RESUMEN
Schizophrenic patients have Theory of Mind (ToM) deficits even during remission, but it is yet unknown whether this could be influenced. We examined the neural correlates of irony understanding in schizophrenic patients, as an indicator of ToM capacity, and evaluated how linguistic help inserted into the context phase could affect irony comprehension. Schizophrenic patients in remission and healthy controls were subjected to event-related functional MRI scanning while performing irony, 'irony with linguistic help', and control tasks. Patients understood irony significantly worse than healthy controls. The patients showed stronger brain activity in the parietal and frontal areas in the early phase of irony task, however the healthy controls exhibited higher activation in frontal, temporal and parietal regions in the latter phase of the irony task. Interestingly the linguistic help not only improved the patients' ToM performance, but it also evoked similar activation pattern to healthy controls.
Asunto(s)
Encéfalo/fisiopatología , Comprensión/fisiología , Lenguaje , Esquizofrenia/fisiopatología , Adulto , Mapeo Encefálico , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Remisión Espontánea , Adulto JovenRESUMEN
There are contradictory results on lateralisation and localisation of rhythm processing. Our aim was to test whether there is a hemispheric dissociation of metric and non-metric rhythm processing. We created a non-metric rhythm stimulus without a sense of metre and we measured brain activities during passive rhythm perception. A total of 11 healthy, right-handed, native female Hungarian speakers aged 21.3 ± 1.1 were investigated by functional magnetic resonance imaging (fMRI) using a 3T MR scanner. The experimental acoustic stimulus consisted of comprehensive sentences transformed to Morse code, which represent a non-metric rhythm with irregular perceptual accent structure. Activations were found in the right hemisphere, in the posterior parts of the right-sided superior and middle temporal gyri and temporal pole as well as in the orbital part of the right inferior frontal gyrus. Additional activation appeared in the left-sided superior temporal region. Our study suggests that non-metric rhythm with irregular perceptual accents structure is confined to the right hemisphere. Furthermore, a right-lateralised fronto-temporal network extracts the continuously altering temporal structure of the non-metric rhythm.
Asunto(s)
Percepción Auditiva/fisiología , Cerebro/fisiología , Dominancia Cerebral/fisiología , Lateralidad Funcional/fisiología , Periodicidad , Percepción del Tiempo/fisiología , Estimulación Acústica/métodos , Mapeo Encefálico/métodos , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Adulto JovenAsunto(s)
Antipsicóticos/uso terapéutico , Catatonia/tratamiento farmacológico , Piperazinas/uso terapéutico , Quinolonas/uso terapéutico , Adulto , Antipsicóticos/administración & dosificación , Aripiprazol , Humanos , Inyecciones Intramusculares , Masculino , Persona de Mediana Edad , Piperazinas/administración & dosificación , Quinolonas/administración & dosificación , Esquizofrenia/tratamiento farmacológico , Resultado del TratamientoRESUMEN
OBJECTIVE: We tested the association between theory of mind (ToM) performance and structural changes in the brains of patients in the early course of schizophrenia. METHOD: Voxel-based morphometry (VBM) data of 18 patients with schizophrenia were compared with those of 21 controls. ToM skills were assessed by computerized faux pas (FP) tasks. RESULTS: Patients with schizophrenia performed significantly worse in FP tasks than healthy subjects. VBM revealed significantly reduced gray matter density in certain frontal, temporal and subcortical regions in patients with schizophrenia. Poor FP performance of schizophrenics correlated with gray matter reduction in the left orbitofrontal cortex and right temporal pole. CONCLUSION: Our data indicate an association between poor ToM performance and regional gray matter reduction in the left orbitofrontal cortex and right temporal pole shortly after the onset of schizophrenia.
Asunto(s)
Corteza Cerebral/patología , Procesamiento de Imagen Asistido por Computador , Imagen por Resonancia Magnética , Teoría de Construcción Personal , Esquizofrenia/diagnóstico , Psicología del Esquizofrénico , Adolescente , Adulto , Cerebelo/patología , Dominancia Cerebral/fisiología , Femenino , Lóbulo Frontal/patología , Hipocampo/patología , Humanos , Masculino , Pruebas Neuropsicológicas , Tamaño de los Órganos/fisiología , Escalas de Valoración Psiquiátrica , Valores de Referencia , Lóbulo Temporal/patología , Adulto JovenRESUMEN
We report on a case of rhabdomyolysis induced by the correction of hyponatremia after psychogenic polydipsia and clozapine use, where the switch to a high dose of olanzapine resulted in the non-recurrence of rhabdomyolysis. The 46-year-old patient with the diagnosis of schizophrenia paranoid type, who had been on clozapine treatment for the previous 4 years, was admitted with the symptoms of generalized seizure and vomiting, and as severe hyponatremia was proved, its correction with the parallel use of clozapine treatment was done. CK concentrations increased to 48 120 U/L without any symptom of neuroleptic malignant syndrome. To prevent acute renal insufficiency, high-volume alkaline diuresis was initiated and clozapine was tapered and stopped. On the day 12 of treatment, olanzapine was started and was elevated to 30 mg/day. CK concentration began to fall returning to the normal concentration on day 20. Six months after the switch to olanzapine no recurrence of rhabdomyolysis was detected; clinical and laboratory findings were normal. We suggest that after a benzodiazepine-type antipychotic-induced rhabdomyolysis, a switch to another atypical antipsychotic can be a cautious clinical strategy.
Asunto(s)
Antipsicóticos/efectos adversos , Antipsicóticos/uso terapéutico , Clozapina/efectos adversos , Rabdomiólisis/tratamiento farmacológico , Intoxicación por Agua/complicaciones , Benzodiazepinas/uso terapéutico , Creatina Quinasa/sangre , Humanos , Masculino , Persona de Mediana Edad , Olanzapina , Esquizofrenia/tratamiento farmacológicoRESUMEN
In 1990, the worldwide accepted Shackleton method, which provides a possibility of determining the steroid metabolites from urine, was adopted in our laboratory. The procedure is very useful in the diagnosis of different endocrine diseases and in the recognition of dysfunction or absence of enzymes with an important role in steroid metabolism, and it gives possibility to control the treatment in patients with these diseases. Besides the proximate clinical application, the method gives a convenient tool to study the steroid background of these disorders, helping us understand the mechanism of their development. In the last few years, we have examined the steroid profile of patients with hair (androgen alopecia /AA/, effluvium /E/), psychiatric problems (major depression /MD/, eating disorders /EDS/, especially anorexia nervosa and bulimia) and osteoporosis (OP). In all of the examined hair loss diseases, the levels of main androgen metabolites were increased, and elevated 5alpha-reductase activity were found. We could observe the alteration of the activity of 11beta-hydroxysteroid dehydrogenase (11beta-HSD) enzyme and marked gender differences in the changes of the steroid metabolism in patients with major depression (MD). In women with OP, the significantly decreased level of certain metabolites points to the role of testosterone, androstenedione and DHEA in postmenopausal bone loss in women. Our experiences contribute to the knowledge of the nature and steroid background of some endocrine and psychiatric diseases.
Asunto(s)
Enfermedades del Sistema Endocrino/orina , Trastornos Mentales/orina , Esteroides/orina , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: The authors' goal was to investigate the presence or absence of theory of mind impairments among people with schizophrenia during remission. Recent research results interpret theory of mind deficits as state rather than trait characteristics, connecting these impairments mainly to the acute episode of psychosis. METHODS: Twenty patients with schizophrenia in remission and 20 matched control subjects were evaluated. Participants were presented with one first-order theory of mind task, one second-order theory of mind task, two metaphor and two irony tasks adapted from previous studies. RESULTS: The schizophrenic patients performed a statistically significant impairment in the irony task, as there were no significant differences in the cases of the other evaluated tasks. CONCLUSIONS: These preliminary results suggest that theory of mind impairments can be detected not only in the acute phase as found in previous research studies, but also in remission.
Asunto(s)
Esquizofrenia , Psicología del Esquizofrénico , Estudios de Casos y Controles , Supervivencia sin Enfermedad , Humanos , Teoría Psicológica , Esquizofrenia/terapia , Análisis y Desempeño de TareasRESUMEN
OBJECTIVES: Recent approaches to the 'theory of mind' and pragmatics support that, if we did not have any idea about what other people know, we could hardly use language effectively. Successful communication (the pragmatic aspect of language) depends on inferring the beliefs and intentions of the partner in the conversation. Such successful communication is linguistically realized in part by cohesion and in part by abiding by the maxims derived from the cooperative principle. However, the violations of the Gricean implicatures are generally used in everyday language, mainly to point at a hidden, most commonly negative opinion on others. We hypothesize that schizophrenics have difficulties in the decoding of these violations, as the core deficit in this disorder is around social cognition, theory of mind and pragmatic language use. MATERIAL AND METHOD: We have examined 26 paranoid schizophrenic patients and 26 normal control subjects by using 4 'question and answer' vignettes, where the Gricean maxim of relevance was violated to express a hidden, negative opinion by one partner during the communicative act. The subjects were asked to judge these opinions and were evaluated by the investigators on a score from 0 to 2 points. In a pilot study, interrater reliability was judged to be satisfactory. The data were analysed statistically by parametric and non-parametric tests. RESULTS: Statistical analyses of our data have shown that schizophrenics made significantly more mistakes during the decoding of the violated maxim as compared with controls (p < 0.0001), reflecting on the difficulties during the correct exploration of the social context, i.e. recognition of the speaker's hidden opinion. CONCLUSION: We conclude that patients with schizophrenia fail to decode intentional violations of conversational implicatures. These results point at a dysfunctional pragmatic language use among schizophrenic patients.
Asunto(s)
Comunicación , Esquizofrenia Paranoide , Conducta Social , Adulto , Actitud , Humanos , Relaciones InterpersonalesRESUMEN
OBJECTIVE: The prevalence of minor physical anomalies (MPAs) (prenatal errors of morphogenesis) was evaluated in patients with schizophrenia and bipolar affective disorder. METHOD: A new modification of the Waldrop-scale was used to detect the presence or absence of 57 MPAs in 30 patients with schizophrenia, 30 with bipolar disorder, and in 30 matched normal controls. RESULTS: Patients with schizophrenia compared to normal controls had significantly higher rates of three minor malformations (furrowed tongue, flat occiput, primitive shape of ears) and those of one phenogenetic variant (wide distance between toes 1 and 2), and they also had a significantly higher rate of one minor malformation (primitive shape of ears), as compared to patients with bipolar disorder. In patients with bipolar disorder, furrowed tongue was significantly more common than in controls. CONCLUSIONS: These results support an 'early' neuro-developmental model of schizophrenia.
Asunto(s)
Trastorno Bipolar/complicaciones , Anomalías Congénitas/epidemiología , Esquizofrenia/complicaciones , Anomalías Múltiples/epidemiología , Estudios de Casos y Controles , Anomalías Craneofaciales/epidemiología , Humanos , Hungría/epidemiología , Modelos Lineales , Oportunidad Relativa , Lengua/anomalíasRESUMEN
The coexistent appearance of delusions of pregnancy and infestation is reported in a male patient with posttraumatic epilepsy. While published organic cases of delusions of pregnancy have involved patients with severe or mild mental retardation, our reported patient had a higher than average IQ. The interpretative role of these delusions in a probable perceptual symptomatology cannot be excluded, as both delusions can be based on sensations in the abdomen or on the skin.
Asunto(s)
Deluciones , Epilepsia/psicología , Enfermedades Parasitarias/psicología , Embarazo/psicología , Trastornos por Estrés Postraumático/psicología , Adulto , Epilepsia/etiología , Femenino , Humanos , Inteligencia , MasculinoRESUMEN
The appearance of psychosis during pregnancy means a challenge for clinicians, either untreated psychiatric disorders or pharmacological treatment of pregnant psychotic females increase risk of complications. Controlled clinical trials can't be evaluated because of ethical considerations, so case reports have higher scientific values than in other clinical issues. The authors inform about a delivery of a young psychotic female, who was treated with olanzapine (atypical antipsychotic) after the 25th weeks of her pregnancy. A healthy newborn was born in the observed case, the Apgar score was 7 at the first minute and 9 at fifth minute.
Asunto(s)
Antipsicóticos/uso terapéutico , Pirenzepina/análogos & derivados , Pirenzepina/uso terapéutico , Resultado del Embarazo , Esquizofrenia/tratamiento farmacológico , Adulto , Antipsicóticos/efectos adversos , Benzodiazepinas , Femenino , Humanos , Olanzapina , Pirenzepina/efectos adversos , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Esquizofrenia/diagnósticoRESUMEN
Many women with mental illnesses would like to breast feed their infants. In light of the limited but rapidly growing data, it seems that in some cases the possible physiological and psychological benefits may outweigh putative risks. All antipsychotics are secreted into breast milk but the concentrations and effects vary. There is a subgroup of mothers with mental illnesses who want to breast feed their infants and who are receiving a single established antipsychotic drug (principally, haloperidol or chlorpromazine) at the lowest possible clinically effective dose. As a tentative conclusion, this group could experience benefits from being able to nurse which would outweigh the risk of exposing their babies to very small amounts of antipsychotic drugs. However, larger study groups with longer follow-up periods would be required to confirm this tentative conclusion. Those mothers who require 2 or more antipsychotic drugs simultaneously and those taking one drug, but at the upper end of the recommended dose range, should not be advised to breast feed. Safety considerations suggest that women taking atypical antipsychotics would be advised not to breast feed because of the limited experience with these agents. When mothers taking antipsychotic drugs do nurse, it is desirable to monitor drug concentrations in breast milk and in the infants themselves. Close monitoring of the infant is essential.
Asunto(s)
Antipsicóticos/efectos adversos , Lactancia Materna/efectos adversos , Adulto , Antipsicóticos/farmacocinética , Femenino , Humanos , Lactante , Recién NacidoRESUMEN
The authors compare the appearance of depressive symptoms in 30 obese children in outpatient care and 30 normal-weight controls. The Montgomery-Asberg Depression Rating Scale showed a significantly higher rate of depression in the obese children (p < 0.01). The results are interpreted in the light of the partially contradictory views in the literature. Reference is also made to the therapeutic aspects of the problem.
Asunto(s)
Depresión/diagnóstico , Obesidad/psicología , Estudios de Casos y Controles , Niño , Conducta Alimentaria/psicología , Femenino , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Estadísticas no ParamétricasAsunto(s)
Anomalías Congénitas/diagnóstico , Anomalías Congénitas/epidemiología , Examen Físico/normas , Esquizofrenia/epidemiología , Trastornos Relacionados con Alcohol/epidemiología , Trastornos Relacionados con Alcohol/genética , Anomalías Congénitas/genética , Familia , Edad Gestacional , Humanos , Hueso Paladar/anomalías , Hueso Paladar/embriología , Examen Físico/estadística & datos numéricos , Prevalencia , Reproducibilidad de los Resultados , Esquizofrenia/genéticaRESUMEN
In past year drug abuse becomes more and more general in Hungary. In addition to consume traditional drugs, other substances are used frequently too. One of them is the Datura stramonium, which contains alkaloids (mostly atropine), and can result in hallucinations. Therefore Datura stramonium is seemingly becoming popular as a hallucinogenic drug. The consumption of any part of the plant causes atropine intoxication, thus anticholinergic delirium. Differential diagnosis of Datura intoxication can be difficult in the everyday medical practise. In our paper the symptomatology, diagnosis, differential diagnosis, and therapy of Datura intoxication are discussed and we report one of our cases.
Asunto(s)
Datura stramonium/envenenamiento , Alucinógenos/envenenamiento , Intoxicación por Plantas/diagnóstico , Plantas Medicinales , Plantas Tóxicas , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Intoxicación por Plantas/terapia , Trastornos Relacionados con Sustancias/diagnóstico , Té/envenenamientoRESUMEN
The authors in their case report show a case of induced hallucinatory psychosis induced in a wife of a patient with alcoholic hallucinosis. They deal with the nosological position of "folie a deux hallucinatoire" (induced hallucinatory psychosis) and integrate the consequences of the case to the general psychopathological theory of hallucinations.
Asunto(s)
Psicosis Alcohólicas/psicología , Trastorno Paranoide Compartido/psicología , Adulto , Femenino , Alucinaciones/psicología , Humanos , Masculino , Persona de Mediana Edad , Psicosis Alcohólicas/complicaciones , Trastorno Paranoide Compartido/complicacionesRESUMEN
Both the rapid emergence of new antipsychotic medications and the increasing fertility rate among women with psychotic disorders have contributed to the growing clinical importance of the treatment of pregnant women who have psychotic illnesses. The treatment of this patient population must always take into consideration the effect of that treatment on the fetus. With regard to the high risk of decompensation during pregnancy and postpartum, continuous antipsychotic medication is needed using the minimum effective dose. The use of high-potency agents appears to be preferable for first-line management, as there are few data regarding the use of atypical agents such as clozapine in pregnancy. Guidelines for treating pregnant women with psychoses vary little from those for nonpregnant patients. Clinicians must always carefully weigh up the risks and benefits for each patient on an individual basis.
Asunto(s)
Antipsicóticos/efectos adversos , Complicaciones del Embarazo/tratamiento farmacológico , Trastornos Psicóticos/tratamiento farmacológico , Antipsicóticos/farmacología , Conducta/efectos de los fármacos , Lactancia Materna , Clozapina/uso terapéutico , Femenino , Feto/efectos de los fármacos , Humanos , Periodo Posparto/efectos de los fármacos , Embarazo , Medición de RiesgoRESUMEN
OBJECTIVE: The authors evaluated the presence or absence of informative morphogenetic variants in patients with schizophrenia compared with alcohol-dependent patients. METHODS: Taking into consideration the criticisms of the Waldrop Scale, which was widely used until recently to define the presence of informative morphogenetic variants, the authors evaluated the presence or absence of 56 informative morphogenetic variants in 50 consecutively admitted patients with schizophrenia and 50 consecutively admitted alcohol-dependent patients. They made a distinction between minor malformations (those developing during organogenesis) and phenogenetic variants (those developing after organogenesis). A kappa index above 75% was considered reliable. RESULTS: Thirty-four of the 56 informative morphogenetic variants met the authors' reliability criterion. Patients with schizophrenia had significantly higher rates of three minor malformations (furrowed tongue, multiple buccal frenula, and hemangioma) and two phenogenetic variants (protruding auricle and large tongue). CONCLUSIONS: The results suggest that using finer distinction in the evaluation of informative morphogenetic variants in schizophrenia may open new perspectives in the research of the neurodevelopmental background of schizophrenia.
Asunto(s)
Alcoholismo/diagnóstico , Anomalías Congénitas/diagnóstico , Variación Genética/genética , Morfogénesis/genética , Esquizofrenia/diagnóstico , Adulto , Alcoholismo/genética , Tipificación del Cuerpo/genética , Encéfalo/embriología , Anomalías Congénitas/embriología , Anomalías Congénitas/genética , Femenino , Humanos , Masculino , Reproducibilidad de los Resultados , Factores de Riesgo , Esquizofrenia/etiología , Esquizofrenia/genéticaRESUMEN
Couvade is a phenomenon, where the expectant father or another relative experiences somatic and/or psychiatric symptoms during a woman's pregnancy. Although epidemiological studies report a frequency of couvade symptoms between 11 and 36% during all pregnancies, psychotic couvade cases are very rare with few case reports. The authors report 2 cases of psychotic couvade and give a psychodynamic interpretation of the cases. They emphasize the important role of ego defect and double identification in the development of the cases. Couvade is a phenomenon, where the expectant father or another relative experiences somatic and/or psychiatric symptoms during a woman's pregnancy. The term couvade was first coined by Tylor in 1865. Somatic symptoms can include indigestion or colic, gastritic symptoms, food cravings, nausea and vomiting, increased or decreased appetite, diarrhea, toothache, headache, itch, muscle tremors, nosebleed or other pains. Abdominal bloating and pseudocyesis have also been reported. Although the psychiatric symptoms most often observed are depression, anxiety, insomnia, irritability, tension and hypochondria there are some reports on psychotic couvade too. In our article we present 2 cases of psychotic couvade.