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Biomedical subjects

M Harrow

Publications and source records attributed to M Harrow.

At least 37 records · Page 2Linked to original sources
PubMed1997

Working memory deficits in HIV-seropositive drug users.

We studied the integrity of working memory operations in 38 HIV-seropositive and 20 seronegative drug users, using a modified version of the Tower of London task. This new task, the Tower of London-Working Memory version (TOL-WM), includes a delayed-response component in addition to the planning required for successful performance of the standard TOL. Symptomatic HIV-seropositive participants solved significantly fewer TOL-WM problems compared to matched seronegative controls. However, seropositive and seronegative subjects showed similar overall levels of planning efficiency, suggesting that the TOL-WM deficit may be associated primarily with failure to encode or maintain an adequate online memory representation. The results of this study confirm our previous report of a possible working memory deficit in HIV-1 infection and suggest that measures of working memory have particular utility in the evaluation of HIV-related cognitive deficits.

Adult↗
PubMed1996

Positive and negative symptoms as risk factors for later suicidal activity in schizophrenics versus depressives.

Seventy schizophrenia patients and 97 depressives were studied prospectively while in the hospital and at periodic follow-ups. Positive symptoms, negative symptoms, and post-hospital functioning were assessed at the 2-year follow-up; and suicidal activity, at the 7.5-year follow-up. The results support an interactive model of suicide risk. Psychotic symptoms (i.e., hallucinations, delusions) predict later suicidal activity only for the schizophrenia patients. Deficit symptoms (psychomotor retardation, concreteness) predict later suicidal activity only for the depressive group. Adequacy of overall functioning predicts later suicidal activity for both diagnostic groups and appears to mediate the effects of psychosis in the schizophrenia group.

Adult↗
PubMed1996

Lithium treatment of bipolar affective disorders under naturalistic followup conditions.

A naturalistic followup was conducted on 41 bipolarmanic inpatients who sought ongoing treatment after hospital discharge. Standardized interviews were conducted 2 and 4.5 years after hospitalization to assess medication use, outcome, and relapse. At followup, 41 percent of the bipolar patients taking lithium had poor outcome. Nearly half met criteria for relapse and had been rehospitalized. Patients on lithium had the same work and overall functioning as those who were not taking it. Patients on lithium alone, however, had significantly better adjustment and fewer relapses compared with those taking lithium plus neuroleptics. A subgroup of good-prognosis bipolar patients may respond to lithium monotherapy under typical clinical conditions, however, those requiring adjunctive maintenance neuroleptics may be at higher risk for poor outcome. Lithium prophyliaxis may be less effective in routine clinical practice than in specialized treatment centers, possibly due to less rigorous treatment monitoring, medication noncompliance, complex affective symptoms, and poorer surveillance to defect recurrent prodromal illness.

Adult↗
PubMed1995

Vulnerability to delusions over time in schizophrenia and affective disorders.

This research used a prospective longitudinal design to study differences in vulnerability to delusions over time in 234 subjects with schizophrenia, schizoaffective disorder, or bipolar or unipolar affective disorder. Patients were assessed at three successive followups over a 7- to 8-year period. Over 60 percent of the schizophrenia and schizoaffective patients assessed experienced delusional activity at one of the three followups. Over 60 percent of the patients who initially had psychotic affective disorders also showed posthospital delusional activity. Significantly more schizophrenia patients than psychotic affective-disordered patients experienced consistent posthospital delusional activity at three successive followups. Unlike the schizophrenia subjects, affective patients showed a significant reduction in delusions after the first followup. After the initial acute psychotic episode that led to hospitalization, psychotic bipolar and unipolar affective patients showed a traitlike vulnerability to episodic delusional activity over time, but schizophrenia patients were vulnerable to more severe delusional activity and to more frequently recurring or sustained delusions. The study results question the views of several major theorists on the importance, persistance, and prognostic significance of delusions in schizophrenia.

Adult↗
PubMed1995

Course and outcome in bipolar affective disorder: a longitudinal follow-up study.

OBJECTIVE: A number of recent studies have questioned whether, despite modern treatment, the natural course of bipolar illness today still involves multiple relapses and impaired psychosocial functioning. This prospective follow-up study examined longitudinal outcome in a large group of inpatients with affective disorders. METHOD: Fifty-one bipolar manic patients and 49 unipolar depressed patients were interviewed three times: 1) during hospitalization, 2) approximately 2 years after discharge, and 3) approximately 4.5 years after discharge. Subjects were treated under routine conditions and assessed for global adjustment, rehospitalization, and work and social functioning. RESULTS: Only 41% of the bipolar group had a good overall outcome by the time of the 4.5-year follow-up. The bipolar patients had more severe work impairment than the unipolar group. More than one-half of the bipolar patients were rehospitalized at least once during the 4.5-year follow-up period. Outcome for both diagnostic groups improved significantly over time. CONCLUSIONS: Many contemporary bipolar patients demonstrate gradual improvement in the first several years after hospitalization. However, a subgroup approaching 60% still experience poor posthospital adjustment in one or more areas of functioning.

Adaptation, Psychological↗
PubMed1995

Vulnerability to psychosis in unipolar major depression: is premorbid functioning involved?

OBJECTIVE: This research examined whether deficits in premorbid functioning are associated with a vulnerability to psychosis in unipolar major depressive disorder. METHOD: A group of 92 inpatients with unipolar major depression were assessed for premorbid functioning and psychotic symptoms during an index hospitalization. They were prospectively assessed for psychotic symptoms 2.0 and 4.5 years after hospital discharge. RESULTS: The psychotic depressed patients had significantly poorer premorbid functioning--particularly, adolescent social functioning--than the nonpsychotic depressed patients. Longitudinal analyses indicated that poor premorbid social adaptation was significantly associated with the emergence of psychosis during the follow-up period in depressed patients who had not been psychotic as inpatients. CONCLUSIONS: Factors related to a vulnerability to psychosis among patients with major depression are present even years before the onset of overt psychotic symptoms. The data could support the view that impaired premorbid functioning is one manifestation of prepsychotic processes that constitute an underlying diathesis for psychotic episodes during the longitudinal course of unipolar major depression. These findings are consistent with other emerging findings pointing to early developmental deficits in patients who subsequently develop psychotic disorders.

Adaptation, Psychological↗
PubMed1995

Recurrent affective syndromes in bipolar and unipolar mood disorders at follow-up.

BACKGROUND: It is in dispute whether affective relapse disrupts psychosocial functioning to the same extent in depressed and manic patients. METHOD: A prospective, naturalistic, longitudinal follow-up of 84 unipolar and bipolar affectively disordered in-patients was conducted to examine the extent of recurrent affective syndromes and their relationship to overall outcome. Global adjustment relative to relapse was assessed at 2- and 4.5-year follow-ups. RESULTS: Nearly half of the bipolar patients had subsequent syndromes, which were often associated with uniformly poor psychosocial functioning. Fewer than one-quarter of those with recurrences had steady work performance. Bipolar patients taking lithium alone had fewer recurrences than those taking lithium as well as neuroleptics (P < 0.05). Bipolar and unipolar patients relapsed with equal frequency, but unipolar relapse was less often associated with readmission to hospital, work impairment, or uniformly poor functioning. CONCLUSION: Affective relapse in bipolar disorders was more detrimental to overall functioning than was recurrence in unipolar depression.

Antipsychotic Agents↗
PubMed1994

Neuropsychological prognosis and clinical recovery.

This report examines prognostic implications of neuropsychological deficit for clinical symptomatic improvement. Neuropsychological performance levels are related to the Brief Psychiatric Rating Scale thinking disturbance, paranoid disturbance, withdrawal/retardation, and anxiety/depression scales at hospital admission and discharge in 68 schizophrenic and psychotic and nonpsychotic mood disorder patients. Findings indicate a relationship between neurocognitive deficit and thinking disturbance at admission; however, neuropsychological impairment predicts blunted affect/emotional withdrawal at discharge, after the acute psychopathology resolves. Neuropsychological deficit is nonspecific, occurring across a broad range of cognitive-perceptual functions. These data suggest that neuropsychological dysfunction may be prognostic of a more chronic residual disorder in both schizophrenia and major psychotic and nonpsychotic mood disorder syndromes.

Adolescent↗
PubMed1994

Depression in schizophrenia: are neuroleptics, akinesia, or anhedonia involved?

To investigate the presence of a full depressive syndrome in schizophrenia years after the acute phase and factors linked to these depressive syndromes, 75 schizophrenia and schizoaffective patients and 32 patients with bipolar affective disorders were studied prospectively at index hospitalization and followed up 4.5 years later as part of the Chicago Followup Study. Over 30 percent of the schizophrenia patients showed full depressive syndromes during the followup year. Schizophrenia patients on neuroleptics were significantly more likely to show full depressive syndromes than those not on neuroleptics during the followup year. This relationship held after the level of posthospital psychosis was controlled. The data suggest that neuroleptic use is one factor linked to the depressive-like syndromes found in the posthospital phase in non-chronic schizophrenia samples. The results did not support the view that these depressive-like syndromes are only a function of akinesia, although they suggest that akinesia is probably one factor involved. The data indicate a strong link between neuroleptic use and anhedonia. These data suggest that one factor involved in the depressive-like symptoms found in schizophrenia patients could be interference by neuroleptics with the mesolimbic dopamine reinforcement system or the dopamine reward system.

Affective Symptoms↗
PubMed1994

Schizophrenic deficits: neuroleptics and the prefrontal cortex.

Modern techniques have been applied to brain modeling, based on recent approaches in the artificial intelligence field that use brain-like "connectionistic" computational architectures. The model proposed by Cohen and Servan-Schreiber uses a gain parameter which they identify with dopamine function. They apply their model to neuroleptically treated schizophrenia patients who show improved task performance which they link to increased dopamine function and increased gain in the prefrontal cortex. However, evidence indicates that antipsychotic medications block dopamine (especially D2) receptors, decreasing mesolimbic and mesocortical dopamine function. If therapeutic dosages of neuroleptics diminish dopamine function, this would decrease gain in context modules needed for adequate task performance. Schizophrenia patients would perform more poorly by further reducing gain in their already compromised context modules. The current investigators suggest three possible ways to resolve this difficulty, to explain why normals perform more poorly when taking neuroleptics, although acute schizophrenia patients' performance may be enhanced in several areas. Evidence would suggest that multiple processes occur simultaneously in neuroleptically treated patients with some processes counterbalancing others.

Antipsychotic Agents↗
PubMed1994

Psychotic unipolar depression at follow-up: factors related to psychosis in the affective disorders.

OBJECTIVE: The current research was designed to investigate the relationship between affective disruption and psychosis in unipolar major depressive disorder and to evaluate whether some depressed patients are particularly vulnerable to subsequent psychosis. METHOD: A group of 31 psychotic and 63 nonpsychotic inpatients with unipolar depression were assessed during hospitalization and then prospectively assessed for depressive and psychotic symptoms 2.4 years after hospital discharge. RESULTS: The psychotic depressed inpatients had significantly higher rates of psychosis during the posthospital period, 2.4 years later, than the originally nonpsychotic depressed inpatients. However, they did not have higher rates of depressive syndromes during the posthospital period. Psychosis during the posthospital period was significantly related to recurrent or persistent affective disruption. The posthospital depressive syndromes of the initially psychotic depressed inpatients tended to be slightly more severe than those of the initially nonpsychotic depressed inpatients. Despite this, psychosis during the inpatient period was more predictive of posthospital psychosis than the severity of the posthospital depressive syndrome. CONCLUSIONS: The interaction of the following two factors was proposed to be central to psychotic depression: 1) a vulnerability to psychosis, and 2) concurrent affective disruption.

Adolescent↗
PubMed1993

Disordered thinking and cerebral dysfunction: laterality effects, language, and intellectual functions.

This report examines two types of thought disorder, bizarre-idiosyncratic thinking and concreteness, in relation to cerebral impairment and psychotropic medication status. Results do not support lateralized dysfunction as a contributing factor for either form of thought disorder. Relationships between specific areas of neuropsychological deficit and thought disorder indicate that intellectual and arithmetic functions are more closely associated with bizarre-idiosyncratic thinking. Further, there were no specific neuropsychological impairments related to concrete thinking, nor was medication status related to either type of thought disorder. Problem-solving or reasoning affects logical orderly cognitive processes more reliably than it affects abstract thinking. Differences between these findings and other research are discussed from the standpoint of how both types of thought disorder are conceptualized and assessed, and how this may influence clinical indications for the use of psychoactive medications.

Journal Article↗
PubMed1991

Posthospital course and outcome in schizophrenia.

To study the early course of schizophrenia, we assessed 79 early phase, young, DSM-III schizophrenic patients at two successive posthospital follow-ups, 2.5 and 5.0 years after index hospitalization. More than 50% of the sample had poor overall outcome, with either severe impairment in functioning and symptoms, or suicide, in the follow-up period. Rehospitalization rates decreased significantly during the course of the two posthospital assessments, despite the sample showing persisting psychosis. Only a small group of schizophrenic patients showed complete remission: 10% at the first follow-up and 17% at the second follow-up, when patients who suicided are excluded from consideration. While progressive deterioration is not common in schizophrenia, our relatively negative findings challenge the conclusions of some other longitudinal studies. Implications of our data on schizophrenic course are discussed.

Adolescent↗
PubMed1991

Early longitudinal course of acute-chronic and paranoid--undifferentiated schizophrenia subtypes and schizophreniform disorder.

This prospective longitudinal study examined symptoms and adjustment at 2 and 4 years posthospital discharge in Research Diagnostic Criteria (RDC) and Diagnostic and Statistical Manual (DSM-III) schizophrenia subtypes and in DSM-III schizophreniform disorder. Delusions, hallucinations, thought disorder, anxiety, depression, and specific areas of community adjustment were assessed at each follow-up. RDC acute and subacute schizophrenia and DSM-III schizophreniform disorder were associated with more satisfactory overall adjustment and lower frequencies of psychotic symptoms over time. No significant differences in the course of symptoms or adjustment were found between paranoid and undifferentiated schizophrenia subtypes. Schizophrenia subtyping schemes based on length of illness features appear more prognostically viable than do symptom-based approaches.

Acute Disease↗
PubMed1991

Risk for suicide in schizophrenia and other psychotic and nonpsychotic disorders.

To determine the rate of suicide in young, early phase schizophrenics and other psychotic disorders, and to analyze risk factors for suicide, a large sample of patients was prospectively assessed at index hospitalization and then followed up systematically after discharge. Thirty-six patients committed suicide and these patients were compared with those who did not commit suicide for major diagnostic and prognostic factors. Results indicated the following: a) During early years, schizophrenics and other types of psychotic patients were more likely to commit suicide than nonpsychotic patients. b) Similarly, among depressives, psychotic depressed patients were more likely to commit suicide than nonpsychotic depressed patients. c) Schizophrenics and other psychotic patients were especially vulnerable to suicide within the first 6 years of their first hospitalization. d) Among the combined sample of psychotic patients (schizophrenic and other psychotic patients), those at greater risk for suicide were unmarried, white, high IQ, male patients with a more gradual onset of disorder and were of "chronic" Research Diagnostic Criteria subtypes.

Depressive Disorder↗
PubMed1991

Prognostic significance of cerebral status: dimensions of clinical outcome.

This report examines the relationship between a set of neurobehavioral predictor variables (premorbid cognitive-perceptual abilities, sensorimotor functions, and complex integrative skills) and three dimensions of clinical outcome (social outcome, work functioning, and rehospitalization) 2 years after discharge from inpatient treatment for a group of psychiatric disorders. Results indicated the strongest relationship was between premorbid ability levels and work performance, particularly maintaining stability of employment or work role function. This finding is discussed from the standpoint of neurological processes underlying early acquisition of basic cognitive-perceptual skills in the prediction of outcome.

Adult↗