[How can we determine the outcome of schizophrenic diseases?]. / Woher wissen wir was über den Ausgang schizophrener Erkrankungen?

With the successful introduction of neuroleptics in the 1950s and improvement of medical and psycho-social care a major breakthrough toward a positive development of the schizophrenic disease in both the short and especially the long term seemed accomplished. By now the initial euphoria has given way to at least temporary disillusionment. How serious is the actual scale of the handicap? How often do permanent health- and social impairments occur? After naming the methodological problems of passed follow-up-studies theoretical requirements of future studies of the course of schizophrenic diseases are being described.

[Pathogenicity of Borna disease virus in psychiatric and neurologic disorders of humans. Current status of research and critical comments]. / Zur Pathogenität von Borna-disease-Virus für psychiatrische und neurologische Störungen beim Menschen. Derzeitiger Forschungsstand und kritischer Kommentar.

Demonstration of BDV-specific serum antibodies, the isolation of BDV from cerebrospinal fluid of neuropsychiatric patients, and the recent demonstration of BDV antigen and BDV-RNA in human brain tissues strongly suggest that BDV can infect humans. Isolation of BD virus from brain tissue is needed for final proof. There is still great controversy about the question of whether BDV antigen, BDV-RNA or BDV can be detected in peripheral blood monocytes or not. Overall, the question of pathogenicity of BDV infection for humans is wide open. Investigations of human cerebrospinal fluid indicate that BDV might cause human lymphocytic meningoencephalitis and so-called symptomatic psychoses in rare cases. Seroepidemiological studies suggest a widely non-specific but possibly pathogenic role of BDV in a spectrum of psychiatric disorders.

Failure to detect Borna disease virus infection in peripheral blood leukocytes from humans with psychiatric disorders.

The presence of antibodies reactive with Borna disease virus (BDV) in the sera of some patients with certain psychiatric illnesses has been taken as evidence that this veterinary neurotrophic virus may occasionally infect and cause psychiatric disorders in humans. In this paper, we report the results of our studies concerning the detection of BDV-specific RNA in blood cells from patients with psychiatric diseases. Contrary to the results obtained by others, we have found no evidence for the presence of BDV-RNA in such cells. Prior work with BDV sequences in the assay environment, together with the exquisite sensitivity of RT-PCR, may account for the sporadic appearance of false positive evidence that BDV-specific RNA is present in human blood cells.

Preattentive information processing as measured by backward masking and texton detection tasks in adolescents at high genetic risk for schizophrenia.

Schizophrenic patients have consistently been reported to show deficits in preattentive information processing as demonstrated by impairments in visual backward masking and texton detection tasks. Texton detection refers to Julesz's texton theory, which defines a certain limited number of texton elements (e.g., one 'L' among many '+') that can be detected readily and simultaneously without attentional effort irrespective of the size of the rest of the visual field. The present study investigated whether deficits of preattentive information processing are more prevalent in a group of adolescents of high genetic risk for schizophrenia compared to matched control subjects. Although differences in the performance in visual backward masking tasks could not be detected with our experimental approach, preattentive texton detection was to a certain extent disturbed in subjects at risk. Moreover, subjects at risk did not show the advantage of the right hemisphere in processing texton elements which was found in the control group. This may point to a subtle dysfunction of the right hemisphere in the risk group. It is concluded from the present study that deficits in preattentive texton detection may represent an indicator for a schizophrenic disposition. However, further studies including other high risk groups, schizophrenics in remission and individuals with a schizotypal personality disorder are needed to confirm this hypothesis.

Investigations of cerebrospinal fluid in Borna disease virus seropositive psychiatric patients.

Borna disease virus (BDV) appears to cause meningoencephalitis and schizophreniform psychosis in sporadic cases according to earlier cerebrospinal fluid (CSF) inoculation experiments (Rott et al, 1991). However, CSF parameters in BDV seropositive psychiatric patients proved nearly all normal; only the most sensitive CSF/serum index I-BDV for intrathecally produced BDV specific IgG was pathologic in 10.5-29.0% (according to different methodological limits) of patients. An increase in sensitivity was attempted to detect specific IgG in CSF in a part of the cases by concentration. Concentration procedure does not significantly increase methodological bias according to a statistical analysis of the results. Our findings support the hypothesis that BDV may cause or contribute to the pathogenesis of a diagnostically broad pattern of psychiatric syndromes. The occurence of a spectrum of diagnoses is expected from non-specificity of psychiatric symptoms in other infectious diseases of the brain as well as from results in experimental Borna disease (BD) in animals, when a majority of the animals showed rather unspecific symptomatology due to slight, preferentially limbic encephalitis. Slight deficiencies from an earlier BDV infection could explain continuing symptoms in a part of the cases. Recurrences years after infection are well known in experimental and natural BD in animals. It remains open, whether this mechanism could play a more prominent role in a form of "symptomatic" cyclothymia and "symptomatic" schizophrenia, although the results of CSF investigations are more clear in BDV seropositive patients with major psychoses.

Preattentive information processing in schizophrenia.

Preattentive and attentive information processing was investigated in 24 schizophrenic patients and 24 control subjects using a texture discrimination task based on Julesz's texton theory. Texton theory essentially defines a certain limited number of texture elements that can be detected readily and simultaneously without attentional effort irrespective of the size and information content of the rest of the visual field. During the first task, subjects had to detect texton elements (one 'L' among 35 '+'), which were presented on slides for 40 ms and were followed by a mask after different stimulus onset asynchronies (SOA: 200-800 ms). At all SOAs tested schizophrenics reported significantly fewer correct responses compared to the control group. In the second task, subjects had to search for texton (one 'L' among 35 '+') and non-texton elements (one 'L' among 35 'T') in the stimulus displays, whereby response times were measured. Schizophrenics showed significantly slower response times only to texton elements, whereas response times to non-texton elements did not significantly differ from controls. Additionally, schizophrenics made significantly more errors detecting non-texton elements than controls. The results suggest a deficit in processing of visual information in schizophrenic patients, which is confined to preattentive processes and may consist of a slowing of those processes. Schizophrenics may also have difficulty in sustaining their attention during search tasks.

[Expanded nuclear magnetic resonance studies in Borna disease virus seropositive psychiatric patients and control probands]. / Erweiterte kernspintomographische Untersuchungen bei Borna-disease-Virus -seropositiven psychiatrischen Patienten und Kontrollen.

There is growing evidence, that Borna Disease virus (BDV) or a variant may cause neuropsychiatric disorders in humans. The presence of specific BDV serum antibodies indicates an earlier contact with BDV. Earlier MRI results showing a raised prevalence of white matter lesions in BDV-seropositive psychiatric patients, possibly indicating encephalitic lesions, are not confirmed in this extended study, however in BDV-seropositive psychiatric patients the occurrence of cerebral atrophy seems to be more frequent, a finding compatible with hydrocephalus e vacuo found in animals after BDV-encephalitis. Because encephalitic lesions in BD are predominantly found in the gray matter of the brain, which is hardly visualized by MRI, the failure to detect lesions in BDV-seropositive patients could be due to methodological problems.

[Coping and compensation strategies of patients with disseminated encephalomyelitis and of patients with schizophrenic psychoses]. / Bewältigungs- und Kompensationsstrategien bei Patienten mit Enzephalomyelitis disseminata (MS) und bei Patienten mit schizophrenen Psychosen.

In ten patients with schizophrenic psychosis and ten patients with multiple sclerosis, the coping and compensation strategies were examined by means of semistructured interviewing. The following categories were considered: 1. avoidance; 2. habituation and/or adaptation to the disease; 3. efforts to compensate the deficits by will-power; 4. efforts to train certain types of behaviour; 5. self-treatment; 6. disease awareness and insight. Examples for these categories are given for both groups of patients. There is a surprising similarity in the statements made by the schizophrenic patients and those with multiple sclerosis. All of the patients with multiple sclerosis had developed coping strategies against psychological symptoms. It is suggested that the neuropsychological deficits in multiple sclerosis resemble the symptoms of reduced energetic potential observed in schizophrenia. In both groups efforts should be made to activate the compensation strategies by adequate training procedures.

Different regulation of adrenocorticotropin and cortisol secretion in young, mentally healthy elderly and patients with senile dementia of Alzheimer's type.

Previous studies suggest that an alteration of the neuroendocrine system may particularly occur in senile dementia of Alzheimer's type (SDAT). In the present study the reactivity of the hypophyseal-adrenocortical axis (HPA) in the elderly was assessed by hormonal stimulation of the hypophysis. Twelve young men (aged 21-24 yr), 15 mentally healthy elderly (aged 65-90 yr), and 12 patients with SDAT (aged 60-84 yr) received an iv bolus injection containing 50 micrograms CRH and 0.5 IU lysine vasopressin after a baseline period of 2 h. ACTH, cortisol, and dehydroepiandrosterone secretion was monitored over a period of 2 h before and after the injection. The baseline ACTH concentrations were increased in both groups of elderly, the baseline cortisol levels were not different in either group. The peak ACTH and cortisol levels were significantly elevated in the mentally healthy elderly, whereas senile demented patients showed a rise comparable with that in the young subjects. Moreover, in the demented patients the post-stimulus decline in plasma ACTH levels seemed to be delayed. Dehydroepiandrosterone was significantly lowered in subjects of all ages. Our results demonstrate an enhanced reactivity of the HPA in mentally healthy elderly. This is possibly due to a diminished sensitivity of the feedback regulation to glucocorticoids. However, SDAT patients had, compared to healthy elderly subjects, an attenuated response to CRH/lysine vasopressin and a prolonged ACTH secretion, indicating alterations of the HPA in this disease.

[Autoprotective mechanisms in patients with schizophrenic psychoses--compensation and coping]. / Autoprotektive Mechanismen bei Patienten mit schizophrenen Psychosen--Kompensation und Bewältigung.

For a long time, the coping and compensatory mechanisms of patients with schizophrenic psychoses have mostly been neglected by the psychiatric research. We extended the six categories of coping mechanisms described in the Bonn Scale for the Assessment of Basic Symptoms (BSABS) by three further categories. With fifty schizophrenic patients in different stages of their disease semistructured interviews concerning these categories were done. The main sociodemographic and historical parameters were registered as well. Then the protocols of the interviews were analyzed, the coping strategies were quantified, and it was tried to disclose relations between the disease progress and sociodemographic parameters. Patients used to a certain degree of autonomy e. g. unmarried patients had--compared to less independent patients--stronger coping strategies. Patients with a strong interest for their disease and a positive opinion about neuroleptic therapy had--compared to patients without interest for their disease and/or negative opinion about neuroleptic therapy--stronger coping and compensatory psychisms. It is concluded that the coping strategies might be reinforced by influencing these parameters.

Disease consciousness and coping strategies of patients with schizophrenic psychosis.

In 50 schizophrenic patients, semistructured interviews were carried out concerning disease consciousness, occupation with the disease and behaviour and coping in case of psychotic experiences; 72% of the patients occupied themselves with their disease. In 84% a disease consciousness was present; 38% gave a multifactorial explanation for their psychosis. In 94% the occasional appearance of psychotic experiences was acknowledged. In 86% specific changes of the individual behaviour for coping with these experiences were described. These changes included withdrawal, increasing of interpersonal contact, cognitive control, symptomatic behaviour and adjustment of the neuroleptic medication. The study shows that schizophrenic patients are not passive victims of their disease. In the majority of cases a disease consciousness is present. The patients try to cope with their psychotic experiences in individually different ways. It is assumed that a better knowledge of these strategies might enable the clinician to use these phenomena as an adjunct to pharmacotherapy.

[Integration and reintegration of first admission psychiatric patients]. / Integration und Reintegration ersteingewiesener psychiatrischer Patienten.

In the framework of a prospective follow-up study, development and outcome of the occupational and social status in 258 first-admission psychiatric patients was investigated. Interviews were made at the time of discharge, 1 year and 5 years later. For that reason prospective data exist on the prehospital and hospital time as well as on short-term and long-term course. Social adjustment, occupational rehabilitation, early retirement, social status and pre- and post-hospital occupational integration were investigated. It must be placed on record, that psychiatric patients are subjected to severe negative changes in their occupational and social life even after the first hospital treatment. Type and quantity of disintegration depended on the diagnostic group. Schizophrenic patients differed from the other patients in every intergration area.

[Coping and psychological compensation in patients with endogenous psychoses of schizophrenic origin]. / Bewältigungs- und Kompensationspsychismen bei Patienten mit endogenen Psychosen aus dem schizophrenen Formenkreis.

For a long period of time, the coping and compensatory mechanisms that arise from the patients with schizophrenic psychoses themselves have been considered only to a small extent by the psychiatric research. On the basis of Huber's concept of basic symptoms, we extended the six categories of coping mechanisms which are described in the Bonn Scale for the Assessment of Basic Symptoms (BSABS) by three further categories. With ten schizophrenic patients - mostly in-patients - semistructured interviews concerning these categories were done. All patients were found to have coping and compensatory mechanisms, and as a contribution to recognize and describe these mechanisms, parts of the patients' remarks are quoted. This is a prerequisite for an operationalized recording on larger patient populations that will possibly also allow correlation-statistical conclusions.