Heinz Katschnig

Facial recognition deficits and cognition in schizophrenia

Previous investigations have found impaired recognition of facial affect and cognition in schizophrenia. We compared patients with schizophrenia and healthy control volunteers on computerized tasks of emotion recognition, to determine whether emotion processing deficits were correlated with neurocognitive performance. A Computerized Neuropsychological Test Battery (CNP) was administered to 40 patients (25 male, 15 female, mean age+/-S.D. 30.4+/-8.1) with schizophrenia (DSM-IV, 15 first episode and 25 chronically ill patients) treated with atypical neuroleptics and 43 healthy volunteers. A German version of the PENN Facial Discrimination, Differentiation and Memory Test, including happy, sad and neutral faces was used. Additionally, all patients were tested with a standard neuropsychological battery and rated for positive and negative symptoms. Patients with schizophrenia performed worse than control subjects on all emotion recognition tasks (p<0.01). We found higher error rates for discrimination of emotion in happy (p<0.02) and happy female faces (p<0.01), for differentiation of sad versus happy faces (p<0.001) and for facial memory (p<0.04). Poorer performance in emotion discrimination and facial memory correlated with severity of negative symptoms, abstraction-flexibility (p<0.001), verbal memory (p<0.01) and language processing (p<0.001). The study did not reveal a specific deficit for emotion recognition in schizophrenia. These findings lend support to the notion that difficulties in emotion recognition are associated in schizophrenia with key cognitive deficits.

Schizophrenia and quality of life

Objective: The purpose of this paper is to examine critically results of quality‐of‐life research in schizophrenic patients living in the community.

Panic disorder and cigarette smoking behavior.

Smoking has been discussed both as a risk factor for panic disorder and as a contributing factor to elevated cardiovascular risk in panic disorder patients. Smoking habits and their association with panic disorder were studied in a sample of 102 panic disorder patients. Both for female and for male patients, rates of smokers and of exsmokers were substantially higher than in the general population. However, a surprisingly high number of patients had succeeded in reducing or quitting cigarette smoking because of their panic disorder, although they experienced little benefit in regard to panic symptoms from doing so. We conclude that the motivation for changing smoking habits is high in this population with elevated smoking prevalence and should be taken into consideration by therapists.

A study of the effects of patient anxiety, perceptions and equipment on motion artifacts in magnetic resonance imaging

We investigated to see if motion artifacts (MA) occurring in magnetic resonance imaging (MRI) are related to prescan anxiety measures and test the feasibility of identifying patients at risk for the development of MA before scanning. Furthermore, to determine a possible influence of constructional differences between a 1.5 and a 0.5 tesla scanner on the frequency of MA. Two hundred and ninety-seven first time MRI patients were surveyed before and after imaging with anxiety and attitude questionnaires. Frequency and impact on diagnostic quality of MA were documented. 12.8% of all scans showed MA not related to normal body pulsations. In 6.4% the diagnostic quality was impaired. Constructional differences did not influence the frequency of MA. Also, anxiety as determined with the most common anxiety measuring instrument was not related to the development of MA. Concern about the technical apparatus identified 70.6% of all individuals developing MA. Patients at risk for the development of MA can be identified prior to scanning. It seems necessary to further develop reliable methods to detect them and to evaluate strategies to prevent MA.

Are commonly used self-report inventories suitable for screening postpartum depression and anxiety disorders?

Objective: The utility of several self‐report symptom inventories were examined for detecting postpartum depression (MDD) and anxiety disorders (AD).

The long-term course of panic disorder and its predictors.

Whereas lifetime prevalence rates of panic disorder--as established in epidemiologic surveys--range between 1.6 and 3.5%, 1-month rates usually amount to much less than one half of the lifetime rates. This finding indicates that a substantial proportion of patients who had panic disorder at some stage in their life must have remitted. In contrast to these results, clinicians tend to regard panic disorder as a chronic condition because, as a rule, they see panic patients only several years after onset of the disorder. A number of small, prospective, long-term studies of such clinical populations indicate that after several years, between 17 and 70% of patients still have panic attacks, and between 36 and 82% have phobic avoidance. In the largest and longest follow-up study published to date, 45% of all patients showed an unremitting--although in a certain proportion waxing and waning--course, 24% followed a pattern of remissions and relapses, whereas 31% went back into a stable remission. The evidence of factors predicting the course of panic disorder in clinical populations suggests that long duration and agoraphobia at baseline--not the severity and frequency of panic attacks--are predictors of an unfavorable course. Additional studies are needed to determine whether personality factors, depression, and other variables are also of predictive relevance. Also, factors working during follow-up, such as positive and negative life events, coping behaviors, and treatment, should be considered in future studies.

The influence of age on the female/male ratio of treated incidence rates in depression

BackgroundPoor data exist on the influence of psychosocial variables on the female/male ratio of depression because of the small number of cases and the resulting limited numbers of variables available for investigation. For this investigation a large number of first admitted depressed patients (N = 2599) was available which offered the unique opportunity to calculate age specific sex ratios for different marital and employment status categories.MethodsAge and sex specific population based depression rates were calculated for first ever admissions for single year intervals. Moving averages with interpolated corrections for marginal values in the age distribution were employed.ResultsFor the total group the female/male ratio of depression showed an inverted U-shape over the life-cycle. This pattern was influenced by the group of married persons, which showed a sex-ratio of 3:1 between the age of 30–50, but ratios of around 1:1 at younger and older ages. For not married persons the female/male ratio was already around 2:1 at the age of 18 and rose to 2.5:1 in mid-life and declined to 1 at around 55. The almost parallel decline of depression rates in employed men and women resulted in a female/male ratio of about 2:1 from age 18 to age 50 and became 1 after the age of 60. The female/male ratio among the not employed was about 1, in mid-life it became negative.ConclusionsOur analyses show that the gender-gap in first admitted depressed patients is age dependent and that psychosocial factors modify the sex ratio.

High frequency of EEG and MRI brain abnormalities in panic disorder.

The frequency and quality of brain abnormalities in panic disorder (PD) were assessed with magnetic resonance imaging (MRI). The use of electroencephalography (EEG) to detect PD patients with a high probability of morphologic brain abnormalities was also explored. Consecutive PD patients (n = 120) were screened with routine EEG examinations and were divided into the following subgroups on the basis of their EEG findings: patients with non-epileptic EEG abnormalities (EEG-A group, n = 28), matched patients with normal EEG results (EEG-N group, n = 28) and matched healthy controls (n = 28). PD patients showed a higher than expected rate of non-epileptic EEG abnormalities (29.2%; 35 of 120). EEG screening was effective in identifying patients with a high probability of morphologic brain abnormalities. MRI abnormalities were found in 60.7% of the EEG-A patients, 17.9% of the EEG-N patients, and only 3.6% of the controls. A high frequency of septo-hippocampal abnormalities was found. Further research should focus on attempts to subtype PD on the basis of neuroanatomic and functional brain abnormalities.

Personality disorder and social anxiety predict delayed response in drug and behavioral treatment of panic disorder

BACKGROUND The aim of this study was to analyze the impact of pretreatment characteristics and personality disorders on the onset of response in the treatment of panic disorder. METHODS The data of 73 out-patients with panic disorder who had completed at least 6 weeks of a randomized trial of 24 weeks of either paroxetine only or paroxetine combined with cognitive group-therapy were analyzed in a Cox proportional hazards model. RESULTS The likelihood of having responded to treatment (defined by a CGI rating of improvement) was more than twice as high for patients without a personality disorder or social phobia than for Patients with a personality disorder or social phobia. CONCLUSIONS We suggest that patients with these characteristics do benefit from prolonged treatment, and they may profit from an additional treatment focused on social anxiety.

Delusional Theme, Sex and Age

In a retrospective study of 865 delusional syndromes, connections were investigated between delusional themes and the sex of patients, and the ages in which these themes extensively occurred. According to previous reports, the results of this investigation indicated that differences exist between the ages of manifestation regarding the themes of hypochondria, persecution, love and jealously. Furthermore, differences could be observed between males and females in relation to the frequency of choice of particular themes, as well as the age of occurrence. Based on psychological studies concerned with the contents dependence on motives we conclude that the age distribution of delusional themes corresponds to the main existential concerns in different life periods.