Massimo Casacchia

Is Theory of Mind in Schizophrenia More Strongly Associated with Clinical and Social Functioning than with Neurocognitive Deficits

This paper examines the correlations between ‘Theory of Mind’ (ToM) and neurocognitive performance, together with clinical and social functioning, in out-patients with schizophrenic disorders. It was hypothesised that, since the ability to make inferences about the environment and about other peoples’ mental states is a key ingredient of social competence, the assessment of ToM would correlate more strongly with current social functioning than with more traditional neurocognitive measures. ‘Independent raters’ assessed Theory of Mind, neurocognitive and clinical variables as well as community functioning in 44 subjects with schizophrenia. The neuropsychological measures were more closely associated with community functioning than with psychiatric symptoms. These associations remained evident when the effects of intelligence were controlled. Patients with a higher level of competence in making social inferences had better overall community functioning than those who showed less ability in this aspect of social cognition. In a regression model, the capacity to comprehend other people’s mental states (ToM-2) was among the best predictors of global social functioning, together with recent onset of illness, good verbal fluency and low levels of negative and positive symptoms. These results are consistent with other recent findings. ToM measures of social cognition may be a useful addition to neuropsychological assessment when developing programmes for reducing clinical impairments and improving the community functioning of subjects with schizophrenic disorders. Further studies are needed to verify the value of these measures as predictors of the successful application of specific psychosocial rehabilitation strategies.

Sensorimotor gating and habituation evoked by electro-cutaneous stimulation in schizophrenia

The present study has been performed in order to evaluate two relevant phenomena related to startle reflex (SR) evoked by electro-cutaneous stimulation in schizophrenic patients: 1) the effect of different interstimulus intervals on R1, R2 magnitude and on R2 latency in schizophrenia in order to verify if the gating effect influences all blink reflex (BR) parameters and 2) to replicate and extend our previous data on SR habituation. Our data have confirmed the existence of an impairment of habituation and an abnormal facilitatory effect of R1 component of BR in schizophrenics compared to healthy controls. The present study provides further evidence of specific defective mechanisms of information processing in schizophrenia. The methodology used for SR paradigm appears to be founded on a sound research basis and represents an advantageous paradigm for assessing attentional variables of information processing in mental disorders.

Risperidone, negative symptoms and cognitive deficit in schizophrenia: an open study

The aim of this study was to evaluate the effects of a new antipsychotic compound on negative symptoms and cognitive deficit in schizophrenia. Psychiatric symptoms and cognition were assessed in 25 patients with schizophrenia, at baseline and after they had taken risperidone for 4 weeks. The Positive and Negative Symptoms Scale (PANSS), the Wisconsin Card Sorting Test (WCST) and two WAIS sub‐tests were used to assess the patients. After the study period, both negative and positive symptoms and also measures of cognitive performance improved significantly. The WCST results correlated with negative symptom scores before and after treatment. This suggests that negative symptoms and cognitive deficit have a common underlying substrate which is the target of the risperidone treatment. Our data show that risperidone may have a substantial effect on complex cognitive functions in schizophrenia, and they suggest that certain cognitive deficits are relatively dependent on the negative symptoms of this disorder.

Reduced temporal lobe areas in schizophrenia: Preliminary evidences from a controlled multiplanar magnetic resonance imaging study

Seventeen young patients with relapsing schizophrenia and 13 normal controls matched for age, gender, and educational level underwent magnetic resonance imaging (MRI) scans. Three sagittal, eight axial, and seven coronal images were obtained for all subjects. Schizophrenic patients showed a reduction of brain tissue in the temporal lobes. Among the several brain structures identified, left temporal lobe area, but not ventricular brain ratio (VBR), discriminated between the two groups. As VBR has been reported to be increased in the more severe forms of schizophrenia, temporal lobe abnormalities may characterize the less severe cases of schizophrenia.

Reliability of an Italian standardized and expanded Brief Psychiatric Rating Scale (BPRS 4.0) in raters with high vs. low clinical experience.

Roncone R, Ventura J, Impallomeni M, Falloon IRH, Morosini PL, Chiaravalle E, Casacchia M. Reliability of an Italian standardized and expanded Brief Psychiatric Rating Scale (BPRS 4.0) in raters with high vs. low clinical experience. Acta Psychiatr Scand 1999: 100: 229–236.

Magnetic resonance imaging findings of amygdala- anterior hippocampus shrinkage in male patients with schizophrenia

Recent magnetic resonance imaging (MRI) studies found abnormalities of medial temporal lobe and basal ganglia structures. We used an inversion recovery (IR) protocol with the assistance of the Talairach atlas to identify neuroanatomical regions of interest in 19 male schizophrenic patients and 14 matched control subjects. The patient group showed smaller amygdala-hippocampus volume as compared with normal control subjects. This finding was more pronounced for the left side, although no diagnosis X side interaction was present. Third ventricle volume was also enlarged in schizophrenic patients. Trends toward an overall reduction of basal ganglia (striatum and lenticular nucleus) and limbic structures and toward an increase in ventricle-brain ratio were also seen. The study confirms previous evidence of mesial temporal lobe shrinkage, more evident on the left side in a group of relapsing noninstitutionalized male schizophrenic patients.

Planum temporale in schizophrenia: a magnetic resonance study

Magnetic resonance imaging (MRI) scans were used to examine the size and asymmetry of the planum temporale (PT) in 20 schizophrenic patients and 12 strictly matched healthy volunteers. PT lengths from coronal sections were measured and then summed to obtain an estimate of their areas. Schizophrenics showed the lack of the physiological PT area asymmetry evidenced in the control sample and a statistically significant diagnosis by side interaction was observed (F = 4.96; p less than 0.05). The study of PT asymmetry could permit us to better analyse the role of laterality in the pathophysiology of schizophrenia.

Planum temporale asymmetry and thought disorder in schizophrenia

Magnetic resonance imaging (MRI) was used to investigate the size and the asymmetry of the planum temporale (PT) in 22 schizophrenic patients and 23 strictly matched healthy volunteers. The degree of thought disorder was related to the reduction of the physiological PT asymmetry. When thought disordered patients were contrasted with non-thought disordered patients and healthy controls for a measure of PT laterality, those with thought disorder showed a statistically significant loss of PT laterality. This finding suggests that thought disordered schizophrenics may be characterized by an abnormal development of cerebral lateralization in a region crucial for language processing.

Effect of S-Adenosyl-L-Methionine (SAMe) upon depressive symptoms

Abstract SAMe is a methyl donor involved in methylation processes generally, including the Central Nervous System. Thirty depressed patients were studied in a double blind trial. The Hamilton Depression Rating Scale was used for symptom evaluation. The drug (45 mg i.m. daily) appeared to have a rapid and beneficial effect mainly upon depressed mood, suicidal tendencies, retardation and performance. Improvement was observed in 80% of the cases in 4–6 days. Studies are now in progress to clarify the biological mechanism involved in SAMes antidepressive action.

Could schizophrenic subjects improve their social cognition abilities only with observation and imitation of social situations

Schizophrenics display impairments in domains of social cognition such as theory of mind and emotion recognition. Recent studies, showing that the relationship of social cognition abilities with functional outcome is more significant than other neuro-cognitive functions, have considered these abilities as a target for intervention research. This article describes preliminary data from a new group-based study focused on Emotion and ToM Imitation Training (ETIT), an imitation treatment aimed at improving social cognition and social functioning in schizophrenia. In the present study, 16 outpatients with schizophrenia completed ETIT assessment and were compared with 17 outpatients who participated to a Problem Solving Training group. Participants were assessed at pre- and post-test on measures of emotion recognition, theory of mind, cognition, flexibility and social functioning. We compared the rehabilitation training effects on neuro-physiological activation through the event-related potentials (ERPs) method, which was recorded pre- and post-rehabilitation training. The results showed that when compared to the control group, ETIT participants improved on every social cognitive measure and showed better social functioning at post-test. Improvement in social cognition, in particular in emotion recognition, is also supported by ERP responses: we recorded an increase in electroactivity of medio-frontal areas only after ETIT treatment. Action observation and imitation could be regarded as a new frontier in rehabilitation.