal model of NMDA receptor hypofunction that has been used to screen novel candidate compounds for the treatment of schizophrenia. Recently, a selective abnormality in the transduction of the acetylcholine signal at the level of the alpha 7 nicotinic receptor has been described in schizophrenia. The existence of a nicotinic cholinergic abnormality in schizophrenia has stimulated interest in a potential therapeutic role for positive allosteric modulation of nicotinic receptors. Galantamine is a compound that possesses two interesting properties: inhibition of acetylcholinesterase and positive allosteric modulation of nicotinic neurotransmission. Theoretically, galantamine would be expected to increase the efficiency or likelihood that acetylcholine will promote channel opening and ionic conductance at nicotinic receptors. As expected, in the current investigation statistically significant popping behavior was elicited by MK-801 in mice (T(22) = 2.16, P < 0.05). This MK-801-elicited popping was significantly attenuated by 100 mg/kg of galantamine (T(22) = 2.24, P < 0.05). The data show that nicotinic interventions can influence NMDA receptor-mediated neurotransmission in the intact mouse.

Animals↗

PubMed2003

Interaction of stress and strain on glutamatergic neurotransmission: relevance to schizophrenia.

Psychosis caused by phencyclidine (PCP) stimulated interest in characterizing rodent behaviors elicited by PCP and its analogues. We have shown that MK-801 antagonizes electrically precipitated seizures (defined as tonic hindlimb extension) and elicits episodes of intense jumping behavior, referred to as "popping," in mice. Moreover, 24 h after stress, MK-801's ability to antagonize electrically precipitated seizures is reduced in outbred NIH Swiss mice. Inbred BALBc mice are more resistant to electrically precipitated seizures than the NIH Swiss strain, and are more sensitive to both MK-801's anticonvulsant effect and ability to elicit popping. In the current experiments, we examined the influence of stress and genetic mouse strain on both MK-801's ability to antagonize electrically precipitated seizures and elicit popping. Stress significantly reduced the threshold voltage for precipitation of seizures in BALBc mice and the anticonvulsant properties of MK-801 in both strains. These data show that factors relevant to schizophrenia and its exacerbation (i.e., acute stress and genetics) influence N-methyl-D-aspartic acid (NMDA) receptor-mediated neurotransmission in intact mice. The BALBc inbred strain of mouse may possess advantages in preclinical screening paradigms designed to assess NMDA receptor agonist interventions for disorders such as schizophrenia. Specifically, stressed BALBc mice showed the greatest behavioral sensitivity to MK-801 with regard to electrically precipitated seizures in the incremental electroconvulsive shock (IECS) paradigm, whereas unstressed BALBc showed the greatest behavioral sensitivity to MK-801 in the "popping" paradigm, relative to BALBc and NIH Swiss mice in the appropriate comparison conditions.

Animals↗

PubMed2003

A review of cognitive training in schizophrenia.

Empirically supported treatments for schizophrenia now include a variety of psychosocial interventions, such as social skills training, vocational rehabilitation, and psychotherapy. As awareness of the functional importance of neurocognitive impairments in schizophrenia has increased, interest in treatments to improve cognition has grown. We review the literature on cognitive training (CT), which has been studied in 17 published randomized, controlled trials to date. The differential effectiveness of noncomputerized and computer-assisted interventions, with and without strategy coaching, and an environmental adaptation intervention, is examined. We conclude that the different types of approaches, whether computer assisted or not, all have effective components that hold promise for improving cognitive performance, symptoms, and everyday functioning. Our recommendations for further research, including the use of functional outcome measures and long-term followup, highlight the importance of improving ecological validity in this area of treatment research.

Activities of Daily Living↗

PubMed2003

Traumatic life events and PTSD among women with substance use disorders and schizophrenia.

OBJECTIVE: The authors assessed the prevalence of traumatic life events and posttraumatic stress disorder (PTSD) among women with schizophrenia or schizoaffective disorder and co-occurring substance abuse or dependence. The association between PTSD and specific traumatic life events was also examined. METHODS: Fifty-four drug-addicted women with schizophrenia or schizoaffective disorder participated in the study. All women were psychiatric outpatients and completed a large battery of structured clinical assessments. RESULTS: High rates of trauma, particularly physical abuse (81 percent), and revictimization--being abused both as a child and as an adult--were reported. The average number of traumatic life events reported was eight, and almost three-quarters of the sample reported revictimization. Rates of current PTSD were considerably higher than those documented in previous study samples of persons with serious mental illness and of drug-addicted women in the general community. PTSD was significantly associated with childhood sexual abuse and revictimization. CONCLUSIONS: The high levels of trauma and revictimization observed in the study highlight the need for the development of evidence-based interventions to treat trauma and its aftermath among women with schizophrenia or schizoaffective disorder. Given the overlap in symptoms between PTSD and schizophrenia, a better understanding is needed of how PTSD is expressed among people with schizophrenia. Recommendations and standards for the assessment of PTSD among this population need to be articulated. Finally, the comparatively high rates of PTSD suggest that the combination of schizophrenia or schizoaffective disorder and substance use disorder makes these women particularly vulnerable to adverse outcomes.

Adult↗

PubMed2002

Interpersonal control, expressed emotion, and change in symptoms in families of persons with schizophrenia.

This study examined the relationships of expressed emotion (EE), change in symptoms in schizophrenia, and interpersonal control patterns in relatives over a 2-year period. Subjects were 56 persons with schizophrenia and their relatives who participated in the NIMH Treatment Strategies in Schizophrenia (TSS) longitudinal study. The relationships among EE, interpersonal control as measured by the Relational Control Coding System (RCCS), and levels of symptoms at each assessment point were analyzed longitudinally with hierarchical linear modeling (HLM). No relationship was found between EE and symptoms, nor did control appear to contribute to symptoms. High-EE relatives reacted more strongly to symptom change than low-EE relatives and in opposite directions. EE may be an indicator of responsiveness rather than either a cause or result of symptoms. Understanding how EE attitudes impact the struggles patients and relatives have in coping with schizophrenia is crucial to knowing how clinicians can support these families most effectively.

Adult↗

PubMed2002

Topiramate antagonizes MK-801 in an animal model of schizophrenia.

The phencyclidine (PCP) model of schizophrenia suggests that N-methyl-D-aspartate (NMDA) receptor hypofunction and its consequences may play an important role in the pathophysiology of this psychiatric disorder. Moreover, the schizophreniform psychosis caused by PCP resembles schizophrenia in all of the relevant domains of psychopathology, especially negative symptoms and cognitive dysfunction. Because of interest in the PCP model and possible NMDA receptor hypofunction in schizophrenia, animal behaviors elicited by PCP and its analogues have been characterized. These preclinical models may serve to identify candidate compounds that possess therapeutic efficacy in schizophrenia. Ideally, negative symptoms and cognitive dysfunction would also serve as therapeutic targets for these novel medications. In the current study, the ability of topiramate to attenuate the severity of a specific behavior elicited by MK-801 (dizocilpine), a high affinity analogue of PCP was studied in mice. Topiramate was chosen because it addresses two of the predicted pathological consequences of NMDA receptor hypofunction. Specifically, topiramate potentiates GABAergic neurotransmission and antagonizes the excitotoxic actions of glutamate at the alpha-amino-3-hydroxy-5-methylisoxazole-4-propionic acid (AMPA)/kainate (KA) classes of glutamate-gated channels. Topiramate was shown to inhibit MK-801-elicited "popping" behavior in a complex dose-dependent manner.

Animals↗

PubMed2002

Age, expressed emotion, and interpersonal control patterning in families of persons with schizophrenia.

Expressed emotion (EE) is a measure of a relative's attitude toward a person with a mental disorder as reflected by comments made to an interviewer. Over the years, an impressive body of research has been generated in attempts to explain the relationship of EE and course of illness, particularly in regard to schizophrenia. Past analyses have demonstrated two common patterns of interpersonal control in families with high-EE relatives. The first was that the relative and patient competed for 'who's in charge', with both rigidly asserting control. The other was that the relatives responded rigidly in one control mode no matter what the offspring was saying. In this study, we tested whether the difference in patterning was due to the patients being older. Study participants were 71 relative-patient dyads. EE was measured with the Five-Minute Speech Sample, the Family Problem-Solving Task was used to generate interaction, and interaction data were coded with the Relational Control Coding System. Multilevel modeling was used to estimate a model with verbal exchanges as Level 1, relatives' EE as Level 2, and age of the patient as Level 3. Results showed that age attenuated the relationship between the patient's message and the parent's response, and this effect was stronger in families with high-EE relatives. This effect may reflect disengagement on the part of the relative, the patient, or both. The over-responsive families may need advice on how to create more distance, or how to be more objective, but the distant families may need more support and encouragement to communicate and problem-solve.

Adult↗