Electroencephalographic sleep in young, never-medicated schizophrenics. A comparison with delusional and nondelusional depressives and with healthy controls

Electroencephalographic (EEG) sleep characteristics of young, never-medicated, nonschizoaffective schizophrenics were compared with the EEG sleep of patients with major depressive disorders (delusional and nondelusional) and with that of healthy controls. Schizophrenics had decreased sleep continuity comparable to delusional depressives. Slow-wave sleep percent was similar to that seen in healthy controls, as was the intranight temporal distribution of EEG delta activity. However, schizophrenics showed diminished delta counts per minute of non-rapid eye movement (NREM) sleep and a decreased total delta wave count. In contrast, depressives showed diminished slow-wave sleep percent compared with controls, greatly decreased delta activity (more so than did the schizophrenics), and an altered temporal distribution of delta activity, as evidenced by a shift of delta activity from the first to the second NREM period. Minutes of slow-wave sleep in the schizophrenics was inversely correlated with the severity of negative symptoms independent of the effects of age and the presence of depression. The schizophrenics showed normal REM latency and first REM period duration, in contrast to the depressives. These findings, reviewed in the historical context of sleep physiologic studies of schizophrenia over the past 30 years, suggest that young, never-medicated schizophrenics do not show the characteristic constellation of abnormalities in the first NREM-REM cycle seen in patients with major depression. However, decreased slow-wave sleep should be investigated as a possible marker for negative symptoms in schizophrenia.     

Attention profile in schizophrenia compared with depression: differential effects of processing speed,selective attention and vigilance

OBJECTIVE: The aim of the study is to investigate whether subjects with schizophrenia and major depression display attention deficits for different reasons. METHOD: Subjects with schizophrenia (n = 53), recurrent major depression (n = 50) and normal controls (n = 50) were administered with 11 measures of processing speed, selective attention and vigilance. Indices of basal speed, speeded attention, non-speeded attention and vigilance were computed. RESULTS: Both clinical groups were impaired on all chronometric tests. The schizophrenic subjects were also more impaired on speeded attention compared with basal processing speed. Only the schizophrenics were impaired on the non-speeded measures of selective attention. Compared with the schizophrenics, the depressives showed a decrement in vigilance. CONCLUSION: Reduced performance on attention tests in major depression is because of a non-specific speed reduction and loss of vigilance consistent with lack of effort. In addition to generally impaired processing speed, the schizophrenic subjects exposed a deficit in selective attention, indicating executive dysfunction.     

Depression and alcohol consumption in non alcoholic and alcoholic women. A clinical study

The relationship between level of depression and alcohol consumption was studied in 64 alcoholic women, 80 non alcoholic female psychiatric patients and 72 healthy women, using a clinical, semistructured interview, SADS, SSP and HSCL-58. Among DSM-III depressive women, the alcohol consumption was bimodally distributed. Among healthy women, there was an inverse relationship between depressive symptoms and alcohol consumption. Among non alcoholic women dysthymic patients consumed significantly more than major depressive, subclinically depressed and psychotic non depressive patients, and significantly less than healthy, non depressive women. Among alcoholic women, there was no difference in consumption between major depressives, dysthymics and the other diagnostic groups. The results show that there was no general dose-response relationship between level of depression and alcohol consumption. Anxiety level and personality disorder may be more influential on the alcohol consumption than the level of depression among depressive women.     

Anhedonia and schizophrenia: how much is in the eye of the beholder?

The subjective experience of anhedonia may differ from its outward expression. We examined the relationship between anhedonia and objective features of schizophrenia. Thirty-six chronic schizophrenic patients were administered the Snaith-Hamilton Pleasure Scale (SHAPS) and clinical and cognitive assessments were performed. SHAPS scores were higher (more anhedonia) than reported for normal subjects and recovered depressives but lower than for depressed patients. A total of 41.7% of the subjects scored within the normal range. SHAPS scores showed moderate correlation with negative symptoms but not test or illness variables. Mean levels of negative symptoms did not differ significantly between hedonic and anhedonic groups. We conclude that most subjects suffering from chronic schizophrenia experience anhedonia but many show normal hedonic tone. Many schizophrenic patients may have a greater capacity to experience pleasure than is apparent to the people around them.     

The dexamethasone suppression test in a group of research diagnostic criteria schizoaffective depressed men

A dexamethasone suppression test (DST) was performed on 8 schizoaffective depressed men. Cross-sectional comparisons were made with three groups: schizophrenics (n = 10), unipolar major depressives (n = 23) and healthy controls (n = 43). All were drug-free and similar in age and body weight. Evaluations utilized the Research Diagnostic Criteria (RDC) for diagnosis, and the Hamilton Rating Scale for Depression for depressive symptom rating. DST nonsuppression, defined as a blood cortisol level of greater than or equal to 5.0 micrograms/dl at 16.00 h postdexamethasone, was observed in 43.5% of the major depressive disorder patients. This was different from the other three groups: 12.5% in schizoaffective depressed, 10.0% in schizophrenics and 9.3% in healthy controls (p less than 0.01, p less than 0.01, and p less than 0.001 respectively). Although schizoaffective depressed patients were significantly different from major depressive disorder patients in their DST responses, both groups were similar in their total HRSD scores and different from the schizophrenics (p less than 0.01 for each). These results, together with others previously reported by us on the thyrotropin-releasing hormone challenge in the same diagnostic groups, may be taken to mean that schizoaffective disorder, depressed type, is biologically distinct from major depressive disorder but not schizophrenia. On the other hand, until further corroborated, they should probably be considered a reflection of the heterogeneity of the schizoaffective syndrome and the nonspecificity of the DST.     

Multiple neuroendocrinological responses in borderline personality disorder patients

ABSTRACT— Male patients suffering from borderline personality disorder (n= 13), major depression (n= 13) or schizophrenia (n= 13) were investigated on several psychopathological (HDRS, BPRS) and neuroendocrinological (DST and TSH, PRL, GH responses to TRH) parameters. Comparisons were made between the borderline group and the other groups of patients. Borderline patients differed from schizophrenics psychopathologically (BPRS) and neuroendocrinologically (DST). Also, borderline patients differed from major depressives in the HDRS, but behaved like them concerning DST. Our findings support the hypothesis that there are neuroendocrinological similarities between borderline personality disorder and major depressive patients, especially on the hypothalamo-pituitary-adrenal axis.     

Beta-phenylethylamine and noradrenergic function in depression.

1. The relationship between plasma levels of beta-phenylethylamine (PEA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) was investigated in depressive patients. 2. The mean PEA level in plasma in healthy subjects was 1.19 ng/ml (N = 32). No clearly age-related difference was found. The plasma levels of PEA were measured in major depression, but no significant difference was found between healthy and depressive subjects. 3. Plasma levels of MHPG correlated positively with age in healthy subjects (N = 22, R = 0.71, p less than 0.01). There was no significant difference in MHPG levels between healthy subjects and depressive patients. 4. There was no significant correlation between PEA and MHPG levels in healthy subjects; however, in depressive patients, there was a significant negative correlation between plasma PEA levels and plasma MHPG levels (N = 14, R = -0.73, p less than 0.05). These results suggested that PEA may regulate noradrenergic function in depression.     

Self-experienced vulnerability, prodromal symptoms and coping strategies preceding schizophrenic and depressive relapses.

For the first time, the present study explores pre-episodic disturbances, i.e. self-experienced vulnerability and prodromal symptoms, and related coping strategies preceding schizophrenic and depressive relapses. After complete recovery from the acute episode, 27 patients with recurrent schizophrenic and 24 patients with recurrent depressive episodes were assessed retrospectively for pre-episodic disturbances and related coping strategies with the "Bonn scale for the assessment of basic symptoms-BSABS". All (100%) of the schizophrenic and 23 (96%) of the depressive patients showed pre-episodic disturbances. Patients with schizophrenia showed significantly more often an increased emotional reactivity and certain perception and thought disturbances. Depressive patients reported significantly more often an impaired tolerance to certain stress and disorders of emotion and affect. Sixty-three percent of the schizophrenics and 87% of the depressives reacted to pre-episodic disturbances with coping strategies. The pre-episodic disturbances in patients with schizophrenia could be described in terms of mild psychotic productivity, those in depressives in terms of mild depressive syndrome. Future studies will have to show if these findings can be replicated in first episode or initial prodromal state samples and if the assessment of mild psychotic productivity and mild depressive syndrome can be used for early diagnosis and early intervention in schizophrenia and depression.     

Premorbid polysomnographic signs in depressed adolescents: a reanalysis of EEG sleep after longitudinal follow-up in adulthood.

BACKGROUND: This is a report of a clinical follow-up study (10-15 years later as young adults) of adolescent major depressives and normal control subjects. Polysomnographic data were obtained during the original study period when the subjects were adolescent (time 1). With clinical follow-up (time 2) assessments in hand, our objective was to ascertain whether there were any premorbid polysomnographic signs associated with depression during adolescence. METHODS: Based upon initial (during adolescence) and follow-up clinical assessments (as adults), new subject groupings were generated: depression-free normal subjects and original normal subjects who experienced a depressive episode during the follow-up period (latent depressives). Suicidality and recurrence of depression were also examined. Multivariate analysis of covariance was used to analyze group differences in sleep measures and logistic regression for predicting three outcomes: lifetime depression, lifetime suicidality, and recurrence. RESULTS: Comparison of the depression-free normal subjects, the latent depressives, and the original major depressives revealed significant differences for sleep latency and sleep period time. Comparing all lifetime depressives (original major depressives and the latent depressives) to depression-free normal subjects revealed significantly more stages 3 and 4 combined (ST34) sleep and greater sleep period times among the depressives. An analysis involving the presence or absence of suicidality revealed no overall significant differences between the groups. Comparison of the lifetime depressives grouped by nonrecurrent and recurrent depressive course to the depression-free normal subjects revealed significant difference for sleep period time. Using logistic regression, we found that a longer sleep latency and sleep period time significantly predicted lifetime depression. Gender, ST34 sleep, and an interaction term for ST34 sleep and REM latency significantly predicted lifetime suicidality. CONCLUSIONS: There was evidence of premorbid sleep abnormalities during adolescence. A general pattern of sleep disruption around sleep onset and during the first 100 min of the sleep period and overall sleep was evident among the major and lifetime depressives, involving sleep latency (initial insomnia), sleep period time (hypersomnia), REM latency, and slow-wave sleep. This adds to the body of literature that highlights the importance of the first 100 min of the sleep period in depression.     

TGFBR2 gene expression and genetic association with schizophrenia

TGFBR2 gene is a tumor suppressor gene located at chromosome 3p22, and the locus is reported to be linked with schizophrenia susceptibility. According to the previous studies, a reduced incidence of cancer is observed in schizophrenic patients compared with the general population and tumor suppressor genes may be associated with schizophrenia. We measured the mRNA expression of TGFBR2 gene in the peripheral leukocytes from 19 medication-free schizophrenics and 25 medication-free major depressive patients compared with age- and sex-matched control subjects using a quantitative real-time PCR method. We also followed up the TGFBR2 mRNA expression levels from 13 schizophrenics after several weeks - antipsychotic treatments. The TGFBR2 mRNA levels of medication free schizophrenics were significantly higher than those of control subjects and decreased to almost the same level as controls after antipsychotic treatment. On the other hand, the TGFBR2 mRNA levels of medication-free major depressive patients were not significantly different from controls. In genetic studies, we failed to find any association between the TGFBR2 gene and schizophrenia with 10 SNPs of TGFBR2 gene in Japanese subjects (279 subjects each) and there was no significant difference with haplotype analysis, either. Our results suggest that the TGFBR2 gene itself does not link to schizophrenia but that the TGFBR2 mRNA levels in the peripheral leukocytes may be a potential state marker for schizophrenia.     

The relationships of childhood socio-demographic factors and early parental loss to major depression in adult life

Sixty middle-aged urban women with a major depressive episode (DSM-III) diagnosed in a community survey were compared with those 400 participants of the study who had no history of major depression. There were no significant differences between groups regarding most childhood demographic variables such as grade of urbanization, social class, school education, size of sibship and ordinal position. The subjects with major depression and especially those with melancholia had experienced parental loss before age 17 significantly more often than had the controls. This difference dealt only with parental divorce and other separations but not with parental death. There were no significant differences regarding parental death between melancholics, non-melancholic major depressives and controls.     

Depression dexamethasone nonsuppression and negative symptoms in schizophrenia

This study compared three measures of depression in schizophrenia and their correlation with the Dexamethasone Suppression Test (DST). The degree of overlap of these three measures with negative symptoms was also examined. The Hamilton Depression Rating Scale (HDRS), the depressive syndrome score of the Present State Examination (PSE), and the Scale for the Assessment of Negative Symptoms (SANS) were administered to 50 acutely ill, hospitalized schizophrenics. Patients were diagnosed using DSM-III criteria for schizophrenia. DSM-III criteria were also used to assess the presence of a major depressive episode. Results were that DST nonsuppression was significantly associated with the presence of a major depressive episode, but not with depressive rating scale scores or with negative symptoms. It is concluded that the DST may be of value in differentiating a depressive syndrome from a negative symptom syndrome in schizophrenia.     

Horizontal and vertical pursuit eye movements,the oculocephalic reflex,and the functional psychoses

Sixteen schizophrenic patients, 16 manic-depressive patients, and 14 nonpatient control subjects were tested for horizontal and vertical smooth pursuit eye movements (SPEM) and the oculocephalic reflex. All patients with impaired horizontal pursuit also displayed disrupted vertical pursuit, suggesting that a common mechanism underlies these abnormalities. The oculocephalic reflex was intact in 96% of the subjects whether or not pursuit was disrupted, suggesting that the locus of the eye movement disorder in psychosis may be cortical. For horizontal pursuit, there were significant differences between schizophrenics and nonpatient controls, and between manic depressives and nonpatient controls, but not between schizophrenics and manic depressives, suggesting that the SPEM disruption occurs with significant prevalence in major functional psychoses and not only in schizophrenia.     

The Pleasure-Displeasure Scale. Use in the evaluation of depressive illness

The Pleasure-displeasure Scale is a self-report instrument consisting of 82 items for measuring the intensity of subjects' affective responses to usually pleasant and unpleasant situations. 81 depressed inpatients were compared to 120 normal subjects. The responses of the depressed patients to the Pleasure sub-scale (French translation of the Fawcett-Clark's Pleasure Scale) are more anhedonic than those of the normal subjects; but the difference did not reach statistical significance. Pleasure scores in the depressive group are bimodally distributed; a distinct subset (11% of depressives) is characterised by an extremely anhedonic Pleasure score. The sensitivity to unpleasant stimuli is significantly greater in the depressive group; however this difference seems to be related rather to a low cultural level than to depression itself. Finally pleasure and displeasure scores are closely correlated: this could possibly imply that anhedonia is not an independent symptom but rather belongs to the wider constellation of affective anesthesia.     

A test of the tripartite model's prediction of anhedonia's specificity to depression: patients with major depression versus patients with schizophrenia

The tripartite model of depression and anxiety suggests that anhedonia represents a relatively specific marker of depression. A strong version of this view is that anhedonic symptoms would particularly characterize depressed patients, even when compared to another diagnostic group-schizophrenic patients-for whom anhedonic symptoms represent a well-studied feature. This prediction was tested among 102 VA psychiatric inpatients (95 men), ages 21-72 (M=43.56; S.D.=8.47), all of whom received diagnoses of either major depression (n=50) or schizophrenia (n=52) based on structured diagnostic interviews. As predicted, patients with major depression scored significantly higher on the anhedonic symptoms scale of the Beck Depression Inventory (BDI) than did patients with schizophrenia. However, there was no difference between the two groups on the BDI total score or the BDI non-anhedonic symptoms score. Consistent with the tripartite model, anhedonic symptoms were more related to depressive vs. schizophrenic diagnostic status, whereas non-anhedonic depressive symptoms were not. Within the study's limitations, results were interpreted as relatively strong support for the validity and extension of the tripartite model.     

Effects of recurrent major depressive disorder on behavior and cognitive function in female depressed patients

Little is known about the effects of recurring depressive episodes on cognition and behavior. The objective of the study was to compare cognitive function and depression-related behavior between healthy female subjects and female outpatients with early-onset DSM-IV recurrent major depressive disorder and to investigate the effect of cumulative depressive duration. Neuropsychological tests and scales for apathy, anhedonia and psychomotor retardation were assessed in 23 female patients and 60 healthy age-matched female controls. Significantly higher levels of apathy, anhedonia and psychomotor retardation, and worse performance on tests of executive function were found in the patient group compared with the healthy controls. In the patient group, cumulative depression duration was not significantly correlated with cognitive function, apathy, anhedonia or psychomotor retardation. The deficits in executive function were not related to the actual level of depression. Mild executive dysfunction may be the effect of the illness process underlying recurrent depressive disorder. Repeated or extensive depressive episodes do not seem to additionally affect cognitive deficits or behavior in depressed patients.     

Traduction et étude de validation de la version française de l’échelle « Specific Loss of Interest and Pleasure Scale,SLIPS » (Échelle de Perte Spécifique de l’Intérêt et du Plaisir,EPSIP)

ObjectivesThe Specific Loss of Interest and Pleasure Scale (SLIPS) has been created by Winer in 2014 to assess recent changes in anhedonia. The aim of the present study was to explore the psychometric properties of the French version of the scale.MethodsA total of 108 inpatients with a DSM-5 diagnosis of major depressive disorder and a score of at least 12 on the Beck Depression Inventory (BDI-II) were included in the study as well as 50 healthy subjects recruted from general population. All the subjects filled out 7 rating scales: SLIPS (23 items), The Snaith Hamiltion Pleasure Scale (SHAPS, 14 items), the Temporal Experience Pleasure Scale (TEPS, 18 items) rating the trait anticipatory (TEPS-ANT) and trait consummatory pleasure (TEPS-CONS), the BDI-II and the anhedonia subscale of the BDI-II (ANH-BDI), the short version of the Physical Anhedonia Scale (PAS). Concurrent, discriminant and incremental validities were studied as well as reliability using the Cronbach alpha coefficient. Internal validity was studied using principal components analysis.Results and ConclusionCronbach's alpha coefficient was satisfactory (0,92) for the SLIPS. Significant correlations were observed between the SLIPS and the other anhedonia scales suggesting satisfactory concurrent validities. Significant difference between groups for the SLIPS was reported with higher scores for depressives comparatively with the controls. Principal components analysis found a one-factor solution suggesting that the SLIPS was unidimensional. The French version of the SLIPS has satisfactory validity and reliability that allow its use notably in depressives to detect the suicidal risk.     

Lytic effector cell function in schizophrenia and depression

Natural killer (NK) cell activity and antibody-dependent cellular cytotoxicity (ADCC) were tested in patients with schizophrenia or depression. It was found that NK activity as well as ADCC were significantly lower in both groups, as compared to healthy control individuals (P less than 0.001). Psychopharmacologic treatment with neuroleptics and antidepressives resulted in a significant increase in NK activity and ADCC (P less than 0.005) in patients with schizophrenia but not in treated patients with depression. In patients with schizophrenia, no correlation could be established between the dose of neuroleptic given and the increase in NK activity. Lithium also did not produce an increase in NK activity and ADCC. The addition of serum, derived from untreated patients with schizophrenia, to cell cultures in concentrations of 10 and 20% had an inhibitory effect upon the ADCC and, to a lesser degree, upon NK activity (20% serum concentration only); sera from treatment schizophrenics produced no inhibition of NK activity, but did affect ADCC. No serum-derived inhibitory effect upon either NK activity or ADCC was found to be present in sera from patients with depression. We conclude that lytic effector mechanisms are impaired in patients with schizophrenia or depression and that this defect is reversed in schizophrenic patients on treatment, but not in depressives on therapy. Patients with schizophrenia also tend to have a reversible serum-mediated inhibition of NK activity which is absent in patients with depression.     

The relationship between cognitive insight, clinical insight, and depression in patients with schizophrenia

Despite comorbid depression being relatively common even in subjects with schizophrenia, to the best of our knowledge, there is, to date, no report in the literature specifically and detailed examining the cognitive and clinical insight in subjects with schizophrenia and a comorbid depressive syndrome. Hence, in this study, we sought to compare the cognitive and clinical insight in our subjects with schizophrenia with and without a comorbid depressive syndrome. We found that participants in the depressive group scored significantly higher on self-reflectiveness and the reflectiveness-certainty (R-C) index scores than those in the nondepressive group. There was no significant difference among groups on the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, and clinical insight scores assessed by the Scale to Assess Unawareness of Mental Disorder. In addition, self-reflectiveness scores significantly correlated with depression, observed depression, hopelessness, and suicidality subscores of the Calgary Depression Scale for Schizophrenia. A better understanding of the cognitive component of insight in schizophrenia with comorbid depression may contribute to develop more efficient cognitive strategies, thus improving patient outcome. However, clinicians should be aware of the possibility of exacerbating a sense of hopelessness and suicide risk during the interventions that improve cognitive insight.     

Cognitive-psychomotor functions with regard to fitness for driving of psychiatric patients treated with neuroleptics and antidepressants

In contrast to the usual type of drug studies it is not our intention to single out specific drug effects, but we are interested in cognitive-psychomotor functioning of psychiatric patients across various periods of therapy, whether due to drug treatment or to underlying mental-affective disorders. 3 groups of psychiatric male patients (7 anxious/inhibited depressives, 7 schizophrenics, 6 patients with psychotic episodes) matched for age (mean = 30 years) and education (no academic training) with a group of healthy controls (n = 7) were examined three times during the first 6-8 weeks of their ordinary clinical therapy. The major criterion for the inclusion of a patient next to these diagnostic categories was an initial favorable response to the specified drugs (amitriptyline for the depressives, haloperidol for the schizophrenics, and thioridazine for the patients with psychotic episodes). Each subject was tested in an experimental laboratory with respect to cognitive-psychomotor performance (vigilance, divided attention, choice reaction time), mood, subjective fitness for driving, depression, and paranoia. All groups of patients improved significantly between the acute and the chronic phase. However, healthy controls showed a sharper increase of achievement. While the depressives and the patients with psychotic episodes function on a level of questionable fitness for driving, schizophrenics vary greatly intra- and interindividually, generally on a lower level.