Body, mind, and human purpose.
Explore the source record for details and available documents.
Biological Psychiatry↗
Biomedical subjects
D W Heinrichs
Publications and source records attributed to D W Heinrichs.
Clinical correlates of the deficit syndrome of schizophrenia.
The authors propose using primary and enduring negative or deficit symptoms for dichotomizing schizophrenic patients into two groups, deficit and nondeficit. The validity of this approach was examined by comparing 17 deficit and 17 nondeficit patients for differences in premorbid adjustment and degree of neurological impairment. Deficit patients were characterized by poorer premorbid adjustment and greater neurological impairment. Neurological impairment was not related to premorbid adjustment in either group or in the total patient population. These findings support the utility of deficit symptoms for defining a more homogeneous subgroup of schizophrenia.
Adult↗
Continuous versus targeted medication in schizophrenic outpatients: outcome results.
The authors report on the outcome of treatment of 116 outpatients with chronic schizophrenia who were assigned to a 2-year, single-blind course of treatment with either targeted or continuous medication. These patients were not restricted to those who were good candidates for a medication reduction strategy. Continuous medication was superior to targeted medication in preventing decompensations and hospitalizations and in extent of employment at 2 years. Other measures of psychopathology and functioning at 1 and 2 years did not differentiate the two groups of patients. The targeted approach achieved a substantial reduction in total medication through a reduction in the number of days of medication administration.
Adult↗
The Neurological Evaluation Scale (NES): a structured instrument for the assessment of neurological signs in schizophrenia.
The significance of neurological signs in schizophrenia is poorly understood. In part, this may reflect the marked variability in the methods of ascertainment in previous studies. The Neurological Evaluation Scale (NES) is designed to standardize the assessment of neurological impairment in schizophrenia. The battery consists of 26 items. Data on the interrater reliability for total score, functional areas of interest, and individual items are presented. Preliminary validity data demonstrate the ability of the battery to discriminate patients with schizophrenia from nonpsychiatric controls.
Brain Damage, Chronic↗
Significance and meaning of neurological signs in schizophrenia.
The authors review studies of abnormal signs on clinical neurological examination of schizophrenic patients. In spite of a number of methodologic limitations, the cumulative evidence strongly argues that there are more neurological signs in schizophrenic patients than in nonpsychiatric control subjects. Although less consistent, there is considerable evidence of more neurological signs in schizophrenic patients than in patients with affective disorders or with mixed, nonpsychotic disorders. The existing literature suggests several preliminary hypotheses with respect to neuroanatomical localization of neurological signs, subtyping of schizophrenia, and utility of studies of relatives at high risk and family history studies. Directions for future research in these areas are described.
Depressive Disorder↗
Deficit and nondeficit forms of schizophrenia: the concept.
The authors provide a rationale for distinguishing the primary, enduring negative symptoms of schizophrenia (termed "deficit symptoms") from the more transient negative symptoms secondary to other factors. They argue that the former are more likely to provide a basis for meaningful subtyping of the schizophrenic syndrome, while the latter are more likely to respond to currently available treatments. They describe their experience in using clinical judgment based on longitudinal observations to identify deficit and nondeficit subtypes of schizophrenic patients and propose criteria for defining schizophrenia with the deficit syndrome.
Adult↗
Deficit and nondeficit forms of schizophrenia: neuropsychological evaluation.
The neuropsychological function of 15 deficit and 15 matched nondeficit syndrome schizophrenics was compared to that of 15 age- and sex-matched normal subjects. Both schizophrenic groups performed poorly on the Psychomotor factor compared to the normals. Only the deficit group performed more poorly on the General Performance factor. The results were not associated with severity of either positive or negative symptoms at the time of testing. These findings support the usefulness of the deficit syndrome distinction in contradistinction to the cross-sectional positive and negative symptom dichotomy.
Adolescent↗
A comparative trial of pharmacologic strategies in schizophrenia.
An open comparative trial was conducted involving 42 schizophrenic outpatients randomly assigned to one of two methods of drug administration: continuous medication (N = 21) and targeted medication plus psychosocial intervention (N = 21). The results, which suggest an extensive similarity with respect to outcome for the two treatments over a 2-year period, argue for the continuation of research on the relative effectiveness of the targeted drug approach, particularly in cases judged suitable for drug reduction strategies.
Adolescent↗
Interpersonal and pharmacologic treatment in schizophrenia: a comparative study of new approaches.
Explore the source record for details and available documents.
Adult↗
Treatment of negative symptoms.
The rational treatment of the negative symptoms of schizophrenia requires a careful differentiation of those secondary to a range of other factors and those that constitute enduring primary or deficit symptoms. Secondary negative symptoms are usually responsive to treatment of the underlying cause. In contrast, there is no intervention currently available with established efficacy in treating deficit symptoms. These distinctions serve to reduce the heterogeneity of negative symptoms. A discussion of the diagnosis and treatment of the various forms of secondary negative symptoms is followed by suggestions for future research in the treatment of deficit symptoms.
Antipsychotic Agents↗
Early insight and the management of schizophrenic decompensation.
Despite maintenance treatment, including the prophylactic use of neuroleptics, there is a significant rate of psychotic relapse and rehospitalization in schizophrenic outpatients. Thus comprehensive aftercare should ideally include clinical strategies of early intervention designed to abort decompensations in their earliest stages before florid psychosis and rehospitalization occur. Factors likely to improve the success rate of such strategies include the presence of a phase of prodromal symptoms preceding florid psychosis during which interventions could be made, as well as the patient's insight at such times that he/she is becoming ill, which would facilitate cooperation with intervention. While there is considerable evidence that a prodromal phase is typically present, there has been little exploration of "early insight." This study examines two hypotheses about early insight: 1) insight is present in a sizable portion of schizophrenic patients in the early phase of relapse; and 2) such early insight predicts a successful resolution of the relapse on an outpatient basis without the need for rehospitalization. In a retrospective research design utilizing clinical progress notes, both hypotheses were corroborated. Of the 38 patients in the sample, 24 (63%) demonstrated early insight, and of these only two (8%) were hospitalized as a result of the relapse. Conversely, seven of 14 (50%) uninsightful patients required rehospitalization (p = .006). This supports the feasibility of an early intervention strategy and confirms that early insight is an important patient attribute that predicts successful implementation of this treatment. Clinical experience in trying to develop early insight in the context of a psychotherapeutic relationship and the implications of early intervention for reducing the overall exposure to neuroleptics in schizophrenic populations are discussed.
Adult↗
Prospective study of prodromal symptoms in schizophrenic relapse.
The authors examined the type and frequency of prodromal symptoms in 47 cases of schizophrenic relapse during which 30 patients were drug free and 17 were medicated. The findings indicate that clinicians who use patient and family reports can identify prodromal symptoms as they occur.
Acute Disease↗
Experience with a drug-free month in schizophrenic outpatients.
Explore the source record for details and available documents.
Adult↗
The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome.
There is growing interest in deficit symptoms in studies of the course and treatment response of schizophrenia. However, existing clinical assessment instruments focus primarily on productive symptoms. The authors describe the Quality of Life Scale (QLS), a 21-item scale based on a semistructured interview designed to assess deficit symptoms and thereby fill an important gap in the range of instruments now available. Data regarding reliability and training in the use of the QLS are presented. A factor analysis of the items yields results compatible with the conceptual model on which the scale is based. The factor analysis was also performed separately by sex and was fundamentally similar for men and women.
Factor Analysis, Statistical↗
Early intervention, time-limited, targeted pharmacotherapy of schizophrenia.
A growing appreciation of the risks of long-term, continuous neuroleptic use in the aftercare of schizophrenic patients has led to a search for alternative strategies. The authors report their experiences with the clinical strategy of "targeted" medication, in which patients are followed drug free until prodromal signs of impending relapse appear. Medication is then initiated to abort the impending episode and discontinued when patients restabilize clinically. Preliminary experience suggests that control of schizophrenic symptomatology comparable to that obtained with maintenance drugs can be achieved with a marked reduction in medication use when the targeted strategy is applied in the context of a broad-based program of psychosocial intervention based on a comprehensive medical model.
Antipsychotic Agents↗
Treatment-relevant subtypes of schizophrenia.
The heterogeneity of schizophrenia and the failure of classical subtypes to predict treatment response reliably have led to two contrasting assumptions. The first is that the treatment approach is essentially the same for all schizophrenics. The second is that the treatment needs of schizophrenic patients can be based only on clinical "hunches" or the biases of the therapist, because meaningful criteria for making therapeutic decisions are lacking. Both assumptions tend to discourage careful and critically reasoned treatment planning. This report argues that current knowledge permits the formulation of subtypes that can assist in the rational choice of individualized treatment approaches. It proffers a number of such subtypes and deals with their application to therapeutic decision-making at various phases of the illness.
Diagnosis, Differential↗
Methodologic standards for treatment outcome research in schizophrenia.
Considerable progress has been made in increasing the formal correctness of outcome research in schizophrenia by employing strict methodologic standards. However, based on a recent review of the literature, the authors note that insufficient attention has been directed toward the meaningfulness of such research. The interest of a particular study derives from its application beyond the specific patients treated; lack of attention to meaningfulness encourages the researcher to posit unjustified or overly generalized conclusions, resulting in the widespread adoption of questionable treatment strategies or the dismissal of potentially useful ones. Increased attention to meaningfulness will make the conclusions of this type of research more valuable, both from pragmatic and theoretical standpoints.
Follow-Up Studies↗