Reduced insight in bipolar I disorder: neurofunctional and neurostructural correlates: a preliminary study.

BACKGROUND: To correlate measures of insight for own psychopathology to structural and functional brain imaging findings in 21 patients with DSM-IV bipolar I disorder. METHODS: Insight was assessed using the Scale to Assess Unawareness of Mental Disorder (SUMD). Resting single photon emission computed tomography (SPECT) and computed tomography (CT) was conducted in patients and 21 normal comparison subjects matched for age, gender and handedness. RESULTS: Reduced general insight and symptom awareness, but not symptom attribution, were significantly related to cortical and subcortical atrophy, respectively. No correlations between SPECT and insight measures were identified. LIMITATIONS: Limited sample size and the use of resting state SPECT. CONCLUSIONS: General and symptom awareness were related to measures of brain atrophy but not to neurofunctioning as measured by SPECT. Future research should consider the structure and function of specific cortical regions, including the frontal and parietal cortices.

Insight, symptoms and neurocognition in bipolar I patients.

BACKGROUND: Level of insight and its relationship to clinical variables and neurocognitive functions was assessed in bipolar I patients. METHODS: Verbal memory, executive functioning, sustained attention, general intelligence and other neurocognitive functions were compared between 37 chronic in- and outpatients and 31 matched normal controls. Detailed psychiatric interviews were completed to define the level of symptomatology and psychosocial functioning. Insight was assessed by the Scale to Assess Unawareness of Mental Disorder (SUMD). RESULTS: Seventy percent of the patients were classified as having impaired insight. Prevalence of impaired insight was 47% and 94% in remitted and symptomatic patients, respectively. Symptomatic patients scored significantly below remitted patients on insight and neurocognition. Illness and symptom unawareness were related to overall level of symptoms, measures of memory, conceptual ability and right hand psychomotor speed and accuracy. Misattribution of symptoms and signs was correlated to visuomotor speed and visuospatial performance in addition to affective symptoms and thought disturbance. CONCLUSIONS: Our findings support the hypothesis that impaired insight and other neurocognitive dysfunctions were present in a large percentage of cases among symptomatic as well as remitted bipolar patients. This may be of clinical relevance and raises important questions about the course and outcome of the illness.

Unawareness of illness in chronic schizophrenia and its relationship to structural brain measures and neuropsychological tests.

The present study seeks to elucidate the relationship between unawareness of illness in schizophrenia and frontal lobe dysfunction, in addition to investigating the relationship between lack of insight and sociodemographic and clinical variables. Twenty-one medicated schizophrenic patients, recruited from in- and out-patient wards at Ullevâl Hospital, underwent the Scale to Assess Unawareness of Mental Disorder (SUMD), neuropsychological testing, psychiatric symptom ratings and neuroimaging procedures (CT). Also, 21 matched normal controls were neuropsychologically tested. CT data were assessed blindly by two experienced neuroradiologists, according to the degree of ventricular enlargement and/or sulcal widening, and an assessment of localisation of atrophy was made. Unawareness of illness was correlated with neuropsychological measures related to executive functioning, but not with other neuropsychological measures. Five patients showed slight frontal atrophy, while two showed moderate frontal atrophy. The remaining 13 patients did not show signs of frontal lobe atrophy. Frontal lobe atrophy documented by structural brain measures was associated with poor insight in schizophrenia. Furthermore, Anergia (BPRS), GAF score and 'undifferentiated' sub-diagnosis correlated with SUMD scores. Unawareness of illness in schizophrenia may be related to frontal lobe deficit. Also, awareness of illness may not be related to general psychopathology, but rather to specific aspects.

Regional cerebral blood flow in schizophrenia: repeated studies during a psychotic episode.

Regional cerebral blood flow (rCBF) measurements and clinical ratings were performed on 17 schizophrenic patients and a subgroup of 10 medication-free patients before and after treatment. While clinically exacerbated patients had normal blood flow, patients in remission showed a redistribution of flow with lower values in frontal areas. Anteroposterior ratios correlated with the degree of behavioral disturbances, suggesting that the level of frontal lobe activity in schizophrenia may be a function of the patient's clinical state at the time of study.

Encephalopathy and polyneuropathy induced by organic solvents.

Twenty-six patients with previous heavy exposure to organic solvents were admitted to a neurological department during a 1 1/2 year period. They were studied with a battery of tests, including general medical and neurological examinations, neuropsychological tests, electroencephalography (EEG) and neurography with electromyography (EMG), and cerebral computerized tomography (CT). The presenting complaints were compatible with encephalopathy and/or polyneuropathy. When patients with alternative diagnosis were excluded, 17 patients (65%) of the initial group were diagnosed as belonging to the organic solvent syndrome. These patients had a mean time of solvent exposure of 23.9 years, ranging from one to 45 years. EEG and cerebral CT showed minor deviations only as did the neurological examination. These methods proved nevertheless of importance in excluding alternative etiologies. Neuropsychological test performances were markedly reduced, especially short-term memory. All patients were injured by occupational exposure to organic solvents, most often from painting and lacquering. Encephalopathy was a more frequent finding than polyneuropathy, and most often classified as slight or marked, whereas severe encephalopathy was not found in the present group.

Neurophysiological aspects of distractability in schizophrenics. A theoretical analysis.

The aim of the present study was to discuss distractability in schizophrenics in neurophysiological terms. A review of the literature strongly suggested that schizophrenics may be abnormally distractible; that is, show an increased tendency to react to irrelevant stimuli. The neuroanatomical structures most clearly implicated in signs of distractability by neurophysiological and behavioural evidence are the prefrontal (orbital) cortex, the nonspecific thalamo-cortical projection system, and inhibitory regions of the reticular formation. The disturbed functioning of these structures, it is suggested, could come about as a result of a lowered task-related activation, primarily of the prefrontal cortices. Apparently, dopaminergic activity could influence the regions involved, suggesting a dopaminergic component in distractability in schizophrenics. The regions in question may also be influenced by other biochemical systems, such as the serotonergic and noradrenergic systems.

Psychophysiological studies of a geographically defined population.

In the Berlevag project attemps have been made at using psycho-physiological and cognitive measures as indexes of psychiatric morbidity.--With skin conductance response, psychotics and neurotics showed signs of autonomic inhibition compared with conduct disorders and normal controls. All groups except psychotics showed cognitive effects in conditioning. No differences between the groups could be established for stereotype indexes, but the Berlevag sample appeared to have unusual high stereotypy indexes. With word associations the patient groups were markedly different from controls, with most deviations in psychotics and least deviations in conduct disorders.--A comparison of word associations in samples of the Oslo and the Berlevag populations suggested that the associative network was very similar in the two populations. There are differences with regard to verbal fluency, response types and reaction times.--It is unresolved whether these differences measure psychiatric morbidity or reflect a culture-dependent character of the word association test.

Changes of associative performance in hospitalized schizophrenics: a 16-year follow-up.

After a mean test-retest interval of 16.6 years a sample of 72 initially acute/subacute as well as chronic schizophrenic patients showed a significant normalisation of performance with respect to associative commonality, idiosyncratic responses, and response latency. The findings are attributed chiefly to effects of psychotropic drugs and improved psychiatric treatment.

Psychophysiological and neurophysiological aspects of schizophrenia.

Recent studies in psychophysiology and neurophysiology strongly indicate that there is an overstimulation of the brain schizophrenia. However, the relationship between overstimulation and schizophrenic symptoms is largely unknown. Neuropathological, anatomical and biochemical data support the conclusion that the schizophrenic syndrome represents a malfunctioning involving at least the neostriatal-thalamus system, perhaps due to an imbalance between dopamine and noradrenaline.

Prolonged clinical and experimental follow-up of hospitalized schizophrenics.

148 chronic schizophrenics admitted between 1938 and 1961 had previously been followed up. In 1972, they were re-examined, on the average 10 years after the first follow-up. 44 belonged to a series of patients studied between 1955 and 1957 with a battery of conditional reflex tests. The patients belonging to the experimental series were retested with word associations. From an experimental point of view the patients performed better over the prolonged observation period. The clinical state also showed improvement. A comparison of the chronic hospital population during 1955-57 and 1972-74 suggests that the new chronics present much less of the severe schizophrenic deterioration than the old ones. They also have remarkably better verbal functions these changes are assumed to be mainly due to drug treatment. The beneficial effects of drugs appear to come mainly within the first 2 years.

Associative changes in hospitalized schizophrenics during a 16-year period.

After a mean test-retest period of 16 years a sample of 39 initially chronic as well as acute/subacute schizophrenic patients showed a statistically significant normalization of associative performance. This finding was corroborated by a cross-sectional comparison between the same 39 patients and a sample of chronic schizophrenics (n = 26)) tested 16 years ago. The findings were attributed to effects of psychotropic drugs and improved psychiatric treatment.