Biomedical subjects

M L Silverstein

Publications and source records attributed to M L Silverstein.

At least 19 recordsLinked to original sources

PubMed2001

Clinical identification of compensatory structures on projective tests: a self psychological approach.

In this article I discuss compensatory structure, a concept from Kohut's (1971, 1977) psychology of the self that is not as familiar as Kohut's other views about the self. Compensatory structures are attempts to repair selfobject failure, usually by strengthening idealization or twinship in the face of mirroring deficits. Compensatory structures, particularly their early indications, can be detected on projective tests for identifying adaptive resources and treatment potential. The clinical identification of compensatory structures on test findings is described using Rorschach and Thematic Apperception Test (Murray, 1943) content. Particular attention is devoted to the 2-part process of demonstrating first, an injury to the self, and second, how attempts to recover from such injuries can be detected on projective tests. Clinical examples are provided, and the differentiation between compensatory structures and defenses and sublimation is discussed.

Adolescent↗

PubMed2000

Clinical and research implications of revising psychological tests.

This article integrates those of other contributors to this special section, "Methods and Implications of Revising Assessment Instruments," to underscore important conceptual factors to consider when undertaking test revisions. These considerations include determination of when test measures have become sufficiently understood to be incorporated in a test revision, cohort effects, revision of administration formats and test instructions, and comparisons of performance levels across test versions. The discussion of these factors also takes into consideration clinical practice and educational implications of making a transition to revised test versions.

Humans↗

PubMed1999

Sustained attention and related perceptuomotor functions.

The present study examined the relationship between two measures of sustained attention on the Continuous Performance Test (reaction time and omission errors) and several performance measures on neuropsychological tests. Analysis suggests that sustained attention as measured by processing speed predicts performance on neuropsychological measures of relatively greater complexity and that the Stroop test, which requires maintaining steady focus on a changing stimulus field, may be more sensitive to lapses in attention than other neuropsychological tests.

Adult↗

PubMed1999

Sustained attention on a continuous performance test.

The present study compared means of 54 nonpatients on two Continuous Performance Test measures in five administration conditions. Both response measures differentiated performance among the conditions, certain of which may have an alerting function that facilitates deployment of attention. Appreciable attentional demand or effort, however, may limit this facilitative effect.

Adolescent↗

PubMed1997

BPRS syndrome scales during the course of an episode of psychiatric illness.

This report examines changes in symptom levels on the four major syndrome scales from the Brief Psychiatric Rating Scale (BPRS): thought disturbance, paranoid disturbance, anxiety/depression, and emotional withdrawal/motor retardation. Baseline BPRS ratings were obtained during the first week of hospitalization for an acute episode of psychiatric illness, in 120 patients with schizophrenia, schizoaffective disorder, and depression. BPRS ratings were carried out in the week prior to discharge. Findings indicated that patients with schizoaffective disorder showed a greater magnitude of general clinical improvement than schizophrenics, although both groups had comparable improvement on thought disorder from admission to discharge. Paranoid symptoms did not recover as completely among schizophrenics compared to schizoaffective disorder patients. As expected, anxiety and depression symptoms remitted most prominently among the depressed inpatients.

Acute Disease↗

PubMed1997

Course and outcome for schizophrenia versus other psychotic patients: a longitudinal study.

We studied 276 patients longitudinally, beginning at the acute phase and continuing at three successive followups over 7.5 years, comparing 74 schizophrenia patients with 74 other psychotic patients and 128 nonpsychotic patients on early course and outcome. Schizophrenia patients showed significantly poorer functioning than patients with other psychotic disorders at each of the three followups (p < 0.05). More schizophrenia patients than other psychotic patients showed consistent psychopathology and a course in which there was not complete remission at any of the three followups (p < 0.05). Most schizophrenia patients did not show severe decrements in social activity level. Poor outcome schizophrenia patients showed significantly slower recovery at each followup than did other psychotic patients with initial poor outcomes (p < 0.01). The results indicate that, during the early course, schizophrenia patients still show relatively poor outcomes, although a small number of schizophrenia patients enter into complete remission. Over time, many schizophrenia patients fluctuate between severe disability and moderate disability rather than always showing severe disability. Schizophrenia patients tend to recover more slowly then other psychotic patients. Differences between schizophrenia patients and other psychotic patients in clinical course over time may be larger than differences at any single followup.

Adult↗

PubMed1997

Neuropsychological dysfunction and clinical outcome in psychiatric disorders: a two-year follow-up study.

The presence of neuropsychological disturbances in schizophrenia and mood disorders raises the question that cognitive impairments might contribute to poor outcome. This report examines changes in neuropsychological performance from hospitalization to a 2-year follow-up evaluation in relation to psychosocial outcome. Findings indicated that unfavorable clinical outcome is associated with marginal changes in neuropsychological performance, whereas good outcome status is associated with neuropsychological improvement. Neuropsychological improvement may thus require a stable period of favorable psychosocial recovery, in schizophrenia and schizoaffective disorder, as well as major mood disorder syndromes.

Adult↗

PubMed1996

Teaching the Rorschach and learning psychodiagnostic testing: a commentary on Hilsenroth and Handler (1995).

A recent report by Hilsenroth and Handler (1995) surveyed graduate students' impressions of their predoctoral-level training on the Rorschach method. My commentary underscores two central points from their article: (a) the problem of program specialization in a crowded curriculum, and (b) students' indication of a need for more secure grounding in personality theory and clinical diagnosis. The focus of these remarks concerns current trends in clinical psychology education, their implications for training in psychological assessment, establishing a reasonable upper limit of solid competence for achieving a journeyman level of ability, and some considerations about a suitable role for continuing education workshops. A sharp distinction between filing in gaps in knowledge and compensating for fundamental deficiencies is emphasized in this context.

Curriculum↗

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↗

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

Levels of psychopathology at hospital admission and discharge: the Million Clinical Multiaxial Inventory as a prognostic measure.

This study compares two pathological personality disorder scales and two severe clinical syndrome scales from the Millon Clinical Multiaxial Inventory in relation to clinical change from admission to discharge on the major dimensions of the Brief Psychiatric Rating Scale. For a sample of 52 inpatients, 17 with schizophrenia, 27 with major depression, and 8 with bipolar (manic) disorder, we investigated the prognostic utility of these Millon scales for identifying clinical improvement. Findings indicated that, while the Millon scales identified admission levels of psychopathology on three Brief Psychiatric Rating Scales, the Millon inventory predicted clinical improvement on only the brief rating of Thinking Disturbance. These findings are considered in light of prognosis as a clinical research question that is distinct from diagnostic discrimination and case identification.

Adult↗

PubMed1993

Differentiating neuropathology from psychopathology with longitudinal and retrospective data: report of a case.

This case study report of diagnostic psychological testing considers the implications of a 53-point verbal-performance IQ differential, with the benefit of neuropsychological and neuroradiologic imaging studies, a 6-month follow-up Wechsler Adult Intelligence Scale-Revised (WAIS-R; Wechsler, 1981) evaluation, and retrospective examination of early school records and test findings. The approach highlights the limitations of cross-sectional clinical studies in differential diagnosis, particularly when both psychodynamic and neuropsychological factors are at issue. This report demonstrates how an early acquired neurodevelopmentally based deficit can alter or restructure the appearance of adult cognitive-perceptual functions. Further, early neurodevelopmental impairment is considered from the standpoint of its influence on compromised autonomous ego functions.

Brain Damage, Chronic↗

PubMed1993

Differential rate of neuropsychological dysfunction in psychiatric disorders: comparison between the Halstead-Reitan and Luria-Nebraska batteries.

This report examined the rate of agreement between scores of the Halstead-Reitan and Luria-Nebraska Neuropsychological Batteries in the classification of impaired and nonimpaired performance of 55 schizophrenic and 64 affective disorder patients: 65.2% for schizophrenics and 67.5% for those with affective disorder, with greater impairment on the Halstead-Reitan battery.

Adult↗

PubMed1991

Two types of thought disorder and lateralized neuropsychological dysfunction.

This report examined positive and negative thought disorder in relation to medication status and cerebral lateralization measures obtained from the Halstead-Reitan Neuropsychological Battery and Wechsler Adult Intelligence Scale in a sample of 59 patients with schizophrenia, schizoaffective and manic disorders, and unspecified functional psychoses. Discriminant function analyses of comparable left- and right-hemisphere variables from the neuropsychological tests were examined for both types of thought disorder, in which presence or absence of psychotropic medications was included as a variable in each analysis. Results indicated a relationship between positive thought disorder and left- but not right-hemisphere variables. Both the left- and right-hemisphere variables were related to negative thought disorder, and these relationships were influenced by the global measures of verbal and performance IQ as well as by medication status. These findings provide qualified support for the left-hemisphere-dysfunction hypothesis, insofar as it is associated specifically with positive thought disorder. Diffuse or bilateral cerebral impairment is more characteristic of negative thought disorder; however, medication status is also equivalent to neuropsychological variables in influencing this relationship.

Adult↗

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↗

PubMed1990

Current conceptualizations of psychiatric illnesses as neurological disorders.

This paper reviews a recent body of evidence from computed tomography, imaging methods, and neuropsychological testing, emphasizing schizophrenia. The review indicates important characteristics of this disorder that can be conceptualized as similar to neurological disorders, and that have a probable neuropathologic basis. Although the argument is compelling in many respects, cautionary observations are also discussed, and a need for positioning subgroups based on neurological etiology is advanced. This serves as an introduction to a discussion of neurological diseases as potential models for psychiatric disorders.

Brain↗

PubMed1988

Personality trait characteristics in relation to neuropsychological dysfunction in schizophrenia and depression.

Knowledge of the personality trait and psychopathology variables that differentiate neuropsychologically impaired and nonimpaired psychiatric patients has been limited relative to the study of higher cortical functions. This study reports findings from the Millon Clinical Multiaxial Inventory (MCMI) developed by Millon (1982) in a sample of hospitalized schizophrenics and depressives who also received the Luria-Nebraska Neuropsychological Battery. The principal findings indicate that neuropsychological dysfunction may be related to substance abuse, including its underlying personality dimensions, in schizophrenia, but only modest support is indicated for the construct of negative symptoms in schizophrenics with neuropsychological dysfunction. Further, the findings do not support the view that psychosis is a characteristic feature of depressives with impaired neuropsychological performance.

Adult↗

PubMed1988

Differential patterns of neuropsychological deficit in psychiatric disorders.

This report investigated differential cerebral impairment on the Luria-Nebraska Neuropsychological Battery in schizophrenia, schizoaffective, and depressive disorders (N = 106). Results indicated impaired tactile-stereognostic processing in schizoaffective and depressive disorder patients and verbal memory deficits in the schizophrenic and schizoaffective disorder patients. These findings question the specificity of functional neuropsychological deficit areas in schizophrenia and depression.

Adult↗