Miklos Losonczy

Severe cognitive impairment in elderly schizophrenic patients: A clinicopathological study ☆

The severe cognitive impairment that affects many of the elderly schizophrenic patients could represent the outcome of schizophrenia in old age for the very severe and chronically ill patients or may be the result of lengthy institutionalization and somatic treatment. Alternatively, it could be due to the presence of concurrent dementing disorders, such as Alzheimers disease (AD) or multi-infarct dementia. Using an identical neuropathological protocol, brain specimens from schizophrenic patients who showed evidence of severe cognitive impairment were compared with 12 age-matched control cases and the same number of age-matched cases of neuropathologically confirmed patients with AD. Despite their relatively advanced age (mean age 77.1 years +/- 2.8), none of the schizophrenia cases showed sufficient degree of senile plaques and neurofibrillary tangle formations to confirm a diagnosis of AD. Other neurodegenerative disorders associated with dementia were also not identified. These studies suggest that alternative explanations need to be sought for the severe cognitive impairment commonly encountered in elderly schizophrenic patients.

Regional cerebral blood flow during the wisconsin card sort test in schizotypal personality disorder

Regional cerebral blood flow (rCBF) was measured by single photon emission computed tomography in 10 patients with schizotypal personality disorder (SPD) and nine age- and sex-matched normal volunteers. Subjects performed both the Wisconsin Card Sort Test (WCST) and a control task, the Symbol Matching Test (SMT). Four-way analyses of variance were performed to assess relative rCBF of the prefrontal cortex and of the medial temporal region. Normal volunteers showed more marked activation in the precentral gyrus, while SPD patients showed greater activation in the middle frontal gyrus. Relative flow in the left prefrontal cortex was correlated with better WCST performance in normal volunteers. SPD patients, however, showed no such correlations in the left prefrontal cortex, but demonstrated correlations of good and bad performance with CBF in the right middle and inferior frontal gyrus, respectively. Thus, at least some SPD patients demonstrate abnormal patterns of prefrontal activation, perhaps as a compensation for dysfunction in other regions.

Seasonal variations of human lumbar CSF neurotransmitter metabolite concentrations

While circadian rhythms of many biological processes have been well characterized in humans, variations throughout the year have been little studied. Lumbar cerebrospinal fluid (CSF) neurotransmitter metabolite levels for homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA), and 3-methoxy-4-hydroxyphenyl glycol (MHPG) were determined in patients with schizophrenia and Alzheimers disease. Samples from both groups taken during October through March had significantly higher levels of HVA and 5-HIAA, but not MHPG, than samples from April through September.

Suicidal ideation among national guard troops deployed to Iraq: the association with postdeployment readjustment problems

Abstract Despite well-documented postdeployment readjustment problems affecting veterans of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF), few studies have explored the possible relationship of readjustment stressors to the recent increase in military suicide. This study examined associations between suicidal ideation and postdeployment readjustment problems using cross-sectional population-based survey data from 1665 National Guard members who recently returned from Iraq. The findings suggested that readjustment problems are widespread, with 45% of veterans endorsing one or more financial or family problems 3 months postdeployment. After adjusting for mental health and combat exposure, veterans with the highest number of readjustment stressors were at 5½ times greater risk of suicidal ideation than those with no stressors. In a psychiatrically impaired subsample, the high stressor group experienced a fourfold risk of suicide ideation compared with those with no stressors. The findings argue for suicide prevention efforts that more directly target readjustment problems in returning OEF/OIF veterans.

Gender Differences in the Risk and Protective Factors Associated With PTSD: A Prospective Study of National Guard Troops Deployed to Iraq

This study examines gender differences in post-traumatic stress symptoms (PTSS) and PTSS risk/protective factors among soldiers deployed to Iraq. We pay special attention to two potentially modifiable military factors, military preparedness and unit cohesion, which may buffer the deleterious psychological effects of combat. Longitudinal data were collected on 922 New Jersey National Guard soldiers (91 women) deployed to Iraq in 2008. Anonymous surveys administered at pre- and post-deployment included the PTSD Checklist (PCL), the Unit Support Scale, and a preparedness scale adapted from the Iowa Gulf War Study. Bivariate analyses and hierarchical multiple regression were used to identify predictors of PTSS and their explanatory effects on the relationship between gender and PTSS. Women had a higher prevalence of probable post-deployment PTSD than men (18.7% vs. 8.7%; OR = 2.45; CI [1.37, 4.37]) and significantly higher post-deployment PTSS (33.73 vs. 27.37; p = .001). While there were no gender differences in combat exposure, women scored higher on pre-deployment PTSS (26.9 vs. 23.1; p ≤ .001) and lower on military preparedness (1.65 vs. 2.41; p ≤ .001) and unit cohesion (32.5 vs. 38.1; p ≤ .001). In a multivariate model, controlling for all PTSS risk/resilience factors reduced the gender difference as measured by the unstandardized Beta (B) by 45%, with 18% uniquely attributable to low cohesion and low preparedness. In the fully controlled model, gender remained a significant predictor of PTSS but the effect size was small (d = .26). Modifiable military institutional factors may account for much of the increased vulnerability of women soldiers to PTSD.

Lateral ventricular enlargement in schizotypal personality disorder

Although an increase in the ratio of ventricular space to brain (ventricle-brain ratio), VBR) on computed tomography (CT) has been among the most robust findings in chronic schizophrenia, VBR has not been investigated in a large, well-characterized clinical population of patients with schizotypal personality disorder (SPD), a clinical entity with a phenomenologic, gentle biological, and treatment response relationship to chronic schizophrenia. Accordingly, CT scans were obtained in 36 male SPD patients, 23 males with other personality disorders, 133 male schizophrenic patients, and 42 male normal volunteers. The mean body of the lateral VBR was significantly greater in the SPD patients than in the patients with other personality disorders. The VBR of the SPD patients did not differ significantly from either that of the normal volunteers or the schizophrenic patients but was intermediate between the two groups. There were no correlations with either psychotic-like or deficit-related symptoms of SPD in either the SPD or total personality disorder cohorts. SPD patients, like schizophrenic patients, may have increased VBRs compared wit patients with other personality disorders; their VBRs fall between the means of schizophrenic patients and normal control subjects.

Memory impairment in schizophrenic patients with tardive dyskinesia.

Memory functioning was contrasted in 40 schizophrenic patients with and without tardive dyskinesia (TD). Visual and verbal memory tests were used to investigate specific types of impairments. The presence of TD was ascertained using the Abnormal Involuntary Movement Scale (AIMS). TD patients scored significantly lower than non-TD patients on two measures of visual learning, though no differences were found for verbal learning or immediate recall. These results are consistent with previous reports that schizophrenic patients with TD demonstrate impaired cognitive functioning. They also raise the possibility that the neurochemical and structural changes underlying TD may produce specific deficits in memory for visual materials. In addition, a significant relationship was found between total score on the Brief Psychiatric Rating Scale (BPRS) and performance on all of the test measures included in the cognitive test battery. This demonstrates the importance of attending to the overall level of schizophrenic symptomatology when evaluating results from experimental learning tasks.

Readjustment Stressors and Early Mental Health Treatment Seeking by Returning National Guard Soldiers With PTSD

OBJECTIVES Readjustment stressors are commonly encountered by veterans returning from combat operations and may help motivate treatment seeking for posttraumatic stress disorder (PTSD). The study examined rates of readjustment stressors (marital, family, and employment) and their relationship to early mental health treatment seeking among returning National Guard soldiers with PTSD. METHODS Participants were 157 soldiers who were surveyed approximately three months after returning from combat operations in Iraq and scored positive on the PTSD Checklist (PCL). The survey asked soldiers about their experience with nine readjustment stressors as well as their use of mental health care in the three months after returning. RESULTS Many readjustment stressors were common in this cohort, and most soldiers experienced at least one stressor (72%). Univariate analyses showed that readjustment stressors were related to higher rates of treatment seeking. These findings remained significant after multivariate analyses adjusted for depression and PTSD severity but were no longer significant after adjustment for age and marital status. CONCLUSIONS Readjustment stressors are common among soldiers returning from duty with PTSD and may be more predictive than PTSD symptom levels in treatment seeking. These effects appeared to be at least partially accounted for by demographic variables and the role of greater familial and occupational responsibilities among older veterans. Treatment seeking may be motivated by social encouragement or social interference and less by symptom severity.

Magnetic resonance abnormalities in HIV infection: A study in the drug-user risk group

Cognitive impairment is a frequent complication of advanced human immunodeficiency virus-1 (HIV-1) infection. However, structural imaging of the brain has not revealed abnormalities that precede the onset of clinical abnormalities. Cranial magnetic resonance (MR) studies were performed in 28 male subjects with intravenous drug use histories; nine were HIV-1 seronegative, 11 were HIV-1 seropositive but asymptomatic, and eight were seropositive and met symptomatic criteria for acquired immune deficiency syndrome (AIDS). Cortical atrophy, but not the degree of ventricular enlargement or signal abnormalities, was increased in the seropositive group compared with the seronegative group and also differed between asymptomatic seropositive and seronegative patients. An increased level of cortical atrophy may reflect the early impact of HIV-1 infection on the brain.

Familial risk of schizophrenia and ventricular size on CT

evidence that patients with schizophrenia as a group have structural brain abnormalities including enlarged ventricles and cortical sulci as well as deficits in cortical gray matter volumes. Whether patients with other psychiaffic disorders have similar structural brain abnormalities has yet to be fully clarified. This study was undertaken to investigate structural brain abnormalities in patients with chronic schizophrenia using MR! and to determine whether a comparison group of patients with bipolar disorder would also differ on the structural brain measures. Twenty-three patients meeting DSM-IlI-R criteria for Chronic Schizophrenia and 14 patients m~ting DSM-IlI-R criteria for Bipolar Disorder were compared to a conerol ~oup consisting of 17 healthy community volunteers. All subjects were scanned using a i.5 Tesla General Electric Signa MR! scanner. A spin echo sequence was used to obtain early and late echo images with 5 nun. thickness and 2.5 ram. intersection skip. A total of 8 axial sections were chosen for this analysis. Axial images were read from computer storage medium into Macintosh workstations and analyzed using NIH Image (Rasband 1992). Images were processed using routines based on the methods of Lira and Pfefferbaum (J Comput Assist Tomogr. 1989). The lateral ventricles were quantified over all sections where they were present. Gray matter, white matter and cerebrospinal fluid volumes were quantified over the upper seven sections. The schizophrenia group had larger cortical sulci than controls (ig.05, one-tailed) while the bipolar group had larger ventricles than controls (p<.05, one-tailed). The schizophrenia group had significant deficits in cortical gray matter volumes compared to controls (p<.05). The results of this MRI study replicate previous work demonstrating increased cortical sulcal volumes with diminished cortical gray matter volumes in patients with schizophrenia as well as increased ventricular volumes in patients with bipolar disorder. Analysis of regional cortical gray matter volumes in these two patient samples will be presented. 379. FAMILIAL RISK OF SCHIZOPHRENIA AND VENTRICULAR SIZE ON CT