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Biomedical subjects

B W Palmer

Publications and source records attributed to B W Palmer.

At least 19 recordsLinked to original sources
PubMed2003

Aging and outcome in schizophrenia.

OBJECTIVE: Controversy exists about long-term outcome of schizophrenia, but few studies have compared older out-patients to normal subjects. We sought to examine the relationship of age to clinical features, psychopathology, movement abnormalities, quality of well-being, and everyday functioning in schizophrenia out-patients and normal comparison subjects, and to further characterize these outcomes in elderly schizophrenia out-patients. METHOD: A total of 290 out-patients and 144 comparison subjects, aged 40-85 years, underwent comprehensive assessments. RESULTS: Among patients, aging was associated with decreased psychopathology, even after controlling for duration of illness. There was no accelerated aging-related decline on any measure in the patients. Yet, elderly patients were more impaired than comparison subjects on various measures. CONCLUSION: The course of schizophrenia in late life appears stable, but most elderly patients remain symptomatic and impaired. Our findings dispute notions of either progressive deterioration or marked improvement in aging schizophrenia out-patients.

Adult↗
PubMed2002

Ethical issues in psychosocial interventions research involving controls.

Psychiatric research is of critical importance in improving the care of persons with mental illness. Yet it may also raise difficult ethical issues. This article explores those issues in the context of a particular kind of research: psychosocial intervention research with control groups. We discuss 4 broad categories of ethical issues: consent, confidentiality, boundary violations, and risk-benefit issues. We believe that, despite the potential difficulties, psychosocial intervention research is vital and can be accomplished in an ethical manner. Further discussion and research into these issues are warranted.

Behavioral Research↗
PubMed2001

Stability and course of neuropsychological deficits in schizophrenia.

BACKGROUND: Neuropsychological deficits in schizophrenia appear to predate clinical symptoms of the disease and become more pronounced at illness onset, but controversy exists about whether and when further neuropsychological progression may occur. OBJECTIVE: To identify and characterize any subset of patients who evidenced progressive neuropsychological impairment, we compared the longitudinal stability of neuropsychological functioning in schizophrenic outpatients and normal comparison subjects. METHODS: One hundred forty-two schizophrenic outpatients and 206 normal comparison subjects were given annually scheduled comprehensive neuropsychological evaluations during an average of 3 years (range, 6 months to 10 years). Clinically and demographically defined subgroups were compared, and test-retest norms were used to identify individual patients who showed unusual worsening over time. RESULTS: The schizophrenic group was neuropsychologically more impaired than the normal comparison subjects but showed comparable test-retest reliability and comparable neuropsychological stability over both short (mean, 1.6 years) and long (mean, 5 years) follow-up periods. No significant differences in neuropsychological change were found between schizophrenic subgroups defined by current age, age at onset of illness, baseline level of neuropsychological impairment, improvement or worsening of clinical symptoms, and occurrence of incident tardive dyskinesia. Norms for change also failed to show neuropsychological progression in individuals with schizophrenia. CONCLUSIONS: Neuropsychological impairment in ambulatory persons with schizophrenia appears to remain stable, regardless of baseline characteristics and changes in clinical state. Our results may not be generalizable to the minority of institutionalized poor-outcome patients.

Adult↗
PubMed2001

Enhancing comprehension of consent for research in older patients with psychosis: a randomized study of a novel consent procedure.

OBJECTIVE: The ability of individuals with schizophrenia to provide informed consent for research has become the focus of public debate. The authors examined whether a novel consent procedure improved the comprehension of consent for older patients with psychosis. METHOD: Fifty outpatients with schizophrenia or other psychotic disorders and 19 normal comparison subjects aged 40-80 were randomly assigned to groups given either a routine or an enhanced consent procedure. The latter utilized a computerized presentation that included sequential bullet points and summaries of key information. A posttest measured comprehension of consent-relevant information. RESULTS: A significantly greater proportion of patients who received the enhanced consent procedure scored 100% on first and second trials of the posttest, compared to those receiving the routine procedure (trial 1: 42.3% versus 8.3%; trial 2: 80.8% versus 45.8%, respectively). CONCLUSIONS: The enhanced consent method improved comprehension of information relevant for consent in older patients with psychosis.

Adult↗
PubMed2001

Association of depressive symptoms with worse functioning in schizophrenia: a study in older outpatients.

BACKGROUND: Subsyndromal depressive symptoms are highly prevalent and associated with substantial impairments of daily function in the general population. Depressive symptoms are common in schizophrenia. However, few studies have examined the relationship of functioning and well-being to the presence of depressive symptoms in schizophrenia. METHOD: 202 middle-aged or elderly outpatients with schizophrenia (DSM-III-R or DSM-IV criteria) were categorized by severity of depressive symptoms on the Hamilton Rating Scale for Depression (HAM-D) using previously validated cutoff points, i.e., HAM-D total score < or = 6 (low), from 7 to 16 (medium), and > or = 17 (high). We also assessed severity of positive and negative symptoms, movement disorders, neurocognitive performance, daily functioning, and health-related quality of well-being with standardized measures. RESULTS: A total of 11.4% of patients had HAM-D scores > or = 17, and 56.4% had HAM-D scores from 7 to 16. Even after adjusting for severity of other psychopathology, patients with more severe depressive symptoms had significantly worse everyday functioning (p < .02), except for physical functioning, and health-related quality of well-being (r = -.365, p < .001) than did those with lower HAM-D scores. These differences were unrelated to those in demographics, extrapyramidal symptoms, tardive dyskinesia, neurocognitive performance, or number of physical illnesses. CONCLUSION: The results suggest the importance of evaluating schizophrenia patients for the presence of depressive symptoms. Effectiveness of adjunct treatment of depressive symptoms with antidepressants and psychosocial management in improving functioning of schizophrenia patients deserves further study.

Age Factors↗
PubMed1999

Neuroleptic discontinuation in clinical and research settings: scientific issues and ethical dilemmas.

The ethics of neuroleptic discontinuation in clinical and research settings are currently a topic of much discussion. The issues underlying this debate are complicated by the fact that these medications can be fairly effective in managing the symptoms and preventing relapse in schizophrenia and other psychotic disorders, yet these drugs have therapeutic limitations and their prolonged use is associated with a risk of serious, potentially persistent side-effects such as tardive dyskinesia. Over the past 47 years, the public perception about the value of neuroleptics has undergone dramatic shifts, based partly on the data available at different time periods. The risk-benefit ratio is better for the atypical antipsychotics compared to the conventional ones, but long-term experience with the newer agents has been limited. At present, a prudent strategy for most clinical and research purposes is to gradually taper the medications in clinically stable, carefully selected, consenting subjects to the lowest doses on which individual patients can be effectively maintained. In this article we discuss clinical, research, and ethical aspects of neuroleptic discontinuation. It is critical to protect potentially vulnerable patients with serious mental illnesses, while allowing them to benefit from appropriate investigations.

Antipsychotic Agents↗
PubMed1999

Extrapyramidal symptoms and neuropsychological deficits in schizophrenia.

BACKGROUND: Extrapyramidal (EP) symptoms and neuropsychological (NP) deficits are both frequently present among schizophrenia patients. EP symptoms, such as motor slowing, could hinder performance on NP tests, yet little is known about the relationship between EP symptoms and NP functioning among schizophrenia patients. METHODS: Using a comprehensive NP test battery and standard ratings of EP symptoms and other psychiatric characteristics, we conducted a cross-sectional exploration of the association between EP symptoms and NP functioning among 96 middle-aged and elderly outpatients with schizophrenia. RESULTS: Severity of EP symptoms was associated with worse NP performance, particularly the areas of learning and motor skills. Regression analyses indicated that the relationship between EP symptoms and NP deficits was not accounted for by slowed motor or mental processing, demographic characteristics, severity of psychopathology, dyskinesia, or medication status. CONCLUSIONS: The pathophysiological mechanisms underlying EP symptoms and some NP deficits in schizophrenia may overlap.

Aged↗
PubMed1999

Consensus statement on the upcoming crisis in geriatric mental health: research agenda for the next 2 decades.

It is anticipated that the number of people older than 65 years with psychiatric disorders in the United States will increase from about 4 million in 1970 to15 million in 2030. The current health care system serves mentally ill older adults poorly and is unprepared to meet the upcoming crisis in geriatric mental health. We recommend the formulation of a 15- to 25-year plan for research on mental disorders in elderly persons. It should include studies of prevention, translation of findings from bench to bedside, large-scale intervention trials with meaningful outcome measures, and health services research. Innovative strategies are needed to formulate new conceptualizations of psychiatric disorders, especially those given scant attention in the past. New methods of clinical and research training involving specialists, primary care clinicians, and the lay public are warranted.

Age Distribution↗
PubMed1999

Use of oral reading to estimate premorbid intellectual and neuropsychological functioning.

Judgment of neuropsychological decline is typically made by comparing a patient's current cognitive performance to data from demographically similar normal individuals. Even within narrowly defined demographic categories, however, there is variability in level of performance, approximating the normal curve. The present study explored the degree to which oral reading scores on the American National Adult Reading Test (ANART) could more accurately predict a person's test performance relative to other demographically similar individuals. In a sample of 141 neurologically healthy participants, the ANART added modestly to the precision of WAIS-R Verbal and Full Scale IQ and Learning score predictions, beyond that achieved by demographics alone; however, ANART score did not significantly improve estimation of Performance IQ, Average Impairment Rating, or Memory score. Use of the ANART tended to improve demographic predictions primarily with "outlier" participants whose oral reading skills were relatively poor. For Verbal IQ, ANART helped with participants who had both poor ANART and relatively high education. Oral reading can be useful for estimating premorbid verbal intelligence and learning in combination with demographic variables, but it does not appear to improve estimates of other neurocognitive abilities.

Adult↗
PubMed1999

Older patients with schizophrenia: challenges in the coming decades.

The number and proportion of older adults with schizophrenia will increase considerably in the coming decades. Although a vast literature on schizophrenia among younger adults exists, much less is known about late-life schizophrenia and its treatment. The authors describe two potential scenarios for 2011, the year that the first baby boomers will turn 65. To ensure that the more favorable scenario becomes a reality, the authors suggest four goals: decrease medical comorbidity and mortality among younger patients with schizophrenia and improve their access to health care so that they can live longer and more productive lives; improve our understanding of the neurobiological and psychosocial factors underlying late-life schizophrenia, as well as the health care and social service needs of such patients; develop more effective and safer pharmacologic, psychosocial, and cognitive behavioral treatments; and improve rehabilitation of older people with schizophrenia. Specific strategies to foster these goals include establishing a consortium for studies of late-life schizophrenia; conducting multicenter studies of treatment effectiveness; and forming interdisciplinary collaborations among researchers, clinicians, government and industry representatives, and patient advocacy groups.

Aged↗
PubMed1999

Cognitive deficits and psychopathology in institutionalized versus community-dwelling elderly schizophrenia patients.

We evaluated psychiatric symptoms and neurocognitive functioning among 25 institutionalized and 25 outpatient DSM-IV-diagnosed schizophrenia patients, as well as 25 middle-aged and elderly normal comparison subjects. All subjects were assessed with the Positive and Negative Syndrome Scale, Hamilton Rating Scale for Depression, modified Simpson-Angus Extrapyramidal Symptom Scale, the Abnormal Involuntary Movement Scale, and the Mattis Dementia Rating Scale (DRS). The two patient groups had similar levels of depressive symptoms, but the institutionalized patients had more severe positive and negative symptoms and were on higher doses of neuroleptic medication. The institutionalized patients had significantly more cognitive impairment on the DRS than outpatients and normal comparison subjects, particularly on the subscales of initiation/perseveration, conceptualization, and memory. Results are discussed in terms of the possible neuropathology associated with cognitive impairment in chronic schizophrenia.

Aged↗
PubMed1998

Relationship of neuropsychological and MRI measures to age of onset of schizophrenia.

Age of onset of schizophrenia (AOS) may be largely determined by neurobiological factors. We examined in a diverse sample of schizophrenia out-patients the relationships of AOS with neuropsychological abilities and structural brain abnormalities as measured on cerebral magnetic resonance imaging (MRI). A total of 82 out-patients meeting DSM-III-R criteria for schizophrenia were evaluated with a comprehensive neuropsychological battery and semi-automated quantitatively analysed cerebral MRI. Earlier AOS correlated with poorer performance in learning and abstraction/cognitive flexibility, and with larger volumes of caudate and lenticular nuclei, and smaller volume of thalamus on MRI. A model for predicting AOS consisting of abstraction and thalamic and caudate volumes remained significant after controlling for duration of illness, current age and daily neuroleptic dose. In conclusion, AOS may be related to specific rather than general measures of cognitive performance and structural brain abnormalities.

Adult↗
PubMed1998

Base rates of "impaired" neuropsychological test performance among healthy older adults.

Base rates of deficient neuropsychological test performance were evaluated among 132 neurologically healthy older normal adults using a variety of measures commonly employed in the "flexible-battery"approach to neuropsychological assessment. Subjects were divided into three age groups (50 to 59, 60 to 69, and 70 to 79 years). Despite the healthy status of our sample, most tests yielded at least some proportion of subjects earning scores in the borderline and impaired ranges (1.3 and 2.0 standard deviations below the age-group mean, respectively). Across the battery of measures, 73% of subjects earned a borderline score on at least one measure, and 20% of subjects earned at least two scores in the impaired range on separate tests. The proportion of subjects consistently earning borderline or impaired scores across multiple measures within specific cognitive domains was generally lower. Results illustrate the problems in interpreting isolated low scores, and the need to consider false-positive base rates in drawing inferences from poor test performance.

Journal Article↗
PubMed1997

Anxiety disorders in the elderly: DSM-IV and other barriers to diagnosis and treatment.

Traditional lore suggests that anxiety disorders are less prevalent in elderly than in younger adults, and late-onset anxiety disorders are especially rare. We question these assumptions, and suggest that these conditions are underdiagnosed in late life. A common problem in the literature is the application of DSM-IV-like criteria developed from studies of younger adults to geriatric samples without regard for atypical symptom presentations, high occurrence of depressive and medical co-morbidity, and influence of aging-related psychosocial changes on the clinical picture. Diagnostic problems are further compounded by therapeutic ones. Clinicians are often forced to make treatment decisions for their elderly patients based on uncontrolled clinical observations or questionable extrapolation of treatment data in younger adults. An open-minded approach unhinged by 'conventional wisdom' is warranted.

Adult↗
PubMed1997

Is it possible to be schizophrenic yet neuropsychologically normal?

This study identified and characterized a group of schizophrenic patients without neuropsychological (NP) impairment. A comprehensive NP battery was administered to 171 schizophrenic outpatients and 63 normal comparison participants. Each participant's NP status was classified through blind clinical ratings by 2 experienced neuropsychologists; 27% of the schizophrenics were classified as NP normal. The NP-normal and NP-impaired schizophrenics were similar in terms of most demographic, psychiatric, and functional characteristics, except that NP-normal patients had less negative and extrapyramidal symptoms, were on less anticholinergic medication, socialized more frequently, and were less likely to have had a recent psychiatric hospitalization. The existence of NP-normal schizophrenics suggests that the pathophysiology underlying the cognitive deficits often associated with schizophrenia may be distinct from that causing some of its core psychiatric features.

Adult↗
PubMed1997

Nondementia nonpraecox dementia praecox? Late-onset schizophrenia.

Schizophrenia has traditionally been viewed as a psychotic disorder with onset in adolescence or early adulthood and a deteriorating course. Over the past decade, the authors have been studying patients meeting DSM-III-R as well as specified research criteria for late-onset schizophrenia (onset after age 45) and several comparison groups with psychiatric, neurologic, neuropsychologic, brain-imaging, psychophysiological, and psychosocial assessments. Results to date suggest a number of similarities and differences between late-onset schizophrenia and comparison groups of other older patients with psychoses (including earlier-onset schizophrenia). Later-onset schizophrenia is probably a neurobiologically distinct subtype of schizophrenia. Differential involvement of cortico-striato-pallido-thalamic circuitry may explain differences in age at onset. The authors propose a new conceptual model for level of functioning at different stages of life in late-onset schizophrenia.

Adult↗
PubMed1996

Neuropsychological deficits among older depressed patients with predominantly psychological or vegetative symptoms.

Depressed outpatients having primarily psychological or vegetative symptoms, as defined by the factor analytically developed Hamilton Depression Scale superfactors described by Rhoades and Overall (1983), were compared with similarly aged normal controls on a comprehensive neuropsychological battery. The vegetative group evidenced poorer performance than controls on several measures associated with right hemisphere functioning and on a task associated with executive functioning. In contrast, the psychological group did not significantly differ from controls on any measure, and had significantly better performance than the vegetative group on several tasks. These findings suggest that neuropsychological deficits associated with depression may be limited to those patients with primarily vegetative symptoms.

Aged↗