Processing and recognition of facial affect in schizophrenia.

A deficit in the recognition of facial affect has been well documented in people with schizophrenia. Our 1995 research with normal subjects showed that hemispheric bias for processing facial affect is related to accuracy of recognition of facial affect. We tested whether this relationship holds in a sample of 25 people with schizophrenia who completed tasks of identification of facial affect and chimeric facial affect. Subjects with a left visual-field bias were significantly more accurate in identifying one facial emotion (sad) than were other subjects. Individual differences in hemispheric advantage for processing affect appears to be an important variable related to functional brain capacity within different populations.

Repetition blindness in schizophrenic patients.

Repetition blindness is the failure to report the detection of repeated items in rapid visually presented lists. It can be explained in terms of either a processing limitation or an active inhibitory process. In two studies conducted in either English or German language we set out to induce repetition blindness under various conditions in a total of 47 control subjects and 30 schizophrenic patients. The patients displayed the phenomenon to at least the same degree as normal control subjects. These results render unlikely accounts of repetition blindness which involve processes known to be dysfunctional in schizophrenic patients. Moreover, the study provides an example of how the performance of schizophrenic patients can constrain theories of normal cognition.

Neurological comorbidity in treatment-resistant dual diagnosis patients.

This paper discusses the possible role of neurological dysfunction in the frequent treatment-resistance of dual diagnosis patients. Through case vignettes, the complex treatment process of three dual diagnosis patients is presented. Each case demonstrates how in addition to both psychiatric and substance abuse problems, the patients also experienced neurological difficulties that made treatment even more complicated. The authors suggest that treatment providers should carefully screen for neurological disorders among this patient population. Attending to such comorbid difficulties in addition to patients' psychiatric and substance abuse problems may sometimes play a pivotal role in enabling patients to attain abstinence. The authors also speculate concerning the role of neurological dysfunction in the etiology of the dual diagnosis syndrome in at least a subgroup of dual diagnosis patients.

One hundred years of schizophrenia: a meta-analysis of the outcome literature.

OBJECTIVE: This study was undertaken to assess the twentieth-century literature on outcome in schizophrenia for historical trends that might be associated with changes in diagnostic and therapeutic practice and to test the hypothesis that both improved biological treatment and changes in diagnostic criteria have influenced outcome. METHOD: Meta-analysis of the international literature on outcome in schizophrenia or dementia praecox from 1895 to 1992 identified 821 studies; 320 of these, with 51,800 subjects in 368 cohorts, met the inclusion criteria for the study. RESULTS: Only 40.2% of patients were considered improved after follow-ups averaging 5.6 years (range = 1-40). Outcome was significantly better when patients were diagnosed according to systems with broad criteria (46.5% were improved) or undefined criteria (41.0% were improved) rather than narrow criteria (27.3% were improved). The proportion of patients who improved increased significantly after mid-century (for 1956-1985 versus 1895-1955, 48.5% versus 35.4%), probably reflecting improved treatment as well as a broadened concept of schizophrenia. However, in the past decade, the average rate of favorable outcome has declined to 36.4%, perhaps reflecting the re-emergence of narrow diagnostic concepts. CONCLUSIONS: Overall, less than half of patients diagnosed with schizophrenia have shown substantial clinical improvement after follow-up averaging nearly 6 years. Despite considerable gains in improvement rates after mid-century, there has been a decline since the 1970s. These historical changes probably reflect improved treatment, shifts in diagnostic criteria, and selection bias related to changes in health care.

Zinc salts for the treatment of olfactory and gustatory symptoms in psychiatric patients: a case series.

BACKGROUND: Zinc salts have been used extensively in medical settings to treat disorders of gustatory and olfactory function. However, zinc supplements have not been tested in psychiatric patients with smell or taste symptoms. METHOD: The authors examined the effects of zinc supplements on five consecutive patients with symptoms of abnormal taste and smell perception in the context of acute psychiatric illness or treatment. RESULTS: All five patients had complete or partial amelioration of these olfactory and gustatory symptoms after treatment with zinc sulfate or zinc gluconate, apparently independent of the improvement in their underlying psychiatric disorder. CONCLUSION: We recommend treating unusual olfactory and gustatory symptoms with zinc salts, independent of the treatment for the underlying psychiatric disorder.

A new identity for misidentification syndromes.

The systematic study of delusional misidentification syndromes has been hampered by the often confusing and imprecise eponymic nomenclature currently in use. We present a case report that demonstrates the inadequacies of the current system. We then propose a new classification system designed to improve research and understanding in this important area.

[Significance of historical and current hallucinogenic research in psychiatry]. / Zur Bedeutung der historischen und aktuellen Halluzinogenforschung in der Psychiatrie.

Research in experimental psychosis has a long tradition extending through several stages. With the world wide abuse of psychoactive substances it came to an abrupt end. Systematic questions within this framework of research are still unresolved, and research on newly developed compounds is almost completely lacking. A review of the pharmacological and psychological effects of various psychoactive agents is provided, and results of recent experimental studies on arylalkylamines are discussed. It is argued that from a systematic as well as from a methodological viewpoint the traditional approach of experimental psychosis represents a valuable tool in psychiatric research.

A neuropsychological perspective on dual diagnosis.

The purpose of this study was to investigate whether patients experiencing both a major psychiatric disorder and a concurrent substance abuse problem (dual diagnosis) manifest greater neuropsychological dysfunctions than patients experiencing a major psychiatric disorder alone. Differences in diagnostic variability and fluidity between dual diagnosis and non-dual diagnosis patients and the occurrence of polysubstance abuse among the dual diagnosis patients were also investigated. The hypotheses were tested by retrospectively reviewing the psychiatric records of 50 dual diagnosis patients and comparing them to 36 chronically hospitalized non-dual diagnosis psychiatric patients. Results revealed that dual diagnosis patients manifested significantly greater neuropsychological impairments than non-dual diagnosis patients and that dual diagnosis patients showed a greater range of diagnoses and diagnostic fluidity than non-dual diagnosis patients. Results also revealed that over one-half of the dual diagnosis patients abused a variety of different substances. An etiological role of neuropsychological dysfunction in the development of the dual diagnosis syndrome in at least a subgroup of dual diagnosis patients is suggested. More specifically, it is suggested that the neuropsychological dysfunctional pattern that is described may represent an organic substrate of a nonspecific vulnerability to developing both (atypical) psychoses and (poly) substance abuse.

Mescaline-induced psychopathological, neuropsychological, and neurometabolic effects in normal subjects: experimental psychosis as a tool for psychiatric research.

The psychological, neuropsychological, and neurometabolic effects of the hallucinogenic agent mescaline were investigated in 12 normal men who were volunteers. Mescaline produced an acute psychotic state 3 1/2-4 hr after drug intake, as measured by the Brief Psychiatric Rating Scale (BPRS) and Paranoid Depression Scale (PDS). The Assessment of Altered States of Consciousness (APZ) questionnaire revealed specific effects of mescaline in the visual system. Neuropsychological effects were studied with a face/nonface decision task with known right-hemisphere advantage, in which mescaline induced a decrease of functioning of the right hemisphere. In functional brain imaging using single photon emission computed tomography (SPECT), mescaline produced a "hyperfrontal" pattern with an emphasis on the right hemisphere, which was correlated with mescaline-induced psychotic psychopathology. Our findings question the validity of the concept of hypofrontality as an explanation for schizophrenic symptomatology. The study of psychoactive substances under controlled laboratory conditions has the methodological advantage of intraindividual control, and hence, minimal variability of data.

[Clinical and laboratory differentiation of alcohol withdrawal syndrome ("predelirium") and alcoholic delirium]. / Zur klinischen und labortechnischen Differenzierung des Alkoholentzugssyndroms ("Prädelir") und des Alkoholdelirs.

In a retrospective study, data from 99 male and female inpatients with alcohol withdrawal syndrome or alcohol withdrawal delirium, treated between 1977 and 1987, were analyzed. DSM-III criteria were used to assign the diagnosis of either withdrawal delirium (with obligatory clouding of consciousness) or alcohol withdrawal syndrome (without disturbances of consciousness and/or perception). No statistically significant differences between the two groups were found with respect to the red and white blood count, liver enzymes, and electrolytes. Significant differences were found in calcium levels, lymphocyte counts, and in electrophoresis. However, these differences are of no use for diagnostic purpose. Moreover, they are unspecific with respect to etiology. Hence, the distinction between alcohol withdrawal syndrome and alcohol withdrawal delirium can only be made clinically, i.e., it is dependent on the presence or absence of a clouded consciousness. This is in line with the findings published by other investigators. In the light of our metabolic findings, alcohol withdrawal syndrome and alcohol withdrawal delirium represent the two extremes of a continuum rather than two separate nosological entities.

Association of tardive dyskinesia with increased frequency of eye movement disturbances in chronic schizophrenic patients. A clinical note.

The study of eye movement dysfunction in chronic schizophrenics by electronystagmography revealed a significant increase of saccadic dysmetria as well as saccadic intrusions in smooth pursuit in schizophrenic patients with tardive dyskinesia (TD) compared with those without TD and with healthy controls. The pattern of eye movement dysfunction in schizophrenia allows clear discrimination from patients with similar movement disorders due to Huntington's disease. Of several possible explanation's of the schizophrenic eye movement dysfunction the authors favour the hypothesis of a common pathogenetic link between TD and eye movement disorders in schizophrenia, consisting in an underlying dysfunction of regions involved in the regulation of involuntary attention such as the parietal cortex and striatolimbic structures of the right hemisphere. Recent literature supports the assumption of right hemispheric dysfunction in schizophrenia.

Disordered recognition and perception of human faces in acute schizophrenia and experimental psychosis.

Three disorders of facial recognition and perception in acute schizophrenia and mescaline-induced psychosis are described and illustrated using original clinical and experimental material: "affective prosopagnosia" or stress-related dysfunctional face recognition; "physiognomization" of the environment or persistent illusions and hallucinations of nonspecific faces; and the "mirror phenomenon" or the experience of inner alienation from one's reflected face, which is perceived as independently alive, sinister, and generally physically distorted. It is proposed that neuropsychology suggests relationships between these phenomena that might otherwise be less apparent. No final neurobiological solution to the problem of dysfunctional facial perception and recognition in psychosis is presented, but various insights and suggestive models from the neurosciences are discussed. Attention is also paid to the conditions under which one might need to combine neuropsychological approaches with hermeneutically oriented analyses.

"Whole brain" politics and brain laterality research.

The paper discusses a recent international conference in Munich (FRG) on brain-laterality research. An open letter on the goals of the conference is considered. In this letter, the "automatic" moral and intellectual decay of "left brain" modern society was predicted, and a clarion call for the reinsertion of "whole brain" values into our over-mechanized culture was sounded. Discussion of the conference itself focuses on the political and social risks involved in selling irrationalist ideologies - even well-meaning ones - in the name of science. The paper calls for a more responsible attitude among modern brain-laterality researchers who would participate in scientific conferences that blur the distinction between description and social prescription.

New mutation to Huntington's disease.

We report a large family with an isolated case of Huntington's disease (HD), which is probably the result of a new mutation. The patient developed clinical signs typical of HD at the age of 36. The clinical course of the patient's disease is documented by several clinical admissions over a period of 14 years at present. The family history is strikingly negative with the parents having been clearly unaffected into their 80s and with 13 older and two younger, living, healthy sibs. Extensive testing of polymorphic markers (blood groups, red cell and serum proteins, HLA antigens) showed no indication of non-paternity, but rather gave strong support to the hypothesis that the proband is a full sib. In addition, DNA typing for several RFLPs known to be closely linked to the HD gene locus indicated that several clearly unaffected sibs share one or the other or both of the patient's haplotypes. This is further evidence in favour of the hypothesis of a new mutation at the HD locus. The posterior probability of a new mutation to HD in the patient exceeds 99%, even if an a priori probability of non-paternity of 10% and a mutation rate of HD of 10(-7) is assumed.