Remote and recent memory in long-hospitalized chronic schizophrenics.

This study shows that chronic, long-hospitalized schizophrenics perform (tested by the Famous Events Questionnaire) at a higher level on remote memory than they do on word list recall. A post hoc, matched-tasks check suggested that this finding was not due to differences in the discriminating power of the tasks. Relative to normals, patients showed no differential performance on the three time periods (1973/74, 1979/80, 1984) represented in the remote memory questionnaire, thus giving no evidence for an amnesic gradient. The findings are discussed in relation to amnesia and dementia hypotheses in chronic schizophrenia.

Performance of chronic schizophrenics on matched word and design recall tasks.

Matched word and design recall tasks were constructed and used to assess the performance of chronic schizophrenics on neuroleptics alone and on both neuroleptic and anticholinergic drugs. The two groups of patients performed at an equally low level on both tasks, without evidence for a differential deficit. The tasks did, however, evoke a differential deficit in clustering performance for designs as opposed to words. Although clustering, which is based on recall, is not necessarily as well matched for words and designs as recall itself, this result suggests a lateralized dysfunction in brain structures related to use of mnemonic organization at retrieval.

Effect of fenfluramine on mood: a double-blind placebo-controlled trial.

Depressed patients (n = 10), schizophrenics (n = 6), and normal control subjects was (n = 9) were administered fenfluramine hydrochloride (FF) (60 mg/os) or placebo in the context of a randomized, double-blind crossover trial. No effect of FF on mood or activation was detected over a 6-hr period. A previous report claiming acute antidepressant effects of FF in depressed subjects was not confirmed.

Facilitation of ECT by caffeine pretreatment.

In this study, eight patients participated in a standardized protocol to assess the effects of caffeine on seizures in ECT. Caffeine sodium benzoate (500-2000 mg) was administered intravenously 10 minutes before ECT, and seizure duration was compared with that of a previous treatment unmodified by caffeine. Seizure duration was significantly increased during ECTs preceded by caffeine. Three other patients given caffeine when seizures of adequate duration could no longer be elicited at maximal stimulus levels experienced longer seizures. Administration of caffeine was not associated with significant cardiovascular or other (including cognitive) adverse effects.

Antidepressant and cognitive effects of twice- versus three-times-weekly ECT.

OBJECTIVE: The purpose of this study was to determine which of the two commonly used schedules of ECT administration, twice or three times weekly, is clinically optimal in terms of antidepressant efficacy and cognitive effects. METHOD: In this double-blind study, 52 consenting, medication-free patients with major depressive disorder, endogenous subtype (Research Diagnostic Criteria), were randomly assigned to bilateral, brief-pulse, constant-current ECT administered over 4 weeks at a rate of three times weekly or twice weekly with the addition of one simulated ECT (anesthesia and muscle relaxant only) per week. Outcome measures were the Hamilton Depression Rating Scale, Acute Cognitive Effects Battery, and Chronic Cognitive Effects Battery. RESULTS: Hamilton depression scale scores were significantly improved by both schedules, with no difference in outcome either 1 week or 1 month after the end of the ECT series. However, the rate of response to ECT three times a week was significantly faster and was related to the rate of real ECT administration. Cognitive effects were more prominent with ECT three times a week. CONCLUSIONS: ECT twice a week is an effective schedule for clinical practice and is potentially advantageous in view of a therapeutic outcome identical to that of ECT three times a week and less severe cognitive effects. ECT three times a week may be specifically indicated when early onset of clinical effect is of primary importance.

Factor analysis of schizophrenic symptoms and comparison of different rating scales.

This study examines the factor structure of persistent schizophrenic symptoms and compares factors derived from different rating scales. Forty stable chronic schizophrenic patients were assessed for positive and negative symptoms. In factor analysis, 3 factors could be detected: a negative factor which correlated with low drug dose and increased involuntary movements, a thought disturbance/paranoid factor which correlated negatively with extrapyramidal side effects and a delusion/hallucination factor which correlated negatively with involuntary movements. These findings support the existence of a negative factor but only partly the trichotomous division of schizophrenic symptoms. Positive symptom organisation is heterogeneous but thought disorder marks one clear dimension and non-paranoid delusions and hallucinations may mark another. The type of scale used has very significant effects on the findings.

Neuroendocrine responses in chronic schizophrenia. Evidence for serotonergic dysfunction.

Neuroendocrine and mood responses to a 60 mg oral dose of the serotonin-releasing agent, fenfluramine, were assessed in ten neuroleptic-free, chronic schizophrenic patients and in age- and sex-matched normal control subjects. The prolactin (PRL) response to fenfluramine was significantly blunted in the schizophrenic subjects. Growth hormone and cortisol levels were not differentially affected by the challenge. There was no significant effect of fenfluramine on mood in either group. The blunted PRL response in the schizophrenic group suggests serotonergic dysfunction; possible mechanisms of this finding and implications for treatment are considered.

Evidence for distinct verbal memory pathologies in severely and mildly disturbed schizophrenics.

It is well known that schizophrenics have difficulty in effectively encoding verbal materials into their long-term memories and consequently show a deficit in recall. Recently, orienting tasks were introduced as a method for achieving equivalent to normal encoding and mnemonic organization in schizophrenics; consequently, their deficit in recall disappeared. A detailed review of the literature, however, showed that such effective orienting tasks had only been applied to mildly disturbed schizophrenics (nonchronic, in a good condition). This report presents three experiments which show that more severely disturbed (chronic, hospitalized) schizophrenics, unlike mildly disturbed patients, have memory deficits that cannot be located at the encoding stage. Severely disturbed schizophrenics show (1) a recall deficit, even after effective encoding and mnemonic organization are induced; (2) excessive forgetting over 24- and 48-hour periods; and (3) a recognition memory deficit. These deficits are in addition to their encoding deficit. The use of a matched-tasks check in experiments 2 and 3 suggests that this postencoding deficit is a differential deficit and does not is a differential deficit and does not simply reflect the schizophrenic generalized deficit. Theoretical implications, also supported by the use of various organizational indices (e.g., clustering, hierarchical clustering schemes, and hierarchical grouping analysis), are discussed.

Optimal use of electroconvulsive therapy: choosing a treatment schedule.

Choice of treatment schedule is an important component of the ongoing efforts to optimize electroconvulsive therapy (ECT) administration and thereby maximize therapeutic benefit while reducing cognitive adverse effects. Frequency of ECT administration (that is, the spacing between treatments) and the total number of treatments in a series are the two factors that define the ECT schedule. Available evidence supports the view that a schedule of twice weekly ECT with a total of six to eight treatments is an effective therapeutic regiment that potentially reduces cognitive morbidity associated with more frequent administration and a larger number of treatments. More frequent administration, however, may accelerate antidepressant response and may be indicated in cases in which rapidity of therapeutic effect is a significant clinical consideration. This consideration may be at the cost of greater cognitive impairment, which could be reduced by limiting the number of treatments administered. Aside from their clinical relevance, these issues have important implications for understanding the mechanisms of action of ECT.

Verbal and visuospatial recall by younger and older subjects: use of matched tasks.

In this study, 18 older (over age 65, M = 75.61 years) and 18 younger (below age 40 and over age 17, M = 26.44 years) healthy volunteers were tested on verbal and visuospatial recall. Tasks were matched on discriminating power. Older Ss performed worse than younger Ss on both tasks. The older Ss also showed a larger deficit in visuospatial than in verbal recall, relative to the younger Ss. These results are consistent with the theory of aging according to which verbal tasks are more resistant to deterioration than are nonverbal tasks. A psychological explanation based on lifetime experience with verbal material is preferred over the physiological explanation advocating faster aging of the right hemisphere.

Sorting consistency as a diagnostic tool for schizophrenics and normals.

This report demonstrates the potential of the Sorting Consistency Task, both for assessing the degree of schizophrenic disturbance in patients, and for screening normals for schizophrenic tendencies. The task can be administered quickly and adapted for individual or group testing. Experiment 1 demonstrated a strong relationship between the Sorting Consistency Task and indicators of schizophrenic disturbance. Experiment 2 used normals and demonstrated that the Sorting Consistency Task could discriminate between subjects who score high or low on the Physical Anhedonia Scale of Chapman et al. (1976).

Recall and recognition in depressives: use of matched tasks.

This study uses matched tasks methodology, and shows that unipolar depressives perform better on recognition than on recall. Since they also show a low level of item clustering in free recall, this suggests that the memory deficit of depressives is partly due to an associative disturbance.

Retrieval from semantic memory using meaningful and meaningless constructs by depressed, stable bipolar and manic patients.

Eleven depressed, 11 stable bipolar and six manic patients, 20 normals and eight late middle-age normals were tested for speech production using a word-fluency task. Fluency was prompted by either a letter (a relatively automatic task), or a semantic category (an effort-demanding task). The results showed that depressed patients were more impaired in speech production than other patients when prompted by a semantic category than when prompted by a letter. A post hoc matched-tasks check suggested that this finding was not due to differences in discriminating power between the two word-fluency tasks. Manic and stable bipolar patients did not differ in their speech production, although matched on age. The results suggest that depressives perform better on more automatic than on effort-demanding tasks, and that manic and stable bipolar patients do not differ in speech production when experimentally imposed restrictions are present.

Performance of long-stay schizophrenics after drug withdrawal on matched immediate and delayed recall tasks.

Both anticholinergic and neuroleptic drugs were withdrawn from eight long-stay hospitalized chronic schizophrenics. These patients and normal controls were then tested on Calev, Venables & Monk's (1983) immediate and delayed matched recall tasks to evaluate their rate of forgetting of verbal well-encoded materials. The results showed rapid forgetting in schizophrenics. This finding suggests that a post-encoding deficit characterizes long-stay schizophrenics after drug withdrawal. Cognitive and brain pathologies that may explain these results are discussed.

ECT and non-memory cognition: a review.

The literature on the effects of electroconvulsive therapy (ECT) on non-memory cognitive functions is reviewed. It is concluded that with early methods of ECT administration (sine wave, high dose), these effects are larger than those of depression. They are less pronounced, and usually do not exceed the effects of depression, when modern methods of ECT administration (brief pulse, moderate or low dose) are used. Following ECT, these functions progressively improve. At one week to seven months after ECT, performance is better than before ECT, probably because of the alleviation of both the effects of depression and of ECT. The time course to full recovery of the non-memory effects resembles that of the recovery of amnesic effects, although the latter are more pronounced. With bilateral ECT, as with right unilateral ECT, there is evidence that right hemisphere effects are more pronounced. The results of this review argue that clinicians should take the non-memory cognitive effects of ECT into account, and patients should be informed of their existence before they sign consent for ECT.

Developmental disorder, Tourette disorder and schizophrenia: a case study.

We present a unique case of an 18-year-old male who had a classic picture of schizophrenia preceded by a well documented history of Tourette Disorder and a developmental disorder. The subject, a member of an ongoing study on first-admission psychosis, has been systematically evaluated and followed up for two years, and the interesting neuropsychological findings are presented and compared to those of the rest of the sample with a diagnosis of schizophrenia. The triad of schizophrenia, Tourette Disorder and developmental disorder is described for the first time in a subject with an adult type schizophrenia. Possible neurodevelopmental impairments explaining the clinical picture are discussed in view of the recent literature.