Schizophrenia patients are more emotionally active than is assumed based on their behavior

Flat affect is a core symptom of schizophrenia. To date, researchers have focused primarily on emotional expression. Only recently has the emotional experience of patients with schizophrenia been studied in laboratory settings. The goal of this study is to assess emotional experience in the complex world of daily life. A structured time-sampling technique, the Experience Sampling Method, was used to collect data. Schizophrenia subjects (n = 58) were compared to 65 nonpatient controls. Patients were divided into blunted and nonblunted subgroups on the basis of Brief Psychiatric Rating Scale (BPRS) behavioral ratings of flat affect. Schizophrenia subjects experienced more intense and more variable negative emotions than controls. For the positive emotions, we found less intensity and less variability in the schizophrenia subjects. No difference in patterns of affect was found between the blunted and the nonblunted schizophrenia subgroups. Our findings suggest that patients with schizophrenia are more emotionally active than has been assumed based on behavioral observations.

Quality of life in depression: daily life determinants and variability

Identifying daily influences on subjective well-being can be helpful in understanding the burden of depression. This study used experience sampling methodology (ESM) to examine the contribution of mood states, physical complaints and enjoyment of activities to a momentary measure of quality of life (mQoL), assessed by responses to the question 'In general, how is it going with you right now?' Sixty-three depressed and 22 healthy control subjects completed ESM self-reports during daily activities, 10 times per day for 6 days. In comparison to control subjects, depressed subjects had lower levels of mQoL, positive mood, and enjoyment of activity, higher negative mood, and more frequent and severe complaints. Depressed subjects were more likely than control subjects to be doing nothing and less likely to be engaged in work. Multilevel regression analysis showed that positive mood and enjoyment of the current activity were associated with higher mQoL, whereas negative mood and complaints were associated with lower mQoL. In depressed subjects, mQoL was more variable over time than in control subjects. In contrast to the ESM results, only negative mood and depression were significant predictors of global measures of QoL. We conclude that QoL has important situational determinants that can in part explain the impact of depression on daily functioning and well-being.

Depression in Europe. Geographical distribution among older people

BACKGROUND

This is the first report of results from the EURODEP Programme.

AIMS

To assess the prevalence of depression judged suitable for intervention in randomised samples of those aged > or = 65 in nine European centres.

METHOD

The GMS-AGECAT package.

RESULTS

Differences in prevalence are apparent, 8.8% (Iceland) to 236% (Munich). When sub-cases and cases are added together, five high- and four low-scoring centres emerge. Women predominated over men. Proportions of sub-cases to cases revealed striking differences but did not explain prevalence. There was no constant association between prevalence and age. A meta-analysis (n = 13,808) gave an overall prevalence of 12.3%, 14.1% for women and 8.6% for men.

CONCLUSIONS

Considerable variation occurs in the levels of depression across Europe, the cause for which is not immediately obvious. Case and sub-case levels taken together show greater variability, suggesting that it is not a matter of case/sub-case selection criteria, which were standardised by computer. Substantial levels of depression are shown but 62-82% of persons had no depressive level. Opportunities for treatment exist.

Auditory hallucinations: a comparison between patients and nonpatients

The form and the content of chronic auditory hallucinations were compared in three cohorts, namely patients with schizophrenia, patients with a dissociative disorder, and nonpatient voice-hearers. The form of the hallucinatory experiences was not significantly different between the three groups. The subjects in the nonpatient group, unlike those in the patient groups, perceived their voices as predominantly positive: they were not alarmed or upset by their voices and felt in control of the experience. In most patients, the onset of auditory hallucinations was preceded by either a traumatic event or an event that activated the memory of earlier trauma. The significance of this study is that it presents evidence that the form of the hallucinations experienced by both patient and nonpatient groups is similar, irrespective of diagnosis. Differences between groups were predominantly related to the content, emotional quality, and locus of control of the voices. In this study the disability incurred by hearing voices is associated with (the reactivation of) previous trauma and abuse.

Risks for oral health with the use of antidepressants

In this article, attention is focused on oral pathology, particularly dental caries, caused by hyposalivation as a consequence of (long-term) use of antidepressants. Changes in clinical psychiatric practice and increasing numbers of prescriptions of antidepressants in primary care and specialty care settings have made awareness of this risk even more relevant than in the past. Normal physiology of salivary glands and changes in the secretion of saliva during use of antidepressants are described. Monitoring, prevention, and treatment of hyposalivation induced by antidepressants are encouraged as an adjunct in the clinical management of depression.

Time, context, and subjective experiences in schizophrenia

Systematic investigations into the experience of schizophrenic patients as they react and adapt to social environments are rare. Yet such information is extremely useful for understanding the psychopathology of schizophrenia, the planning of treatments, as well as for creating optimal treatment and living environments. In this study, dynamic fluctuations of mental state, social context, and experience in the daily life of schizophrenic patients were measured. Data were collected using the Experience Sampling Method on nine schizophrenic subjects and seven nonpsychiatric controls. Schizophrenic patients spent more time alone than normal--a difference that was largely created by the subsample of outpatients; hospitalized patients were less alone. As a group, the patients felt best when they were with one to three persons. The most troublesome condition reported was being alone or being in the company of more than three people. Three cases are presented to illustrate the individual variability of subjects' experience.

Psychotherapeutic outcome: measuring reliable clinical change

Psychotherapeutic research is generally carried out to investigate the effectiveness of specific techniques with selected, often homogeneous samples of patients. This leads to problems when applying research findings to the clinical reality where the patient population is heterogeneous. In this study, we examine psychotherapy outcome in a natural treatment setting using criteria established by Jacobson and his colleagues for measuring improvement in psychotherapy, reliable change and clinical significance. Outcome was evaluated in a sample of 117 Dutch ambulatory mental health center patients with the SCL-90 Symptom Checklist and the Target Complaints List. On both instruments improvement rates varied greatly and were only moderately correlated. Our findings suggest that a more limited application of the Jacobson criteria derived from selected samples is warranted when applied in a general patient population.

The daily life of ambulatory chronic mental patients

The purpose of this research is to describe in greater detail than is typically done the daily life experiences of 11 ambulatory chronic mental patients and 11 nonpsychiatric controls. The subjects, although diagnostically heterogeneous, were representative of Dutch chronic mental patients. The Experience-Sampling Method was used to signal subjects randomly 10 times a day for 6 consecutive days to fill out self-rating forms assessing mental state and contextual information at the moment of the signal. Compliance was good. In time-allocation comparisons with nonpsychiatric subjects the patients were found to live relatively "normal" lives. As expected, their psychopathology was influenced by social environments such as being alone, at home, or in society at large. Contrary to other studies that stress the social isolation of such individuals, the chronic subjects reported feeling better away from home and among people than normal subjects. When alone, chronic patients reported daydreaming more and noted a tendency to drift away from thoughts about current activities. Mental state fluctuations and daily interactions, characteristic of this group, are examined in relation to theories of vulnerability and coping style of chronic mental patients, with an eye to individualized treatment applications.

Investigating mental disorders in their natural settings

This issue of The Journal of Nervous and Mental Disease reports fundamental research into the nature of mental disorders, using both new and traditional time-sampling approaches. The studies present convincing findings gathered in a variety of patient populations and demonstrate the utility of using quantitative and replicable methods in psychiatric research and clinical care. Research that adequately describes the person in context as well as the influence of situations on mental state has proved difficult. Methods such as the diary and Experience-Sampling Method that explore experiences in daily life overcome some of the shortcomings of previous psychiatric research strategies, such as reliance on retrospective recall and the failure to take the variability of mental state more fully into account. The studies in this issue introduce techniques for creating a data base for psychiatric research and clinical practice that is anchored in patient experience and behavior.

Temperament and infant mortality among the Masai of East Africa

On the basis of Western studies suggesting that infants with difficult temperaments are at greater risk for behavioral and physical disorders, the author postulated that Masai infants with difficult temperaments would be at greater risk in the harsh environment created by the sub-Saharan drought in 1974, which disrupted the life of the Masai people of East Africa and resulted in increased infant mortality. Two groups of infants with difficult and easy temperaments were defined and followed. Contrary to expectations, mortality was greater for the infants with easy temperaments. The infant's contribution, child-rearing orientation, and feeding practices were factors influencing survival.

Cultural relativity of toilet training readiness: a perspective from East Africa

Ideas about infant capabilities and toilet training practice have changed in the United States following cultural trends and the advice of child care experts. Anthropologists have shown that a society's specific infant training practices are adaptive to survival and cultural values. The different expectations of infant behavior of the East African Digo produces a markedly different toilet training approach than the current maturational readiness method recommended in America. The Digo believe that infants can learn soon after birth and begin motor and toilet training in the first weeks of life. With a nurturant conditioning approach, night and day dryness is accomplished by 5 or 6 months. The success of early Digo training suggests that sociocultural factors are more important determinants of toilet training readiness than is currently thought.