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R Walter Heinrichs

Publications and source records attributed to R Walter Heinrichs.

13 recordsLinked to original sources
PubMed2006

The University of California Performance Skills Assessment (UPSA) in schizophrenia.

This study evaluated the University of California Performance-based Skills Assessment (UPSA) in a Canadian outpatient schizophrenia setting. The UPSA was administered to 64 patients with schizophrenia and schizoaffective disorder and to 42 nonpsychiatric controls. Patient and control samples did not differ in age, gender composition, first language or country of birth. Patients demonstrated significantly lower performance than healthy participants on 3 of 5 UPSA subscales as well as on a summary index. Moreover, performance varied significantly with patients' support requirements in the community. In contrast, the Household Management and Transportation subscales yielded non-significant group differences and failed to correlate with community support requirements. Examination of score distributions raised the possibility of a ceiling effect that limited the discriminating power of UPSA subscales, thus imposing qualifications on clinical interpretations of this instrument. Performance-based assessment of life skills provides an important new perspective on functional outcome in schizophrenia and serious mental illness. However, psychometric properties, task difficulty and the nature of different mental health settings, populations and communities must be considered in the design and application of these instruments.

Adolescent↗
PubMed2006

Stability and validity of memory-based subtypes of schizophrenia.

This study assessed whether verbal memory performance indexed by the California Verbal Learning Test (CVLT) can organize and reduce the heterogeneity of schizophrenia. The temporal stability, cognitive and clinical validity of: (a) a putatively cortical-subcortical-normative typology derived from dementia patients' scores on the CVLT and (b) a memory performance dichotomy based on a psychometric criterion and 1 CVLT summary score were evaluated. These memory subtypes were examined in 102 schizophrenia patients, 55 of whom were assessed again 3 years later. The results indicate that both methods yield potentially valuable illness distinctions on a cross-sectional basis, but fail to show truly trait-like properties. Furthermore, the evidence favors the validity of a parsimonious dichotomy over a more complex dementia-based typology.

Adult↗
PubMed2005

The primacy of cognition in schizophrenia.

Cognitive tasks and concepts are used increasingly in schizophrenia science and treatment. Recent meta-analyses show that across a spectrum of research domains only cognitive measures distinguish a majority of schizophrenia patients from healthy people. Average effect sizes derived from common clinical tests of attention, memory, language, and reasoning are twice as large as those obtained in structural magnetic resonance imaging and positron emission tomography studies. Chronic stress, genes, brain disturbances, task structure, gender, and sociocultural background may all enhance the sensitivity of cognitive performance to schizophrenia. At the same time, disease heterogeneity and the presence of endophenotypes and subtypes within the patient population may place upper limits on the strength of any specific cognitive finding. Schizophrenia is a complex biobehavioral disorder that manifests itself primarily in cognition.

Adult↗
PubMed2005

Depression in multiple sclerosis: a quantitative review of the evidence.

The published literature on depression in multiple sclerosis (MS) is reviewed quantitatively. The authors report mean effect sizes for 20 studies comparing depression scores of MS patients with those of healthy participants (d=1.07) and 21 studies comparing depression scores of MS patients with those of patients who have other chronic conditions (d=-0.14). The confidence interval for the mean overall MS-medical comparison included 0. However, subgroups of patients with chronic fatigue and spinal-neuromuscular conditions were more and less depressed than MS patients, respectively. Results indicate that a majority of MS patients with mild to moderate disability levels are distinguishable from healthy people in terms of depressive symptoms. However, the depression-disease link is complex and not specific to this form of demyelinating illness.

Chronic Disease↗
PubMed2004

Meta-analysis and the science of schizophrenia: variant evidence or evidence of variants?

Quantification (meta-analysis) of the neuroscience evidence on schizophrenia shows very modest average differences between patient and control distributions across a great variety of measures and literatures. The strongest findings involve cognitive and psychophysiological measures. Several possible explanations for this situation are reviewed including technical immaturity, methodological variability, dimensional and multiple illness models and the nature of cognitive measurement. An argument is developed that biological subtypes and endophenotypes within the broad diagnostic category of schizophrenia underpin the meta-analytic evidence. Considerations in the use of this evidence to identify illness variants are described and four candidate subtypes are proposed. Schizophrenia is a disease that will resist biological definition until its variants are isolated and extracted from the generic patient population.

Case-Control Studies↗
PubMed2004

Verbal memory errors and symptoms in schizophrenia.

OBJECTIVE: To extend and test hypotheses linking positive and negative symptoms to selective aspects of verbal memory in schizophrenia. BACKGROUND: Verbal memory includes the ability to discriminate and prevent the intrusion of irrelevant information into recall and recognition. This ability has been proposed as a cognitive process that differentially mediates positive and negative symptoms. METHOD: Four error discrimination and 1 general recall memory index from the California Verbal Learning Test as well as general ability (IQ) and sex were used as predictors of symptom ratings in 55 schizophrenia patients within a regression framework. RESULTS: Intrusion errors during free recall contributed significantly to the prediction equation for negative symptoms (Brief Psychiatric Rating Scale). In contrast, positive symptoms and general psychopathology were not predicted by any of the discrimination indices. However, general recall memory (California Verbal Learning Test total words trials 1-5) contributed significantly to the prediction of general psychopathology and marginally to the prediction of negative symptoms. CONCLUSIONS: Impaired recall memory predicts levels of nonspecific psychopathology in schizophrenia. Negative symptoms associate with low intrusion error rates, but there is no evidence of an association between elevated errors and positive symptoms.

Adult↗
PubMed2003

Sex differences in verbal memory in schizophrenia patients treated with "typical" neuroleptics.

The relationship between sex and verbal learning and memory was investigated in 70 males and 36 females with a diagnosis of schizophrenia. Ninety-seven percent of the sample was receiving typical neuroleptic medication as treatment and had never received atypical medications. Selected scores from the California Verbal Learning Test (CVLT) [Delis, D.C., Kramer, J.H., Kaplin, E., Ober, B., 1987. The California Verbal Learning Test-Research Edition. Psychological Corporation, New York] were dependent variables in a series of hierarchical multiple regression analyses. Predictors comprised demographic, clinical and general cognitive measures. Sex was the most powerful predictor of both cumulative learning (Trial A5 recall) and the absolute number of words recalled after 20 min (Long-Delay Free Recall), accounting for 14% and 16% of score variance, respectively. Chlorpromazine-equivalent dose was negatively related to learning and recall. However, recall savings (Percent Retention) was unrelated to any predictor. This pattern of results parallels sex differences observed in the general population, albeit at a lower overall level of performance and with the suggestion of greater relative deficit in males. Schizophrenia does not eliminate and may even increase the advantage women demonstrate over men in some aspects of verbal memory.

Adult↗
PubMed2003

Quantification of frontal and temporal lobe brain-imaging findings in schizophrenia: a meta-analysis.

Magnetic resonance imaging (MRI) and positron emission tomography (PET) studies of the frontal and temporal lobes in schizophrenia patients and healthy controls have proliferated over the past 2 decades, but there have been relatively few attempts to quantify the evidence. In this meta-analytic review, 155 studies on frontal and temporal lobe neurobiology were synthesized, reflecting results from 4043 schizophrenia patients and 3977 normal controls. Cohen's d was used to quantify case-control differences, and moderator variable analysis indexed the relation of sample and imaging characteristics to the magnitude of these differences. Frontal metabolic and blood flow deficiencies in conjunction with cognitive activation tasks ("hypofrontality") emerged as the strongest body of evidence, demonstrating abnormalities that distinguish approximately half of schizophrenia patients from healthy people. Most case-control comparisons with structural and functional imaging yield small and in many cases unstable findings. Technical scanning parameters like slice thickness and magnet strength did not vary with case-control differences consistently across the meta-analyses. However, patient sample characteristics including sample size, handedness and gender composition emerged frequently as moderators of brain-imaging effect sizes.

Adult↗
PubMed2003

Historical origins of schizophrenia: two early madmen and their illness.

Schizophrenia is a serious mental illness with a remarkably short recorded history. Unlike depression and mania, which are recognizable in ancient texts, schizophrenia-like disorder appeared rather suddenly in the psychiatric literature of the early nineteenth century. This could mean that the illness is a recent disease that was largely unknown in earlier times. But perhaps schizophrenia existed, embedded and disguised within more general concepts of madness and within the arcane languages and cultures of remote times. Both possibilities present major challenges to historical and psychiatric scholarship. These challenges are explored in this paper by presenting two "new" cases of schizophrenia, one from the eighteenth and one from the fourteenth century. The cases suggest that the illness may have existed as early as the medieval period. However, establishing the population prevalence of schizophrenia in earlier times--and therefore resolving the permanence-recency debate--may not be a feasible enterprise.

Europe↗
PubMed2003

Depression and neurocognitive functioning in mild traumatic brain injury patients referred for assessment.

The relationship between depression and performance on selected neurocognitive tests was examined in two mild head injury samples (n1 = 72, n2 = 50). A series of hierarchical regression analyses showed that scores on depression-related scales of both the MCMI-II (Millon Clinical Multi-Axial Inventory; Millon, 1987) and MMPI-2 (Minnesota Multiphasic Personality Inventory; Hathaway & McKinley, 1989) were largely independent of cognitive performance. Depression may be prevalent in mild injury, but it is unlikely to mediate deficits observed on commonly used measures of problem solving, visual-motor speed, prose and figural recall.

Adult↗
PubMed2002

Schizophrenia and memory impairment: evidence for a neurocognitive subtype.

Evidence is presented that verbal memory impairment distinguishes a subgroup of patients with schizophrenia who also differ in symptom profile and illness adjustment. On the basis of the California Verbal Learning Test (CVLT), a sample of patients was partitioned into memory-impaired (n=16) and memory-unimpaired groups (n=16). Groups were matched for age, sex, IQ, and anti-psychotic medication. These groups were then compared using the Brief Psychiatric Rating Scale (BPRS) and the Sickness Impact Profile (SIP). Results indicate that memory-impaired schizophrenia patients experience significantly more positive symptoms and a poorer quality of life than their memory-unimpaired counterparts. This finding supports the idea that neurocognitive measures are a valuable way of organizing the heterogeneous disease states of schizophrenia.

Adolescent↗
PubMedDate not supplied

Demographic, clinical, and neurocognitive predictors of quality of life in schizophrenia patients receiving conventional neuroleptics.

We sought to evaluate demographic, clinical, and neurocognitive predictors of self-rated life quality and hospitalization in schizophrenia patients without the potentially cognition-enhancing influence of newer generation neuroleptic medication. A sample of 55 atypical neuroleptic-naive schizophrenia patients was assessed at index and 3 years later. Index neurocognitive measures included general intellectual ability (IQ), executive ability (Wisconsin Card Sorting Test [WCST]), verbal memory (California Verbal Learning Test [CVLT]), and manual dexterity (Purdue Pegboard). These measures, along with demographic (age, sex, education) and clinical (symptoms, prior hospitalizations) variables, were entered into regression equations to predict life quality (Sickness Impact Profile [SIP]) at follow-up, as well as rehospitalization during the 3-year period. Stability data were also analyzed. Demographic and cognitive data predicted subjective quality of life, but not rehospitalization. Changes in memory over time rather than performance levels related to life quality at follow-up. Rehospitalization was related only to demographic data and previous hospital admissions. The findings support the predictive value of selected aspects of neurocognition in relation to a subjective outcome domain in schizophrenia.

Adolescent↗