Biomedical subjects

Warren B Bilker

Publications and source records attributed to Warren B Bilker.

At least 55 records · Page 3Linked to original sources

PubMed2004

Emergence of resistance to chloramphenicol among vancomycin-resistant enterococcal (VRE) bloodstream isolates.

Therapeutic options for vancomycin-resistant enterococcal (VRE) bloodstream infections are extremely limited. Chloramphenicol is effective when VRE isolates are susceptible to this agent. However, longitudinal trends in chloramphenicol-resistant VRE (CR-VRE) are unknown. The possible association between CR-VRE and antibiotic use has not been studied. We analyzed the antimicrobial susceptibility profiles of all VRE blood isolates from 1991-2000 at our institution. We performed a correlational study to examine the relationship between annual hospital-wide use of specific antibiotics and antibiotic classes and CR-VRE prevalence. During the 10-year study period, the prevalence of CR-VRE increased from 0 to 11% ( P< 0.001, trend). CR-VRE prevalence was correlated only with chloramphenicol use (P=0.05 ) and quinolone use (P= 0.01 ). If these trends continue, dependence on newer, more expensive agents will increase. The correlation between both chloramphenicol use and quinolone use and the prevalence of CR-VRE suggests that efforts to preserve the utility of chloramphenicol in VRE infections may depend on optimizing the use of these agents.

Anti-Bacterial Agents↗

PubMed2004

Represcription of penicillin after allergic-like events.

OBJECTIVE: We sought to determine the frequency of represcription of penicillin to individuals with penicillin allergy and the risk of a second reaction in those who had a previous reaction. METHODS: A retrospective cohort study was conducted within the UK General Practice Research Database. All patients who had received a prescription for penicillin were identified. Within that source population, records of patients who had received at least 2 prescriptions for penicillin at least 60 days apart were selected and examined for allergic-like (hypersensitivity) events on the day of or within 30 days after a prescription. RESULTS: At least one prescription for penicillin was given to 3,375,162 patients. Of 6212 (0.18%) patients who experienced an allergic-like event after the initial prescription, 48.5% were given a second prescription compared with 59.8% of those without an initial allergic-like event (risk ratio, 0.81; 95% CI, 0.79-0.83). Two or more prescriptions for penicillin were given to 2,017,957 patients. Three thousand fourteen (0.15%) patients experienced an allergic-like event after the first prescription, and 57 (1.89%) of those had another event after the second prescription. The unadjusted odds ratio of an allergic-like event after the second prescription for those who experienced an allergic-like event after the first prescription, compared with those who had no initial event was 11.2 (95% CI, 8.6-14.6). Adjusting for confounding had no substantive effect on this result. CONCLUSION: The risk of an allergic-like event after penicillin is markedly increased in those who have had a prior event, although the absolute difference is small (1.72%). Represcription of penicillin to such patients is more frequent than anticipated.

Adolescent↗

PubMed2004

Effects of chronic olanzapine and haloperidol differ on the mouse N1 auditory evoked potential.

Auditory evoked potentials have been used in a variety of animal models to assess information-processing impairments in schizophrenia. Previous mouse models have primarily employed a paired click paradigm to assess the transient measures of auditory gating. The current study uses stimulus trains at varied interstimulus intervals (ISI) between 0.25 and 8 s in mice to assess the effects of chronic olanzapine and haloperidol on auditory processing. Data indicate that olanzapine increases the amplitude of the N40, P80, and P20/N40 components of the auditory evoked potential, whereas haloperidol had no such effect. The ISI paradigm also allowed for an evaluation of several components of the mouse evoked potential to assess those that display response properties similar to the human P50 and N100. Data suggest that the mouse N40 displays an ISI response relationship that shares characteristics with the human N100, whereas the P20 appears more consistent with the human P50 across the ISI range evaluated in this task. This study suggests that olanzapine may help improve N100 impairments seen in schizophrenia, while haloperidol does not.

Acoustic Stimulation↗

PubMed2004

Patient attitudes towards surgically implantable, long-term delivery of psychiatric medicine.

The introduction of surgically implantable medication delivery systems provides psychiatric patients with reversible, uninterrupted access to medication for up to 14 months. This study designed and administered a survey to assess patients' attitudes and beliefs towards illness, medication, and this potential new treatment method. The survey included questions about demographics, insight and attitudes towards illness, current and past medication adherence, attitudes towards psychiatric and nonpsychiatric medications, and understanding and attitudes towards surgical implants. The sample of 206 psychiatric patients was almost equally split between favorably and unfavorably considering implants. Patients favorable towards implants ascribed forgetting and failure to refill medication on time as the reasons for missing doses, recognized the benefits of medication in general, and understood that the implant would be inserted under the skin. Favorable consideration of implants was positively correlated with the desire to avoid adverse consequences of missing medicine, stay well, avoid the need for daily oral medications, and decrease family burden. Unfavorable consideration of implants was related to a preference to take medication orally, concern about feeling controlled, unwillingness to try something new, and not understanding that the implant would be placed under the skin. Demographic variables, past/current medications, specific diagnosis, and illness severity did not influence the decision. This survey elucidates patients' attitudes and beliefs towards illness, medication, and surgical implants. The results indicate that a significant proportion of patients recognize the difficulties of medication adherence and the need for better methods to attain therapeutic response. Thus, the study provides impetus for future work in this area.

Adult↗

PubMed2004

Seasonal variation in flares of inflammatory bowel disease.

BACKGROUND & AIMS: Previous research has yielded conflicting data as to whether the natural history of inflammatory bowel disease follows a seasonal pattern. The purpose of this study was to determine whether relapse of inflammatory bowel disease follows a seasonal pattern either across a cohort of patients or within individual patients. METHODS: We used 1988 to 1997 data from the General Practice Research Database to conduct a retrospective cohort study of 1587 patients with Crohn's disease (mean age at start of follow-up, 41 +/- 17 years) and 2773 patients with ulcerative colitis (mean age at start of follow-up, 48 +/- 16 years). Flares of disease were identified by receipt of a new prescription for either corticosteroids or 5-ASA medications following an interval of at least 4 months without prescriptions for either class of medication. Logistic regression was used to adjust the association of season of the year and flare of disease for potential confounding variables. RESULTS: There was no association between season of the year and flare of Crohn's disease (P = 0.66). Season of the year was only weakly associated with flares of ulcerative colitis (P = 0.02). Compared with winter, spring had very slightly higher rates of flares (OR = 1.13, 95% CI: 1.05-1.23). We did not observe seasonal patterns within individual patients experiencing multiple flares (P > 0.05 for Crohn's disease and ulcerative colitis). CONCLUSIONS: Although we observed a slight increase in exacerbations of ulcerative colitis in the spring, in general, these data do not support an association between season of the year and flares.

Adrenal Cortex Hormones↗

PubMed2004

Risk factors for disseminated candidiasis in children with candidemia.

OBJECTIVE: To determine the risk factors for disseminated infection in hospitalized children with candidemia. METHODS: We performed a nested case-control study within a cohort of hospitalized children with candidemia. The cohort was defined by all patients with positive blood cultures for Candida species in a large, urban, academic, tertiary care children's hospital from 1998 to 2001. Cases were patients with clinical, microbiologic or radiographic evidence of disseminated candidiasis. Controls were patients with no evidence of disseminated candidiasis. RESULTS: Among 168 total children with candidemia, the median age was 3.5 years (interquartile range, 0.6-14.3). There were 189 episodes of candidemia. Candida species included:Candida albicans (41%), Candida parapsilosis (24%), Candida glabrata (13%) and Candida tropicalis (9%). The most common underlying diagnoses were oncologic (24%), gastrointestinal (15%) and cardiac (10%) diseases. Eighty-nine patients (53%) were admitted to an intensive care unit, 46 (27%) to a general pediatric or surgical ward and 33 (20%) to the oncology ward. Of the 168 patients with candidemia, 153 were included in the analysis of risk factors for disseminated candidiasis. Of 153 (17%) patients, 26 had evidence of organ dissemination. Organ involvement was most commonly identified in the lung (58%), followed by the liver (23%), kidney (16%), brain (12%), spleen (8%), eye (8%) and heart (8%). Eight of the 26 patients had evidence of dissemination to more than 1 organ. Independent risk factors for disseminated candidiasis were persistently positive blood cultures for Candida (>3 days) with a central venous catheter in place (odds ratio, 3.0; 95% confidence interval, 1.2, 7.8; P = 0.02) and immunosuppression (odds ratio, 2.9; 95% confidence interval, 1.2, 7.0; P = 0.02). CONCLUSIONS: Prolonged duration of candidemia with a central venous catheter in place and immunosuppression were independent risk factors for disseminated candidiasis in children with candidemia. Furthermore review of the epidemiology of candidemia at our institution revealed a heterogeneous population of children at risk for candidemia and a predominance of non-albicans species as the cause of these infections. Future studies are needed to determine the extent of evaluation needed for detecting dissemination among children with candidemia and to explore interventions for its prevention.

Adolescent↗

PubMed2004

Comparative cardiac safety of low-dose thioridazine and low-dose haloperidol.

AIM: To compare the rate of ventricular arrhythmia, sudden death and unexplained or unattended death among users of thioridazine and haloperidol. METHODS: Observational cohort study of thioridazine and haloperidol users in the UK General Practice Research Database (GPRD) using data from 1987 through 29 June 2000. Patients were followed for 30 days following each study prescription. The event of interest was a diagnosis of ventricular arrhythmia, sudden death, or unexplained or unattended death. Cox regression was used to calculate rate ratios (RRs) and 95% confidence intervals (CIs), to examine potential confounding factors, and to examine dose-response relationships. RESULTS: Use of thioridazine and haloperidol in the GPRD was primarily in older patients, at low dose (median daily dose 31 mg thioridazine, 1.8 mg haloperidol). There was no association between thioridazine use and the rate of ventricular arrhythmia, sudden death, and unexplained or unattended death (adjusted RR 0.9, 95% CI 0.7, 1.1). The rate did not appear to increase with dose for either drug over the range observed. CONCLUSIONS: These results suggest that low-dose thioridazine and haloperidol have similar cardiac safety.

Adolescent↗

PubMed2003

Levels-of-processing effect on word recognition in schizophrenia.

BACKGROUND: Individuals with schizophrenia have difficulty organizing words semantically to facilitate encoding. This is commonly attributed to organizational rather than semantic processing limitations. By requiring participants to classify and encode words on either a shallow (e.g., uppercase/lowercase) or deep level (e.g., concrete/abstract), the levels-of-processing paradigm eliminates the need to generate organizational strategies. METHODS: This paradigm was administered to 30 patients with schizophrenia and 30 healthy comparison subjects to test whether providing a strategy would improve patient performance. RESULTS: Word classification during shallow and deep encoding was slower and less accurate in patients. Patients also responded slowly during recognition testing and maintained a more conservative response bias following deep encoding; however, both groups showed a robust levels-of-processing effect on recognition accuracy, with unimpaired patient performance following both shallow and deep encoding. CONCLUSIONS: This normal levels-of-processing effect in the patient sample suggests that semantic processing is sufficiently intact for patients to benefit from organizational cues. Memory remediation efforts may therefore be most successful if they focus on teaching patients to form organizational strategies during initial encoding.

Adult↗

PubMed2003

Inhibition of auditory evoked potentials and prepulse inhibition of startle in DBA/2J and DBA/2Hsd inbred mouse substrains.

Previous data have shown differences among inbred mouse strains in sensory gating of auditory evoked potentials, prepulse inhibition (PPI) of startle, and startle amplitude. These measures of sensory and sensorimotor gating have both been proposed as models for genetic determinants of sensory processing abnormalities in patients with schizophrenia and their first-degree relatives. Data from our laboratory suggest that auditory evoked potentials of DBA/2J mice differ from those previously described for DBA/2Hsd. Therefore, we compared evoked potentials and PPI in these two closely related substrains based on the hypothesis that any observed endophenotypic differences are more likely to distinguish relevant from incidental genetic heterogeneity than similar approaches using inbred strains that vary across the entire genome. We found that DBA/2Hsd substrain exhibited reduced inhibition of evoked potentials and reduced startle relative to the DBA/2J substrain without alterations in auditory sensitivity, amplitude of evoked potentials or PPI of startle. These results suggest that gating of auditory evoked potentials and PPI of startle measure different aspects of neuronal function. The differences between the substrains might reflect genetic drift. Alternatively, differences could arise from different rearing environments or other non-genetic factors. Future studies will attempt to determine the cause of these differences in sensory and sensorimotor processing between these two closely related inbred mouse strains.

Acoustic Stimulation↗

PubMed2003

Absence of cross-reactivity between sulfonamide antibiotics and sulfonamide nonantibiotics.

BACKGROUND: The safety of sulfonamide nonantibiotics is unclear in patients with prior allergic reactions to sulfonamide antibiotics. METHODS: We conducted a retrospective cohort study using the General Practice Research Database in the United Kingdom, examining the risk of allergic reactions within 30 days after the receipt of a sulfonamide nonantibiotic. Patients with evidence of prior hypersensitivity after the receipt of a sulfonamide antibiotic were compared with those without such evidence. Similar analyses were also performed with the use of penicillins instead of sulfonamides, to determine whether any risk was specific to sulfonamide cross-reactivity. RESULTS: Of 969 patients with an allergic reaction after a sulfonamide antibiotic, 96 (9.9 percent) had an allergic reaction after subsequently receiving a sulfonamide nonantibiotic. Of 19,257 who had no allergic reaction after a sulfonamide antibiotic, 315 (1.6 percent) had an allergic reaction after receiving a sulfonamide nonantibiotic (adjusted odds ratio, 2.8; 95 percent confidence interval, 2.1 to 3.7). However, the risk of allergic reactions was even greater after the receipt of a penicillin among patients with a prior hypersensitivity reaction to a sulfonamide antibiotic, as compared with patients with no such history (adjusted odds ratio, 3.9; 95 percent confidence interval, 3.5 to 4.3). Furthermore, among those with a prior hypersensitivity reaction after the receipt of a sulfonamide antibiotic, the risk of an allergic reaction after the subsequent receipt of a sulfonamide nonantibiotic was lower than the risk of an allergic reaction after the subsequent receipt of a penicillin (adjusted odds ratio, 0.7; 95 percent confidence interval, 0.5 to 0.9). Finally, the risk of an allergic reaction after the receipt of a sulfonamide nonantibiotic was lower among patients with a history of hypersensitivity to sulfonamide antibiotics than among patients with a history of hypersensitivity to penicillins (adjusted odds ratio, 0.6; 95 percent confidence interval, 0.5 to 0.8). CONCLUSIONS: There is an association between hypersensitivity after the receipt of sulfonamide antibiotics and a subsequent allergic reaction after the receipt of a sulfonamide nonantibiotic, but this association appears to be due to a predisposition to allergic reactions rather than to cross-reactivity with sulfonamide-based drugs.

Anti-Bacterial Agents↗

PubMed2003

Retrospective drug utilization review, prescribing errors, and clinical outcomes.

CONTEXT: Retrospective drug utilization review is required of all state Medicaid programs and is performed by most private-sector prescription programs. However, it has not been shown to improve clinical outcomes or reduce the rate of potential prescribing errors, known as "exceptions." OBJECTIVE: To look for an effect of retrospective drug utilization review on the rate of exceptions and of clinical outcomes in patients with an exception. DESIGN, SETTING, AND PARTICIPANTS: Longitudinal ecologic study of the rate of exceptions, controlling for preintervention trends and calendar time; and a cohort study of all-cause and cause-specific hospitalizations in patients with an exception, controlling for potential individual-level confounders in 6 Medicaid programs using the same software in the mid-1990s. MAIN OUTCOME MEASURES: The rate of exceptions was examined as a function of retrospective drug utilization review implementation. In addition, before-after comparisons were made of the incidence of all-cause and cause-specific hospitalization in patients with exceptions. RESULTS: We found no reduction in the rate of exceptions coincident with retrospective drug utilization review implementation (rate increase, 0.064 exceptions per 1000 prescriptions per month; 95% confidence interval [CI], -0.006 to 0.133). We also found no effect of retrospective drug utilization review on the incidence of all-cause hospitalization (odds ratio, 0.99; 95% CI, 0.98-1.00) or cause-specific hospitalization. These results persisted in multiple subgroup analyses. Study states intervened using physician alerts in between 1% and 25% of exceptions. CONCLUSIONS: We were unable to identify an effect of retrospective drug utilization review on the rate of exceptions or on clinical outcomes. Given the lack of evidence for effectiveness, and suggestions from previous research of possible harm, policymakers should consider withdrawing the legislative mandate for retrospective drug utilization review.

Drug Utilization Review↗

PubMed2003

Detection of proximal adenomatous polyps with screening sigmoidoscopy: a systematic review and meta-analysis of screening colonoscopy.

BACKGROUND: The relative effectiveness of flexible sigmoidoscopy compared with colonoscopy to screen for colorectal cancer depends on the magnitude of the association between findings in the proximal and distal colon and the false-negative rate of screening sigmoidoscopy for proximal neoplasia. To address this, we performed a systematic review and meta-analysis of screening colonoscopy studies. METHODS: Published studies through July 31, 2000, of asymptomatic patients undergoing screening colonoscopy were identified from the MEDLINE database. We generated pooled estimates of the odds ratio for the association between findings in the distal and proximal colon and the prevalence of isolated proximal adenomatous neoplasia. RESULTS: Using the sigmoid-descending colon junction to identify the beginning of the distal colon, the pooled odds ratio for the association between distal adenomatous polyps and any proximal neoplasia was 2.40 (95% confidence interval [CI], 1.42-4.05). Diminutive distal adenomatous polyps were also associated with proximal neoplasia (odds ratio, 2.36; 95% CI, 1.30-4.29). Distal hyperplastic polyps were not associated with proximal neoplasia (odds ratio, 1.44; 95% CI, 0.79-2.62). The prevalence of isolated advanced proximal neoplasia in the 3 studies was 2%, 3%, and 5%. Using the sigmoid-descending colon junction to identify the beginning of the distal colon yields a pooled estimate of isolated proximal neoplasia of 16.3% (95% CI, 13.6%-19.1%). CONCLUSIONS: Distal adenomatous polyps, including diminutive distal adenomatous polyps, are associated with an increased prevalence of synchronous proximal neoplasia. Two percent to 5% of patients undergoing screening colonoscopy may have isolated advanced proximal neoplasia. Even more patients may have isolated nonadvanced proximal neoplasia.

Adenomatous Polyps↗

PubMed2003

Changes in the prevalence of vancomycin-resistant enterococci in response to antimicrobial formulary interventions: impact of progressive restrictions on use of vancomycin and third-generation cephalosporins.

This study sought to assess the impact of restricting use of vancomycin and third-generation cephalosporins on vancomycin-resistant enterococci (VRE) prevalence. All clinical enterococcal isolates identified at a large academic medical center during a 10-year period were analyzed. Changes in VRE prevalence after sequential restrictions on use of vancomycin and third-generation cephalosporins were evaluated. The correlation between antibiotic use and VRE prevalence was also investigated. Vancomycin use initially decreased by 23.9% but returned to preintervention levels by the end of the study. Third-generation cephalosporin use decreased by 85.8%. However, VRE prevalence increased steadily from 17.4% to 29.6% during the 10-year period (P<.001). Clindamycin use was significantly correlated with VRE prevalence. Restricting the use of vancomycin and third-generations cephalosporins had little impact on VRE prevalence. The association between clindamycin use and the prevalence of VRE suggests that restriction of this and perhaps other antianaerobic agents might be an important component of future antimicrobial interventions.

Cephalosporins↗

PubMed2003

Descriptive analyses of the integrity of a US Medicaid claims database.

PURPOSE: To examine the integrity of six Medicaid databases for use in pharmacoepidemiology research. METHODS: We performed descriptive analyses to examine four categories of potential data errors: incomplete claims for certain time periods; absence of an accurate indicator of inpatient hospitalizations; missing hospitalizations for those aged 65 years and over; and diagnostic codes in demographic groups in which those conditions should be rare. RESULTS: Prescription claims appeared to be missing intermittently in some states. No valid marker of inpatient hospitalizations could be found for three of six states. Hospitalizations appeared to be missing to varying degrees for those aged 65 years and over. Gross errors in diagnostic codes and demographic data did not appear to be widespread. CONCLUSIONS: Whenever possible, investigators using administrative data should perform macro-level descriptive analyses on the parent data set. In particular, researchers should examine the number of medical and pharmacy claims over time, looking for gaps. Validity of markers of hospitalization should be assessed. The accuracy of diagnosis and demographic data should be examined. Such a descriptive macro-level approach should be used to supplement, and perhaps precede validation of study outcomes using clinical records.

Aged↗

PubMed2003

Neuropsychological deficits among patients with late-onset minor and major depression.

Cognitive ability of minor depressed patients (N=28), major depressed patients (N=26) and healthy elderly (N=38) was examined cross-sectionally to determine if cognitive abilities of patients with late-onset depression decrease with increasing severity of disease and if cognitive scores for minor depressed patients fall between those of healthy elderly and major depressed patients. A pooled within-group principal component analysis of cognitive test scores identified five components, three of which showed significant group differences. Verbal Recall and Maintenance of Set separated controls from major depressed patients and minor from major depressed patients. Executive Functioning separated controls from minor depressed patients, and Working Memory was borderline for separating controls from major depressed patients. The component representing Nonverbal Recognition was not statistically significant. Partial correlations controlling for age and education indicate that cognitive performance does decrease as severity of depression increases, and the magnitude of the change varies from a trend to a significant deficit depending on the cognitive domain. This decline in cognitive performance parallels a similar trend observed in neuroanatomical studies in which the volume of the frontal and temporal lobes decrease with increasing severity of depression.

Age of Onset↗

PubMed2003

Neurocognitive performance and clinical changes in olanzapine-treated patients with schizophrenia.

Diffuse cognitive impairment characterizes patients with schizophrenia throughout the course of illness. The deficits persist despite clinical improvement associated with neuroleptic intervention and are related to outcome. It is unclear whether treatment with atypical agents is associated with improved cognition that relates to symptoms and outcome. Using a set of computerized neurocognitive measures, we evaluated whether the effects of olanzapine are greater than practice effects for specific neurocognitive domains that could provide targets for large-scale randomized studies. We enrolled 19 patients with schizophrenia before initiation of treatment with olanzapine and 16 of them were examined at 6 weeks and 6 months of follow-up. They were compared to 34 healthy participants who enrolled, 24 of whom were evaluated longitudinally. Improvement exceeding practice effects was observed in patients for abstraction and spatial memory and the latter correlated with clinical improvement in negative symptoms. These results suggest that some effects of olanzapine may impact both symptoms and cognitive performance.

Adolescent↗

PubMed2003

Distribution of microtubule-associated protein MAP2-immunoreactive interstitial neurons in the parahippocampal white matter in subjects with schizophrenia.

OBJECTIVE: Evidence suggests that schizophrenia is a neurodevelopmental disorder that may involve abnormal connectivity between various cortical and subcortical brain areas. The parahippocampal gyrus is an area important for higher cognition in which a variety of cytoarchitectural, neuronal morphometric, and innervation abnormalities in schizophrenia have been reported. Previous studies have reported abnormal distributions of interstitial white matter neurons in prefrontal, parietal, and temporal neocortices, which suggests that schizophrenia may be related to prenatal disturbances in the cortical subplate, a transitory structure involved in the formation of connections in the developing cortex from which the interstitial white matter neurons derive. Abnormalities in the distribution of interstitial white matter neurons in the parahippocampal gyrus in schizophrenia may indicate an alteration in the migration of subplate neurons or in the pattern of programmed cell death that could lead to defective cortical circuitry and impaired cognition. METHOD: The authors used a monoclonal antibody against the microtubule-associated protein MAP2 to label interstitial white matter neurons in the anterior region of the parahippocampal gyrus from 41 individuals with schizophrenia and 15 comparison subjects. The distribution of MAP2-labeled neurons in relation to the gray matter/white matter boundary was determined by computer-assisted microscopy. RESULTS: The number of interstitial white matter neurons decreased with increasing white matter depth in both groups, but significantly more slowly in the schizophrenia group, with interstitial white matter neurons located deeper in white matter in schizophrenia subjects. CONCLUSIONS: These findings indicate there is an abnormality in the residua of the cortical subplate in the anterior region of the adult parahippocampal gyrus in schizophrenia subjects.

Adult↗

PubMed2003

Facial emotion recognition in schizophrenia: intensity effects and error pattern.

OBJECTIVE: The authors used color photographs of emotional and neutral expressions to investigate recognition patterns of five universal emotions in schizophrenia. METHOD: Twenty-eight stable outpatients with schizophrenia (19 men and nine women) and 61 healthy subjects (29 men and 32 women) completed an emotion discrimination test that presented mild and extreme intensities of happy, sad, angry, fearful, disgusted, and neutral faces, balanced for gender and ethnicity. Analyses evaluated accuracy of identifying emotions as a function of intensity, diagnosis, and gender of poser and rater. RESULTS: Patients performed worse than comparison subjects on recognition of all emotions and neutral faces combined, including mild and extreme expressions. For specific emotions, patients performed worse on recognition of fearful, disgusted, and neutral expressions. For all emotions except disgust, recognition of extreme intensity was better than recognition of mild intensity. However, patients showed less benefit from increased intensity for all emotions combined, and the difference was most pronounced for fear. Thus, patients were more impaired than healthy comparison subjects in identifying high-intensity expressions, even though this was an easier task than identifying low-intensity expressions. In the comparison of patterns of errors, patients and healthy subjects differed only in misattributions of neutral expressions; patients overattributed disgusted expressions and underattributed happy expressions. CONCLUSIONS: Patients with schizophrenia were impaired in overall emotion recognition, particularly fear and disgust, and did not benefit from increased emotional intensity. Error patterns indicate that patients misidentified neutral cues as negatively valenced.

Adult↗