Illness awareness in outpatients with schizophrenia

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(Active, Withdrawn and Unreality) which may parallel threesyndrome models of schizophrenia (Gruzelier et al, 1995; Gruzelier, 1995). Here we examined relations between normal schizotypy (N= 160) and extremes of maturation. Relations were almost exclusively syndromal. Unreality was associated with both extremes, moreso with early maturation (p < 0.02), and particularly true for unusual perceptions (p<0.008). Cognitive aspects of Unreality (odd beliefs) were associated with both extremes in males (p<0.07), and early maturation in females (p<0.02). Early maturing females were also Withdrawn (p<0.002), with features of social withdrawal (p<0.01), anhedonia (p<0.001) and low arousal (p<0.07). In contrast, Withdrawn males were late maturers (p<0.01), with features of social withdrawal (p < 0.07) and social anxiety (p<0.005). In females it was the Active syndrome that was associated with late maturation (p<0.002): odd speech (p < 0.05), impulsivity (p < 0.06), and activity (p < 0.05). The results have relevance for both neurophysiological and social theories of personality, sex differences and psychopathology.

IV.F. Other IV.F.1 NON-VERBAL BEHAVIOUR PATTERNS OF SCHIZOPHRENIC PATIENTS: ANALYSIS, EMPIRICAL FINDINGS, AND PERSPECTIVES FOR THERAPEUTIC INTERVENTIONS A. Altorfer a n d S. Jossen

University of Bern, Department of Theoretical and Evaluative Psychiatry, Bolligenstrasse 111, CH-3072 Bern/ Ostermundigen, Switzerland Behavioural variables are regarded as important indicators of mental illness. Usually there relevance is included implicitly into the diagnostic process in using more or less defined behavioural categories. Especially in schizophrenic symptomatology, the popular distinction between 'negative' and 'positive' symptoms refers to behavioural characteristics that constitute some deficit or added elements relative to normal performance. From a social interactional viewpoint, fiat affect and social withdrawal (as 'negative' symptoms) are labels which are built up by rating behavioural aspects with little knowledge about their quantitative appearance in behavioural patterns. The present study introduces a quantitative analysis of head movements recorded automatically during a social interaction task (conversation) by using ultrasonic and infrared devices. Based on these objective data, movement patterns are extracted and related to the on-going verbal interaction. A comparison between schizophrenic patients (investigated just before discharge and during remission) and normal controls reveals remarkable differences in patterns of head movements and their location during social interaction: compared to controls, schizophrenic patients show a small range of head movement patterns rigidly placed especially during turn taking. Based on the

predominance of these physical patterns, other more complex and possibly more interactive head movements are hidden and seem to be overlooked by partners. The first findings of this project are interpreted in accordance with a functional approach of behavioural symptoms (reflecting underlying biological deficits) by pointing to interactionally maladaptive behaviours which may be relevant for therapeutic interventions.

IV.F.2 ILLNESS AWARENESS IN OUTPATIENTS WITH SCHIZOPHRENIA F.B. Dickerson, J.J. Boronow, N, Ringel a n d F. Parente

Sheppard Pratt Health System, 6501 N. Charles St., Baltimore, MD 21204, U.S.A. Illness awareness (IA) is important in schizophrenia because many patients have difficulty identifying their illness symptoms and cooperating with treatment. We examined a sample of 87 outpatients with schizophrenia in community programs. We measured IA by a combination of 1) Patients' score on the PANSS item Lack of Judgment and Insight and 2) Patients' responses to a short questionnaire about illness awareness. Patients were also administered neuropsychological tests including WCS, WAIS-R, TMT, and completed the Social Functioning Scale (SFS) and the GAS. Pearson correlations were performed between IA and demographic, PANSS, social functioning, and neuropsychological variables. Significant variables were entered into a simultaneous multiple regression equation on IA. Chi-square analysis was used to compare IA with residential placement. We found that IA was predicted by the PANSS items Anxiety, Stereotyped Thinking, and Difficulty in Abstract Thinking, and the SFS Social Activities Scale (p < .01 ). These variables yielded a multiple R square of .419. We found a significant and inverse correlation (p < .05) between IA and degree of residential supervision. Our results indicate that IA is predicted by anxiety and social activation and the relative absence of concrete thinking and impoverished speech. Assessments of IA may improve residential outcomes by increasing the number of appropriate placements.

IV.F.3 DIAGNOSTIC CONCORDANCE SCHIZOPHRENIA ACCORDING AND ICD CRITERIA

FOR TO DSM

M. F l a u m M.D. a n d the D S M - I V Psychotic Disorders Field Trial C o n s o r t i u m

Mental Health Clinical Research Center, University of Iowa College of Medicine, Department of Psychiatry # 2887 J. P. P., 200 Hawkins Drive, Iowa City, Iowa, U.S.A. The two major diagnostic systems used in psychiatry throughout the world, the International Classification of Disease