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Biomedical subjects

P H Lysaker

Publications and source records attributed to P H Lysaker.

At least 19 recordsLinked to original sources
PubMed2000

Emotional discomfort and impairments in verbal memory in schizophrenia.

Research has demonstrated that impairments in verbal memory in schizophrenia are linked with psychosocial deficits. Less is known, however, about their relationship to clinical features of illness. This study explores the hypothesis that impairments in verbal memory, particularly forms of memory requiring deeper levels of encoding, are uniquely linked to symptoms of dysphoria or emotional discomfort. Accordingly, we examined the association between concurrent measures of symptoms and verbal memory for 84 subjects with schizophrenia. Measures of positive, negative, cognitive, excitement and emotional discomfort symptoms were derived from factor scores of the Positive and Negative Syndrome Scale. Verbal memory was assessed using two tests requiring relatively superficial levels of encoding: The Hopkins Verbal Memory Test and the Digit Span subtest; and one test requiring deeper levels of encoding: the Logical Memory subtests I and II. As predicted, multiple regressions controlling for age, education and attention revealed that poorer performance on Logical Memory was strongly associated with greater levels of emotional discomfort (R(2)=0.22 and 0.25, respectively) while performance on the Hopkins test was related to cognitive symptoms scores (R(2)=0.08 and 0.09, respectively). Implications for the conceptualization of verbal memory deficits in schizophrenia are discussed.

Adult↗
PubMed2000

Self-Appraisal of Illness Questionnaire (SAIQ): relationship to researcher-rated insight and neuropsychological function in schizophrenia.

The Self-Appraisal of Illness Questionnaire (SAIQ) is a self-report instrument designed to assess attitudes toward mental illness among persons receiving psychiatric treatment. This instrument was developed for use in community settings, adapted closely from the Patient's Experience of Hospitalization questionnaire. In order to examine the validity of the SAIQ, a factor analysis was first conducted on the items of this instrument in a sample of 59 outpatients with schizophrenia or schizoaffective illness. Three factors emerged: Need for Treatment, Worry, and Presence/Outcome of Illness. Next, to examine the concurrent validity of these three SAIQ subscales, they were correlated with researcher rated insight scales and neuropsychological tests. Results indicated that the Need for Treatment and Presence/Outcome subscales were significantly correlated with both researcher-rated insight scales and with neuropsychological tests of executive functioning. The Worry subscale was not associated with either researcher-rated insight scales or neuropsychological tests. It was concluded that the Need for Treatment and Presence/Outcome subscales may be used in combination as a brief screening instrument for clients with schizophrenia receiving outpatient psychiatric treatment who may be at risk for treatment non-compliance due to a lack of insight into illness.

Adult↗
PubMed2000

Obsessive and compulsive symptoms in schizophrenia: clinical and neurocognitive correlates.

Although research suggests that the presence of obsessive and compulsive symptoms in schizophrenia is associated with graver levels of psychosocial dysfunction, it is unclear whether it is also related to clinical features of illness. Accordingly, the present study compared the symptom levels and neurocognitive function of participants with schizophrenia who had and did not have significant obsessive or compulsive symptoms. Analyses of variance revealed that participants with significant levels of either obsessive or compulsive symptoms (N = 21) had higher levels of positive and emotional discomfort symptoms on the Positive and Negative Syndrome Scale (PANSS) and performed more poorly on the Wisconsin Card Sorting Test, a measure of executive function, than participants without obsessions or compulsions (N = 25). ANCOVAs controlling for level of obsessions also revealed that participants with significant levels of compulsions (N = 12) in particular had higher levels of negative and positive symptoms on the PANSS than participants without compulsions (N = 34). The impact of obsessive-compulsive phenomena on the course and outcome of schizophrenia is discussed.

Adult↗
PubMed1999

Personality and psychopathology in schizophrenia: the association between personality traits and symptoms.

Research has indicated that stable individual differences in personality exist among persons with schizophrenia, and that they likely predate the onset of illness. Little is known, however, about whether individual differences in personality are related to levels of psychopathology. This study tested the hypotheses that levels of Extroversion, Neuroticism, and Psychoticism are associated with symptomatology. Accordingly, measures of these dimensions of personality and of symptomatology were obtained simultaneously for 113 male subjects with schizophrenia or schizoaffective disorder. Next, subjects were characterized as having high or low levels on each personality dimension and their scores on the five components of the Positive Negative Syndrome Scale were compared using multivariate and univariate procedures. Results indicate that extroverted subjects had lower levels of Positive, Negative, and Emotional Discomfort symptoms, and higher levels of Excitement symptoms than introverted subjects. Subjects with higher levels of Neuroticism had higher levels of Positive and Emotional Discomfort symptoms than subjects with lower levels of Neuroticism. No differences in symptoms were found among subjects with higher versus lower levels of Psychoticism. Results suggest individual differences in personality are associated with psychopathology in schizophrenia and may help further explain the heterogeneity widely observed in this disorder.

Adaptation, Psychological↗
PubMed1999

Psychotherapy as an element in supported employment for persons with severe and persistent mental illness.

Recent literature has urged that vocational and clinical services for persons with severe and persistent mental illness should be integrated. Unclear in this model is what role psychotherapy could play. In particular, it is unknown whether psychotherapy can make a unique contribution and whether there are issues it might systematically address in the context of vocational rehabilitation. To examine these questions we report on the psychotherapy of six consumers enrolled in supported employment, a prominent form of vocational rehabilitation. Using these cases as illustrations, we suggest that in an integrative team approach, psychotherapy can facilitate vocational rehabilitation by helping consumers reconstruct aspects of personal narratives related to disability and work and by processing painful affects evoked by work. We report how within a reflective and nonhierarchical relationship consumers were allowed to reframe old ideas, question inconsistencies, and keep track of the structure and content of revised narrative until fully integrated into memory. Despite a wide range of severe impairments, this process enabled consumers to incorporate work into a now more complete and coherent life narrative. Implications for practice and research are discussed.

Adolescent↗
PubMed1998

Personality and psychosocial dysfunction in schizophrenia: the association of extraversion and neuroticism to deficits in work performance.

Research on vocational dysfunction in schizophrenia has as yet only examined associated features of illness. We hypothesized that personality variables may be also associated with work function. We reasoned that higher levels of extraversion and neuroticism would predict poor function by virtue of the social support seeking and passive/avoidant coping styles associated with each. To test this, multiple regressions were conducted in which measures of extraversion and neuroticism predicted work performance among 43 subjects with schizophrenia or schizoaffective disorder. Higher levels of extraversion and neuroticism significantly predicted poorer function, accounting for between 7% and 27% of the variance in global cooperativeness, work quality, work habits and personal presentation measures of work behavior. The potential importance of assessing personality in rehabilitation is discussed.

Adult↗
PubMed1998

Insight and interpersonal function in schizophrenia.

Research has linked impaired insight in schizophrenia to poorer medication compliance and treatment outcome. It is unclear, however, whether poorer interpersonal function is also associated with impaired insight. To examine this question, subjects with schizophrenia or schizoaffective disorder were classified as having unimpaired (N = 44) or impaired (N = 57) insight, and their scores on Heinrichs et al.'s Quality of Life (QOL) Scale were compared. Multiple regressions were conducted to determine the relationship between individual components and social function. Results indicate that subjects with impaired insight had significantly poorer QOL interpersonal relation and intrapsychic foundation scores than unimpaired subjects, despite having equivalent deficit symptoms. Unawareness of the social consequences of illness was found to be the component of insight more closely linked to social dysfunction. This suggests that impairments in insight may be uniquely associated with social dysfunction.

Adult↗
PubMed1998

Neurocognitive function and insight in schizophrenia: support for an association with impairments in executive function but not with impairments in global function.

It remains unclear how impaired insight and neurocognitive impairment are related to one another in schizophrenia. In order to examine this relationship, subjects with schizophrenia or schizoaffective disorder were classified as having 'impaired' (n=38) or 'unimpaired' (n=43) insight based on their insight rating on the Positive and Negative Syndrome Scale (PANSS). Their performance on neuropsychological tests of global function, executive function, memory and vigilance was then compared. Multivariate analyses followed by Scheffe tests indicated that subjects with impaired insight performed less well on the Wisconsin Card Sorting Test, demonstrating poorer abstract flexibility and heightened perseveration. No differences were found between the groups with regard to global cognitive function, memory or vigilance. This suggests that insight is closely linked to deficits in executive function, and that it may be associated with the compromise of frontal lobe function.

Adult↗
PubMed1997

Clinical benefits of paid work activity in schizophrenia: 1-year followup.

In a previous article in the Schizophrenia Bulletin (Vol. 22, No. 1, 1996), we presented findings of a study on the clinical and rehabilitative effects of work activity on 150 subjects diagnosed with schizophrenia or schizoaffective disorder. Subjects were randomly assigned to either a Pay ($3.40/hr) or No-Pay group and given 6-month work placements in a Department of Veterans Affairs medical center. At the 5-month followup, Pay subjects had worked more hours and earned more money (from any employment) than No-Pay subjects. Pay subjects also had significantly greater improvement in symptoms and lower rehospitalization rates. Clinical improvement was closely linked to amount of participation. We concluded that pay increased participation. The current study examined clinical and rehabilitative outcomes at 1-year followup, 6 months after the conclusion of the work program. Results indicated that the Pay subjects had a significant decrease in work activity once they had completed the work program. However, 75 percent of those who had fully participated in the program continued working during the subsequent 6 months, either as volunteers or for pay. Clinical outcomes for subjects in the Pay condition were attenuated at 1-year followup but still significantly better than for subjects in the No-Pay condition. More than 40 percent of participants continued to be "much improved" on total symptoms, and more than 50 percent were "much improved" on positive symptoms. Discussion focuses on the importance and limitations of work for pay as a clinical intervention and concludes that continuous work services are necessary and beneficial for many people with schizophrenia.

Adult↗
PubMed1997

Cognitive impairment and substance abuse history as predictors of the temporal stability of negative symptoms in schizophrenia.

Research has not consistently indicated that negative symptoms in schizophrenia are temporally stable. One possible explanation for this is that stable negative symptoms are a characteristic of only some individuals with schizophrenia. The current study explored whether cognitive impairment and stimulant abuse history were associated with amount of change in negative symptom level over a 1-year period. Results indicated that among 72 subjects with schizophrenia, performance on the Wisconsin Card Sorting Test and history of stimulant abuse significantly accounted for 18% of the variance in symptom variability after age, intelligence quotient, and initial symptom severity were controlled. As hypothesized, poorer performance on the Wisconsin Carding Sorting Test was associated with less symptom variability, whereas a more extensive stimulant abuse history was associated with greater variability. A discriminant function analysis was able to correctly classify 96% of subjects as having stable symptoms but only 30% as having unstable symptoms indicating a sensitive, but not specific, classification. This finding suggests that cognitive deficits may be a necessary but insufficient condition for temporal stability of negative symptoms and that negative symptoms in schizophrenia are a complex phenomenon best understood in the context of other features of illness and psychosocial variables.

Adult↗
PubMed1996

Clinical benefits of paid work activity in schizophrenia.

Although indirect support can be found for the clinical benefits of work, it has not been studied in randomized designs, nor have critical variables been manipulated. One such variable is pay incentive. The authors present a study of 150 subjects with schizophrenia or schizoaffective disorder who were randomized into Pay ($3.40/hour) and No-Pay conditions and offered 6-month work placements within a Department of Veterans Affairs medical center. Subjects participated in a work-related support group and were evaluated weekly on symptom measures. Results indicated that Pay subjects worked more hours and earned more money than No-Pay subjects. Pay subjects showed more total symptom improvement at followup, and more improvement, particularly on positive and emotional discomfort symptoms. They also had a significant lower rate of rehospitalization than No-Pay subjects. Participation in work activity was closely associated with symptom improvement. Participators showed more total symptom improvement at followup than partial participators or nonparticipators, and more improvement, particularly on positive, hostility, and emotional discomfort symptoms. We concluded that pay increased participation and that, in this study, participation in work activity was primarily responsible for symptom reduction.

Adult↗
PubMed1995

Psychiatric symptoms and work performance among persons with severe mental illness.

The study examined the relationship between psychiatric symptoms and work performance for 61 subjects with a DSM-III-R diagnosis of schizophrenia or schizoaffective disorder who participated in a work rehabilitation program. Symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) to predict performance on the Work Personality Profile at three and 13 weeks of the program. Twenty-seven percent of the variance in work performance measures could be explained by symptom components measured by the PANSS, including the cognitive, negative, and hostility components, but the positive component did not predict work performance. Ratings of symptoms done concurrently with ratings of work performance were more powerful predictors than ratings of symptoms done at three and 13 weeks before ratings of work performance.

Adult↗
PubMed1995

Social skills at work. Deficits and predictors of improvement in schizophrenia.

While the impact of social learning programs upon social deficits in schizophrenia has been widely studied, less is understood about which patients have the poorest social skills, and among those which patients have deficits most refractory to rehabilitation. To explore these questions, this study compared the symptom levels and performance on neuropsychological testing of 91 subjects with impaired and unimpaired social skills enrolled in a vocational rehabilitation program. After 10 weeks of rehabilitation and a supportive group treatment, social skills among a subsample of 41 subjects with initially impaired social skills were reassessed. Results indicate that subjects with initially impaired social skills had significantly higher levels of negative symptoms. However, multiple regression analysis revealed that cognitive impairments at intake, rather than level of negative symptoms, predicted improvement among subjects with initially impoverished social skills (R2 = .35). Results suggest that level of cognitive impairment is associated with the persistence of social skills deficits in schizophrenia.

Cognition Disorders↗
PubMed1995

Cognitive deficits in schizophrenia. Prediction of symptom change for participators in work rehabilitation.

While recent studies have found that most patients with schizophrenia who participate in work rehabilitation experience symptom improvement, there appears to be a subgroup of patients whose symptoms remain stable or even worsen. The present study explores the hypothesis that cognitive impairment is one factor which reduces the clinical effectiveness of rehabilitation and accounts for a lack of improvement in some patients. To explore this question, performance on two neuropsychological tests was used to predict improvement on six symptom dimensions for 59 subjects who completed 5 months of work in a rehabilitation program. Discriminant function analyses indicated that quadratic combinations of standardized scores on the Wisconsin Card Sorting Test and thought disorder scores from the Gorham Proverbs Test could correctly classify 83% of subjects as improved or unimproved on a total symptom measure, and between 84% and 100% of subjects as improved or unimproved on various symptom dimensions, with greater levels of cognitive impairments at intake predicting no symptom improvement. Implications for the potential role of cognitive remediation in rehabilitation are discussed.

Adult↗
PubMed1994

Concurrent validity of the cognitive component of schizophrenia: relationship of PANSS scores to neuropsychological assessments.

Cognitive symptoms of schizophrenia may represent a separate component of the disorder that is distinct from positive or negative syndromes. In a previous study, we reported a factor analysis of the Positive and Negative Syndrome Scale (PANSS) that revealed five components, one of which we labeled the Cognitive component. In the present study, we explored the validity of the PANSS Cognitive component by examining correlations between neuropsychological measures and the five factor-analytically derived PANSS scores for 147 subjects with diagnoses of schizophrenia or schizoaffective disorder. Higher scores on the PANSS Cognitive component were significantly correlated with poorer performance on all neuropsychological tests, including the Wisconsin Card Sorting Test (WCST), the Digit Symbol Substitution Task, the Slosson Intelligence Test, and the Gorham Proverbs Test. Multiple regression revealed that these test scores explained 37% of the variance in the Cognitive component score. Neuropsychological tests have very limited associations with the other PANSS components. These results suggest that the Cognitive component of the PANSS is a valid measure of cognitive deficits in schizophrenia, and they support the hypothesis that Cognitive impairment is a distinctive feature of schizophrenia independent of positive and negative syndromes.

Adult↗
PubMed1994

Five-component model of schizophrenia: assessing the factorial invariance of the positive and negative syndrome scale.

A five-component model of schizophrenia has been presented by Kay and Sevy based upon an analysis of the Positive and Negative Syndrome Scale. Kay and Sevy found factorial validity for negative and positive syndromes, and they identified excitement, depressive, and cognitive components as well. They suggested that subtypes and syndromes can be mapped along dimensions presented in their model. The present study compares the five-component solution for a new sample of 146 subjects to a reanalysis of the Kay and Sevy data. Despite divergent demographic characteristics, the two samples produce similar dimensions. Correlations of component loadings and subject scores as well as confirmatory factor analysis are presented. Discussion focuses on points of agreement and important differences in the symptoms assigned to each component. How the dimensions relate to rationally derived models of positive and negative syndromes is reviewed, and implications for subtyping and other methods of examining the heterogeneity of schizophrenia are considered.

Adult↗