Are we witnessing the disappearance of catatonic schizophrenia?

The decrease in the frequency of diagnosed catatonic subtypes among schizophrenic disorders as a whole during the last 50 years has long been regarded as an established fact. Until now the factors responsible for this development have been under discussion. As it is not clear if there is a true decrease or an ostensible one due to other factors such as changed diagnostic habits or neuroleptic treatment, we examined 174 consecutively admitted schizophrenic patients from three different psychiatric institutions diagnosed according to DSM-IV and Leonhard's criteria. It turned out that-depending on the diagnostic system-the rates of diagnosed catatonias were 10.3% (DSM-IV) and 25.3% (Leonhard's criteria). Comparison of the two original Leonhard cohorts (1938 to 1968, 1969 to 1986) with our own (1994 to 1999) shows a decrease in the frequency of catatonias from 35% to 25%, which-albeit statistically significant-is much less pronounced than in studies that used a narrower definition of catatonia. Here, besides sociocultural developments, the use of neuroleptics seems to effect the decrease in the frequency of catatonias in two ways: on one hand, they cause a decrease of hyperkinesia, excitement, or impulsivity; while on the other hand, they themselves produce motor abnormalities like rigidity, effects that favor the attribution of motoric symptoms to neuroleptics.     

Transient phase-locking and dynamic correlations: Are they the same thing?

This work represents an attempt to bring together two important themes in neuronal dynamics. The first is the characterization of dynamic correlations in multiunit recordings of spike activity using joint-peri-stimulus time histograms (J-PSTHs) [Aertsen and Preissl, 1991: Non Linear Dynamics and Neural Networks]. The second is transient phase-locking at high (gamma) frequencies, either in terms of spiking in separable spike trains [e.g., Eckhorn et al., 1988: Biol Cybern 60:121–130, Gray and Singer, 1989 Proc Natl Acad Sci USA 86:1698–1702], or using continuous electrical or biomagnetic signals [e.g., Desmedt and Tomberg, 1994 Neurosci Lett 168:126–129]. In this paper we suggest that transient phase-locking is necessary for frequency-specific, dynamic event-related correlations. This point is demonstrated using the gamma-frequency (36 Hz) component of neuromagnetic signals measured in the prefrontal and partial regions of a subject during self-paced movements. A J-PSTH analysis revealed dynamic changes in prefronto-parietal correlations in relation to movement onset. These frequency-specific dynamic correlations were associated with changes in the degree of phase-locking, of the sort reported by Desmedt and Tomberg [1994 Neurosci Lett 168:126–129]. Hum. Brain Mapping 5:48–57, 1997. © 1997 Wiley-Liss, Inc.     

Psychogenic seizures and psychogenic movement disorders: Are they the same patients?

Psychogenic nonepileptic seizures (PNES) and psychogenic movement disorders (PMD) are common and disabling problems with abnormal psychological profiles, and they may have common features that could aid in better understanding and management. Since PNES and PMD are investigated and reported separately, comparisons are lacking. Psychogenic nonepileptic seizure and psychogenic movement disorder patients completed demographic, clinical, and psychological inventories including the Short Form (SF)-12 Health Status Survey (Physical and Mental Health Summary Scores), the Brief Symptom Inventory (BSI)-18 (somatization, depression, and anxiety subscales), and the Lorig Self-Efficacy Scale. Psychogenic nonepileptic seizure and psychogenic movement disorder patients had similar psychological profiles with reduced SF-12 Physical Health and Mental Health Summary Scores and increased BSI somatization, depression, and anxiety ratings. They varied slightly in age and gender, but their main distinguishing features were the presenting signs. These similar profiles suggest that PNES and PMD may not be distinct or separate entities and that collaborative investigative efforts and management are warranted.     

Magnetic resonance spectroscopy and schizophrenia: what have we learnt?

OBJECTIVE: Magnetic resonance spectroscopy (MRS) has been increasingly used to investigate the in vivo biochemistry of particular regions of the brain in patients with schizophrenia. We review the literature and discuss the theoretical constructs that form the presumed impetus for these studies in light of the current methodological limitations. Future directions are noted. METHOD: The available published literature in English formed the basis for this review. RESULTS: The results of 31P-MRS have been interpreted as reflecting a relative increase in cell membrane degradation in prefrontal cortical regions at certain phases of schizophrenia. 1H-MRS studies, though less consistent, provide evidence suggestive of a decrease in neuronal cell mass in the hippocampal region, which supports the findings of volumetric studies. Both groups of MRS studies support a neuro-developmental hypothesis of brain dysfunction in schizophrenia. However, current methodological problems limit the reliable interpretation of MRS data. A clear understanding of the methodology and its reliable interpretation is yet to emerge. CONCLUSIONS: MRS remains a research instrument that is yet to be fully utilised in schizophrenia research. A few replicated findings are emerging, although the interpretation of these spectroscopic findings needs to be validated.     

Are schizophrenia and schizoaffective disorder neuropsychologically distinguishable?

This study sought to objectify the distinction between schizophrenia and schizoaffective disorder in terms of standard tasks measuring verbal and non-verbal cognitive ability, auditory working memory, verbal declarative memory and visual processing speed. Research participants included 103 outpatients with a diagnosis of schizophrenia, 48 with schizoaffective disorder, and 72 non-patients from the community. Schizophrenia patients were impaired on all cognitive measures relative to schizoaffective patients and non-psychiatric participants. Regression-based prediction models revealed that cognitive measures classified schizophrenia patients accurately (91%), but not patients with schizoaffective disorder (35%). In addition, there was no statistical evidence for the unique predictive validity of any specific cognitive task. Patients with schizophrenia were significantly more symptomatic and had greater community support requirements than those with schizoaffective disorder. However, group differences in cognitive performance are insufficient to separate these syndromes of psychotic illness.     

Genetics in schizophrenia: where are we and what next?

Understanding the genetic basis of schizophrenia continues to be major challenge. The research done during the last two decades has provided several candidate genes which unfortunately have not been consistently replicated across or within a population. The recent genome-wide association studies (GWAS) and copy number variation (CNV) studies have provided important evidence suggesting a role of both common and rare large CNVs in schizophrenia genesis. The burden of rare copy number variations appears to be increased in schizophrenia patients. A consistent observation among the GWAS studies is the association with schizophrenia of genetic markers in the major histocompatibility complex (6p22.1)-containing genes including NOTCH4 and histone protein loci. Molecular genetic studies are also demonstrating that there is more overlap between the susceptibility genes for schizophrenia and bipolar disorder than previously suspected. In this review we summarize the major findings of the past decade and suggest areas of future research.     

Issues & opinions: Are fibrillation potentials and positive sharp waves the same? No

Electrodiagnostic medicine consultants report electrical activity in muscle recorded at rest and during voluntary movement by means of waveform and firing rate characteristics. This principle allows us to distinguish fibrillation potentials from positive sharp waves. Although in most cases these two potentials have the same clinical significance, there are at least five different situations in which they do not have an identical meaning: (1) positive sharp waves can be recorded earlier after a peripheral nerve injury than can fibrillation potentials; (2) occasionally, nonclinically significant diffuse positive sharp wave activity may be seen in the absence of fibrillation activity (i.e., “EMG disease”); (3) positive sharp waves may be seen in distal muscles of “normal” subjects without the presence of fibrillation activity or clinical significance; (4) positive sharp waves without fibrillation potentials may be seen following local muscle trauma; and (5) positive sharp waves may be seen alone in some demyelinating polyneuropathies. By accurately describing the observed potentials, the electrodiagnostic medicine consultant may be able to obtain more clinically useful information from an electrodiagnostic study. © 1996 John Wiley & Sons, Inc.     

Are child-, adolescent-, and adult-onset depression one and the same disorder?

This paper reviews prior research studies examining neurobiological correlates and treatment response of depression in children, adolescents, and adults. Although there are some similarities in research findings observed across the life cycle, both children and adolescents have been found to differ from depressed adults on measures of basal cortisol secretion, corticotropin stimulation post-corticotropin releasing hormone (CRH) infusion, response to several serotonergic probes, immunity indices, and efficacy of tricyclic medications. These differences are proposed to be due to 1) developmental factors, 2) stage of illness factors (e.g., number of episodes, total duration of illness), or 3) heterogeneity in clinical outcome (e.g., recurrent unipolar course vs. new-onset bipolar disorder). Relevant clinical and preclinical studies that provide support for these alternate explanations of the discrepant findings are reviewed, and directions for future research are discussed. To determine whether child-, adolescent-, and adult-onset depression represent the same condition, it is recommended that researchers 1) use the same neuroimaging paradigms in child, adolescent, and adult depressed cohorts; 2) carefully characterize subjects' stage of illness; and 3) conduct longitudinal clinical and repeat neurobiological assessments of patients of different ages at various stages of illness. In addition, careful attention to familial subtypes (e.g., depressive spectrum disorders vs. familial pure depressive disorders) and environmental factors (e.g., trauma history) are suggested for future investigations.     

Are we addressing the 'right stuff' to enhance adherence in schizophrenia? Understanding the role of insight and attitudes towards medication

Background

Despite the fact that medication adherence is among the most important health related behaviors in relapse prevention and recovery in schizophrenia, it is often not sufficiently endorsed by patients. Poor insight and negative attitudes towards medication are risk factors for non-adherence. Their relationship and the influence of more general attitudes towards pharmacotherapy besides attitudes towards antipsychotics have not been fully understood. The present study investigated whether these factors independently influence adherence or whether they mediate one another.

Methods

A cross-sectional sample of 150 outpatients completed the Beliefs about Medication Questionnaire. It assesses patients' beliefs about antipsychotic medication in terms of necessity and concerns and more general beliefs about pharmacotherapy in terms of distrust. Additionally, the patients' global awareness of illness (Scale to assess Unawareness of Mental Disorder), and medication adherence (Brief Adherence Rating Scale, Service Engagement Scale) were assessed.

Results

Using structural equation modeling, the study found evidence for a mediational model. Awareness of illness contributed to medication adherence via patients' perceived necessity of antipsychotics. The model further revealed a direct negative relationship between concerns regarding antipsychotics and adherence and an indirect negative effect of a general distrust regarding pharmacotherapy and adherence via antipsychotic specific attitudes.

Conclusion

Interventions to enhance medication adherence may be more effective if they focus on treatment related attitudes rather than on global insight into illness. Clinicians may not only enhance the patients' perceived necessity of antipsychotic treatment but also explore and address concerns and the patients' distrust in pharmacotherapy in a more personalized way.     

Are worry,rumination, and post-event processing one and the same?: Development of the repetitive thinking questionnaire

Accumulating evidence suggests that repetitive negative thinking (RNT) is a transdiagnostic phenomenon. However, various forms of RNT such as worry, rumination, and post-event processing have been assessed using separate measures and have almost exclusively been examined within the anxiety, depression, and social phobia literatures, respectively. A single transdiagnostic measure of RNT would facilitate the identification of transdiagnostic maintaining factors of RNT, and would be more efficient than administering separate measures for each disorder. Items from three existing measures of RNT were modified to remove diagnosis-specific content and administered to a sample of undergraduate students (N = 284). Exploratory factor analysis yielded two factors labeled Repetitive Negative Thinking and Absence of Repetitive Thinking (ART). The RNT scale demonstrated high internal reliability and was associated with anxiety, depression, anger, shame, and general distress. Moreover, the RNT scale was associated with constructs that are theoretically related to engagement in RNT, including positive and negative metacognitions, cognitive avoidance, thought suppression, and thought control strategies. The ART scale had little predictive utility. Theoretical and clinical implications are discussed.     

Patent foramen ovale closure and migraine: Are we following the wrong pathway?

Journal of Neurology -     

Editorial: How in the world are we handling COVID-19?

These are not normal times. As an editorial team, we felt that there was an urgency to reflect on our global experiences of the COVID-19 pandemic with our international colleagues. Instead of our planned debate series, we therefore commissioned a series of reflections on the impact of the pandemic on child and adolescent mental health throughout the world. We hope that you will find these reflections informative, thought-provoking, and in some cases, inspirational.