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Biomedical subjects

M Harrow

Publications and source records attributed to M Harrow.

At least 55 records · Page 3Linked to original sources
PubMed1991

Outcome of schizoaffective disorder at two long-term follow-ups: comparisons with outcome of schizophrenia and affective disorders.

OBJECTIVE: This research assessed whether the outcome of schizoaffective disorder is more similar to that of schizophrenia or that of affective disorders. METHOD: The authors conducted a prospective follow-up study of 101 schizoaffective, schizophrenic, bipolar manic, and depressed patients assessed at three times: during hospitalization and 2 and 4-5 years later. The follow-up test battery involved detailed assessment of social functioning, work performance, symptoms, posthospital treatment, and rehospitalization. RESULTS: Outcome for schizoaffective patients 4-5 years after hospitalization differed significantly from that for patients with unipolar depression. However, the differences between schizoaffective and bipolar manic patients were more equivocal. Unlike the patients with bipolar disorder, only a limited number of patients with schizoaffective disorder showed complete recovery in all areas throughout the year preceding the 2-year follow-up and the year preceding the 4- to 5-year follow-up. The differences in outcome between schizoaffective and schizophrenic patients were also mixed. These two groups showed some similarities in outcome, but there were fewer schizoaffective than schizophrenic patients with uniformly poor outcome in all areas. CONCLUSIONS: Overall, schizoaffective patients showed some similarities to both schizophrenic and bipolar manic patients. Schizoaffective patients had somewhat better overall posthospital functioning than patients with schizophrenia, somewhat poorer functioning than bipolar manic patients, and significantly poorer functioning than patients with unipolar depression. The data suggest that when mood-incongruent, schizophrenic-like psychotic symptoms are present in the acute phase, they predict considerable difficulty in outcome, even when affective syndromes are also present, as in schizoaffective disorder. It is likely that schizoaffective disorder is not just a simple variety of affective disorder.

Adult↗
PubMed1991

European versus U.S. data on the course of schizophrenia.

OBJECTIVE: The present research attempts to add to the existing body of data on the course of schizophrenia by comparing the findings of a prospective study of a group of U.S. schizophrenic patients with data from two European studies. METHOD: Seventy-four U.S. patients given the diagnosis of schizophrenia according to Research Diagnostic Criteria were longitudinally assessed at hospitalization and at three intervals up to 10 years after illness onset. The longitudinal criteria for type of onset, course of illness, and outcome were derived from the European studies of Manfred Bleuler and Luc Ciompi. The type of onset, course of illness, and outcome of the U.S. patients were compared with those of the patients in the two European studies. RESULTS: A lower rate of acute onset and of episodic illness was found in the U.S. patients, but the relative frequency of a number of major overall course patterns was similar across studies. CONCLUSIONS: Despite many potential threats to comparability, the results of the European and U.S. longitudinal studies of the course of schizophrenia were fairly congruent in terms of the relative rate with which patients fell into the categories established by Bleuler and Ciompi. These results are encouraging in that they point to the possibility of estimating the rate of occurrence of particular expressions of the overall course of schizophrenia.

Cross-Cultural Comparison↗
PubMed1990

Outcome in manic disorders. A naturalistic follow-up study.

To study outcome in manic patients treated under routine clinical conditions, 73 manic and 66 unipolar depressed patients were followed up 1.7 years after hospitalization. A surprisingly large percentage of manic patients showed difficulty in post-hospital adjustment, and over 40% experienced a manic syndrome during the follow-up period. Manic patients showed poorer outcomes than did unipolar depressives. Manic patients taking lithium carbonate did not show better outcome than those not taking lithium carbonate. The results suggest (1) many hospitalized manic patients have a severe, recurrent, and pernicious disorder; and (2) in routine clinical practice, lithium carbonate treatment is an effective prophylaxis for fewer than the 70% to 80% of manic patients previously reported.

Adult↗
PubMed1990

Rapid cycling in unipolar and bipolar affective disorders.

To characterize the nature of rapid cycling affective disorders, the authors analyzed mood fluctuation patterns in 570 patients with affective disorders hospitalized in 1960, 1975, or 1985. Patients' records were rated for the frequency, duration, and complexity of distinct affective states. Very rapid mood fluctuations were absent among bipolar patients in 1960 but were evident in 1975 and 1985. In each year, bipolar patients displayed more frequent, complex, and mixed episodes than did unipolar patients. The results suggest that more frequent episodes occur among bipolar than unipolar patients and that very rapid switch processes have become more widespread for some bipolar patients.

Adult↗
PubMed1989

Impaired perspective and thought pathology in schizophrenic and psychotic disorders.

Impaired perspective was studied in schizophrenic and thought-disordered patients to analyze hypotheses about its role in thought disorder. Eighty-three schizophrenic patients, other psychotic patients, and nonpsychotic patients judged the adequacy of their own and others' verbalizations under several different conditions. Thought-disordered patients had significantly more impaired perspective than nonthought-disordered patients (p less than 0.05). Patients had significantly poorer perspective about their own verbalizations than about those of other patients (p less than 0.01). Schizophrenic and other psychotic patients showed poor perspective about their own verbalizations. Thought-disordered patients did not view their bizarre verbalizations as stranger than their nonbizarre verbalizations. Impaired perspective and bizarre responses were more frequent under certain conditions. When focusing on the adequacy of their response, patients were significantly less idiosyncratic. The results support the hypothesis that impaired perspective plays a role in thought disorder. A more comprehensive model of thought disorder and disorganization, which includes impaired perspective, is discussed.

Adult↗
PubMed1989

Cyclothymic mood swings in the course of affective disorders and schizophrenia.

The authors assessed cyclothymic mood swings and psychosocial adjustment in 38 unipolar depressed, 27 bipolar, 35 schizophrenic, and 27 other psychiatric patients 4 years after hospital discharge and in 153 normal control subjects. The patients were significantly more cyclothymic at follow-up than the control subjects, but there were no differences in cyclothymia between the diagnostic groups. Cyclothymic patients showed significantly poorer posthospital functioning than noncyclothymic patients. These findings raise questions concerning the scope of the hypothesized cyclothymic-bipolar spectrum. Minor mood swings in a variety of patients with poor posthospital adjustment may reflect persistent vulnerability to psychopathology.

Adaptation, Psychological↗
PubMed1987

Schizophrenic thought disorder at follow-up. A persistent or episodic course?

This follow-up investigation examined the course of thought disorder in early, young schizophrenic, other psychotic, and nonpsychotic patients. Patients were assessed for the severity of thought disorder at index hospitalization and at two and four years after hospital discharge. Follow-up evaluations included assessments of adjustment and short-term outcome. Schizophrenic patients showed more thought disorder than nonschizophrenic patients at all three periods. Almost 40% (16/41) of the schizophrenic patients exhibited persistent thought disorder symptoms after the acute phase and an additional 37% (15/41) showed an episodic thought disorder course. Across diagnoses, patients who were thought disordered at both follow-ups demonstrated higher rates of unemployment and rehospitalization than did patients in non-thought-disordered and episodic thought disorder groups. To date, 25% (16/65) of psychotic nonschizophrenic patients showed persistent thought disorder courses similar to schizophrenia, while another 40% (24/65) showed remitting thought disorder symptoms more common to nonpsychotic patients.

Adult↗
PubMed1987

Process-reactive dimension and outcome for narrow concepts of schizophrenia.

The data presented by the authors suggest a more successful prediction of outcome by the process-reactive dimension when it is applied to schizophrenic patients defined according to broad concepts of schizophrenia (e.g., DSM-II) than to narrow concepts of schizophrenia (e.g., DSM-III). Research indicates that the DSM-III is more likely than the DSM-II diagnosis to be composed of "poor prognosis" schizophrenia, as defined by the classical prognostic indicators. In general, the overall results could support the views of Herron and others that the process-reactive dimension is more valuable as a predictor for a schizophrenia spectrum than for modern, narrow concepts of schizophrenia. However, while recent data of the authors indicate that DSM-III schizophrenic patients show poorer outcome than DSM-II schizophrenic patients, they also indicate that (1) DSM-III schizophrenic patients still show heterogeneity in prehospital functioning and outcome, and (2) other prognostic indexes, such as the Zigler-Phillips Scale and the Vaillant-Stephens Scale, have some efficacy in predicting course and outcome among DSM-III schizophrenic patients. Data on prehospital functioning and outcome are discussed in terms of two contrasting models--a developmental model and a natural history model of the course of schizophrenia.

Humans↗
PubMed1987

The prognostic relevance of delusions in depression: a follow-up study.

To determine whether delusional depression has a different clinical course from other types of depression, the authors followed up 31 unipolar delusional depressed patients, 28 unipolar nonpsychotic depressed patients, and 51 schizophrenic patients 14 months after hospital discharge. Patients were assessed on 1) overall outcome, 2) psychotic, anxiety-neurotic, and depressive symptoms, 3) social and work functioning, and 4) rehospitalization. The delusional depressed patients showed significantly more mood-incongruent delusions at follow-up. Surprisingly, the nonpsychotic depressed patients exhibited more depressed mood and significantly more anxiety at follow-up. The findings suggest that the diagnostic distinction between delusional and nonpsychotic depression is relevant to the clinical course of major depression.

Adaptation, Psychological↗
PubMed1986

A longitudinal study of thought disorder in manic patients.

To study the persistence of thought disorder in manic patients, 34 manic patients were compared with 30 schizophrenic and 30 nonpsychotic patients on four indexes of thought pathology at two phases of disorder: during the acute inpatient phase and one year after hospitalization. Patients were also compared with a control sample of 34 normal subjects. The data indicated that during the acute in hospital phase, both manic and schizophrenic patients were severely thought disordered; at follow-up, a subsample of manic patients showed severe thought disorder; despite the severe thought disorder found at follow-up in some manic and schizophrenic patients, both groups showed a significant reduction of thought pathology at follow-up; and there was a trend for a larger reduction of thought disorder in manic than in schizophrenic patients. The difference, however, was not significant when initial levels of severity were controlled.

Adolescent↗
PubMed1986

Predictors of outcome in schizophrenia: the process-reactive dimension.

Premorbid social-sexual competence and the process-reactive dimension, as assessed by the Phillips Scale, were investigated as predictors of posthospital adjustment in a prospective study of two samples of 141 young, early phase schizophrenics (a private hospital sample and a state hospital sample). The Phillips Scale predicted subsequent outcome at significant levels for one of the two samples of DSM-II schizophrenics (a "broad" construct of schizophrenia). It did not predict outcome as well for DSM-III schizophrenics (a "narrow" construct of schizophrenia). Mixed results emerged from separate analyses of first-admission schizophrenics only and for male schizophrenics only. The data indicated that marital status accounts for some of the positive relationship between the Phillips Scale and later outcome. A more focused measure of prehospital social adjustment successfully predicted social functioning at followup for both DSM-II and DSM-III schizophrenics (p less than .05). There were some significant and near-significant relationships, but overall results suggest that when the influence of chronicity and marital status is reduced, the relationship between the Phillips Scale and subsequent outcome is less robust than was once thought.

Adult↗
PubMed1986

The early course of schizophrenic thought disorder.

The current investigation studied the early course of positive thought disorder and its relationship to other aspects of schizophrenic outcome. Forty-eight schizophrenics diagnosed using the Research Diagnostic Criteria (RDC), 51 psychotic nonschizophrenics, and 67 nonpsychotic patients were studied at index hospitalization and at a 1.5-year followup. Most thought-disordered schizophrenics and other psychotic patients showed some reduction in thought pathology between index hospitalization and followup (p less than .02). A larger percentage of schizophrenics than other psychotic and nonpsychotic showed thought disorder at the acute phase and at followup assessment (p less than .05), although only a subgroup of 27 percent of the schizophrenics showed severe thought disorder at followup. At followup, severely thought-disordered schizophrenics showed residual signs of psychosis and poor functioning in other areas. Positive thought disorder in schizophrenics at followup most often occurred within the context of an unremitted illness and was less frequently due to a new, acute episode of disturbance. Continuously thought-disordered schizophrenics exhibited more severe impairments in life adjustment at 1.5-year followup than did episodic or nonthought-disordered schizophrenics (p less than .02). The results suggest that severe thought disorder is a persistent characteristic in a subgroup of early schizophrenics.

Acute Disease↗
PubMed1986

Schizophrenic thought disorder at followup: its persistence and prognostic significance.

To assess the prominence, persistence, and prognostic significance of positive thought disorder in schizophrenia, we studied a large sample of psychiatric inpatients at the acute phase and then followed them up twice--1 1/2-2 years and 4 years after hospital discharge. Positive thought disorder was more prominent at the acute phase in schizophrenic and manic patients than in other types of psychotic and nonpsychotic disorders. At followup, positive thought disorder did not persist for all schizophrenics, but a significantly larger percentage of schizophrenic than other psychotic and nonpsychotic patients followed a course in which positive thought disorder was either persistently or episodically present. Positive thought disorder, when seen after the acute phase, was related to concurrent functioning, and predicted subsequent poorer outcome and functioning for both schizophrenic and nonschizophrenic patients. Positive thought disorder was one of several central features of the active schizophrenic disorder. Among schizophrenics, it was related to other major types of psychopathology, especially delusions, another positive symptom with cognitive-ideational elements. Severe positive thought disorder after the acute phase indicated a sustained episode, and suggested a more severe type of schizophrenia with a poorer prognosis.

Acute Disease↗
PubMed1986

Evaluating bizarre-idiosyncratic thinking: a comprehensive index of positive thought disorder.

A summary of our method of assessing positive thought disorder, or bizarre-idiosyncratic thinking, from two short verbal tests is presented. This measure provides for standardized thought disorder assessments of: the overall presence and severity of thought disorder, and the type of disordered thinking shown. A definition and examples of bizarre-idiosyncratic thinking are provided, along with information on the reliability and validity of the scoring system. A method of establishing subject groups based on the severity of positive thought disorder also is presented--ranging from no thought disorder, to abnormal thinking, to severe formal thought disorder. This measure has been used to assess longitudinal changes in thought disorder symptoms over time and to evaluate relationships between thought disorder, other aspects of psychopathology (such as delusions), and adjustment in other areas of functioning across diagnostic groups.

Humans↗
PubMed1986

Features associated with thought disorder in manic patients at 2-4-year follow-up.

The authors assessed 47 formerly hospitalized manic patients for thought disorder 2-4 years after discharge and studied the relationship between thought disorder and other major clinical variables. Fourteen (30%) of the manic patients showed severe positive thought disorder 2-4 years after hospitalization. Partial correlations and multiple regression analyses indicated that thought disorder at follow-up was most closely related to the presence of manic behavior and psychosis. It was also more frequent in manic patients with poor posthospital functioning and in manic patients with multiple previous manic episodes or a more chronic course of illness.

Adolescent↗
PubMed1985

Paranoid and nonparanoid schizophrenia: drive dominated thinking and thought pathology at two phases of disorder.

A sample of acutely hospitalized paranoid and nonparanoid schizophrenics and another sample of paranoid and nonparanoid schizophrenics studied at follow-up were compared on measures of cognitive functioning, disordered thinking, and drive dominated thinking using the WAIS, the Rorschach test, the object sorting test, and an overall index of outcome functioning (N = 67). Results suggested that cognitive regression is related more to acute psychological disturbance than to the presence or absence of paranoia, that the presence of socialized drive dominated thinking during the acute phase is related to better posthospital adjustment at follow-up, and that paranoid schizophrenics show better cognitive functioning after the acute phase. Results did not support the theory that suggests an etiological relation between homosexual conflict and paranoia.

Adult↗
PubMed1985

The thought behind the words: a view of schizophrenic speech and thinking disorders.

Chaika (1982) has proposed that what is frequently viewed as a schizophrenic thought disorder should more precisely be regarded as a speech disorder. We suggest, however, that one should emphasize constructs concerning disordered schizophrenic thinking. We support this position since the schizophrenic's strange speech can fit into a larger view about his disordered thinking which is grounded in a nomological net involving various different types of strange behavior. Other support comes from (1) the use of tests assessing disordered nonverbal behavior, (2) evidence that schizophrenics intermingle personal concerns (ideas) into their verbalizations, (3) bizarre schizophrenic behavior, and (4) the very large percent of schizophrenics with delusions. There is an intricate link between language--which includes a system of symbols, words, and meanings--and thinking. Thus, we have proposed that the disturbance most frequently observed in schizophrenic verbalizations be viewed as involving conceptual-linguistic activity, and not just a problem of speech activity.

Cognition Disorders↗