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This study compared relatives' attributions and affective reactions toward patients with severe mental illness (SMI) only (N = 32) and patients with dual SMI and a substance use disorder (N = 36). Family members of patients with dual disorders perceived their ill relatives to have greater control over the causes of their psychiatric symptoms and to be more responsible for their symptoms than did family members of patients with SMI only. Key relatives of dual-diagnosed patients also reported more negative affect toward the patient than did key relatives of patients with SMI only, but the two groups did not differ in their level of positive affect. Consistent with attribution theory, severity of patients' substance abuse was positively associated with relatives' attributions of controllability, which, in turn, were positively associated with judgments of responsibility. Furthermore, judgments of responsibility were positively related to negative affect and inversely related to positive affect.

The purpose of the study was to assess alcohol expectancies and motives of psychiatric outpatients with and without comorbid current or lifetime substance use disorders. Seventy-five psychiatric outpatients with diagnoses of mood disorders, anxiety disorders, and substance use disorders were administered the Alcohol Effect Expectancy Questionnaire-Abridged Version and the Drinking Motives Measure. Results demonstrated that the internal reliabilities for the two scales were comparable with those reported for these measures in the general population. Psychiatric outpatients with a history of comorbid substance use disorders reported greater expectancies and motives for using alcohol than did patients with no such history. In addition patients with comorbid alcohol and drug use disorders, and only comorbid alcohol use disorder, showed significantly greater expectancies and motives for alcohol use than patients with only comorbid drug use disorders and patients with no history of comorbid substance use disorder. We discuss the implications of the findings for role of expectancies and motives in the maintenance and treatment of substance abuse in psychiatric patients.

In this study we sought to understand the relationship between obtaining competitive employment and changes in nonvocational domains of functioning (symptoms, substance abuse, hospitalizations, self-esteem, quality of life) in persons with severe mental illness. A group of 143 unemployed patients participating in a study of vocational rehabilitation programs were assessed in nonvocational areas of functioning at baseline and 6, 12, and 18 months later. Statistical analyses examined the relationship between work status at the follow-up assessments and nonvocational functioning, controlling for baseline levels of nonvocational variables. Patients who were working at follow-up tended to have lower symptoms (particularly thought disorder and affect on the Brief Psychiatric Rating Scale), higher Global Assessment Scores, better self-esteem, and more satisfaction with their finances and vocational services than unemployed patients. Employment is associated with better functioning in a range of different nonvocational domains, even after controlling for baseline levels of functioning.

Previous work posits that severity of substance abuse and severity of schizophrenic symptoms should be linked by either or both of two mechanisms: self-regulation of symptoms and drug-induced exacerbation of symptoms. Research on these relationships has yielded mixed results. We examined the interrelationships of schizophrenic symptoms and substance abuse in 172 patients with co-occurring disorders. Relationships were weak or nonexistent, without any consistent pattern. Our findings do not support the view that substances are used to self-regulate symptoms. In addition, our results suggest that substance abuse may lead to higher rates of institutionalization through mechanisms other than by exacerbating symptoms.

The relationships between positive and negative symptoms of schizophrenia and between negative symptoms and social dysfunction were investigated using cluster analysis. Clustering across schizophrenic subjects produced three distinct groups, each characterized by some mix of positive and negative symptoms. Clustering across symptoms and behavioral variables produced a cluster comprising negative symptoms and measures of social adjustment and an additional cluster comprising only measures of social skill. A series of correlations revealed a positive relationship between positive and negative symptom measures. chi 2 analysis revealed a significant relationship between the cluster solution across subjects and classification of patients according to negative symptoms based on previously published criteria. Results are discussed in terms of the implications for the further development and refinement of subclassification schemes for schizophrenia.

The frequency of social interactions emitted by two groups of hospitalized psychotic patients was studied with a time sampling procedure during lunch periods in the ward dayroom. One group was treated with neuroleptic medication upon admission to the ward, and the other group was medicated after a 2- to 3-week washout period. The data suggest that the principle effect of the medication is to produce a transient depression in social interaction frequency which returns to baseline with continued drug treatment. The results are supportive of previous research which indicated that the major impact of pharmacotherapy is on activity rather than social behaviors, and highlights the utility of including baseline measures to ensure adequate drug vs. control comparisons.