Arnold E. Merriam

The Psychiatric Symptoms of Alzheimer's Disease

The authors used a semistructured interview administered to primary family caregivers to assess the prevalence and nature of psychiatric pathology in 175 well‐diagnosed community‐residing Alzheimers disease patients. Symptoms that are indicative of depression in the cognitively intact were virtually ubiquitous in this demented population. A variety of psychotic features were also regularly reported. The implications of these findings for the recognition and treatment of reversible psychiatric impairment are discussed.

Neurological signs and the positive-negative dimension in schizophrenia

Schizophrenic patients have been observed to manifest a variety of abnormal neurological signs, but the nature of their association with differing clinical presentations is less well established. To address this issue, we administered a newly compiled neurological inventory to 28 well-characterized chronic schizophrenic inpatients and separately assessed them on the Positive and Negative Syndrome Scale and on control variables that included measures of global pathology, chronicity of illness, neuropsychological and intellectual integrity, and extrapyramidal dysfunction. We found, first, that our neurological battery provided statistically independent measures of apraxia, fine motor function, and prefrontal, parietal, and nonlocalizing signs. A significant association emerged between negative symptomatology and neurological signs of prefrontal impairment (p less than 0.01), which could not be accounted for by any of the control variables. Positive symptoms were associated with an absence of parietal and nonlocalizing signs; however, these correlations were mediated by higher neuroleptic doses in these patients. There was no association between any neurological sign and age, extrapyramidal symptoms, general neuropsychological integrity, education, IQ, or severity or chronicity of illness. We concluded that the negative syndrome in schizophrenia represents a distinct dimension of psychopathology that is related specifically to prefrontal deficit.

Visual information processing in positive, mixed, and negative schizophrenic syndromes

The purpose of this study was to determine whether schizophrenics with positive, mixed, and negative syndromes are distinguished in terms of visual stimulus registration thresholds and efficiency of information processing. Forty-five schizophrenic inpatients were classified accordingly into groups of 15 each and compared with one another and with 15 normal control subjects on a visual backward masking task. Repeated-measures analysis of variance revealed that all three schizophrenic groups were less efficient information processors than were normal subjects. Relative to the positive group, the negative group displayed significantly longer registration thresholds, fewer correct target stimulus detections, and longer time intervals to achieve their first significant improvement in performance and to first exceed chance response levels. The three syndrome groups were not significantly different in their rates of improvement over trials. Secondary correlational analyses showed that the information-processing measures were unrelated to a variety of demographic, psychiatric, and cognitive developmental variables, although shorter recognition thresholds and shorter unmasking interval scores were associated with faster psychomotor rates. Complex interrelationships were uncovered between the information-processing measures, positive and negative symptomatology, and general psychopathology. The results were interpreted as supporting the validity of the positive-negative distinction for explaining some of the heterogeneity in schizophrenia

Atrophy of the Cerebellar Vermis: Relevance to the Symptoms of Schizophrenia

Degeneration of the cerebellar vermis is a common pathological and neuroradiological feature of chronic schizophrenia, but its relationship to symptoms of the disease are poorly understood. We investigated the relationship of vermal cerebellar atrophy on CT scan to features of positive (productive) and negative (defect) dimensions of schizophrenia as well as to symptoms of general psychopathology in a sample of 23 chronic schizophrenic patients. For comparison, we also studied the relationship of third ventricular width (TVW), which reflects periventricular and diencephalic atrophy, to these features of schizophrenic symptomatology. Vermal cerebellar atrophy was found in 43.5% of patients and correlated significantly with general psychopathology and, more specifically, with feelings of guilt and disturbance of volition. It was unrelated to global positive or negative features of schizophrenia. By contrast, TVW was uniquely associated with global negative syndrome. These observations indicate that degenera...

Headache and Cortisol Responses to M-Chlorophenylpiperazine are Highly Correlated

The serotonin receptor agonist m-chlorophenylpiperazine (m-CPP) stimulates the release of cortisol and prolactin, and induces migraine-like headaches. We have studied the neuroendocrine and headache responses to m-CPP in 8 subjects with migraine and I0 normal subjects. Each subject underwent two challenge tests, one with 0.25 mg/kg PO of m-CPP and the other with placebo, administered in a double-blind crossover format. Serial measurements of serum cortisol, prolactin, and m-CPP levels were made at 30-min intervals for 210 min following ingestion of the medication. The incidence and severity of headache was assessed by a structured telephone interview after each test. We confirmed that m-CPP stimulates the release of cortisol and prolactin, and may induce headache, in both migraine subjects and normal controls. The cortisol response as well as ratings of headache severity and duration directly correlated with plasma levels of m-CPP. There were highly significant associations between the cortisol response and both headache severity and duration, independent of m-CPP plasma levels. We did not find statistically significant differences between the migraine and normal subjects in terms of their neuroendocrine or headache responses to m-CPP.

Corpus callosum function in schizophrenia: A neuropsychological assessment of interhemispheric information processing

Impaired corpus callosum function has been reported in schizophrenia. We measured intra- and interhemispheric visual information processing in 16 schizophrenic patients and 16 matched controls. Although the schizophrenics performed worse between than within cerebral hemispheres, this pattern was similar to that of the normal controls. Schizophrenics do not show particular dysfunction of the corpus callosum.

Calcification of the choroid plexus as a marker of depression in schizophrenia

Dear Editors, Although depressive symptoms are a common and serious problem in schizophrenia, little is known about their biological substrate (Hirsch et al., 1989; Green et al., 1990). Depression has been linked to decreased cerebral serotonin (5-HT) functions in both nonpsychotic and chronic schizophrenic patients (Van Praag, 1982, 1983) particularly those with suicidal behavior (Van Praag, 1983) and enlarged cerebral ventricles (Potkin et al., 1983). The metabolic activity of the choroid plexus (CP), which is the major site for cerebrospinal fluid (CSF) production in the brain (Cserr, 1971) is regulated by the 5-HT system (Moskowitz et al., 1979; Napoleone et al., 1982; Faraci et al., 1989). We suggest, therefore, that alterations in the metabolic activity of the CP may underlie depressive symptoms in schizophrenia. To test this hypothesis, we recruited 22 consecutive patients (20 men, two women) from predominantly male wards of an urban pyschiatric hospital. They were selected for a schizophrenic diagnosis by RDC and DSM-III criteria (Spitzer et al., 1978; American Psychiatric Association, 1980) and absence of focal abnormalities on a screening neurological examination. The sample characteristics appear in Table 1. To standardize the psychotropic medication, all patients were stabilized on chlorpromazine over 4-5 weeks (group mean = 928.8 mg/day). Patients were then clinically assessed and subjected to non-

Brain white-matter lesions and psychosis.

Self-harm and depressive disorder SIR: Ennis et a! (Journal, January 1989, 154, 41—47) found a 31% point prevalence of major depressive episode (MDE) in their sample using DSM—III criteria. We conducted a similar study at Reims Hospitals Emergency Unit with 113 deliberate self harm patients consulting a psychiatrist (Thérett a!, 1988). A 58% point prevalence of MDE was found using the Structured Clinical Interview for DSM—III—R (SCID). As discrepant results may arise from different methods, we would like to discuss some points. The DSM—III—R criteria for MDE are known to be more stringent than those ofDSM—III,so the discrepancy of results cannot be explained by the use of different classifications. In our study the cases of self-harm wererestrictedtodrugself-poisonings, butitis known that the latter account for approximately 90% of the former. The sampleofEnnis etats studymight not be representative of the patientsconsulting in psychiatry afteradeiberateself-harmatToronto Hospital, since only 23% (71 of25 1)of the patients admitted for that cause at the Emergency Department entered the study. The inter-rater diagnostic reliability was low (x=0.445) despite heuseofachecklistcontaining the DSM—III criteria for MDE. A standardised diagnos tic assessment tool would have been more appropri ate. The results are thus ofless practical value. Finally, an astonishing statement by the authors is that attempted suicide and parasuicide are synonymous terms. Such an assimilation could lead to a confusion in the definitions. Kreitmans definition of para suicide (Dyer & Kreitman, 1984) does not take suicidal intent into account, so that parasuicidal (or deliberate non-fatal self-harm) people constitute a much broader group than suicide attempters. LAURENT TiEi@r J. G. PASCALIS Clinique Universitaire de Psychiatric C.H. U. —¿ Hà ́pita!Robert Debré Rue Alexis Carrel 51092 Reims Cedex, France

Neuropsychological sequelae of partial complex status epilepticus

Relatively little is known about the risk of residual neurological deficit following partial complex status epilepticus (PCSE). To address this issue, we administered serial neuropsychological assessments and EEGs to a young cocaine abuser following the resolution of an extended episode of PCSE. Results suggest that PCSE may be associated with prolonged but reversible generalized neuropsychological and EEG abnormalities, as well as persistent focal deficits.

Atrophy of the cerebellar vermis: Relevance to the symptoms of schizophrenia

Degeneration of the cerebellar vermis is a common pathological and neuroradiological feature of chronic schizophrenia, but its relationship to symptoms of the disease are poorly understood. We investigated the relationship of vermal cerebellar atrophy on CT scan to features of positive (productive) and negative (defect) dimensions of schizophrenia as well as to symptoms of general psychopathology in a sample of 23 chronic schizophrenic patients. For comparison, we also studied the relationship of third ventricular width (TVW), which reflects periventricular and diencephalic atrophy, to these features of schizophrenic symptomatology. Vermal cerebellar atrophy was found in 43.5% of patients and correlated significantly with general psychopathology and, more specifically, with feelings of guilt and disturbance of volition. It was unrelated to global positive or negative features of schizophrenia. By contrast, TVW was uniquely associated with global negative syndrome. These observations indicate that degeneration of the cerebellar vermis and enlargement of the third ventricle are integral aspects of schizophrenia, and that each contributes independently to specific clinical aspects of the disease.