Neurocognitive deficits in adolescents with schizophrenia: longitudinal stability and predictive utility for short-term functional outcome.

OBJECTIVE: Previous cross-sectional studies in adolescents with early-onset schizophrenia (EOS; onset of psychotic symptoms by 18 years of age) have reported patterns of generalized neurocognitive deficits as compared to healthy comparison subjects (HCSs). Here, the authors examined the longitudinal stability of neuropsychological deficits in adolescents with EOS relative to HCS and the associations of these deficits with short-term functional outcome in patients. METHOD: Fifty-two subjects (26 EOS, 26 HCS) were evaluated using a comprehensive neuropsychological test battery a median of 13 months after baseline examination. The stability of scores and the relationship between baseline test performance and functional outcome in patients was explored. RESULTS: Adolescents with EOS were impaired across neurocognitive domains at baseline and follow-up compared to HCSs; these deficits remained relatively stable over time. Follow-up social/communication, personal living, and community living skills were significantly related to attention/vigilance, working memory and verbal memory at baseline; individual cognitive domains were more strongly related to functional outcome than a global measure of intelligence. CONCLUSIONS: Neuropsychological impairment in patients with EOS appears to remain relatively stable over time regardless of changes in clinical state. In addition, this report offers preliminary support for a longitudinal relationship between neurocognitive performance in specific domains and functional outcome.

Holotropic Breathwork: the potential role of a prolonged, voluntary hyperventilation procedure as an adjunct to psychotherapy.

OBJECTIVES: To pose the question of whether Holotropic Breathwork (HB), a prolonged, voluntary hyperventilation procedure, might be useful in treatment of common psychiatric conditions such as anxiety and depressive disorders. DESIGN: This is a hypothesis-posing paper pertaining to a potential novel treatment. SUMMARY: The neurophysiology and psychology of hyperventilation are reviewed, including findings demonstrating that hyperventilation leads to significant changes in central nervous system activity as measured by various technological means. Preliminary evidence suggesting efficacy for HB is reviewed. A tentative biopsychologic hypothesis is offered, suggesting a potential mechanism that may underlie putative therapeutic effects of HB. Specifically, when HB is used in the context of ongoing psychotherapy, hyperventilation may facilitate generalized extinction of avoidance behaviors, resulting in therapeutic progress. Individuals high in trait absorption and social desirability who have failed to respond adequately to psychotherapy might be those most likely to respond to HB. Recommendations for future research directions examining the therapeutic potential of HB are offered. CONCLUSIONS: Further research using more sophisticated methodologies than have been used to date will be necessary in order to confirm or refute the hypothesis that HB may be useful in treatment of psychiatric disorders.

Early-onset schizophrenia is associated with impaired adolescent development of attentional capacity using the identical pairs continuous performance test.

The authors examined performance on the Continuous Performance Test-Identical Pairs "numbers" task in adolescents with schizophrenia (n=59) and healthy controls (n=55). Adjusting for an estimate of premorbid intelligence and socioeconomic status, patients performed worse than normal controls on all three d' conditions (2-digit, 3-digit, 4-digit). However, there was a significant group-by-age-by-condition interaction (F[4,100]=4.69, p<.01) indicating an interaction between development and disease state. At the simplest level of the task (2-digit) the difference between patients with schizophrenia and controls was evident at all ages; while for the more difficult levels of the task (3-digit, 4-digit), differences between groups gradually increased across the tested age span (10 to 20 years of age). Premorbid social isolation was associated with worse attentional performance in patients, suggesting a relationship and continuity with negative symptoms. These data suggest that attentional differences in adolescents with schizophrenia are better captured by different tasks at different ages. The discrepant findings of attentional impairments reported in the literature for adolescents with schizophrenia could reflect the underlying etiological complexity of the disorder that may have a variable impact on involved brain regions and neurocognitive functioning.

Neurocognitive profile in adolescents with early-onset schizophrenia: clinical correlates.

BACKGROUND: Neurocognitive impairments have been documented in adolescents with early-onset schizophrenia (EOS; onset by age 18) and are important treatment targets. Information concerning the severity, pattern, and clinical correlates of these deficits in EOS remains limited. METHODS: Tests assessing motor skills, attention, memory, visuospatial abilities and executive functioning were administered to 54 clinically stabilized adolescents with EOS and 52 age- and sex-matched healthy controls. Childhood-onset patients (onset by age 13) were compared to those with an adolescent onset of illness. Patients' neurocognitive profiles were compared to those of controls. Relationships between neurocognitive deficits and demographic and clinical characteristics were explored. RESULTS: Neurocognitive profiles did not differ between childhood- and adolescent-onset participants. Patients showed a generalized neurocognitive deficit of 2.0 SDs compared to controls, with relative deficit in executive functioning and relative sparing of language and visuospatial abilities. Degree of generalized neurocognitive impairment was associated with premorbid adjustment and negative symptom severity (Adjusted R(2) = .39). CONCLUSIONS: Results document both a significant generalized deficit and a relative deficit of executive functioning in adolescents with EOS. The overall pattern is similar to that observed in severely ill first-episode adult patients. The impairments across multiple neurocognitive domains suggest widespread brain dysfunction in EOS.

Attention-deficit/hyperactivity disorder: a preliminary diffusion tensor imaging study.

BACKGROUND: The purpose of this study was to explore whether there are white matter (WM) abnormalities in children with attention-deficit/hyperactivity disorder (ADHD) using diffusion tensor imaging. Based upon the literature, we predicted decreased fractional anisotropy (FA) findings in the frontal and cerebellar regions. METHODS: Eighteen patients with ADHD and 15 age- and gender-matched healthy volunteers received DTI assessments. Fractional anisotropy maps of WM were compared between groups with a voxelwise analysis after intersubject registration to Talairach space. RESULTS: Children with ADHD had decreased FA in areas that have been implicated in the pathophysiology of ADHD: right premotor, right striatal, right cerebral peduncle, left middle cerebellar peduncle, left cerebellum, and left parieto-occipital areas. CONCLUSIONS: These preliminary data support the hypothesis that alterations in brain WM integrity in frontal and cerebellar regions occur in ADHD. The pattern of decreased FA might implicate the corticopontocerebellar circuit in the pathophysiology of ADHD.

White matter abnormalities in early-onset schizophrenia: a voxel-based diffusion tensor imaging study.

OBJECTIVE: To investigate abnormalities in the structural integrity of brain white matter as suggested by diffusion tensor imaging in adolescents with early-onset schizophrenia (onset of psychosis by age 18). METHOD: Twenty-six patients with schizophrenia and 34 age- and gender-matched healthy volunteers received diffusion tensor imaging and structural magnetic resonance imaging examinations. Fractional anisotropy maps were compared between groups in the white matter using a voxelwise analysis after intersubject registration to Talairach space. RESULTS: Compared with healthy volunteers, patients demonstrated lower fractional anisotropy values in the left anterior cingulate region in close proximity to the caudate nucleus (95% confidence interval of schizophrenic-healthy: -66 to -20). Using regression analysis, the rate of change in fractional anisotropy differed significantly between groups in this region across the age span examined (10-20 years), after adjusting for group differences in premorbid intellectual capacity and parental socioeconomic status. There were no areas of significantly higher fractional anisotropy in patients compared with healthy volunteers. CONCLUSIONS: These data suggest that early-onset schizophrenia is associated with a disruption in the structural integrity of white matter tracts in the anterior cingulate region. These structural abnormalities may contribute to the deficits in motivation, attention, memory, and higher executive functions in adolescents with schizophrenia.

Affective reactivity of language and right-ear advantage in schizophrenia.

A subset of schizophrenic patients has demonstrated increased language dysfunction in affectively stressful, compared to non-stressful conditions. Affective reactivity of right-ear advantage has been demonstrated in studies of dichotic listening in schizophrenia. The present study assessed whether participants who showed affective reactivity of speech were also those who showed affective reactivity of right-ear advantage. Data from 18 schizophrenic outpatients were analyzed. Affective reactivity of language was associated with affective reactivity of right-ear advantage. Findings should be regarded as preliminary due to the small sample size; however, they may potentially contribute to construct the validity of affective reactivity as a process discriminator in schizophrenia.