Kostas Fokas

Community dysfunction in schizophrenia: rate-limiting factors.

The purpose of the present study was to investigate the impact of cognitive functioning, psychopathology, and severity of extrapyramidal side effects on community outcome in a group of Greek outpatients with schizophrenia. Participants were 40 outpatients with schizophrenia (25 men). Social adjustment was assessed with the Quality of Life Scale (QLS). Severity of symptoms of schizophrenia was measured with the Positive and Negative Syndrome Scale (PANNS), and extrapyramidal symptoms with the Extrapyramidal Symptom Rating Scale (ESRS). Finally, a battery of neuropsychological tests was administered in order to assess the following cognitive domains: executive functioning/set shifting, executive functioning/inhibition, fluency, verbal memory, visual memory, working memory, attention, visuospatial ability, and psychomotor speed/visual scanning. Total scores on the QLS were significantly correlated with negative symptoms, parkinsonism, and performance on the fluency tasks. Interpersonal relations subscale was significantly related with negative symptoms and fluency. No significant relationship was found between the Instrumental Role Functioning subscale and the PANSS, ESRS, or any cognitive domain. Scores on the Intrapsychic Foundation subscale were significantly correlated with negative symptoms and fluency. Finally, scores on the Common Objects and Activities subscale were significantly related with severity of negative symptoms, parkinsonism and visual memory. Our findings suggest that severity of negative symptoms, cognitive dysfunction, especially performance on fluency tasks and visual memory, as well as parkinsonism, are important determinants of functional outcome in schizophrenia.

Deficits in sustained attention in schizophrenia but not in bipolar disorder

The aim of the present study was to investigate sustained attention in remitted patients with bipolar disorder and in patients with schizophrenia, as compared to each other and to healthy controls; a secondary aim was to investigate the correlations of different symptom dimensions with performance on sustained attention in the two patient groups. Participants were 29 (18 men) outpatients with schizophrenia (SZ), 19 (8 men) patients with bipolar disorder I (BP) in remission, and 30 (15 men) healthy controls (HC); all three groups were matched on age, sex ratio, and level of education. Symptom severity (positive symptoms, negative symptoms, and general psychopathology) of patients with SZ were assessed with the Greek version of the Positive and Negative Syndrome Scale (PANSS); residual affective symptoms of patients with BP were assessed with the Young Mania Rating Scale (YMRS) and the Montgomery-Asberg Depression Rating Scale (MADRS). Sustained attention was measured by means of the Penn Continuous Performance Test (PCPT). The three groups differed significantly on the PCPT scores. Patients with SZ performed more poorly than both the BP and HC groups, whereas patients with BP did not differ significantly from HC. Performance on the PCPT did not correlate significantly with scores on the YMRS and MADRS in patients with BP. Also, scores on the PCPT did not correlate significantly with scores on any of the three subscales of the PANSS. Outpatients with schizophrenia presented deficits in sustained attention, whereas patients with bipolar disorder I in remission did not manifest such impairment. These results imply that impaired sustained attention might be a more enduring deficit in schizophrenia than it appears to be in bipolar disorder.

Sex differences in neuropsychological functioning among schizophrenia patients

Objectives: Evidence from the literature addressing sex differences in cognition in schizophrenia remains equivocal, with some researchers suggesting that male schizophrenia patients are more impaired than female subjects, while others report no significant sex differences in cognitive functioning. The aim of the present study was to investigate whether the differential pattern of cognitive performance observed in healthy men and women is preserved in male and female schizophrenia patients. Method: Ninety-six schizophrenia patients (56 men) were compared with 62 age- and gender-ratio matched healthy controls (31 men), on a battery of neuropsychological tests that assessed basic cognitive abilities: attention, working memory, abstraction, inhibition, fluency, verbal learning and memory, visual memory, visuospatial skills, and psychomotor speed. Results: As a group, schizophrenia patients were significantly impaired in each of the cognitive domains assessed, with the exception of psychomotor speed. The effect of sex was significant for verbal learning and memory, wherein women outperformed men. No significant group × sex interactions were found in any cognitive domains, indicating that the female advantage typically observed in verbal learning and memory remained the same in the schizophrenia patients. Conclusion: The degree of cognitive impairment is the same for male and female schizophrenia patients. Those sex differences found among the patients were typical of the healthy population as well. Therefore, differential decrements in basic cognitive domains do not appear to account for the favourable course of schizophrenia in women relative to men.

Humor appreciation deficit in schizophrenia: the relevance of basic neurocognitive functioning.

The purpose in undertaking the present study was to investigate humor appreciation in patients with schizophrenia. Moreover, we sought to explore the potential relationship of humor appreciation with measures of psychopathology and cognitive functioning among the patients. Thirty-six patients with schizophrenia were compared with 31 normal controls matched for age, sex, and education on a computerized test comprising captionless cartoons: Penn’s Humor Appreciation Test (PHAT). The patients were also evaluated on the symptom dimensions derived from the Positive and Negative Symptom Scale (positive symptoms, negative symptoms, cognitive symptoms, depression, and excitement), as well as a battery of neuropsychological tests measuring executive functions, attention, working memory, verbal and visual memory, visuospatial ability, and psychomotor speed. Patients with schizophrenia had significantly lower scores on the PHAT than normal controls. The patients’ performance on the PHAT correlated with scores on Penn’s Continuous Performance Test, the Stroop Color-Word Test, and the phonological subscale of the Greek Verbal Fluency Test. Our findings indicated impaired humor appreciation among patients with schizophrenia. The relationship found between the appreciation of captionless cartoons involved an incongruous detail and performance on a broad neuropsychological battery suggested that the deficit in humor appreciation in schizophrenia could be attributed to impairment in more basic neurocognitive domains, namely, selective and sustained attention as well as phonological word fluency.

Emotion perception in obsessive-compulsive disorder.

The purpose of the present study was to investigate the ability to perceive facial and vocal affect in a group of patients with obsessive-compulsive disorder (OCD) and to explore the specific emotions that might be troublesome for them. Participants were 25 patients with OCD and 25 healthy controls, matched for age, education, and gender. They were assessed with computerized tests of affect perception using visual faces [Kinneys Affect Matching Test (KAMT)], visual everyday scenarios [Fanties Cartoon Test (FCT)], and prosody [Affective Prosody Test (APT)], as well as a facial recognition test [Kinneys Identity Matching Test (KIMT)]. Severity of OCD symptoms in the patient group was measured with the Yale-Brown Obsessive Compulsive Scale. Patients with OCD were not impaired in the perception of emotion, in either the visual [still photographs (KAMT) or sketches of everyday scenarios (FCT)] or the vocal (APT) modality, as compared with age-, sex-, and education-matched healthy individuals. Moreover, patients with OCD did not differ from healthy individuals in discriminating facial identity (KIMT). With regard to each emotion type separately, patients performed equally well as healthy individuals in all the emotions examined. Emotion processing of both facial expressions and prosody does not appear to be deficient in patients with OCD (JINS, 2009, 15, 148-153).

No increased levels of the nicotine metabolite cotinine in smokers with schizophrenia.

The prevalence of smoking cigarettes has repeatedly been found to be greater in schizophrenia as compared with other psychiatric patients and the general population. Patients with schizophrenia have been found to engage in heavy smoking and consumption of higher doses of nicotine, probably by deeper inhalation of cigarettes. The aim of the current study was to assess nicotine exposure through smoking by measuring urinary cotinine, the major nicotine metabolite, in a group of smokers from Greece of smokers with schizophrenia and smokers from the general population. Participants were current smokers and belonged to one of two groups: 35 patients with schizophrenia and 48 healthy controls matched in age, education, and gender. The quantitative analysis of cotinine, the major metabolite of nicotine, in urine samples was performed by a modified high performance liquid chromatography (HPLC). Patients with schizophrenia who smoke presented a significantly larger time interval between last cigarette smoked and urine sample collection, as well as a significantly higher average number of cigarettes consumed daily than normal smokers. Urinary cotinine levels of patients with schizophrenia who smoke did not significantly differ from that of normal smokers when adjusted for average number of cigarettes per day and time interval between last cigarette smoked and urine collection. These results suggest that patients with schizophrenia did not present higher nicotine exposure through smoking compared with smokers from the community. The pharmacokinetic or pharmacodynamic properties of nicotine, as well as patient medications of the patients may explain our findings.

Tardive Nocturnal Akathisia Due to Clozapine Treatment

In the following case report we present a 43-year-old male patient diagnosed with schizophrenia, paranoid type, who exhibited nocturnal tardive akathisia or pseydoakathisia approximately one year after being treated with clozapine 300 mg per day. Because of the low occurrence of akathisia due to clozapine, the episodes of restlessness were at first considered as a sign of worsening of the patients psychopathology. Since the patient was resistant to other antipsychotic agents, clozapine was reinitiated. A week later, the patient once again exhibited episodes of restlessness. This time, the episodes were diagnosed as akathisia and the patient was treated with biperidene and lorazepam, while he had already been on propanolol for cardiovascular reasons. The episodes continued without any change in frequency or severity. Therefore, treatment with clozapine was discontinued and the patient was started on a new regimen with ziprasidone. Three days later, the episodes that caused distress to the patient resolved. Thus, it is possible that apart from episodes of acute akathisia, episodes of tardive akathisia or pseydoakathisia can also occur in patients treated with atypical antipsychotics.

Humor appreciation of captionless cartoons in obsessive-compulsive disorder

BackgroundIt seems that the core neural regions and cognitive processes implicated in obsessive-compulsive disorder (OCD) pathophysiology may overlap with those involved in humor appreciation. However, to date, there have been no studies that have explored humor appreciation in OCD. The purpose of the present work was to investigate humor appreciation in a group of patients with OCD.MethodsWe examined 25 patients with OCD and 25 healthy controls, matched by age, education, and gender. We administered Penns Humor Appreciation Test (PHAT), a computerized test comprising captionless cartoons by Mordillo. Each set of stimuli consisted of two almost identical drawings, one of which was funny due to the alteration of a detail in the cartoon, whereas the other was not funny. Severity of psychopathology was evaluated with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).ResultsNo significant effect for group, gender or group × gender interaction was found on the PHAT scores. In OCD patients, humor appreciation was not significantly associated with age of onset, duration of illness, and obsessions, but correlated significantly with compulsions.ConclusionsHumor appreciation, based on captionless cartoons in OCD, does not seem to be deficient compared to healthy subjects but may be related to illness characteristics.

Differential effects of sentence context on lexical ambiguity resolution in different subgroups of patients with schizophrenia

Background It has been suggested that a failure in the processing of context information may account for the heterogeneous manifestations of schizophrenia. In a previous study, we have shown that patients with schizophrenia were impaired in their ability to use sentence context during lexical ambiguity resolution. The most striking patient deficit appeared in sentence contexts related to the dominant (i.e. more frequent) meaning of homonyms; however, this deficit was present in only 50% of patients. The present study aimed to investigate priming patterns in patients with normal (NP) and reduced (RP) priming of dominant targets following dominant sentence contexts.

Treatment of neuropsychiatric symptoms associated with euthyroid Hashimoto thyroiditis with antidepressants: a case report

It has been suggested that autoimmune thyroid disease may be linked to psychiatric disorders, particularly depression and anxiety [1–3]. Although this association is still controversial [4], it is of great relevance, for three reasons: first, autoimmune thyroid disease, depression and anxiety are not uncommon; the prevalence of autoimmune thyroid disease in the community ranges between 4% and 25% [1,4], and the lifetime prevalence of major depressive disorder and anxiety disorder is approximately 15% and 25%, respectively [1]. Second, the presence of antithyroid antibodies has been reported to predict a poor response to standard antidepressant treatment [2,5]. Third, the association between thyroid autoimmunity and psychiatric disorders can occur independently of the presence of thyroid function abnormalities, as reflected in thyroid hormone blood levels [1]. We present the case of a patient in whom anxious and depressive symptoms and migraines associated with Hashimoto thyroiditis continued to evolve despite normalization of thyroid hormone levels, but remitted upon antidepressant treatment. K.J., a 39-year-old housewife, presented for psychiatric consultation with symptoms of depression and anxiety. The patient reported having been constantly depressed for the past 5 months, while at the same time, she had been suffering from migraines with a frequency of once or twice per week. The patients history included migraine with aura with onset in adolescence; her psychiatric history had been unremarkable up to 2 years before consultation when she had developed “episodes” of depressed mood in combination with the migraine attacks. These episodes were characterized by extreme feelings of fatigue and psychomotor retardation, diminished ability to think and concentrate, and selfreprocating ideas; they severely interfered with work and everyday activities, and the patient would usually remain essentially bedridden during their course. The episodes initially appeared with a frequency of once or twice per month and a duration of 2–3 days, without being associated to any particular phase of the menstrual cycle. At that time, the patient had been diagnosed with hypothyroidism due to