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Schizophrenia

  • Stephen J. Bartels
  • Kim T. Mueser
  • Keith M. Miles
Chapter
Part of the The Springer Series in Adult Development and Aging book series (SSAD)

Abstract

Schizophrenia is a severe and frequently debilitating illness that affects one percent of the population (Gurland & Cross, 1982). Not surprisingly, there is a substantial literature of the phenomenology, course, biology, and treatment of schizophrenia in young adults. However, there is a remarkable lack of data on this disorder in late life. In this chapter we provide an overview of the clinical features of schizophrenia and aging. First, we will discuss changing views on the onset and outcome of schizophrenia, including features of early- and late-onset schizophrenia in the elderly. Next, we will discuss factors that appear to be important in the long-term outcome of schizophrenia, including the role of age cohorts, family resources, antipsychotic medication, and medical comorbidity. Finally, we will outline the elements of a strategy for the treatment of schizophrenia in the elderly based on the application of a comprehensive biopsychosocial model.

Keywords

Negative Symptom Schizophrenic Patient Antipsychotic Medication Severe Mental Illness Tardive Dyskinesia 
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References

  1. Abramowitz, I. A., & Coursey, R. D. (1989). Impact of an educational support group on family participants who take care of their schizophrenic relatives. Journal of Consulting and Clinical Psychology, 57 232–236.PubMedGoogle Scholar
  2. Almeida, O. P., Förstl, H., Howard, R., & David, A. S. (1993). Unilateral auditory hallucinations. British Journal of Psychiatry, 162 262–264.PubMedGoogle Scholar
  3. Almeida, O. P., Howard, R. J., Levy, R., & David, A. (1995a). Psychotic states arising in late life (late paraphrenia): The role of risk factors. British Journal of Psychiatry, 166 215–228.PubMedGoogle Scholar
  4. Almeida, O. P., Howard, R. J., Levy, R., & David, A. (1995b). Psychotic states arising in late life (late paraphrenia): Psychopathology and nosology. British Journal of Psychiatry, 166 205–214.PubMedGoogle Scholar
  5. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.) Washington, DC: Author.Google Scholar
  6. Bartels, S. J. (1989). Organic mental disorder: When to suspect medical illness as a cause of psychiatric symptoms. In J. M. Ellison (Ed.), Psychopharmacology: A primer for the psychotherapist (pp. 205–239). Chicago: Year Book Medical Publishers.Google Scholar
  7. Bartels, S. J., & Drake, R. E. (1988). Depressive symptoms in schizophrenia: Comprehensive differential diagnosis. Comprehensive Psychiatry, 29 467–483.PubMedGoogle Scholar
  8. Bartels, S. J., & Drake, R. E. (1989). Depression in schizophrenia: Current guidelines to treatment. Psychiatric Quarterly 60, 333–345.Google Scholar
  9. Bartels, S. J., & Liberto, J. (1995). Dual diagnosis in the elderly. In A. F. Lehman & L. B. Dixon (Eds.), Double jeopardy: Chronic mental illness and substance use disorders (pp. 139–158). Chur, Switzerland: Harwood Academic.Google Scholar
  10. Bartels, S. J., Drake, R. E., Wallach, M. A., & Freeman, D. H. (1991). Characteristic hostility in schizophrenic outpatients. Schizophrenia Bulletin, 17 163–171.PubMedGoogle Scholar
  11. Bartels, S. J., Teague, G. B., Drake, R. E., Clark, R. E., Bush, P., & Noordsy, D. L. (1993). Service utilization and costs associated with substance abuse among rural schizophrenic patients. Journal of Nervous and Mental Disease, 181 227–232.PubMedGoogle Scholar
  12. Bartels, S. J., Miles, K. M., Dain, B., & Smyer, M. A. (1998). Community mental health service use by elderly with severe mental illness. Manuscript under review.Google Scholar
  13. Bartels, S. J., Mueser, K. T., & Miles, K. M. (1997). A comparative study of elderly patients with schizophrenia and bipolar disorder in nursing homes and the community. Schizophrenia Be-search, 27(2-3), 181–190.Google Scholar
  14. Bartels, S. J., Mueser, K. T., & Miles, K. M. (1997). Functional impairments in elderly patients with schizophrenia and major affective disorder living in the community: Social skills, living skills, and behavior problems. Behavior Therapy, 28 43–63.Google Scholar
  15. Belitsky, R., & McGlashan, T. H. (1993). The manifestations of schizophrenia in late life: A dearth of data. Schizophrenia Bulletin, 19 683–689.PubMedGoogle Scholar
  16. Bellack, A. S., & Mueser, K. T. (1993). Psychosocial treatment of schizophrenia. Schizophrenia Bulletin, 19,317–336.PubMedGoogle Scholar
  17. Bellack, A. S., Turner, S. M., Hersen, M., & Luber, R. F. (1984). An examination of the efficacy of social skills training for chronic schizophrenic patients. Hospital and Community Psychiatry, 35 1023–1028.PubMedGoogle Scholar
  18. Bellack, A. S., Morrison, R. L., Wixted, J. T., & Mueser, K. T. (1990). An analysis of social competence in schizophrenia. British Journal of Psychiatry, 156 809–818.PubMedGoogle Scholar
  19. Bleuler, M. (1974). The long-term course of the schizophrenic psychoses. Psychological Medicine, 4 244–254.Google Scholar
  20. Brier, A.M., & Strauss, J. S. (1983). Self-control of psychotic behavior. Archives of General Psychiatry, 40 1141–1145.Google Scholar
  21. Brown, G. W., Birley, J. L. T., & Wing, J. K. (1972). Influence of family life on the course of schizophrenic disorders: A replication. British Journal of Psychiatry, 121 241–258.PubMedGoogle Scholar
  22. Bulger, M. W., Wandersman, A., & Goldman, C. R. (1993). Burdens and gratifications of caregiving: Appraisal of parental care of adults with schizophrenia. American Journal of Orthopsychiatry, 63 255–265.PubMedGoogle Scholar
  23. Carr, V. (1988). Patients’ techniques for coping with schizophrenia: An exploratory study. British Journal of Medical Psychology, 61 339–352.PubMedGoogle Scholar
  24. Castle, D., Wessely, S., Der, G., & Murray, R. (1991). The incidence of operationally defined schizophrenia in Camberwell, 1965 to 1984. British Journal of Psychiatry, 159 790–794.PubMedGoogle Scholar
  25. Castle, D. J., & Murray, R. M. (1993). The epidemiology of late-onset schizophrenia. Schizophrenia Bulletin, 19 691–700.PubMedGoogle Scholar
  26. Ciompi, L. (1980). The natural history of schizophrenia in the long term. British Journal of Psychiatry, 336,413–420.Google Scholar
  27. Cohen, C. I. (1993). Poverty and the course of schizophrenia: Implications for research and policy. Hospital and Community Psychiatry, 44 951–958.PubMedGoogle Scholar
  28. Cohen, C. I. (1995). Studies on the course and outcome of schizophrenia in later life. Psychiatric Services, 46 877–889.PubMedGoogle Scholar
  29. Cohen, C. I., & Berk, I. L. (1985). Personal coping styles of schizophrenic outpatients. Hospital and Community Psychiatry, 36 407–410.PubMedGoogle Scholar
  30. Davidson, M., Harvey, P. D., Powchick, P., Parrella, M., White, L., Knobler, H. Y., Losonczy, M. F., Keefe, R. S., Katz, S., & Frecska, E. (1995). Severity of symptoms in chronically institutionalized geriatric schizophrenic patients. American Journal of Psychiatry, 152 197–207.PubMedGoogle Scholar
  31. Dobson, D. J. G., McDougall, G., Busheikin, J., & Aldous, J. (1995). Social skills training and symptomatology in schizophrenia. Psychiatric Services, 46 376–380.PubMedGoogle Scholar
  32. Drake, R. E., Gates, C., Whitaker, A., & Cotten, P. G. (1985). Suicide among schizophrenics: A review. Comprehensive Psychiatry, 26 90–100.PubMedGoogle Scholar
  33. Drake, R. E., Osher, F. C., & Wallach, M. A. (1989). Alcohol use and abuse in schizophrenia: A prospective community study. Journal of Nervous and Mental Disease, 177 408–414.PubMedGoogle Scholar
  34. Dworkin, R. H. (1994). Pain insensitivity in schizophrenia: A neglected phenomenon and some implications. Schizophrenia Bulletin, 20 235–248.PubMedGoogle Scholar
  35. Eisdorfer, C. (1991). Care giving: An emerging risk factor for emotional and physical pathology. Bulletin of the Meninger Clinic, 55 238–247.Google Scholar
  36. Falloon, I., Boyd, J., McGill, C., Razani, J., Moss, H., & Gilderman, A. (1982). Family management in the prevention of exacerbations of schizophrenia. New England Journal of Medicine, 306 1437–1440.PubMedGoogle Scholar
  37. Falloon, I. R. H., & Talbot, R. E. (1981). Persistent auditory hallucinations: Coping mechanisms and implications for management. Psychological Medicine, 11 329–339.PubMedGoogle Scholar
  38. Fischer, W. H. (1996). Mental health services for an aging population: What history cannot teach us in planning for the twenty-first century. In S. M. Sorreff (Ed.), Handbook for the treatment of the seriously mentally Ill (pp. 503–515). Seattle, WA: Hogrefe & Huber.Google Scholar
  39. Glynn, S., Randolph, E., Eth, S., Paz, G., Shaner, A., Strachan, A. (1990). Patient psychopathology and expressed emotion in schizophrenia. British Journal of Psychiatry, 157 877–880.PubMedGoogle Scholar
  40. Goldberg, T. E., Hyde, T. M., Kleinman, J. E., & Weinberger, D. R. (1993). Course of schizophrenia: Neuropsychological evidence for a static encephalopathy. Schizophrenia Bulletin, 19 797–804.PubMedGoogle Scholar
  41. Goldstein, J. M. (1988). Gender differences in the course of schizophrenia. American Journal of Psychiatry, 145 684–689.PubMedGoogle Scholar
  42. Gurland, B. J., & Cross, P. S. (1982). Epidemiology of psychopathology in old age. Psychiatric Clinics of North America, 5 11–26.PubMedGoogle Scholar
  43. Häfher, H., Riecher-Rössler, A., van der Heiden, W., Maurer, K., Fätkenheuer, B., & Löffler, W. (1993). Generating and testing a causal explanation of the gender difference in age at first onset of schizophrenia. Psychological Medicine, 23 925–940.Google Scholar
  44. Harding, C. M., Brooks, G. W., Ashikaga, T., Strauss, J. S., & Breier, A. (1987a). The Vermont longitudinal study of persons with severe mental illness, I: Methodology, study sample, and overall status 32 years later. American Journal of Psychiatry, 144 718–726.PubMedGoogle Scholar
  45. Harding, C. M., Brooks, G. W., Ashikaga, T., Strauss, J. S., & Breier, A. (1987b). The Vermont longitudinal study of persons with severe mental illness. II: Long-term outcome of subjects who retrospectively met DSM-III criteria for schizophrenia. American Journal of Psychiatry, 144 727–735.PubMedGoogle Scholar
  46. Harris, M., & Jeste, D. (1988). Late-onset schizophrenia: An overview. Schizophrenia Bulletin, 14 39–55.PubMedGoogle Scholar
  47. Heaton, R., Paulsen, J. S., McAdams, L. A., Kuck, J., Zisook, S., Braff, D., Harris, M. J., & Jeste, D. V. (1994). Neuropsychological deficits in schizophrenics: Relationship to age, chronicity, and dementia. Archives of General Psychiatry, 51 469–476.PubMedGoogle Scholar
  48. Hegarty J. D., Baldessarini, R. J., Tohen, M., Waternaux, C., & Oepem, G. (1994). One hundred years of schizophrenia: A meta-analysis of the outcome literature. American Journal of Psychiatry, 151 1409–1416.PubMedGoogle Scholar
  49. Herbert, M., & Jacobson, S. (1967). Late paraphrenia. British Journal of Psychiatry, 113 461–469.PubMedGoogle Scholar
  50. Herz, M. I. (1985). Prodromal symptoms and prevention of relapse in schizophrenia. Journal of Clinical Psychiatry, 46 22–25.PubMedGoogle Scholar
  51. Hogarty, G. E., Anderson, C. M., Reiss, D. J., Kornblith, S. J., Greenwald, D. P., Javna, CD., & Madonia, M. J. (1986). Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. I: One-year effects of a controlled study on relapse and expressed emotion. Archives of General Psychiatry, 43 633–642.PubMedGoogle Scholar
  52. Howard, R., Castle, D., Wessely, S., & Murray, R. (1993). A comparative study of 470 cases of early-and late-onset schizophrenia. British Journal of Psychiatry, 163 352–357.PubMedGoogle Scholar
  53. Huber, G., Cross, G., Schuttler, R., & Linz, M. (1989). Longitudinal studies of schizophrenic patients. Schizophrenia Bulletin, 6 592–605.Google Scholar
  54. Hughes, J. R., Hatsukami, D. K., Mitchell, J. E., & Dahlgren, L. A. (1986). Prevalence of smoking among psychiatric outpatients. American Journal of Psychiatry, 143 993–997.PubMedGoogle Scholar
  55. Jackson, J. H. (1984). Remarks on the evolution and dissolution of the nervous system. Journal of Mental Science, 33 25–48.Google Scholar
  56. Jeste, D. V., Lacro, J. P., Gilbert, P. L., Kline, J., & Kline, N. (1993). Treatment of late-life schizophrenia with neuroleptics. Schizophrenia Bulletin, 19 817–830.PubMedGoogle Scholar
  57. Jeste, D. V., Eastham, J. H., Lacro, J. P., Gierz, M., Field, M. G., & Harris, M. J. (1996). Management of late-life psychosis. Journal of Clinical Psychiatry, 57(Supp. 3), 39–45.PubMedGoogle Scholar
  58. Kane, J., Woerner, M., & Lieberman, J. (1988). Tardive dyskinesia: Prevalence, incidence, and risk factors. Journal of Clinical Psychopharmacology, 8 52–56.Google Scholar
  59. Kane, J., Jeste, D., Barnes, T., Casey, D., Cole, J., Davis, J., Gualtieri, C., Schooler, N., Sprague, R., & Wettstein, R. (1992). Tardive dyskinesia: A task force report of the American Psychiatric Association. Washington, DC: American Psychiatric Association.Google Scholar
  60. Kane, J. M. (1989). Innovations in the psychopharmacologic treatment of schizophrenia. In A. S. Bellack (Ed.), A clinical guide for the treatment of schizophrenia (pp. 43–75). New York: Plenum.Google Scholar
  61. Kane, J. M., & Marder, S. R. (1993). Psychopharmacologic treatment of schizophrenia. Schizophrenia Bulletin, 19 287–302.PubMedGoogle Scholar
  62. Kavanagh, D. J. (1992). Recent developments in expressed emotion and schizophrenia. British Journal of Psychiatry, 160 601–620.PubMedGoogle Scholar
  63. Kay, D., & Roth, M. (1961). Environmental and hereditary factors in the schizophrenias of old age (‘late paraphrenia’) and their bearing on the general problem of causation in schizophrenia. Journal of Mental Science, 107 649–686.PubMedGoogle Scholar
  64. Koran, L. M., Sox, H. C., Marton, K. I., Molzen, S., Sox, C. H., Kraemer, H. C., Imai, K., Kelsy, T. G., Rose, T. G., & Levin, L. C. (1989). Medical evaluation of psychiatric patients. Archives of General Psychiatry, 46 733–740.PubMedGoogle Scholar
  65. Koranyi, E. K. (1979). Morbidity and rate of undiagnosed physical illnesses in a psychiatric clinic population. Archives of General Psychiatry, 36 414–419.PubMedGoogle Scholar
  66. Kraepelin, E. (1971). Dementia praecox and paraphrenia (R. M. Barclay, Trans.). Huntington, NY: Kreiger. (Original work published in 1919)Google Scholar
  67. Leff, J., Kuipers, L., Berkowitz, R., Eberlein-Vries, R., & Sturgeon, D. (1982). A controlled trial of social intervention in the families of schizophrenic patients. British Journal of Psychiatry, 141 121–134.PubMedGoogle Scholar
  68. Lesser, I., Miller, B., Swartz, R., Boone, K., Mehringer, C., & Mena, I. (1993). Brain imaging in late-life schizophrenia and related psychoses. Schizophrenia Bulletin, 19 773–782.PubMedGoogle Scholar
  69. Lewine, R. J. (1988). Gender in schizophrenia. In H. A. Nasrallah (Ed.), Handbook of Schizophrenia (Vol. 3, pp. 379–397). Amsterdam: Elsevier.Google Scholar
  70. Lewine, R. R. J. (1990). A discriminant validity study of negative symptoms with a special focus on depression and antipsychotic medication. American Journal of Psychiatry, 147 1463–1466.PubMedGoogle Scholar
  71. Lewine, R. R. J., Gulley, L. R., Risch, S. C., Jewart, R., & Houpt, J. L. (1990). Sexual dimorphism, brain morphology, and schizophrenia. Schizophrenia Bulletin, 16 195–203.PubMedGoogle Scholar
  72. Liberman, R. P., Mueser, K. T., & Wallace, C. J. (1986). Social skills training for schizophrenic individuals at risk for relapse. American Journal of Psychiatry, 143 523–526.PubMedGoogle Scholar
  73. Liberman, R. P., Mueser, K. T., Wallace, C. J., Jacobs, H. E., Eckman, T., & Massel, H. K. (1986). Training skills in the psychiatrically disabled: Learning coping and competence. Schizophrenia Bulletin, 12 631–647.PubMedGoogle Scholar
  74. Liberman, R. P., DeRisi, W. J., & Mueser, K. T. (1989). Social skills training for psychiatric patients. Needham Heights, MA: Allyn & Bacon.Google Scholar
  75. Light, E., & Lebowitz, B. D. (1991). The elderly with chronic mental illness. New York: Springer.Google Scholar
  76. MacGregor, P. (1994). Grief: The unrecognized parental response to mental illness in a child. Social Work, 39,160–166.PubMedGoogle Scholar
  77. Marder, S. R., Liberman, R. P., Wirshing, W. C., Mintz, J., Eckman, T. A., & Johnston-Cronk, H. (in press). Management of risk relapse in schizophrenia. American Journal of Psychiatry.Google Scholar
  78. Meeks, S., Carstensen, L. L., Stafford, P. B., Brenner, L. L., Weathers, F., Welch, R., & Oltmanns, T. F. (1990). Mental health needs of the chronically mentally ill elderly. Psychology and Aging, 5 163–171.PubMedGoogle Scholar
  79. Meltzer, H. Y. (1990). Clozapine: Mechanism of action in relation to its clinical advantages. In A. Hales, C. N. Stefanis, & J. Talbott (Eds.), Recent advances in schizophrenia (pp. 237–256). New York: Springer-Verlag.Google Scholar
  80. Meltzer, H. Y. (1994). An overview of the mechanism of clozapine. Journal of Clinical Psychiatry, 55 (Suppl. B), 47–52.PubMedGoogle Scholar
  81. Mittelman, M., Ferris, S., Shulman, E., Stenberg, G., Mackell, J., & Ambinder, A. (1994). Efficacy of a multicompont individualized treatment to improve the well-being of AD caregivers. In E. Light, G. Niederehe, & Lebowitz (Eds.), Stress effects on family caregivers of Alzheimer’s patients (pp. 185–204). New York: Springer.Google Scholar
  82. Mittelman, M. S., Ferris, S. H., Shulman, E., Steinberg, G., & Levin, B. (1996). A family intervention to delay nursing home placement of patients with Alzheimer disease: A randomized controlled trial. Journal of American Medical Association, 276(21), 1725–1731.Google Scholar
  83. Moak, G. S. (1990). Discharge and retention of psychogeriatric long-stay patients in a state mental hospital. Hospital and Community Psychiatry, 41 445–448.PubMedGoogle Scholar
  84. Moak, G. S. (1996). When the seriously mentally ill patient grows old. In S. M. Sorreff (Ed.), Handbook for the treatment of the seriously mentally Ill (pp. 279–294). Seattle: Hogrefe & Huber.Google Scholar
  85. Mueser, K. T., & Glynn, S. M. (1995). Behavioral family therapy for psychiatric disorders. Needham Heights, MA: Allyn & Bacon.Google Scholar
  86. Mueser, K. T., Yarnold, P. R., Levinson, D. F., Singh, H., Bellack, A. S., Kee, H., Morrison, R. L., & Yadalam, K. G. (1990). Prevalence of substance abuse in schizophrenia: Demographic and clinical correlates. Schizophrenia Bulletin, 16 31–56.PubMedGoogle Scholar
  87. Mueser, K. T., Douglas, M. S., Bellack, A. S., & Morrison, R. L. (1991). Assessment of enduring deficit and negative symptom subtypes in schizophrenia. Schizophrenia Bulletin, 17 565–582.PubMedGoogle Scholar
  88. Mueser, K. T., Sayers, S. L., Schooler, N. R., Mance, R. M., & Haas, G. L. (1994). A multi-site investigation of the reliability of the Scale for the Assessment of Negative Symptoms. American Journal of Psychiatry, 151 1453–1462.PubMedGoogle Scholar
  89. Mueser, K. T., Wallace, C. J., & Liberman, R. P. (1995). New developments in social skills training. Behavior Change, 12 31–40.Google Scholar
  90. Mueser, K. T., Valentiner, D. P., & Agresta, J. (in press). Coping with negative symptoms of schizophrenia: Patient and family perspectives. Schizophrenia Bulletin.Google Scholar
  91. Mulsant, B. H., Stergiou, A., Keshavan, M. S., Sweet, R. A., Rifai, A. H., Pasternak, R., & Zubenko, G. S. (1993). Schizophrenia in late life: Elderly patients admitted to an acute care psychiatric hospital. Schizophrenia Bulletin, 19 709–721.PubMedGoogle Scholar
  92. Nuechterlein, K. H., & Dawson, M. E. (1984). A heuristic vulnerability/stress model of schizophrenic episodes. Schizophrenia Bulletin, 10 300–312.PubMedGoogle Scholar
  93. Pearlson, G. D., & Rabins, P. V. (1988). The late-onset psychoses—Possible risk factors. Psychiatric Clinics of North America, Psychosis and Depression in the Elderly, 11 15–33.Google Scholar
  94. Pearlson, G. D., Kreger, L., Rabins, P. V., Chase, G. A., Cohen, B., Wirth, J. B., Schlaepfer, T. B., & Tune, L. E. (1989). A chart review study of late-onset and early-onset schizophrenia. American Journal of Psychiatry, 146 1568–1574.PubMedGoogle Scholar
  95. Pickar, D. (1995). Prospects for the pharmacotherapy of schizophrenia. Lancet, 4 345 (8949), 557–562.Google Scholar
  96. Platt, S. (1985). Measuring the burden of psychiatric illness on the family: An evaluation of some rating scales. Psychological Medicine, 15 383–393.PubMedGoogle Scholar
  97. Post, F. (1966). Persistent persecutory states of the elderly. London: Pergamon.Google Scholar
  98. Prager, S., & Jeste, D. V. (1993). Sensory impairment in late-life schizophrenia. Schizophrenia Bulletin, 19 755–772.PubMedGoogle Scholar
  99. Rabins, P. V., Pauker, S., & Thomas, J. (1984). Can schizophrenia begin after age 44? Comprehensive Psychiatry, 25 290–293.PubMedGoogle Scholar
  100. Randolph, E. T., Eth, S., Glynn, S. M., Paz, G. G., Leong, G. B., Shaner, A. L., Strachan, A., Van Vort, W., Escobar, J. L., & Liberman, R. P. (1994). Behavioral family management in schizophrenia: Outcome of a clinic-based intervention. British Journal of Psychiatry, 164 501–506.PubMedGoogle Scholar
  101. Roy, A. (1986). Suicide in schizophrenia. In A. Roy (Ed.), Suicide (pp. 97–112). Baltimore: Williams & Wilkins.Google Scholar
  102. Salokangas, R. K. R., Palo-Oja, T., & Ojanen, M. (1991). The need for social support among outpatients suffering from functional psychosis. Psychological Medicine, 21 209–217.PubMedGoogle Scholar
  103. Salzman, C., Vaccaro, B., & Lief, J. (1995). Clozapine in older patients with psychosis and behavioral disruption. American Journal of Geriatric Psychiatry, 3 26–33.Google Scholar
  104. Seeman, M. V. (1986). Current outcome in schizophrenia: Women vs. men. Acta Psychiatrica Scandinavica, 73 609–617.Google Scholar
  105. Seeman, M. V., & Lang, M. (1990). The role of estrogens in schizophrenia gender differences. Schizophrenia Bulletin, 16 185–194.PubMedGoogle Scholar
  106. Solomon, P., Draine, J., Mannion, E., & Meisel, M. (1996a). Impact of brief family psychoeducation on self-efficacy. Schizophrenia Bulletin, 22 41–50.PubMedGoogle Scholar
  107. Solomon, P., Draine, J., Mannion, E., & Meisel, M. (1996b). The impact of individualized consultation and group workshop family psychoeducation interventions on ill relative outcomes. Journal of Nervous and Mental Disease, 184 252–255.PubMedGoogle Scholar
  108. Stone, R., & Kemper, P. (1989). Spouses and children of disabled elders: How large a constituency for long-term care reform? Milbank Quarterly, 67 485–506.PubMedGoogle Scholar
  109. Szymanski, S. R., Canoon, T. H., Gallacher, F., Erwin, R. J., & Gur, R. E. (1996). Course of treatment response in first-episode and chronic schizophrenia. American Journal of Psychiatry, 153 519–525.PubMedGoogle Scholar
  110. Tarrier, N., Barrowclough, C., Vaughn, C., Bamrah, J., Porceddu, K., Watts, S., & Freeman, H. (1988). The community management of schizophrenia: A controlled trial of a behavioral intervention with families to reduce relapse. British Journal of Psychiatry, 153 532–542.PubMedGoogle Scholar
  111. Tarrier, N., Beckett, R., Harwood, S., Baker, A., Yusupoff, L., & Ugarteburu, I. (1993). A trial of two cognitive behavioral methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients. I. Outcome. British Journal of Psychiatry, 162 524–532.PubMedGoogle Scholar
  112. Taylor, A., & Dowell, D. A. (1986). Social skills training in board and care homes. Psychosocial Rehabilitation Bulletin, 10 55–69.Google Scholar
  113. Test, M. A., & Berlin, S. B. (1981). Issues of special concern to chronically mentally ill women. Professional Psychology, 12 136–145.Google Scholar
  114. Test, M. A., Burke, S. S., & Wallisch, L. S. (1990). Gender differences of young adults with schizophrenic disorders in community care. Schizophrenia Bulletin, 16 331–344.PubMedGoogle Scholar
  115. Tsuang, M., & Winokur, G. (1975). The Iowa 500: Field work in a 35-year follow-up of depression, mania and schizophrenia. Canadian Psychiatric Association Journal, 20 359–365.PubMedGoogle Scholar
  116. Tsuang, M. T., Woolson, R. F., & Fleming, J. A. (1980). Premature deaths in schizophrenia and affective disorders. Archives of General Psychiatry, 37 979–983.PubMedGoogle Scholar
  117. Van Putten, T., & Marder, S. R. (1986). Low-dose treatment strategies. Journal of Clinical Psychiatry, 47 Suppl. 5), 12–16.PubMedGoogle Scholar
  118. Vaughn, C., & Leff, J. (1976). The influence of family and social factors on the course of psychiatric illness. British Journal of Psychiatry, 129 125–137.PubMedGoogle Scholar
  119. Vaughn, C., Snyder, K., Jones, S., Freeman, W., & Falloon, I. (1984). Family factors in schizophrenia relapse. Archives of General Psychiatry, 41 1169–1177.PubMedGoogle Scholar
  120. Ventura, J., Nuechterlein, K. H., Lukoff, D., & Hardesty, J. P. (1989). A prospective study of stressful life events and schizophrenic relapse. Journal of Abnormal Psychology, 98 407–411.PubMedGoogle Scholar
  121. Wing, J. H. (1987). Long term social adaptation in schizophrenia. In N. E. Miller & G. D. Cohen (Eds.), Schizophrenia and aging (pp. 183–199). New York: Guilford.Google Scholar
  122. Wright, L., Clipp, E., & George, L. (1993). Health consequences of caregiver stress. Medicine. Exercise, Nutrition, and Health, 2 181–195.Google Scholar
  123. Wyatt, R. J. (1991). Neuroleptics and the natural course of schizophrenia. Schizophrenia Bulletin, 17, 325–351.PubMedGoogle Scholar
  124. Xiong, W., Phillips, M. R., Hu, X., Ruiwen, W., Dai, Q., Kleinman, J., & Kleinman, A. (1994). Family-based intervention for schizophrenic patients in China: A randomised controlled trial. British Journal of Psychiatry, 165 239–247.PubMedGoogle Scholar
  125. Yassa, R., & Suranyl-Cadotte, B. (1993). Clinical characteristics of late-onset schizophrenia and delusional disorder. Schizophrenia Bulletin, 19 701–707.PubMedGoogle Scholar
  126. Zigler, E., & Glick, M. (1986). A developmental approach to adult psychopathology. New York: Wiley.Google Scholar
  127. Zisook, S., Heaton, R., Moranville, J., Kuck, J., Jernigan, T., & Braff, D. (1992). Past substance abuse and clinical course of schizophrenia. American Journal of Psychiatry, 149 552–553.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1998

Authors and Affiliations

  • Stephen J. Bartels
    • 1
  • Kim T. Mueser
    • 1
  • Keith M. Miles
    • 1
  1. 1.Department of Psychiatry and Community and Family Medicine, New Hampshire-Dartmouth Psychiatric Research CenterDartmouth Medical SchoolConcordUSA

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