Jeroen A. van der Linden

Blunted cortisol response to a psychosocial stressor in schizophrenia

Schizophrenia is considered a neurodevelopmental disorder in which vulnerability to stress may be a contributing factor. Coping is an important psychological component of stress processing, and the hypothalamic-pituitary-adrenal system (HPA system) is one of the biological components of stress adaptation. Disturbances of either of these components may make schizophrenic patients more vulnerable to develop a psychosis under stressful circumstances. In this study, 10 schizophrenic men were compared with 10 healthy male controls in their response to a psychosocial stressor, consisting of a public-speaking task. Heart rate was monitored as a measure of autonomic arousal. HPA responses were assessed by measuring salivary cortisol. Coping skills were measured by using the Utrecht Coping List and the Ways of Coping Checklist. The stress of speaking in public increased the heart rate in both patients and controls; however, a significant cortisol response was found in the controls, but not in the schizophrenic patients. The patients used more passive and avoidant coping strategies than controls. The findings provide support for the notion that schizophrenic patients have an impaired ability to adapt, both psychologically and biologically, to their environment.

The Effect of Clozapine on Caudate Nucleus Volume in Schizophrenic Patients Previously Treated with Typical Antipsychotics

Typical antipsychotics have been reported to enlarge the caudate nucleus in schizophrenic patients. The atypical antipsychotic, clozapine, is associated with a decrease in caudate size in patients previously treated with typical antipsychotics. The present study investigates whether a change in caudate volume after switching from treatment with typical antipsychotics to treatment with clozapine is related to improvement in symptoms or tardive dyskinesia (TD). Twenty-six schizophrenic patients participated in this open study. Caudate nucleus volume and TD were assessed before discontinuing typical antipsychotics and after 24 weeks of treatment with clozapine. After discontinuing typical antipsychotics, symptoms were assessed in a 3 days drug-free period and subsequently once a month. Treatment with clozapine resulted in a decrease in caudate volume, improvement in symptoms and amelioration of TD. However, no difference in caudate volume changes was found between responders and non-responders to clozapine and no correlations were found between caudate volume changes and reduction of TD. In conclusion, this study replicates earlier findings that clozapine decreases caudate volume in patients previously treated with typical antipsychotics and suggests that this effect is unrelated to treatment response or to amelioration of TD.

Reduction of nucleus accumbens volume in schizophrenia: A volumetric MIR-study

phology may be abnormal in certain psychopathologic conditions, but analysis is complicated by sex differences. The present study examined the size of the CC in 258 subjects comprising 8 groups (using DSM-III-R criteria based on structured interviewsadditional distinctions among schizophrenia): first-episode schizophrenia (n=52; M/F =29/23), first-episode schizophreniform (n = 19; MfF = 8/11), chronic schizophrenia (n = 27; MfF = 23/4), schizoalfective (n = 39; M/F=24/15), bipolar (n=20; M/F = 10/10), psychotic major depression (n = 13; MfF =4/9), major depression (n=14; MfF=5f9) and healthy controls (n= 74; MfF=41/33). Midsagittal brain images (slice thickness= I mm) were created and AC-PC aligned by reformatting whole brain coronal FLASH MRI scans (original slice thickness = 3.1 mm, in-plane resolution = I mmx I mm). Slice volume was measured by semi-automated tracing and length was computed as the distance between planes intersecting most anterior and posterior CC perpendicular to the AC-PC line. ANCOV~ (cortical volume as covariate) revealed: 1) Greater CC length m men than women (75.5 mm vs 72mm); 2) Significant sex·group interaction for length, with group differences only among men: nonpsychotic major depression and bipolar (80.5 mm, 79.6 mm) both had longer CC than those with first-episode schizophrenia, schizoalfective and psychotic major depression (73.8 mm, 73.9 rom. 7\.9 rom). These findings suggest that there may be diagnostic effects on CC size and that psychosis may be related to decreased CC length, possibly reflecting a more global neurodevelopmental shape difference.