Magnetic resonance imaging abnormalities in lenticular nuclei and cerebral cortex in schizophrenia.

Neuropathologic and brain imaging studies have produced evidence of brain abnormalities in schizophrenic patients, often within the cerebrum's limbic lobe, and, less frequently, within basal ganglia. In the present study we used magnetic resonance imaging morphometric techniques to estimate volumes of specific cerebral structures in schizophrenic patients and age- and sex-matched normal controls. Estimates of the volume of mesial temporal lobe structures were reduced and estimates of the volume of the lenticular nucleus were increased in the schizophrenic patients. There was also evidence of reduced cranial volume in some schizophrenics. The magnitude of the lenticular abnormality, but not the temporal lobe abnormality, was associated with age at first psychiatric contact; earlier onset was associated with larger lenticular nuclei. The possible relevance of these results to neurodevelopmental hypotheses about the pathogenesis of schizophrenia is discussed.

The generalized pattern of neuropsychological deficits in outpatients with chronic schizophrenia with heterogeneous Wisconsin Card Sorting Test results.

Forty schizophrenic outpatients and 40 normal subjects were assessed using extensive clinical (eg, Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms and Scale for the Assessment of Positive Symptoms) and neuropsychological (extended Halstead-Reitan Battery) measures. The schizophrenic patients had multiple neuropsychological deficits on tests of complex conceptual reasoning, psychomotor speed, new learning and incidental memory, and both motor and sensory-perceptual abilities. Neuropsychological impairment correlated more strongly with negative than positive symptoms. Overall, the schizophrenic outpatients showed relatively modest increases in the number of perseverative responses on the Wisconsin Card Sorting Test of abstraction flexibility. A subgroup of these schizophrenic patients seemed to be particularly impaired on the Wisconsin Card Sorting Test. This pattern of results, in conjunction with previous studies, supports the idea that, while some schizophrenic patients may have fixed, frontally based dysfunctions, these dysfunctions may be most prominent, and even fixed, in deteriorated, kraepelinian patients. These data provide evidence for diffuse and far-reaching deficits in a majority of outpatients with chronic schizophrenia.

Past substance abuse and clinical course of schizophrenia.

To evaluate the effects of previous alcohol and drug use on the course and symptoms of schizophrenia, the authors compared 34 patients with schizophrenia who had histories of substance abuse with 17 patients with schizophrenia who were lifelong abstainers. Surprisingly, they did not find that individuals with past histories of abuse were more impaired or had more symptoms.

Antipsychotics.

The multiple medical problems in the geriatric population complicate the issues of diagnosis and management of behavioral symptoms. Systematic evaluation of the etiology, course, and prognosis of behavioral and psychotic symptoms associated with dementia may clarify the indications for treatment. Further research is needed to evaluate effective adjuncts and alternatives to neuroleptic treatment in the demented elderly and to minimize medication side effects.

[Anomalies of the T wave following treatment of complete chronic left branch block by massage of the carotid sinus or injection of adenosine triphosphate]. / Anomalies de l'onde T après effacement d'un bloc complet de la branche gauche d'allure chronique par massage du sinus carotidien ou injection d'adénosine triphosphorique.

We studied the T wave during normal conduction in 25 patients aged 42 to 81 years (average 62 +/- 5) during sinus rhythm and complete left bundle branch block which regressed transiently after carotid sinus massage (22 cases) or injection of adenosine triphosphate (5 cases). Six patients had angina pectoris; coronary arteriography in 3 of the other 19 patients was normal. The reversion to normal intraventricular conduction was obtained with a lengthening of the ventricular cycle in all patients. The T wave axis with narrow QRS complexes was between + 70 degrees and -140 degrees (normal T axis in 11/25 patients); in the horizontal plane, the T wave was negative in V2 in 4 patients, in V2-V4 in 12 patients, in V2-V6 in 7 patients and in V4 in 1 patient. The amplitude of inversion in V2 varied from 0.1 to 1.5 mV; there was no significant difference between the patients with angina (0.50 +/- 0.31) and the remainder (0.43 +/- 0.16). In normal conduction, the T wave changes were more common in the horizontal plane (24/25 patients: 96%) than in the frontal plane (14/25 patients, 56%). The high incidence of abnormalities of ventricular repolarisation after regression of complete left bundle branch block does not appear to be related to coronary artery disease. Another explanation is proposed because of the analogy with the changes observed after terminating right ventricular pacing and after regression of a Wolff-Parkinson-White syndrome. An abnormality of initial ventricular depolarisation--common to left bundle branch block, the Wolff syndrome and right ventricular pacing--could be responsible for these T wave changes during normal conduction.(ABSTRACT TRUNCATED AT 250 WORDS)

Negative symptomatology in schizophrenic outpatients.

This study examines the prevalence of negative symptoms, and assesses the convergence of negative and depressive symptoms in 60 chronically ill schizophrenic outpatients. Negative symptoms were assessed with the Scale for the Assessment of Negative Symptoms and the negative symptom cluster of the Brief Psychiatric Rating Scale (BPRS). Depressive symptoms were assessed with the depression subscale of the Brief Symptom Inventory and the depressive symptom cluster of the BPRS. A majority of patients in this group of relatively stable, schizophrenic outpatients demonstrated mild to moderate degrees of both negative and depressive symptoms. Correlations were not significant between negative symptom and depressive symptom measures, which suggests that the symptom constructs are relatively independent. Comparisons between a subgroup with prominent negative symptoms (N = 18) and a subgroup with minimal negative symptoms (N = 32) also revealed no significant group differences in variables that characterize clinical course (i.e., age of onset and frequency and duration of hospitalization) or in the severity of depressive symptoms. This lack of any significant differences on the clinical course variables may be partially explained by the heterogeneity of negative symptoms. The constellation of negative symptoms may differ not only in etiology but also in their temporal relationships to other aspects of the patient's clinical course. Longitudinal studies will be needed to track the long-term outcome of negative and depressive symptoms.