Exploring the relationship between auditory hallucinations, trauma and dissociation.

BACKGROUND: It is clinically imperative to better understand the relationship between trauma, auditory hallucinations and dissociation. The personal narrative of trauma has enormous significance for each individual and is also important for the clinician, who must use this information to decide on a diagnosis and treatment approach. AIMS: To better understand whether dissociation contributes in a significant way to hallucinations in individuals with and without trauma histories. METHOD: Three groups of participants with auditory hallucinations were recruited, with diagnoses of: schizophrenia (without trauma) (n = 18), post-traumatic stress disorder (PTSD, n = 27) and comorbid schizophrenia and PTSD (SCZ+PTSD), n = 26). Clinician-administered measures included the PTSD Symptoms Scale Interview (PSSI-5), the Clinician-Administered Dissociative States Scale (CADSS) and the Psychotic Symptom Rating Scales (PSYRATS). RESULTS: Dissociative symptoms were significantly higher in participants with trauma histories (PTSD and SCZ+PTSD groups) and significantly correlated with hallucinations in trauma-exposed participants, but not in participants with schizophrenia (without trauma history). Hallucination severity was correlated with the CADSS amnesia subscale score, but depersonalisation and derealisation were not. CONCLUSIONS: Dissociation may be a mechanism in trauma-exposed individuals who hear voices, but it does not explain all hallucinatory experiences. The SCZ+PTSD group were in an intermediary position between schizophrenia and PTSD on dissociative and hallucination measures. The PTSD and SCZ+PTSD groups experienced dissociative phenomena much more frequently than the schizophrenia group, with a significant trend towards the amnesia subtype of dissociation.

Grey matter abnormalities in first-episode schizophrenia and affective psychosis.

BACKGROUND: Grey matter and other structural brain abnormalities are consistently reported in first-onset schizophrenia, but less is known about the extent of neuroanatomical changes in first-onset affective psychosis. AIMS: To determine which brain abnormalities are specific to (a) schizophrenia and (b) affective psychosis. METHOD: We obtained dual-echo (proton density/T2-weighted) magnetic resonance images and carried out voxel-based analysis on the images of 73 patients with first-episode psychosis (schizophrenia n=44, affective psychosis n=29) and 58 healthy controls. RESULTS: Both patients with schizophrenia and patients with affective psychosis had enlarged lateral and third ventricle volumes. Regional cortical grey matter reductions (including bilateral anterior cingulate gyrus, left insula and left fusiform gyrus) were evident in affective psychosis but not in schizophrenia, although patients with schizophrenia displayed decreased hippocampal grey matter and increased striatal grey matter at a more liberal statistical threshold. CONCLUSIONS: Both schizophrenia and affective psychosis are associated with volumetric abnormalities at the onset of frank psychosis, with some of these evident in common brain areas.

Grey matter abnormalities in first-episode schizophrenia and affective psychosis.

BACKGROUND: Grey matter and other structural brain abnormalities are consistently reported in first-onset schizophrenia, but less is known about the extent of neuroanatomical changes in first-onset affective psychosis. AIMS: To determine which brain abnormalities are specific to (a) schizophrenia and (b) affective psychosis. METHOD: We obtained dual-echo (proton density/T2-weighted) magnetic resonance images and carried out voxel-based analysis on the images of 73 patients with first-episode psychosis (schizophrenia n=44, affective psychosis n=29) and 58 healthy controls. RESULTS: Both patients with schizophrenia and patients with affective psychosis had enlarged lateral and third ventricle volumes. Regional cortical grey matter reductions (including bilateral anterior cingulate gyrus, left insula and left fusiform gyrus) were evident in affective psychosis but not in schizophrenia, although patients with schizophrenia displayed decreased hippocampal grey matter and increased striatal grey matter at a more liberal statistical threshold. CONCLUSIONS: Both schizophrenia and affective psychosis are associated with volumetric abnormalities at the onset of frank psychosis, with some of these evident in common brain areas.

The structural brain correlates of neurological soft signs in AESOP first-episode psychoses study

Patients with schizophrenia and related psychoses have an excess of minor neurological abnormalities (neurological soft signs of unclear neuropathological origin. These include poor motor coordination, sensory perceptual difficulties and difficulties in sequencing complex motor tasks. Neurological soft signs seem not to reflect primary tract or nuclear pathology. It still has to be established whether neurological soft signs result from specific or diffuse brain structural abnormalities. Studying their anatomical correlates can provide not only a better understanding of the aetiopathogenesis of soft signs, but also of the pathophysiology of schizophrenia. Suprisingly few studies have investigated the brain correlates of neurological soft signs. In the present study, we investigated the relationship between brain structure and neurological soft signs in an epidemiologically based sample of 77 first-episode psychosis patients. We used the Neurological Evaluation Scale for neurological assessment and high-resolution MRI and voxel based methods of image analysis to investigate brain structure. Higher rates of soft neurological signs (both motor and sensory) were associated with a reduction of grey matter volume of subcortical structures (putamen, globus pallidus and thalamus). Signs of sensory integration deficits were additionally associated with volume reduction in the cerebral cortex, including the precentral, superior and middle temporal, and lingual gyri. Neurological soft signs and their associated brain changes were independent of antipsychotic exposure. We conclude that neurological soft signs are associated with regional grey matter volume changes and that they may represent a clinical sign of the perturbed cortical-subcortical connectivity that putatively underlies psychotic disorders(AU)

The structural brain correlates of neurological soft signs in AESOP first-episode psychoses study.

Patients with schizophrenia and related psychoses have an excess of minor neurological abnormalities (neurological soft signs) of unclear neuropathological origin. These include poor motor coordination, sensory perceptual difficulties and difficulties in sequencing complex motor tasks. Neurological soft signs seem not to reflect primary tract or nuclear pathology. It still has to be established whether neurological soft signs result from specific or diffuse brain structural abnormalities. Studying their anatomical correlates can provide not only a better understanding of the aetiopathogenesis of soft signs, but also of the pathophysiology of schizophrenia. Surprisingly few studies have investigated the brain correlates of neurological soft signs. In the present study, we investigated the relationship between brain structure and neurological soft signs in an epidemiologically based sample of 77 first-episode psychosis patients. We used the Neurological Evaluation Scale for neurological assessment and high-resolution MRI and voxel-based methods of image analysis to investigate brain structure. Higher rates of soft neurological signs (both motor and sensory) were associated with a reduction of grey matter volume of subcortical structures (putamen, globus pallidus and thalamus). Signs of sensory integration deficits were additionally associated with volume reduction in the cerebral cortex, including the precentral, superior and middle temporal, and lingual gyri. Neurological soft signs and their associated brain changes were independent of antipsychotic exposure. We conclude that neurological soft signs are associated with regional grey matter volume changes and that they may represent a clinical sign of the perturbed cortical-subcortical connectivity that putatively underlies psychotic disorders.

Gender differences in premorbid adjustment of patients with first episode psychosis.

Gender differences in premorbid adjustment, clinical presentation, and longitudinal course have been considered increasingly in explanatory models of psychotic disorders, such as the schizophrenias. Indeed, findings of a male propensity to poor premorbid adjustment, negative and non-affective symptoms, and poor outcome relative to their female counterparts, has led to suggestions that males are more prone to an early-onset dementia praecox type of schizophrenic disorder. The current study investigated a sample of 38 male and 20 female patients presenting with their first episode of psychosis (broadly defined, but excluding obvious drug-induced disorders) from a defined catchment area population, which had been systematically ascertained without prejudice to diagnostic subtype or illness duration. The study investigated gender, diagnosis and interaction of gender and diagnosis on differences within the three developmental age categories of childhood, early adolescence and late adolescence, to identify where, within these age categories, differences lie. The second part of the study was to investigate the relationship between premorbid adjustment, gender, and psychopathology as measured by the PANSS and SCL-90. General linear modelling revealed that males were reported to have had poorer premorbid adjustment in late adolescence when compared to females, notably in items examining school performance, adaptation to school, social interests and sociosexual development. Males were observed to have higher levels of negative symptoms but not for positive or general symptoms on the PANSS. This finding is independent from the effect of diagnosis or of the interaction effect between gender and diagnosis on premorbid adjustment. There were no gender effects for the self reported global indices on the SCL-90. The results suggest that in comparison with their female counterparts, males who develop a psychotic illness have significantly poorer premorbid adjustment at the late adolescent stage and that this may contribute to higher levels of negative symptoms.