Rich Lewine | University of Louisville (original) (raw)

Papers by Rich Lewine

BRAIN PIMPING and VENUS VANISHING I studied the brains of psychiatric patients and non-psychiatri... more BRAIN PIMPING and VENUS VANISHING I studied the brains of psychiatric patients and non-psychiatric healthy comparison individuals for more than 10 years, managing multiple publications and even some interesting findings. At the end of my NIMH MERIT award (which funded the brain studies) I wrote a summary report which, in conjunction with a review of brain structure in schizophrenia I completed for Comprehensive Psychiatry, forced me to conclude that further study of the physical brain in schizophrenia was not fruitful. I wrote, with self-puffery and in a self-congratulatory manner that "unlike all other research reports, this one concludes that 'no further brain research is necessary'". Not because I had answered all the questions, but because I thought they were inappropriate.

unpublished

I focus here on the issue of neuroimaging and schizophrenia, specifically that neuroimaging has ... more I focus here on the issue of neuroimaging and schizophrenia, specifically that
neuroimaging has added little to our understanding of schizophrenia that has served to improve treatment4 and, if anything, distracts us from needed research. As suggested by the title of this article, the conflating of brain with mind2 has led to a false sense of progress in our understanding and treatment of schizophrenia.

Archives of General Psychiatry, 1995

Clozapine Therapy and Increases in Homovanillic Acid K and colleagues1 reported that increases in... more Clozapine Therapy and Increases in Homovanillic Acid K and colleagues1 reported that increases in the cerebrospinal fluid (CSF) homovanillic acid (HVA) to 5-hydroxyindoleacetic acid (5-HIAA) ratio (HVA/HIAA ratio) are correlated with antipsychotic response to haloperidol treatment in patients with schizophrenia or schizoaffective disorder. In their study, haloperidol treatment was associated with significant increases in both CSF HVA concentrations and the CSF HVA/ 5-HIAA ratio, while CSF 5-HIAA concentrations were

American Journal of Psychiatry, 2004

The effect of antipsychotic medication on neurocognitive function remains controversial, especial... more The effect of antipsychotic medication on neurocognitive function remains controversial, especially since most previous work has compared the effects of novel antipsychotic medications with those of high doses of conventional medications. This study compares the neurocognitive effects of olanzapine and low doses of haloperidol in patients with first-episode psychosis. Method: Patients with a first episode of schizophrenia, schizoaffective disorder, or schizophreniform disorder (N=167) were randomly assigned to double-blind treatment with olanzapine (mean modal dose= 9.63 mg/day) or haloperidol (mean modal dose=4.60 mg/day) for the 12-week acute phase of a 2-year study. The patients were assessed with a battery of neurocognitive tests at baseline and 12 weeks after beginning treatment. Results: An unweighted neurocognitive composite score, composed of measures of verbal fluency, motor functions, working memory, verbal memory, and vigi

American Journal of Psychiatry, 1989

The authors compared the medical records of 20 randomly selected schizophrenic patients who were ... more The authors compared the medical records of 20 randomly selected schizophrenic patients who were receiving fiuphenazine decanoate with the records of 20 other randomly selected schizophrenic patients who were receiving oral medications only. The fiuphenazine decanoate group had a significantly higher mean chlorpromazine equivalent dose (2010±836) than the oral medication group (3 73 ±384). The two groups did not, however, differ on any of the other variables studied.

American Journal of Psychiatry, 1990

If the construct validity of the negative symptom syndrome is to be established, the conceptual a... more If the construct validity of the negative symptom syndrome is to be established, the conceptual and operational overlap between negative symptoms and other syndromes such as depression and the effects of medication must be explained. The author assessed 26 patients with schizophrenia and 21 patients without schizophrenia, most of whom had depression, at the end of an average 2-week drug washout period and after approximately 2 months of psychotropic medication administration. Negative symptoms were remarkably consistent in patients with schizophrenia despite pharmacological intervention. In contrast, the patients without schizophrenia manifested significant decreases in negative symptoms.

International Journal for the Scholarship of Teaching and Learning, 2011

The academic impact of serious depression among college students is beginning to receive increase... more The academic impact of serious depression among college students is beginning to receive increased attention in the research literature. In contrast, we know very little about the affect of mild depression, or dysphoria, on academic performance. This study examines the relationship of baseline dysphoria in 188 students to five measures of academic performance following baseline. Results suggest that even mild dysphoria is associated with poorer academic performance among, paradoxically, academically stronger female students. We discuss the importance of attending to this group of students who are often overlooked because they are relatively high achievers, but who may benefit from short-term, low-level intervention.

Psychopharmacology bulletin, 1992

Trichotillomania is characterized by chronic hair-pulling resulting in noticeable hair loss. In a... more Trichotillomania is characterized by chronic hair-pulling resulting in noticeable hair loss. In a preliminary study, cerebrospinal fluid (CSF) measures in 8 medication-free, female, trichotillomania patients were compared to those of matched, normal controls. There was no difference between patients and controls in measures of CSF cortisol, 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylglycol (MHPG). CSF measures did not correlate with measures of trichotillomania symptomatology. However, degree of response to treatment with serotonin re-uptake inhibitors significantly correlated with baseline CSF 5-HIAA. This suggests that central serotonin turnover is specifically relevant to treatment response to serotonin re-uptake inhibitors in trichotillomania.

Journal of Abnormal Psychology, 1978

British Journal of Psychiatry, 1978

SummaryTeachers' comments in the childhood school records (grades K-12) of 143 psychiatric pa... more SummaryTeachers' comments in the childhood school records (grades K-12) of 143 psychiatric patients and their matched controls were coded along 23 bipolar dimensions. Two methods of grouping these scales were compared: rational clusters and factor analysis. Factor analysis yielded more numerous and narrowly defined behavioural groupings. Schizophrenics, personality disorder patients, neurotics, and depressives were compared to their matched controls on each of the cluster and factor scores. Both schizophrenics and personality disordered patients were significantly less agreeable in childhood than their respective controls. Pre-schizophrenics also were significantly more unstable. Depressives were more independent than their controls, while neurotics did not differ significantly in any respect from normals in childhood. The data suggest that schizophrenia may have specific developmental patterns of possible aetiological or early diagnostic significance.

ABSTRACT The present study sought to determine whether childhood behavior was predictive of adult... more ABSTRACT The present study sought to determine whether childhood behavior was predictive of adult neuropsychological performance in a group of male schizophrenic patients. Childhood Behavior Checklist (CBCL) ratings were obtained from retrospective maternal reports for Courage periods: birth-4 years. 4-8 years. 8-12 years, and 12-16 years. A battery of neuropsychological measures was administered to the patients as adults. The results indicated that childhood withdrawn behavior predicted poorer performance on a number of adult neuropsychological measures. Childhood attention and social problems were linked with poorer motor performance in adulthood. Childhood anxiety/depression predicted better adult neuropsychological performance. Results are discussed in terms of the developmental continuity of behavioral syndromes and symptoms. (C) Lippincott-Raven Publishers.

American Journal of Psychiatry, 1984

Contrary to earlier epidemiological data, recent evidence points to a significantly greater propo... more Contrary to earlier epidemiological data, recent evidence points to a significantly greater proportion of men than women among schizophrenic patients diagnosed by current restrictive criteria. In this study, the authors analyzed the effect of using six different diagnostic systems (varying in their stringency) on the male to female ratio of schizophrenia among 387 inpatients. Diagnostic criteria representing a broad conceptualization of schizophrenia, such as the New Haven Schizophrenia Index, consistently yielded equal rates of schizophrenia among men and women. Those diagnostic systems representing more stringently defined schizophrenia, such as the Research Diagnostic Criteria, consistently yielded a male to female ratio significantly greater than the male to female ratio of the total sample.

Schizophrenia Research, 1994

Journal of Poverty, 2021

It is commonly accepted that college students from poverty have disadvantages contributing to exp... more It is commonly accepted that college students from poverty have disadvantages contributing to expected likelihood of failure. This four-year longitudinal study of a group of college students from p...

Journal of College Student Retention: Research, Theory & Practice

The popular view of students reared in poverty is that they fall short across a wide range of dom... more The popular view of students reared in poverty is that they fall short across a wide range of domains relative to their more advantaged peers. In this ongoing longitudinal study, we follow a cohort of college students who come from poverty and were awarded full financial support for four years at a large public research university. The results after two full academic years are striking for the lack of difference in dropout rate and grade point average between these economically disadvantaged students and their college peers. We suggest that it is not poverty per se that leads to poorer college academic performance in such students but rather the demand on their time and energy to meet ongoing financial needs.

Clinical Psychological Science

To the Editor: The recent article by Weinberg, May, Klonsky, Kotov, and Hajack (2017) admirably p... more To the Editor: The recent article by Weinberg, May, Klonsky, Kotov, and Hajack (2017) admirably pursues the neural basis for suicide risk using late positive potential (LPP) response as a marker. Specifically, those who have attempted suicide “exhibited a blunted threat-elicited LPP compared” (p. 952) to nonattempters. Although it is encouraging, there is a significant problem with the study. Of the suicide attempters, 61% had a diagnosis of either bipolar I or psychosis; only 21% of the nonattempters had this diagnosis. This is critical because we can assume (in the absence of data from the authors) that the suicide attempters were more likely to be on antipsychotic medications that block dopamine receptors. This, in turn, could reduce LPP response to both positive and threatening stimuli, as found in patients with Parkinson’s disorder who suffer from blocked dopamine (e.g., Dietz et al., 2013) and whose symptoms are frequently mimicked among people receiving antipsychotic medications. There is, therefore, a potential conflation between medication effects and individual characteristics or behaviors that may be associated with individual suicide risk. This makes risk assessment and causal explanation difficult, at best, until the role of medications is thoroughly explored.

Illness, Crisis & Loss

People with schizophrenia are often unable to realize vocational expectations because of schizoph... more People with schizophrenia are often unable to realize vocational expectations because of schizophrenia-related functional impairments. This is particularly acute in those individuals from advantaged sociocultural backgrounds of whom much is expected. We present the case history of an acclaimed woman artist who lost artistic productivity with the advent of severe and persistent psychotic symptoms. We suggest that “loss of vocational potential” is a major loss worthy of grief work. Introduction and rationale are presented, followed by a case presentation that aims to illustrate the psychological effects of intangible loss for individuals suffering from serious mental illness. Three approaches to grief work are reviewed. The notion of incorporating grief work into the treatment of persons with schizophrenia is introduced. The authors call for increased attention to and study of the symbolic and emotional impact of the interpersonal and vocational losses that accompany schizophrenia. A ...

American Journal of Psychiatry

The Canadian Journal of Psychiatry

A series of studies of the phenomenology and biochemistry of schizophrenia suggests that the fund... more A series of studies of the phenomenology and biochemistry of schizophrenia suggests that the fundamental nature of schizophrenia differs in men and women. In men, schizophrenia appears to be an amotivational syndrome possibly mediated by dopaminergic underactivity; in women, schizophrenia is perhaps best conceptualized as an affective disorder variant.