Cognitive Features of High-functioning Adults with Autism and Schizophrenia Spectrum Disorders.

OBJECTIVE: Autism Spectrum Disorder (ASD) and schizophrenia share common features in terms of pathophysiology and clinical appearance. Cognitive deficits are also present in both disorders. However, ASD and schizophrenia are heterogeneous syndromes, and  few  studies  have addressed patients with these disorders who have above average educational attainment. In this study, we assessed the cognitive functions of a group of adult ASD patients with adequate mental development and verbal communication skills (High Functioning Autism, HFA) and compared them with a group of Schizophrenia patients matched for level of education. METHOD: Three groups of patients and controls [(HFA, n= 32), Schizophrenia (n= 17), Controls (n= 23)], all with at least a high school education, were assessed with the Wechsler Adult Intelligence Scale (WAIS), Wisconsin Card Sorting Test (WCST), and Rey Auditory Verbal Learning Test (RAVLT). For the assessment of HFA, scores on the Autism Spectrum Disorders in Adults Screening Questionnaire were taken into consideration. Clinical diagnoses were based on DSM-IV TR and DSM-5 criteria. RESULTS: High Functioning Autism and Schizophrenia groups performed similarly in all subtests except for WAIS Comprehension and Digit Symbol, WCST Perseveration, and RAVLT Learning. CONCLUSION: Comprehension abilities of educated adults with HFA could be higher than average in situations that do not involve social interaction. Tendency to perseveration in the presence of adequate concept formation ability may reflect the clinical symptoms of rigidity and repetitive behavior. In patients with higher levels of functioning and education, their diagnosis appears to be weakly associated with cognitive functioning. The potential roles of other variables, such as environmental factors, during development deserve further exploration in future studies.

Fighting against cigarette smoking among medical students: a success story.

A survey in the year 2007 among medical students of Ankara University Medical School to assess the smoking rates showed that 25.1 % of them were smoking. Moreover, the smoking rate was 35 % at sixth grade students and 60 % of the smokers specified that they started smoking at medical school. This report provides a successful approach to decrease smoking among medical students by measures against starting smoking. An "Antismoking Group" composed of voluntary academic staff, nurses, students, psychologists, and a social worker of the medical school was established to engage in lowering the smoking rate and eliminating it eventually among our students. Several methods including regular monthly meetings, annual "Smoking or Health" symposiums, and lectures to first, second, and third grade students to increase their awareness related to harms of smoking and their role in the fight against smoking were carried out. Our surveys in the years 2009 (641 students) and 2012 (975 students) showed that total smoking rates dropped to 15.0 and 11.0 %, respectively (p < 0.0002). Moreover, the smoking rate for the sixth grade students dropped from 35.0 % in 2007 to 21.8 and 8.8 % in the years 2009 and 2012, respectively (p < 0.0002). In 2012, the smoking rates of first year and sixth year students were 7.8 and 9.0 %, respectively. These close rates of smoking at the first and last years of medical school training and the significant drop in smoking rates in 5 years confirm that our group pursued a realistic and successful strategy against smoking.

Theory of Mind in Schizophrenia and Asperger's Syndrome: Relationship with Negative Symptoms.

OBJECTIVE: Although previous studies have shown that the theory of mind (ToM) ability is impaired in Asperger's Syndrome (AS) and in schizophrenia, few controlled studies compared the ToM performance between the two disorders. Besides, the relationship between the degree of ToM impairment and symptom dimensions is unclear, and presence of ToM impairment in remitted patients with schizophrenia is controversial. Here, we tested the hypothesis that schizophrenia patients with prominent negative symptoms were closer to AS patients and different than schizophrenia patients without prominent negative symptoms and healthy controls in terms of ToM functioning. METHOD: Fourteen patients with AS, 20 with schizophrenia and 20 healthy controls, matched by age, educational level and IQ scores were enrolled. AS was diagnosed according to the DSM-IV criteria and independently confirmed by two psychiatrists. Schizophrenia patients were diagnosed by the Turkish version of Structured Clinical Interview for DSM-IV Diagnosis (SCID-I) and symptom severity was evaluated with the Scale for the Assessment of Negative and Positive Symptoms. Schizophrenia group consisted of clinically stable patients. The ToM battery included stories to assess first and second order false belief tasks (ToM1 and ToM2). The full-scale IQ, Verbal Comprehension, Freedom from Distractibility and Perceptual Organization scores were assessed by Weschler Adult Intelligence Scale-Revised (WAIS-R). Non-parametric tests were used to compare the neuropsychological performances of the three groups. In order to investigate whether schizophrenia patients with prominent negative symptoms were similar to AS patients, schizophrenia patients were divided into high (Sch-HN) and low (Sch-LN) negative-symptom subgroups by median split. For these four groups (AS, Sch-HN, Sch-LN, and controls) between group comparisons were performed. Correlations between the clinical measures and ToM performance were assessed by Spearman correlation test. RESULTS: AS and schizophrenia patients performed significantly worse than controls in the ToM2 task, while the AS group had worse ToM1 performance than both schizophrenia patients and healthy controls. The Sch-HN subgroup had significantly lower ToM2 scores than the Sch-LN patients, and worse ToM1 functioning than the controls. CONCLUSIONS: These results suggest that clinically stable schizophrenia patients have ToM impairments. Sch-HN group performed comparably poorly as the AS group, while the Sch-LN group was relatively spared. The most profoundly impaired patients with schizophrenia in terms of ToM functioning were represented by those with high negative symptoms (Sch-HN). Similar to AS, as a neurodevelopmental impairment, these patients may not have developed ToM ability, or they may have lost their ToM capacity as a result of a neurodegenerative process during the illness. Supplementary studies using other methods (e.g., neuroimaging, neurophysiology) may highlight the brain regions that are affected differentially in AS and schizophrenia, the relationship of ToM impairments and negative symptoms, and the role of ToM impairments in the neurodevelopmental or neurodegenerative hypothesis of schizophrenia.

[Proton magnetic resonance spectroscopy in Asperger's syndrome: correlations with neuropsychological test scores]. / Asperger Sendromunda Proton Manyetik Rezonans Spektroskopi: Nöropsikolojik Testlerle Iliskisi.

OBJECTIVES: It has been shown that autistic spectrum patients have impaired theory of mind (ToM) performance; however, no study has investigated the relationship between ToM performance and brain neurochemistry in these patients. The present study aimed to investigate the correlations between dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC) N-acetyl-aspartate (NAA)/choline (Cho), NAA/creatine (Cr), and Cho/Cr values based on 1H magnetic resonance spectroscopy and ToM tests. METHOD: The study sample included 13 adult, right-handed, Caucasian males with Asperger's syndrome (AS) (age range: 17-37 years) and 20 controls matched by age, gender, handedness, and Wechsler Adult Intelligence Scale, Revised (WAIS-R) full-scale IQ scores. RESULTS: AS cases had significantly lower ToM performance. DLPFC NAA/Cho levels were inversely correlated to ToM scores (r = -0.738, P = 0.004). On the other hand, ToM performance improved as DLPFC Cho/Cr increased (r = 0.656, P = 0.015). ACC MRS variables were not significantly correlated with ToM performance in the AS group. No significant correlation was observed between ACC or DLPFC MRS variables and ToM performance in the control group. DISCUSSION: Because NAA/Cho was inversely correlated with ToM performance and Cho/Cr was correlated with ToM performance, it can be suggested that the Cho level was related to better ToM test performance in the AS group. An increase in the Cho peak was associated with an increase in membrane breakdown or turnover. The Cho peak was also thought to reflect cellular density and astrocytosis. It is suggested that membrane turnover and astrocytosis might affect cognitive functioning.

Impaired verbal memory and otherwise spared cognition in remitted bipolar patients on monotherapy with lithium or valproate.

OBJECTIVES: Patients with bipolar disorder have been reported to have neurocognitive deficits; however, it is not known whether the cognitive dysfunctions are state-dependent or a stable trait. Lithium and valproate, 2 of the most widely used mood stabilizers in the treatment of bipolar disorder, have also been associated with cognitive impairment. However, the degree and pattern of neurocognitive impairment in euthymic bipolar patients on either monotherapy with lithium or valproate have not been compared before in depth. METHODS: We compared 17 euthymic outpatients with bipolar disorder (BD) on lithium monotherapy to 11 euthymic outpatients with BD on valproate monotherapy and 29 comparison subjects using tests measuring immediate verbal memory and executive functions in addition to 3 subtests of the Wechsler Adult Intelligence Scale Revised. The groups were similar in terms of level of education, duration and severity of illness, and gender distribution. Patients on lithium monotherapy were older than patients on valproate and healthy controls. Mood symptoms as assessed by standardized scales were mild to non-existent in both patient groups. RESULTS: Immediate verbal memory was impaired in both patient groups compared to controls, where the main effect of age was not significant. No significant differences could be found on the other cognitive measures. CONCLUSIONS: Both lithium and valproate may be associated with immediate verbal memory impairment, sparing other cognitive functions. Presence of a similar verbal memory deficit in the lithium and valproate groups suggests that this deficit might be intrinsic to BD or that the 2 medications influence immediate verbal memory similarly. Larger samples of remitted bipolar patients on monotherapy should be studied for more precise conclusions.

[Validity and reliability of the Turkish version of the Wender Utah Rating Scale for attention-deficit/hyperactivity disorder in adults]. / Wender-Utah Derecelendirme Olçegi Türkçe formunun eriskin dikkat eksikligi ve hiperaktivite bozuklugu'nda geçerlik ve güvenilirlik çalismasi.

OBJECTIVE: To determine reliability and validity of Turkish form of the 25 item Wender Utah Rating Scale (WURS), which is designed as an aid for diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) in adults. METHOD: The scale was administered to 59 patients who were diagnosed as having ADHD according to DSM-IV criteria after comprehensive psychiatric and neuropsychological assessments in outpatient clinics of University of Ankara Medical School, Department of Psychiatry. Control groups consisted of 59 patients with depression, 44 patients with bipolar affective disorder in remission, and 145 healthy controls. Subjects who were illiterate and younger than 18 years of age were excluded from the study. WURS was readministered to 63 of the healthy controls after 4 weeks. RESULTS: Principal components analysis revealed 5 factors explaining 61.3% of the variance. The factors were labeled as Irritability, Depression, School Problems, Behavioral Problems/Impulsivity and Attentional Deficits. Mean factor scores of ADHD group was higher than all groups except Depression factor. Turkish form of WURS demonstrated excellent internal consistency (Cronbach's alpha= 0.93), and the test-retest coefficient for the WURS (total score) was 0.81. Item-total score correlations varied between 0.31-0.75. A cut off score of 36 or higher identified 82.5% of the adults with ADHD (sensitivity), 90.8% of the healthy controls (specificity), 66% of patients with depression, and 64.3% of patients with bipolar affective disorder correctly. CONCLUSION: Turkish form of the WURS is a reliable and valid scale in assessing childhood symptoms in adults for ADHD. However overlapping mood disorder items lowers specificity of the scale.

Relative sparing of executive functions in the early phase of schizophrenia.

Findings about the impairment of executive functions in schizophrenia are not conclusive. The authors hypothesized that the severity of the impairments in the abilities that comprise EF might be different. Forty patients were assessed with a comprehensive battery that included four measures of executive functions and were compared with 60 healthy subjects. Set shifting and response inhibition showed no significant between-group differences. Mental flexibility and concept formation were significantly worse in patients, but the effect sizes were small. Some executive functions might be relatively spared, at least in the early phase of schizophrenia. Studies on individual executive functions may yield more replicable findings.

[Neuropsychological findings in adults with attention deficit hyperactivity disorder]. / Dikkat Eksikligi ve Hiperaktivite Bozuklugu olan eriskinlerde nöropsikolojik bulgular.

OBJECTIVE: Attention Deficit Hyperactivity Disorder (ADHD) is a common disorder with childhood onset and persistence into adulthood. Role of neuropsychological testing is becoming an important clinical measure in the assessment and diagnosis of adults with ADHD. The aim of this study was to assess neuropsychological functions of adults with ADHD compared to healthy controls. METHOD: Neuropsychological functions of 16 adults with DSM-IV diagnosis of ADHD and 16 healthy controls were assessed. Control grup was matched in age, gender and years of education. Benton Visual Retention Test, Wisconsin Card Sorting Test (WCST), Wechsler Memory Scale and Stroop Color and Word Test were used for neuropsychological assessment. RESULTS: 13 of the ADHD patients were male and 3 were female. Mean age was 29.5+/-8.1, and mean education year was 13.4+/-2.2. In Stroop Color and Word Test, adults with ADHD completed word and color word subtests in a longer time than normal controls, made more mistakes in color reading subtest, made more corrections in word subtest, and had higher interferance scores compared to healthy controls (p.05). Adults with ADHD also showed poorer performance in Wechsler Memory Scale's logical memory subtest (p<.05). Patients' and healthy controls' performances were similar in Wisconsin Card Sorting Test and Benton Visual Retention Test. CONCLUSION: Although ADHD adults' perfomance in traditional measures of executive functioning (WCST) were similar to normal controls, they showed poor performance in tests measuring selective attention, distractibility and response inhibition (Stroop Test) indicating that attention problems do not remit with age and persist in adulthood.

Dissociation between inattentiveness during mental status testing and social inattentiveness in the Scale for the Assessment of Negative Symptoms attention subscale.

The Scale for the Assessment of Negative Symptoms (SANS) attention subscale has been found valid and reliable by some studies; however, there is some evidence to the contrary. We hypothesized that social inattentiveness (SANS 22) and inattentiveness during mental status testing (SANS 23) might be describing discrete constructs, and this dissociation might be a source of controversy. Thirty-five patients with DSM-IV schizophrenia were assessed by the Scale for the Assessment of Positive Symptoms (SAPS), SANS and a neuropsychological battery. The 2 attention items were not significantly interrelated. SANS 22 was correlated with bizarre behavior and alogia, and none of the neuropsychological test scores, whereas SANS 23 showed strong correlations with the Wechsler Memory Scale mental control subscore, total errors on the Benton Revised Visual Retention Test, and the information, similarities and the general verbal subscores on the Wechsler Adult Intelligence Scale. Regression analyses showed that SANS 23 could be a good estimate of general verbal abilities. These findings point to a dissociation between the 2 SANS attention items. Similar analyses should be repeated in larger and heterogeneous samples and include a factor analysis of the individual items rather than the global ratings.