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Clinical benefits of work therapy for patients with schizophrenia
93
The Bell Object Relations Reality Testing Inventory is a selfreport instrument developed to assess object relations and reality testing deficits in schizophrenia. It is an empirically sound instrument with excellent psychometric properties and has been used for the past fourteen years to investigate the role of ego function deficits in psychosis, borderline states, eating disorders, depression, multiple personality disorders and many other disorders. It has been an outcome measure in treatment studies. This presentation will provide attendees with a description of the instrument and illustrates its application in schizophrenia research. For example, in a recent publication, object relations deficits were described in various schizophrenia subtypes. Prominent negative symptoms were associated with a pattern of higher scores on Alienation and Egocentricity subscales and lower scores on Insecure Attachment. This instrument is to be published by Western Psychology Services this year with accompanying scoring and interpretative software. Translations are available in French, Dutch, Norwegian and Hebrew. Prepublication copies of the manual and prototypical instruments and scoring materials will be available without cost to attendees.
COGNITIVE COMPONENT OF SCHIZOPHRENIA: FACTORIAL CONCURRENT VALIDITY
AND
M.D. Bell*, P.H. Lysaker, R.M. Milstein, J.L. Goulet
CLINICAL PATIENTS M.D.
Bell*,
BENEFITS OF WORK THERAPY WITH SCHIZOPHRENIA R.M.
Milstein,
FOR
P.H. Lysaker
Psychology Service 1168, V.A.M.C., West Haven, CT 06516, USA While there have long been work therapy programmes for patients with schizophrenia, the clinical efficacy of work treatment has not been examined. In this study, 100 subjects with schizophrenia or schizoaffective disorder were offered a six month work therapy programme. Subjects were evaluated at intake, six month and one year follow-up to determine the effects of work participation. Results indicate that participation in work therapy was associated with fewer days of hospitalization for the first six months (R2=.26, pc.01) and for the period between the end of the work programme and the one year follow-up (R2=.20, p<.O5). Hours worked was associated with improvement from intake to six-month follow-up on Positive and Negative Syndrome Scale (PANSS) scores for four of five factor analytically derived components: Positive (~28. p<.Ol), Negative (t=.20, pc.05). Hostility (r=.25, p<.Ol), and Emotional Discomfort (r=.31, pc.01). Hours worked was associated with improvement from intake to 1 year follow-up on two of the PANSS components: Cognitive (~24, pc.05) and Emotional Discomfort (~25, p<.O5). These results suggest work therapy in the context of ongoing care reduces symptoms and the need for intensive inpatient treatment. When work therapy stops, much of the symptom gains are lost. We conclude work therapy is an effective psychosocial treatment for patients with schizophrenia.
Psychology Service 116B, VA Medical Center, West Haven, CT 06516, USA
AFFECT PERCEPTION It has been suggested that cognitive symptoms of schizophrenia are a separate component of the disorder distinct from positive or negative syndromes. In a previous study we reported a factor analysis of Positive and Negative Syndrome Scale (PANSS) which revealed five factors, one of which we labelled the cognitive component. In the present study we attempt to test the validity of our PANSS cognitive component by examining correlations between neuropsychological measures of cognitive disturbance and the five factor analytically derived PANSS scores for 117 subjects with diagnoses of schizophrenia or schizoaffective disorder. Results indicate that higher scores on the PANSS cognitive component were significantly related to poorer performance on the Wisconsin Card Sorting Task, the Slosson Intelligence Test, and Digit Symbol Substitution Test. Higher scores on the cognitive component were also related to concrete and bizarre thinking on the Gorham Proverbs Test. Positive component scores were related only to bizarre thinking on the Proverbs test, while Negative Component scores were not related to scores from any of these tests. These results suggest the cognitive component of the PANSS is a valid measure of cognitive deficits in schizophrenia. The results also support the hypothesis that cognitive disorder is a distinctive feature of schizophrenia, independent of positive and negative syndromes.
IN SCHIZOPHRENIA
AS. Bellack*, J.J. Blanchard, K.T. Mueser, S.L. Sayers Medical College of Pennsylvania at EPPI, Department of Psychiatry, 3200 Henry Avenue, Philadelphia, PA 19129, USA The ability to accurately perceive and decode social cues, referred to as social perception, is essential for effective interactions. There is considerable evidence to suggest that schizophrenia patients may have marked impairments in this domain, particularly in regards to the perception of affect. However, the results have been inconsistent, and may reflect variations in samples and assessment methodology rather than meaningful and consistent detitits. The purpose of this study was to examine the diverse aspects of affect perception in a carefully diagnosed cohort. subjects included 35 schizophrenia patients in an acute care hospital, 10 matched patients with bipolar disorder, and 20 matched non-patient controls. Affect perception was assessed on multiple domains, including: standardized facial photographs, and a carefully standardized videotape of social interactions that was presented both with and without sound. Symptom ratings and several neuropsychological measures were also administered. In contrast to
The Bell Object Relations Reality Testing Inventory is a selfreport instrument developed to assess object relations and reality testing deficits in schizophrenia. It is an empirically sound instrument with excellent psychometric properties and has been used for the past fourteen years to investigate the role of ego function deficits in psychosis, borderline states, eating disorders, depression, multiple personality disorders and many other disorders. It has been an outcome measure in treatment studies. This presentation will provide attendees with a description of the instrument and illustrates its application in schizophrenia research. For example, in a recent publication, object relations deficits were described in various schizophrenia subtypes. Prominent negative symptoms were associated with a pattern of higher scores on Alienation and Egocentricity subscales and lower scores on Insecure Attachment. This instrument is to be published by Western Psychology Services this year with accompanying scoring and interpretative software. Translations are available in French, Dutch, Norwegian and Hebrew. Prepublication copies of the manual and prototypical instruments and scoring materials will be available without cost to attendees.
COGNITIVE COMPONENT OF SCHIZOPHRENIA: FACTORIAL CONCURRENT VALIDITY
AND
M.D. Bell*, P.H. Lysaker, R.M. Milstein, J.L. Goulet
CLINICAL PATIENTS M.D.
Bell*,
BENEFITS OF WORK THERAPY WITH SCHIZOPHRENIA R.M.
Milstein,
FOR
P.H. Lysaker
Psychology Service 1168, V.A.M.C., West Haven, CT 06516, USA While there have long been work therapy programmes for patients with schizophrenia, the clinical efficacy of work treatment has not been examined. In this study, 100 subjects with schizophrenia or schizoaffective disorder were offered a six month work therapy programme. Subjects were evaluated at intake, six month and one year follow-up to determine the effects of work participation. Results indicate that participation in work therapy was associated with fewer days of hospitalization for the first six months (R2=.26, pc.01) and for the period between the end of the work programme and the one year follow-up (R2=.20, p<.O5). Hours worked was associated with improvement from intake to six-month follow-up on Positive and Negative Syndrome Scale (PANSS) scores for four of five factor analytically derived components: Positive (~28. p<.Ol), Negative (t=.20, pc.05). Hostility (r=.25, p<.Ol), and Emotional Discomfort (r=.31, pc.01). Hours worked was associated with improvement from intake to 1 year follow-up on two of the PANSS components: Cognitive (~24, pc.05) and Emotional Discomfort (~25, p<.O5). These results suggest work therapy in the context of ongoing care reduces symptoms and the need for intensive inpatient treatment. When work therapy stops, much of the symptom gains are lost. We conclude work therapy is an effective psychosocial treatment for patients with schizophrenia.
Psychology Service 116B, VA Medical Center, West Haven, CT 06516, USA
AFFECT PERCEPTION It has been suggested that cognitive symptoms of schizophrenia are a separate component of the disorder distinct from positive or negative syndromes. In a previous study we reported a factor analysis of Positive and Negative Syndrome Scale (PANSS) which revealed five factors, one of which we labelled the cognitive component. In the present study we attempt to test the validity of our PANSS cognitive component by examining correlations between neuropsychological measures of cognitive disturbance and the five factor analytically derived PANSS scores for 117 subjects with diagnoses of schizophrenia or schizoaffective disorder. Results indicate that higher scores on the PANSS cognitive component were significantly related to poorer performance on the Wisconsin Card Sorting Task, the Slosson Intelligence Test, and Digit Symbol Substitution Test. Higher scores on the cognitive component were also related to concrete and bizarre thinking on the Gorham Proverbs Test. Positive component scores were related only to bizarre thinking on the Proverbs test, while Negative Component scores were not related to scores from any of these tests. These results suggest the cognitive component of the PANSS is a valid measure of cognitive deficits in schizophrenia. The results also support the hypothesis that cognitive disorder is a distinctive feature of schizophrenia, independent of positive and negative syndromes.
IN SCHIZOPHRENIA
AS. Bellack*, J.J. Blanchard, K.T. Mueser, S.L. Sayers Medical College of Pennsylvania at EPPI, Department of Psychiatry, 3200 Henry Avenue, Philadelphia, PA 19129, USA The ability to accurately perceive and decode social cues, referred to as social perception, is essential for effective interactions. There is considerable evidence to suggest that schizophrenia patients may have marked impairments in this domain, particularly in regards to the perception of affect. However, the results have been inconsistent, and may reflect variations in samples and assessment methodology rather than meaningful and consistent detitits. The purpose of this study was to examine the diverse aspects of affect perception in a carefully diagnosed cohort. subjects included 35 schizophrenia patients in an acute care hospital, 10 matched patients with bipolar disorder, and 20 matched non-patient controls. Affect perception was assessed on multiple domains, including: standardized facial photographs, and a carefully standardized videotape of social interactions that was presented both with and without sound. Symptom ratings and several neuropsychological measures were also administered. In contrast to