Emotion recognition deficits among persons with schizophrenia: Beyond stimulus complexity level and presentation modality.

Studies have shown that persons with schizophrenia have lower accuracy in emotion recognition compared to persons without schizophrenia. However, the impact of the complexity level of the stimuli or the modality of presentation has not been extensively addressed. Forty three persons with a diagnosis of schizophrenia and 43 healthy controls, matched for age and gender, were administered tests assessing emotion recognition from stimuli with low and high levels of complexity presented via visual, auditory and semantic channels. For both groups, recognition rates were higher for high-complexity stimuli compared to low-complexity stimuli. Additionally, both groups obtained higher recognition rates for visual and semantic stimuli than for auditory stimuli, but persons with schizophrenia obtained lower accuracy than persons in the control group for all presentation modalities. Persons diagnosed with schizophrenia did not present a level of complexity specific deficit or modality-specific deficit compared to healthy controls. Results suggest that emotion recognition deficits in schizophrenia are beyond level of complexity of stimuli and modality, and present a global difficulty in cognitive functioning.

Evaluating new types of tourniquets by the Israeli Naval special warfare unit.

BACKGROUND: Extremity injuries, which accounts for 20% of all battlefield injuries, result in 7-9% of deaths during military activity. Silicone tourniquets were used, by the Israeli Defense Force (IDF) soldiers, for upper extremity and calf injuries, while thigh injuries were treated by an improvised "Russian" tourniquet (IRT). This is the first study, performed in the IDF, comparing the IRT with Combat Application Tourniquets (CAT) and Special Operations Force Tactical Tourniquets (SOFTT). 23 operators from the Israeli Naval Unit (Shayetet 13) were divided into two groups according to their medical training (11 operators trained as first-responders; 12 operators as medics). Repetitive applications of the three tourniquets over the thigh and upper arm, and self-application of the CAT and SOFTT over the dominant extremity were performed using dry and wet tourniquets (828 individual placements) with efficacy recorded. Cessation of distal arterial flow (palpation; Doppler ultrasound) confirmed success, while failure was considered in the advent of arterial flow or tourniquet instability. Satisfaction questionnaires were filled by the operators. RESULTS: CAT and SOFTT were found to be superior to the IRT, in occluding arterial blood flow to the extremities (22%, 23% and 38%, respectively, failure rate). The application was quicker for the CAT and SOFTT as compared to the IRT (18, 26, 52 seconds, respectively). Wet tourniquets neither prolonged application nor did they increase failure rates. Similarly, medics didn't have any advantage over non-medic operators. No findings indicated superiority of CAT and SOFTT over one another, despite operators' preference of CAT. CONCLUSIONS: CAT and SOFTT offer an effective alternative to the IRT in stopping blood flow to extremities. No difference was observed between medics and non-medic operators. Thus, the CAT was elected as the preferred tourniquet by our unit and it is being used by all the operators.

The role of the precuneus in metaphor comprehension: evidence from an fMRI study in people with schizophrenia and healthy participants.

Comprehension of conventional and novel metaphors involves traditional language-related cortical regions as well as non-language related regions. While semantic processing is crucial for understanding metaphors, it is not sufficient. Recently the precuneus has been identified as a region that mediates complex and highly integrated tasks, including retrieval of episodic memory and mental imagery. Although the understanding of non-literal language is relatively easy for healthy individuals, people with schizophrenia exhibit deficits in this domain. The present study aims to examine whether people with schizophrenia differentially recruit the precuneus, extending to the superior parietal (SP) cortex (SPL), to support their deficit in metaphor comprehension. We also examine interregional associations between the precuneus/SPL and language-related brain regions. Twelve people with schizophrenia and twelve healthy controls were scanned while silently reading literal word pairs, conventional metaphors, and novel metaphors. People with schizophrenia showed reduced comprehension of both conventional and novel metaphors. Analysis of functional connectivity found that the correlations between activation in the left precuneus/SPL and activation in the left posterior superior temporal sulcus (PSTS) were significant for both literal word pairs and novel metaphors, and significant correlations were found between activation in the right precuneus/SPL and activation in the right PSTS for the three types of semantic relations. These results were found in the schizophrenia group alone. Furthermore, relative to controls, people with schizophrenia demonstrated increased activation in the right precuneus/SPL. Our results may suggest that individuals with schizophrenia use mental imagery to support comprehension of both literal and metaphoric language. In particular, our findings indicate over-integration of language and non-language brain regions during more effortful processes of novel metaphor comprehension.

[Advanced imaging methods as a basis for more reliable classification and better treatment for patients with depressive symptoms--an example for conceptual change in the psychiatric diagnostic method].

The current editorial study focuses on the idea of using advanced imaging methods in order to better classify and treat patients with depression and other psychiatric illnesses. The editorial is based on the review of Heymann and Bonne, published in this issue of the journal, showing differences between bi-polar and uni-polar depression using functional neuroimaging methods. This example, although not applicable yet in clinical practice, is the basis for future advances in psychiatric classification, together with clinical subtyping, and more biological markers, including genetic profiling.

Speed-accuracy tradeoff in decision-making performance among pathological gamblers.

BACKGROUND: Pathological gambling is classified as an impulse control disorder in the DSM-IV-TR; however, few studies have investigated the relationship between gambling behavior and impulsive decision-making in time-non-limited situations. METHODS: The subjects performed the Matching Familiar Figures Test (MFFT). The MFFT investigated the reflection-impulsivity dimension in pathological gamblers (n = 82) and demographically matched healthy subjects (n = 82). RESULTS: Our study demonstrated that pathological gamblers had a significantly higher rate of errors than healthy controls (p = 0.01) but were not different in terms of response time (p = 0.49). We found a similar power of correlation between the number of errors and response time in both pathological gamblers and controls. We may conclude that impaired performance of our pathological gamblers as compared to controls in a situation without time limit pressure cannot be explained by a trade-off of greater speed at the cost of less accuracy. CONCLUSIONS: The results of our study showed that pathological gamblers tend to make more errors but do not exhibit quicker responses as compared to the control group. Diminished MFFT performance in pathological gamblers as compared to controls supports findings of previous studies which show that pathological gamblers have impaired decision-making. Further controlled studies with a larger sample size which examine MFFT performance in pathological gamblers are necessary to confirm our results.

Patterns and prognostic value of troponin, interleukin-6, and leptin after pediatric open-heart surgery.

PURPOSE: Leptin and interleukin-6 (IL-6) are inversely correlated and associated with decreased survival in critically ill patients. We investigated changes in leptin, IL-6, and troponin in children undergoing open-heart surgery, hypothesizing that IL-6 and troponin will increase after cardiopulmonary bypass (CPB) and will be negatively correlated with leptin. PATIENTS AND METHODS: Serial blood samples were collected from 21 patients 24 hours before and up to 48 hours after surgery. RESULTS: Leptin levels decreased by 50% during CPB (P < .001), then gradually increased, reaching baseline levels 12 hours after surgery. The IL-6 levels increased (P < .001) during CPB, peaking 2 hours after surgery and remaining slightly elevated at 24 hours after surgery (P < .001). Leptin and IL-6 were negatively correlated (R = -0.448, P < .001). Troponin levels increased during CPB (P < .001). Postoperative leptin and troponin were inversely correlated (r = -0.535, P < .001). Patients with modest elevations in troponin levels (<20 microg/L) had a shorter aortic clamp and CPB time (P < .01), lower IL-6 peak levels (P = .03), and shorter duration of ventilation and inotropic support compared with patients with peak troponin levels greater than 20 microg/L. CONCLUSIONS: Lower leptin and higher IL-6 levels correlated with troponin, a marker of myocardial injury. Because leptin may have cardioprotective effects, the postoperative drop in its levels may further contribute to myocardial dysfunction.

Neuropsychological mechanisms of Digit Symbol Substitution Test impairment in Asperger Disorder.

Our aim was to investigate the neurocognitive mechanisms recruited by adolescents with Asperger Disorder (AD), in comparison to controls, and to detect the underlying mechanisms during the complex information processing required for the performance of the Digit Symbol Substitution Test (DSST). Male adolescents (n=23; mean age 15.1+/-3.6 years) with a DSM-IV diagnosis of AD were compared with a normal male control group with similar demographic characteristics (n=43; mean age: 15.1+/-3.6 years). A computerized neurocognitive battery was administered and included: Inspection Time (IT), Finger Tapping Test (FTT), Simple Reaction Time (SRT), Choice Reaction Time (CRT), Digit Running task (DRT), Stroop test and Digit Symbol Substitution Test (DSST). Adolescents with AD performed significantly worse than controls on the DSST. This impaired DSST performance was related to cognitive mechanisms different from those employed by normal controls. Motor slowness and inability to deal with increased amounts of information affected the performance of the AD group, while shifting of attention was the limiting factor in the controls. Both groups were similarly dependent on response selection. This study demonstrated differences in performance in complex cognitive tasks between adolescents with AD and normal controls that may be related to differences in neurocognitive mechanisms underlying information processing. Future neuroimaging studies are needed to clarify the neural network involved in the differences in cognitive performance between AD subjects and normal controls.

Refractive errors and schizophrenia.

BACKGROUND: Refractive errors (myopia, hyperopia and amblyopia), like schizophrenia, have a strong genetic cause, and dopamine has been proposed as a potential mediator in their pathophysiology. The present study explored the association between refractive errors in adolescence and schizophrenia, and the potential familiality of this association. METHODS: The Israeli Draft Board carries a mandatory standardized visual accuracy assessment. 678,674 males consecutively assessed by the Draft Board and found to be psychiatrically healthy at age 17 were followed for psychiatric hospitalization with schizophrenia using the Israeli National Psychiatric Hospitalization Case Registry. Sib-ships were also identified within the cohort. RESULTS: There was a negative association between refractive errors and later hospitalization for schizophrenia. Future male schizophrenia patients were two times less likely to have refractive errors compared with never-hospitalized individuals, controlling for intelligence, years of education and socioeconomic status [adjusted Hazard Ratio=.55; 95% confidence interval .35-.85]. The non-schizophrenic male siblings of schizophrenia patients also had lower prevalence of refractive errors compared to never-hospitalized individuals. CONCLUSIONS: Presence of refractive errors in adolescence is related to lower risk for schizophrenia. The familiality of this association suggests that refractive errors may be associated with the genetic liability to schizophrenia.

Psychiatric disorders related to menstrual bleeding among an ultra-orthodox population: case series and literature review.

The relationship between menstrual cycle and obsessive-compulsive disorder (OCD) has been documented in the past and is related to sexual hormone changes. In the ultra-orthodox Jewish population menstrual bleeding is associated both with meticulous rituals of cleanliness and with stressful meanings related to sin, impurity and punishment. Those aspects of the menstrual cycle can be related to specific OCD symptoms among ultra-orthodox women. The current study presents three cases related to the development of obsessive-compulsive symptoms in relation to the menstrual cycle among ultra-orthodox women, and discusses the biological and social-cultural basis of the disorder.

Fibromyalgia among major depression disorder females compared to males.

The Fibromyalgia syndrome (FMS) is characterized by widespread pain and diffuse tenderness in specified locations. The literature clearly points out that FMS is more prevalent in females rather than males, and among patients with major depression disorder (MDD). The aim of the current study was to obtain a better conception of the linkage existing between depression, gender and FMS. Forty-two male patients and 42 age-matched females, as well as age-matched male and female healthy controls were evaluated for coexisting FMS using the American College of Rheumatology (ACR) classification criteria. Each patient completed a questionnaire characterizing the quality of their sleep, a Sheehan disability scale (SDS) and SF-36 scale to measure the quality of life. The degree of depression of each patient was scored using Hamilton depression rating scales (HDRS) and Global assessment was done using the Clinical Global Impression-Severity (CGI-S). Disease parameters were worse for men as compared to women; CGI-S: 5.4 +/- 1 (mean +/- standard deviation), versus 4.0 +/- 1 (t = 6.634, P < 0.001), HDRS: 23.9 +/- 6 versus 20.8 +/- 6 (t = 2.304, P = 0.024), respectively. Yet, FMS was more prevalent among depressed females; 26% versus 2%, (chi2(3) = 9.722, P = 0.002) and so were the average number of tender points (TP) (6.1 +/- 5 versus 2.2 +/- 3, t = 4.399, P < 0.001). The SF-36, SDS and sleep quality scores were similar between males and females. A one-way analysis of variance with gender and disease (depressed vs. non-depressed) revealed that both gender and disease were found to be significant contributing factors for the number of TP (F = 21.131, P < 0.0001; F = 65.232, P < 0.0001, respectively). A one-way analysis of covariance for TP with CGI-S and HDRS as covariates revealed that gender was a significant factor regardless of depression severity (F = 30.028, P < 0.001). CGI-S and Hamilton scores correlated with TP count in females (r = 0.396, P = 0.009, r = 0.531, P < 0.001) but not in males. Female gender is a risk factor for FMS in depressed population. Depression is associated with FMS among women but not among men. Among females, depression severity is significantly correlated to FMS severity. FMS is correlated to sleep quality and to quality of life among depressed patients.

Relationship between childhood sexual abuse and obsessive-compulsive disorder: case control study.

BACKGROUND: The psychiatric sequelae of childhood sexual abuse (CSA) is associated with a variety of psychiatric disorders, such as eating disorders, depression, posttraumatic-stress disorder and borderline personality disorder. This study examined the association of CSA and obsessive-compulsive disorder (OCD) in adults. METHODS: Frequency of CSA was examined among 30 OCD patients and in two control groups: 17 patients with panic disorder (PD) and 26 non-psychiatric rheumatic patients (NPRP). Study tool was a semi-structured interview. RESULTS: A significantly higher frequency of CSA involving physical contact was found among the OCD (53.3%) and PD patients (52.9%) as compared to NPRP (23.1%). No significant differences were found in the frequencies of non-contact CSA. LIMITATIONS: Differences could partially be attributed to the tendency of psychiatric patients to provide personal information, especially when motivated to pinpoint an external factor for their illness. CONCLUSIONS: A positive association was found between contact-CSA and OCD as well as PD.While it is not definitely clear whether CSA is a unique entity or has influence similar to any other stressful life event, the findings of this study support further investigation of the role of contact CSA in OCD and PD, as well as in other psychiatric disorders.

Elevated serum homocysteine levels in male patients with PTSD.

It has been suggested that an elevated serum or plasma homocysteine level may be a risk factor for neuropsychiatric conditions such as Alzheimer's disease, schizophrenia, and depression. Because depression is closely related to anxiety disorders, and because it has been suggested that stress may be associated with an elevated homocysteine level, we studied whether serum homocysteine levels are elevated in patients with posttraumatic stress disorder (PTSD). Total serum homocysteine levels in 28 male patients with PTSD were compared to those of 223 healthy controls. The effect of PTSD on the serum homocysteine level was significant (F=42.96, P<.0001). In a regression model for the PTSD patients, the duration of PTSD was found to predict serum homocysteine levels (t=2.228, P=.035). Our results suggest that elevated levels of homocysteine in male patients with PTSD may be related to pathophysiological aspects associated with the chronicity of this disorder.

Changes in blood lipid levels following silastic ring vertical gastroplasty.

BACKGROUND: The purpose of this study was to evaluate the effect of the Silastic Ring Vertical Gastroplasty (SRVG) operation on blood lipid levels in obese men and women during the first year following surgery. METHODS: 25 patients (11 men and 14 women) age 17-50 (mean 33 years) who suffered from morbid obesity (BMI >40, range 45.9+/-4.7 kg/m2) underwent SRVG. Blood samples were collected before operation and 3, 6 and 12 months following surgery and tested for: triglycerides, total cholesterol, HDL-C, LDL-C, VLDL-C, and Lp(a). RESULTS: Both men and women lost weight significantly. Mean BMI decreased from 48.0 to 32.5 kg/m2 in men and from 44.3 to 29.0 kg/m2 in women (P<0.01). Blood lipid levels 1 year following surgery demonstrated the following changes: In women, triglycerides, total cholesterol, LDL, VLDL cholesterol and Lp(a) decreased from 160.7 mg/dL to 67.7 mg/dL (P<0.01), from 220 mg/dL to 189 mg/dL, from 138.3 mg/dL to 111 mg/dL, from 17 mg/dL to 12 mg/dL, and from 77.5 mg/dL to 18.5 mg/dL (P<0.01), respectively, and HDL increased from 45 mg/dL to 50.5 mg/dL. In men, triglycerides, total cholesterol, LDL, VLDL cholesterol and Lp(a) decreased from 246 mg/dL to 140 mg/dL (P<0.01), from 206 mg/dL to 170 mg/dL (P<0.01), from 134 mg/dL to 112 mg/dL (P<0.05), from 25 mg/dL to 15 mg/dL (P<0.01), and from 30.3 mg/dL to 11.6 mg/dL (P<0.01), respectively, and HDL increased from 31.3 mg/dL to 37.4 mg/dL (P<0.05). CONCLUSION: SRVG improved blood lipid profile in obese patients during the first year following surgery. Reduction in cholesterol and its fractions reaches statistical significance only in men.

The etiology of some menstrual disorders: a gynecological and psychiatric issue.

Some menstrual disorders with distinct gynecological character such as amenorrhea or menometrorrhagia (MMR) may have psychogenic etiology. On the other hand, in menstrual psychosis (MP), a distinctly psychiatric disorder, the etiology is not necessarily psychogenic, but rather is hormonal-biological. We present 4 cases, one each of primary and secondary amenorrhea, MMR, and MP, respectively. In the first 3 cases (2 amenorrhea and 1 MMR), we found psychogenic factors: an insult to feminine development after rape (case 1) or marriage problems (cases 2 and 3). In the case of a recurrent MP, no relevant psychological etiology was found. Furthermore, some of the patient's relatives had menstrual or peripartum psychiatric disorders. Menstrual disorders' etiology can be psychogenic or hormonal. The correct etiology is the guide for the adequate therapeutic way: psychotherapy based in psychogenic disorders and neuroleptic or antiovulatory drugs in those of biological etiology.

[Suicide: clinical and systematic aspects of the self-responsibility dimension].

Suicide is a tragic, extreme, and unusual act which evokes powerful emotions. Doctors, psychologists, social workers, lawyers and Renaissance men are trying to research factors leading to suicide. They believe that finding the critical factors may reduce the incidence of suicide. The causative factors leading to suicide are complicated and diverse. A society's moral stance on the issue of suicide influences an individual's inclination to implement the act itself. There is a wide variety of viewpoints between different societies. Societies, with a supportive view, that treat suicide as a noble act, have a high incidence of suicide. Those with a condemning view, that may even deem suicide as a criminal act, have a lower suicide rate. Society's view of suicide is linked to the question of responsibility for the act itself. The responsibility is composed of moral, public and legal obligations. The question is: should most of the responsibility be the deceased's or society's medical and paramedical personnel, who might be held responsible for not recognizing the warning signs and not preventing the act itself. We wish to contend that a professional, cultural, public and legal approach that preserves an individual's responsibility for one's own decisions - even one of self-destruction - will prevent a moral judgment and criticism of the deceased. The aforementioned may decrease the incidence of suicide seen with a neutral approach that foregoes the deceased's individual responsibility. The second section of the article deals with the legal aspects of the act of suicide as expressed in the legislation for the treatment of the mentally ill. The assumption is that the law reflects the viewpoint of a society, thereby influencing the tendencies and processes within. Therefore, a change or amendment to the law may influence the attitude towards it, and the prevalence of the phenomenon in the long run.

Premorbid behavioral and intellectual functioning in schizophrenia patients with poor response to treatment with antipsychotic drugs.

INTRODUCTION: Approximately one third of schizophrenia patients show partial or no response to pharmacotherapy. Despite intensive investigations, the phenomenological and biological characteristics of such patients are far from elucidated. This study examined the premorbid behavioral and intellectual functioning of schizophrenia patients who showed poor response to antipsychotic treatment. METHOD: One hundred twenty-nine schizophrenia patients who showed poor response to treatment were ascertained from a national register and matched by gender, age and education to 129 patients who showed adequate response. The groups were compared on premorbid measures of behavioral and intellectual functions. RESULTS: As a group, treatment-resistant male patients had significantly lower (worse) social functioning [p=0.002], and individual autonomy [p<0.0001] scores before the onset of the illness compared to treatment non-resistant patients. Male and female treatment-resistant patients did not differ from non-resistant patients in premorbid intellectual functioning [p>0.1]. CONCLUSIONS: Low premorbid social functioning and individual autonomy, but not intellectual functioning, could serve as predictors of poor treatment response in schizophrenia.

Acute stress disorder and post-traumatic stress disorder among medical personnel in Judea and Samaria areas in the years 2000-2003.

OBJECTIVE: We aimed to evaluate the incidence of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) among medical staff members serving in Judea and Samaria during 2000-2003. METHODS: The study population included 141 medics and 19 medical doctors who provided emergency medical treatment during 23 violent events. Information regarding the incidence of ASD and PTSD was abstracted from Israel Defense Forces mental health files, as was a history of previous exposures to similar events, personal acquaintance with the victims, being under fire during the event, number of victims killed and/or wounded in the event, and length of time in service. RESULTS: One medic was affected by PTSD, whereas one medical doctor and 12 medics suffered from ASD. The number of people killed in the event was associated with ASD in medics (p = 0.0002). CONCLUSIONS: The prevalence of PTSD within the study population was very low, possibly because of post-trauma treatment and the training process for the medical staff members.

High-dose vitamin B6 decreases homocysteine serum levels in patients with schizophrenia and schizoaffective disorders: a preliminary study.

UNLABELLED: Vitamin B6 plays an essential role in the normal functioning of the central nervous system. Normal homocysteine (Hcy) serum level is maintained by remethylation of Hcy to methionine by enzymes that require folic acid and vitamin B12 and by catabolism to cysteine by a vitamin B6-dependent enzyme. These findings may be consistent with the hypothesis that the vitamin B6 status may influence plasma Hcy levels. The aims of this preliminary study were (1) to determine whether a correlation exists between Hcy and vitamin B6 levels in patients with schizophrenia and schizoaffective disorders and (2) to investigate whether treatment with high-dose vitamin B6 may reduce Hcy levels in these patients. METHODS: In this preliminary study, we enrolled 11 patients with schizophrenia or schizoaffective disorders (7 men and 4 women; mean age +/- SD, 50 +/- 12 years) receiving high doses of vitamin B6 treatment (1200 mg/d) for 12 weeks. Blood samples for the assessment of pyridoxal-5-phosphate and Hcy serum levels were obtained at baseline and after 12 weeks of treatment. RESULTS: Age was significantly positively correlated with Hcy levels at baseline (r = 0.392, P = 0.004). All other parameters, including diagnosis, disease duration, and pyridoxal-5-phosphate serum level, were not correlated with Hcy serum levels at baseline. After vitamin B6 treatment, Hcy serum levels significantly decreased (14.2 +/- 3.4 vs. 11.8 +/- 2.0 micromol/L, respectively, t = 2.679, P = 0.023); this decrease being statistically significant in men but not in women. CONCLUSIONS: High doses of vitamin B6 lead to a decrease in Hcy serum level in male patients with schizophrenia or schizoaffective disorder.

Plasma homocysteine levels in female patients with eating disorders.

OBJECTIVE: To examine plasma homocysteine, vitamin B(12), and folate levels in females with restricting and bingeing/purging eating disorders (EDs). METHOD: Adolescent and adult female patients were compared to appropriate control groups with regard to plasma homocysteine levels. RESULTS: The plasma homocysteine level of the adult ED patients was higher than that of controls for all age groups examined. In adolescents, no significant difference was found comparing ED patients younger than 16 years of age to control data, whereas in the 16-20 year age group, the plasma homocysteine level was significantly higher among the ED group, regardless of the type of ED. Vitamin B(12) and folate levels were within normal limits in all ED groups. CONCLUSION: Elevated plasma homocysteine levels were found in adult and older adolescent female ED patients (but not in younger adolescents) compared to controls. This finding is not related to deficiencies in vitamin B(12) or folate.

Dopamine D2-like receptors and the antidepressant response.

Converging lines of evidence suggest a role for the mesolimbic dopamine system in the response to somatic antidepressant therapies. Here, we review evidence suggesting that antidepressant treatments of different types share the effect of increasing the sensitivity of dopamine D2-like receptors in the nucleus accumbens, clinical studies suggesting that activation of these receptors has antidepressant efficacy, as well as relevant imaging and genetic data on the role of this system in the antidepressant response. We then attempt to reconcile this data with evidence of a common target of antidepressant drugs in the cyclic adenosine monophosphate (cAMP) response element binding protein-brain-derived neurotrophic factor (CREB-BDNF) pathway in a model that suggests potential directions for future inquiry.