Music psychopathology. V. Objective features of instrumental performance and psychopathology.

Mental disease systematically impairs musical expression according to nosologic classification. This was demonstrated with a polarity profile of the instrumental performances of 60 inpatients and 14 controls matched for musical aptitude. Objective performance characteristics such as irregularities and playing faults were analyzed too. No meaningful correlation between these features and psychopathology resulted. This indicates that even in severe psychopathologic alterations performance features, which depend mainly on education and actual training, are not altered in a systematic manner, in contrast to expressive qualities.

Music psychopathology. VI. The course objective instrumental performance characteristics with psychiatric inpatients.

The impairment of musical expression due to mental disease is reversible with growing remission. This finding resulted from follow-up examinations of instrumental playings assessed by means of a polarity profile with 60 psychiatric inpatients and 14 controls. A follow-up comparison of objective performance characteristics as defined by careful analysis of the recordings did not reveal a meaningful variation. This is taken as a strong indication that even in severe psychopathologic alterations, learned motor patterns of music performance are fairly stable. A simple reduction in playing irregularities cannot explain the systematic influence of psychopathology on musical expression.

Brain dysfunction in psychiatric patients during music perception measured by EEG mapping: relation to motor dysfunction and influence of neuroleptic drugs.

We report here our findings on music perception obtained as a companion study to the investigation with 16-channel EEG mapping in psychiatric patients during motor activation, published recently elsewhere. We decided to add on a study of this functional circuit, since there is evidence that it is disturbed in various psychiatric patient groups (another "functio laesa"). Involved in the study were 23 male and 25 female schizophrenics, 11 male and 18 female non-endogenously depressed patients (not presently under medication, i.e. drug-naive or wash-out period from 1 week to 17 years), 26 male and 37 female endogenously depressed patients (medicated with tri- or tetracyclic antidepressants and/or benzodiazepines; no lithium), and 22 male and 17 female control subjects (i.e. n = 179). We compared resting conditions after a special relaxation procedure with three music perception tasks: (1) a standardised rumba rhythm generated by a keyboard and delivered binaurally by earphones, (2) the same as an arpeggio in D major, and (3) the same as an arpeggio with a tonic-subdominant-dominant cadence. Major results were obtained in the delta and alpha frequency bands, yielding signs of "diffuse hyperactivation", most prominent in schizophrenic males, and not observed to a similar extent in any other patient group or in normal controls. Interestingly, there were major sex differences, yielding a more diffuse EEG activation pattern in normal females than in males and thus possibly obscuring signs of brain function diffusion in female patients. Viewing our broader evidence of similar brain dysfunction when examining motor functional circuits, especially in schizophrenics, these findings provide further evidence of a brain disorganization with lack of laterality/diffusion which may be found in subgroups of these patients and not in other psychiatric disorders. In schizophrenic patients, these EEG signs of "diffuse hyperactivation" on simple motor and/or music stimulation were reduced to nearly normal by neuroleptic medication. The latter finding may contribute to possible clinical applications of EEG mapping, considering the EEG's unique suitability for long-term brain function monitoring. Other neuroimaging methods like SPECT and PET should be used for additional "external validation".

Music psychopathology. IV. The course of musical expression during music therapy with psychiatric inpatients.

The music therapeutic productions of 67 psychiatric inpatients were analyzed concerning a systematic variation in the course of therapy. The impairment of performance was not as regular as with customary music, nevertheless with growing remission it was reversible in all diagnostic subgroups. The change for the better of rhythmic and motor skills of endogenous-depressed patients was seen to the same extent as with traditional music. The polarity profile developed for the assessment of music proved meaningful in the characterization of music therapeutic utterances.

Psychomotor disturbances in psychiatric patients as a possible basis for new attempts at differential diagnosis and therapy. IV. Brain dysfunction during motor activation measured by EEG mapping.

In parts I-III of this series psychometric evidence was reported of a "psychotic motor syndrome" (PMS) in schizophrenic and endogenous depressed patients, which was not found in non-endogenous depressed or healthy persons. An attempt is reported to establish signs of brain dysfunction in these patient groups during motor activation, using a 16-channel EEG mapping system. "Resting" conditions after a special relaxation procedure were compared with simple and complex motor tasks (and music perception/reproduction; to be reported separately). Two measurements, at least 2 weeks apart, were obtained for each subject, in order to obtain information on the influence of drug treatment and/or psychopathological improvement on brain dysfunction. In all, 23 male and 25 female schizophrenics, 11 male and 18 female non-endogenous depressed patients (not actually mediated, i.e. drug naive or wash-out period of 1 week to 17 years), and 26 male and 37 female endogenous depressed patients (medicated with tri- or tetracyclic antidepressants and/or benzodiazepines; no lithium treatment) were compared with 22 male and 17 female control persons (i.e. total n = 179). Major findings were obtained in the delta and alpha frequency bands yielding signs of "diffuse hyperactivation" in schizophrenic and endogenous depressed patients as compared with the patterns found in healthy persons. However, since in the non-endogenous patients a (less marked) hyperactivation of various EEG parameters was also found, unspecific effects such as anxiety/arousal may have influenced the results in psychotic patients, which was to be explored further. Drug treatment tended to "normalize" the activation pattern both in schizophrenics and endogenous depressed patients. Viewing the findings on schizophrenics using neuroimaging methods [single photon emission computerized tomography-(SPECT), magnetic resonance imaging-(MRI), positron emission tomography-(PET)], these results suggest pathological brain organization connected to an impaired motor performance (evident peripherally as PMS) in schizophrenic and endogenous depressed patients. If it is possible to further "externally validate" (by SPECT/MRI/PET) EEG mapping data this method may exclusively offer the possibility of innocuous long-term follow up of brain dysfunction in psychotic patients ("brain function monitoring"). This could enable the early recognition (and early therapy) of negative symptoms. Finally, the EEG mapping findings provide further neurophysiological basis for the use of motor training programs in the additional therapy of psychiatric patients.

Mean age, sex ratio and psychopathology in alcohol psychoses.

In a retrospective study the case histories of 154 patients with acute alcohol psychosis were examined. The obvious diagnostic criteria in the doctor's differential diagnosis between alcohol withdrawal delirium and alcohol hallucinosis was clouding of sensorium and disorientation. 103 patients were diagnosed as having alcohol withdrawal delirium, 51 patients alcohol hallucinosis. Mean age and sex ratio were the same in both groups. Further psychopathological symptoms in both groups supporting differential diagnosis are discussed.

Time estimation of depressive patients: the influence of interval content.

Duration judgements for intervals of different lengths and content were studied in depressive in-patients (n = 47) and a control sample of surgical in-patients (n = 16). As suggested by research on non-clinical subjects, tasks during the intervals influenced the depressed patients' duration judgements. Severely depressed endogenous depressives (n = 17) over-estimated time when left completely unoccupied or when attending to tasks requiring concentration. Endogenous depressives (n = 17) remitted with regard to subjective depression but, exhibiting signs of psychomotor retardation, selectively over-estimated time when required to concentrate under time pressure. Neurotic/reactive depressives (n = 13) with an intermediate level of subjective depression and almost normal psychomotor functioning did not over-estimate any of these intervals. Time estimations of patients and controls did not differ for intervals in the range of seconds and minutes requiring attention to time only, and for a longer part of the experimental session. Alteration of time estimation and results of a time experience inventory corresponded for endogenous depressives but not for neurotic/reactive depressives. Results are discussed in terms of the influence of affective state and subjective concentration effort on the over-estimations observed.

Music psychopathology. II. Assessment of musical expression.

A short polarity profile which was well suited for the assessment of the musical expression of performances recorded from mentally ill patients and controls is described. 9 out of 12 polarities showed sufficient differentiating qualities, ranging from professional to poor amateur performances. Only 3 polarities had to be reformulated. The assessments of the 3 experts had a high interrater reliability and retest stability. The very significant correlation between the results of the experts and 50 independent subjects indicates the validity of the experiment.

Music psychopathology. III. Musical expression and psychiatric disease.

Musical expression of the instrumental playing of 61 mentally ill patients and 29 controls recorded several times was assessed by means of a short polarity profile. The performances were reversibly impaired in correlation with the psychopathology. Musical expression followed a systematic variation according to nosological classification. Endogenous-depressive patients could be clearly distinguished from neurotic-depressive patients due to weakened motoric qualities in their playing. In schizophrenia, motoricity did not seem to be so much involved, although the performances were altered in the dimension of musical logic and order. Maniform syndromes had the least effect on musical expression.

Music psychopathology. I. Musical tempo and psychiatric disease.

In 53 psychiatric inpatients and 31 matched controls musical tempo was examined by means of instrumental playing of a well-known children's song. Despite an extreme interindividual tempo range the individual tempo remained surprisingly stable also over longer periods of time. The assumption that tempo would slow down in correlation with depressed mood could only be confirmed for endogenous-depressive patients, although neurotic and schizophrenic patients were often depressed to a comparable extent. Tapping at maximum speed refers to the supposed correlation with weakened motor performance in psychotic depression which is discussed.

The functions of polymorphonuclear leukocytes emigrating into the skin.

The functions of polymorphonuclear leukocytes (PMNs) emigrating into the skin and of others separated simultaneously from the circulation were determined and compared in healthy individuals. The PMNs emigrating into the skin were separated with a skin chamber technique. The C3 rosette forming capacities of the skin migrating and the circulating PMNs were similar. The chemotactic responsiveness was evaluated using three different chemoattractants: zymosan-activated serum, casein and lymphocyte-derived chemotactic factor. The skin PMNs gave practically no chemotactic response in the Boyden chamber, irrespective of the chemoattractant used. On the other hand, the skin PMNs exhibited higher plastic surface adherence, nitroblue tetrazolium reduction and Candida albicans killing activities. The data indicate that some functional activities of PMNs undergo alteration during in vivo emigration into the skin. The alterations, overall, may be of importance in the physiological protective function of the skin.