Mentalization and empathy as predictors of violence in schizophrenic patients: Comparison with nonviolent schizophrenic patients, violent controls and nonviolent controls.

There are conflicting results concerning risk of violence in schizophrenia. Empathy and mentalization deficits are associated both with schizophrenia and violence, however, there are only a few studies with equivocal results concerning their relationship. 88 violent and nonviolent paranoid schizophrenic and violent and nonviolent control males in psychiatric, forensic psychiatric and correctional institutions completed the Ekman 60 Faces test, Faux Pas Recognition Test, Eysenck IVE test, Interpersonal Reactivity Index, and the Spielberger Anger Expression Scale. Data were analysed with ANOVA and logistic regression models. Significant group differences with a characteristic pattern were detected in mentalization, facial affect recognition, fear and anger recognition, interpersonal distress, and frequency of direction of anger expression. Predictors of violent behaviour were different in the schizophrenic and non-schizophrenic groups. Lack of major differences in empathy and mentalization between violent and nonviolent schizophrenia patients suggests that such deficits are core features of schizophrenia but do not determine emerging violence in this illness. Our results emphasise the importance of distinguishing between violence related to core positive symptoms of schizophrenia and that emerging from independent comorbid antisocial personality traits in order to identify targets for screening, detection, prevention and management of violence risk in different subpopulations of schizophrenia patients.

Minor physical anomalies in bipolar I and bipolar II disorders - Results with the Méhes Scale.

Minor physical anomalies (MPAs) are external markers of abnormal brain development, so the more common appearence of these signs among bipolar I and bipolar II patients can confirm the possibility of a neurodevelopmental deficit in these illnesses. The aim of the present study was to investigate the rate and topological profile of minor physical anomalies in patients with bipolar I and - first in literature - with bipolar II disorders compared to matched healthy control subjects. Using a list of 57 minor physical anomalies (the Méhes Scale), 30 bipolar I and 30 bipolar II patients, while as a comparison 30 matched healthy control subjects were examined. Significant differences were detected between the three groups comparing the total number of minor physical anomalies, minor malformations and phenogenetic variants and in the cases of the ear and the mouth regions. The individual analyses of the 57 minor physical anomalies by simultaneous comparison of the three groups showed, that in the cases of furrowed tongue and high arched palate were significant differences between the three groups. The results can promote the concept, that a neurodevelopmental deficit may play a role in the etiology of both bipolar I and bipolar II disorders.

Symptom profiles and parental bonding in homicidal versus non-violent male schizophrenia patients.

BACKGROUND AND PURPOSE: To compare the intensity and the profile of psychotic symptoms and the characteristics of parental bonding of male schizophrenia patients with a history of homicide and those without a history of violent behaviour. Clinical question - We hypothesized more intense psychotic symptoms, especially positive symptoms as signs of a more severe psychopathology in the background of homicidal behaviour. We also hypothesized a more negatively perceived pattern (less Care more Overprotection) of parental bonding in the case of homicidal schizophrenia patients than in non-violent patients and non-violent healthy controls. METHODS: Symptom severity and symptom profiles were assessed with the Positive and Negative Syndrome Scale in a group of male schizophrenia patients (n=22) with the history of committed or attempted homicide, and another group (n=19) of male schizophrenia patients without a history of violent behaviour. Care- and Overprotection were assessed using the Parental Bonding Instrument (PBI) in a third group of non-violent healthy controls (n=20), too. RESULTS: Positive, negative and general psychopathology symptoms in the homicidal schizophrenia group were significantly (p<0.005) more severe than in the non-violent schizophrenia group. Non-violent schizophrenia patients scored lower on Care and higher on Overprotection than violent patients and healthy controls. Homicidal schizophrenia patients showed a pattern similar to the one in the healthy control group. CONCLUSION: It seems imperative to register intense positive psychotic symptoms as predictive markers for later violent behaviour. In the subgroup of male homicidal schizophrenia patients negatively experienced parental bonding does not appear to be major contributing factor to later homicidal behaviour.

Minor physical anomalies are more common among the first-degree unaffected relatives of schizophrenia patients - Results with the Méhes Scale.

Minor physical anomalies are external markers of abnormal brain development,so the more common appearance of these signs among the relatives of schizophrenia patients can confirm minor physical anomalies as intermediate phenotypes. The aim of the present study was to investigate the rate and topological profile of minor physical anomalies in the first-degree unaffected relatives of patients with schizophrenia compared to matched normal control subjects. Using a list of 57 minor physical anomalies (the Méhes Scale), 20 relatives of patients with the diagnosis of schizophrenia and as a comparison 20 matched normal control subjects were examined. Minor physical anomalies were more common in the head and mouth regions among the relatives of schizophrenia patients compared to normal controls. By the differentiation of minor malformations and phenogenetic variants, we have found that only phenogenetic variants were more common in the relatives of schizophrenia patients compared to the control group, however individual analyses showed, that one minor malformation (flat forehead) was more prevalent in the relative group. The results can promote the concept, that minor physical anomalies can be endophenotypic markers of the illness.

Minor physical anomalies are more common in schizophrenia patients with the history of homicide.

Minor physical anomalies may be external markers of abnormal brain development, so the more common appearance of these signs in homicidal schizophrenia might suggest the possibility of a more seriously aberrant neurodevelopment in this subgroup. The aim of the present study was to investigate the rate and topological profile of minor physical anomalies in patients with schizophrenia with the history of committed or attempted homicide comparing them to patients with schizophrenia without homicide in their history and to normal control subjects. Using a list of 57 minor physical anomalies, 44 patients with the diagnosis of schizophrenia were examined with the history of committed or attempted homicide, as a comparison 22 patients with the diagnosis of schizophrenia without the history of any kind of homicide and violence and 21 normal control subjects were examined. Minor physical anomalies are more common in homicidal schizophrenia patients compared to non-homicidal schizophrenia patients and normal controls, which could support a stronger neurodevelopmental component of etiology in this subgroup of schizophrenia. The higher rate of minor physical anomalies found predominantly in the head and mouth regions in homicidal schizophrenia patients might suggest the possibility of a more seriously aberrant brain development in the case of homicidal schizophrenia.

[Social cognitive differences in first-degree relatives of patients with schizophrenia. A systematic review]. / Szociális kognitiv eltérések szkizofrén paciensek elso foku hozzátartozói között.

The impairment of social functioning and difficulties in social integration are frequently found in patients with schizophrenia, and may affect the quality of life, thus revealing the underlying mechanisms of these differences appear to be of high importance. The impairment of social functioning has been reported in first-degree relatives of schizophrenia patients and individuals at ultra-high risk for psychosis. Two meta-analyses and 15 studies were reviewed, in which various ToM tests were performed involving first-degree relatives of patients with schizophrenia,with diverse findings, both positive and negative results have been found, and in addition other cognitive deficits were reported in some cases. In the background of different findings methodological differences can be presumed. Overall the social cognitive functions of first-degree relatives were found affected, which suggests the role of social cognition as endophenotypic marker of schizophrenia.

[Minor physical anomalies in the relatives of schizophrenia patients. A systematic review of the literature]. / Minor fizikális anomáliák szkizofrén betegek hozzátartozói között. Szisztematikus áttekinto közlemény.

Minor physical anomalies are mild, clinically and cosmetically insignificant errors of morphogenesis which have a prenatal origin and may bear major informational value for diagnostic, prognostic and epidemiological purposes. Since both the central nervous system and the skin are derived from the same ectodermal tissue in utero, minor physical anomalies can be external markers of abnormal brain development and they appear more commonly in neurodevelopmental disorders. Recently studies were published on the prevalence of minor physical anomalies in the relatives of patients with schizophrenia. In a systematic review of literature 11 studies were identified with mixed results. We suppose that the differentiation of minor malformations and phenogenetic variants can help to clarify the minor anomaly profile as a potential endophenotype in schizophrenia.

[Psychosis and violence -- literature review from a preventive point of view]. / Pszichózis és eroszak -- szakirodalmi áttekintés preventive nézopontból.

Clinical experience shows that being diagnosed with a serious mental illness (SMI) significantly increases the risk of violent behaviour. The study gives a brief overview of literature on the neurophysiological, cognitive and emotional factors hypothesized behind the violent behaviour of psychotic patients. Clinical profiles show that a distinct constellation of psychotic symptoms known as threat/control-override, comorbid substance abuse, decreased adherence to and compliance with treatment as well as a higher level of hostility as measured by the PANSS, are characteristic for these patients. There is, however, no established causal link between being diagnosed with SMI and committing a violent crime. In a great number of cases, the factors behind such a crime are not psychosis-related. The study postulates several pathways ending in violent behaviour that result from the interaction of multiple factors. Following a preventive approach, it focuses on preexisting factors that go unnoticed for many years before the appearance of violent behaviour and may therefore have significant predictive value. Elevated levels of catecholamines, the dysfunction of the ventromedial-orbitofrontal cortical-amygdala system, decreased grey matter volume in the hippocampal and parahippocampal areas have proven to be important markers of vulnerability. In many cases, these factors later show in distinct impairments of neurocognitive performance and emotional functioning, prominently indeficits of executive functioning as well as in increased levels of impulsivity. Based on these established premorbid markers, the study emphasizes the importance of the prevention of violent behaviour through the early detection of cognitive and emotional dysfunction and the application of corrective measures.

[Minor physical anomalies in autism]. / Minor fizikális anomáliák autizmusban.

BACKGROUND AND PURPOSE: Minor physical anomalies are mild, clinically and cosmetically insignificant errors of morphogenesis which have a prenatal origin and may bear major informational value for diagnostic, prognostic and epidemiological purposes. Since both the central nervous system and the skin are derived from the same ectodermal tissue in utero, minor physical anomalies can be external markers of abnormal brain development and they appear more commonly in neurodevelopmental disorders. In a recently published meta-analysis Ozgen et al. have published the results of seven studies--all have used the Waldrop Scale which contains 18 minor physical anomalies--and reported on the higher prevalence of minor physical anomalies among patients with autism. There are only a very few data on the individual analysis of the prevalence of minor physical anomalies in autism. METHODS: In our study we have studied the prevalence of 57 minor physical anomalies in 20 patients with autism and in 20 matched control subjects by the use of the Méhes Scale. RESULTS: The prevalence of minor physical anomalies was significantly higher in the autism group (p < 0.001). The individual analysis of the 57 minor physical anomalies showed the significantly more frequent apperance of four signs (primitive shape of ear p = 0.047, abnormal philtrum p = 0.001, clinodactylia p = 0.002, wide distance between toes 1 and 2 p = 0.003). No correlation was found between the four significantly more common minor physical anomalies. CONCLUSION: The higher prevalence of minor physical anomalies in autism supports the neurodevelopmental hypothesis of the disorder and the individual analysis of minor physical anomalies can help to understand the nature of the neurodevelopmental defect.

Psychosis as a process--new implications of staging models of schizophrenia.

The article discusses contributing factors in the pathogenesis of schizophrenia. In the last fifteen years, the emphasis has shifted from curative to prodromal and premorbid characteristics of later schizophrenia patients. Nevertheless, most studies are limited to the area of early detection and intervention of schizophrenia with much fewer focusing on actual prevention. A more general preventive approach not limited to psychotic condition is clearly underestimated. Following a review of current literature on prodromal approaches and identified premorbid markers of schizophrenia, the article outlines a possible trajectory of later psychotic condition with detectable, distinct stages from birth on. Based on this extended staging model involving neurotoxic impact and early prefrontal-limbic dysfunction, it argues for a refined, phase-specific treatment protocol including preventive interventions. Accepting a model of schizophrenia as an illness with detectable, phase-specific signs and symptoms from infancy on leads to the need to implement preventive interventions. Through this approach, we could, in the optimal case, be able to identify early signs of neuromotoric and cognitive dysfunction not specific for psychosis. Furthermore, it would be useful to lay greater emphasis on the detection of these early signs in the training of health care professionals. This approach calls for a close cooperation between psychologists, psychiatrists, neuropsychologists and special education experts and a change in the way we view psychotic illness.

[The mystery of schizophrenia. The role of a preventive approach in the treatment of mental illness]. / A szkizofrén pszichózis rejtélye. A preventiv szemlélet szerepe az elmebetegségek kezelésében.

Despite decades of research, there is still a disquieting amount of unanswered questions concerning the genesis as well as the efficient therapy of schizophrenia. The classic approaches emphasizing genetic and family influences were followed by more comprehensive ones that focus on the interplay between the cognitive and the emotional social symptoms of the illness. The demand-access-matching model and, perhaps even more clearly, the cognitive appraisal model seek to integrate biological and early childhood experience factors and show their impact on cognitive as well as emotional functioning. The health-psychosis-continuum model, on the other hand, offers a possible answer to the quantity-quality dilemma of psychotic symptoms. Following a review of the different approaches as well as recent findings in research, the present study outlines a possible route to the development of mental illness starting from a genetically determined more general vulnerability leading to non-specific cognitive dysfunct on in early childhood on to an impaired synchronicity finally leading to a distancing from external reality in the form of overt psychotic symptoms. The second part of the study focuses on the advantages and difficulties of the different therapeutic approaches to mental illness. Based on these approaches, the study outlines an alternative preventive model that, rather than focusing on the former dichotomies lays the emphasis on the early identification and detection of non-specific childhood cognitive dysfunction and early intervention to correct these. These interventions certainly require the close cooperation between psychologists, psychiatrists and special education experts.