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Biomedical subjects

Martin Harrow

Publications and source records attributed to Martin Harrow.

18 recordsLinked to original sources
PubMed2006

Neurocognition as a stable endophenotype in bipolar disorder and schizophrenia.

Linkage and association studies have paid increasing attention to neurocognition as a putative endophenotype. However, there exists little documentation of its trait stability in schizophrenia or bipolar disorder. Our aim was to determine the longitudinal stability of neurocognitive performance in bipolar versus schizophrenia probands. We administered a neurocognitive battery at two time points, approximately 5 years apart, in 16 schizophrenia and 16 bipolar disorder age-matched subjects. There were no significant changes over time on variables including education, estimated IQ, depression, psychosis, global functioning, or medication status. Schizophrenia subjects showed significant deterioration in one measure of executive functioning but no significant changes in seven of eight other domains. Bipolar patients showed stability over time in attentional measures but greater variability in other domains. These preliminary findings suggest that neurocognitive domains appear longitudinally stable across broad domains in schizophrenia. In contrast, stable functioning may be more limited to attentional domains in bipolar disorder.

Adult↗
PubMed2006

Sex differences in outcome and recovery for schizophrenia and other psychotic and nonpsychotic disorders.

OBJECTIVE: It is generally believed by the field of psychiatry that women with schizophrenia have better outcomes and higher rates of recovery than their male counterparts, because many studies on the topic support this finding. Fewer data are available to assess potential sex differences among individuals with other psychotic disorders. This study used longitudinal data on sex differences previously unavailable to the field to examine long-term global outcome, potential recovery, course of illness, and rehospitalization for schizophrenia, other psychotic disorders, and nonpsychotic disorders. METHODS: A total of 239 young psychiatric patients (mean age of 23.4 years) were assessed prospectively at the index hospitalization and then followed over 15 years at five follow-up points (at a mean of two, 4.5, 7.5, ten, and 15 years). The sample consisted of 69 patients with schizophrenia, 56 with other psychotic diagnoses, and 114 with nonpsychotic psychiatric disorders. RESULTS: Sex differences in outcome were found for both patients with schizophrenia and those with other psychotic disorders, with women consistently showing better functioning over time, more frequent periods of good functioning and periods of recovery, less likelihood of uniformly poor outcome, and fewer and shorter rehospitalizations. Unlike both groups of patients who were psychotic, the patients with nonpsychotic disorders showed no significant sex differences in outcome. CONCLUSIONS: Both longitudinally and at each individual follow-up point, the data suggest that women with schizophrenia and with other types of psychotic disorders generally show better outcome than men with similar diagnoses. The sex differences in outcome for patients with schizophrenia were consistent over time. However, these sex differences were only moderate in size compared with the much larger difference in outcome between the diagnostic groups. The longitudinal data add a new dimension to previous research and suggest that sex differences in outcome are not specific to patients with schizophrenia but rather occur among patients with psychotic disorders in general.

Adult↗
PubMed2005

Subjective life satisfaction and objective functional outcome in bipolar and unipolar mood disorders: a longitudinal analysis.

BACKGROUND: Quality of life (QOL) has gained increasing attention as an important yet underappreciated component of functional outcome in mood disorders. In particular, the relationship between subjective life satisfaction and objective measures of psychosocial adjustment has not been well-studied. The goal of the present study was to examine the longitudinal associations between subjective life satisfaction and objective functional outcome among individuals with bipolar and unipolar mood disorders. METHOD: One hundred fifty-seven mood disordered subjects were assessed at index hospitalization for bipolar mania (n=35), unipolar psychotic depression (n=27), or unipolar nonpsychotic depression (n=95). All were prospectively followed up three times, at approximately 2, 4.5 and 7-8 years. Global outcome, work performance, social adjustment, recurrent depressive episodes, and dimensions of life satisfaction were assessed by semi-structured interviews using standardized ratings. RESULTS: Subjective life satisfaction strongly paralleled global functioning, work performance and social adjustment at each follow-up for patients with unipolar nonpsychotic depression, but not bipolar disorder or unipolar psychotic depression. Depressive symptoms and objective functional impairment contributed to poor QOL in most domains, independent of illness chronicity, medication use, or affective disorder subtype. LIMITATIONS: Findings might have differed had a different QOL measure been used, although the present measure showed concurrent validity with a previously used instrument. Sample sizes for the bipolar and psychotic depression groups were sufficient to detect moderate, but not small, correlations between objective functioning and subjective QOL. CONCLUSIONS: Recurrent depression remains a substantial contributor to poor life satisfaction across affective disorder subtypes. Subjective QOL in bipolar and unipolar psychotic depression patients may not accurately reflect objective functional outcome status, potentially due to diminished insight, demoralization, or altered life expectations over time.

Activities of Daily Living↗
PubMed2005

Do patients with schizophrenia ever show periods of recovery? A 15-year multi-follow-up study.

Contrary to older views, with modern treatment some or many patients with schizophrenia may show intervals of recovery. The current 15-year prospectively designed follow-up research comparing schizophrenia patients with other types of psychotic and nonpsychotic patients studied how many schizophrenia patients ever show intervals of recovery. Two hundred seventy-four early young psychiatric patients from the Chicago Followup Study, including 64 schizophrenia patients, 12 schizophreniform patients, 81 other psychotic patients, and 117 nonpsychotic patients, were assessed as inpatients and then reassessed 5 times over 15 years. Patients were evaluated for recovery for 1 or more years using an operational definition of recovery. Cumulatively, over the 15-year period slightly over 40% of patients with schizophrenia showed 1 or more periods of recovery. However, schizophrenia is still a relatively poor outcome disorder, showing poorer courses than other types of psychotic and nonpsychotic disorders (p < .001). Most schizophrenia patients did not show the severe social isolation often described prior to the modern treatment era. Schizophreniform patients tended to show more favorable outcomes than schizophrenia patients. Over 50% of the schizophrenia patients did not have a disorder that was chronic and continuous. Rather, their disorder was episodic, although for many more vulnerable and less resilient schizophrenia patients the episodes were more frequent and severe, with slower recovery.

Adult↗
PubMed2005

Change in the relationship between anhedonia and functional deficits over a 20-year period in individuals with schizophrenia.

Although early theorists suggested that deficits in emotional experience be considered a hallmark characteristic of schizophrenia, there has been limited research, and inconsistent findings, on the relationship between anhedonia and functional capacity in individuals after the onset of schizophrenia. Stronger relationships have typically been reported for chronic samples in contrast to first episode samples, although it is not clear whether this is due to selection biases that influence recruitment in these different groups, or whether results reflect a change over the course of illness. The current longitudinal study examined the relationship between physical anhedonia and functional status in a sample of 61 individuals with schizophrenia at regular intervals over a 20-year period. Subjects were recruited into the study during an index hospitalization and completed assessments at 2-, 4.5-, 7.5-, 10-, 15-, and 20-year follow-ups. Analyses indicate that the relationship between anhedonia and impairments increases over time, although mean performance on these measures is stable across this same time period. These results suggest increasing convergence of impairments in emotional, adaptive, and cognitive capacities over time, with physical anhedonia associated with poorer outcome.

Activities of Daily Living↗
PubMed2005

Long-term remission and recovery in bipolar disorder: a review.

Longitudinal outcome studies of bipolar disorder show that most patients encounter affective recurrences, interepisode symptoms, and residual functional impairment. The kindling model suggests that the timing and periodicity of recurrent episodes may help to predict future illness course. This article examines contemporary data regarding patterns of affective recurrence, and the extent to which variable versus consistent or sustained remissions influence long-term illness course. Consequences of affective recurrence are examined from psychosocial, pharmacologic, and neurobiological perspectives. Multiple affective recurrences may be linked with subsequent treatment resistance, psychosocial disability, and possible functional neuroanatomic changes. Existing data support the prognostic importance of effective treatment early in the course of illness, with a goal to achieve and maintain clinical homeostasis.

Affect↗
PubMed2005

Long-term outcome of patients with schizophrenia: a review.

OBJECTIVE: To review empirical studies that assess outcome of patients with schizophrenia and evaluate the degree to which reported outcome is affected by research methodology, treatment variables, prognostic factors, epidemiologic factors, and patient resilience. METHOD: We reviewed studies that used control subjects and lasted for a decade or more, comparing them with respect to research methodology and choice of outcome variables. RESULTS: Like other mental illnesses and medical illness in general, the natural course of schizophrenia showed itself to have a threefold division of mild, moderate, and severe. Although a great deal of variance in outcome occurred across the studies reviewed, schizophrenia is nevertheless a disorder with relatively poor outcome. Patients with schizophrenia consistently showed poorer courses and outcomes than patients with other psychotic and nonpsychotic psychiatric disorders. On the positive side, subgroups of schizophrenia patients had extended periods of recovery-some without the benefit of extensive mental health aftercare treatment-and patients with schizophrenia did not show a progressive downhill course. CONCLUSION: While documenting the heterogeneity in outcome and the generally poorer outcomes of patients with schizophrenia, the studies reviewed also alert us to the danger of suicide and early death in schizophrenia. In addition, they expose problems in clinical management and treatment and also help us anticipate the possibility of intervals or periods of recovery, some of which appear spontaneously and may be tied to individual patient factors such as resilience.

Follow-Up Studies↗
PubMed2004

Consistency of remission and outcome in bipolar and unipolar mood disorders: a 10-year prospective follow-up.

BACKGROUND: Previous studies of the natural course of bipolar disorder have suggested that relapse and psychosocial impairment are more common than many would expect during treatment under routine conditions. The present research sought to identify patterns of consistency in longitudinal recovery after an index manic or depressive episode in patients formerly hospitalized for major affective disorders. The data extend prior findings from the Chicago Follow-up Study involving four successive assessments of course and outcome for bipolar and unipolar patients over a 10-year follow-up interval. METHODS: Thirty-four RDC bipolar I manic, 17 psychotic unipolar depressed, and 72 nonpsychotic unipolar depressed patients were assessed at index hospitalization and prospectively followed-up at 2, 4.5, 7.5 and 10 years. Psychosocial functioning, rehospitalization, and overall outcome were rated by standardized instruments. Patterns of consistent remission or impairment in functioning were compared across follow-up periods. RESULTS: Consistently good functioning was observed more often among patients with unipolar nonpsychotic depression than bipolar disorder or unipolar psychotic depression. Psychosis at index hospitalization was not associated with poorer outcomes for either the bipolar or unipolar groups, although it significantly predicted psychosis at follow-up more robustly for unipolar than bipolar patients. Less than half of the bipolar cohort had good work performance at each follow-up, while unipolar nonpsychotic depressed patients had consistently better work functioning. Rehospitalization was more common for the bipolar than unipolar patients at the 4.5- and 7.5-year assessments. Sustained remission across follow-ups was associated with remission at subsequent follow-ups regardless of diagnostic polarity at index hospitalization. LIMITATIONS: The observational design, small sample size, and naturalistic treatment of subjects in this protocol prompts caution when interpreting treatment outcome findings. The availability of a bipolar cohort with relatively low attrition over a 10-year period may limit the generalizability of the current findings to patients who remain engaged in sustained contact with a long-term research program. CONCLUSIONS: Over a 10-year follow-up period, about half of bipolar patients show sustained remissions or patterns of improvement, while 30-40% experience some functional decline. The degree of consistency in remission patterns over time may hold greater prognostic significance than the polarity of an index affective episode in anticipating subsequent levels of psychosocial adjustment in severe mood disorders.

Adult↗
PubMed2004

Followup of psychotic outpatients: dimensions of delusions and work functioning in schizophrenia.

We studied three characteristics or dimensions of delusions in schizophrenia patients living in the community, including their influence on work and community functioning. The 149-patient sample included 57 delusional schizophrenia and nonschizophrenia outpatients, 50 nondelusional outpatient controls, and 42 delusional inpatient controls. The data indicated the strength and prominence of acute-phase psychopathology on characteristics of delusions, with large significant differences in intensity of delusions between the acute inpatient phase and the postacute inpatient and outpatient phases. Contrary to some views, the data indicate that the overall presence of any delusions in general, and the various dimensions of delusions, both influence work performance and community functioning, with the greater part of the variance due to the presence of delusions in general. Despite their outpatient status, delusional outpatients showed surprisingly poor self-monitoring about whether others would regard their delusional ideation as unrealistic. Schizophrenia and affectively disordered patients with high emotional commitment to their delusions showed significantly poorer work functioning and were significantly more likely to be rehospitalized (p < 0.05), indicating the important impact on functioning of patients' feelings of immediacy and urgency about their unrealistic beliefs.

Activities of Daily Living↗
PubMed2004

Are negative symptoms associated with functioning deficits in both schizophrenia and nonschizophrenia patients? A 10-year longitudinal analysis.

The current analyses assess the functional correlates of negative symptoms across diagnoses and across time to assess the appropriateness of a dimensional approach to the study of negative symptoms--specifically, whether negative symptoms should be studied as a single construct across diagnostic groups. Seventy-two schizophrenia/schizoaffective, 36 other psychotic, and 42 nonpsychotic depressed patients were recruited at index hospitalization and were followed up 4.5, 7.5, and 10 years later. At each followup assessment, data were collected on symptoms and adaptive and cognitive functioning. Analyses indicated that negative symptoms showed some similar functional associates in all three diagnostic groups, although results were strongest for the schizophrenia spectrum patients. Negative symptoms at the 10-year followup were associated with different patterns of social deficits prior to index hospitalization in the three diagnostic groups. The data provide some support for a dimensional approach to the study of mental illness, with negative symptoms associated with deficits across diagnosis, but also provide evidence of some diagnostic differences.

Adult↗
PubMed2004

Thought disorder in schizophrenia: working memory and impaired context.

This research was designed to provide data on whether thought disorder in schizophrenia patients is due to difficulty in holding external stimuli or the external context online in working memory. We assessed 231 early phase acute inpatients, including 68 schizophrenic patients and 38 bipolar manic patients. Patients were administered a thought disorder test that requires holding stimuli online in working memory as they respond and another in which the stimuli is in direct view of the patients throughout the test procedure. The results indicated that patients who were thought disordered on the test requiring holding the external stimuli online in memory also were more thought disordered on the test that provides full vision of the stimuli throughout the testing (p < 0.001). Thus, schizophrenia patients vulnerable to thought disorder show thought disorder regardless of whether or not they are required to hold the stimuli online in memory. Overall, the data did not support the formulation that thought disorder is primarily a consequence of failure to hold external stimuli or contextual material online in working memory. An alternate view of thought disorder is presented.

Adult↗
PubMed2002

The relationship between positive symptoms and instrumental work functioning in schizophrenia: a 10 year follow-up study.

This longitudinal investigation was designed to determine the association between the positive symptoms of psychosis and instrumental work functioning among patients with schizophrenia in comparison to patients with affective disorders. 173 participants were assessed prospectively for the presence of psychosis and concurrent work adjustment using a series of standardized measures at four consecutive follow-ups over a 10 yr period. The data demonstrate a significant relationship between psychosis and increased impairment in work functioning across diagnostic groups for three of the four follow-up periods (p<0.01), with this relationship being most consistent for the schizophrenia patients throughout the course of their disorder (p<0.01). The more severely psychotic patients, regardless of diagnosis, are least likely to be working effectively; however, the debilitating effect of psychosis on work adjustment is most evident for schizophrenia patients.

Adolescent↗
PubMed2002

Executive function in schizophrenia: is it linked to psychosis and poor life functioning?

The authors examined the relationship of major aspects of executive function to acute psychosis and long-term outcome in patients enrolled in a 15-year study of the natural history of psychosis. They evaluated 157 patients, including 42 schizophrenic, 42 other psychotic, and 73 nonpsychotic psychiatric patients 15 years after index hospitalization. Patients were administered the Wisconsin Card Sorting Test (WCST) and measures of psychosis and posthospital adjustment. Schizophrenia patients performed significantly worse than both nonschizophrenic psychiatric control groups on WCST indices, regardless of psychosis. Aspects of executive function were impaired in schizophrenia patients with severe deficits in their level of overall functioning and outcome and also in many with only moderate impairment in overall functioning; however, these deficits were seen to a greater degree in schizophrenia patients with very poor overall functioning. Executive function deficits appear to be a core component of schizophrenia rather than an effect of acute psychotic disorganization, and are associated with long-term outcome.

Activities of Daily Living↗
PubMed2002

The course of anhedonia during 10 years of schizophrenic illness.

Although anhedonia has been proposed to be a trait-like characteristic in schizophrenia patients, its persistence and stability have not been tested using multiple assessments over a multiyear period. Specific definitions of anhedonia vary across studies, and relationships between different types of anhedonia as well as their relationship to schizophrenic symptoms over the course of illness have not been addressed. The current research, using prospectively collected longitudinal data covering a 10-year span for 127 individuals with schizophrenic illness, found that (a) physical, but not depressive, anhedonia is a stable characteristic over a 10-year period; (b) physical anhedonia does not show strong and consistent relationships with psychotic, negative, or depressive symptoms; and (c) the relationship between some premorbid characteristics and physical anhedonia are significant even 10 years into the course of illness.

Adult↗
PubMedDate not supplied

Disordered verbalizations in schizophrenia: a speech disturbance or thought disorder?

This research provides empirical data relevant to the long-standing theoretical issue of whether disordered speech in schizophrenia should be viewed as a speech disturbance or a thought disorder. The study analyzed whether schizophrenia patients with disordered speech on one test also show strange nonverbal behavior and unrealistic ideas on other assessments. One hundred eighty-four patients, including 55 schizophrenia patients, were assessed at the acute phase and followed up twice, over 4.5 years. Patients were assessed (1) with a standardized measure that can elicit disordered speech, (2) with a different measure that can elicit an atypical sorting of objects and an intermingling of personal ideas, and (3) for delusions (unrealistic thinking). Schizophrenia patients with disordered speech on the Proverbs Test also (1) sorted objects strangely on the Object Sorting Test (P <.05), (2) showed an intermingling of personal ideas into their thinking (P <.01), and (3) had delusional ideas when assessed at two successive follow-ups over a multiyear period (P <.001). The data suggest that most schizophrenia patients and other psychotic patients with disordered speech also show strange nonverbal behavior and unrealistic ideas/beliefs. These data support a theoretical framework in which disordered speech in schizophrenia and other types of psychotic patients is viewed as not just due to a speech disorder, but is often part of a broader constellation that includes gross reality distortions, strange behavior and ideas, and disordered thinking.

Adult↗