The onset of schizophrenia

This survey deals with findings and results of systematic clinical-psychiatric and -psychological studies of the true onset of schizophrenia and its significance. Many symptoms precede the psychotic onset of schizophrenia. These have been described by Huber as 'basic symptoms', who developed the concept of basic stages and basic symptoms gradually since the 1950's. The basic symptoms are experiential and not behavioral in kind and only recognizable by the self-reports of the patients. They are rateable using a structural scale (Bonn Schedule for the Assessment of Basic Symptoms: BSABS) described below. They form the two precursor syndromes: (1) prodromes lead on average within 3.3 years to a psychotic episode; and (2) outpost syndromes that are completely remitting on average within 5 months and precede the first psychotic episode on average 10 years. Basic symptoms can be further divided into level 1 (non-specific) and level 2 (characteristic) basic symptoms. Basic symptoms, positive and negative symptoms have to be differentiated; they also develop in this chronological sequence: first non-specific, then characteristic basic symptoms, followed on average many years later by positive symptoms, and, finally by negative symptoms. Structured ratings of the basic symptoms and their recognition in the precursor syndromes enables physicians to detect early symptoms of a schizophrenic illness that, if treated at this stage, can lead to a better long-term outcome.     

Neurodevelopmental schizophrenia: the concept of developmental origins of certain forms of schizophrenia

This article presents the concept of neurodevelopmental schizophrenia and reviews the studies that contributed to its formulation. According to this concept some forms of schizophrenia (early onset, with predominating negative symptoms) are conditioned by distorted CNS development, probably in prenatal period. Such pathogenesis of certain forms of the disease is suggested by the following results of the studies on the CNS structure and function in schizophrenia: 1) structural abnormalities on in vivo brain imaging and postmortem studies 2) cytoarchitectural distortions in some brain regions, suggestive of disruption of cell migration during the CNS developmental processes 3) co-occurrence of the CNS congenital anomalies, minor physical anomalies and schizophrenia 4) neurological defects and psychosocial childhood dysfunction in individuals with adult onset schizophrenia. Genetical conditions, viral infections in prenatal period, obstetric complications or combination of the mentioned factors are considered as the factors disturbing the CNS developmental processes.     

The ABC Schizophrenia Study: a preliminary overview of the results

The ABC Schizophrenia Study, a large-scale epidemiological and neurobiological research project commenced in 1987, initially pursued two aims: (1) to elucidate the possible causes of the sex difference in age at first admission for schizophrenia and (2) to analyse the early course of the disorder from onset until first contact and its implications for further course and outcome. First, transnational case-register data (for Denmark and Germany) were compared, second, a population-based sample of first-episode cases of schizophrenia (n = 232) were selected and third, the results obtained were compared with data from the WHO Determinants of Outcome Study by using a systematic methodology. A consistent result was a 3-4 years higher age of onset for women by any definition of onset, which was not explainable by social variables, such as differences in the male-female societal roles. A sensitivity-reducing effect of oestrogen on central D2 receptors was identified as the underlying neurobiological mechanism in animal experiments. Applicability to humans with schizophrenia was established in a controlled clinical study. A comparison of familial and sporadic cases showed that in cases with a high genetic load, the sex difference in age of onset disappeared due to a clearly reduced age of onset in women, whereas in sporadic cases it increased. To analyse early course retrospectively, a semistructured interview, IRAOS, was developed. The early stages of the disorder were reconstructed in comparison with age- and sex-matched controls from the same population of origin. The initial signs consisted mainly of negative and affective symptoms, which accumulated exponentially until the first episode, as did the later emerging positive symptoms. Social disability appeared 2-4 years before first admission on average. In early-onset cases, social course and outcome, studied prospectively over 5 years, was determined by the level of social development at onset through social stagnation. In late-onset cases, decline from initially high social statuses occurred. Socially negative illness behaviour contributed to the poor social outcome of young men. Symptomatology and other proxy variables of the disorder showed stable courses and no sex differences. Further aspects tested were the sequence of onset and the influence of substance abuse on the course of schizophrenia, primary and secondary negative symptoms, structural models and symptom clusters from onset until 5 years after first admission.     

Prevalence and severity of substance use disorders and onset of psychosis in first-admission psychotic patients

BACKGROUND: Past studies have found inconsistent evidence that substance use disorders are related to earlier onset of schizophrenia or more severe symptoms. This study examines prevalence and severity of current substance use disorders and onset of psychotic illness in a multi-facility sample. METHODS: Data are from the Suffolk County Mental Health Project, an epidemiological study of first admission psychosis. The SCID and instruments measuring symptomatology, personality and background characteristics were administered. Respondents were stratified into three groups: (a) no life-time substance diagnosis; (b) in remission or reporting current mild use at admission; and (c) current moderate-severe substance abuse at admission. RESULTS: Using the SCID severity rating, 17.4% of males and 6.2% of the females had moderate or severe current substance abuse, while 41.5% of males and 68.2% of females had no lifetime substance diagnosis. In almost all cases categorized as moderate-severe, the substance diagnosis predated onset of psychosis. Females categorized as moderate-severe have an earlier age of onset of psychosis than did females in the other groups. There were only slight differences in symptom severity among the groups but more marked antisocial behaviour in the moderate-severe group. Variables discriminating the moderate-severe from non-abuse groups were BPRS thought disturbance, adult anti-social behaviour and current cigarette smoking for males and adult anti-social behaviour and child-teen antisocial behaviour for females. CONCLUSIONS: Severity of substance abuse does not appear to be a pivotal correlate of the early features of psychotic illness.     

A revised psychoanalytic conception of schizophrenia: An interdisciplinary update.

The psychoanalytic conception and treatment of schizophrenia is in need of fundamental revision because of (a) refinements in nosology which have separated out the borderline and affective disorders with which it had formerly been confused; (b) the development of newer psychoanalytic schools; and (c) the impact of various aspects of neurobiological research, the putative outcome of which seems to confirm that many, if not most, schizophrenics begin with a hereditary and/or congenital vulnerability to life and are disadvantaged in how they experience life, not only emotionally, but also neuroperceptually, neurocognitively, and neurobehaviorally. This contribution seeks to put schizophrenia and psychoanalysis in an interdisciplinary perspective by assigning the concept of disorders of psychical meaningfulness to the neurotic portion of the schizophrenic personality and of psychical meaninglessness to the psychotic portion of the personality. Whereas all psychoanalytic schools traditionally employ models that address meaningfulness, I suggest the employment of a newer model to deal with schizophrenia as a "disorder of self-regulation" (of meaninglessness), the latter being the neurobiological contribution. To the former I should like also to append the concept of a "disorder of interactional regulation" as its interpersonal complement in the sense of psychosocial, object relations, and systems theory interactions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The structure of psychosis: latent class analysis of probands from the Roscommon Family Study

BACKGROUND: The nosologic structure of psychotic illness, still influenced as much by historical as empirical perspectives, remains controversial. METHODS: Latent class analysis was applied to detailed symptomatic and outcome assessments of probands (n=343) with broadly defined schizophrenia and affective illness ascertained from a population-based psychiatric registry in Roscommon County, Ireland. First-degree relatives (n=942) were assessed by personal interview and/or review of hospital record. RESULTS: Six classes were found, all of which bore substantial resemblance to current or historical nosologic constructs. In order of decreasing frequency, they were (1) classic schizophrenia, (2) major depression, (3) schizophreniform disorder, (4) bipolar-schizomania, (5) schizodepression, and (6) hebephrenia. These classes differed on many historical and clinical variables not used in the latent class analysis. Compared with relatives of controls, significantly increased rates of major depression were seen in relatives of depressed and schizodepressed probands. Significantly increased rates of bipolar illness were restricted to relatives of bipolar-schizomanic probands. The risks for schizophrenia and schizophrenia spectrum disorders were significantly increased in relatives of all proband classes except major depression. This increase was moderate for bipolar-schizomanic probands, substantial for schizophrenic, schizophreniform, and schizodepressed probands, and marked for hebephrenic probands. CONCLUSIONS: These results suggest a relatively complex typology of psychotic syndromes consistent neither with a unitary model nor with a Kraepelinian dichotomy. The familial vulnerability to psychosis extends across several syndromes, being most pronounced in those with schizophrenialike symptoms. The familial vulnerability to depressive and manic affective illness is somewhat more specific.     

Sommeil, insomnie et psychopathologie.

Sleep plays a critical role in psychological well-being and adaptation. Not surprisingly, sleep disturbance is a frequent problem among individuals facing situational psychological difficulties as well as among those with more chronic psychopathology. This article examines the relationship among sleep, insomnia, and psychopathology. In the first section, we address the issue of comorbidity by examining prevalence rates of sleep disturbances in the general population and among subgroups of individuals with selected psychopathologies and, conversely, rates of psychological symptoms/syndromes among individuals with and without sleep disturbances. The data indicate high rates of psychological syndromes (40%) associated with insomnia among community-based samples, and even higher rates (80%) of sleep disturbances among selected samples of patients with psychopathology. Comorbidity is particularly high among patients with insomnia, major depression, and generalized anxiety disorder. Although insomnia is often a symptom of an underlying psychopathology, longitudinal studies show that it can also be an important risk factor for a new onset major depressive disorder. The second section of this article summarizes the main subjective and EEG sleep impairments in selected anxiety disorders, mood disorders, and schizophrenia. Insomnia is a common clinical feature or even a diagnostic criterion of several of those disorders. Other related symptoms such as fatigue, low energy and poor concentration are shared across insomnia, major depression, and generalized anxiety disorder, suggesting some common mechanisms among those conditions. In addition to subjective sleep complaints, there is also evidence of EEG sleep abnormalities, such as impairment of sleep continuity, reduced slow wave sleep, and altered REM sleep patterns, with the latter two features being more specific to mood disorders. The third section of this article examines the effects of insomnia treatment on co-existing psychological symptoms or disorders and, conversely, the effects of treatment of selected anxiety and mood disorders on sleep. These results indicate that treatments of depression and anxiety may produce some sleep improvements but, in many cases, residual sleep disturbances persist and may actually increase the risk of subsequent relapse. The main implication is that treatment should directly target both co-existing conditions. Additional implications for the treatment and prevention of comorbid sleep disturbances and psychopathology and for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Neuroleptic-induced acute extrapyramidal syndromes and tardive dyskinesia

Neuroleptic drug-induced acute extrapyramidal symptoms and later-onset tardive dyskinesia are major limitations to these valuable drugs. Each of these disorders can be described by special risk factors that include patient characteristics, drug factors, and temporal considerations. The limitations that derive from these motor side effects have been one of the major reasons propelling the search for neuroleptic drugs that are free of these side effects. Strategies for managing the acute and late-onset extrapyramidal syndromes are presented. Significantly more research is needed, however, on all these disorders before a unified and cohesive explanation can account for these seemingly disparate syndromes. New medications, which effectively treat schizophrenia and are free of acute extrapyramidal syndromes and tardive dyskinesia, will be a giant step forward in patient care and our knowledge of the mechanisms controlling both mental function and motor control.     

Advances in the diagnosis and treatment of children with serious mental illness

As a nation, we are becoming aware that a significant number of children develop severe neuropsychiatric disorders. Unfortunately, knowledge of DSM-IV criteria does not always help the child and family social worker identify children with these disorders. Early onset schizophrenia, bipolar disorders, and severe depression can cause child behaviors that differ markedly from symptoms manifested by adults with serious mental illness. This article provides specific information for screening and treating children who develop long-term neuropsychiatric disorders.     

A known virus in animals is suspected in humans. Borna disease virus has been detected in human neuropathy

Borna disease virus (BDV) is a newly classified non-segmented neurotrophic negative-strand RNA virus with a worldwide distribution and affecting warm-blooded animals ranging from birds to primates. Infection may be asymptomatic or results in manifest disturbances of movement behaviour. Although BDV has not been unequivocally implicated in any human disease, several reports have suggested relationship to exist between BDV infection and certain neuropsychiatric syndromes including affective disorders, chronic fatigue syndrome, and schizophrenia. Moreover, at least one centre has initiated a trial of antiviral therapy in patients with affective disorders attributable to BDV. The article consists in a review of recent advances in the molecular biology, pathogenesis and epidemiology of BDV, and an outline of anticipated directions for future research.     

Early intervention, untreated psychosis and the course of early schizophrenia

BACKGROUND: Studies have proved that early intervention can delay psychotic relapses, and prevent psychosocial deterioration in people with schizophrenia and related disorders. METHOD: Our study with young people with recent onset schizophrenia has shown that an intensive intervention programme had a beneficial effect on the occurrence of psychotic relapse and the course of psychotic syndromes. This effect lasted until the end of the 15-month intervention. No significant effect of the two different intervention conditions became apparent. RESULTS: The results of a follow-up study showed that this beneficial effect did not last. Fifteen per cent of the people had a psychotic relapse during the intervention, whereas 64% relapsed during follow-up. CONCLUSIONS: These results show that referral to other mental health agencies after intervention is not sufficient and that more support is required to continue disease management, medication compliance and stress management.     

Prodromal symptoms vs. early warning signs and clinical action in schizophrenia

The term "prodromal symptoms" has traditionally referred to prepsychotic changes in thought, affect, and cognition that precede the initial onset of schizophrenia. Recently, however, the term has been extended into a clinical action context to refer to the early warning signs (EWS) of impending relapse in patients already diagnosed as having schizophrenia. However, recent reports reviewed by Norman and Malla (1995, this issue) use a narrow definition of prodromal symptoms and question their use in the clinical action context. We argue that the dual use of the term "prodromal symptoms" has led to conceptual confusion and to the impression that EWS cannot be used effectively for clinical action. The ability to base clinical action on EWS is central to schizophrenia therapeutics and is the cornerstone of pharmacological strategies based on early intervention. Our review of the evidence suggests that the effective clinical use of EWS depends on (1) the inclusion of both psychotic and nonpsychotic symptoms as EWS; (2) the use of clinician judgment in combination with predefined symptom changes to define the occurrence of EWS; (3) frequent clinical visits; and (4) the use of family or caregiver informants. We therefore suggest that, in the clinical action context, the terminology "early warning signs of impending relapse" should be used instead.     

Test-retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI)

The structure and content of the Munich-Composite International Diagnostic Interview (M-CIDI) for the assessment of DSM-IV symptoms, syndromes, and diagnoses is described along with findings from a test-retest reliability study. A sample of 60 community respondents were interviewed twice independently by trained interviewers with an average time interval of 38 days between investigations. Test-retest reliability was good for almost all specific DSM-IV core symptom questions and disorders examined, with kappa values ranging from fair for two diagnoses--bulimia (kappa 0.55) and generalized anxiety disorder (kappa 0.45)--to excellent (kappa above 0.72) for all other anxiety disorders and alcohol use disorders. Test-retest reliability for age of onset and time-related questions was fairly consistently high (intra-class correlation values of 0.79 or above), with one notable exception: the assessment of disorders with onset before puberty. We concluded that the M-CIDI is acceptable for respondents, efficient in terms of time needed for and ease of administration, and reliable in terms of consistency of findings over time periods of at least 1 month.     

The role of gender differences in the reduction of etiologic heterogeneity in schizophrenia

Recent research has shown a resurgence of interest in the study of gender differences in schizophrenia. Accumulated evidence suggests that, compared with women, men have a higher incidence of schizophrenia, earlier age of onset, poorer course and medication response, poorer premorbid social and intellectual functioning, fewer affective symptoms, lower family morbid risk of schizophrenia and affective disorders, more evidence of obstetric complications in their mothers, and greater structural brain abnormalities. The roles of estrogen, neurodevelopment, and family history of affective disorder are evaluated as co-contributors to the observed gender differences in schizophrenia. Particular emphasis is given to evaluating the hypothesis that men are more prone to a hypothesized poor-prognosis, neurodevelopmental subtype of schizophrenia, for which early environmental brain insults play an important etiologic role, whereas women may be more prone to a hypothesized good-prognosis, affective subtype that is genetically related to the affective disorders. This hypothesis is evaluated in terms of (a) its ability to account for gender differences in schizophrenia, (b) its ability to link differences in clinical presentation to proposed differences in etiology; and (c) its potential to generate testable predictions for future schizophrenia research.     

Syndrome of juvenile asthenic deficiency

A clinical and follow-up study of 155 young adults with a symptomcomplex of "juvenile asthenic deficiency"--"endogener juveniler asthenischer Versagensyndrome" (J.Glatzel, G.Huber, 1968) was carried out. It was found that protracted states in the youth with prevalence of educational disadaptation, weakening of initiative, psychophysical fatiguability should be attributed to atypical depressions, characterized by predominance of ideatoric disturbances with obliterated thymic and motor components. Depending on the specificities of ideatoric disturbances, 3 basic typological varieties of such depressions were recognized, i.e. depressions with prevalence of inhibition, disautomatization or distortion of cognitive processes, which statistically correlated reliably with definite nosological forms (affective disorders, schizophrenia). Depending on the nosologic belonging the studied states differed also in frequency of comorbid disturbances (obsessive-phobic, depersonalization, overvalued ideas), which occurred significantly rarer in the cases of affective disorders, than in schizophrenia. On the whole, follow-up study revealed relatively favourable prognosis of youth endogenous depressions with a clinical picture of "juvenile asthenic deficiency": in cases of affective disorders the course of disease was more frequently in the form of a single cyclothymic attack, while in cases of schizophrenia it took the form of protracted atypical pubertal attack.     

Delusional misidentification syndromes]

According to ICD-10 and DSM-IV classifications, delusional misidentification syndromes are a specific subgroup of unspecified persistent delusional disorders. They are characterized by systematic incorrect identification and the basic delusional idea--the concept of a double, illusion of a double. The authors present the most frequent delusional misidentification syndromes, and the most frequent elements of the clinical picture and etiological hypotheses. Because of their small frequency and the basic characteristics of these syndromes to appear mostly as a part of some other disturbance, the authors emphasize the importance of a careful differential diagnostic procedure, which has therapeutic implications.     

MR imaging of muscle and tendon injury

The nature and MRI appearance of injuries to the muscle including delayed onset muscle soreness, muscle contusion, muscle strain, and compartment syndromes are described and examples shown. The nature of degenerative disease of tendon (tendinosis) is discussed and representative examples of the MRI appearance of various stages are illustrated. The role of MR in the clinical management of these disorders is discussed where appropriate.     

In vivo and in vitro production of monoclonal antibodies: current possibilities and future perspectives. Discussion

It is well known that various perceptual abnormalities exist in autism. However, because perceptual phenomena are intersubjective, a phenomenological approach is required for getting hold of the reality of the modes of perception involved in autism. From this standpoint, the author has proposed the concept of 'perception metamorphosis phenomenon' (PMP) as the mode of perception peculiar to autistics. This mode of perception is notable to some degree in infancy and adolescence, and points to the appearance of behavior that is indicative of the environmental world being perceived in a manner different from before by the autistic child. The phenomenon has been classified into three basic categories according to the aspect of perception: (i) visual PMP; (ii) auditory PMP; and (iii) situational PMP. The proposal of this concept was made with the objective of capturing the onset of autism or the mechanism of appearance of the various symptoms from a more phenomenological viewpoint, to serve as a possible starting point for understanding the inner world of autistics. The proposal was made emphasizing the validity of this approach in mapping out new therapeutic approaches and for re-investigating the relationship between autism and schizophrenia.     

Personality disorder is disease.

There is no inconsistency in maintaining, on the one hand, that man is morally accountable for most of his misdeeds and that psychological rather than medical training is basic to competence in the personality disorders, "and affirming, on the other hand, that the latter disorders are genuine manifestations of illness." On these points, issue is taken with the positions of Szasz (1960) and Mowrer (1960). "Szasz' (1960) contention that the concept of mental illness 'now functions merely as a convenient myth' is grounded on four unsubstantiated and logically untenable propositions" which are specified and criticized. "Definition of behavior disorder in terms of sin or difficulties associated with ethical choice and responsibility would substitute theological disputation and philosophical wrangling about values for specifiable quantitative and qualitative criteria of disease." From Psyc Abstracts 36:02:2JA69A. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mononuclear blood cell sulfidoleukotriene generation in the presence of interleukin-3 and whole blood histamine release in honey bee and yellow jacket venom allergy

OBJECTIVES: The aim of this study is to determine the predictive value on rehospitalization of sociodemographic variables, positive/negative symptoms and thought disorders. The results are part of research project founded by the Basque Health Department. METHODS: A 18 month follow-up study of a cohort of 60 patients with acute exacerbation of schizophrenia was carried out. The assessment was performed with DSM III-R diagnostic criteria, PANSS and CGI rating scales, and SCID-P semistructured interview. All patients received antipsychotic treatment. The sociodemographic and disease data, the dimensional score of the PANSS subscales, the score of CGI scale, the items 2, 12, 13 and 14 of the PANSS as indicators of formal thought disorders; and the items 1, 5, 6, 17 and 23 of the PANSS as content thought disorders were established as predictors. The predictive value was determined by the Cox regression test (Lee 1992). RESULTS: We did not find predictive value either in the PANSS scores or in the 9 thought disorders evaluated (Wald and RR tests were not significative). Nevertheless, considering the values of standard error obtained in the Cox regression we were not in a position to assure that they did not have an incidence in the hospitalizations. The CGI was the only scale that showed prognostic value (Wald test = 1.9945; RR = 1.7499). Our results indicated that the lower number of previous hospitalizations (Wald test = 1.1437; RR = 1.1437) and the high level of studies (Wald test = 2.4258; RR = 1.8052) diminished the risk of rehospitalization. CONCLUSIONS: 1 o The predictive value on rehospitalization for the positive/negative symptoms and thought disorders was not confirmed. 2 o CGI is the only scale with predictive value. That fact makes us consider the importance of what German psychiatrists called "smelling the schizophrenia" or "The smell of schizophrenia". 3 o Our results indicate that the lower number of previous hospitalizations, and the high level of studies diminish the risk of rehospitalization.