Sensitive period for white-matter connectivity of superior temporal cortex in deaf people

Previous studies have shown that white matter in the deaf brain changes due to hearing loss. However, how white-matter development is influenced by early hearing experience of deaf people is still unknown. Using diffusion tensor imaging and tract-based spatial statistics, we compared white-matter structures among three groups of subjects including 60 congenitally deaf individuals, 36 acquired deaf (AD) individuals, and 38 sex- and age-matched hearing controls (HC). The result showed that the deaf individuals had significantly reduced fractional anisotropy (FA) values in bilateral superior temporal cortex and the splenium of corpus callosum compared to HC. The reduction of FA values in acquired deafness correlated with onset age of deafness, but not the duration of deafness. To explore the underlying mechanism of FA changes in the deaf groups, we further analyzed radial and axial diffusivities and found that (1) the reduced FA values in deaf individuals compared to HC is primarily driven by higher radial diffusivity values and (2) in the AD, higher radial diffusivity was correlated with earlier onset age of deafness, but not the duration of deafness. These findings imply that early sensory experience is critical for the growth of fiber myelination, and anatomical reorganization following auditory deprivation is sensitive to early plasticity in the brain.     

Clinical and serotonergic predictors of non-affective acute remitting psychosis in patients with a first-episode psychosis

Objective: The study aimed to establish clinical predictors of non‐affective acute remitting psychosis (NARP) and assess whether these patients showed a distinct serotonergic profile. Method: First‐episode never treated psychotic patients diagnosed of paranoid schizophrenia (n = 35; 21 men and 14 women) or NARP (n = 28; 15 men and 13 women) were included. Results: NARP patients showed significantly lower negative symptomatology, better premorbid adjustment, shorter duration of untreated psychosis, more depressive symptomatology and a lower number of 5‐HT2A receptors than the paranoid schizophrenia patients. In the logistic regression, the four variables associated with the presence of NARP were: low number of 5‐HT2A receptors; good premorbid adjustment; low score in the item ‘hallucinatory behaviour’ and reduced duration of untreated psychosis. Conclusion: Our findings support the view that NARP is a highly distinctive condition different from either affective psychosis or other non‐affective psychosis such as schizophrenia, and highlight the need for its validation.     

Deafness and mental health: psychiatric and psychosomatic illness in the deaf

The prevalence of psychiatric and psychosomatic diseases amongst patients who had become deaf in adolescence or in adult life due to otosclerosis was studied. This was to test the hypothesis that the deaf would be more susceptible to suffer from psychiatric disorders than control subjects. Assessment of 49 deaf patients who had a bilateral hearing loss of 40 dB or more and 40 control subjects who had a unilateral hearing loss of 40 dB or more by the Cornell Index N₂ Questionnaire and psychiatric interview showed psychiatric illness to be significantly more common in the deaf than in the control subjects. Amongst the deaf patients, depressive illness was found to be the predominant type of psychiatric illness. There was, however, no significant difference in the prevalence of psychosomatic disorders between the two groups. The relationship of psychiatric illness in the deaf and such factors as positive psychiatric family history, the severity of deafness, living alone, duration of deafness were investigated. On the basis of the findings of this study, the significance of deafness as a psychological precipitant is discussed.     

Visual acuity and ocular pathology in the paranoid and affective psychoses of later life.

The visual acuity and ocular pathology occurring in association with functional psychoses in later life is examined in two groups of elderly patients (54 paranoid and 57 affective) in whom the prevalence of social deafness and hearing loss has already been studied.Visual acuity for distant vision is found to be considerably worse in the paranoid group but significantly so only in the eyes with less good vision. No difference between the groups is noted with respect to near vision.On the basis of a screening test, significant ocular pathology is found in the eyes of 30 paranoid and 21 affective patients. Significantly more cataract is detected among the paranoid patients than the affectives; and within the paranoid group, an association between deafness and cataract is found which is not due to age. The implications of these findings are discussed.     

Is paranoid illness associated with sensory defects in the elderly?

A study of 340 elderly psychiatric patients did not show the expected association between paranoid illness and sensory defects. Neither the blind nor the deaf had an increased incidence of paranoid illness. Although the blind had more than the expected number of delusions of persecution and organically based psychiatric illnesses, analysis of covariance showed that these findings were due to their increased age and not to the sensory defect. The deaf had fewer delusions of guilt and affective disorders than the hearing. If this last finding is generally true then previous comparisons of paranoid and affective disorders of the deaf may have led to erroneous conclusions. A decreased incidence of affective disorders would have led to an apparent, not real, increase in paranoid disorders.     

Cortical reorganization in deaf children

Topographic mapping of the cerebral cortex of 79 deaf children and a group of matched hearing children was performed, using measures of electroencephalographic coherence, phase, and power. Deaf children manifested higher coherence and lower phase in certain left hemispheric areas, suggesting less neural differentiation; but lower coherence and higher phase in certain right hemispheric areas, suggesting greater differentiation. Deaf children had higher total power in bilateral frontal cortex than did hearing children. The data also suggested compensatory functioning in the visual cortex of the deaf subjects. The pattern of results varied somewhat in relation to cause of deafness. These findings support the hypothesis that prelingual deafness results in a partial reorganization of cerebral cortex.     

Hallucinatory modalities in prelingually deaf schizophrenic patients: a retrospective analysis of 67 cases

In order to examine the effect of congenital or early acquired deafness on hallucinatory modalities in schizophrenia, we interviewed 67 prelingually deaf schizophrenic patients (using sign language) about their hallucinatory experiences over the entire course of their illness. We also analysed the clinical records of our subjects' previous hospitalizations. In our deaf sample, visual and tactile hallucinations were plainly over-represented as hallucinatory modalities in comparison with hearing schizophrenic samples. Although some patients reported visual hallucinatory perceptions of sign language messages, the hallucinatory reception of meaningful information in deaf patients seems also to remain affiliated to the ‘auditory’ modality. It was concluded that the different representation of hallucinatory modalities reflects in particular the influence of ‘the deaf way’ of sensory experience on imagery processes.     

Hippocampal volume in first-episode psychoses and chronic schizophrenia: a high-resolution magnetic resonance imaging study

BACKGROUND: It has been proposed that the hippocampus is a potential site for a neurodevelopmental lesion in schizophrenia. While smaller hippocampal volumes have been described in chronic schizophrenia, there have been few magnetic resonance imaging studies in first-episode psychosis. Furthermore, no studies have examined the specificity of this finding to first-episode schizophrenia, compared with first-episode affective psychosis. METHODS: Hippocampal and whole-brain volumes were estimated using high-resolution magnetic resonance imaging in 140 controls, 46 patients with chronic schizophrenia, and 32 patients with first-episode psychosis. RESULTS: Patients with chronic schizophrenia and first-episode psychosis had significantly smaller hippocampal volumes as compared with controls. Within the first-episode group, both patients with schizophrenia/schizophreniform psychosis and those with affective psychosis had smaller left hippocampal volumes as compared with controls. Smaller right hippocampal volumes were associated with age and illness duration in patients with chronic schizophrenia. Hippocampal volumes were not correlated with age of illness onset or medication dosage in either patient group. CONCLUSIONS: These data show that smaller hippocampal volumes are present from the onset of illness. While these findings would support the neurodevelopmental model of schizophrenia, the finding of smaller left hippocampal volume in patients with first-episode schizophrenia and affective psychosis does not support the prediction that smaller hippocampi are specific to schizophrenia. The association of smaller right hippocampal volumes with increased illness duration in chronic schizophrenia suggests either that there is further neurodegeneration after illness onset or that bilateral small hippocampi predict chronicity.     

Cortical reorganization following auditory deprivation predicts cochlear implant performance in postlingually deaf adults

Long‐term hearing loss in postlingually deaf (PD) adults may lead to brain structural changes that affect the outcomes of cochlear implantation. We studied 94 PD patients who underwent cochlear implantation and 37 patients who were MRI‐scanned within 2 weeks after the onset of sudden hearing loss and expected with minimal brain structural changes in relation to deafness. Compared with those with sudden hearing loss, we found lower gray matter (GM) probabilities in bilateral thalami, superior, middle, inferior temporal cortices as well as the central cortical regions corresponding to the movement and sensation of the lips, tongue, and larynx in the PD group. Among these brain areas, the GM in the middle temporal cortex showed negative correlation with disease duration, whereas the other areas displayed positive correlations. Left superior, middle temporal cortical, and bilateral thalamic GMs were the most accurate predictors of post‐cochlear implantation word recognition scores (mean absolute error [MAE] = 10.1, r = .82), which was superior to clinical variables used (MAE: 12.1, p < .05). Using the combined brain morphological and clinical features, we achieved the best prediction of the outcome (MAE: 8.51, r = .90). Our findings suggest that the cross‐modal plasticity allowing the superior temporal cortex and thalamus to process other modal sensory inputs reverses the initially lower volume when deafness becomes persistent. The middle temporal cortex processing higher‐level language comprehension shows persistent negative correlations with disease duration, suggesting this area's association with degraded speech comprehensions due to long‐term deafness. Morphological features combined with clinical variables might play a key role in predicting outcomes of cochlear implantation.     

Bilateral sudden deafness as a prodrome of anterior inferior cerebellar artery infarction

BACKGROUND: Acute ischemic stroke in the distribution of the anterior inferior cerebellar artery is known to be associated with hearing loss, facial weakness, ataxia, nystagmus, and hypalgesia. There have been few reports on bilateral deafness and vertebrobasilar occlusive disease. Furthermore, previous reports have not emphasized the inner ear as a localization of bilateral deafness. OBJECTIVE: To describe the presentation of acute ischemic stroke in the distribution of the anterior inferior cerebellar artery as sudden bilateral hearing loss with minimal associated signs. DESIGN AND SETTING: Case report and tertiary care hospital. PATIENT: A 66-year-old man with diabetes mellitus developed sudden bilateral deafness, unilateral tinnitus, and vertigo 7 days before the onset of dysarthria, facial weakness, and ataxia. T2-weighted magnetic resonance imaging scans showed hyperintensities in the right lateral pons and right middle cerebral peduncle and a possible abnormality of the left middle cerebellar peduncle. A magnetic resonance angiogram showed moderately severe stenosis of the distal vertebral artery and middle third of the basilar artery. The patient's right limb coordination and gait improved steadily over several weeks, but there was no improvement in hearing in his right ear. CONCLUSIONS: The relatively isolated onset of deafness as well as the severity and persistence of the hearing loss led us to conclude that the hearing loss in this case was likely due to prominent hypoperfusion of the internal auditory artery, with labyrinthine infarction as the earliest event. Vertebrobasilar occlusive disease should be considered in the differential diagnosis of sudden bilateral deafness.     

Prediction of psychosis onset in Alzheimer disease: The role of cognitive impairment, depressive symptoms, and further evidence for psychosis subtypes.

BACKGROUND: Psychotic symptoms in Alzheimer disease (AD+P) identify a heritable phenotype associated with more rapid cognitive decline. The authors have proposed that AD+P is itself a composite of a misidentification and a paranoid subtype with increased cognitive impairment restricted to the misidentification type. Most prior studies of the clinical correlates of AD+P have been limited, however, by the inclusion of prevalent cases. METHODS: Subjects with possible or probable AD or mild cognitive impairment (MCI) without psychosis at study entry were assessed at the time of initial presentation and then annually. Psychotic symptoms were assessed using the CERAD Behavioral Rating Scale. Survival analyses used Cox proportional hazard models with time-dependent covariates to examine the predictors of psychosis onset. RESULTS: A total of 288 subjects completed at least one follow-up examination. Mean duration of follow-up was 22.1 months. The incidence of psychosis was 0.19 per person-year. Cognitive impairment was associated with onset of psychosis, largely as a result of its association with onset of the misidentification, but not the paranoid, subtype. Including psychotropic medication use in the model revealed an association of antidepressant use with the onset of psychosis. This latter association appeared to arise from an underlying association between depression and the risk of psychosis onset rather than from antidepressant treatment. CONCLUSION: These findings are consistent with the hypothesis that the misidentification and the paranoid subtypes each define a more biologically homogeneous group than AD+P as a whole. Further exploration of the relationship between depressive symptoms and psychosis in patients with AD is warranted.     

Psychomotor epilepsy and psychosis. II PHYSICAL ASPECTS

In a controlled investigation the clinical findings in 96 patients with paranoid/hallucinatory psychosis and partial epileptic seizures with complex symptoms, were compared with the findings in 96 control patients with the same type of epilepsy without psychosis of median 24 years' duration. The median age at onset of psychosis was 34 years, after epilepsy of median 21 years' duration. The seizure frequency of complex, partial seizures was significantly lower in the psychotic group, while the frequency of generalized seizures did not differ. A significant preponderance in the psychotic group of left-handed patients, etiological factors and neurological signs reflecting organic damage, and seizures of automatic behaviour indicates that epileptic psychoses are caused by structural lesions affecting the deep parts of the temporal lobe.     

Trajectory to a first episode of psychosis: a qualitative research study with families

Aim: The trajectory in psychotic disorders which leads from a relatively normal premorbid state in young people to a first episode of psychosis is only partly understood. Qualitative research methods can be used to begin to elucidate the temporal unfolding of symptoms leading to a first episode of psychosis, and its impact on families. Methods: We conducted open‐ended interviews with family members of 13 patients with recent onset non‐affective psychotic disorders, which focused on changes observed, effects on the family, explanatory models, help‐seeking patterns and future expectations. Standard data analytic methods employed for qualitative research were used. Results: Narratives by family members were remarkably similar. First, social withdrawal and mood symptoms developed in previously normal children; these changes were typically ascribed to drugs or stress, or to the ‘storminess’ of adolescence. Coping strategies by family members included prayer and reasoning/persuasion with the young person, and family initially sought help from friends and religious leaders. Entry into the mental health system was then catalysed by the emergence of overt symptoms, such as ‘hearing voices’, or violent or bizarre behaviour. Family members perceived inpatient hospitalization as traumatic or difficult, and had diminished expectations for the future. Conclusions: Understanding families' explanatory models for symptoms and behavioural changes, and their related patterns of help‐seeking, may be useful for understanding evolution of psychosis and for the design of early intervention programmes. Dissatisfaction with hospitalization supports the mandate to improve systems of care for recent‐onset psychosis patients, including destigmatization and a focus on recovery.     

Course of adolescent psychotic disorder with schizoaffective episodes

This study examines educational/occupational outcome and social functioning of adolescents treated for psychosis (mean onset age 16.1 yrs±1.3). In a sample of 157 subjects, 26 patients with schizoaffective episodes (defined as any episode meeting ICD-9 criteria for schizoaffective psychosis, occurring at any time during the course of illness) were compared to 101 patients with schizophrenia, and to 30 affective disordered patients, all without schizoaffective episodes. Follow-up information (mean interval 7.3 yrs ±4.3) was obtained on 130 subjects. The three groups did not differ concerning sex, duration of first inpatient treatment, symptoms and social competence at discharge, nor at follow-up. At the time of outcome subjects with schizoaffective episodes showed greater similarities to schizophrenic than to severe affective disorder. Educational and occupational impairment was found in 72% of the schizoaffective group (schizophrenic group 79%, affective group 40%), obvious or more severe social disability in 86% of the schizoaffective group (schizophrenic 79%, affective 40%). Disabilities regarding performance of specific social roles and specific downward educational and occupational drifts were found to be more marked in schizoaffective than in affective disorder. Implications for further research and clinical practice are discussed.     

Review of the operational definition for first-episode psychosis

Aim: Given the growing interest in the study of first‐episode psychosis, clinical and research programmes would benefit from a conceptual clarification of how to operationalize ‘first‐episode psychosis’. We review the variety of definitions in use and discuss their relative merits with respect to both clinical (e.g. early treatment) and research (e.g. obtaining meaningfully homogeneous populations) agendas. Methods: We completed a selective review of the literature to investigate how first‐episode psychosis was operationally defined. Results: Operational definitions for ‘first‐episode psychosis’ fall largely into three categories: (i) first treatment contact; (ii) duration of antipsychotic medication use; and (iii) duration of psychosis. Each definitional category contains a number of underlying assumptions that contribute to the strengths and weaknesses of the definition. Conclusions: The term ‘first‐episode psychosis’ as used within clinical and research settings is misleading regardless of which operational definition is used. This term is typically used to refer to individuals early in the course of a psychotic illness or treatment rather than individuals who are truly in the midst of a first ‘episode’ of illness. The alternative of ‘recent‐onset psychosis’ with related definitions based on ‘duration of psychosis’ is proposed. Based on this review, we provide suggestions with regard to the overarching pragmatic consideration of setting up a clinical service that can attract and assemble a population of early psychosis patients for the related purposes of treatment and research.     

Non-cognitive psychiatric symptoms in vascular and Alzheimer brain disease

Psychiatric symptoms, other than dementia, are compared in two groups of mental hospital patients who came to autopsy and had complete brain examination. One group had Alzheimer brain changes with no cerebral infarction. The other group had cerebral infarction with no Alzheimer brain changes. Onset with a non-dementing paranoid illness after the age of 50 was commoner in the Alzheimer group. There was no predominance of affective symptoms in either group. Suddenness of onset of psychosis distinguished the infarct cases, even in cases where there was no neurologically evident stroke, and when there were long time intervals between onset and death. Those destined to suffer Alzheimer brain changes had a less sudden onset, fewer discharges and rehospitalizations and more frequent transition to dementia.§     

Selenium concentrations in blood and serum from patients with mental diseases

Blood and serum concentrations of selenium have been determined in a group of psychiatric patients and in 35 healthy controls. The psychiatric group consisted of 14 schizophrenics, seven paranoid disorders, six affective psychosis (manic-depressive), four reactive psychosis, 11 dementia senilis, 17 with a diagnosis of neurosis and two with delirium tremens. Normal values were found in all groups except for delirium tremens where decreased blood and serum values were found.     

Vibrotactile activation of the auditory cortices in deaf versus hearing adults

Neuroplastic changes in auditory cortex as a result of lifelong perceptual experience were investigated. Adults with early-onset deafness and long-term hearing aid experience were hypothesized to have undergone auditory cortex plasticity due to somatosensory stimulation. Vibrations were presented on the hand of deaf and normal-hearing participants during functional MRI. Vibration stimuli were derived from speech or were a fixed frequency. Higher, more widespread activity was observed within auditory cortical regions of the deaf participants for both stimulus types. Life-long somatosensory stimulation due to hearing aid use could explain the greater activity observed with deaf participants.     

Long-term course of acute reactive paranoid psychosis. A follow-up study

ABSTRACT The study comprises a retrospective evaluation of the case records of 49 first-admission patients with acute reactive paranoid psychosis and of the subsequent follow-up almost 10 years later, with special reference to clinical and social course and outcome. Ten of the 41 followed-up patients were diagnosed schizophrenic in the observation period and a further five fulfilled the Catego Class S⁺ at a PSE interview. Three patients were diagnosed affective psychosis and one fulfilled Class MT. Three patients were diagnosed paranoid psychosis and four more fulfilled Class P7PT while six patients had reactive psychosis relapses but were non-psychotic at follow-up. During the observation period the number of disabled pensioners increased from three to 21, and at follow-up only seven patients were well-adjusted in their family and work. The need is stressed for valid predictors in the prognosis of acute paranoid psychoses with or without associated stressful life events.     

Organic factors and the clinical features of late paranoid psychosis: a comparison with Alzheimer's disease and normal ageing

The diagnostic allocation and aetiological basis of paranoid psychoses with late onset is controversial. We examined the clinical features of patients with a diagnosis of paranoid psychosis and we compared their cranial computed tomography (CT) scans and electroencephalographic (EEG) recordings with findings from matched samples of patients with Alzheimer's disease and non-demented elderly controls. During a 5-year period, 81 patients (15 men and 66 women) with a diagnosis of paranoid psychosis and onset after age 50 were referred to our Institute. They represent 5.4% of the patients older than 50 admitted during the same period. More than half of these patients had first-rank symptoms. The ventricles, anterior and sylvian fissures of the paranoid group were larger than in non-demented controls but smaller than in Alzheimer's disease. The posterior dominant alpha EEG rhythm was slower than in normal ageing and faster than in Alzheimer's dementia. If paranoid patients with first-rank symptoms were distinguished from the ones without, the former had less severe brain atrophy and faster posterior dominant rhythm, although they received higher doses of neuroleptics. This could be explained by the existence of at least 2 subgroups of late paranoid psychosis: late-onset schizophrenia and organic paranoid syndrome, the former characterized by first-rank symptoms and less severe brain atrophy, the latter by more severe EEG and CT scan changes with a closer resemblance to degenerative brain disease.