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The ability of schizophrenics to perceive and cope with negative affect
299 Schizophrenia Research, 4 (1991) 299 - 310
0 1991 Elsevier Science Publishers B.V. 0920-9964/91/$03.50
PSYCHOSOCIAL
ISSUES
Discriminating characteristics between schizophrenic and “schizoaffective” patients L. Beasley, J.J. Boronow*,
N. Ringel, F. Parente
The Sheppard and Enoch Pratt Hospital, 6501 N. Charles Street, Towson, MD 21204, USA.
Kraepelin identified a significant group of patients with a mixture of schizophrenic and affective symptoms. However, there exists continuing uncertainty as to what extent schizoaffective disorder represents a unique diagnostic group. We compared cross-sectional and longitudinal features on chronic inpatients meeting RDC criteria for either schizophrenia (S, n = 35) or schizoaffective disorder, mainly schizophrenic (SA, n = 33). 85% of the SA patients were bipolar, and the remaining unipolar depressed SA patients had recurrent major depressive episodes. Patients with a coexisting neurological or chemical dependency diagnosis were excluded. Weekly BPRS ratings, a 24 hourly time-sampling of social behavior, and a standardized historical database were used to assess the subjects. A representative week was chosen for each patient towards the end of their hospitalization (mean length of stay = 5.7 months) to reflect optimal functioning in the patients after treatment. All subjects were judged to have benefitted maximally from treatment, and patients discharged prematurely due to insurance or other limitations were excluded from the sample. Interventions covered a wide spectrum of neuroleptics and thymoleptics, as well as ECI. Both groups were typical of the “young adult chronic patient,” with mean age of 33, onset at age 20,8 prior hospitalizations, and a male to female ratio of 1.7:1. Their mean total BPRS score was 43.9, and mean CPZE was 1,081 mg (S vs Sa, NS for all comparisons). SA patients showed less of the time-sampled behavior of autistic withdrawal (p = .035) and more social interaction (p= .016). They also scored higher on BPRS measures of anxiety (p= .034) and excitement (p = .032), and lower on blunted affect (p = .OOl) and the Withdrawal/Retardation Factor (p = 0.45). SApatients were also more likely to have made a suicide attempt (p = .016), to have had chumships as children, to have less autistic sexuality (p=.O24), and to have never worked (p=.OO8). An attempt to use these distinguishing characteristics as a discriminant function and demonstrate a “point of rarity” or a “linear discontinuity” in the method of Kendell and Brockington failed. We conclude that although there are significant differences in SApatients which pertain to the affective/social dimension, their overall clinical course and degree of impairment is quite similar to chronic schizophrenia, even when treated with thymoleptics.
The ability of schizophrenics to perceive and cope with negative affect A.S. Bellack*, K.T. Mueser, J. Wade, S. Sayers, R.L. Morrison HentyAvenue, Philadelphia, PA 19129, USA
Medical College of Pennsylvania at EPPI, Dept. of Psychiatq 3200
It is clear that high Expressed Emotion can have a powerful impact on the schizophrenia patient, but it is not clear how and why high EE attitudes and related behaviors have such an effect. The current study was designed to examine the hypothesis that schizophrenics are vulnerable to high EE because they lack the social skills needed to deflect or reduce negative affect expressed by others. The study also investigated whether the skill deficits are specific to interactions with close relatives, and if they are more marked inpatients who have regular
300 contact with high EE relatives. Thirty four schizophrenia patients in an acute inpatient hospital were compared to 24 inpatients with MAD, and 19 non-patient controls on a role play test of social skills and a test of affect perception. The role play test consisted of 12 simulated conversations in which the subject was confronted by parents and friends expressing high EE criticism or non-critical dissatisfaction. Family members of a subset of the patients were also assessed on the Camberwell Family Interview. Schizophrenia patients exhibited significant deficits in assertiveness and social skill in all conditions, but they did not show any differential impairment when presented with high EE. Notably, they consistently lied when criticized or confronted (e.g., “I didn’t do it.“) rather than making appropriate assertive responses or apologizing for errors. There were no differences between patients with or without high EE relatives. On the affect perception test, schizophrenia patients consistently underestimated the intensity or “negativeness” of negative emotions, but were not deficient in perception of positive emotional displays. The data do not support the hypothesis that schizophrenia patients have a differential skills deficit in dealing with high EE behaviors, but do indicate that their ability to cope with even mild negative affect is impaired. This disability might result from failure to accurately perceive negative affect cues, a possibility supported by research on the neurophysiology of emotion recognition. However, their propensity to lie in response to even mild criticism suggests that they may have considerable difficulty coping with conflict and negative affect expressed by others. Minimizing the intensity of negative affective displays might be a self-protective response to reduce distress.
Coping behavior in schizophrenic patients in terms of a situation/operation theory of stress and coping W. Baker*, H.D. Brenner,
H.B. Ruth Genner,
A. Ratziwill
Psychiatric Clinic of the University of Bem, Switzerland, Deparfment of Theoretical and Evaluative Psychiatq Bern, Switzerland
The fact that the vulnerability-stress model of schizophrenia has received such widespread acclaim has begun to stimulate growing interest in the systematic investigation of coping behavior in schizophrenic patients both from a pathogenetical and a therapeutical perspective. Further investigation into the role of coping behavior in the onset and the course of schizophrenia implies the necessity of developing models which diagnostically classify and describe the different forms of coping behavior elicited and then investigate how they interact with relevant factors applying to other areas of research. A situation/operation model of stress and coping connects perceived situational characteristics as antecedents with behavioral characteristics as consequences. We are presently investigating whether schizophrenic patients’ coping attempts adhere to certain rules formulated in accordance with theoretical and empirical evidence and if they do so, which ones and to what extent coping operations are distinguished according to whether they are problem-oriented or not, and whether they occur on the level of action, cognition or emotion. Results obtained in a first study with 30 chronic patients classified according to DSM-III-R seem to indicate that the individual patients can be characterized by the degree to which they adhere to rules based on empirical and clinical evidence (concerning the relationship between cognitive representations and coping operations) and according to the kind of rules (functional vs dysfunctional) they adhere to. Furthermore, the above-mentioned factors interact with psychopathological (positive vs negative symptoms, basic cognitive disorders) and anamnestic variables. Implications for further clarification of the role of coping behavior in schizophrenia are discussed.
Measuring the character of community treatments Implications for efficacy and heterogeneity
for schizophrenics:
J.S. Brekke*, M.A. Test School of Social Work, University of Southern Calijomia, Los Angeles, CA 900894411,
USA.
A growing body of literature indicates that community-based models of treatment and rehabilitation for persons diagnosed with schizophrenia can favorably impact their short-term and long-term community and psychiatric functioning. There are also an increasing number of these community support programs (CSPs) as
0 1991 Elsevier Science Publishers B.V. 0920-9964/91/$03.50
PSYCHOSOCIAL
ISSUES
Discriminating characteristics between schizophrenic and “schizoaffective” patients L. Beasley, J.J. Boronow*,
N. Ringel, F. Parente
The Sheppard and Enoch Pratt Hospital, 6501 N. Charles Street, Towson, MD 21204, USA.
Kraepelin identified a significant group of patients with a mixture of schizophrenic and affective symptoms. However, there exists continuing uncertainty as to what extent schizoaffective disorder represents a unique diagnostic group. We compared cross-sectional and longitudinal features on chronic inpatients meeting RDC criteria for either schizophrenia (S, n = 35) or schizoaffective disorder, mainly schizophrenic (SA, n = 33). 85% of the SA patients were bipolar, and the remaining unipolar depressed SA patients had recurrent major depressive episodes. Patients with a coexisting neurological or chemical dependency diagnosis were excluded. Weekly BPRS ratings, a 24 hourly time-sampling of social behavior, and a standardized historical database were used to assess the subjects. A representative week was chosen for each patient towards the end of their hospitalization (mean length of stay = 5.7 months) to reflect optimal functioning in the patients after treatment. All subjects were judged to have benefitted maximally from treatment, and patients discharged prematurely due to insurance or other limitations were excluded from the sample. Interventions covered a wide spectrum of neuroleptics and thymoleptics, as well as ECI. Both groups were typical of the “young adult chronic patient,” with mean age of 33, onset at age 20,8 prior hospitalizations, and a male to female ratio of 1.7:1. Their mean total BPRS score was 43.9, and mean CPZE was 1,081 mg (S vs Sa, NS for all comparisons). SA patients showed less of the time-sampled behavior of autistic withdrawal (p = .035) and more social interaction (p= .016). They also scored higher on BPRS measures of anxiety (p= .034) and excitement (p = .032), and lower on blunted affect (p = .OOl) and the Withdrawal/Retardation Factor (p = 0.45). SApatients were also more likely to have made a suicide attempt (p = .016), to have had chumships as children, to have less autistic sexuality (p=.O24), and to have never worked (p=.OO8). An attempt to use these distinguishing characteristics as a discriminant function and demonstrate a “point of rarity” or a “linear discontinuity” in the method of Kendell and Brockington failed. We conclude that although there are significant differences in SApatients which pertain to the affective/social dimension, their overall clinical course and degree of impairment is quite similar to chronic schizophrenia, even when treated with thymoleptics.
The ability of schizophrenics to perceive and cope with negative affect A.S. Bellack*, K.T. Mueser, J. Wade, S. Sayers, R.L. Morrison HentyAvenue, Philadelphia, PA 19129, USA
Medical College of Pennsylvania at EPPI, Dept. of Psychiatq 3200
It is clear that high Expressed Emotion can have a powerful impact on the schizophrenia patient, but it is not clear how and why high EE attitudes and related behaviors have such an effect. The current study was designed to examine the hypothesis that schizophrenics are vulnerable to high EE because they lack the social skills needed to deflect or reduce negative affect expressed by others. The study also investigated whether the skill deficits are specific to interactions with close relatives, and if they are more marked inpatients who have regular
300 contact with high EE relatives. Thirty four schizophrenia patients in an acute inpatient hospital were compared to 24 inpatients with MAD, and 19 non-patient controls on a role play test of social skills and a test of affect perception. The role play test consisted of 12 simulated conversations in which the subject was confronted by parents and friends expressing high EE criticism or non-critical dissatisfaction. Family members of a subset of the patients were also assessed on the Camberwell Family Interview. Schizophrenia patients exhibited significant deficits in assertiveness and social skill in all conditions, but they did not show any differential impairment when presented with high EE. Notably, they consistently lied when criticized or confronted (e.g., “I didn’t do it.“) rather than making appropriate assertive responses or apologizing for errors. There were no differences between patients with or without high EE relatives. On the affect perception test, schizophrenia patients consistently underestimated the intensity or “negativeness” of negative emotions, but were not deficient in perception of positive emotional displays. The data do not support the hypothesis that schizophrenia patients have a differential skills deficit in dealing with high EE behaviors, but do indicate that their ability to cope with even mild negative affect is impaired. This disability might result from failure to accurately perceive negative affect cues, a possibility supported by research on the neurophysiology of emotion recognition. However, their propensity to lie in response to even mild criticism suggests that they may have considerable difficulty coping with conflict and negative affect expressed by others. Minimizing the intensity of negative affective displays might be a self-protective response to reduce distress.
Coping behavior in schizophrenic patients in terms of a situation/operation theory of stress and coping W. Baker*, H.D. Brenner,
H.B. Ruth Genner,
A. Ratziwill
Psychiatric Clinic of the University of Bem, Switzerland, Deparfment of Theoretical and Evaluative Psychiatq Bern, Switzerland
The fact that the vulnerability-stress model of schizophrenia has received such widespread acclaim has begun to stimulate growing interest in the systematic investigation of coping behavior in schizophrenic patients both from a pathogenetical and a therapeutical perspective. Further investigation into the role of coping behavior in the onset and the course of schizophrenia implies the necessity of developing models which diagnostically classify and describe the different forms of coping behavior elicited and then investigate how they interact with relevant factors applying to other areas of research. A situation/operation model of stress and coping connects perceived situational characteristics as antecedents with behavioral characteristics as consequences. We are presently investigating whether schizophrenic patients’ coping attempts adhere to certain rules formulated in accordance with theoretical and empirical evidence and if they do so, which ones and to what extent coping operations are distinguished according to whether they are problem-oriented or not, and whether they occur on the level of action, cognition or emotion. Results obtained in a first study with 30 chronic patients classified according to DSM-III-R seem to indicate that the individual patients can be characterized by the degree to which they adhere to rules based on empirical and clinical evidence (concerning the relationship between cognitive representations and coping operations) and according to the kind of rules (functional vs dysfunctional) they adhere to. Furthermore, the above-mentioned factors interact with psychopathological (positive vs negative symptoms, basic cognitive disorders) and anamnestic variables. Implications for further clarification of the role of coping behavior in schizophrenia are discussed.
Measuring the character of community treatments Implications for efficacy and heterogeneity
for schizophrenics:
J.S. Brekke*, M.A. Test School of Social Work, University of Southern Calijomia, Los Angeles, CA 900894411,
USA.
A growing body of literature indicates that community-based models of treatment and rehabilitation for persons diagnosed with schizophrenia can favorably impact their short-term and long-term community and psychiatric functioning. There are also an increasing number of these community support programs (CSPs) as