Recall and recognition confabulation in psychotic and bipolar disorders: evidence for two different types without unitary mechanisms.

Several forms of confabulation have been identified recently in schizophrenic patients, but it has not yet been investigated whether these forms are specific to schizophrenia. Furthermore, the origin of confabulation is unclear. The present study investigated recall and recognition confabulation and their relations with symptomatology, cognitive domains (abstraction and flexibility, verbal fluency, verbal memory, motor activity, and visual-motor processing/attention), computed tomographic (CT) measures (ventricular, cerebral, and Sylvian fissure size), and auditory event-related potentials (amplitudes and latencies of peak components in oddball paradigms) in 33 schizophrenic patients, 35 bipolar I patients, eight schizoaffective patients, and seven patients with other psychotic disorders. We found that neither type of confabulation was specific of any diagnostic group. Recall confabulation was mainly predicted by the predominance of positive symptoms, while recognition confabulation was predicted by a delay in P300 latency and the doses of antipsychotics used. Our results suggest two different mechanisms for both types of confabulation based on interference with the adequate retrieval of information and slowness in early stimulus detection.

Similar effect of family history of psychosis on Sylvian fissure size and auditory P200 amplitude in schizophrenic and bipolar subjects.

Several cerebral studies point to the non-specificity of structural and functional changes described in schizophrenia and bipolar disorders. Furthermore, the origin of these changes is still unclear. The present study investigated the effect of a family history (FH) of psychotic disorders in first-degree relatives on computed tomographic (CT) measures (ventricular, cerebral and Sylvian fissure size) and auditory event-related potentials (amplitudes and latencies of peak components in oddball paradigms) in 30 schizophrenic patients and 24 bipolar type I patients. We found a significant correlation between FH and the size of the right Sylvian fissure, and between FH and auditory P200 amplitude. More specifically, the schizophrenic and bipolar patients with negative FH (n=36) had larger right Sylvian fissures and smaller P200 amplitude than patients with positive FH (n=18). These findings were independent of the specific diagnosis, gender, and age of subjects. Our results suggest some underlying process common to schizophrenia and bipolar I disorder, and they provide support for the continuum view of the nosologic structure of psychotic illness.

Use of needles and syringes in Miami and Valencia: observations of high and low availability.

Two studies engaged in gathering data on injecting drug users (IDUs) employed supplementary resources to enhance their ethnographic components and compare patterns of use of needles/syringes (n/s) in two geographically similar but culturally distinct cities. Despite its policy of making n/s highly available at fair prices, Valencia, Spain, has markedly higher rates of HIV seroprevalence among its IDUs than does Miami, Florida, where possession of n/s is illegal. Ethnographically based models that track IDUs through choices of injection venues help to explain this difference. Inability of IDUs in Valencia to use their own domiciles as venues for injection contrasts sharply with problems of Miami IDUs, who have access to houses but have difficulty finding n/s. This research suggests that intervention in Valencia needs to focus on how people select places where they inject, and intervention in Miami needs to focus on improving availability of n/s.

[Neurophysiology and neuropsychology of recognition confabulation in hospitalized schizophrenic patients]. / Neuropsicología y neurofisiología de la confabulación de reconocimiento en pacientes esquizofrénicos hospitalizados.

Recognition confabulation was studied in 16 schizoprhenic patients and 16 normal controls. Half of the schizophrenics presented recognition confabulation, while the remaining 8 and 16 controls did not. This type of confabulation was associated to attentional deficiency, difficulties in perceptual follow-up and perceptive changes. These test satisfactorily discriminated confabulating schizoprhenics and both ill and healthy non-confabulating subjects. The possible mechanisms underlying this type of confabulation are discussed, in relation to the deficiences observed.

Mortality among psychiatric patients referred to the mental health services in Valencia.

The rate of survival and causes of mortality in a cohort of 2103 psychiatric patients registered on a psychiatric case register and followed up for 7 years are compared with those of a general population sample (n = 2382) randomly extracted from the municipal census in Valencia (Spain). Using multivariate analysis by Cox regression, patients suffering organic psychoses and those diagnosed with drug abuse or dependency exhibited a greater risk of death than the general population for the total causes of death; no interaction was found between sociodemographic variables and psychiatric pathology. In terms of the causes of death, and controlling for the effect of age and sex, organic psychoses involved a greater risk of death due to cardiovascular and respiratory causes, and a greater risk of non-natural deaths than the general population. Schizophrenia and related conditions, the abuse of alcohol/ other drugs, and neurosis/personality disorders all presented a higher risk of death from liver disease. The major affective disorders involved a greater risk of death due to suicide or accidents. The study concludes with a discussion of the possible explanations of these results.

[Intentions and behaviors of risky drug consumption in users at the rehabilitation centers in Valencia]. / Intenciones y prácticas de consumo de riesgo en usuarios de centros de deshabituación de drogas en Valencia.

A study was made of the factors associated with high-risk behavior and intention to change among 126 intravenous drug users (IVDU) seen at drug treatment centers. Needle-sharing in the last month was associated with intravenous cocaine use, whereas sharing water or drug preparations was associated with variables related to the level of instruction or the reduction in the number of syringes shared in the last month. The intention to abandon high-risk behavior was not associated with the information, attitudes, or norms of the group, but was associated with the perception of personal capacity for reducing high-risk behavior. Finally, the importance and applications of these results in health counseling for IVDUs is discussed.

[Prevalence of human immunodeficiency virus infection among parenteral drug users in the community of Valencia 1987-1991)]. / Prevalencia de la infección por el virus de inmunodeficiencia humana en consumidores de drogas por vía parenteral en la Comunidad Valenciana (1987-1991).

BACKGROUND: To contribute to the knowledge of the frequency and distribution of infection by the HIV-1 in intravenous drug consumers (IVDC) the prevalence of infection in those in whom the voluntary serologic testing was practised and tendency over 5 years were studied. METHODS: The study included 2794 IVDC from centers of primary health care (70%) or those who attended directly (30%), from 1987 to 1991, to three Centers of Information and Prevention of AIDS located in the cities of Valencia, Alicante and Castellón in which the voluntary and free practice of the test of antibodies versus HIV-1 was performed. The serologic test (enzymoimmunoassay) was carried out in 2694 individuals whose positive results were confirmed by Western-blot. Risk factors of the infection in addition to sociodemographic data were collected by questionnaire. RESULTS: The estimated global prevalence was of 49.9% with confidence intervals of 95% (CI 95%) of 48.1% to 51.7%. Differences were observed according to the city with the highest being Valencia (55.3%, CI 95%: 52.8%; 57.8%) in comparison with Alicante (43.7%. CI 95%: 40.5%; 46.9%) and Castellón (41.3%, CI 95%: 35.6%, 47%). A decrease in prevalence was detected during the period studied (chi 2 of tendency = 6.37; p = 0.011), with this decrease only being produced in Alicante and Castellón. No differences were found with regard to sex in contrast to those found according to age, from 35.3% in those under 20 years of age to 59.5% in those over 29 years (chi 2 of tendency = 80.62; p < 0.0001). Only in the youngest age groups was a decreased tendency in prevalence found. The IVDC attended reported interchanging of needles at the time of consultation in 16.9% (CI 95%: 15.5%; 18.3%) with a descending temporal tendency from 27.7% in 1987 to 2.8% in 1991 (chi 2 of tendency = 14.18; p = 0.0001). Only 18.7% (CI 95%: 17.2%; 20.2%) of the IVDC used condoms in more than 66% of their sexual encounters of vaginal coitus. No differences were found with respect to sex or year of consultation. CONCLUSIONS: The prevalence of infection by the HIV-1 in intravenous drug consumers requesting the serologic test is decreasing in the Community of Valencia. This reduction in frequency should be confirmed by estimated rate of incidence of seroconversion. The frequency of the use of condoms in intravenous drug consumers is low conditioning a high risk of extension of the epidemics by sexual transmission.