The symmetry of symptom patterns in pre-post treatment designs

This article proposes a new nonparametric method for statistical evaluation of clinical pre-post treatment designs. In clinical research, models of marginal symmetry typically are estimated from log-linear models of axial and quasi-symmetry. As such, they provide overall goodness-of-fit information concerning change in probabilities of categories of one variable that was observed twice. This paper proposes the following three extensions: (1) using models of marginal symmetry for changes in patterns of two or more variables, and (2) following up global marginal symmetry tests using Lehmacher's sign tests. (3) To protect the experiment-wise alpha, a modified Bonferroni-Holm procedure is proposed. The new approach allows researchers to make statements about treatment effects at the level of single symptoms. Examples illustrate application of all three symmetry models and the follow-up test using data from pharmaco-psychiatry. The discussion relates Lehmacher's tests to two-sample Configural Frequency Analysis of multi-discrimination types. Strategies of statistical significance testing are presented and the importance of the proposed methodological approach for psychiatric research is discussed.

Effects of disease-related cues in alcoholic inpatients: results of a controlled "Alcohol Stroop" study

We tested the hypothesis that alcoholics develop a disease-related attentional bias. Therefore, alcohol-related, but task-irrelevant, words should cause a specific perceptual-processing bias. We investigated this by using a special color-naming task. We subjected 40 male alcohol-dependent inpatients and 40 healthy male controls (matched according to age and verbal IQ) to a modified card version of the Stroop color-naming task that consisted of a neutral and an alcohol word condition ("Alcohol Stroop"). Alcoholic inpatients performed significantly poorer than the control group under the critical experimental condition (color-naming of disease-related words), as compared with the noncritical condition (color-naming of neutral words; p = 0.03). Concerning the possible neuropsychological impairment of the patients, no effects could be found on the reaction time of the "Standard Stroop" using only neutral words (i.e., color-naming of incongruent color words administered without time limitation). The information processing bias on the "Alcohol Stroop" thus qualifies as a cognitive process, which is independent from putative neuropsychological deficits of alcoholic patients and might represent an essential feature of alcoholic psychopathology. The "Alcohol Stroop" contributes to the experimental psychopathology of alcoholism.

[Ambulatory short-term therapy of anxiety patients with autogenic training and hypnosis. Results of treatment and 3 months follow-up]

The aim of the study was to examine the effects of a short-term outpatient treatment (6 sessions à 90 minutes) with autogenic training (Schultz 1932) or hypnosis (Erickson and Rossi 1979), concerning patients with anxiety- and panic disorders (according to DSM-III-R and ICD-10-criteria). 27 Outpatients were recruited by newspaper articles. Most of them had not been treated before. Both short-term treatments consisted of 6 weekly group sessions (4-6 patients). Psychological examinations were carried out before and after treatment and at a follow-up after 3 months. Trait anxiety (STAI-X2) and psychosomatic complaints (BfS/BL') decreased in both groups significantly after treatment. This therapeutic effect was stable during the following 3 months. The frequency of panic attacks decreased as well under treatment, and this effect was even more marked during the 3 month following treatment. The therapeutic success was influenced by the frequency of autosuggestive exercises carried out by the patients at home. This form of short-term treatment is not sufficient for all patients with anxiety disorders but the results of that study encourage to use short-term interventions with autogenic training and hypnosis as initial therapeutic approaches for such patients and to combine them with other therapeutic interventions.

Distraction resulting from disease related words in alcohol-dependent inpatients: a controlled dichotic listening study

To test whether alcoholics develop an information processing bias towards disease-related stimuli, 30 alcoholic inpatients and 30 controls were administered a dichotic listening task. Three different stimulus types were presented to the right (ignored) channel: neutral words, rare neutral words and alcohol-related words. The hypothesized information processing bias should cause patients to make disproportionally more shadowing errors in the third condition. An ANOVA revealed a significant condition effect (P < 0.001), a tendency towards a group effect (P = 0.09) and a significant interaction (P < 0.01) in the expected direction. There was a marked increase of errors in alcoholics when disease-related stimuli were presented compared to the neutral conditions and to the controls.

Findings significant with respect to short- and medium-term outcome in schizophrenia--a preliminary report

1. The objective of the study was to determine the relationship of psychopathological, psychobiological, and clinical psychological variables to short- and medium-term outcome in schizophrenia. 2. The predictive power of several variables described as potential predictors in the literature were evaluated. To these we added clinical psychological variables; most of these had never been examined in a prospective study. 3. The sample consisted of a total of 45 patients. None of the patients was on medication and all were tested shortly after admission to the hospital. The following factors were regarded as outcome criteria: change in the GAS-score four weeks after admission, length of hospitalization after index admission, relapse nine months after admission and two years after discharge. 4. We found that the psychobiological data set as well as the clinical psychological data set had the highest predictive power with respect to short- and medium-term outcome. 5. An analysis of the single variables within the clinical psychological data set revealed that the patients with attention disorder and a low Stimulus Barrier Function (Bellak-scale) responded better to a four-week Haloperidol treatment. Patients with a low Stimulus Barrier Function at admission had, in comparison to this, a poor outcome after two years (relapse). (No patient was taking drugs regularly at this time.) The expressed emotion of the relative approached only significance (p less than .07) as a factor to be connected with relapse after two years. 6. As psychological factors the ANS activity and the CT were measured. The latter in order to evaluate possible atrophic alterations in the brain. 7. Higher activity of the ANS was found in those patients who were hospitalized for a longer period. Slight atrophic alterations of the brain (CT scan) were related to poor outcome after two years (relapse). 8. No significant relationship was found between the psychopathological state at admission and short- or medium-term course of the illness. 9. The findings are interpreted as showing the importance of psychobiological as well as clinical psychological variables in order to uncover the factors related to the heterogeneous course of the schizophrenic illness.

Autonomic nervous system differences as predictors of short-term outcome in schizophrenics

Skin conductance and heart rate of 19 drug-free acute schizophrenic patients were measured before neuroleptic therapy was started. The patients were divided into two groups according to therapeutic outcome. The Discriminant Analysis revealed a difference in the ANS activity pattern between the group with low improvement and the group with a more favorable outcome. The low improvement group showed a paradoxical ANS reactivity pattern: relatively lower activity in skin conductance level under demand (attention task) and relatively higher activity, as reflected by the cardiovascular response to neutral stimuli (orienting stimuli), which suggests poor adaptation of ANS arousal to the environment in these schizophrenics. This finding agrees with those reported in other short-term outcome studies that considered differences in ANS activity in a schizophrenic population. The authors' findings indicate that these differences in the ANS response in schizophrenics should be included in future biochemical and pharmacotherapeutic investigations on schizophrenia.

On the meaning of electrodermal nonresponding in schizophrenia

The skin conductance responses of schizophrenics, neurotics and normals to orienting stimuli were examined. Only the schizophrenic group showed a high incidence of absence of skin conductance orienting responses. A subdivision of the schizophrenic sample into thosee who did not show any orienting response and those who responded more than three times revealed significant differences in a dichotic listening shadowing task and symptomatology. The schizophrenic nonresponders as compared to the responders made more errors of omission in the dichotic listening task and showed a symptom pattern of low spontaneous activity and withdrawal. The lack of skin conductance responses in some schizophrenics was interpreted as a protective mechanism.