Clinical identification of compensatory structures on projective tests: a self psychological approach

In this article I discuss compensatory structure, a concept from Kohut's (1971, 1977) psychology of the self that is not as familiar as Kohut's other views about the self. Compensatory structures are attempts to repair selfobject failure, usually by strengthening idealization or twinship in the face of mirroring deficits. Compensatory structures, particularly their early indications, can be detected on projective tests for identifying adaptive resources and treatment potential. The clinical identification of compensatory structures on test findings is described using Rorschach and Thematic Apperception Test (Murray, 1943) content. Particular attention is devoted to the 2-part process of demonstrating first, an injury to the self, and second, how attempts to recover from such injuries can be detected on projective tests. Clinical examples are provided, and the differentiation between compensatory structures and defenses and sublimation is discussed.

Vulnerability to delusions over time in schizophrenia and affective disorders

This research used a prospective longitudinal design to study differences in vulnerability to delusions over time in 234 subjects with schizophrenia, schizoaffective disorder, or bipolar or unipolar affective disorder. Patients were assessed at three successive followups over a 7- to 8-year period. Over 60 percent of the schizophrenia and schizoaffective patients assessed experienced delusional activity at one of the three followups. Over 60 percent of the patients who initially had psychotic affective disorders also showed posthospital delusional activity. Significantly more schizophrenia patients than psychotic affective-disordered patients experienced consistent posthospital delusional activity at three successive followups. Unlike the schizophrenia subjects, affective patients showed a significant reduction in delusions after the first followup. After the initial acute psychotic episode that led to hospitalization, psychotic bipolar and unipolar affective patients showed a traitlike vulnerability to episodic delusional activity over time, but schizophrenia patients were vulnerable to more severe delusional activity and to more frequently recurring or sustained delusions. The study results question the views of several major theorists on the importance, persistance, and prognostic significance of delusions in schizophrenia.

Clinical and research implications of revising psychological tests

This article integrates those of other contributors to this special section, "Methods and Implications of Revising Assessment Instruments," to underscore important conceptual factors to consider when undertaking test revisions. These considerations include determination of when test measures have become sufficiently understood to be incorporated in a test revision, cohort effects, revision of administration formats and test instructions, and comparisons of performance levels across test versions. The discussion of these factors also takes into consideration clinical practice and educational implications of making a transition to revised test versions.

Sustained attention on a continuous performance test

The present study compared means of 54 nonpatients on two Continuous Performance Test measures in five administration conditions. Both response measures differentiated performance among the conditions, certain of which may have an alerting function that facilitates deployment of attention. Appreciable attentional demand or effort, however, may limit this facilitative effect.

Sustained attention and related perceptuomotor functions

The present study examined the relationship between two measures of sustained attention on the Continuous Performance Test (reaction time and omission errors) and several performance measures on neuropsychological tests. Analysis suggests that sustained attention as measured by processing speed predicts performance on neuropsychological measures of relatively greater complexity and that the Stroop test, which requires maintaining steady focus on a changing stimulus field, may be more sensitive to lapses in attention than other neuropsychological tests.

Neuropsychological dysfunction and clinical outcome in psychiatric disorders: a two-year follow-up study

The presence of neuropsychological disturbances in schizophrenia and mood disorders raises the question that cognitive impairments might contribute to poor outcome. This report examines changes in neuropsychological performance from hospitalization to a 2-year follow-up evaluation in relation to psychosocial outcome. Findings indicated that unfavorable clinical outcome is associated with marginal changes in neuropsychological performance, whereas good outcome status is associated with neuropsychological improvement. Neuropsychological improvement may thus require a stable period of favorable psychosocial recovery, in schizophrenia and schizoaffective disorder, as well as major mood disorder syndromes.

BPRS syndrome scales during the course of an episode of psychiatric illness

This report examines changes in symptom levels on the four major syndrome scales from the Brief Psychiatric Rating Scale (BPRS): thought disturbance, paranoid disturbance, anxiety/depression, and emotional withdrawal/motor retardation. Baseline BPRS ratings were obtained during the first week of hospitalization for an acute episode of psychiatric illness, in 120 patients with schizophrenia, schizoaffective disorder, and depression. BPRS ratings were carried out in the week prior to discharge. Findings indicated that patients with schizoaffective disorder showed a greater magnitude of general clinical improvement than schizophrenics, although both groups had comparable improvement on thought disorder from admission to discharge. Paranoid symptoms did not recover as completely among schizophrenics compared to schizoaffective disorder patients. As expected, anxiety and depression symptoms remitted most prominently among the depressed inpatients.

Course and outcome for schizophrenia versus other psychotic patients: a longitudinal study

We studied 276 patients longitudinally, beginning at the acute phase and continuing at three successive followups over 7.5 years, comparing 74 schizophrenia patients with 74 other psychotic patients and 128 nonpsychotic patients on early course and outcome. Schizophrenia patients showed significantly poorer functioning than patients with other psychotic disorders at each of the three followups (p < 0.05). More schizophrenia patients than other psychotic patients showed consistent psychopathology and a course in which there was not complete remission at any of the three followups (p < 0.05). Most schizophrenia patients did not show severe decrements in social activity level. Poor outcome schizophrenia patients showed significantly slower recovery at each followup than did other psychotic patients with initial poor outcomes (p < 0.01). The results indicate that, during the early course, schizophrenia patients still show relatively poor outcomes, although a small number of schizophrenia patients enter into complete remission. Over time, many schizophrenia patients fluctuate between severe disability and moderate disability rather than always showing severe disability. Schizophrenia patients tend to recover more slowly then other psychotic patients. Differences between schizophrenia patients and other psychotic patients in clinical course over time may be larger than differences at any single followup.

Teaching the Rorschach and learning psychodiagnostic testing: a commentary on Hilsenroth and Handler (1995)

A recent report by Hilsenroth and Handler (1995) surveyed graduate students' impressions of their predoctoral-level training on the Rorschach method. My commentary underscores two central points from their article: (a) the problem of program specialization in a crowded curriculum, and (b) students' indication of a need for more secure grounding in personality theory and clinical diagnosis. The focus of these remarks concerns current trends in clinical psychology education, their implications for training in psychological assessment, establishing a reasonable upper limit of solid competence for achieving a journeyman level of ability, and some considerations about a suitable role for continuing education workshops. A sharp distinction between filing in gaps in knowledge and compensating for fundamental deficiencies is emphasized in this context.

Levels of psychopathology at hospital admission and discharge: the Million Clinical Multiaxial Inventory as a prognostic measure

This study compares two pathological personality disorder scales and two severe clinical syndrome scales from the Millon Clinical Multiaxial Inventory in relation to clinical change from admission to discharge on the major dimensions of the Brief Psychiatric Rating Scale. For a sample of 52 inpatients, 17 with schizophrenia, 27 with major depression, and 8 with bipolar (manic) disorder, we investigated the prognostic utility of these Millon scales for identifying clinical improvement. Findings indicated that, while the Millon scales identified admission levels of psychopathology on three Brief Psychiatric Rating Scales, the Millon inventory predicted clinical improvement on only the brief rating of Thinking Disturbance. These findings are considered in light of prognosis as a clinical research question that is distinct from diagnostic discrimination and case identification.

Neuropsychological prognosis and clinical recovery

This report examines prognostic implications of neuropsychological deficit for clinical symptomatic improvement. Neuropsychological performance levels are related to the Brief Psychiatric Rating Scale thinking disturbance, paranoid disturbance, withdrawal/retardation, and anxiety/depression scales at hospital admission and discharge in 68 schizophrenic and psychotic and nonpsychotic mood disorder patients. Findings indicate a relationship between neurocognitive deficit and thinking disturbance at admission; however, neuropsychological impairment predicts blunted affect/emotional withdrawal at discharge, after the acute psychopathology resolves. Neuropsychological deficit is nonspecific, occurring across a broad range of cognitive-perceptual functions. These data suggest that neuropsychological dysfunction may be prognostic of a more chronic residual disorder in both schizophrenia and major psychotic and nonpsychotic mood disorder syndromes.

Disordered thinking and cerebral dysfunction: laterality effects, language, and intellectual functions

This report examines two types of thought disorder, bizarre-idiosyncratic thinking and concreteness, in relation to cerebral impairment and psychotropic medication status. Results do not support lateralized dysfunction as a contributing factor for either form of thought disorder. Relationships between specific areas of neuropsychological deficit and thought disorder indicate that intellectual and arithmetic functions are more closely associated with bizarre-idiosyncratic thinking. Further, there were no specific neuropsychological impairments related to concrete thinking, nor was medication status related to either type of thought disorder. Problem-solving or reasoning affects logical orderly cognitive processes more reliably than it affects abstract thinking. Differences between these findings and other research are discussed from the standpoint of how both types of thought disorder are conceptualized and assessed, and how this may influence clinical indications for the use of psychoactive medications.

Differentiating neuropathology from psychopathology with longitudinal and retrospective data: report of a case

This case study report of diagnostic psychological testing considers the implications of a 53-point verbal-performance IQ differential, with the benefit of neuropsychological and neuroradiologic imaging studies, a 6-month follow-up Wechsler Adult Intelligence Scale-Revised (WAIS-R; Wechsler, 1981) evaluation, and retrospective examination of early school records and test findings. The approach highlights the limitations of cross-sectional clinical studies in differential diagnosis, particularly when both psychodynamic and neuropsychological factors are at issue. This report demonstrates how an early acquired neurodevelopmentally based deficit can alter or restructure the appearance of adult cognitive-perceptual functions. Further, early neurodevelopmental impairment is considered from the standpoint of its influence on compromised autonomous ego functions.

Differential rate of neuropsychological dysfunction in psychiatric disorders: comparison between the Halstead-Reitan and Luria-Nebraska batteries

This report examined the rate of agreement between scores of the Halstead-Reitan and Luria-Nebraska Neuropsychological Batteries in the classification of impaired and nonimpaired performance of 55 schizophrenic and 64 affective disorder patients: 65.2% for schizophrenics and 67.5% for those with affective disorder, with greater impairment on the Halstead-Reitan battery.

Prognostic significance of cerebral status: dimensions of clinical outcome

This report examines the relationship between a set of neurobehavioral predictor variables (premorbid cognitive-perceptual abilities, sensorimotor functions, and complex integrative skills) and three dimensions of clinical outcome (social outcome, work functioning, and rehospitalization) 2 years after discharge from inpatient treatment for a group of psychiatric disorders. Results indicated the strongest relationship was between premorbid ability levels and work performance, particularly maintaining stability of employment or work role function. This finding is discussed from the standpoint of neurological processes underlying early acquisition of basic cognitive-perceptual skills in the prediction of outcome.

Two types of thought disorder and lateralized neuropsychological dysfunction

This report examined positive and negative thought disorder in relation to medication status and cerebral lateralization measures obtained from the Halstead-Reitan Neuropsychological Battery and Wechsler Adult Intelligence Scale in a sample of 59 patients with schizophrenia, schizoaffective and manic disorders, and unspecified functional psychoses. Discriminant function analyses of comparable left- and right-hemisphere variables from the neuropsychological tests were examined for both types of thought disorder, in which presence or absence of psychotropic medications was included as a variable in each analysis. Results indicated a relationship between positive thought disorder and left- but not right-hemisphere variables. Both the left- and right-hemisphere variables were related to negative thought disorder, and these relationships were influenced by the global measures of verbal and performance IQ as well as by medication status. These findings provide qualified support for the left-hemisphere-dysfunction hypothesis, insofar as it is associated specifically with positive thought disorder. Diffuse or bilateral cerebral impairment is more characteristic of negative thought disorder; however, medication status is also equivalent to neuropsychological variables in influencing this relationship.

Current conceptualizations of psychiatric illnesses as neurological disorders

This paper reviews a recent body of evidence from computed tomography, imaging methods, and neuropsychological testing, emphasizing schizophrenia. The review indicates important characteristics of this disorder that can be conceptualized as similar to neurological disorders, and that have a probable neuropathologic basis. Although the argument is compelling in many respects, cautionary observations are also discussed, and a need for positioning subgroups based on neurological etiology is advanced. This serves as an introduction to a discussion of neurological diseases as potential models for psychiatric disorders.

Intelligence and neuropsychological functioning in psychiatric disorders

The present report examines consistency across four psychiatric conditions (schizophrenia, schizoaffective disorder, manic disorder, and depression) on neuropsychological dysfunction assessed by two different instruments, the Halstead-Reitan and Luri-Nebraska batteries, in relation to WAIS-IQ. Results indicated that the impairment scale from the Luria-Nebraska has a stable relationship to IQ across diagnostic groups. In contrast, the impairment index from the Halstead-Reitan battery shows a diagnosis-dependent relationship. Schizophrenics, schizoaffective and manic disorder subjects show a more uniform linear relationship. This is contrary to expectation given Halstead's (1947) distinction between "biological" and psychometric intelligence. The findings are discussed from the standpoint of clinical severity and outcome associated with contemporary diagnostic formulations of nonschizophrenic affective disorders.

Lateralized cerebral dysfunction in schizophrenia and depression: gender and medication effects

The neuropsychological functioning of 52 schizophrenic and 39 major depressive patients was examined using the four Luria-Nebraska Neuropsychological Battery lateralization scales, with the effects of gender and medication status examined alone and in interaction with diagnosis and laterality variables. Comparisons between the diagnostic groups revealed that gender influences some aspects of neuropsychological performance, particularly those involving bilateral complex cognitive-perceptual rather than sensorimotor skills. This effect was more distinct for depressives than schizophrenics when cerebral lateralization differences were present. There was no significant left hemisphere disadvantage for schizophrenics which was gender-related. Medication status revealed no appreciable effects for depressives, although both male and female schizophrenics receiving neuroleptics showed a greater degree of complex perceptual-cognitive dysfunction compared to unmedicated schizophrenics. Level of cerebral impairment was equivalent for the right and left hemispheres for both groups. Consequently, these data are not consistent with other findings demonstrating differential hemispheric disadvantages between schizophrenia and depression.

Personality trait characteristics in relation to neuropsychological dysfunction in schizophrenia and depression

Knowledge of the personality trait and psychopathology variables that differentiate neuropsychologically impaired and nonimpaired psychiatric patients has been limited relative to the study of higher cortical functions. This study reports findings from the Millon Clinical Multiaxial Inventory (MCMI) developed by Millon (1982) in a sample of hospitalized schizophrenics and depressives who also received the Luria-Nebraska Neuropsychological Battery. The principal findings indicate that neuropsychological dysfunction may be related to substance abuse, including its underlying personality dimensions, in schizophrenia, but only modest support is indicated for the construct of negative symptoms in schizophrenics with neuropsychological dysfunction. Further, the findings do not support the view that psychosis is a characteristic feature of depressives with impaired neuropsychological performance.

Differential patterns of neuropsychological deficit in psychiatric disorders

This report investigated differential cerebral impairment on the Luria-Nebraska Neuropsychological Battery in schizophrenia, schizoaffective, and depressive disorders (N = 106). Results indicated impaired tactile-stereognostic processing in schizoaffective and depressive disorder patients and verbal memory deficits in the schizophrenic and schizoaffective disorder patients. These findings question the specificity of functional neuropsychological deficit areas in schizophrenia and depression.

Neuropsychological test performance among major clinical subtypes of depression

Thirty-six patients with diagnoses of major depression were administered the Luria-Nebraska Neuropsychological Battery. Comparisons were made on six dichotomous subtypes of depression: agitated-nonagitated, endogenous-nonendogenous, primary-secondary, psychotic-nonpsychotic, retarded-nonretarded, and unipolar-bipolar. The psychotic depressives were more impaired than the nonpsychotics on the Profile Elevation and Impairment scales. No differences were found for other subtype comparisons on these global measures of neuropsychological dysfunction. Analysis of age effects indicated that older depressives performed more slowly on timed performance items and significant subtype differences on these items occurred for subtype diagnoses of psychotic, primary, and retarded depression. Localization and Lateralization scales revealed significant impairment for the psychotic and retarded patients, with less impairment for other subtypes. The relevance of these findings for neuropsychological evaluation are discussed, particularly with regard to the potentially confounding effects of depression on test performance.

A longitudinal study of thought disorder in manic patients

To study the persistence of thought disorder in manic patients, 34 manic patients were compared with 30 schizophrenic and 30 nonpsychotic patients on four indexes of thought pathology at two phases of disorder: during the acute inpatient phase and one year after hospitalization. Patients were also compared with a control sample of 34 normal subjects. The data indicated that during the acute in hospital phase, both manic and schizophrenic patients were severely thought disordered; at follow-up, a subsample of manic patients showed severe thought disorder; despite the severe thought disorder found at follow-up in some manic and schizophrenic patients, both groups showed a significant reduction of thought pathology at follow-up; and there was a trend for a larger reduction of thought disorder in manic than in schizophrenic patients. The difference, however, was not significant when initial levels of severity were controlled.

Neuropsychological dysfunction in schizophrenia. Relation to associative thought disorder

Recent evidence suggests that cerebral atrophy with cognitive deficits is associated with negative schizophrenic symptoms, including poverty of speech and speech content. This report investigates the relationship between specific measures of neuropsychological dysfunction and four major indices of associative thought disorder in schizophrenia, to ascertain whether neuropsychologically impaired schizophrenics show more associative disturbance than neuropsychologically intact schizophrenics. Twenty neuropsychologically intact and 12 impaired schizophrenics, rigorously diagnosed by the Research Diagnostic Criteria, were administered the Luria-Nebraska Neuropsychological Battery. These two groups of schizophrenics were compared on a continuous word-association test, which included two nonverbal and two verbal measures of associative disturbance. The neuropsychologically impaired schizophrenics had slower reaction times (p less than .05), but did not differ from the neuropsychologically intact schizophrenics on the verbal measures. Results indicated a stronger relationship between neuropsychological functions and the nonverbal dimensions (p less than .02), than with the verbal measures. This challenges the assumption that a left hemisphere abnormality in schizophrenia is particularly associated with cognitive disturbance, and suggests that neuropsychologically impaired schizophrenics may show greater potential for negative schizophrenic symptoms.

Examining the Chapman and Chapman theory of schizophrenia through continuous word association with two nosological systems

Examined the Chapman and Chapman (1973) theory of excessive yielding to normal response biases in schizophrenia by using the technique of continuous word association. The word association stimulus list included items with single and multiple meanings (homographs) in order to investigate differential response characteristics between single- and multiple-meaning items and the relative neglect of nondominant meaning responses. Several word association variables were examined, including logical relatedness, reaction time, and response productivity. Further, two discrete samples were studied: A DSM-II-diagnosed sample of schizophrenic and non-schizophrenic Ss (N = 61) and a sample (N = 60) diagnosed according to the more contemporary Research Diagnostic Criteria of Spitzer, Endicott, and Robins (1978) with schizophrenic, manic, and schizoaffective disorder diagnoses. Results were not in accord with predictions derived from the Chapmans' theory using either diagnostic approach.

Word association: multiple measures and multiple meanings

Investigated the interrelationships between reaction time and three major verbal word association variables (response commonality, idiosyncratic responses, and degree of logical relatedness) in schizophrenics (N = 42) and nonschizophrenic psychiatric controls (N = 30). This study investigated the degree to which these four measures assess similar or different components of associative thought disorder in the same Ss, using both verbal associative measures and a nonverbal performance measure. Results indicated that reaction time was largely independent of all verbal measures in schizophrenics. These data were discussed in regard to the meaning and interpretation of word association test data as a function of choice of dependent variables for measuring associative thought disturbance.

Goal-directed thinking in schizophrenics' associations

The relationships between associative structure and higher order cognitive processes in schizophrenia were investigated with a continuous word association technique. The chaining hypothesis involves the derailment of organized thought by response-produced stimuli, and the continuity hypothesis postulates a progressive disorganization of connotative meaning. Neither hypothesis was confirmed, as both schizophrenics and nonschizophrenics maintained the set of guiding responses according to the starting stimuli. Further, both groups showed progressive response disorganization despite the overall higher degree of relatedness in the nonschizophrenics. There was also no differential performance observed when comparing schizophrenics subgrouped by paranoid status and premorbid adjustment.

Associative thinking in schizophrenia: a contextualist approach

Explored the question of whether responses that appeared to be highly pathological on the basis of the word association test did indeed reflect an underlying aberrant associative process or whether the associations actually had a greater degree of meaning than was evident from the test (N = 60). Utilizing contextualist techniques designed by the authors, which were analogous to the word association test but yet measured schizophrenic associative thinking in specific contexts that more closely approximated natural language situations, the quality and purposiveness of the schizophrenics' associations were examined. The word association test technique was judged to be inadequate by itself to account for underlying associative processes involved in schizophrenic associative thought disorder. A majority of responses (70% schizophrenic, 81% nonschizophrenic) judged to be pathological on the basis of the word association test alone became meaningful in the context of a sentence created by the Ss to explain purposively their associations. The schizophrenics' experience of a stimulus word and consequent associations to that word became clearer when placed within an appropriate context (i.e., a sentence), rather than examined as isolated semantic features (as in the word association test).

Inter-relationships among three measures of disordered thinking in continuous word association

This report investigated the inter-relationships among three word-association indices (response commonality, degree of logical relatedness, and idiosyncratic responses) for a continuous word-association test to examine continuous-association procedures as a technique for studying associative thought disorder in schizophrenia. Results indicated high intercorrelations among all measures for both schizophrenics ( n = 42) and nonschizophrenic psychiatric controls ( n = 30). These data provide evidence in support of the utility of the continuous word-association test as an instrument capable of assessing associative disturbance in schizophrenia in a manner similar to the more familiar single word-association test.

Thought pathology in manic and schizophrenic patients. Its occurrence at hospital admission and seven weeks later

To evaluate the extent and persistence of thought pathology in manic patients, 113 manic, schizophrenic, and nonpsychotic patients were assessed at the acute phase, and a subsample was reevaluated seven weeks later. Another subsample of 55 patients was assessed medication free at the acute phase. Three major indices of thought disorder were used. The data indicate that (1) most hospitalized manics are severely thought disordered; (2) hospitalized manics are as thought disordered as schizophrenics; (3) unmedicated manics are as severely thought disordered as unmedicated schizophrenics; (4) both manics' and schizophrenics' thought disorders improve after the acute phase; (5) even after the acute phase, some manics show severe thought pathology. The results support formulations that thought disorder is not unique to schizophrenia. Some factors involved in manic and schizophrenic thought pathology are similar. There may be a general psychosis factor that cuts across psychotic diagnoses.

Schneiderian first-rank symptoms in schizophrenia

Schneider's first-rank symptoms (FRS) are recognized by many psychiatrists worldwide as definitive criteria for establishing the diagnosis of schizophrenia. The relationships between FRS and major aspects of psychopathology were examined. Clinical course and outcome, indices of current functioning and symptom severity, premorbid adjustment, and prognostic indicators were assessed. Major comparisons were made between schizophrenics with FRS at follow-up and schizophrenics with psychotic symptoms exclusive of FRS. Positive findings in select areas of outcome functioning argue for the utility of FRS. However, several findings indicated that FRS were not more effective than non-Schneiderian psychotic symptoms in delineating central characteristics of the schizophrenic syndrome; they may identify a subgroup of schizophrenics with a more chronic course, but they do not appear to have the unique importance or diagnostic specificity that has been accorded them.

Relevance of modern neuropsychology to psychiatry

This review of new developments in clinical neuropsychology is intended to acquaint the practicing psychiatrist with the current status of the field, focusing on its applicability to a variety of psychiatric situations. The approach of Luria is described in some detail, essentially because this represents one of the major formulations of the functional organization of the brain, which is now available for standardized assessment purposes as the Luria-Nebraska Neuropsychological Battery. At this juncture, it is relevant for psychiatry to gain familiarity with these new approaches, as an important adjunct to the diagnostic, therapeutic, and prognostic problems of brain damage in the psychiatric patient.

Auditory misperceptions of word-association stimuli in schizophrenia

This study examined whether auditory misperception of stimulus words on a word-association test can account for idiosyncratic responses of 37 schizophrenics. Results indicated performance comparable to 19 nonschizophrenics' under conditions of auditory and visual presentation, and thus did not support the position that mishearing of stimuli artifactually increased associative thought disturbance.

Decay and interference processes in short-term retention of normal and brain-damaged patients

The present study examined decay and interference mechanisms in short-term verbal retention in brain damaged patients with and without clinical memory impairment. Petersons' distractor technique was modified for this purpose. Results indicated that decay and impaired consolidation of memory traces was greater in organic amnesics, accounting for a greater degree of forgetting than proactive interference. Absence of an interference function is discussed in terms of the modified technique utilizing repeated trials to recall and more rigorously eliminating covert rehearsal, in addition to employing a more representative sample of organic amnesics than in provious studies.

First-rank symptoms in the postacute schizophrenic: a follow-up study

Schneider's diagnostic system of first-rank symptoms (FRS) is acknowledged by psychiatrists throughout the world as a decisive basis for the diagnosis of schizophrenia. Recently, the author's and others' works have challenged this view. This report examines the relationship between FRS, psychotic symptoms, prognosis, and outcome at the postacute stage. The assessment of FRS was made from an interview schedule (a modification of the Wing Present State Examination) developed for the systematic assessment of psychotic symptoms. The results question the utility of FRS as a primary diagnostic approach to schizophrenia, suggesting that Schneider's system may not be superior to other diagnostic approaches.

Is modern-day schizophrenic outcome still negative?

To evaluate formulations about more positive outcome in modern-day schizophrenic patients, the authors assessed 132 young patients 2.7 years after hospital discharge. Despite modern treatment techniques, only 14%-17% of the 79 schizophrenic patients in the study group were functioning effectively without relapses; 50% had adjusted very poorly. The schizophrenic patients were functioning significantly more poorly than the nonschizophrenic patients in all areas (p less than .01), showing poor adjustment, high symptom levels, and high rehospitalization rates. The two major acute subgroups (schizo-affective and acute schizophrenic patients) were functioning better than those with paranoid and chronic schizophrenia. Overall, the authors conclude, diagnosis carries prognostic implications. Schizophrenic outcome is more favorable today than it was in Bleuler and Kraepelin's era, but it is still relatively negative.

Psychotic symptoms in schizophrenia after the acute phase

Sixty schizophrenic and 34 nonschizophrenic patients were assessed 3 years after discharge on 17 types of psychotic symptoms. Schizophrenics were significantly higher than nonschizophrenic patients on the overall index of psychotic features (p less than .01) and on the index of delusions (p less than .01). Using a weighted estimate, 38.5 percent of the nonparanoid schiziphrenics showed clear evidence of psychotic features, and another 20.5 percent showed some evidence of psychotic features which were weak or sporadic or which the patients seemed able to bring into perspective. Schizophrenic subdiagnosis did not predict later psychotic sysmptoms, although there was a trend for more psychotic features in paranoid and in chronic schizophrenics. The belief that psychotic symptoms in schiziphrenia are not just temporary states was supported. However, conceptions about psychotic symptoms persisting in all schizophrenics were not affirmed.