Biomedical subjects

J M Gold

Publications and source records attributed to J M Gold.

At least 19 recordsLinked to original sources

PubMed2001

Generalization of training effects in schizophrenia.

The primary goal of this study was to investigate transfer of training (generalization) in patients with schizophrenia. We randomly assigned 33 schizophrenia subjects to one of three conditions: training on the Wisconsin Card Sort Test (WCST-T), training on the Halstead Category Test (CAT-T), or no training (No-T). The WCST and CAT were administered to all subjects at baseline. Subjects in the WCST-T and CAT-T groups then received training on the respective test, while the No-T group received additional untrained trials. All participants were subsequently retested on the WCST and CAT, and completed a brief neuropsychological battery. As hypothesized, the WCST-T and CAT-T groups exhibited large improvements on the trained test and moderate improvement on the untrained test, while the No-T group failed to show improvement on either test. These results suggest that the training paradigm did produce generalization, and that the changes were not due to practice effects. The extent of generalization across both training groups was strongly associated with neuropsychological test performance (Spearman's rho=0.56, P<0.05). The implications of these findings for rehabilitation programs were discussed, and recommendations were made for future research.

Adult↗

PubMed2001

Is position "special" in visual attention? Evidence that top-down processes guide visual selection.

The role of spatial position in selective visual processing has been the source of recent debate. Experiments by Tsal and Lavie (1988) and van der Heijden et al. (1996) have been designed to establish the status of position in visual selection. Tsal and Lavie found that observers tend to select letters from a briefly presented array according to position. Using the same paradigm, van der Heijden et al. found that observers tend to select according to colour, except under conditions of low contrast and unrestricted eye movements. The present study attempted to reconcile these findings by exploring the influence of top-down processes (task instructions) while explicitly controlling for eye movements. Experiment 1 demonstrated there was no inherent selection bias for stimuli similar to those used by van der Heijden et al., suggesting that the tendency to select according to colour found by van der Heijden et al. was due to task demands. Experiment 2 further established the role of top-down factors by replicating the results of van der Heijden et al. with our stimuli. Experiment 3 demonstrated that selection can be switched from colour to position by changing the demands of the task. These results suggest that selection may be accounted for by task demands (e.g., instructions) with no priority access for position information.

Analysis of Variance↗

PubMed2001

Perioperative beta-blocker withdrawal and mortality in vascular surgical patients.

OBJECTIVE: Our purpose was to determine the effect of postoperative beta-blocker withdrawal on mortality and cardiovascular events after vascular surgery. METHODS: Detailed data were collected on perioperative cardiovascular medication use and discontinuation and cardiovascular risk factors among consecutive major vascular surgical procedures at two university hospitals. RESULTS: A total of 140 patients received beta-blockers preoperatively. Mortality in the 8 patients who had beta-blockers discontinued postoperatively (50%) was significantly greater than in 132 patients who had beta-blockers continued (1.5%, odds ratio 65.0, P<.001). The effect of beta-blocker discontinuation was unaffected by adjustment by stratification for risk factors (all P< or =.01), for contraindications to restarting beta-blockers (P = .006), and by multivariable analyses adjusting for potential confounders (adjusted odds ratio 17.0, P =.01). beta-Blocker discontinuation also was associated with increased cardiovascular mortality (0% vs 29%, P =.005) and postoperative myocardial infarction (odds ratio 17.7, P =.003). CONCLUSION: Discontinuing beta-blockers immediately after vascular surgery may increase the risk of postoperative cardiovascular morbidity and mortality.

Adrenergic beta-Antagonists↗

PubMed2001

Correlates of insight in serious mental illness.

This study extends research into insight by examining its relationship to a variety of demographic, clinical, neurocognitive, and psychosocial variables among a broad diagnostic sample of 211 adults with serious mental illness. Participants completed a full battery of instruments measuring these variables. Results support a relationship between ratings of poor insight and a psychotic (vs. mood) diagnosis, increased psychiatric symptoms, poorer social skills, and negative medication attitudes. Minorities and those with a substance abuse diagnosis were also more likely to be rated as having poor insight. No relationship was found between level of insight and age, gender, education level, neurocognitive deficits, hospitalization history, size of one's social network, or quality of life measures. Results are discussed in the context of improving the measurement and assessment of insight, conceptualizing interventions aimed at addressing level of insight, and improving outcomes for patients with severe and persistent mental illness. Findings also support a need for continued investigation of how mental illness is understood, experienced, and expressed across diverse groups of people living with mental illness.

Adult↗

PubMed2001

Correlates of long-term unemployment among inner-city adults with serious and persistent mental illness.

This study identified demographic, clinical, and vocational rehabilitation-related correlates of long-term unemployment among 219 adults with severe mental illness. Fifty-one percent of the sample had been unemployed five or more years before enrollment. Older age, a diagnosis of psychosis, severity of negative symptoms, and more previous hospitalizations were all significantly related to long-term unemployment. Gender, race, education, substance disorder diagnosis, severity of negative symptoms, and vocational training experience were not. The findings underscore the relevance of clinical and neurocognitive impairments to long-term unemployment and point to the need to critically reevaluate the effectiveness of traditional vocational rehabilitation services.

Adult↗

PubMed2001

The effect of the physical characteristics of cues and targets on facilitation and inhibition.

The present experiment was conducted in order to examine the role of cue-target discriminability on early occurring attentional cuing effects and late occurring inhibition of return (IOR). The experiment used a single target stimulus in conjunction with three different cue stimuli. The cues were the same as the target, different in color, shape, and luminance to the target, or did not spatially overlap with the target. At shorter stimulus onset asynchronies (SOAs; 100 and 200 msec), attentional cuing effects were only found with the nonoverlapping cues. However, at longer SOAs (400 and 800 msec), approximately equal IOR effects were found with all three types of cues. The results indicated that the physical characteristics of the cues and targets affected the pattern of reaction times at the shorter SOAs but not at the longer SOAs. The conclusion is that the biphasic pattern of early facilitation and late inhibition following a peripheral cue should not be considered the definitive signature of the peripheral cuing paradigm.

Adult↗

PubMed2000

Short form of the WAIS-III for use with patients with schizophrenia.

The recent publication of the Wechsler Adult Intelligence Scale (WAIS-III), the most widely used standard test of intelligence, requires the development of a new short form for use with patients with schizophrenia for many clinical and research purposes. We used regression analyses of complete WAIS-III data on 41 outpatients with schizophrenia and 41 education-, and age-matched healthy subjects to determine the best combination of subtests to use as a short form. Excluding three subtests that are time-consuming to administer, and requiring that the solution includes one subtest from each of the four WAIS index scores, the combination that most fully accounted for the variance in full-scale IQ (FSIQ) for both participants with schizophrenia (R(2)=0.90) and healthy controls (R(2)=0.86) included the information, block design, arithmetic, and digit symbol subtests. When the restrictions regarding which subtests could enter were relaxed, the best four-subtest solution included information, block design, comprehension, and similarities. Although the latter explained 95% of the variance in FSIQ for schizophrenia participants and 90% of the variance for healthy controls, it consistently overestimated FSIQ for the schizophrenia group. We recommend the four-factor short form for use in future research and clinical practice in which a quick, accurate IQ estimate is desired.

Adult↗

PubMed2000

Effects of contextual processing on visual conditional associative learning in schizophrenia.

BACKGROUND: We adapted visual conditional associative learning paradigms to assess the contextual processing deficit model of schizophrenic cognitive impairment proposed by J.D. Cohen and D. Servan-Schreiber in 1992. In this task subjects learn the associations between four sets of stimuli through the use of feedback. We administered two experimental conditional associative learning conditions: in one, the eight stimuli used to make four pairs were all different; in the other, the pairs were made from different combinations of four identical stimuli, requiring the use of contextual information to mediate correct performance. Two additional associative learning tasks were administered where subjects generated the stimulus pairings or observed the experimenter form the pairs, eliminating the need to learn from feedback. METHODS: We tested 37 patients with schizophrenia and 20 healthy control subjects in each conditional associative learning task condition. RESULTS: Patients demonstrated significant impairments on all four conditional associative learning tasks. The demand to process contextual information did not differentially impact patient performance. Patients were better able to learn associations if they generated or observed the pairings rather than utilized feedback to guide learning. CONCLUSIONS: Patients with schizophrenia demonstrate pronounced deficits in the ability to utilize feedback to guide learning. We found no evidence of an additional deficit in processing of contextual information.

Adult↗

PubMed2000

Deriving behavioural receptive fields for visually completed contours.

The visual system is constantly faced with the problem of identifying partially occluded objects from incomplete images cast on the retinae. Phenomenologically, the visual system seems to fill in missing information by interpolating illusory and occluded contours at points of occlusion, so that we perceive complete objects. Previous behavioural [1] [2] [3] [4] [5] [6] [7] and physiological [8] [9] [10] [11] [12] studies suggest that the visual system treats illusory and occluded contours like luminance-defined contours in many respects. None of these studies has, however, directly shown that illusory and occluded contours are actually used to perform perceptual tasks. Here, we use a response-classification technique [13] [14] [15] [16] [17] [18] [19] [20] to answer this question directly. This technique provides pictorial representations - 'classification images' - that show which parts of a stimulus observers use to make perceptual decisions, effectively deriving behavioural receptive fields. Here we show that illusory and occluded contours appear in observers' classification images, providing the first direct evidence that observers use perceptually interpolated contours to recognize objects. These results offer a compelling demonstration of how visual processing acts on completed representations, and illustrate a powerful new technique for constraining models of visual completion.

Discrimination, Psychological↗

PubMed2000

Auditory working memory and verbal recall memory in schizotypy.

Deficits on verbal memory tasks, as well as on spatial and auditory working memory tasks, have been observed in schizophrenia patients. A useful strategy in the determination of the premorbid indicator status of specific cognitive and memory deficits observed in patients is to examine those persons at increased biological risk for schizophrenia (e.g. first-degree relatives), schizotypal personality disorder patients, and/or psychometrically identified schizotypes for comparable deficits, though perhaps less profound than those seen in actual patients. We examined verbal memory and auditory working memory functioning in 31 schizotypic and 26 normal control subjects from a large randomly ascertained non-clinical university population. Schizotypy status was determined psychometrically using the well-known Perceptual Aberration Scale. Contrary to our theory-guided expectations, noteworthy deficits in verbal memory and auditory working memory were not observed in the schizotypic subjects and the two experimental groups did not differ significantly on any of the memory measures. These results were discussed in light of prior results obtained using the spatial delayed response task (i.e. spatial working memory) and Wisconsin Card Sorting Test performance on these same subjects. The theoretical implications of these findings are discussed in relation to the putative processes involved in the working memory system, as well as in relation to the schizotypy construct.

Adult↗

PubMed2000

Decisional capacity for informed consent in schizophrenia research.

BACKGROUND: The adequacy of subjects' informed consent to research is the focus of an important public and professional debate. The potential impairment of decisional capacity in persons with schizophrenia is central to the discussions. This study ascertains the decisional capacity for informed consent in schizophrenic research subjects, to determine if reduced capacity relates to specific aspects of psychopathologic features and to test the hypothesis that reduced capacity can be remediated with an educational informed consent process. METHODS: Decisional capacity was assessed for 30 research subjects with schizophrenia and 24 nonill (normal) comparison subjects. Measures of psychopathologic features and cognition were obtained for the subjects with schizophrenia. Subjects who performed poorly on the decisional capacity measure received an educational intervention designed to improve their ability to provide informed consent and were then retested. RESULTS: The patient group did not perform as well as the controls on initial decisional capacity assessment. Poor performance was modestly related to the extent of symptoms but robustly related to cognitive impairments. Following the educational intervention, the performance of subjects with schizophrenia was equal to that of the nonill comparison group. CONCLUSIONS: Many persons with schizophrenia may be challenged by the cognitive demands of an informed consent process for research participation. In many cases, their reduced capacity can be compensated by a more intensive educational intervention as part of the informed consent process.

Adult↗

PubMed2000

Cognitive impairments in patients with schizophrenia displaying preserved and compromised intellect.

BACKGROUND: Although intellectual and neurocognitive deficits accompany schizophrenia, there are inconsistencies in the literature concerning issues of intellectual decline, premorbid deficits, a modal deficit pattern, and preserved abilities. METHODS: A battery of neuropsychological tests was administered once to 117 consecutively admitted patients with chronic schizophrenia and a group of 27 healthy control subjects to examine patterns of premorbid and current intellect (measured by means of reading scores and IQ, respectively) and the attendant cognitive profiles in schizophrenia using classification methods based on clinically derived (IQ levels) and atheoretical (cluster) techniques. RESULTS: Sixty patients (51%) with schizophrenia who displayed a general intellectual decline of 10 points or greater from estimated premorbid levels also exhibited deficits of executive function, memory, and attention. Twenty-eight patients (23%) with consistently low estimated premorbid intellect and current intellectual levels who displayed no evidence of IQ decline exhibited language and visual processing deficits in addition to deficits present in the intellectually declining group. The remaining 29 patients (25%) who displayed average estimated premorbid intellectual levels did not show IQ decline and exhibited a cognitive profile similar to normal, with the exception of executive function and attention impairment. Atheoretical analyses support the findings from clinically derived subgroups. CONCLUSIONS: These results suggest that IQ decline, although modal in schizophrenia, is not universally characteristic and that executive function and attention deficits may be core features of schizophrenia, independent of IQ variations.

Adult↗

PubMed2000

A comparison of rCBF patterns during letter and semantic fluency.

To evaluate the functional neuroanatomies underlying letter and category fluency, 18 normal controls were studied with oxygen-15 water regional cerebral blood flow positron emission tomography. Three counterbalanced conditions each consisted of 6 trials (45 s each): letter fluency (generating words when cued with a particular letter), semantic fluency (generating words when cued with a particular category), and a control condition (generating days of the week and months of the year). Relative to the control, participants activated similar brain regions during both fluency tasks, including the anterior cingulate, left prefrontal regions, thalamus, and cerebellum; reductions were found in parietal and temporal regions. In a direct comparison of the 2 fluency tasks, inferior frontal cortex and temporoparietal cortex (hypothesized to participate in a phonologic loop for accessing word pronunciation) were activated more during letter than semantic fluency, whereas left temporal cortex (associated with access to semantic storage) was activated more during semantic than letter fluency. This study identifies subtle differences in the neural networks underlying letter and semantic fluency that may underlie the dissociation of these abilities in patients.

Adult↗

PubMed2000

Learning and forgetting in schizophrenia.

Recent studies of patients with schizophrenia have consistently demonstrated marked deficits on measures of initial learning. However, contradictory results have been reported concerning retention and forgetting. The present study examined the level of initial and delayed recall of stories and visual figures in a group of 76 patients with schizophrenia and 51 normal controls. Schizophrenia patients demonstrated marked impairments in initial and delayed recall as well as significantly worse percentage retention scores. However, schizophrenia patients and healthy controls individually matched on level of initial recall had nearly identical delayed recall performance. The results suggest a primary deficit in the initial acquisition of information rather than an accelerated rate of forgetting in schizophrenia.

Adult↗

PubMed1999

Neuropsychological performance of monozygotic twins discordant for bipolar disorder.

BACKGROUND: A paradigm that involves cognitive assessment of monozygotic (MZ) twins discordant for a neuropsychiatric disorder (here bipolar illness) allows for the examination of both disease-specific impairments (in the comparison of affected to unaffected twins) and risk factors (in the comparison of unaffected twins to normal twins). METHODS: Neuropsychological functions were evaluated in seven MZ twin pairs discordant for bipolar illness and seven pairs of normal MZ twins in an attempt to highlight cognitive abilities associated with manifestations of disease and genetic risk factors. At the time of testing, 3 of the affected twins were euthymic, 2 had depressive symptoms, and 2 had manic symptoms; all were receiving medication. All twins receive neuropsychological tests to evaluate intelligence, attention, visuospatial skills, language, learning and memory, and problem solving. RESULTS: Statistical analyses revealed that the affected twins were significantly impaired as compared to the unaffected (and normal) twins on some measures of visuospatial functioning and some verbal memory measures. In contrast to a sample of MZ twins discordant for schizophrenia studied previously, the cognitive impairments we observed in bipolar twins were mild in nature and fairly circumscribed. The unaffected twins performed significantly worse than normal controls on a Brown-Petersen memory task, verbal list learning, and overall Wechsler Memory Quotient. CONCLUSIONS: These data suggest that while some visuospatial deficits and verbal memory deficits may be features of bipolar disorder related to disease parameters, mild attenuations in overall memory or retrieval function may be related to genetic factors associated with the illness.

Adult↗

PubMed1999

Localization and expression of cartilage oligomeric matrix protein by human rheumatoid and osteoarthritic synovium and cartilage.

Synovium and cartilage from patients with osteoarthritis or rheumatoid arthritis were analyzed for expression of cartilage oligomeric matrix protein. Immunostaining of synovium with antiserum to cartilage oligomeric matrix protein demonstrated positive staining in both diseases. In osteoarthritis, there was positive staining within the synovial cells and immediately subjacent connective tissue, with less intense staining in the deeper connective tissue. In rheumatoid arthritis, there was less intense staining within the synovial cells and marked intense staining in the deeper connective tissue. In situ hybridization performed with an antisense digoxigenin-labeled riboprobe to human cartilage oligomeric matrix protein confirmed the presence of cartilage oligomeric matrix protein mRNA in the cells of the synovial lining in both types of synovium. Quantitative polymerase chain reaction with a cartilage oligomeric matrix protein MIMIC demonstrated increased cartilage oligomeric matrix protein mRNA in rheumatoid cartilage and synovium as compared with osteoarthritic cartilage and synovium, respectively; mRNA levels in rheumatoid synovium were similar to those from osteoarthritic chondrocytes. As a result of the high expression of cartilage oligomeric matrix protein from rheumatoid synovium, inflammatory synovium should be considered as a potential tissue source of cartilage oligomeric matrix protein in any investigation of biological markers of cartilage metabolism. The upregulated expression of cartilage oligomeric matrix protein in inflammatory tissues suggests its in vivo regulation by cytokines.

Arthritis, Rheumatoid↗

PubMed1999

Cognitive rehabilitation for schizophrenia: problems, prospects, and strategies.

Increasing awareness of the importance of neurocognitive impairments in schizophrenia has fostered considerable interest in the prospects for cognitive rehabilitation. Nevertheless, optimism has outpaced progress. We first review recent literature on the central assumptions that underlie cognitive rehabilitation, including the hypothesis that cognitive deficits play a central role in social disability and other problems schizophrenia patients experience in daily living, and that these impairments must be rectified if we are to achieve effective rehabilitation. We next discuss developments in knowledge about the neurobiology of schizophrenia that bear on the potential for cognitive rehabilitation and the selection of appropriate targets for intervention. Third, we propose a new research strategy for investigating cognitive functioning in schizophrenia and for examining the relationship of cognitive deficits to role functioning in the community: examining patients who have good vocational outcomes in order to identify strengths or compensatory factors that compensate for core deficits. We present new data that lend support to our proposed approach. We next discuss putative limits to cognitive rehabilitation based on data documenting cognitive deficits in healthy siblings and parents. Finally, we briefly describe an interim rehabilitation strategy that minimizes the load on cognitive processes rather than attempting to improve cognitive functioning.

Activities of Daily Living↗

PubMed1999

Repeatable battery for the assessment of neuropsychological status as a screening test in schizophrenia I: sensitivity, reliability, and validity.

OBJECTIVE: Cognitive impairment is an important feature of schizophrenia and is correlated with functional outcome. However, psychiatry lacks a screening instrument that can reliably assess the types of cognitive impairment often seen in schizophrenia. The authors assessed the sensitivity, convergent validity, and reliability of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as well as the relationship of the RBANS to symptoms and employment status. This newly published test takes 25 minutes to administer and was standardized on a U.S.-Census-matched adult population. The test provides a total score and five index scores, each with a mean value of 100 (SD = 15). METHOD: RBANS data were obtained from 129 patients with schizophrenia in the outpatient and inpatient programs of the Maryland Psychiatric Research Center. RBANS data were correlated with WAIS-III and Wechsler Memory Scale, 3rd ed. performance in 38 patients. Reliability data for alternate forms of the RBANS were obtained from 53 patients; symptom ratings were obtained from 48 patients; and employment status was examined in 77 patients. RESULTS: The patients with schizophrenia demonstrated marked impairment on the RBANS (their mean total score was 71.4). The patients' index scores suggested that they had relatively less impairment of language and visual functions than of memory and attention. The RBANS demonstrated high correlations with full-scale IQ and memory measures. The total score demonstrated good reliability. RBANS performance minimally correlated with Brief Psychiatric Rating Scale ratings but was strongly related to employment outcome. CONCLUSIONS: The RBANS appears to be a useful cognitive screening instrument in schizophrenia. The instrument may be a useful prognostic indicator and offers a means of assessing cognitive status.

Adult↗