Difference in brain densities between chronic alcoholic and normal control patients.

The densities of the brains of 11 chronic alcoholics were compared with those of 11 age-matched normal control subjects. Densities were determined from the density numbers generated by computerized tomography at three levels of the brain-the highest level of the lateral ventricles and the next two higher levels-with adjustments made to control for possible artifacts in the data. The advantage of the dominant hemisphere over the nondominant hemisphere was lessened in alcoholics.

Structural brain deficits in schizophrenia. Identification by computed tomographic scan density measurements.

Research has suggested the presence of brain damage as a cause or concomitant of chronic schizophrenia. The most recent research in this area has been the identification of abnormalities in schizophrenia by computed tomographic (CT) scans. A study was done to investigate localized changes in CT scan density numbers in the brains of schizophrenic patients, as opposed to the brains in normal control subjects. Twenty-four normal subjects and 23 schizophrenic patients were tested with CT scans. Density measurements in each area of the brain (left, right, anterior and posterior) were compared to three separate CT scan levels. Of six measurements of anterior left-hemisphere density, it was found that five showed lower density in schizophrenic brains, as compared with normal brains. Of the remaining 18 measurements that evaluated other areas of the brain, only three differentiated between schizophrenic patients and normal subjects. The results support the hypothesis that there are primary structural deficits in some schizophrenic patients, and these deficits are centered in and around the anterior area of the left (dominant) hemisphere. The results also demonstrated further implications.

Cerebral ventricular size and neuropsychological impairment in young chronic schizophrenics. Measurement by the standardized Luria-Nebraska Neuropsychological Battery.

The relationship between size of cerebral ventricles in chronic schizophrenics and performance on a comprehensive neuropsychological battery, the Standardized Luria-Nebraska Neuropsychological Battery, was investigated. Ventricular size was determined by using a planimeter to measure the size of the lateral ventricles and the ventricular body, if present, on the computerized tomographic (CT) scan image that showed the largest lateral ventricles. This number was divided by the size of the brain as a whole on the same image of the CT scan to yield a ventricular brain ratio. This ratio was then correlated with the scores on the Luria-Nebraska Neuropsychological Battery. Eight of the 14 scales of the Luria-Nebraska Neuropsychological Battery correlated significantly at the .05 level with the ventricular brain ratio in a sample of 42 chronic schizophrenics with an average age of 32.3 years. Overall, there was a multiple correlation of .72 between the ventricular brain ratio and Luria scores. The overall ventricular brain ratio for the schizophrenics was significantly above that found in normal populations. Changes in the size of the ventricles in schizophrenics appear to have significant correlates with measures of neuropsychological performance.

Regional cerebral blood flow in schizophrenics. Tests using the xenon Xe 133 inhalation method.

Measurements of intrahemispheric and bilateral regional cerebral blood flow (CBF) for gray and white matter were compared in 29 schizophrenic patients and 22 normal controls, using the xenon Xe 133 inhalation method. Results showed significantly lower CBF values for all brain regions in the schizophrenic group, and post hoc comparisons showed relatively greater reduced gray-matter CBF values in the anterior areas of the brain. There was also a left-hemisphere frontal loss similar to that reported previously, although it was in the context of a generalized loss in anterior functioning. Interhemispheric comparison within both groups showed no differences between homologous regions for gray matter, and greater white-matter CBF values in the right hemisphere than in the left hemisphere. The findings support a hypothesis of a bilateral anterior deficit in schizophrenia.

Hemispheric asymmetries in schizophrenia.

The growing literature on hemispheric asymmetries in schizophrenic populations is critically reviewed. Studies of lateral asymmetries in schizophrenics are discussed which have employed a wide range of methodologies, including assessment of motor, sensory, electrophysiological, neuropsychological, and structural abnormalities. This literature is discussed in relation to two theoretical viewpoints, one emphasizing impaired functioning of the corpus callosum, and the other positing left hemisphere overactivation and dysfunction in schizophrenic populations. It is concluded that the hypothesis of impaired callosal function has not been adequately tested because of methodological problems, the most serious of which is the failure to show differential deficit. The hypothesis of left hemisphere abnormality has gained consistent support, although methodological problems were noted. This research suggests a structural locus for schizophrenic pathology which is consistent with the symptomatology of the disorder, and provides avenues for further research.

A circumvaginal muscle nomogram: a new diagnostic tool for evaluation of female sexual dysfunction.

Female orgasmic capacity was previously shown to vary significantly with the condition of the pubococcygeus muscle as evaluated by an extensive digital examination and readings from a perineometer, a pressure sensitive device inserted into the vagina. Subsequently, a discriminant analysis was applied to 6 types of perineometer readings to determine if an optimal combination of readings could alone serve as an accurate evaluation of muscle condition. Initial strength resting and initial strength contracting predicted "good" versus "bad" muscle with 73.4% accuracy. A nomogram is presented for clinical use.

Aging, regional cerebral blood flow, and neuropsychological functioning.

Previous studies found changes in regional cerebral blood flow (rCBF) patterns related to both age and various cognitive tasks. However, no study has yet demonstrated a relationship between rCBF and performance on the Luria-Nebraska Neuropsychological Battery (LNNB) in an elderly group. Seventy-nine elderly volunteers (56-88 years old), both healthy and demented, underwent the 133xenon inhalation rCBF procedure and were given the LNNB. The decrements in the gray-matter blood flow paralleled decrements in performance on the LNNB. Using partial correlations, a significant proportion of shared variance was observed between gray-matter blood flow and the LNNB scales. However, there was much less of a relationship between white-matter blood flow and performance on the LNNB. This study suggests that even within a restricted age sample rCBF is related in a global way to neuropsychological functioning.

Identification of neuropsychological subtypes in a sample of delinquent adolescents.

Although research has long recognized a relationship between neurological dysfunction and delinquency, the nature of this relationship is unclear. Based on the theory that there may be clusters of delinquents with different types of neurological dysfunction which contribute to the delinquency in different ways, the present research attempted to identify these subtypes using neuropsychological testing. Seventy-seven such adolescents were administered the full Luria-Nebraska Neuropsychological Battery-III (LNNB-III) and a battery of assessments measuring behavioral functioning and substance use. A Hierarchical Cluster Analysis yielded four identifiable neuropsychological clusters: Verbal/Left-Hemispheric Deficits, Subcortical-Frontal Deficits, Mild-Verbal Deficits, and Normals. The distinctiveness of these subtypes was confirmed by univariate analyses. Results further indicated that the number of LNNB scales that were in the abnormal range differed per subtype, with each subtype differing significantly from one another. These neuropsychological subtypes were found to be associated with specific psychological and behavioral problems.

Biological contributions to the presentation and understanding of attention-deficit/hyperactivity disorder: a review.

Attention-deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed disorder in children today with estimated prevalence rates falling between 3 and 5% of children (American Psychiatric Association, 1994). From inception, research has focused on studying varying facets of this disorder with initial efforts primarily focusing on treatment outcome. However, prominent efforts have been made in recent research efforts to shed light on the etiology of this disorder. Such research has discovered the contribution of genetic inheritance, as well as environmental factors that lead to the development of this disorder. Furthermore, studies using neurological and neuropsychological assessment measures have implicated the involvement of various Parts of the brain. This article critically reviews this body of research in light of its impact on the current specific neuropsychologically based etiological theories, as well as the most beneficial directions for future research.

The Conners' Parent Rating Scales: a critical review of the literature.

The Conners' Parent Rating Scales (CPRS) have undergone a considerable amount of scrutiny--and subsequent refining, reshaping, and revising--since their development in 1970. While such longitudinal scrutiny has ultimately led to a more reliable, valid assessment tool, it has left behind a wake of literature filled with misinformation and ambiguity. Multiple versions of the Conners' Rating Scales (CRS), their misuse, and inaccurate reporting by researchers have created a body of literature that is difficult to interpret and misleading to both researchers and clinicians. This review is aimed at clarifying issues regarding the proper use of the CPRS as both a diagnostic instrument and a research tool.

Ventricular enlargement in major depression.

Major depression accompanied by psychosis may be a separate nosological entity from nonpsychotic depression. Investigators have noted behavioral and biochemical differences in psychotic and nonpsychotic patients, as well as differences in response to treatment. A previous study using computed tomography (CT) found enlargement of the lateral cerebral ventricles in patients with manic-depressive illness with psychotic symptoms. The present study examined CT scans of patients with major affective illness that was accompanied by hallucinations, delusions, or both. The ventricles of the depressed group were significantly larger than those of a group of normal controls.

Effects of long-term neuroleptic use on brain density.

Mean density values of the brain in four quadrants were determined for a sample of 16 chronic schizophrenic patients who had received between 0 and 3,000 grams of lifetime neuroleptics. Significant correlations were found between the measures of density in the posterior quadrants of both hemispheres and total lifetime medication usage. Correlations with anterior density were insignificant. Corrections for age and current severity of the disorder (as measured by the Brief Psychiatric Rating Scale) did not alter the significant finding. Possible explanations for the results are discussed as well as their possible implications.

The BPRS in assessing symptom correlates of cerebral ventricular enlargement in acute and chronic schizophrenia.

The present study was an attempt to investigate hypotheses about the interrelationship of brain dysfunction and symptoms of schizophrenia using the Brief Psychiatric Rating Scale (BPRS) and a measure of cerebral ventricular size. The ventricular brain ratio (VBR) was correlated with admission and discharge scores on the BPRS in 46 schizophrenic patients. A significant relationship was found between VBR and discharge BPRS scores. In general, the results were partially supportive of relationships found between neuropsychological data and the BPRS in a previous study, but shed little light on the relationships between brain damage and negative and positive symptoms. Limitations of using the BPRS, as well as possible sampling variations, are discussed.

Potential impact of age- and education-corrected scores on HRNB score patterns in participants with focal brain injury.

Heaton, Grant, and Matthews (1991) presented an alternate scoring system for the Halstead-Reitan Neuropsychological Battery (HRNB) using age-, education-, and gender-corrected T scores to replace the raw score system traditionally employed with the test. This study addressed the impact of using this system on the score patterns generated by the HRNB in 64 clients with localized injuries to one of four quadrants of the brain. Results showed that the raw scores show more overall impairment than do the T scores, but overall the systems are statistically equal in their ability to separate the localized groups. The patterns of differences among the systems also differ. Although these findings suggest overall equivalence of the systems, they also show that each may have strengths that will show up in different analyses. A process of using both scoring systems for their own unique information is advocated as most appropriate at the current time until additional research addresses the questions raised in this study and elsewhere.

WMS-R and MAS correlations in a neuropsychological population.

The present study was an attempt to examine the relationship between the Wechsler Memory Scale-Revised (WMS-R; Wechsler, 1987) and the Memory Assessment Scale (MAS; Williams, 1991). The sample consisted of 51 patients referred for neuropsychological examination. Average age was 55.29 (SD = 20.94). Average education was 11.94 years (SD = 3.18). Average Full Scale IQ was 94.75 (SD = 15.44). The results showed that no MAS index correlated higher than.60 with any of the WMS-R indices. There was minimal specific prediction between instruments across each memory domain. Agreement between the tests clinically was low as well. Corrections for such factors as age, education, intelligence or diagnosis lowered the relationships between the tests although not significantly. Corrections to the correlations for the inherent reliability of each test increased correlations between the tests but still resulted in a maximum common variance of 56% (for the visual measures) down to 40% (for General Memory). These results are consistent with the argument that "general memory" is not as useful a construct as that of "general intelligence" and that these tests of general memory measure different underlying constructs. This has important impact on how we conceive and report memory test results.

Vitamin supplements and purported learning enhancement in mentally retarded children.

Dr. Ruth Harrell and her colleagues conducted a study in 1981 in which the administration of high dosages of vitamins were determined to dramatically improve the intellectual functioning of mentally retarded children. This paper documents the efforts of its authors to replicate the Harrell et al. research and, although no significant differences were found between active treatment groups and control groups at study's end, a thorough comparison is made between the two research efforts.

Brain damage among mentally disordered sex offenders.

The incidence and nature of structural brain dysfunction was investigated in a pilot study sample of individuals currently assigned the Nebraska Penal Code designation of mentally disordered sexual offender. It was hypothesized that the sexual offenders would show a significantly higher incidence of dysfunction than a psychosocially normal group as evidenced by computed tomography scan measures, regional cerebral blood flow, and neuropsychological instruments. The hypothesis was tested by two different methods. One method used a 160 by 160 printout of density numbers generated by computer from computed tomography scans administered to the sexual offenders. The second method used mean blood flow data generated from a Harshaw TASC-5 Regional Cerebral Blood Flow analysis system. Additionally, the Luria-Nebraska Neuropsychological Test Battery was administered as a measure of the behavioral correlates of brain dysfunction. Preliminary analyses indicate that 50% of the sexual offenders tested showed brain dysfunction as demonstrated by decreased density measures, decreased blood flow, and performance deficits on the Luria Battery. The implications of these findings, if confirmed, are substantial on issues of criminal responsibility, sentencing, treatment, and rehabilitation of the sex offender. Case reports of the patients studied are presented.

Neuropsychological performance of sexual assaulters and pedophiles.

Persons who had been arrested for sexual assault were administered the Luria-Nebraska Neuropsychological Battery and the results compared to a group of normal controls. The sexual assaulters performed significantly worse on 7 of the 14 scales of the battery. The data were then broken down into three groups: (1) those who had forcibly assaulted postpubescent victims, (2) those subjects who had sexually molested a prepubescent child, and (3) normal controls. A discriminant analysis correctly classified 68% of the subjects on the basis of their neuropsychological performance alone.

Interpretation of VIQ-PIQ and intersubtest differences on the Spanish version of the WAIS.

Although the Spanish version of the Wechsler Adult Intelligence Scale (WAIS; Escala de Inteligencia Wechsler para Adultos [EIWA]) is the most frequently used intellectual assessment for Spanish speaking clients in the United States, there is little information available on score differences necessary to establish reliable and abnormal differences between Performance IQ (PIQ) and Verbal IQ (VIQ), and between the various subtests of the EIWA. The present study, based on EIWA standardization data (N = 616 Puerto Ricans), reports reliability data and base rates to assist in evaluating the clinical significance of PIQ-VIQ differences. The results demonstrated substantial similarity between the EIWA and the English versions of the Wechsler tests. The interpretation of these differences is discussed, and tables are presented of statistically and clinically significant differences.

Optimal short forms of the Spanish WAIS (EIWA).

Although the Spanish version of the WAIS (Escala de Inteligencia Wechsler para Adultos, EIWA) is widely used as a measure of intelligence in Spanish-speaking populations, little is known about the psychometric characteristics of the test beyond the information given in the test manual. Despite this, users have assumed that the test functions clinically and statistically as does the original WAIS. This assumption has been applied to the area of short test forms which are assumed to be as valid as those used with the WAIS. The present study is an attempt to determine the optimal two-, three-, four-, and five-test short forms for estimation of Full Scale IQ based on the EIWA standardization test data. In addition, the relative amount of common and specific variance in the EIWA subtests was determined, along with the degree of measurement error. The study emphasizes the limitations of using the EIWA arising from its out-of-date norms, use of a restricted Spanish-speaking population, and failure to make updates since its introduction. These cautions suggest that the EIWA (long and short forms) should not be used for determining IQs; instead its use should be limited to research and to tracking cognitive changes over time.