E. Cem Atbasoglu

Peculiar word use as a possible trait marker in schizophrenia

Peculiar word use in schizophrenia has been emphasized by many authors, however the definition or the linguistic and clinical correlates of this phenomenon are not clear. We propose a new, standard and reliable method to extract a numerical measure of peculiar word use with operationalized definitions. We applied a modified version of the Controlled Word Association Test (Turkish version) to a pool of healthy subjects (N=55) and used the data as norm to compare the degree of peculiarity and patterns of word association among patients with schizophrenia (N=33), their healthy siblings (N=31) and healthy controls (N=32). We also explored the relationship of peculiar word use with patterns of word association (semantic versus phonologic) and formal thought disorder. Patients and their siblings performed worse on measures of verbal fluency. They also generated more peculiar words and relied less on semantic associations, compared to healthy controls. Peculiar word use was associated with the severity of formal thought disorder and the tendency to make use of phonologic associations in the patient group and their siblings, whereas neither of the word association patterns predicted peculiar word use in the control group. Our results provide empirical support to previous observations about the peculiarity of schizophrenic speech. Peculiar word use could be associated with a deficit to employ semantic classifications in verbal fluency tasks and thus relying more on sound-based associations. Excess use of phonologic associations may be playing a mediating role between semantic processing abnormalities and formal thought disorder.

Cortical inhibition in first-degree relatives of schizophrenic patients assessed with transcranial magnetic stimulation

Although cortical inhibition deficit has been shown in schizophrenia patients by transcranial magnetic stimulation (TMS), some controversies remain, possibly due to confounding factors such as medication use and clinical state at the time of assessment. First-degree relatives of schizophrenia patients, who share various degrees of genetic vulnerability with the patients, but are free from confounds related to medication and/or florid psychosis, have not been studied to date. We compared 12 relatives with 14 controls on several paradigms with TMS. Three of the 12 healthy relatives lacked transcallosal inhibition (TI) in one or more of the stimulation levels. There were no significant differences in other parameters. The lack of TI in 25% of the relatives is an important finding that needs to be replicated in larger samples that are heterogeneous in terms of psychosis-proneness.

The effectiveness of intramuscular biperiden in acute akathisia: a double-blind, randomized, placebo-controlled study.

Neuroleptic-induced acute akathisia (NIA) is a distressing condition and an important clinical problem because it is associated with treatment noncompliance and suicidal or impulsive behavior. Anticholinergics are among the treatment options; however, a review of the literature fails to identify a double-blind, randomized, placebo-controlled study of these medications in NIA. In a randomized, double-blind, placebo-controlled design, we studied the effectiveness of intramuscular biperiden (n = 15) or isotonic saline (n = 15) in the treatment of NIA diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. Injections were repeated up to 3 times unless akathisia was completely treated (scored 0 for global akathisia with the Barnes Akathisia Rating Scale). Patients were assessed for akathisia, other movement disorders, and psychiatric symptoms at baseline and 3 times after the first injection at 2-hour intervals. Response was defined as at least a 2-point decline in the global akathisia score. The numbers of responders in the 2 groups were not significantly different (7 and 5 in the biperiden and placebo groups, respectively). The courses of individual items on the Barnes Akathisia Rating Scale were also similar. Our results suggest that intramuscular biperiden should not be considered as a first-line treatment of NIA.

Dissociation between Inattentiveness during Mental Status Testing and Social Inattentiveness in the Scale for the Assessment of Negative Symptoms Attention Subscale

The Scale for the Assessment of Negative Symptoms (SANS) attention subscale has been found valid and reliable by some studies; however, there is some evidence to the contrary. We hypothesized that social inattentiveness (SANS 22) and inattentiveness during mental status testing (SANS 23) might be describing discrete constructs, and this dissociation might be a source of controversy. Thirty-five patients with DSM-IV schizophrenia were assessed by the Scale for the Assessment of Positive Symptoms (SAPS), SANS and a neuropsychological battery. The 2 attention items were not significantly interrelated. SANS 22 was correlated with bizarre behavior and alogia, and none of the neuropsychological test scores, whereas SANS 23 showed strong correlations with the Wechsler Memory Scale mental control subscore, total errors on the Benton Revised Visual Retention Test, and the information, similarities and the general verbal subscores on the Wechsler Adult Intelligence Scale. Regression analyses showed that SANS 23 could be a good estimate of general verbal abilities. These findings point to a dissociation between the 2 SANS attention items. Similar analyses should be repeated in larger and heterogeneous samples and include a factor analysis of the individual items rather than the global ratings.

Higher schizotypy predicts better metabolic profile in unaffected siblings of patients with schizophrenia

RationaleType 2 diabetes (T2D) is more frequent in schizophrenia (Sz) than in the general population. This association is partly accounted for by shared susceptibility genetic variants.ObjectiveWe tested the hypotheses that a genetic predisposition to Sz would be associated with higher likelihood of insulin resistance (IR), and that IR would be predicted by subthreshold psychosis phenotypes.MethodsUnaffected siblings of Sz patients (n = 101) were compared with a nonclinical sample (n = 305) in terms of IR, schizotypy (SzTy), and a behavioural experiment of “jumping to conclusions”. The measures, respectively, were the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), Structured Interview for Schizotypy-Revised (SIS-R), and the Beads Task (BT). The likelihood of IR was examined in multiple regression models that included sociodemographic, metabolic, and cognitive parameters alongside group status, SIS-R scores, and BT performance.ResultsInsulin resistance was less frequent in siblings (31.7%) compared to controls (43.3%) (p < 0.05), and negatively associated with SzTy, as compared among the tertile groups for the latter (p < 0.001). The regression model that examined all relevant parameters included the tSzTy tertiles, TG and HDL-C levels, and BMI, as significant predictors of IR. Lack of IR was predicted by the highest as compared to the lowest SzTy tertile [OR (95%CI): 0.43 (0.21–0.85), p = 0.015].ConclusionHigher dopaminergic activity may contribute to both schizotypal features and a favourable metabolic profile in the same individual. This is compatible with dopamine’s regulatory role in glucose metabolism via indirect central actions and a direct action on pancreatic insulin secretion. The relationship between dopaminergic activity and metabolic profile in Sz must be examined in longitudinal studies with younger unaffected siblings.