What Is Going On? The Process of Generating Questions about Emotion and Social Cognition in Bipolar Disorder and Schizophrenia with Cartoon Situations and Faces.

Regarding the notion of putative “best” practices in social neuroscience and science in general, we contend that following established procedures has advantages, but prescriptive uniformity in methodology can obscure flaws, bias thinking, stifle creativity, and restrict exploration. Generating hypotheses is at least as important as testing hypotheses. To illustrate this process, we describe the following exploratory study. Psychiatric patients have difficulties with social functioning that affect their quality of life adversely. To investigate these impediments, we compared the performances of patients with schizophrenia and those with bipolar disorder to healthy controls on a task that involved matching photographs of facial expressions to a faceless protagonist in each of a series of drawn cartoon emotion-related situations. These scenarios involved either a single character (Nonsocial) or multiple characters (Social). The Social scenarios were also Congruent, with everyone in the cartoon displaying the same emotion, or Noncongruent (with everyone displaying a different emotion than the protagonist should). In this preliminary study, both patient groups produced lower scores than controls (p < 0.001), but did not perform differently from each other. All groups performed best on the social-congruent items and worst on the social-noncongruent items (p < 0.001). Performance varied inversely with illness duration, but not symptom severity. Complete emotional, social, cognitive, or perceptual inability is unlikely because these patient groups could still do this task. Nevertheless, the differences we saw could be meaningful functionally and clinically significant and deserve further exploration. Therefore, we stress the need to continue developing novel, alternative ways to explore social cognition in patients with psychiatric disorders and to clarify which elements of the multidimensional process contribute to difficulties in daily functioning.

Familial comorbidity of bipolar disorder and multiple sclerosis: genetic susceptibility, coexistence or causal relationship?

Our purpose in undertaking the present study was to examine the hypotheses proposed for explaining the frequent comorbidity of bipolar disorder and multiple sclerosis. One hypothesis posits that, when there is comorbidity, MS plays a causal role in psychiatric manifestations. Another suggests that both disorders have a common underlying physiological process that increases the likelihood of their co-occurrence. We examined two adult siblings with comorbidity and their relatives, including three generations of family members with psychiatric morbidity. We found an extensive multigenerational history of bipolar disorder in this family. This history would seem to support the hypothesis of a common underlying brain process (potentially genetically-based) to explain the comorbidity of BD and MS, but cannot clarify whether this comorbidity implies a relationship between the two disorders or merely reflects parallel processes of brain deterioration. We cannot, however, rule out the possibility of a subclinical MS-related process leading to the early manifestation of BD, with MS appearing much later in time, or even a third, undetermined factor, leading to familial comorbidity. Although we have insufficient information to support either hypothesis definitively, we present the familial cases as a springboard for a discussion of dilemmas related to teasing apart MS and BD comorbidity. Further observation of the clinical course of the younger family members, who have not yet shown any neurological signs, over the next few years may elucidate the current picture further.

Sex differences in neuropsychological functioning among schizophrenia patients.

OBJECTIVES: Evidence from the literature addressing sex differences in cognition in schizophrenia remains equivocal, with some researchers suggesting that male schizophrenia patients are more impaired than female subjects, while others report no significant sex differences in cognitive functioning. The aim of the present study was to investigate whether the differential pattern of cognitive performance observed in healthy men and women is preserved in male and female schizophrenia patients. METHOD: Ninety-six schizophrenia patients (56 men) were compared with 62 age- and gender-ratio matched healthy controls (31 men), on a battery of neuropsychological tests that assessed basic cognitive abilities: attention, working memory, abstraction, inhibition, fluency, verbal learning and memory, visual memory, visuospatial skills, and psychomotor speed. RESULTS: As a group, schizophrenia patients were significantly impaired in each of the cognitive domains assessed, with the exception of psychomotor speed. The effect of sex was significant for verbal learning and memory, wherein women outperformed men. No significant group x sex interactions were found in any cognitive domains, indicating that the female advantage typically observed in verbal learning and memory remained the same in the schizophrenia patients. CONCLUSION: The degree of cognitive impairment is the same for male and female schizophrenia patients. Those sex differences found among the patients were typical of the healthy population as well. Therefore, differential decrements in basic cognitive domains do not appear to account for the favourable course of schizophrenia in women relative to men.

Effects of sentence context on lexical ambiguity resolution in patients with schizophrenia.

Previous research has suggested that a failure in processing contextual information may account for the heterogeneous clinical manifestations and cognitive impairments observed in schizophrenia. In the domain of language, context processing in schizophrenia has been investigated mostly with single-word semantic priming paradigms; however, natural language comprehension depends on more than semantic relations between words. The present study aimed to systematically assess sentence context effects in homonym meaning activation in patients with schizophrenia. Fourteen patients with schizophrenia and 14 normal controls matched to the patients on sex, age, education and parental education, were examined using a cross-modal priming paradigm. Primes were sentences biasing the first, second, or neither meaning of a sentence-final equibiased homonym; targets were related to either the first or the second meaning of the homonym and appeared after an interstimulus interval (ISI) of 0ms or 750ms. Patients with schizophrenia exhibited a trend towards facilitation of both target types following unbiased sentences at ISI=0ms, similar to controls. However, in contrast to the pattern of selective target facilitation exhibited by control subjects following first- or second meaning-biased sentences, no significant target facilitation was observed in patients in the same condition. At ISI=750ms, patients did no longer exhibit significant target facilitation in any sentence context condition. This pattern of results is compatible with the assumption of a combined impairment in lexical (automatic spreading of activation within the semantic network) and extralexical (working memory) processes in patients with schizophrenia.

Metformine for psychosis associated with the menstrual cycle in a patient with polycystic ovary syndrome.

There are several reports of periodic psychotic disorders that appear in connection with the various phases of the menstrual cycle. Although the pathogenesis of menstrual psychosis has not been systematically investigated, it appears that it might be linked to an estrogen cascade that follows a period of sustained high estrogen levels, as in the case in anovulatory cycles. We present a case of psychosis associated with the menstrual cycle in a patient with polycystic ovary syndrome, a disorder typically characterized by anovulatory cycles, in whom the restoration of normal menstruation with use of metformine led to significant improvement of psychotic symptoms.

Factor structure of the Greek translation of the Scale for the Assessment of Thought, Language and Communication.

OBJECTIVE: The Scale for the Assessment of Thought, Language and Communication (TLC) is a widely used instrument for the assessment of formal thought disorder. TLC disorders were initially conceptualized as having only two underlying dimensions, a negative and a positive one. But studies of the factorial structure of the TLC have not provided confirmation for the positive-versus-negative distinction. The aim of the present study was to assess the factorial structure of the Greek translation of the TLC. METHOD: Subjects were 103 patients (69 male, 34 female) with psychotic disorders randomly recruited from both inpatient and outpatient facilities. The TLC was assessed by two raters based on a 20 min clinical interview. RESULTS: Principal component analysis with varimax rotation yielded a three-factor structure; the three factors consisted off items reflecting (i) disorganization of speech; (ii) peculiarities of speech; and (iii) verbosity. The disorganization factor could be further divided into two dimensions reflecting disturbances in the flow of ideas and in the structure of speech. CONCLUSION: The investigation of the factorial structure of the Greek translation of the TLC scale found no support for the positive-versus-negative distinction of TLC disorders. Three factors (disorganization, speech peculiarities, and verbal productivity) were found to underlie the variance of the scale.

Impaired perception of affective prosody in remitted patients with bipolar disorder.

Patients with bipolar disorder present deficits in facial emotion perception, both during a manic episode as well as upon recovery. Our goal in the present study was to investigate the ability of remitted patients with bipolar disorder to perceive affective prosody and to explore potential differences in the specific emotions that are troublesome for them. Participants included 19 patients with bipolar disorder I, currently in remission, and 22 healthy comparison subjects, matched on age, education, and gender. An affective prosody test (APT) was administered to all participants. Bipolar patients had significantly lower overall scores on the APT than healthy individuals. This impairment was specific to female patients and certain emotions (e.g., fear and surprise).

Humor appreciation in remitted patients with bipolar disorder.

The purpose of the present study was to investigate humor appreciation in a group of remitted patients with bipolar disorder. We examined 19 patients (8 men) with bipolar disorder I, currently remitted, and 22 (9 men) healthy controls, matched on age, education, and gender, on a computerized test comprising captionless cartoons, the Penn's Humor Appreciation Test (PHAT). Residual manic symptoms were evaluated with the Young Mania Rating Scale and residual depressive symptoms with the Montgomery-Asberg Depression Rating Scale. Patients with bipolar disorder performed worse than the healthy group on the PHAT, but this difference was not statistically significant. Performance on the PHAT did not significantly correlate with age of onset and duration of illness, or with residual manic or depressive symptoms measured by Young Mania Rating Scale and Montgomery-Asberg Depression Rating Scale, respectively. Humor appreciation, based on captionless cartoons, in bipolar disorder does not seem to be deficient at least during remission, suggesting that this high-order cognitive function may not be considered a trait deficit of the disorder.

Humor appreciation deficit in schizophrenia: the relevance of basic neurocognitive functioning.

The purpose in undertaking the present study was to investigate humor appreciation in patients with schizophrenia. Moreover, we sought to explore the potential relationship of humor appreciation with measures of psychopathology and cognitive functioning among the patients. Thirty-six patients with schizophrenia were compared with 31 normal controls matched for age, sex, and education on a computerized test comprising captionless cartoons: Penn's Humor Appreciation Test (PHAT). The patients were also evaluated on the symptom dimensions derived from the Positive and Negative Symptom Scale (positive symptoms, negative symptoms, cognitive symptoms, depression, and excitement), as well as a battery of neuropsychological tests measuring executive functions, attention, working memory, verbal and visual memory, visuospatial ability, and psychomotor speed. Patients with schizophrenia had significantly lower scores on the PHAT than normal controls. The patients' performance on the PHAT correlated with scores on Penn's Continuous Performance Test, the Stroop Color-Word Test, and the phonological subscale of the Greek Verbal Fluency Test. Our findings indicated impaired humor appreciation among patients with schizophrenia. The relationship found between the appreciation of captionless cartoons involved an incongruous detail and performance on a broad neuropsychological battery suggested that the deficit in humor appreciation in schizophrenia could be attributed to impairment in more basic neurocognitive domains, namely, selective and sustained attention as well as phonological word fluency.

Impaired emotion perception in schizophrenia: a differential deficit.

We investigated previously reported contradictory findings regarding the nature of deficits in emotion perception among patients with schizophrenia. Some studies have concluded that such deficits are due to a generalized impairment in visual processing of faces, while others have found it to be restricted to facial emotional expressions. We examined 37 patients and 32 healthy controls, matched on age and education, using three computerized tests: matching facial identity, matching facial emotional expressions, and discrimination of subtle differences in the valence of facial emotional expressions. Our results showed impaired matching of emotions in patients with schizophrenia. This impairment did not manifest on tasks that depended on perceiving the identity of faces or cues of the relative valence of facial emotional expressions. Our findings support the differential deficit hypothesis of emotion perception in schizophrenia.

Shared cognitive processes underlying performance on the Wisconsin Card Sorting Test and the Stroop Test in patients with schizophrenia: a measurement artifact?

We explored the hypothesis that, while sensitive to different aspects of executive functioning in patients with schizophrenia, the Wisconsin Card Sorting Test (WCST) and the Stroop Test also measure the same construct, namely, inhibitory control. Specifically, our goal was to confirm and extend previous findings [A. Rossi, E. Daneluzzo, P. Mattei, M. Bustini, M. Cassachia, P. Stratta, Wisconsin Card Sorting Test and Stroop performance in schizophrenia: a shared construct, Neurosci. Lett. 226 (1997) 87-90] by demonstrating the independence of this construct from other abilities necessary to successfully perform the tasks. More importantly, we sought to improve on this previous study by eliminating the influence of the variance of speed of responding. We examined 55 patients with schizophrenia and initially found that performance on the Stroop Color-Word condition could, indeed, be predicted only by the percentage of perseverative errors on the WCST, and not variables reflective of other cognitive skills, thus replicating and extending previous findings. Once we removed the influence of speed of responding from our measure, however, thus isolating the inhibitory process, this finding disappeared. Therefore, our findings highlight the importance of isolating the individual components of interest from complex measures before drawing conclusions regarding the cognitive processes underlying particular test performance.

Impaired perception of affective prosody in schizophrenia.

The authors aimed to explore schizophrenia patients' ability to perceive affective prosody. Specifically, certain emotions that may be more troublesome for patients and possible gender differences in prosody perception were assessed. Thirty six schizophrenia patients and 32 age-, education-, and gender-matched healthy comparison subjects assessed on an affective prosody test were examined. Patients were impaired on recognition of affective prosody overall, and their difficulties with prosody perception may be attributed to those emotions with negative valence, specifically anger and sadness. Findings revealed that only male patients were impaired on prosody perception. Deficits in the perception of affective prosody were principally evident in emotions with negative valence and male patients with schizophrenia. Future studies should explore the influence of these deficits on social and interpersonal functioning more directly.

Neuropsychological profile of cognitively impaired patients with schizophrenia.

OBJECTIVE: Our purpose in undertaking the present study was to explore the existence of specific areas of cognitive deficits within the context of generalized poor performance in a group of Greek patients with schizophrenia. We also sought to identify any patients who might be cognitively normal. METHOD: Participants were 70 patients with schizophrenia and 42 healthy control subjects. The 2 groups were matched on age and male-female ratio but differed in their level of education. A battery of neuropsychological tests was selected to assess executive functions/abstraction, fluency, verbal and spatial working memory, verbal and nonverbal memory, attention, visuospatial ability, and psychomotor speed. RESULTS: Patients with schizophrenia performed more poorly than healthy control subjects, when we controlled for differences in level of education, on executive functions, working memory, verbal memory, nonverbal memory, fluency, visuospatial ability, and attention. In contrast, no significant differences were found between the 2 groups on psychomotor speed. Patients showed a more pronounced deficit on executive functions, verbal and visual memory, and visuospatial ability. Overall, 13% to 62% of the patients with schizophrenia scored within 1 SD of the mean z scores of healthy control group depending on the cognitive domains examined. In the entire sample of patients with schizophrenia, however, no individual scored within 1 SD of the mean z scores of the control group in all cognitive domains. CONCLUSIONS: We found a generalized deficit in cognitive functioning in a group of patients with schizophrenia. We failed to find any individual patients who were healthy across all cognitive areas. The current neuropsychological profile, indicating widespread impairment, is comparable to that reported in the international literature and thus appears to be characteristic of schizophrenia. Our findings of increased difficulties with executive functions, verbal and visual memory, and visuospatial ability support previous suggestions of generalized brain dysfunction in the pathophysiology of schizophrenia.

Impaired emotion processing in remitted patients with bipolar disorder.

In the present study, we examined whether there is an impairment in affect matching abilities in remitted patients with bipolar disorder and if this could be attributed to problems with facial perception per se and/or the ability to perceive the relative valence of facial expressions indicating emotions. We examined 19 patients with bipolar disorder I, currently remitted, and 30 healthy controls (15 men), matched on age, education, and gender, using two computerized tests: matching facial identity [Kinney's Identity Matching Test (KIMT)] and matching facial emotional expressions [Kinney's Affect Matching Test (KAMT)]. Patients with bipolar disorder performed significantly worse than the healthy group on the KAMT, but not on the KIMT. Performance on the KAMT and KIMT did not correlate with age of onset and duration of illness, or with manic or depressive residual symptoms. The present findings support the differential deficit hypothesis regarding impaired affect perception in bipolar disorder during remission. Patients' deficits were restricted to the matching of facial emotional expressions despite their intact perception of facial identity.

Community dysfunction in schizophrenia: rate-limiting factors.

The purpose of the present study was to investigate the impact of cognitive functioning, psychopathology, and severity of extrapyramidal side effects on community outcome in a group of Greek outpatients with schizophrenia. Participants were 40 outpatients with schizophrenia (25 men). Social adjustment was assessed with the Quality of Life Scale (QLS). Severity of symptoms of schizophrenia was measured with the Positive and Negative Syndrome Scale (PANNS), and extrapyramidal symptoms with the Extrapyramidal Symptom Rating Scale (ESRS). Finally, a battery of neuropsychological tests was administered in order to assess the following cognitive domains: executive functioning/set shifting, executive functioning/inhibition, fluency, verbal memory, visual memory, working memory, attention, visuospatial ability, and psychomotor speed/visual scanning. Total scores on the QLS were significantly correlated with negative symptoms, parkinsonism, and performance on the fluency tasks. Interpersonal relations subscale was significantly related with negative symptoms and fluency. No significant relationship was found between the Instrumental Role Functioning subscale and the PANSS, ESRS, or any cognitive domain. Scores on the Intrapsychic Foundation subscale were significantly correlated with negative symptoms and fluency. Finally, scores on the Common Objects and Activities subscale were significantly related with severity of negative symptoms, parkinsonism and visual memory. Our findings suggest that severity of negative symptoms, cognitive dysfunction, especially performance on fluency tasks and visual memory, as well as parkinsonism, are important determinants of functional outcome in schizophrenia.

Deficits in sustained attention in schizophrenia but not in bipolar disorder.

The aim of the present study was to investigate sustained attention in remitted patients with bipolar disorder and in patients with schizophrenia, as compared to each other and to healthy controls; a secondary aim was to investigate the correlations of different symptom dimensions with performance on sustained attention in the two patient groups. Participants were 29 (18 men) outpatients with schizophrenia (SZ), 19 (8 men) patients with bipolar disorder I (BP) in remission, and 30 (15 men) healthy controls (HC); all three groups were matched on age, sex ratio, and level of education. Symptom severity (positive symptoms, negative symptoms, and general psychopathology) of patients with SZ were assessed with the Greek version of the Positive and Negative Syndrome Scale (PANSS); residual affective symptoms of patients with BP were assessed with the Young Mania Rating Scale (YMRS) and the Montgomery-Asberg Depression Rating Scale (MADRS). Sustained attention was measured by means of the Penn Continuous Performance Test (PCPT). The three groups differed significantly on the PCPT scores. Patients with SZ performed more poorly than both the BP and HC groups, whereas patients with BP did not differ significantly from HC. Performance on the PCPT did not correlate significantly with scores on the YMRS and MADRS in patients with BP. Also, scores on the PCPT did not correlate significantly with scores on any of the three subscales of the PANSS. Outpatients with schizophrenia presented deficits in sustained attention, whereas patients with bipolar disorder I in remission did not manifest such impairment. These results imply that impaired sustained attention might be a more enduring deficit in schizophrenia than it appears to be in bipolar disorder.

Verbal fluency in institutionalized patients with schizophrenia: age-related performance decline.

Several studies have reported a relatively stable level of cognitive deficits among patients with schizophrenia regardless of age, while others have suggested continued deterioration with age. We compared the performance of 42 institutionalized patients with schizophrenia and 42 age- and education-matched healthy controls on a semantic and phonemic verbal fluency test. Each group was divided into young participants (<65 years old) and elderly participants (> or =65 years old). We found a fluency condition x diagnostic group x age group interaction on total words produced, a fluency condition x diagnostic group interaction on the number of cluster-related words, and a fluency condition x age group interaction on the number of switches. Patients with schizophrenia generally used similar strategies (i.e., semantic or phonemic cluster-related words and switches) as healthy individuals when generating words, but to a lesser degree. We found a disproportionate decline in the elderly schizophrenic patients relative to that of healthy controls only on the phonemic, relative to the semantic test. This decline in performance appears related to the effects of aging rather than severity or chronicity of illness, duration of institutionalization, or a progressive degenerative process associated with the disorder.

Pathological correlates of poststroke depression in elderly patients.

OBJECTIVE: The authors examined the relationship between poststroke depression and location of stroke. METHODS: They performed a clinicopathological analysis of 95 consecutively autopsied elderly initial-stroke survivors. RESULTS: The severity of brain vessel arteriosclerosis and frequency of brain vascular lesions were not significantly different between 21 cases with poststroke depression and 74 cases without. Earlier death was the only variable significantly associated with poststroke depression. No lesion pattern characterized the depression group. CONCLUSIONS: Neuropathological data confirm that depression is associated with worse prognosis in elderly stroke patients and lend support to the hypothesis that psychological rather than neurological factors are the main determinants of poststroke depression.

Disproportionate impairment in semantic verbal fluency in schizophrenia: differential deficit in clustering.

The purpose of the current study was to investigate whether patients with schizophrenia present disproportionate impairment in semantic, relative to phonemic, fluency. Specifically, we explored whether this impairment could be explained by differential deficits in clustering or switching strategies. The Greek Verbal Fluency Test was administered to 119 patients with schizophrenia and 150 age-, education-, and gender-matched healthy controls. We calculated the total number of words generated, the number of cluster related words, and the number of switches on the semantic and phonological fluency tasks separately. Patients with schizophrenia generated fewer total words, cluster related words and switches than healthy controls on both fluency tasks. When controlling for the total number of words produced, however, the differences between the two groups in the number of cluster related words and switches disappeared. We found a disproportionate impairment in semantic, compared with phonemic, fluency in schizophrenia for total word production and the number of cluster related words, but not for the number of switches. In conclusion, patients with schizophrenia used the same strategies as healthy controls to perform on a word fluency test, but they used them less effectively. Disproportionate impairment in semantic fluency in schizophrenia resulted from a differential deficit only in clustering. Therefore, disproportionately impaired category fluency in schizophrenia may be primarily due to disorganization and not to inefficient access to and retrieval from semantic store.

No increased levels of the nicotine metabolite cotinine in smokers with schizophrenia.

The prevalence of smoking cigarettes has repeatedly been found to be greater in schizophrenia as compared with other psychiatric patients and the general population. Patients with schizophrenia have been found to engage in heavy smoking and consumption of higher doses of nicotine, probably by deeper inhalation of cigarettes. The aim of the current study was to assess nicotine exposure through smoking by measuring urinary cotinine, the major nicotine metabolite, in a group of smokers from Greece of smokers with schizophrenia and smokers from the general population. Participants were current smokers and belonged to one of two groups: 35 patients with schizophrenia and 48 healthy controls matched in age, education, and gender. The quantitative analysis of cotinine, the major metabolite of nicotine, in urine samples was performed by a modified high performance liquid chromatography (HPLC). Patients with schizophrenia who smoke presented a significantly larger time interval between last cigarette smoked and urine sample collection, as well as a significantly higher average number of cigarettes consumed daily than normal smokers. Urinary cotinine levels of patients with schizophrenia who smoke did not significantly differ from that of normal smokers when adjusted for average number of cigarettes per day and time interval between last cigarette smoked and urine collection. These results suggest that patients with schizophrenia did not present higher nicotine exposure through smoking compared with smokers from the community. The pharmacokinetic or pharmacodynamic properties of nicotine, as well as patient medications of the patients may explain our findings.