The clinical features, course, aetiology, epidemiology, differential diagnosis and management of Asperger's syndrome are described. Classification is discussed and reasons are given for including the syndrome, together with early childhood autism, in a wider group of conditions which have, in common, impairment of development of social interaction, communication and imagination.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291700053332

Asperger's syndrome: a clinical account.

The relationships between symptoms in 40 schizophrenic patients, selected for persistence of symptoms, were examined. The symptoms segregated into three syndromes: psychomotor poverty (poverty of speech, lack of spontaneous movement and various aspects of blunting of affect); disorganisation (inappropriate affect, poverty of content of speech, and disturbances of the form of thought); and reality distortion (particular types of delusions and hallucinations). Both the psychomotor poverty and disorganisation syndromes were associated with social and occupational impairment; in particular, the psychomotor poverty syndrome was associated with impairment of personal relationships, and the disorganisation syndrome with poor self-care and impersistence at work.

The symptoms of chronic schizophrenia. A re-examination of the positive-negative dichotomy.

Objective: The relationship between cognition and outcome in people with schizophrenia has been established in studies that, for the most part, examined chronic patients and were cross-sectional in design. The purpose of this study was to analyze the relationships between neurocognitive variables assessed at illness onset and functional outcome in a longitudinal design. An additional area of interest was whether the severity of negative symptoms would predict outcome independently from neurocognitive variables or whether there would be an overlap in their predictive power. Method: The authors administered a comprehensive cognitive battery and clinical assessments to 99 subjects who were in their first episode of illness and analyzed the relationship of cognition and symptom severity at intake with community outcome after an average follow-up period of 7 years. Results: Verbal memory, processing speed and attention, and the severity of negative symptoms at intake were related to subsequent outcome. Global psychosocial functioning was predicted by negative symptoms and attention. Verbal memory was the significant predictor of the degree of impairment in recreational activities. Impairment in relationships was predicted by negative symptoms and memory, whereas attention and negative symptoms were predictive of work performance. There was an overlap in the variance in outcome explained by cognitive variables and negative symptoms. Conclusions: Verbal memory and processing speed and attention are potential targets for psychosocial interventions to improve outcome. Results from cross-sectional or chronic patient studies do not necessarily correspond to the findings of this prospective first-episode study in which cognition appears to explain less of the variance in outcome.

Predictive Values of Neurocognition and Negative Symptoms on Functional Outcome in Schizophrenia: A Longitudinal First-Episode Study With 7-Year Follow-Up

Background. Schizophrenia has a high natural mortality of a largely environmental aetiology. There is, however, little research about possible risk factors. This study measured the diet, cigarette and alcohol use, exercise and obesity of a cohort of people with schizophrenia and compared results to general population rates.Methods. Semi-structured interview using validated research instruments on 102 middle-aged subjects with a diagnosis of schizophrenia, living in the community. Results were compared to general population norms using standard statistical tests.Results. The subjects ate a diet higher in fat and lower in fibre than the general population. They took little exercise but were not significantly more obese. They smoked heavily but drank less alcohol. Most differences remained significant after controlling for social class.Conclusions. People with schizophrenia have an unhealthy lifestyle, which probably contributes to the excess mortality of the disease. They are therefore an appropriate target group for health promotion interventions.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291798008186

The unhealthy lifestyle of people with schizophrenia.

Since its development, the Strengths and Difficulties Questionnaire (SDQ) has been widely used in both research and practice. The SDQ screens for positive and negative psychological attributes. This review aims to provide an overview of the psychometric properties of the SDQ for 4- to 12-year-olds. Results from 48 studies (N = 131,223) on reliability and validity of the parent and teacher SDQ are summarized quantitatively and descriptively. Internal consistency, test-retest reliability, and inter-rater agreement are satisfactory for the parent and teacher versions. At subscale level, the reliability of the teacher version seemed stronger compared to that of the parent version. Concerning validity, 15 out of 18 studies confirmed the five-factor structure. Correlations with other measures of psychopathology as well as the screening ability of the SDQ are sufficient. This review shows that the psychometric properties of the SDQ are strong, particularly for the teacher version. For practice, this implies that the use of the SDQ as a screening instrument should be continued. Longitudinal research studies should investigate predictive validity. For both practice and research, we emphasize the use of a multi-informant approach.

/pdf/psychometric-properties-of-the-parent-and-teacher-versions-x86czyeqey.pdf

Psychometric Properties of the Parent and Teacher Versions of the Strengths and Difficulties Questionnaire for 4- to 12-Year-Olds: A Review

BACKGROUND Following the development of a child and adolescent version of the Health of the Nation Outcome Scales (HoNOSCA), field trials were conducted to assess their feasibility and acceptability in routine outcome measurement.

AIMS To evaluate the reliability, validity and acceptability of HoNOSCA in routine outcome measurement.

METHOD Following training, 36 field sites provided ratings on 1276 cases at one time point and outcome data on 906. Acceptability was assessed by way of written feedback and at a debriefing meeting.

RESULTS HoNOSCA demonstrated satisfactory reliability and validity characteristics. It was sensitive to change and its ability to measure change accorded with the clinicians' independent rating. HoNOSCA was reasonably acceptable to clinicians' from a range of disciplines and services.

CONCLUSIONS Provided that training needs can be met, HoNOSCA represents a satisfactory brief outcome measure which could be used routinely in child and adolescent mental health services.

Brief scale for measuring the outcomes of emotional and behavioural disorders in children. Health of the Nation Outcome Scales for children and Adolescents (HoNOSCA).

A simple classification of chronicschizophrenia, based on ratings of mental symptoms made at a standard interview, has been shown to have satisfactory reliability as between raters, and to be relatively stable over time. Scores representing different types of social behaviour provide some validity for the classification.

A Simple and Reliable Subclassification of Chronic Schizophrenia

I. Problems with disruptive, antisocial or aggressive behaviour Include behaviour associated with any disorder, such as hyperkinetic disorder, depression, autism, drugs or alcohol. Include physical or verbal aggression (e.g. pushing, hitting, vandalism, teasing), or physical or sexual abuse of other children. Include antisocial behaviour (e.g. thieving, lying, cheating) or oppositional behaviour (e.g. defiance, opposition to authority or tantrums). Do not include overactivity rated at Scale 2. Truancy, rated at Scale 13, selfharm rated at Scale 3.

Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). Glossary for HoNOSCA score sheet.

BACKGROUND Health of the Nation Outcome Scales (HoNOS) have been developed to measure of outcomes in people with mental health problems.

AIMS The particular physical and cognitive problems affecting older people requires a specific scale for their measurement. We describe the development of such a scale, named HoNOS 65+.

METHOD Pilot, validity and reliability studies were carried out on an amended scale. Validity was assessed by comparison with existing scales reflecting depression, cognitive function, psychiatric symptomatology, activities of daily living and functional abilities. Reliability was measured in two centres.

RESULTS HoNOS 65+ was successfully amended to include specific aspects of mental health problems in older people including the phenomenology of depression, delusions occurring in the presence of dementia, incontinence and agitation/restlessness. HoNOS 65+ was able to discriminate between people suffering from organic and functional illnesses. Correlations with other scales indicated reasonable validity. Reliability was satisfactory.

CONCLUSIONS Aversion of HoNOS 65+ is presented (see pp. 435-438, this issue) which is appropriate for use in elderly people with mental health problems.

J. K. Wing

Papers

Brief scale for measuring the outcomes of emotional and behavioural disorders in children. Health of the Nation Outcome Scales for children and Adolescents (HoNOSCA).

A Simple and Reliable Subclassification of Chronic Schizophrenia

Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). Glossary for HoNOSCA score sheet.

Health of the Nation Outcome Scales for elderly people (HoNOS 65

Reasoning about madness