Factorial structure of the Scale of Prodromal Symptoms

Data from the Scale of Prodromal Symptoms (SOPS) [Early Intervention in Psychotic Disorders, pp. 135-150] on 94 hitherto never-psychotic individuals were entered into a principal components analysis, revealing six components with an eigenvalue greater than 1.0. Based upon scree-plot analysis, further extractions were limited to three, then two, factors. Varimax rotation of the three-component extraction revealed factors with reasonable congruence with a priori content areas. All symptoms labeled as negative in the SOPS loaded on one factor, and four of five symptoms labeled as positive loaded on another. The remaining positive symptom, conceptual disorganization, has been found not to load with other positive-labeled symptoms in studies of schizophrenia using applicable instruments. All symptoms labeled as "general" in the SOPS loaded on a third factor, which appears to reflect the nonspecific psychological distress that might be expected in psychosis-naïve individuals experiencing the preliminary stages of a serious psychiatric disorder. The independence of this component from the positive and negative symptom factors suggests that the structure obtained suggests a clinical continuity between the at-risk presentations seen in this sample and established schizophrenia.

Neuropsychological status of subjects at high risk for a first episode of psychosis

Thirty-six subjects aged 16 years or older judged at risk for a first episode of psychosis within a North American multi-site study of the schizophrenia prodrome [McGlashan et al., Schizophr. Res. (2003); Miller et al., Schizophr. Res. (2003)] performed at levels intermediate to population norms and data reported for schizophrenia samples on a comprehensive neuropsychological exam. In the context of normal intelligence, this intermediate status suggests that, as a group, these subjects are not fully normal in neuropsychological functioning. Conversely, the finding that they do not show the levels of impairment commonly observed in schizophrenia, including within the first episode, suggests that prodromal interventions might conceivably prevent, delay, or lessen the severity of declines associated with first psychotic episodes.

The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. I. Study rationale and design

The first double-blind placebo-controlled clinical trial of an atypical neuroleptic medication is being conducted in symptomatic treatment-seeking patients meeting new diagnostic criteria for a putative prodromal syndrome. This identifies them as being at high risk for developing psychosis in the near future. The study aims include prevention of psychosis onset and disability, as well as palliation of ongoing symptomatology. This report presents the study rationale and design. Recent studies will be reviewed that have advanced our knowledge about the early course of schizophrenia and our ability to predict onset prospectively, advances that have rendered prodromal intervention research feasible and ethical. The study design has many novel features. It tests for prevention versus delay in psychosis onset, as well as for efficacy and safety in a newly defined clinical population. This has required the development of innovative clinical research assessment instruments and a new operational definition of psychosis onset. The integration of these novel elements into an otherwise typical clinical trial design is detailed. The companion report will address sample recruitment and the clinical phenomenology at baseline of this putative "prodromal" entity.

The PRIME North America randomized double-blind clinical trial of olanzapine versus placebo in patients at risk of being prodromally symptomatic for psychosis. II. Baseline characteristics of the "prodromal" sample

The first double-blind placebo-controlled clinical trial of an atypical neuroleptic medication is being conducted in symptomatic treatment-seeking patients meeting new diagnostic criteria for a putative prodromal syndrome. This identifies them as being at high risk for developing psychosis in the near future. The study aims include prevention of psychosis onset and disability, as well as palliation of ongoing symptomatology. The purpose of this report is to describe the study's "prodromally symptomatic" sample at baseline, i.e., at intake immediately prior to randomization and prior to receiving study medication. Sixty treatment-seeking patients meeting prodromal inclusion criteria were recruited across four sites: New Haven, CT (n=39), Toronto, Ontario (n=9), Calgary, Alberta (n=6), and Chapel Hill, NC (n=6). The sample was young (median age 16), largely male (65%), and came from families with high titers of serious mental illness (44%). Most patients (93%) met criteria for the Attenuated Positive Symptom (APS) prodromal syndrome and presented with significant but nonpsychotic suspiciousness, perceptual aberrations, unusual thought content, and conceptual disorganization. They presented with minimal to mild affective symptoms and substance use/abuse, but they were quite functionally compromised (mean Global Assessment of Functioning (GAF) score=42). The prodromal sample was compared with other clinical-trial samples of adolescent depression, adolescent mania, and first episode schizophrenia. Prodromal patients proved not to be depressed or manic. They were less severely ill than untreated first episode schizophrenia but more severely ill than treated first episode schizophrenia. While not psychotically disabled, these patients nevertheless present with a clinical syndrome. Subsequent reports will detail the effects of drug versus placebo on prodromal symptoms, neuropsychological profile, and the rate of conversion to psychosis.

The influence of IQ stratification on WAIS-III/WMS-III FSIQ-general memory index discrepancy base-rates in the standardization sample

Since memory performance expectations may be IQ-based, unidirectional base rate data for IQ-Memory Score discrepancies are provided in the WAIS-III/WMS-III Technical Manual. The utility of these data partially rests on the assumption that discrepancy base rates do not vary across ability levels. FSIQ stratified base rate data generated from the standardization sample, however, demonstrate substantial variability across the IQ spectrum. A superiority of memory score over FSIQ is typical at lower IQ levels, whereas the converse is true at higher IQ levels. These data indicate that the use of IQ-memory score unstratified "simple difference" tables could lead to erroneous conclusions for clients with low or high IQ. IQ stratified standardization base rate data are provided as a complement to the "predicted difference" method detailed in the Technical Manual.

Estimated yield of early detection of prodromal or first episode patients by screening first degree relatives of schizophrenic patients

Screening a population of relatives of current schizophrenic patients could be an efficient means to accrue a sample of early first episode or prodromal patients for a prediction study or an intervention study. The risk of new onset schizophrenia cases in any one year in a population of relatives depends on the number of schizophrenic probands and three additional factors: (1) the age of onset distribution for schizophrenia; (2) the lifetime risk of the at-risk group of relatives selected; and (3) the number of at-risk relatives per proband and their age distribution. Estimates are made for each of these parameters, and calculations are presented. The base model suggests that screening all siblings and children of patients with schizophrenia would yield approximately 19 new cases of schizophrenia per year per 10,000 relatives screened. The results of the calculation are relatively insensitive to reasonable variation of most model parameter estimates. The yield of new cases obtained by screening relatives of current patients appears to be low if the purpose is to recruit a sample for an early intervention study over a relatively short period of time.

Use of the Medication Event Monitoring System to estimate medication compliance in patients with schizophrenia

OBJECTIVE

To determine the feasibility of using the Medication Event Monitoring System (MEMS) to estimate medication compliance in patients with schizophrenia or schizoaffective disorder.

SUBJECTS AND SETTING

Fourteen of 35 consecutive patients admitted to a psychiatric inpatient hospital with schizophrenia or schizoaffective disorder who met eligibility requirements and gave informed consent.

INTERVENTION

After random assignment to either risperidone or typical antipsychotic treatment, medication upon discharge from hospital was dispensed in a bottle with a MEMS cap which recorded the number of bottle openings and the date and time of each opening. The first 6 patients were asked to return monthly for data downloading. The next 8 were asked to return weekly during the first month and every 2 weeks thereafter; they were also paid $5 for returning each bottle.

OUTCOME MEASURES

MEMS data collected over a 6-month period and hospital readmission data.

RESULTS

Patient medication compliance data were collected from 10 (71%) of 14 patients during the first month, from 7 (58%) of 12 (2 patients dropped out) during the second and from 5 (45%) of 11 (a third patient dropped out) during months 3-6. Mean compliance rates were 63% for the first month and ranged from 56% to 45% over the next 5. First-month compliance rates were significantly lower for those who were subsequently readmitted to hospital (n = 7) than for those who were not (p < 0.01).

CONCLUSIONS

Electronic monitoring devices can be used to estimate compliance with medication regimens in patients with severe schizophrenic disorders, but there are methodological improvements that can be made to increase data recovery and compliance, and these are discussed.

Predictors of nonadherence to HIV-related medication regimens during methadone stabilization

Nonadherence to HIV-related medication regimens among drug-abusing patients decreases therapeutic effectiveness and may limit patient access to newer, highly active antiretroviral therapies (HAART). A number of factors have been associated with medication nonadherence; however, few studies have examined predictors of nonadherence specifically in HIV-positive drug abusers. In the current study, a comprehensive assessment battery was administered to 42 HIV-positive, injection drug users beginning methadone maintenance. HIV-related medication adherence was assessed weekly by self-report during the 4-week methadone stabilization phase. Thirty-six percent of patients reported less than 80% adherence to their medication regimen at entry into methadone. Medication adherence increased significantly during the 4-week stabilization phase. Significant zero-order correlations were found between nonadherence during stabilization and viral load, low educational attainment, depression, and neuropsychological tests of problem solving ability and cognitive flexibility. Independent predictors of nonadherence were low levels of education and poor emotional functioning. Implications for early intervention are discussed.

Effects of estrogen on global gene expression: identification of novel targets of estrogen action

The important role played by the sex hormone estrogen in disease and physiological processes has been well documented. However, the mechanisms by which this hormone elicits many of its normal as well as pathological effects are unclear. To identify both known and unknown genes that are regulated by or associated with estrogen action, we performed serial analysis of gene expression on estrogen-responsive breast cancer cells after exposure to this hormone. We examined approximately 190,000 mRNA transcripts and monitored the expression behavior of 12,550 genes. Expression levels for the vast majority of those transcripts were observed to remain constant upon 17beta estradiol (E2) treatment. Only approximately 0.4% of the genes showed an increase in expression of > or =3-fold by 3 h post-E2 treatment. We cloned five novel genes (E2IG1-5), which were observed up-regulated by the hormonal treatment. Of these the most highly induced transcript, E2IG1, appears to be a novel member of the family of small heat shock proteins. The E2IG4 gene is a new member of the large family of leucine-rich repeat-containing proteins. On the basis of architectural and domain homology, this gene appears to be a good candidate for secretion in the extracellular environment and, therefore, may play a role in breast tissue remodeling and/or epithelium-stroma interactions. Several interesting genes with a potential role in the regulation of cell cycle progression were also identified to increase in expression, including Pescadillo and chaperonin CCT2. Two putative paracrine/autocrine factors of potential importance in the regulation of the growth of breast cancer cells were identified to be highly up-regulated by E2: stanniocalcin 2, a calcium/phosphate homeostatic hormone; and inhibin-beta B, a TGF-beta-like factor. Interestingly, we also determined that E2IG1 and stanniocalcin 2 were exclusively overexpressed in estrogen-receptor-positive breast cancer lines, and thus they have the potential to serve as breast cancer biomarkers. This data provides a comprehensive view of the changes induced by E2 on the transcriptional program of human E2-responsive cells, and it also identifies novel and previously unsuspected gene targets whose expression is affected by this hormone.

Continuation of high-risk behavior by HIV-positive drug users. Treatment implications

Drug users who are positive for the human immunodeficiency virus (HIV) represent a major vector of HIV transmission, yet relatively little is known about their continued drug- and sex-related HIV-risk behavior, which may impede the development of effective risk-reduction interventions. In this study, 50 HIV-seropositive injection drug users entering methadone maintenance treatment completed a comprehensive risk assessment battery, including self-report of HIV-risk behavior since learning HIV serostatus, and measures of risk-reduction information, motivation, and behavioral skills. We found that a disconcertingly high proportion of patients (66%) reported having engaged in HIV-risk behavior since learning their HIV-seropositive status. Level of HIV-related knowledge did not predict high-risk behavior. Drug-related risk behavior was predicted by psychiatric severity and poor behavioral skills. Sex-related risk was predicted by low levels of motivation and poor behavioral skills. Implications of these findings for treatment are discussed.

WWOX, a novel WW domain-containing protein mapping to human chromosome 16q23.3-24.1, a region frequently affected in breast cancer

Studies were conducted with the final goal of identifying genes of interest mapping to the chromosome region 16q23.3-24.1, an area commonly affected by allelic losses in breast cancer. To this end we generated a detailed physical map of the genomic region spanning between sequence-tagged site markers D16S518 and D16S516. To identify candidate genes, we used shotgun genomic sequencing as well as isolation and analysis of transcripts mapping to the area of interest. We identified and cloned a novel gene, the genomic structure of which spans the whole region of interest. We named this gene WWOX because it contains two WW domains coupled to a region with high homology to the short-chain dehydrogenase/reductase family of enzymes. The ORF of WWOX is 1245 bp long, encoding a 414-amino acid protein. This gene is composed of nine exons. We performed a mutation screening of WWOX exons in a panel of breast cancer lines, most of which are hemizygous for the 16q genomic region indicated. We found no evidence of mutations, thus indicating that WWOX is probably not a tumor suppressor gene. However, we observed that one case of homozygous deletion as well as two previously described translocation breakpoints map to intronic regions of this gene. We speculate that WWOX may span the yet uncharacterized common fragile site FRA16D region. In expression studies we found overexpression of WWOX in breast cancer cell lines when compared with normal breast cells and tissues. The highest normal expression of WWOX was observed in hormonally regulated tissues such as testis, ovary, and prostate. This expression pattern and the presence of a short-chain dehydrogenase/reductase domain and specific amino acid features suggest a role for WWOX in steroid metabolism. Interestingly, the presence of WW domains in the structure of WWOX indicate the likelihood that this protein physically interacts with other proteins. The unique features of WWOX and its possible association with cancer processes make it an interesting target for further investigation.

Memory deficits in patients with schizophrenia: preliminary data from the Wechsler Memory Scale-Third Edition support earlier findings

OBJECTIVE

To determine whether memory data presented for a schizophrenia sample in the Technical Manual of the Wechsler Memory Scale-Third Edition support trends identified in a previously published review of studies employing an earlier version of the instrument, the Wechsler Memory Scale-Revised.

DESIGN

Archival: reformulation of published data.

PATIENTS

Patients with schizophrenia, Alzheimer's disease, Korsakoff's syndrome or traumatic brain injury (TBI) for whom intelligence and memory data were reported in the Technical Manual of the Wechsler Adult Intelligence Scale-Third Edition Wechsler Memory Scale-Third Edition (WAIS-III WMS-III).

OUTCOME MEASURES

Mean Full Scale, Verbal, and Performance Intelligence Quotients of the WAIS-III and mean WMS-III Immediate and General Memory Indexes. Single-trial learning and learning slope data were also culled from the WAIS-III WMS-III Technical Manual.

RESULTS

Memory indexes for patients with Alzheimer's disease or Korsakoff's syndrome were substantially lower than those for patients with schizophrenia or TBI. In tests of learning processes, patients with schizophrenia had an inferior ability to repeat material presented just once, in comparison with the standardization sample. However, they did relatively better with repeated presentations than patients with Alzheimer's disease or Korsakoff's syndrome. The learning slope for patients with schizophrenia demonstrated an ability to absorb and consolidate increasing amounts of material with repeated exposure that is inconsistent with pronounced memory impairment.

CONCLUSIONS

Although patients with schizophrenia exhibit new learning deficiencies, their memory capabilities are not substantially weaker than their general intellectual abilities, and do not approach the memory impairment exhibited by patients with Alzheimer's disease or Korsakoff's syndrome.

California Verbal Learning Test practice effects in a schizophrenia sample

Practice effects on the California Verbal Learning Test (CVLT; >Delis et al., 1987), a measure of new learning and memory, were evaluated in a sample of patients with schizophrenia who were administered the CVLT at baseline, week 10, and week 14 in the context of a study of the effects of a non-pharmacological intervention on psychiatric status. Large effects attributable to prior exposure to the test were evident at weeks 10 and 14. These effects indicate that caution must be exercised in interpreting serial performances on this commonly used test, whether in research or clinical circumstances. Additionally, although the exact nature of the learning involved is unclear, the influence of prior exposure on later performance reveals considerable retention over time of new information in this sample of persons with schizophrenia.

Will the novel antipsychotics significantly ameliorate neuropsychological deficits and improve adaptive functioning in schizophrenia?

The recent and pending introduction of new antipsychotic medications carries the hope of a significant advance in the treatment of schizophrenia. Although the propensity of these agents to cause fewer motor side-effects than conventional neuroleptics may lead to improved compliance and clinical effectiveness, the promise of a significant impact upon the lives of patients may primarily reside in the evidence that the atypicals alleviate negative features such as emotional flattening, social withdrawal and impoverished speech. Auditory hallucinations and delusional thinking are the more dramatic expressions of illness, but these negative symptoms, along with neuropsychological deficits, are arguably more responsible for the persisting debilitation exhibited by schizophrenics (McKay, 1980; Pogue-Geile & Harrow, 1985; Breier et al. 1991; Crow, 1991; Mukherjee et al. 1991; Kane & Freeman, 1994; Perlick et al. 1992; Green, 1996; Green et al. 1997). Negative symptoms and neuropsychological deficits are minimally responsive to conventional neuroleptics (Goldberg et al. 1991; Meltzer, 1992; Lee et al. 1994; Meltzer et al. 1994), leaving schizophrenics ill-equipped to deal with the demands of normal living.

The claim is often made that clozapine alleviates both negative symptoms and neurocognitive deficits (e.g. Meltzer, 1995a). Although there is hope that the newer antipsychotics will do likewise, the evidence for neurocognitive gains in particular is, so far, limited. Only a few studies of the effects of novel antipsychotics (such as risperidone, olanzapine, sertindole and related in-trial agents) on neuropsychological functioning have been undertaken. When effects have been demonstrated, their significance has remained unclear.

This state of affairs is unsatisfactory, as a positive impact upon neuropsychological functioning would be of interest for more than just clinical reasons. An amelioration of cognitive deficiencies would suggest that these features are not inexorably tied to an irreversible pathology, such as gross neurodevelopmental aberrations or loss of neural tissue. Rather, such gains would suggest a treatable underlying pathophysiology, lending hope to other treatments, including cognitive rehabilitation. Since these deficits are increasingly viewed as fundamental to our conceptions of severe psychiatric illness (Goldberg et al. 1991; Green, 1996; Nuechterlein & Subotnik, 1996), neurocognitive changes might reciprocally shed light on these medications and schizophrenia. Finally, differential effects on cognition across medications should be factored into cost–benefit analyses, particularly when these effects are accompanied by broader adaptive functioning gains.

Is there any reason to believe that the novel antipsychotics will significantly improve the functional capacities of schizophrenics? Several considerations are relevant, including purported action mechanisms, animal behaviour findings, neurological effects, negative symptoms effects and existing cognitive outcome data.

Can line clinicians master the conceptual complexities of dialectical behavior therapy? An evaluation of a State Department of Mental Health training program

Dialectical behavior therapy for borderline personality disorder has rapidly attained wide-spread popularity, with one indication being the development of training initiatives by the Department of Mental Health within at least two States in USA. Efficacy data published by the originator of the treatment, Marsha Linehan, and her colleagues, probably accounts at least in part for this popularity. However, the complexity of DBT raises a fundamental question regarding these broader applications: can clinicians of diverse backgrounds acquire a shared and sophisticated understanding of the treatment theory? The clinical utility of a treatment rests heavily upon ease of dissemination (APA, Template for developing guidelines: Interventions for mental disorders and psychosocial aspects of physical disorders. Washington, DC: Author, 1995), and in that regard DBT--a complicated, multifaceted approach--could appear vulnerable. This vulnerability is heightened when institutional adoption involves the collaboration of numerous clinicians, who, despite occupying diverse roles, must nevertheless develop a shared understanding of the treatment. Using a detailed examination of DBT knowledge, we evaluated the conceptual mastery of 109 clinicians trained via a State Department of Mental Health initiative. Performance on the examination correlated specifically with DBT training. Prior education or background in behavior therapy accounted for little variance, indicating that clinicians occupying diverse roles acquired reasonable intellectual mastery over this complex model.

Normal neurocognitive performance after extended practice in patients with schizophrenia

This study evaluated new methods for improving the performance of patients with schizophrenia on specific neurocognitive tasks. Patients (n = 22) practiced sustained perceptual, memory and motor tasks 5 times/week for 10 weeks. Tasks were initially easy enough for patients to do well, but were made gradually more difficult over the 10 weeks. Patients received base pay and performance-based monetary supplements. No coaching or ongoing instruction was provided, and performance gains were assumed to depend upon implicit learning. High functioning healthy controls (n = 5) were given the same tasks at difficulty levels comparable to those achieved by patients after 10 weeks of practice. After 10 weeks of practice, 16 of the 22 patients performed as well or better than the best control on the perceptual and memory tasks, and 11 patients performed within the range of control subjects on the motor task. Half of the patients retested 6 months after training maintained supranormal performance, while the others showed marked performance declines. Patients with schizophrenia appear to have greater potential for neurocognitive improvement, and potentially for employment, than generally appreciated.

Memory deficits in schizophrenia: inadequate assimilation or true amnesia? Findings from the Wechsler Memory Scale--revised

Researchers disagree about why patients with schizophrenia perform poorly on memory tests. Some argue the presence of a fundamental memory deficit stemming from dysfunction in medial temporal lobe structures, principally the hippocampus. Others, stressing the contributions of impaired attention or executive failings such as a disorganized approach to learning, implicate larger neural networks. We compared data from psychometrically similar procedures, the Wechsler Memory Scale-Revised (WMS-R) and Wechsler Adult Intelligence Scale-Revised (WAIS-R), generated by 17 schizophrenia-spectrum patients and 33 psychiatric controls. We then compared our findings in detail with all published WMS-R/WAIS-R schizophrenia data. Our findings and the literature indicate that the acquisition of new information is disrupted in schizophrenia, but they provide little support for claims that memory deficits are especially pronounced relative to other weaknesses. Since schizophrenia patients exhibit reasonable retention following intervening activity, theories that place primary emphasis upon hippocampal dysfunction are not well supported.

Cognition, negative symptoms, and diagnosis: a comparison of schizophrenic, bipolar, and control samples

Forty-six schizophrenic, 22 bipolar, and 26 normal control subjects were administered negative and positive symptoms scales and tests of cognitive function. Test performance was related to diagnosis and to positive and negative symptom ratings within the schizophrenic group. Bipolar patients were significantly superior in cognitive status when compared with all schizophrenic patients, but less so when compared only with those who did not have key negative symptoms (affective nonresponsivity and poverty of speech). The schizophrenic patients with negative symptoms displayed severe impairment, performing significantly worse than the control, bipolar, and other schizophrenic subjects. Negative symptoms thus are significantly implicated in the cognitive inferiority of schizophrenic to bipolar patients. Although the data suggest bipolar patients may also have cognitive deficiencies, these findings are inconclusive and require cross-validation.

Working memory, attention, and communication disturbances in schizophrenia

The authors hypothesized that schizophrenic communication disturbances reflect specific cognitive deficits in the areas of working memory and attention. They examined the cognitive correlates of communication disturbances, as measured by linguistic reference performance, in schizophrenic (n = 48), bipolar (n = 24), and nonpsychiatric control (n = 23) individuals. Reference performance ratings in the schizophrenic patients were associated with scores on tests of working memory and attention and were not related to performance on concept formation or verbal fluency tests. In contrast, in the bipolar and nonpsychiatric individuals, reference performance was associated with concept formation and verbal fluency test scores but was not related to performance on tests of working memory. Implications with respect to the processes underlying schizophrenic communication disturbances are discussed.

Working memory, attention, and communication disturbances in schizophrenia

The authors hypothesized that schizophrenic communication disturbances reflect specific cognitive deficits in the areas of working memory and attention. They examined the cognitive correlates of communication disturbances, as measured by linguistic reference performance, in schizophrenic (n = 48), bipolar (n = 24), and nonpsychiatric control (n = 23) individuals. Reference performance ratings in the schizophrenic patients were associated with scores on tests of working memory and attention and were not related to performance on concept formation or verbal fluency tests. In contrast, in the bipolar and nonpsychiatric individuals, reference performance was associated with concept formation and verbal fluency test scores but was not related to performance on tests of working memory. Implications with respect to the processes underlying schizophrenic communication disturbances are discussed.

Limitations of cognitive status exams: a case-based discussion

Despite their extensive use in psychiatric and medical settings, brief mental status examinations have significant limitations that are easily overlooked in the pressure-cooker environments within which they are commonly used. Although undoubtedly of value as quick screening devices, the sheer brevity of these instruments all but guarantees limited validity. Brief examinations perform best with grossly impaired cases, alerting clinicians to the fact that something is badly amiss in patients who are significantly confused, disoriented, aphasic, or otherwise severely impaired. Very poor scores are accordingly frequently useful. Moderate or even perfect scores, however, will frequently be misleading, because patients with compromised brains often obtain them (Nelson et al. 1986). One such case follows.

Support for abbreviation of the Wide Range Achievement Test-Revised spelling subtest in neuropsychological assessments

The Wide Range Achievement Test-Revised (Level 2) provides valuable data in neuropsychological assessments, but its inclusion is costly in time. Although the Reading and Arithmetic subtests are inappropriate for abbreviation, the Spelling subtest is unnecessarily lengthy for most clinical needs. In a retrospective study of the reliability of data obtained from split-half and split-third tabulations with mixed psychiatric and forensic subjects, strong correlations were obtained between the split-halves and between split-half and full administration scores. A Spearman-Brown correction of the relationship between the split-halves yielded a correlation of .97, higher than that reported for any WAIS-R subtest (Wechsler, 1981). Standard scores generated by split-half tabulations were within 10 points of those generated from the complete raw data in 94.6% of cases. These findings suggest that the Spelling subtest could be abbreviated in clinical settings with minimal loss of reliability.

Can digit symbol-verbal fluency comparisons facilitate detection of pseudodementia? A preliminary study

Depressive psychomotor retardation may impair performance on timed tests. By comparison word association measures of verbal fluency are reportedly unaffected by depression. Comparisons of a brief psychomotor test with a measure of verbal fluency may therefore prove useful when there is a concern that depression may be undermining adaptive functioning, assuming both measures display: (1) broad-spectrum sensitivity to brain impairment, (2) differential vulnerability to depression, and (3) moderate correlation in nondepressed persons. Digit Symbol (DS) and the "FAS" measure of verbal fluency are sensitive to genuine dementia, satisfying the first criterion. We found that depressed schizophrenics performed at significantly lower levels on DS, but not on FAS, than nondepressed schizophrenics. The two groups differed significantly on a discrepancy score derived by subtracting FAS from DS scores; normals obtained discrepancy scores highly similar to those of nondepressed schizophrenics. As the normals had higher DS and FAS scores, this discrepancy-score similarity suggests that this index may have wide application. The third criterion is satisfied by the findings of a 0.64 correlation between DS and FAS scores adjusted for age (DS and FAS) as well as gender and educational attainment (FAS) in nondepressed samples. Implications for further research and clinical applications are discussed.

Normative implications of the relationship between reading vocabulary and Boston Naming Test performance

The 60-item Boston Naming Test (BNT) was published in 1983 with norms described as provisional. One recent finding (Thompson & Heaton, 1989) suggests that verbal intelligence, and the Wechsler Adult Intelligence Scale (WA1S)-Revised Vocabulary subtest, in particular, is strongly correlated with BNT performance, and that education is moderately so. High false-positive rates for naming deficit may conceivably result from the application of the published norms with subjects of lower verbal abilities or limited educational backgrounds. To further explore the relationship of naming to other verbal abilities, analyses were undertaken of the correlations between Level 7-9 Gates-MacGinite Reading Vocabulary Test (G-MRVT) and BNT data from 97 schizophrenic, bipolar, and normal subjects. Reading vocabulary is strongly correlated with BNT performance, and the nature of this relationship is essentially the same across the three diagnostic groups. Application of the published norms would have resulted in a high false-positive rate for naming deficit in all groups among subjects with reading vocabularies equivalent to twelfth grade or less. As a word-recognition based reading exercise, the G-MRVT is likely to provide a brain-compromise-resistant index against which the adequacy of naming performances can be assessed. Accordingly, G-MRVT based BNT performance expectation guidelines are presented for use as a complement to the published norms. Other implications are discussed.

Occupational neurotoxicology: some neuropsychological issues and challenges

Occupational neurotoxicology offers the opportunity for demonstration of neuropsychological capacity to detect otherwise non-demonstrable CNS compromise, and thereby the enhancement of human well-being. Simultaneously, neuropsychological applications in this field highlight some of the disciplines persisting problems, such as uncertainties over the differential sensitivities of tests, lack of a common functional taxonomy, limited employment of component-analysis procedures, insufficiencies of control over extraneous variance (including malingering and social expectancy effects), and knowledge limits regarding the everyday significance of findings. These problems are especially troublesome where effects are subtle, diffuse, or of insidious onset, and where physically demonstrable lesioning is uncommon. With neuroimaging advances, conditions so characterized may become increasingly the focus of neuropsychological efforts. The likelihood of increasing involvement with legal issues such as compensation makes awareness of these difficulties, and concerted efforts to resolve them, crucial.

Hepatotoxicity following vincristine therapy

A patient is reported with small cell lung cancer treated with combination chemotherapy (cyclophosphamide, vincristine and etoposide [VP-16-213] who developed transient liver function abnormalities secondary to vincristine therapy. Serum transaminase (SGOT and SGPT) levels rose by 2 to 6 times, lactic dehydrogenase (LDH) 1.5 to 2 times, and alkaline phosphatase and gamma-glutamyl transpeptidase (GGTP) 1.5 to 2 times normal. Enzyme abnormalities were observed by the 6th day following drug administration and returned to normal between 16 and 48 days, except for the GGTP elevations which persisted longer. Vincristine has been suspected to cause liver damage and to enhance radiation-induced hepatic injury. The authors report this case of moderate transient transaminitis confirmed by rechallenge with vincristine.

Simultaneous occurrence of mycosis fungoides and Hodgkin disease: clinical and histologic correlations in three cases with ultrastructural studies in two

We present three patients who manifested both Hodgkin disease and mycosis fungoides. Ages ranged from 39 to 66 and two were male. Skin lesions were present from 3 to 40 years before the diagnosis of Hodgkin disease. In all cases, mycosis fungoides was confirmed histologically by skin biopsy; the clinical course of the mycosis fungoides was indolent in all cases. Hodgkin disease was confirmed histologically in three, and confirmed by electron microscopy in two. All three patients responded to appropriate treatment for Hodgkin disease and are alive and well at the present time.