Neurobehavioural and cognitive function is linked to childhood trauma in homeless adults.

OBJECTIVES: To describe levels of traumatic childhood events in a sample of homeless individuals and to assess the contribution of traumatic events to neurobehavioural traits (measured with the Frontal Systems Behaviour Scale, FrSBe) and general cognitive function (IQ). DESIGN: A sample of 55 homeless adults was recruited from homeless services in the city of Sheffield, UK. All were interviewed to acquire substance misuse information, record experiences of childhood trauma, and assess cognitive and neurobehavioural traits. METHODS: Experiences of abuse and neglect were assessed with the Childhood Trauma Questionnaire. Participants also completed the Wechsler Abbreviated Scale of Intelligence and the FrSBe, which was completed with respect to current behaviour and conduct prior to homelessness. RESULTS: Around three-quarters of the sample scored in the clinically significant range for current neurobehavioural impairment. They also reported high levels of impairment when rating retrospectively for the period before they were homeless. The mean group IQ was below average at 88. Abuse or neglect during their upbringing was reported by 89% of the sample. Emotional abuse, emotional neglect, and physical neglect were all positively correlated with total FrSBe scores. Sexual abuse, emotional neglect, and physical neglect were all negatively correlated with IQ. The associations between trauma and IQ and neurobehavioural traits appear generally unrelated to the presence of substance misuse in the sample. CONCLUSION: Our homeless sample displayed relatively low IQ with high levels of neurobehavioural impairment. Our evidence suggests that these neuropsychological factors may, in part, constitute a long-term consequence of childhood trauma.

Treatment effects of therapeutic cholinesterase inhibitors on visuospatial processing in Alzheimer's disease: a longitudinal functional MRI study.

BACKGROUND/AIMS: Visuospatial impairments are known to occur in Alzheimer's disease (AD). We hypothesised that functional magnetic resonance imaging (fMRI) response in task-related brain regions would be impaired in patients with AD during the task and that treatment with acetyl cholinesterase inhibitors would enhance activations in brain regions concerned with this visual perceptual processing. METHOD: Ten AD subjects were neuropsychologically assessed and underwent fMRI imaging whilst performing a series of visuospatial perception tasks, before and after treatment with acetyl cholinesterase inhibitors. Eleven healthy elderly comparison subjects were also scanned twice. RESULTS: Regions of increased brain activation in AD included the left precuneus, left cuneus, left supramarginal gyrus, right parieto-temporal cortex and right inferior parietal lobule. Further, increased activation in the left precuneus was found to correlate significantly with improved functioning of activities of daily living. CONCLUSIONS: We believe this to be the first fMRI study that, after controlling for the confound of repeat scanning, demonstrates altered patterns of brain activation associated with visuospatial processing following treatment in patients with AD. The treatment-related improvement of visual perception in AD may rely on enhanced attentional mechanisms, thereby possibly supporting independent living through improvement on activities of daily living.

Performance on the clock drawing task correlates with FMRI response to a visuospatial task in Alzheimer's disease.

The clock drawing (CD) task involves visual integration skills associated with parietal lobe function. Seven mild Alzheimer's Disease (AD) patients and 11 healthy elderly controls (EC) underwent functional magnetic resonance imaging (fMRI) scanning while viewing a radial motion (RM) task. This RM task in EC activated the bilateral secondary visual cortex and parietal regions, whereas AD patients activated only the right-sided secondary visual cortex. The magnitude of the fMRI signal in the left superior parietal lobe was positively correlated with performance on the CD task in AD patients. These findings suggest that complex visuospatial processing impairments reflect the underlying AD neuropathology in parietal regions.

Evidence of mnemonic ability selectively affecting truthful and deceptive response dynamics.

In the executive model of deception, the telling of a lie necessitates the inhibition of a veridical prepotent response (the truth), and such inhibition incurs a temporal penalty, manifest as a longer response time. If memory processes are engaged in generating such truths, then memory function should affect truthful and deceptive response times. To investigate this we examined the relationship between performance on a semantic knowledge deception task and a test of verbal memory in 40 college students. We found that verbal memory performance differentially affects the temporal parameters of truth and deception.

Time perception and its neuropsychological correlates in patients with schizophrenia and in healthy volunteers.

Disordered time perception has been reported in schizophrenia. We investigated time perception dysfunction and its neuropsychological correlates in patients with schizophrenia. Participants comprised 38 patients and 38 age- and sex-matched healthy volunteers who were compared in an auditory temporal bisection paradigm using two interval ranges (a 400/800 ms condition and a 1000/2000 ms condition). In the temporal bisection, subjects were required to categorise a probe duration as short or long, based upon the similarity with two reference durations. All subjects also completed a battery of neuropsychological tests measuring sustained attention, short- and long-term memory and executive function. In the 400/800 ms condition, patients judged durations significantly shorter than did control subjects. Patients also exhibited decreased temporal sensitivity in both conditions. We found in both groups a negative association between temporal sensitivity and sustained attention for the 400/800 ms condition, and between temporal sensitivity and long-term memory for the 1000/200 ms condition. In patients, short-term memory performance was negatively associated with duration judgement in both conditions, while executive dysfunction was correlated to a general performance deficit in the 400/800 ms condition. These findings suggest the possibility that time perception abnormalities in schizophrenia are part of neuropsychological dysfunction and are likely to adversely impact upon activity of daily living.

The neural basis of visuospatial perception in Alzheimer's disease and healthy elderly comparison subjects: an fMRI study.

The neural basis of visuospatial deficits in Alzheimer's disease is unclear. We wished to investigate the neural basis of visuospatial perception in patients with Alzheimer's disease compared with healthy elderly comparison subjects using functional magnetic resonance imaging (fMRI). Twelve patients with AD and thirteen elderly comparison subjects were investigated. The patients were recruited from the local clinic and comparison subjects were from spouses and community. All participants underwent fMRI whilst viewing visuospatial stimuli and structural MRI, and findings were analysed using voxel-based morphometry. The comparison group activated V5, superior parietal lobe, parieto-occipital cortex and premotor cortices. The AD group demonstrated hypoactivation in the above regions and instead showed greater activation in inferior parietal lobule and activated additional areas. There was no structural atrophy above and beyond that found globally in patients in the identified regions of BOLD activation. To our knowledge, this is the first study to explore the neuroanatomy of perception of depth and motion in Alzheimer's disease. These specific functional deficits in AD provide evidence for an underlying patho-physiological basis for the clinically important symptom of visuospatial disorientation in patients with AD.

Time perspective, depression, and substance misuse among the homeless.

Using the Zimbardo Time Perspective Inventory (ZTPI; P. G. Zimbardo & J. N. Boyd, 1999), the authors found that homeless people, in comparison with a control group, had a significantly more negative outlook concerning their past and present as evinced by high Past-Negative and Present-Fatalistic scores and low Past-Positive scores on the ZTPI. However, the homeless individuals were almost indistinguishable from control participants on measures of Present-Hedonism and Future thinking. The homeless individuals had significantly higher levels of depression, with 31 out of 50 (62%) reaching criteria for probable depression. However, this finding was unrelated to their atypical time perspective. There was no significant relation between substance misuse and time perspective. Despite their current difficulties, including depression and drug abuse, the homeless individuals maintained a propensity toward future thinking characterized by striving to achieve their goals.

Lateral response dynamics and hemispheric dominance for speech perception.

In this study, we investigated the mechanism for the left cerebral hemisphere's dominance for speech perception. We utilized the crossover of auditory pathways in the central nervous system to present speech stimuli more directly to the left hemisphere (via the right ear) and right hemisphere (via the left ear). Using functional MRI, we found that estimated duration of neural response in the left auditory cortex increased as more speech information was directly received from the right ear. Conversely, response duration in the right auditory cortex was not modulated when more speech information was directly received from the left ear. These data suggest that selective temporal responding distinguishes the dominant from nondominant hemisphere of the human brain during speech perception.

Voice familiarity engages auditory cortex.

Familiarity with a speaker's voice has been shown to enhance its auditory processing, implicating physiological effects at the level of the auditory cortex, although auditory cortical involvement has not previously been demonstrated. Eleven healthy right-handed male participants performed two tasks during blood oxygenation level-dependent functional MRI at 1.5 T. Both tasks used the same vocal stimuli. In task 1, they classified speakers as familiar or unfamiliar. In task 2, they judged stimuli as being in the right or left auditory field. Our analysis showed an area of auditory cortex on the lower bank of the superior temporal sulcus that was preferentially activated by familiar voices in both tasks. Familiar voices may elicit access to detailed sensory expectations, allowing enhanced auditory cortical processing.

Increased cerebellar vermis white-matter volume in men with schizophrenia.

We aimed to investigate cerebellar structural abnormalities and their functional significance in patients with schizophrenia. Forty right-handed men with schizophrenia and 40 sex, age and handedness matched controls underwent a volumetric magnetic resonance scan with 1 mm3 isotropic spatial resolution. Cerebellar grey- and white-matter volumes were analysed using voxel-based morphometry. Patients with schizophrenia completed a battery of neuropsychological tests assessing sustained attention (continuous performance test), memory (Hopkins memory test) and executive function (verbal fluency and Wisconsin card sorting tests). Patients with schizophrenia exhibited significantly increased cerebellar vermis white-matter volume compared with controls. By contrast, total cerebellar volume, and grey- and white-matter volumes of cerebellar hemispheres were not significantly different between groups. Increased vermis white-matter volume in patients was associated with poor verbal fluency performance. We concluded that increased white-matter in the cerebellar vermis, possibly suggesting anomalous connectivity, may be associated with verbal executive dysfunction in men with chronic schizophrenia.

Fronto-temporal-lobe atrophy in early-stage Alzheimer's disease identified using an improved detection methodology.

Alzheimer's disease (AD) is associated with widespread brain atrophy including structures subserving memory. We applied an improved structural detection methodology to examine the less well known progression of atrophy in early-stage AD. We sought to i) longitudinally study volumetric differences in patients with early-stage AD and healthy volunteers; and ii) test the hypothesis that hippocampal volumes would be correlated with clinically relevant cognitive function. Seven patients and eleven healthy subjects underwent two structural MRI scans and neuropsychological assessments. Scans were normalised to a study-specific template and 'morphologically opened' to reduce tissue misclassification. Using brain-parcellation, patient atrophy was localised to left fusiform and parahippocampal gyri, whilst left hippocampal volumes were correlated with a cognitive performance measure. A whole-brain search methodology, showed that patients had reduced volumes including fronto-temporal regions bilaterally, in hippocampi and amygdalae and right cerebellum. Whole-brain correlational analyses revealed that cognitive performance was correlated with volumes of both hippocampi, superior temporal gyri and left insula. Neither group exhibited significant longitudinal volumetric changes. Utilising a novel methodology, we have shown that in early-stage AD, clinically relevant cognitive deficits are correlated with regionally specific grey-matter volumes, which are detectable at an early stage of the illness.

A systematic review of cognition in homeless children and adolescents.

Objectives The cognitive function of homeless children and adolescents may be overlooked, albeit understandably, when societal interventions focus on their immediate housing needs. Nevertheless, homelessness might be hypothesized to carry many risks for the developing mind and brain. We wanted to discover whether this hypothesis had been tested previously. Design A systematic review to examine whether cognitive impairments were reported in homeless children and adolescents. Setting Objective, systematic review of standard databases, examined by key word searches. Participants Children and adolescents. Main outcome measures Formal assessments of cognition. Results We found that in spite of there being many homeless children in the world, fewer than 2000 have been assessed cognitively and reported in the literature. Yet when compared with those who are domiciled, these children tend to have lower intellectual functioning and decreased academic achievement. Furthermore, adolescents evince cognitive impairments in the contexts of drug, physical, and sexual abuse. Conclusions We suggest that cognitive and mental health screening be incorporated into those intervention programs deployed to facilitate societal reintegration of homeless children and adolescents.

A functional magnetic resonance imaging study of social cognition in schizophrenia during an acute episode and after recovery.

OBJECTIVE: Difficulty with social interactions is a characteristic of schizophrenia. The authors used functional magnetic resonance imaging (fMRI) to investigate brain activation changes during a social cognition paradigm in patients with schizophrenia during and after an acute episode and their association with social and executive function. METHOD: In a longitudinal study design, 14 patients with schizophrenia experiencing an acute episode had an fMRI scan. They returned for a follow-up scan after clinical improvement. Fourteen healthy comparison subjects were also scanned twice with approximately the same time interval between scans as in the patient group. The authors employed a social cognition fMRI paradigm involving empathic and forgivability judgments. Schizophrenia symptoms, social functioning and illness insight scales, and the Wisconsin Card Sorting Test were used to examine whether improvement on these measures was associated with recovery of brain activation in response to the social cognition paradigm. RESULTS: After recovery from the acute episode, patients exhibited increased activation in the left medial prefrontal cortex, which was, in turn, significantly correlated with improved insight and social functioning. Decreased symptom severity and improved performance on the Wisconsin Card Sorting Test were not significantly associated with increased left medial prefrontal cortex activation. CONCLUSIONS: This is the first study to the authors' knowledge to use a social cognition paradigm to reveal improved left medial prefrontal cortex activation in schizophrenia after recovery from an acute episode. These results suggest that restored left medial prefrontal cortex activation may mediate improvement of insight and social functioning in patients with schizophrenia.

A new dissimilarity measure for finding semantic structure in category fluency data with implications for understanding memory organization in schizophrenia.

The ordering of words in category fluency lists is indicative of the semantic distance between items in conceptual memory. Several studies have concluded from structural analyses of such data, using cluster analysis or multidimensional scaling, that the semantic memory of patients with schizophrenia is more disorganized than that of controls. Previous studies have based their analyses on a measure of average interitem dissimilarity devised by A. S. Chan et al. (1993). Here the authors derive a new and improved method of determining dissimilarity and show that when this measure is applied to the fluency lists of patients with schizophrenia, the average pattern of organization for the animal category has similar structure to that of controls, but with greater variability between individuals.

Self-harm and homeless adults.

BACKGROUND: Homelessness is associated with an increased incidence of mental illness and risk of self-harm, including suicide. AIMS: To assess the prevalence of self-harm (including nonsuicidal self-injury and attempted suicide) among a UK sample of homeless adults and to compare demographic, clinical, and homeless-related variables to determine which are linked to self-harm in this population. METHOD: A sample of 80 homeless adults were interviewed regarding history of self-harm, mental health history, demographic, and homeless-related information. RESULTS: Sixty-eight percent of the sample reported past acts of self-harm. Those with histories of self-harm started using significantly more substances since becoming homeless and were younger when they first became homeless. They were also significantly more likely to have a past psychiatric admission and thoughts of self-harm in the past year. CONCLUSION: Self-harm is common among homeless adults and linked to long-term and enduring social and mental health concerns.

Premorbid and current neuropsychological function in opiate abusers receiving treatment.

BACKGROUND: There is an established corpus of evidence linking substance abuse with neuropsychological impairment, particularly implicating frontal lobe functions. These could potentially be premorbid to, rather than consequences of, direct effects of substance abuse. METHODS: A matched pairs design was employed in which currently abstinent opiate abusers in treatment were matched to 22 healthy control individuals. These were compared for premorbid and current neurobehavioral abnormalities with the self-report Frontal Systems Behavior Scale (FrSBe). Estimated premorbid and current IQ scores were also ascertained. RESULTS: There was no difference between the groups regarding socioeconomic background. There was no evidence for an alteration in cognitive function as measured by current IQ associated with opiate abuse, nor evidence of premorbidly lower IQ. However, with the FrSBe, the opiate abusers reported overall higher levels of apathy. They also had raised FrSBe total scores, indicating the presence of neurobehavioral features associated with frontal lobe impairment. Furthermore, the opiate abusers reported higher levels of these neurobehavioral abnormalities compared to their matched controls, even in the period preceding substance abuse. CONCLUSIONS: The results suggest that some substance abusing individuals in treatment demonstrate raised levels of neurobehavioral abnormalities, independently of general intellectual functioning. Furthermore, the results imply that these abnormalities may have already been present prior to the effects on the nervous system of substance abuse.

Speech and language therapy intervention in schizophrenia: a case study.

BACKGROUND: There is a significant body of evidence documenting the speech and language abnormalities found in adult psychiatric disorders. These speech and language impairments can create additional social barriers for the individual and may hinder effective communication in psychiatric treatment and management. However, the role of speech and language therapy in this patient population has not been extensively studied. AIMS: Speech and language therapy is reported in a 53-year-old adult male patient who presented with severe poverty of speech as part of his diagnosis of schizophrenia. The aims of speech and language therapy focused on increasing the patient's verbal communication using a combination of traditional and non-traditional speech and language therapy methods. METHODS & PROCEDURES: Two phases of speech and language therapy were implemented. The first phase focused on desensitizing the patient to verbal communication. The second phase developed the patient's language productivity and increased his awareness of his social communication skills. Five separate measures were taken as baselines which were repeated at the end of the intervention. OUTCOMES & RESULTS: Post-intervention scores showed that the intervention was partly successful. The patient's verbal communication increased and he developed more appropriate social communication skills. His negative attitude to communication remained unchanged even though his self-evaluative status improved. CONCLUSIONS: The intervention is discussed in terms of the pre- and post-intervention measures and the role of speech and language therapy in schizophrenia. The study suggests that speech and language therapy can contribute to the understanding and management of schizophrenia and other adult psychiatric disorders.

Neurocognitive basis of insight in schizophrenia.

People with schizophrenia have been categorised into three groups: those with full insight (aware, correct attributers); those aware of being unwell, but who misattributed their symptoms (aware, incorrect attributers); and those unaware of being ill (unaware). Cluster analysis of 'awareness of illness'and 'relabelling of symptoms'scores on the Schedule for the Assessment of Insight confirmed three distinct subgroups. The unaware group were impaired on executive and memory tests, whereas those in the aware, misattributing group were cognitively intact. Findings support an association between unawareness of illness and executive dysfunction, and highlight the separation of symptom misattribution from unawareness of illness.

Association of cigarette smoking and depressive symptoms in a forensic population.

The link between mental health issues and smoking has been an important area of investigation. However, little is known about this association in a general adult, male forensic population. The aim of this study was to identify demographic and clinical (depression and anxiety) variables that predict smoking in a forensic population. A large cohort of 353 inmates in a high-security prison underwent a psychiatric interview, including administration of the Montgomery-Asberg Rating Scale for Depression (MADRS) and Hamilton's Rating Scale for Anxiety (HAM-A). Multiple regression analysis suggested that younger age and higher depression scores might predict the amount of daily smoking in this population. In contrast, anxiety symptoms were not an independent predictor for smoking in our study. These findings support the need for additional research to focus on those factors associated with smoking in forensic populations. Psychiatric screening for younger male individuals in forensic settings and targeted cognitive-behavioral interventions to treat depressed smokers may ameliorate the smoking abstinence rate in prisons.

Executive dysfunction screening test for neuropsychiatric disorders.

The Analogies Understanding Test (AUT) was developed as a brief cognitive screening task of executive problem solving. A few of the test items at the beginning are "facilitated" as a means of engaging patients. Individuals with schizophrenia and mild Alzheimer's Disease (AD) made significantly less correct responses than their control groups. The schizophrenia patients, but not AD patients, made significantly more perseverations than controls on the AUT. As expected, AUT performance in schizophrenia patients correlated with the Wisconsin Card Sorting test measures. Preliminary findings suggest that the AUT test may be useful as a measure of executive dysfunction in neuropsychiatric patients.