Executive deficits: a continuum schizophrenia-bipolar disorder or specific to schizophrenia?

Executive dysfunction is a core deficit in schizophrenia (SCH). However, some controversy exists when examining such deficits in studies of bipolar disorder (BD). The aim of the present research was to investigate whether executive deficits were similar or distinct in both illnesses. 148 patients with BD, 262 patients with stable SCH and 108 healthy controls (CT) were recruited for the study. The BD patients were also differentiated according to the clinical subtype (BD subtype I, BDI, or subtype II, BDII) they exhibited and according to whether there was a previous history of psychosis. All subjects completed a broad neuropsychological battery. The influences of other clinical data were also evaluated. Both the BD and SCH patients showed widespread deficits in all executive tasks, with no differences between these two groups of patients. BDII patients only showed some selective deficits, and their scores on planning and inhibitory tasks fell on the continuum between the CT, the BDI and the SCH patients. Psychotic phenotypes did not influence the BD patients' performance on the battery. Other clinical variables related to illness severity did influence deficits in any subgroup of patients. Our results point to the existence of common executive disturbances in both diagnostic categories. Moreover, the inclusion of subclinical phenotypes in research may be helpful in cognitive assessment studies.

NR4A2: effects of an "orphan" receptor on sustained attention in a schizophrenic population.

NR4A2 (nuclear receptor subfamily 4 group A member 2) or Nurr1 is a transcription factor implied in the differentiation, maturation, and survival of dopaminergic neurons. It also has a role in the expression of several proteins that are necessary for the synthesis and regulation of dopamine (DA), such as tyrosine hidroxilase, dopamine transporter, vesicular monoamine transporter 2, and cRET. DA is an important neurotransmitter in attentional pathways. Our aim was to evaluate the influence of NR4A2 gene in the performance of schizophrenia (SZ) patients and healthy subjects on a sustained attention task. For this study, we collected 188 SZ subjects (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and 100 control individuals. We genotyped 5 tag SNPs in NR4A2 gene: rs1150143 (C/G), rs1150144 (A/G), rs834830 (A/G), rs1466408 (T/A), and rs707132 (A/G). We also analyzed the influence of its haplotypes (frequency>5%). To examine sustained attention, all the individuals completed the Degraded Stimulus Continuous Performance Test. We evaluated "hits," "reaction time," "sensibility a," and "false alarms." In the schizophrenic group, recessive genotypes of rs1150143, rs1150144, rs834830, and rs707132 were associated with a worse performance. SZ subjects who carried GGGTG haplotype showed less hits (P<.004), lower sensibility a scores (P<.009), and a higher reaction time (P=.013). We observed a sex effect of the gene: genotype and haplotype associations were only present in the male group. We conclude that NR4A2 gene is involved in attentional deficits of SZ patients, modifying hits, sensibility a, and reaction time.

P50 sensory gating is a trait marker of the bipolar spectrum.

UNLABELLED: Sensory gating deficit, assessed by a paired auditory stimulus paradigm (P50), has been reported as a stable marker of schizophrenia. The aim of this study was to explore if this neurophysiological disturbance also fulfilled stability criteria in the bipolar disorder (BD) spectrum bipolar, as state independence is one of the main points to be considered as a potential endophenotype of the illness. The P50 evoked potential was studied in 95 healthy controls and 126 bipolar euthymic patients. Euthymia was established according to Van Gorp's criteria. Bipolar I and II subtypes were analyzed separately. The influence of a lifetime history of psychoses was also evaluated in the clinical sample. P50 gating was deficitary in all the subsamples of patients relative to healthy comparison subjects. Bipolar I patients with and without a history of psychosis showed higher P50 ratios than the other subgroups of patients, although these differences were not significant. P50 alterations were mainly due to a deficit in the inhibition of the second wave (test wave or S2) amplitude. CONCLUSIONS: The findings suggest that this inhibitory deficit can be considered characteristic of the illness and that the intensity of the gating abnormality varies according to the severity of BD.

Personality profiles between obese and control subjects assessed with five standardized personality scales.

BACKGROUND/AIM: Psychopathology may exert influence on developing and maintaining obesity. Studies of personality traits or psychopathology of personality in obesity are scarce and contradictory. The aim of this study was to compare personality profiles between obese and normal-weight subjects and to determine the most useful tool to detect differences, considering that psychological assessment and psychotherapeutical support should be included within the overall management of these patients.* METHOD: We examined 55 obese subjects (mean BMI=43kg/ m2) and 66 controls (mean BMI =21.7kg/m2). We used the personality assessment tools: MCMI-II, TCI-R, EPQ-A, BIS-111 and SSS. Factorial multivariate analysis of variance was applied; with factors BMI, Gender and Age as a covariate. RESULTS: Significant differences between groups were more marked in the clinical syndrome scales of MCMI-II, particularly in Major-Depression, Thought-Disorder, Anxiety, Somatoform and Alcohol-Dependence. Among obese, women scored higher than men in all scales but not significantly. We have found significant differences in normal personality dimensions between both groups in TCI-R. Obese showed higher scores in Harm Avoidance, and lower in Novelty Seeking, Persistence and Self-transcendence. The remaining tests have not been useful for differentiating personality traits between both groups. CONCLUSION: Obese subjects showed different personality profiles than control subjects. The most useful scales for determining these differences might be those designed to assess pathological personality such as MCMI-II. Less important would be those intended to measure normal personality traits, such as TCI-R and EPQ-A.

A study of verbal memory in a sample of euthymic patients with bipolar disorder.

BACKGROUND: Recent studies have confirmed the presence of cognitive impairment in euthymic patients with Bipolar Disorder (BD). A significant relationship between memory difficulties and poor psychosocial adjustment has also been found in these subjects. While some studies suggest that these memory deficits may be secondary to executive functioning instead of being directly related to a primary impairment of the memory systems, others suggest that these memory deficits may be secondary to clinical symptoms. Some authors reject the existence of any relationship between clinical state and neurocognitive impairments and suggest that this relationship may be mediated by other factors. The goal of this research was to replicate the findings of verbal memory impairment in euthymic patients with Bipolar Disorder and relate these impairments with neocortex structures. METHODOLOGY: We carried out a cross-sectional study. The sample was made up of 44 BDI and 9 BDII euthymic patients and 32 healthy subjects, aged 18-65 years. Both groups were evaluated with the California Verbal Learning Test. RESULTS: Both bipolar patients performed worse than healthy control subjects in most memory measures and showed difficulties in components of memory that are associated with both frontal (semantic organization) and temporal lobe function (recall and recognition). CONCLUSIONS: We have hypothesized that verbal memory could be a trait marker of bipolar disorder.

Estudio de memoria verbal en una muestra de pacientes con Trastorno Bipolar en fase eutímica / A study of verbal memory in a sample of euthymic patients with Bipolar Disorder

Introducción: Estudios recientes han demostrado la persistencia de disfunciones cognitivas en fases de remisión del trastorno bipolar (TB). Se ha encontrado una relación significativa entre los déficit de memoria y un pobre ajuste psicosocial. Mientras que algunos estudios apuntan a un déficit mnésico secundario a déficit de tipo ejecutivo, má sque a una alteración primaria de los procesos de memoria, otros estudios sugieren que los déficit mnésicos podrían ser secundarios a la sintomatología clínica. Otros autores, no encuentran relación entre el estado clínico y los déficit neurocognitivos y sugieren que esta relación debe estar mediada por otros factores. El objetivo de este trabajo fue replicarlos hallazgos de déficit en memoria verbal en pacientes con trastorno bipolar en fase eutímica y relacionar dichos déficit con estructuras del neocórtex. Metodología: Se realizó un estudio transversal. La muestra estuvo compuesta por 44 pacientes eutímicos con TBI, 9 con TBII en fase de eutimia y 32 sujetos sanos, con edades comprendidas entre los 18 y los 65 años. Se utilizócomo instrumento de evaluación de la memoria el California Verbal Learning Test. Resultados: Se observaron déficit en los dos subtipos de sujetos con TB, tanto en los componentes de memoria asociados con estructuras frontales (organización semántica)como en los relacionados con estructuras temporales(recuerdo y reconocimiento).Conclusiones La memoria verbal podrían ser una variable rasgo del TB (AU)

Background. Recent studies have confirmed the presence of cognitive impairment in euthymic patients with Bipolar Disorder (BD). A significant relationship between memory difficulties and poor psychosocial adjustment has also been found in these subjects. While some studies suggest that these memory deficits may be secondary to executive functioning instead of being directly related to a primary impairment of the memory systems, others suggest that these memory deficits may be secondary to clinical symptoms. Some authors reject the existence of any relationship between clinical state and neurocognitive impairments and suggest that this relationship may be mediated by other factors. The goal of this research was to replicate the findings of verbal memory impairment in euthymic patients with Bipolar Disorder and relate these impairments with neocortex structures. Methodology. We carried out a cross-sectional study. The sample was made up of 44 BDI and 9 BDII euthymic patients and 32 healthy subjects, aged 18-65 years. Both groups were evaluated with the California Verbal Learning Test. Results. Both bipolar patients performed worse than healthy control subjects in most memory measures andshowed difficulties in components of memory that are associated with both frontal (semantic organization) and temporal lobe function (recall and recognition) (AU)

Perfiles de personalidad en sujetos obesos y control medidos con cinco escalas estandarizadas de personalidad / Personality profiles between obese and control subjects assessed with five standardized personality scales

Introducción. La psicopatología puede ejercer influencia en el desarrollo y mantenimiento de la obesidad. Los estudios sobre los rasgos de personalidad o la psicopatología de la personalidad en obesidad son escasos y contradictorios. El objetivo de este estudio fue la comparación de los perfiles de personalidad entre sujetos obesos y normo-peso y la determinación de la herramienta más útil para la detección de diferencias, considerando que la evaluación psicológica y el apoyo psicoterapéutico deberían incluirse en el manejo de estos pacientes. Metodología. Examinamos 55 sujetos obesos (IMC=43kg/m2) y 66 controles (IMC=21,7kg/m2). Empleamos las herramientas de valoración de la personalidad: MCMI-II, TCI-R,EPQ-A, BIS-111 y SSS. Aplicamos un análisis multivariado dela varianza incluyendo los factores IMC, sexo y edad como covariables. Resultados. Se encontraron diferencias significativas más marcadas entre los grupos fueron más marcadas en las escalas clínicas del MCMI-II, especialmente en la de Depresión Mayor, Pensamiento psicótico, Ansiedad, Histeriforme y Abuso de alcohol. Entre los obesos, las mujeres puntuaron más que los hombres en todas las escalas, aunque no fue significativo. Encontramos diferencias significativas en los rasgos normales de personalidad entre ambos grupos en el TCI-R. Los obesos presentaron mayores puntuaciones en Evitación del daño y menores en Búsqueda de novedad, Persistencia y Trascendencia. El resto de los test no presentaron utilidad para la diferenciación de los rasgos de personalidad entre ambos grupos. Conclusión. Los sujetos obesos presentaron distintos perfiles de personalidad que los sujetos control. Las escalas de mayor utilidad para la determinación de estas diferencias podrían ser aquellas diseñadas para la evaluación de la personalidad patológica, tales como el MCMI-II. De menor importancia serían aquellas dirigidas a medir los rasgos de personalidad normal, tales como el TCI-R y el EPQ-A (AU)

Background/aim. Psychopathology may exert influence on developing and maintaining obesity. Studies of personality traits or psychopathology of personality in obesity are scarce and contradictory. The aim of this study was to compare personality profiles between obese and normal-weight subjects and to determine the most useful tool to detect differences, considering that psychological assessment and psychotherapeutical support should be included within the overall management of these patients. Method. We examined 55 obese subjects (mean BMI=43kg/m2) and 66 controls (mean BMI =21.7kg/m2). We used the personality assessment tools: MCMI-II, TCI-R, EPQ-A, BIS-111and SSS. Factorial multivariate analysis of variance was applied; with factors BMI, Gender and Age as a covariate. Results. Significant differences between groups were more marked in the clinical syndrome scales of MCMI-II, particularly in Major-Depression, Thought-Disorder, Anxiety, Somatoform and Alcohol-Dependence. Among obese, women scored higher than men in all scales but not significantly. We have found significant differences in normal personality dimensions between both groups in TCI-R. Obese showed higher scores in Harm Avoidance, and lower in Novelty Seeking, Persistence and Self-transcendence. The remaining tests have not been useful for differentiating personality traits between both groups. Conclusion. Obese subjects showed different personality profiles than control subjects. The most useful scales for determining these differences might be those designed to assess pathological personality such as MCMI-II. Less important would be those intended to measure normal personality traits, such as TCI-R and EPQ-A (AU)

Relevance of functional neuroimaging in the progression of mild cognitive impairment.

AIM: To assess whether combining neuropsychological tests and cerebral blood flow markers improves progression accuracy from mild cognitive impairment (MCI) to Alzheimer's disease (AD) than each of them on its own. METHODS: Forty-two patients were investigated prospectively, undergoing baseline and 3-year follow-up neuropsychological tests and neuroimaging with Tc-ECD-SPECT. Twenty-one patients had developed AD while 21 retained their initial diagnosis. The relative blood flow and cognitive differences were studied. Validity parameters, multivariant analysis and logistic regression model were calculated. RESULTS: Patients who deteriorated showed lower scoring than stable subjects in some neuropsychological tests (p = 0.03-0.001) and in relative blood flow in selected regions (8-10%). Low cognitive test scoring and low relative blood flow in some regions showed sensibilities and specificities from 70% to 86% for the diagnosis of early Alzheimer's disease. The relative risk of progression to AD was up to 4.7 times higher for these patients (p = 0.0001). The left frontal relative blood flow, the CAMCOG and orientation scoring were the best data to predict the risk of progression to AD. CONCLUSIONS: The combination of functional imaging and neuropsychological tests can diagnose with high sensitivity and specificity if a patient is suffering cognitive impairment in its early stages, and may aid in predicting the risk of developing dementia.