Neuropsychological outcomes following stereotactic laser amygdalohippocampectomy

ObjectiveThe objective was to analyze neuropsychological testing data from 15 patients before and after stereotactic laser ablation surgery for temporal lobe epilepsy and to describe the seizure outcomes after stereotactic laser ablation surgery.MethodsA retrospective review of 15 patients who underwent stereotactic laser ablation and who also underwent neuropsychological testing before and after surgery was performed. Verbal and visual memory was assessed in all 15 patients using California Verbal Learning Test and Wechsler Memory Scale IV. Naming was assessed in 9 of 15 patients using the Boston Naming Test. Statistical analysis was performed to determine clinically significant changes using previously validated reliable change indices and proprietary Advanced Clinical Solutions software. Seizure outcome data were evaluated using Engel classification.ResultsPostsurgery neuropsychological evaluation demonstrated that all 15 patients experienced at least 1 clinically significant decline in either verbal or visual memory. Ten patients in this series, including five with dominant-hemisphere surgery, demonstrated decline in delayed memory for narrative information (Logical Memory II). By contrast, the Boston Naming Test demonstrated more favorable results after surgery. Two of nine patients demonstrated a clinically significant increase in naming ability, and only one of nine patients demonstrated a clinically significant decline in naming ability. With at least 6 months of follow-up after surgery, 33% reported seizure freedom.ConclusionStereotactic laser ablation can result in clinically significant and meaningful decline in verbal and visual memory when comparing patients to their own presurgical baseline. Naming ability, conversely, is much less likely to be impacted by stereotactic laser ablation and may improve after the procedure.     

Extended retention intervals can help to bridge the gap between subjective and objective memory impairment

PurposeDespite their excellent clinical validity, objective measures of memory often do not reflect self-perceived memory impairment. This discordance has mostly been attributed to depressed mood. Alternatively, a lack of ecological validity due to the rather short standard retention intervals of 20–60 min may be responsible for this discordance. Therefore, we explored the value of extended retention intervals in regard to subjective memory deficits.MethodsOur prospective study was based on 73 patients with epilepsy. In addition to the standard 30-min retention interval of a verbal learning and memory test (VLMT) patients were randomized to either a free delayed recall after 1 week or after 4 weeks. Mood was assessed by the Beck Depression Inventory (BDI).ResultsForty-four patients (60%) reported self-perceived memory deficits, whereas objective verbal memory impairment was present in 26 patients (36%). Concordance between subjective and objective memory performance was observed in 53% of the patients. Multivariate analyses identified memory performance after 4 weeks and self-rated mood as determinants of subjective memory impairment. Self-perceived memory impairment correlated with the number of remembered words after 4 weeks (r = ?0.361, p = 0.030) and the BDI total score (r = 0.332, p = 0.004) but neither with recall performance after 30 min nor after 1 week.ConclusionSubjective memory appears to follow a different time scale than routine memory testing. Thus, the introduction of longer retention intervals may enhance the ecological validity of standard memory tests. Furthermore, the findings again underscore that controlling for mood is mandatory when dealing with subjective memory complaints.     

Measuring social desirability amongst men with intellectual disabilities: the psychometric properties of the Self- and Other-Deception Questionnaire-Intellectual Disabilities

BackgroundSocial desirability has been construed as either inaccurately attributing positive characteristics to oneself (self-deception), or inaccurately denying that one possesses undesirable characteristics to others (other-deception or impression management). These conceptualisations of social desirability have not been considered in relation to people with intellectual disabilities (IDs), but they are important constructs to consider when undertaking a psychological assessment of an individual, especially within forensic contexts. Therefore, we revised two existing measures of self- and other-deception and considered their psychometric properties.MethodsThirty-two men with mild IDs and 28 men without IDs completed the Self- and Other-Deception Questionnaires—Intellectual Disabilities (SDQ-ID and ODQ-ID) on two occasions, two weeks apart.ResultsMen with IDs scored significantly higher on the SDQ-ID and the ODQ-ID than men without IDs. However, these differences disappeared when Full Scale IQ, Verbal IQ and Performance IQ were controlled in relation to the SDQ-ID, and partially disappeared in relation to the ODQ-ID. The SDQ-ID and the ODQ-ID had substantial internal consistency in relation to men with IDs (k = 0.82 and 0.84 respectively). The test-retest reliability of the SDQ-ID was good (r_i = 0.68), while the test-retest reliability of the ODQ-ID was moderate (r_i = 0.56), for men with IDs. The SDQ-ID had moderate (k = 0.60) and the ODQ-ID had substantial (k = 0.70) internal consistency in relation to men without IDs, while the test-retest reliability of the SDQ-ID was excellent (r_i = 0.87) as was the case for the ODQ-ID (r_i = 0.85).ConclusionsThe SDQ-ID and the ODQ-ID have satisfactory psychometric properties in relation to men with and without IDs. Future research using these instruments is proposed.     

Cognitive improvement after long-term electrical stimulation of bilateral anterior thalamic nucleus in refractory epilepsy patients

IntroductionThe cognitive and behavioral effect of deep brain stimulation (DBS) administered to the deep cerebral nuclei for epilepsy treatment is unknown. We investigated the cognitive outcomes at least 12 months after DBS to the bilateral anterior thalamic nucleus (ATN) for controlling intractable epilepsy.MethodsNine patients with intractable epilepsy who were not candidates for resective surgery, but who were treated by bilateral ATN DBS underwent cognitive and behavioral assessments before implantation and more than 1 year after DBS surgery. Postoperative cognitive assessments were carried out under a continuous stimulation mode.ResultsThe mean seizure-reduction rate of these patients after ATN DBS was 57.9% (35.6–90.4%). Cognitive testing showed favorable results for verbal fluency tasks (letter and category, p < 0.05), and a significant improvement in delayed verbal memory was observed (p = 0.017). However, we did not observe any significant changes in general abilities (IQ, MMSE), information processing (digit forward and backward, Trail A, and Digit Symbol), or executive function (Trail B and WCST). Interestingly, we did not observe any significant cognitive decline approximately 1 year (mean, 15.9 months) after ATN DBS surgery.ConclusionsWe showed that ATN DBS not only resulted in promising clinical effects but was also associated with improvements in both verbal recall and oral information processing, which may be related to the bilateral activation of the fronto-limbic circuit following DBS surgery. Further controlled, long-term studies with larger populations are warranted for elucidating the clinical effects of ATN DBS.     

Decreased processing speed might account for working memory span deficit in schizophrenia,and might mediate the associations between working memory span and clinical symptoms

ObjectiveVerbal working memory span is decreased in patients with schizophrenia, and this might contribute to impairment in higher cognitive functions as well as to the formation of certain clinical symptoms. Processing speed has been identified as a crucial factor in cognitive efficiency in this population. We tested the hypothesis that decreased processing speed underlies the verbal working memory deficit in patients and mediates the associations between working memory span and clinical symptoms.MethodForty-nine schizophrenia inpatients recruited from units for chronic and acute patients, and forty-five healthy participants, were involved in the study. Verbal working memory span was assessed by means of the letter-number span. The Digit Copy test was used to assess motor speed, and the Digit Symbol Substitution Test to assess cognitive speed.ResultsThe working memory span was significantly impaired in patients (F(1,90) = 4.6, P < 0.05). However, the group difference was eliminated when either the motor or the cognitive speed measure was controlled (F(1,89) = 0.03, P = 0.86, and F(1,89) = 0.03, P = 0.88). In the patient group, working memory span was significantly correlated with negative symptoms (r = –0.52, P < 0.0001) and thought disorganisation (r = –0.34, P < 0.025) scores. Regression analyses showed that the association with negative symptoms was no longer significant when the motor speed measure was controlled (β = –0.12, P = 0.20), while the association with thought disorganisation was no longer significant when the cognitive speed measure was controlled (β = –0.10, P = 0.26).ConclusionsDecrement in motor and cognitive speed plays a significant role in both the verbal working memory impairment observed in patients and the associations between verbal working memory impairment and clinical symptoms.     

Hippocampal volume and memory in narcoleptics with cataplexy

Background/ObjectiveThe objective of this study was to investigate the differences in hippocampal volume (HV) between narcoleptics and normal controls and determine if HV is associated with memory function in narcoleptics. Left and right HV and intracranial volumes (ICV) were manually measured and compared between two groups.MethodsThe study consisted of 36 drug-naïve narcoleptics with cataplexy and 36 age- and sex-matched controls (mean age 29.0 years). All subjects underwent 1.6-mm-thick spoiled gradient recalled magnetic resonance imaging and took the Korean California Verbal Learning Test and the Rey Complex Figure Test to assess verbal and visual memory.ResultsThe mean ICV was not different between groups (1599.2 cm³ in narcoleptics vs. 1623.5 cm³ in controls, p = .450). Bilateral mean HVs were significantly smaller in narcoleptics (left, 2907.2 mm³ in narcoleptics vs. 3092.3 mm³ in controls, p = 0.005; right, 2990.8 mm³ in narcoleptics vs. 3184.3 mm³ in controls, p = 0.004). Significance of HV differences between groups remained after corrections were made for gender, age, and ICV. In narcoleptics, bilateral HV was positively correlated with mean sleep and REM sleep latencies in Multiple Sleep Latency Tests. Absolute memory scores were not different between groups and were not correlated with HV in narcoleptics.ConclusionsNarcoleptics had smaller bilateral HVs compared to controls. HV had a significant relationship with sleep and REM sleep latencies. This study provides supportive evidence of the functional and anatomical deficits in medial temporal areas that are related to the severity of narcolepsy.     

Long-term accelerated forgetting of verbal and non-verbal information in temporal lobe epilepsy

IntroductionWe investigated whether pre-surgical patients with temporal lobe epilepsy (TLE) forget verbal and non-verbal material faster than healthy controls over retention intervals of an hour and 6 weeks, and whether any observed memory loss was associated with structural changes to the hippocampus and/or seizure frequency.MethodsA mixed factorial design compared the performance of 27 patients with TLE and 22 healthy control participants, matched for IQ, age and gender, on tests of story recall and complex figure recall at three delays: immediate, 1 h and 6 weeks. Performance of the patient and control groups was matched at the immediate delay, which enabled comparisons of forgetting rate over the longer delays.ResultsWe found that TLE can affect the acquisition and retention of new memories over a relatively short delay of 1 h. This deficit was associated with structural hippocampal abnormality, with a material-specific effect that was particularly evident for the verbal task. We also found evidence of accelerated long-term forgetting in both patient groups, for the verbal and non-verbal tasks. It was demonstrated most strongly on the verbal task by the patients with right lateralized hippocampal sclerosis whose verbal recall was normal at the 1-h delay. Accelerated long-term forgetting was not associated with hippocampal pathology, but was associated with the frequency of epileptic seizures.DiscussionThe findings from the verbal task in particular provide evidence consistent with an extended period of memory consolidation that can be disrupted by both left and right TLE. The material-specific effects at the 1-h delay only, suggest that the initial consolidation of verbal and non-verbal, information depends on the integrity of the left and right hippocampus, respectively.     

Clinical utility of the Wechsler Memory Scale — Fourth Edition (WMS-IV) in patients with intractable temporal lobe epilepsy

IntroductionThe Wechsler Memory Scale (WMS) is one of the most widely used test batteries to assess memory functions in patients with brain dysfunctions of different etiologies. This study examined the clinical validation of the Dutch Wechsler Memory Scale — Fourth Edition (WMS-IV-NL) in patients with temporal lobe epilepsy (TLE).MethodThe sample consisted of 75 patients with intractable TLE, who were eligible for epilepsy surgery, and 77 demographically matched healthy controls. All participants were examined with the WMS-IV-NL.ResultsPatients with TLE performed significantly worse than healthy controls on all WMS-IV-NL indices and subtests (p < .01), with the exception of the Visual Working Memory Index including its contributing subtests, as well as the subtests Logical Memory I, Verbal Paired Associates I, and Designs II. In addition, patients with mesiotemporal abnormalities performed significantly worse than patients with lateral temporal abnormalities on the subtests Logical Memory I and Designs II and all the indices (p < .05), with the exception of the Auditory Memory Index and Visual Working Memory Index. Patients with either a left or a right temporal focus performed equally on all WMS-IV-NL indices and subtests (F(15, 50) = .70, p = .78), as well as the Auditory–Visual discrepancy score (t(64) = − 1.40, p = .17).ConclusionThe WMS-IV-NL is capable of detecting memory problems in patients with TLE, indicating that it is a sufficiently valid memory battery. Furthermore, the findings support previous research showing that the WMS-IV has limited value in identifying material-specific memory deficits in presurgical patients with TLE.     

Verbal fluency as a possible predictor for psychosis

BackgroundNeurocognitive abnormalities are prevalent in both first episode schizophrenia patients and in ultra high risk (UHR) patients.AimTo compare verbal fluency performance at baseline in UHR in patients that did and did not make the transition to psychosis.MethodBaseline verbal fluency performance in UHR-patients (n = 47) was compared to match first episode patients (n = 69) and normal controls (n = 42).ResultsVerbal fluency (semantic category) scores in UHR-patients did not differ significantly from the score in first episode schizophrenia patients. Both the UHR group (p < 0.003) and the patient group (p < 0.0001) performed significantly worse than controls. Compared to the non-transition group, the transition group performed worse on verbal fluency, semantic category (p < 0.006) at baseline.ConclusionsVerbal fluency (semantic category) is disturbed in UHR-patients that make the transition to psychosis and could contribute to an improved prediction of transition to psychosis in UHR-patients.     

Cognitive functions in children exposed to antiepileptic drugs in utero - Study in Georgia

ObjectiveThe cognitive teratogenicity of antiepileptic drugs (AEDs) has gained increasing attention in the last decade. The objective of the current study was to assess the effects of AED fetal exposure on the cognitive development of children of mothers with epilepsy from Georgia in a controlled study taking into consideration major confounding factors.MethodsA prospective cohort group was formed from children and mothers registered in the Georgian National AED-Pregnancy Registry. The study group's age- and gender-matched control children without fetal AED exposure were selected retrospectively. The Intelligence Quotient (IQ) using the Wechsler Adult Intelligence Scale – revised (WAIS-R) was assessed in mothers. The Wechsler Preschool and Primary Scale of Intelligence (WPPSI-4) were used to assess intellectual functioning for children of both study and control groups. Linear regression analysis was performed to detect association of AED exposure on the cognitive performance of children.ResultsIn total, 100 children aged 36 to 72 months were evaluated. The IQ of WWE was significantly lower compared to women without epilepsy in all modalities. Exposure to valproate (VPA) (n = 18) was associated with lowest cognitive performance regarding Full Scale IQ (FSIQ) (β, − 12.04; p = 0.006) and verbal comprehension (VCI) (β, − 8.89; p = 0.019). Maternal FSIQ, maternal performance IQ (PIQ), and child's age at first phrases were independent factors associated with the cognitive development of children.ConclusionsMultivariate analysis showed VPA to be an independent predictor for decreased cognitive performance. Maternal FSIQ, PIQ, and child developmental achievements were significant confounders for cognitive performance in children.     

Pseudohypacusis in childhood and adolescence is associated with increased gray matter volume in the medial frontal gyrus and superior temporal gyrus

Pseudohypacusis is a somatoform disorder characterized by hearing loss with discrepancies between pure-tone audiometry and auditory brainstem response (ABR), but the underlying neuronal mechanisms remain unclear. Using voxel-based morphometry (VBM) with magnetic resonance (MR) imaging for 14 unmedicated, right-handed patients and 35 healthy control subjects, we investigated whether functional hearing loss was associated with discernible changes of brain morphology. Group differences in gray matter volume (GMV) were assessed using high-resolution, T1-weighted, volumetric MR imaging datasets (3T Trio scanner; Siemens AG) and analyzed with covariant factors of age, sex, socioeconomic status (SES), and total GMV, which was increased by 27.9% in the left medial frontal gyrus (MFG) (Brodmann area 10) (p = .001, corrected cluster level) and by 14.4% in the right superior temporal gyrus (STG) and the adjacent middle temporal gyrus (MTG) (BA42 to 21) (p = .009, corrected cluster level) in patients with pseudohypacusis. The GMV in the right STG (BA42) and verbal intelligence quotient (IQ) were correlated significantly with the Wechsler Intelligence Scale for Children – Third Edition (WISC-III) (ß = ?.57, p < .0001) and level of SES (ß = ?.55, p < .0001). The present findings suggest that the development of the auditory association cortex involved in language processing is affected, causing insufficient pruning during brain development. We therefore assert that differences in the neuroanatomical substrate of pseudohypacusis subjects result from a developmental disorder in auditory processing.     

Moderating effect of schizotypy on the relationship between smoking and neurocognition

PurposeSmoking rates in schizotypic individuals are shown to be elevated, as in patients with schizophrenia, although findings on the association of smoking with different symptomatology of schizotypy have been mixed. Moreover, possible moderating effects of schizotypy on the relationship between smoking and cognition have not been well documented.Subjects and methodsThe Schizotypal Personality Questionnaire (SPQ) and the full version of the Wechsler Memory Scale-Revised (WMS-R) were administered to 501 healthy adults. Subjects were divided into smokers (n = 85) and non-smokers (n = 416) based on the presence/absence of current smoking.ResultsThe analysis of covariance (ANCOVA) on the three factor scores as well as the total score of the SPQ, controlling for age and gender, revealed that cognitive-perceptual factor was significantly associated with an increased rate of smoking (P = 0.048). The ANCOVA on the WMS-R indices, with smoking group as a fixed factor and age, gender and total SPQ score as covariates, revealed that the schizotypy-by-smoking interaction was significant for attention/working memory (P = 0.029).Discussion and conclusionPositive schizotypy may be associated with more smoking. Schizotypy and smoking could interact with each other to negatively affect attention/working memory.     

Preoperative IQ predicts seizure outcomes after anterior temporal lobectomy

PurposeIQ tests are frequently used in the preoperative neuropsychological assessment of candidates for anterior temporal lobectomy (ATL). We reviewed IQ test results and surgery outcomes to evaluate the roles of IQ tests in the preoperative work-up.MethodsA total of 205 adult patients who had undergone ATL and whose seizure outcomes were followed for 2 years after surgery were included. The short form WAIS-R was used to estimate intelligence. Multiple linear regression and logistic regression analyses were used to examine the variables for IQ and seizure outcomes.ResultsEducation, duration of epilepsy and gender were factors that accounted for 24.6% of the variance in the full-scale IQ (FSIQ) scores. The verbal IQ and performance IQ discrepancies at various magnitudes could not lateralize the seizure foci. Freedom of seizure was noted in 128 (62.4%) of the patients. Seizure outcomes, however, correlated with the preoperative FSIQ. After adjustment for variables that affect seizure outcomes, the FSIQ was an independent predictor of postoperative seizure outcomes (OR 1.04, 95% CI 1.01–1.06, p = 0.003). Of patients who had FSIQ lower than 70, 50% became free from seizures by 2 years after surgery.ConclusionsIn our study, IQ tests were unable to lateralize seizure foci but may serve as an independent predictor of postoperative seizure outcomes. Since a longer duration of epilepsy had deleterious effects on intelligence, earlier surgical intervention might better preserve neuropsychological function and, consequently, allow better seizure control after ATL. Nonetheless, patients with lower IQ scores could still benefit from ATL.     

Correlation between interictal cerebral glucose hypometabolism and IQ in children with epilepsy

The aim of this study was to understand the relationship between IQ and glucose metabolism in brain cells in a wide variety of subjects with epilepsy. The study participants were 78 children with epilepsy and 15 healthy children for comparison. All participants were administered the Chinese Wechsler Intelligence Scale for Children (C-WISC). The verbal intelligence quotient (VIQ), performance intelligence quotient (PIQ), and full-scale intelligence quotient (FIQ) were compared between children with epilepsy and typically developing children. Seventy-eight patients underwent interictal positron emission computed tomography (PET) using 2-deoxy-2[¹⁸F]fluoro-d-glucose (FDG) as the tracer for evaluating brain glucose metabolism. Verbal intelligence quotient, PIQ, and FIQ based on the C-WISC were significantly lower in children with epilepsy than those in the healthy comparison group (P < 0.001, P = 0.001, and P < 0.001, respectively). The IQ of patients with normal metabolism, unifocal abnormal hypometabolism, and multifocal abnormal hypometabolism determined by PET differed significantly. The extent of the abnormal hypometabolism was negatively correlated with the FIQ (rs = − 0.549, P < 0.001). In patients with lateralized hypometabolism based on PET, the VIQ/PIQ discrepancy scores (|VIQ − PIQ| ≥ 15 points) differed significantly between the left hemisphere abnormal hypometabolism and right hemisphere abnormal hypometabolism subgroups, with negative values in the left and positive values in the right subgroups (P = 0.004). In conclusion, brain metabolic abnormalities are correlated with IQ, and performing interictal PET along with C-WISC can better assess the extent of severity of cognitive impairment and VIQ/PIQ discrepancy.     

Sleep instability and cognitive status in drug-resistant epilepsies

ObjectiveThe aims of this study were to evaluate the sleep habits of children with drug resistant epilepsy and to correlate sleep abnormalities with epilepsy and level of intelligence.Subjects and methodsTwenty five subjects with drug resistant epilepsy (14 males, age range 2–16.4 years) were recruited for this study. A control group was formed by 23 normal children. Two instruments to assess sleep habits were administered to the patients with epilepsy: a questionnaire on sleep habits (to preschool children) and a questionnaire on sleep behavior (for children aged more than seven years old); a cognitive test (Wechsler Intelligence Scale for Children-WISC) was also performed. Patients underwent a complete polysomnographic study and sleep parameters, including CAP, were analyzed and correlated according to cognitive-behavioral measures in children with epilepsy.ResultsChildren with drug-resistant epilepsy and severe mental retardation showed sleep abnormalities such as low sleep efficiency, high percentage of wakefulness after sleep onset, reduced slow wave sleep, and reduced REM sleep. Sleep microstructure evaluated by means of CAP analysis showed a decrease in A1 index during N3 in patients with more severe cognitive impairment. Children with epilepsy and cognitive impairment (n = 10) had higher Sleep Behavior Questionnaire for Children (SBQC) total scores (65.60 ± 18.56) compared to children with epilepsy and normal IQ (50.00 ± 10.40), p < 0.05.ConclusionsChildren with drug-resistant epilepsy have a greater incidence of sleep problems regarding qualitative aspects, macrostructure, and CAP. The decrease of CAP rate and of A1, mainly during slow wave sleep (associated to REM sleep reduction), might represent a sleep microstructural pattern of intellectual disability.     

Outcome after cortico-amygdalo-hippocampectomy in patients with temporal lobe epilepsy and normal MRI

RationaleWe describe seizure and neuropsychological outcome obtained after CAH in patients with TLE and normal MRI evaluated in the modern imaging era.MethodsForty-five adult consecutive patients with TLE and normal MRI were studied. All patients had neuropsychological testing, interictal and ictal EEG recordings and MRI. They were divided into two groups: Group 1 (n = 18), included patients in whom non-invasive neurophysiological evaluation was lateralizing and Group 2 (n = 27) included patients with non-lateralizing neurophysiological data who were submitted to invasive recordings.ResultsSeventy-seven percent of the Group 1 patients were rated as Engel I; 11% were rated as Engel II and 11% as Engel III. In Group 2, there were 57% of patients seizure-free, 26% in Engel II and 14% in Engel III. Pre-operatively, mean general IQ was 82 and 78 in Groups1 and 2, respectively; post-operatively, mean general IQ was respectively 86 and 71. Some degree of verbal memory decline was noted in all patients submitted to dominant temporal lobe resection in both Groups 1 and 2. At last follow-up visit, 22% of Group 1 and 11% of Group 2 patients were receiving no antiepileptic drugs (AED).ConclusionsOur data showed that patients with TLE and normal MRI could get good surgical results after CAH although 60% of them would need invasive recordings and their results regarding seizure control and cognition were worse than those obtained in patients with MRI defined temporal lobe lesions. Caution should be taken in offering dominant temporal lobe resection to this subset of patients.     

Long-term outcomes in patients with schizophrenia treated with risperidone long-acting injection or oral antipsychotics in Spain: Results from the electronic Schizophrenia Treatment Adherence Registry (e-STAR)

BackgroundThe electronic Schizophrenia Treatment Adherence Registry (e-STAR) is a prospective, observational study of patients with schizophrenia designed to evaluate long-term treatment outcomes in routine clinical practice.MethodsParameters were assessed at baseline and at 3 month intervals for 2 years in patients initiated on risperidone long-acting injection (RLAI) (n = 1345) or a new oral antipsychotic (AP) (n = 277; 35.7% and 36.5% on risperidone and olanzapine, respectively) in Spain. Hospitalization prior to therapy was assessed by a retrospective chart review.ResultsAt 24 months, treatment retention (81.8% for RLAI versus 63.4% for oral APs, p < 0.0001) and reduction in Clinical Global Impression Severity scores (?1.14 for RLAI versus ?0.94 for APs, p = 0.0165) were significantly higher with RLAI. Compared to the pre-switch period, RLAI patients had greater reductions in the number (reduction of 0.37 stays per patient versus 0.2, p < 0.05) and days (18.74 versus 13.02, p < 0.01) of hospitalizations at 24 months than oral AP patients.ConclusionsThis 2 year, prospective, observational study showed that, compared to oral antipsychotics, RLAI was associated with better treatment retention, greater improvement in clinical symptoms and functioning, and greater reduction in hospital stays and days in hospital in patients with schizophrenia. Improved treatment adherence, increased efficacy and reduced hospitalization with RLAI offer the opportunity of substantial therapeutic improvement in schizophrenia.     

Theory of mind in obsessive-compulsive disorder: Comparison with healthy controls

AimTheory of mind (ToM) is the ability to represent one's own or another's mental states and has been found to be impaired in many psychiatric disorders. Our objective was to compare ToM abilities of patients with obsessive-compulsive disorder (OCD) with healthy controls and to investigate the relation between some illness features, other cognitive functions and ToM abilities of patients.MethodThirty OCD patients and age, sex and education matched 30 healthy controls were compared according to their performances on ToM tasks (including first and second order false belief, hinting task and double-bluff task), verbal memory processes test, Weschler memory test (WMT) (logical memory, visual reproduction and digit span sub-tests), stroop test.ResultsPatients’ performances were worse than healthy controls on all of the ToM tasks, but the results were significant for only for double-bluff task (t = ?3.992, df = 36.157, p < 0.01). Performance on double-bluff task was significantly and positively correlated with visual reproduction-immediate recall (r = ?0.411, p < 0.05) and visual reproduction-delayed recall (r = 0.478, p < 0.05), hinting task was significantly and positively correlated with verbal memory (r = 0.481, p < 0.05).ConclusionThese results show “basic” ToM abilities of OCD patients are generally preserved, but they show significant reduction in their “advanced” ToM abilities, which seem to be related to their reduced memory capacities. The possible reasons for the relation between memory and ToM impairments, as well as the clinical significance of ToM deficits in OCD are discussed.     

Anterior cingulate morphology in people at genetic high-risk of schizophrenia

BackgroundMorphological abnormalities of the anterior cingulate (AC) occur in patients with schizophrenia and in symptomatic high-risk individuals, and may be predictive of subsequent psychosis. We investigated AC sulcal morphology in the Edinburgh High Risk Study cohort to see if such abnormalities are evident and predict psychosis in patients’ relatives. We also investigated the association of the cingulate sulcus (CS) and paracingulate sulcus (PCS) variants with intelligence quotient (IQ).Patients and methodsWe compared cingulate and paracingulate sulcal anatomy, using reliable standardised measurements, blind to group membership, in those at high genetic risk (n = 146), first episode patients (n = 34) and healthy controls (n = 36); and compared high-risk subjects who did (n = 17) or did not develop schizophrenia.ResultsInterruptions of the cingulate sulcus were more common in high-risk individuals and in those with schizophrenia, in both hemispheres, compared to controls. When separated by gender, these results were only present in males in the left hemisphere and only in females in the right hemisphere. A well-formed paracingulate sulcus was less common in high-risk participants and patients with schizophrenia, compared to controls; but this association was only present in males. These morphological variants of the paracingulate sulcus and the continuous cingulate sulcus were also associated with the higher IQ in male high-risk individuals.ConclusionsAn interrupted cingulate sulcus pattern in both males and females and paracingulate morphology in males are associated with increased genetic risk of schizophrenia. Associations between cingulate and paracingulate morphology and premorbid IQ scores provide evidence that intellectual ability could be related to particular cytoarchitectural brain regions. Given that these sulci develop in early fetal life, such findings presumably reflect early neurodevelopmental abnormalities of genetic origin, although environmental effects and interactions cannot be ruled out.     

Self reported adverse effects of mono and polytherapy for epilepsy

PurposeAdverse effects of anti epileptic drugs (AEDs) can significantly affect the life of people with epilepsy. We used a register to determine if polytherapy with AED has more adverse effects than monotherapy.MethodsWe established a register for people with epilepsy (www.UKAED.info). Participants were requested to complete the Liverpool Adverse Event Profile (LAEP) to quantify adverse effects. We also recorded type of epilepsy, seizure control and AED including drug doses. Five hundred and seventy six complete data sets were available, monotherapy (n = 186), polytherapy (n = 325) and control subjects not taking AED (n = 65).ResultsThe mean LAEP scores in polytherapy (45.56, confidence interval (CI) = 44.36–46.76) were significantly higher than the mean LAEP scores in monotherapy (42.29, CI = 40.65–44.02) and the mean LAEP scores in controls (33.25, CI = 31.05–35.44). Tiredness, memory problems and difficulty concentrating were the most common symptoms in patients taking AED and were consistently higher in polytherapy than in monotherapy. Tiredness was reported as always or sometimes being a problem in (polytherapy/monotherapy/controls) 82.5%/75.6%/64.6%, memory problems in 76%/63.2%/29.2% and difficulty concentrating in 68%/63.9%/30.8%. The proportion of seizure-free patients was significantly lower in the polytherapy group (17%) than in the monotherapy group (55%). Depression rates between the monotherapy and polytherapy groups were similar. Drug dosages were higher in polytherapy, however this did not reach statistical significance.ConclusionPatients on polytherapy had significantly higher LAEP scores than patients on monotherapy. This should be carefully discussed with the patient before a second AED is added.