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.

Growth and development four years after treatment for the Trichuris dysentery syndrome

A follow-up study is reported of 18 children 4 y after treatment for the Trichuris dysentery syndrome (TDS) and matched control children. The TDS children were initially severely stunted and had extremely low developmental levels. They showed catch-up in height of 1.9 z-scores even though they remained in very poor environments. Their intelligence quotients, school achievement and cognitive function remained significantly lower than those of the controls. Controlling for their earlier developmental levels, the TDS children showed a small improvement in mental development relative to the controls (Au)

Evaluation of school feeding programs: some Jamaican examples

It is hypothesized that giving children a daily breakfast at school may improve their scholastic achievement through several mechanisms: increasing the time spent in school, improving certain cognitive functions and attention to tasks, and, perhaps indirectly, improving nutritional status. Two Jamaican studies showed that providing breakfast to students at school improved some cognitive functions, particularly in undernourished children. However, changes in classroom behavior varied depending on the quality of ths school. Children in better-organised schools concentrated on tasks for longer periods and made fewer undesirable movements, whereas in poorly organized schools the children's behavior deteriorated. Studies to date have provided insufficient evidence to determine whether children's long-term scholastic achievement is imporved by eating breakfast daily. Well-designed, randomized, controlled. long-term trials are essential for determining public policy on the implementation of schools feeding programme(AU)

Breakfast and education performance in schoolchildren

This paper reviews the recent evidence as to what extent school feeding programmes and breakfast, in particular, benefit children's attainment levels. Several recent well designed studies have shown that children's cognition is improved. Less rigorous studies suggest that school achievement levels, attendance and tardiness also improves in the short term. (AU)

Hormonal counterregulation of hypoglycaemia in IDDM patients during and after pregnancy

An increased frequency of hypoglycaemic events is commonly observed during pregnancy in intensively treated IDDM patients. It has been speculated upon whether this is due in part to impairment of the hormonal counterregulation. The main aim of this study was to clarify if the hormonal response to hypoglycaemia is modified during pregnancy. Therefore we assessed plasma levels of catecholamines, GH and cortisol as well as subjective symptoms and cognitive functions during a hyperinsulinaemic, hypoglycaemic clamp in the third trimester of pregnancy and 6-12 months after delivery. Venous samples for the analysis of hormones and free insulin were taken every 15 minutes and symptoms of hypoglycaemia were recorded on a visual analogue scale at 30-min intervals. Cognitive functions were studied by a psychological test system at normoglycaemia and at hypoglycaemia. The Wilcoxon signed rank test was used for statistical calcuations. The levels of noradrenaline (mean at hypoglycaemia pregnant 2.30, and non-pregnant 2.44 nmol/l, n.s.) increased the same way on the two occasions, while the adrenaline response was some what higher in the pregnant state (2.09 vs 1.66 nmol/l non-pregnant, p<0.05). The cortisol increase was faster and more pronounced during pregnancy (mean increase 327 vs 130 nmol/non-pregnant, p<0.0001) while the increase in GH was higher in the non-pregnant state (mean increase 23.6 vs 8.7 æg/l pregnant, P<0.0001). We conclude that the present study does not, with the exception of GH, give evidence that pregnancy per se diminishes the counterregulatory hormones response (AU)

Trichuris trichiura infection and cognitive function in Jamaican school children

Trichuris trichiura is extremely prevalent worldwide and there is concern that this geohelminth may affect the cognitive function of children in developing countries. A random-controlled, double-blind, treatment trial was conducted in Jamaican children with light to moderate infections. This was part of a research programme involving several studies in Jamaica. Ninety-seven subjects, each with a minimum of 1200 T. trichiura eggs/g faeces, were randomly assigned to placebo (N = 48) or treatment (N = 49) groups. Each pair of infected children was matched with an uninfected classmate (N = 48). All children were given seven cognitive functions tests: French-learning; digit spans (forward and backwards), Corsi block span; fluency; picture search; and silly sentences. Albendazole was given to the treatment group and the other groups received a placebo. Three months later, these treatments were repeated, and the cognitive function battery was given again. On pre-test, the infected groups performed significantly poorer only in the silly-sentence test (analysis of variance F-value=8.17; two degrees of freedom; p<0.001). There was no significant improvement with treatment in any of the tests. Taking into account these findings and those of the other Jamaican studies, it is therefore probable that light to moderate Trichuris infections have little effect on cognitive functioning in school children who have adequate nutritional status.(AU)

Trichuris trichiura infection and cognition in children: results of a randomized clinical trial

The effects of mild to moderate infections of Trichuris trichiura on cognitive functions were investigated in Jamaican children aged 7 to 10 years. In all, 189 infected children and 100 uninfected classmates were studied. The infected children were randomly assigned to receive treatment (albendazole) or a placebo. All children were given cognitive tests on enrolment and 14 weeks later. These included verbal fluency (generation of ideas), digit span (working memory), number choice (speed of processing of visual stimuli), visual search (sustained attention) and a French Vocabulary test (paired-associate learning). At baseline, the infected children had lower scores than the uninfected ones in fluency (P=0.01), search (P=0.02) and French (P=0.01). Treatment effects were examined among infected children and there was no significant treatment effect for any of the tests. However, there was a significant treatment by weight-for-age interaction in fluency (P<0.05). The children with low weight-for-age (Z-score < -1) improved with treatment while there was no improvement with treatment among the other children. We concluded that treatment of children with mild to moderate T. trichiura infections using albendazole produces little benefit in cognition if they are adequately nourished; however, undernourished children are more likely to benefit (AU)

Cross-cultural cognition: developing tests for developing countries

The problems of adapting measures of cognitive performance to Third World conditions are described, and three novel adaptations are proposed, one based on speed of sentence comprehension, one on vocabulary acquisition, and a third on speed of visual search using pictorial material. These and other existing tests are applied to studying the cognitive performance of Jamaican children as part of an investigation into the effects on cognition of infection by the parasitic worm Trichuris trichiura. We demonstrate that the tests are usable under Third World field conditions, and give reliable results. The validity of our proposed test is indicated by their capacity to predict scholastic performance. Despite their brevity and avoidance of any demand on literacy, they yielded substantial correlations with the reading, spelling and arithmetic sales of the Wide Range Achievement Test.(AU)

The short term effects of breakfast on the cognitive functions of school children

A large sum of money is spent annually on school feeding programmes in developed and developing nations. However few of these programmes have been evaluated in developing countries. The short term effects of breakfast on cognitive functions were examined in 97 undernourished (weight-for-age) ó - 1.00 SD) and 100 adequately nourished (weight-for-age > - 1.00 SD) children attending grades three and four of four remote, rural schools in Jamaica. Half the children were given breakfast and the other half a quarter an orange as a placebo at 8.30 a.m. Treatment began at least one week prior to testing. Children were retested a few weeks later when the treatment order was reversed. The cognitive functions measured were sustained attention (Memory and Search), auditory short term memory (Digital Span), generation of ideas and motivation (Fluency), and reaction time and information processing (Number Choice). Girls performed better than boys in tasks of sustained attention and reaction time (p < 0.001 and 0.002 respectively), breakfast had a beneficial effect in scores of fluency in the undernourished children, and boys had higher scores in Digit Span with breakfast but the scores of girls declined (with breakfast). The results suggested that a breakfast program of this type can have some benefits on children's cognitive function. (AU)

School breakfast improves verbal fluency in undernourished Jamaican children

School feeding programs exist in many countries, but few have been properly evaluated. In this study, the short-term effects of breakfast on children's cognitive functions were examined. The subjects were 97 undernourished (weight-for-age < or = -1 SD of reference) and 100 adequately nourished (weight-for-age > -1 SD) children in four primary schools in rural Jamaica. The children were randomly assigned to a group provided with breakfast or a group given a quarter of an orange as a placebo, and the given a battery of four cognitive function tests. After a few weeks the treatments were reversed and the tests repeated. Undernourished children's performance improved significantly on a test of verbal fluency when they received breakfast, whereas that of the adequately nourished children did not change (breakfast x group interaction, P < 0.05). They were no other effects of breakfast on test scores. The findings extend those of a previous Jamaican study conducted under more controlled conditions, and support the targeting of school meals to undernourished children (AU)

The short-term effects of breakfast on the cognitive functions of school children - abstract

A large sum of money is spent annually on school feeding programmes in developed and developing countries. However, a few of these programmes have been evaluated in developing countries. The short-term effects of breakfast on cognitive functions were examined in 97 undernourished (weight-for age < 1 SD) and 100 adequately nourished (weight-for-age > - 1 SD) children attending grades three and four of four remote rural schools in Jamaica. Half of the children were given breakfast and the other half a quarter of an orange as a placebo at 8:30 a.m. Treatment began at least one week prior to testing. Children were retested a few weeks later when the treatment order was reversed. The cognitive functions measured were sustained attention (Memory and Search), auditory short-term memory (Digit Span), fluency and choice reaction time (Numbers). Girls performed better than boys in tasks of sustained attention and choice reaction time (p<0.001 and 0.002, respectively). Breakfast had a beneficial effect in scores of fluency in the undernourished group not in the adequately nourished group. Both adequately nourished and undernourished boys scored higher in test of digit span when given breakfast. The results suggest that breakfast programmes can have some benefits on children's cognitive functions (AU)

Effects of missing breakfast on the cognitive functions of school children of differing nutritional status

We examined the effects of omitting breakfast on the cognitive functions of three groups of children: stunted, nonstunted controls, and previously severely malnourished. They were admitted to a metabolic ward twice. After an overnight fast half the children received breakfast on their first visit and a cup of tea the second time. The treatment order was reversed for the other half. When breakfast was omitted, both the stunted and previously malnourished groups responded similarly. The malnourished groups had lower scores in influency and coding whereas the control group had higher scores in arithmetic. The children were divided into wasted and nonwasted groups. Wasted children were adversely affected in digit span backwards test and wasted members of the malnourished groups were adversely affected on efficiency of problem solving and those control group in digit span forwards. These results indicate that cognitive functions are more vulnerable to missing breakfast in poorly nourished children (AU)

The effects of missing breakfast on the cognitive functions of school children of differing nutritional status

Being hungry in school may result in the cognitive functions and hence, the school achievement of children being adversely affected. More importantly, malnourished children may be more vulnerable to these effects than adequately nourished ones. However, this had not been previously investigated. The effects of the omission of breakfast were therefore examined in three groups of poor children aged 9 and 10 years old: stunted (n=30), non-stunted (n=30) and previously severely malnourished (n=30). They were admitted to a metabolic ward on two occasions, one week apart. After an overnight fast, half the children received breakfast on their first visit and a cup of tea the second time. The treatment order was reversed for the other children. The breakfast (590 Cals) comprised items from the Jamaican schoolfeeding program. When breakfast was omitted, the stunted and previously severely malnourished groups responded similarly and differently from the control group. Both malnourished groups had lower scores in the fluency and visual short-term memory (coding) tests (p<0.005 and p<0.05 respectively). In contrast, when fasted the controls performed better in arithmetic and in problem solving efficiency (p<0.02 and p<0.05 respectively). The sample was then divided into waste and non-waste sets. When they missed breakfast, the wasted children were adversely affected in their performance of the digit span backwards test, a measure of auditory short-term memory with an immediate processing element (p<0.05). In addition, the wasted members of the malnourished groups were adversely affected in the efficiency of problem solving (p<0.02). The wasted controls also had lower scores in the digit span forward test (auditory short-term memory) when breakfast was omitted (p<0.03). All the findings remained when the children's usual caloric intake for breakfast and their IQs were statistically controlled. This implied that the findings were independent of these factors. There is therefore, an indication that cognitive functions are more vulnerable to missing breakfast in malnourished children. As a result, their school achievement levels would be expected to benefit more from schoolfeeding programs than those of adequately nourished children (AU)

Chronic undernutrition and cognitive abilities

This review attempts to summarize recent developments in our understanding of the relationship between childhood malnutrition and cognitive abilities. The first questions briefly discussed relate to methods: the definition of malnutrition and the selection of suitable methods of measuring cognitive abilities. Next are considered the effects on mental development of undernutrition, social background and the behavioural patterns of mothers. The consequences of an episode of severe malnutrition in infancy and of confinement in hospital represent a special but important case. The review ends with a discussion of the factors that influence recovery and of strategies for intervention which might be included in a health care programme.(AU)

The significance of marihuana in a small agricultural community in Jamaica / Cannabis and culture

A comprehensive field study, including videotape coverage and extensive laboratory research, was carried out in a small agricultural community in Jamaica, the West Indies. The research sought to explore whether cannabis altered the user's cognitive and psychological frame of reference in a specific socioeconomic and cultural context. The findings indicate that (1) heavy cannabis smokers enact subtle alterations in the stream of consciousness; (2) subjective (smoker) impressions of cannabis-induced alterations in specific tasks contrast with descriptions based on analysis of research records of those activities; (3) alterations associated with cannabis smoking seem to be appropriate to the users as members of the socioeconomic cultural system. Multidisciplinary research procedures are suggested for further study of these findings. (AU)