Night terrors associated with thalamic lesion.

OBJECTIVE: To describe a case with night terrors (NT) symptomatic of a thalamic lesion. METHODS: Videopolysomnography and brain MRI were used to study a 48 year old woman with a recent onset of brief episodes, occurring exclusively during nocturnal sleep, where she suddenly sat up in bed, screamed and appeared to be very frightened. RESULTS: Videopolysomnography recorded an episode suggestive of NT. Sleep fragmentation with frequent brief arousals or microarousals was also evident mainly during slow wave sleep. The brain MRI showed increased T2 signal from the right thalamus suggestive of a low-grade tumor. CONCLUSIONS: Our case suggests that NT starting in adulthood can, rarely, be symptomatic of neurological disease, and warrant further investigation with MRI. SIGNIFICANCE: A thalamic dysfunction, disrupting at this level the arousal system, may play a role in provoking NT.     

Akathisia: clinical phenomenology and relationship to tardive dyskinesia.

Akathisia and tardive dyskinesia (TD) are disorders of movement that are often associated with administration of antipsychotic medication. We surveyed 196 outpatients in a schizophrenia clinic, all receiving antipsychotic medication, for the presence of these disorders. Clinical global ratings of akathisia were reliable. Akathisia was found in 36% of patients, and TD in 23.5%. Akathisia was disproportionately common in patients receiving high-potency neuroleptics. The data affirmed recent revisions in the dose-equivalence formulas used with fluphenazine decanoate. Akathisia and TD did not seem to be interrelated. Because akathisia is common and often limits medication dose and contributes to noncompliance, psychiatrists must take this into account when prescribing antipsychotic medication.     

Insight in schizophrenia. Its relationship to acute psychopathology

The relationship between insight and acute psychopathology was explored in a group of 52 acutely psychotic, schizophrenic patients. A measure of insight, reflecting patients' recognition of their illness and need for care, was validated against ratings from a semi-structured interview and against assessments of patients' compliance with medication. Contrary to expectations, degree of insight was not consistently related to the severity of acute psychopathology, as measured on two structured scales. Nor did changes in insight during hospitalization vary consistently with changes in acute psychopathology. These data suggest that very little of the deficiency in insight seen in schizophrenic patients is explainable on the basis of acute psychopathological features. The mechanism that accounts for impairment in insight in schizophrenia may be relatively resistant to treatment with neuroleptic medication.     

Cigarette smoking in schizophrenia: relationship to psychopathology and medication side effects.

OBJECTIVE: The authors' goal was to study the relationship between smoking status and clinical characteristics in schizophrenic patients. METHOD: Seventy-eight schizophrenic outpatients were assessed by a single rater using the Brief Psychiatric Rating Scale (BPRS), the Abnormal Involuntary Movement Scale, and the Simpson-Angus Scale for extrapyramidal symptoms. Current smokers (N = 58) were compared with nonsmokers (N = 20) on clinical variables by independent t tests and chi-square tests. Differences in outcome variables were tested by multiple analysis of covariance (ANCOVA) with smoking status and gender as factors and age, neuroleptic dose, and caffeine consumption as covariates. RESULTS: Seventy-four percent of patients were current smokers and reported a mean of 19 cigarettes smoked per day. Compared to nonsmokers, current smokers were significantly more likely to be men, to be younger, and to have had an earlier age at onset and a greater number of previous hospitalizations. Current smokers and nonsmokers received mean neuroleptic doses of 1160 and 542 mg/day (chlorpromazine equivalents); the difference was significant. Current smokers also displayed significantly less parkinsonism and more akathisia and had higher total scores on the BPRS. Overall multiple ANCOVA demonstrated a significant main effect for smoking status but not gender or the interaction between gender and smoking status. Univariate ANCOVAs demonstrated a significant main effect of smoking status only for the Simpson-Angus Scale score. CONCLUSIONS: Cigarette smokers receive significantly higher neuroleptic doses, in part because of a smoking-induced increase in neuroleptic metabolism. Smoking is also associated with significant reduction in levels of parkinsonism. Smoking status is a significant factor that should be considered in assessment of neuroleptic dose requirements and neuroleptic side effects.     

Two models of impulsivity: relationship to personality traits and psychopathology.

BACKGROUND: Impulsivity is prominent in psychiatric disorders. Two dominant models of impulsivity are the reward-discounting model, where impulsivity is defined as inability to wait for a larger reward, and the rapid-response model, where impulsivity is defined as responding without adequate assessment of context. We have compared the role of these models of impulsivity in human psychopathology, based on the hypothesis that rapid-response impulsivity would be more strongly related to other aspects of psychopathology and to impulsivity as described by questionnaires.METHODS: We investigated relationships between personality and laboratory measures of impulsivity, and between these measures and clinical characteristics, in parents of adolescent subjects with disruptive behavioral disorders (DBDs) and matched control subjects. Diagnoses were rendered using the Structured Interview for DSM-IV. The Barratt Impulsiveness Scale (BIS) was used as a trait measure of impulsivity. Rapid-response impulsivity was assessed using a form of the Continuous Performance Test, the Immediate Memory-Delayed Memory Task (IMT/DMT). Reward-delay impulsivity was measured using two tasks where subjects could choose between smaller immediate or larger delayed rewards.RESULTS: Rapid-response, but not reward-delay impulsivity, was significantly higher in subjects with lifetime Axis I or Axis II diagnoses. Scores on the BIS were elevated in subjects with Axis I diagnoses and correlated significantly with both rapid-response and reward-delay tests, but more strongly with the former. Multiple regression showed that rapid-response, but not reward-delay performance or intelligence quotient, contributed significantly to BIS scores. Correlations were similar in parents of control subjects and of DBD subjects.CONCLUSIONS: These data suggest that measures of rapid-response impulsivity and of reward-delay impulsivity are both related to impulsivity as a personality characteristic. The relationship appears stronger, however, for rapid-response impulsivity, as measured by the IMT/DMT. Laboratory and personality measures of impulsivity appear to be related to risk of psychopathology.     

Platelet serotonin levels in schizophrenia: relationship to race and psychopathology

To explore the possible role of serotonin (5-HT) in the etiology of schizophrenia, platelet 5-HT concentrations were determined in 41 schizophrenic (and schizoaffective, mainly schizophrenic) patients diagnosed by the RDC and 34 normal controls. There was a significant difference between the patient and control groups with the 16 paranoid, 11 undifferentiated, and 8 schizo-affective depressed patients having significantly higher mean platelet 5-HT concentrations than the controls. An analysis of variance considering the effect of race, sex, and diagnosis demonstrated a significant difference between black patients and black controls but no significant difference between white patients and white controls. Within the patient sample, platelet 5-HT concentrations were positively correlated with severity of auditory hallucinations (on the PSE) and negatively correlated with lack of insight (on the PSE) and conceptual disorganization (on the BPRS). In a subsample of 21 patients, there was no relationship between platelet 5-HT and CT findings of either enlarged ventricles or cortical atrophy.     

The phenomenology of non-clinical panic in older adults in comparison to younger adults

The prevalence and nature of panic symptoms in the elderly are poorly understood. In a replication and extension of Deer and Calamari [J. Behav. Ther. Exp. Psychiatry 29 (1998) 303], the current study sought to determine which symptoms of anxiety best differentiated elderly endorsers of panic from elderly who do not panic, and to compare these results to a reference younger sample. Based on a sample of 302 community-dwelling older adults and a comparison group of 275 younger adults, non-clinical panic (NCP) was endorsed in 26.2% of older adults, which is less frequent than the younger adults (42.7%). Although older and younger adults were similar in terms of clinical features of panic, health factors interacted significantly with panic symptoms in the elderly. When controlling for health, cognitive symptoms of anxiety were stronger predictors of panic in older adults than were physiological symptoms. Clinical implications for the assessment of panic in older adults are discussed.     

Hippocampus and amygdala in schizophrenia: assessment of the relationship of neuroanatomy to psychopathology.

The hippocampus and amygdala are believed to be involved in the pathology of schizophrenia. In this study, we attempted to replicate the reported bilateral volume reduction of the hippocampus and amygdala and to study the relationship of the volumes of these structures to the symptoms of schizophrenia. The hippocampus-amygdala complex (HAC) was manually traced on 3-mm coronal T(1)-weighted MRIs, resampled into 1-mm coronal slices, from 20 male patients with schizophrenia and 20 age-matched male controls. The complex was divided into three parts: anterior one-third representing the amygdala and middle and posterior thirds representing the anterior and posterior halves of the hippocampus. Positive and negative symptoms and severity of hallucinations and thought disorder (conceptual disorganization) were quantified using the Brief Psychiatric Rating Scale (BPRS). None of the above structures, controlled for brain volume, differed significantly in patients compared with normal controls. When the relationship between volumes and symptoms was examined, the left HAC was found to inversely correlate with thought disorder and negative symptoms. Specifically, significant inverse correlations were found between (i) left amygdala and thought disorder, (ii) left hippocampus and negative symptoms, and (iii) left anterior and posterior hippocampus volumes and positive and negative symptoms, respectively. Our findings further support the role of the HAC in the pathophysiology of schizophrenia and suggest unique associations between individual structures and specific symptoms of the illness.     

The enigmatic relationship of creativity to mental health and psychopathology.

Creativity is a capacity with many faces, some sublime, others pathological, and still others somewhere in between. Creativity plus the talent to use it are the necessary ingredients of the great artist. People who have had the experience of emotional depths and who have had talent may constitute the majority of artists. Those with talent who have been taken over by their emotions may still be great artists--but there is a difference.     

The psychopathology instrument for mentally retarded adults: psychometric characteristics, factor structure, and relationship to subject characteristics

The self-report and a modified informant version of the Psychopathology Instrument for Mentally Retarded Adults (PIMRA) was used to assess 160 mentally retarded adults. Statistics relating to the instrument's internal consistency and test-retest reliability were calculated. The effects of demographic variables were analyzed and the factor structure of the instrument was examined. Of the psychometric statistics examined, only the item-total correlations were as robust as in the original reports. Significant relationships between PIMRA scores and age, sex, and level of mental retardation were found, but there was no significant effect due to residential setting (institution versus community). The factor structure for both versions of the PIMRA was similar to that in the initial reports.     

The relationship between Axis I psychopathology and quality of life in adults with mild to moderate intellectual disability

Individuals with intellectual disability are at risk for impaired quality of life (QOL) compared to the general population. Little is known, however, about factors that may affect QOL in those with intellectual disability. The current study examined the role that Axis I psychopathology plays in the QOL of 138 adults with moderate to borderline intellectual disability. Scores on the Quality of Life Questionnaire (QOL-Q) were compared between those with a Psychotic Disorder, those with a Mood/Anxiety Disorder, and those with no Axis I diagnosis. Additionally, the effects of number of Axis I diagnoses was explored. Those with no Axis I diagnosis were found to have significantly higher QOL-Q scores than those in either diagnostic group. No significant differences were found between the two diagnostic groups. Additionally, those with no Axis I diagnosis were found to have significantly higher QOL-Q scores than those presenting with two or more Axis I diagnoses. The results and their implications are discussed.     

Dissociation in adolescent girls with anorexia: relationship to comorbid psychopathology

This study investigated the relationship between dissociation and psychological symptoms in adolescent girls with anorexia. First, the psychometric properties of the Adolescent Dissociative Experiences Scale (A-DES) were examined using data from 181 nonclinical adolescent boys and girls. Thereafter, A-DES scores and correlations with a range of psychological symptoms were compared across 20 girls with anorexia, 19 mixed clinical girls, and 86 nonclinical girls. The A-DES had a one-factor structure and good psychometric characteristics. Dissociation scores were significantly correlated with level of symptomatology for all groups. Although the group with anorexia did not have significantly higher dissociation scores than the other two groups, dissociation in the anorexic girls was related to psychopathology in a distinct way. Adolescent girls with anorexia appear to use dissociation specifically to avoid processing angry affect with an interpersonal basis, although it is also related to their use of somatization, and obsessive-compulsive features.     

T-cells and psychopathology in schizophrenia: relationship to the outcome of neuroleptic therapy

Until recently, attention has been focused on the pathogenetic aspects of immunological findings in schizophrenic patients. There has been no mention of the relationship between such findings and schizophrenic symptoms. To study the probable relationship between T-cells and T-cell subgroups in the course and prognosis of schizophrenia, immunological and psychopathological parameters were correlated in 55 patients suffering from schizophrenia (ICD-9: 295.0–295.6) or schizoaffective psychosis (ICD-9: 257.7) before neuroleptic treatment. The correlations were performed for a second time in 24 of these patients after clinical improvement at a reinvestigation. Positive correlations of the Brief Psychiatric Rating Scale and the Scale for Assessment of Negative Symptoms with the numbers of CD3⁺ and CD4^- T-cells (total T- and T-helper cells), which were enhanced compared with controls, were found at the reinvestigation after clinical improvement, whereas no significant correlation could be detected at the pretreatment investigation. These results show that the cellular immune parameters are related to the course of the psychopathological symptoms in schizophrenia and, possibly, are a marker of the therapeutic outcome of neuroleptic treatment.     

Severity of children's psychopathology and impairment and its relationship to treatment setting.

OBJECTIVE: The study investigated the settings in which children and adolescents were treated to determine whether clinicians assigned individuals who had greater needs to more intensive treatment. METHODS: Subjects were 603 children four to 16 years of age who visited a mental health treatment facility in Western Australia, where, as is the case throughout Australia, universal publicly funded health care is provided. DSM-IV criteria were used to make diagnoses, and clinicians assessed each child's level of impairment. The clinicians assigned the children to inpatient treatment, day treatment, or outpatient treatment, or they saw the child only for a psychiatric consultation. Measures included parents' and children's reports of children's psychopathology and parents' reports of family functioning, family life events, and parental mental health symptoms and treatment. RESULTS: Clinicians' ratings of impairment were highest for children assigned to the inpatient and day treatment settings. Parents' ratings of total psychopathology and of internalizing and externalizing symptoms were highest for children in the inpatient and day treatment settings. Parents' reports also indicated that family dysfunction and parental alcohol problems were most severe in the inpatient group. No differences in parents' mental health problems were found across treatment settings. CONCLUSIONS: Children with more severe psychopathology and more severe family dysfunction and parental problems were more likely to be provided treatment in the most costly and time-intensive treatment settings. The results provide empirical evidence for what many clinicians consider best clinical practice-to assign children and families to treatment settings appropriate to their level of impairment.