First-episode 'coenesthetic' schizophrenia presenting with alien hand syndrome and partial agenesis of the corpus callosum.

We describe the case of a 23-year-old Caucasian woman who presented with alien hand syndrome and a first episode of the coenesthetic subtype of schizophrenia. 'Alienness' of her non-dominant hand was intimately phenomenologically associated with the onset of first-psychosis. Cerebral MRI revealed a partial agenesis of the corpus callosum with a complete absence of the rostrum, hypoplastic anterior and inferior genu, and a hypoplastic splenium. This case suggests that this syndrome can occur with the development of a functional disconnection syndrome involving the anterior callosum, and in this case the 'second hit' proposed to occur in early adulthood in schizophrenia may have interacted with her earlier neurodevelopmental lesion to result in a combination of psychosis and alien hand syndrome.

Defining subjects at risk for psychosis: a comparison of two approaches.

The ability to detect individuals at high risk for developing schizophrenia before they express the disease will lead to targeted early intervention. It has been proposed that subjects at risk share a core deficit with people who already have schizophrenia. This includes cognitive impairment, affective symptoms, social isolation and decline in social functioning. In a sample of 104 help-seeking patients from a specialised outpatient clinic we investigated how well two different sets of criteria define the at-risk group and capture this core deficit. One set of criteria is the well-established ultra high-risk model of McGlashan et al. [McGlashan 2001 (SIPS) McGlashan, T. H., Miller, T. J., Woods, S. W., et al. (2001) Structured Interview for Prodromal Syndromes (Version 3.0, unpublished manuscript). New Haven, Connecticut: PRIME Research Clinic, Yale School of Medicine.]; the other criteria were those defined by Cornblatt et al. [Cornblatt, B., Lencz, T., Smith, C.W., Correll, C.U., Auther, A., Nakayama, E., 2003. The schizophrenia prodrome revisited: a neurodevelopmental perspective. Schizophr. Bull. 29, 633-651.]. There was considerable overlap in the two sets of criteria. However, when the basic symptoms of Klosterkötter [Klosterkötter, J., Hellmich, M., Steinmeyer, E.M., Schultze-Lutter, F., 2001a. Diagnosing schizophrenia in the initial prodromal phase. Arch. Gen. Psychiatry, 58, 158-164.] were included in the McGlashan et al. model, a more narrow and homogeneous group was defined.

Balloon catheter dilatation of common canaliculus stenoses.

OBJECTIVE: To determine the efficacy of balloon catheter dacryocystoplasty in treating stenoses of the common canaliculus. MATERIALS AND METHODS: Between 1997 and 2004, elective balloon catheter dilatation was performed under local anesthesia in 36 patients with epiphora and dacryocystography (DCG)-proven high-grade stenosis of the common canaliculus. Eight of the 36 patients had additional stenosis of the nasolacrimal duct. A 2.5-mm diameter balloon was used for common canaliculus obstructions, a 3-mm balloon for nasolacrimal duct obstructions. RESULTS: Dilatation was technically successful in 34/36 patients. In 2/36 patients the guide wire could not be advanced beyond the obstruction. There were no complications. During a mean follow-up of 9 months restenosis occurred in 4/36 patients, in one of whom it led to occlusion of the common canaliculus; a chronic dacryocystitis had already resulted in occlusion of the common canaliculus in this patient's other eye. Two of four restenoses were successfully dilated in a second procedure. In one patient, a bilateral presaccal occlusion was suspected clinically. DCG revealed a high-grade common canaliculus stenosis in both eyes. After balloon catheter dilatation the patient was complaint free in one eye, and in the other eye symptoms improved. CONCLUSIONS: The therapy of choice for common canaliculus stenoses in addition to canaliculodacryocystorhinostomy is silicone tube implantation. The results of both procedures, however, are often disappointing. Balloon catheter dilatation is a minimally invasive technique carried out under local anesthesia which represents an alternative therapy option for the treatment of stenoses of the common canaliculus.