Insight, grey matter and cognitive function in first-onset psychosis

BACKGROUND: Several studies have suggested that neuropsychological and structural brain deficits are implicated in poor insight. Few insight studies however have combined neurocognitive and structural neuroanatomical measures. AIMS: Focusing on the ability to relabel psychotic symptoms as pathological, we examined insight, brain structure and neurocognition in first-onset psychosis.METHOD: Voxel-based magnetic resonance imaging data were acquired from 82 individuals with psychosis and 91 controls assessed with a brief neuropsychological test battery. Insight was measured using the Schedule for the Assessment of Insight. RESULTS: The principal analysis showed reduced general neuropsychological function was linked to poor symptom relabelling ability. A subsequent between-psychosis group analysis found those with no symptom relabelling ability had significant global and regional grey matter deficits primarily located at the posterior cingulate gyrus and right precuneus/cuneus. CONCLUSIONS: The cingulate gyrus (as part of a midline cortical system) along with right hemisphere regions may be involved in illness and symptom self-appraisal in first-onset psychosis.

Quantification of EEG waves in healthy persons and patients with brain disorders [abstract]

The biological processes that give rise to many disorders of the brain such as schizophrenia, depression and epilepsy are yet to be clearly explained. The electroencephalograms (EEG) from patients with these disorders have been reported to exhibit "chaotic" properties. Coarse-grained correlation dimension (Dcg) has been found to be an effective tool in analyzing waveforms with chaotic properties. We therefore tested the hypothesis that the Dcg of the EEG of patients with the above disorders will be different from those of healthy volunteers. Twenty-five minutes of EEG recordings were obtained from different regions of the brain of 20 healthy volunteers, seven patients with schizophrenia, one with depression, and one with partial seizure. Each person's EEG was edited to obtain 51 seconds of artifact-free recording. A software was developed in-house and used to obtain estimates of the Dcg. A confidence interval for each of the 21 EEG electrode points was established for the healthy volunteers (control group). Compared to the control group, the Dcg measurements of some of the schizophrenics, of the depressed patients, and that of the epileptics showed significant differences (p< 0.005). The results of this study indicate that the Dcg of the EEG for some brain disorders may be of use in the diagnosis of these conditions. Given the preliminary nature of this study, further work with larger sample sizes will be necessary in order to determine the reliability and sensitivity of this method. (AU)

Human spongiform encephalopathy: the National Institutes of Health series of 300 cases of experimentally transmitted disease

We present a synthesis of clinical, neuropatholgical, and biological details of the National Institutes of Health series of 300 experimentally transmitted cases of spongiform encephalopathy from among more than 1,000 cases of various neurological disorder inoculated into nonhuman primates during the past 30 years. The series comprises of 278 subjects with Creutzfeldt-Jakob disease, of whom 234 had sporadic, 36 familial, and 8 iatrogenic disease; 18 patients with kuru; and 4 patients with Gerstmann-Straussler-Scheinker syndrome. Sporadic Creutzfeldt-Jakob disease, numerically by far the most important representative, showed an average age at onset of 60 years, with the frequent early appearance of cerebellar and visual/oculomotor signs, and a broad spectrum of clinical features during the subsequent course of illness, which was usually fatal in less than 6 months. Characteristic spongiform neuropathology was present in all but 2 subjects. Microscopically visible kuru-type amyloid plaques were found in 5 percent of patients with Creutzfeldt-Jakob disease. 75 percent of those with kuru, and 100 percent of those with Gerstmann-Straussler-Scheinker syndrome; brain biopsy was diagnostic in 95 percent of cases later confirmed at autopsy, and proteinase-resistant amyloid protein was identified in Western blots of brain extracts from 88 percent of tested subjects. Experimental transmission rates were highest for iatrogenic Creutzfeldt-Jakob disease (100 percent), kuru (95 percent), and sporadic Creutzfeldt-Jakob disease (90 percent), and considerably lower for most familiar forms of disease (68 percent). Incubation periods as well as the durations and character of illness showed great variability, even in animals receiving the same inoculum, mirroring the spectrum of clinical profiles seen in human disease. Infectivity reached average levels of nearly 10(to the 5th power) median lethal doses/gm of brain tissue, but was only irregularly present (and at much lower levels) in tissues outside the brain, and, except for cerebrospinal fluid, was never detected in bodily secretions or excretions (AU)

Clinical manifestations of childhood lead poisoning

The medical records of 58 children admitted with a diagnosis of lead poisoning to the Bustamante Hospital for Children between January 1979 and June 1987 were reviewed. Clinical data consisting of age, sex, source of exposure to lead, presenting symptoms and signs were collected from the records. Laboratory investigations, namely, haemoglobin, peripheral blood smear, blood lead levels and X-rays, were also reviewed. Reports of Public Health Inspectors were used to identify the source of exposure and information was also obtained from parents or guardians

Epilepsy: disappearing lesions appearing in the United Kingdom

Objective: - Investigation of spontaneously resolving lesions associated with epilepsy. Design:- Observational study during one year. Setting:- One neurology department. Patients:- 4 cases in patients (one of Indian parents, one African, one white English, and one Afro-Caribbean) resident in the United Kingdom, who presented with transient epilepsy. Main outcome measures:- Findings on computed tomography and on screening for infections. Results:- In all four cases a small mass lesion in one cerebral hemisphere was observed on computed tomography, which resolved after 9, 4, 3 and 1.5 months respectively without surgery. Conclusions:- The number of cases seen in one year suggests that the lesions may be more common in the United Kingdom than previously recognised and that research into their cause is warranted. (AU)

En-plague subdural sarcoidosis: a rare neurological entity

En-plaque sarcoidosis is reported in a 74-year-old black woman. The diagnosis was made at autopsy. The patient also had adenocarcinoma of the sigmoid colon with liver metastases. Subdural sarcoidosis is very rare in that only four cases have been previously reported, all of which were diagnosed clinically and treated (AU)

Crises of childhood: The role of the central nervous system, social and environmental factors as determinants of child psychiatric disorders

There are several factors which can disturb the normal psychological development of the child such as parental deviancy, the quality of parent/child relationship, nutritional status and the integrity of the central nervous system. Psychiatric disorders commonly observed in children attending Clinics in Jamaica are emotional and conduct problems, learning difficulties, hyperkinesia and childhood psychoses. Parents and responsible adults must be aware of the risk-factors involved and appropriate steps should be taken to ensure the normal development of the child (AU)

Cerebral space-consuming lesions of an infectious nature: ecology diagnosis and management

The cerebral nervous system offers little resistance to infection when compared with other tissues of the body. As a result micro-organisms which are usually considered to be a low pathogenicity may produce a variety of space consuming lesions when they obtain access to the brain. The ecology of most of the pyogenic infections of the cerebral nervous system is well elucidated. What is less well known and recognized is the evolution and optimum mode of therapy of the granulomatous, fungal and viral infections of the brain and in particular those which cause discrete space-consuming lesions. In recent years the development of more sophisticated techniques for diagnosing intracranial pathology has kept pace with the advances in the detection, identification and eradication of pathogenic micro-organisms. The purpose of this communication is to review the cerebral space-consuming lesions caused by infectious agents with particular emphasis on those of a tropical nature. Clinical, laboratory, radiological and therapeutic considerations will be discussed. Special interest will be devoted to nocardiosis, actinomycosis, candidiasis, cryptococcosis, tuberculosis and herpes simplex encephalitis (AU)