Mimi C. Roberts

Depressive symptoms at baseline predict fewer negative symptoms at follow-up in patients with first-episode schizophrenia.

There is uncertainty regarding the prognostic value of depressive symptoms in schizophrenia, having previously been associated with both favourable and poor outcome. This study investigated the relationship between baseline depressive symptoms and treatment outcome at 6, 12 and 24 weeks in 80 subjects with first-episode schizophrenia or schizophreniform disorder in terms of PANSS total and subscale score changes. No significant association was found between baseline PANSS depression factor scores and PANSS total and subscore changes. However, a significant inverse correlation between baseline depression scores and negative scores at 6, 12 and 24 weeks was found (p=0.044, 0.023 and 0.012, respectively). Multiple regression analysis indicated that this finding could not be explained on the basis of age, gender or duration of untreated psychosis. These findings support previous work suggesting that high baseline depressive scores predict favourable outcome.

Psychiatric manifestations and magnetic resonance imaging in HIV-negative neurosyphilis

Neurosyphilis can mimic virtually any psychiatric disorder. Since there are no studies measuring the relationship between its psychiatric manifestations and neuroradiological findings, we performed magnetic resonance imaging (MRI) on 20 newly diagnosed patients with neurosyphilis and 20 healthy volunteers. MRI abnormalities occurred in 13 neurosyphilis patients. These included foci of increased signal intensity of T2-weighted images, and generalized cerebral atrophy. Two control subjects showed minor focal changes. In the neurosyphilis patients, frontal lesions showed statistically significant associations with the overall degree of psychiatric morbidity as measured by the brief psychiatric rating scale (p < 0.05). Temporo-parietal lesions showed a near significant association with cognitive impairment as measured by the Mini mental-state examination (p = 0.06). Atrophy measures correlated significantly with cognitive impairment. The results suggest that the site of brain lesions may be important in determining the nature of the psychiatric symptoms in neurosyphilis.

Disordered water homeostasis and cognitive impairment in schizophrenia

To investigate a possible association between disordered water homeostasis and cognitive impairment in schizophrenia, neuropsychological tests were applied to 16 schizophrenic patients with severely deranged water homeostasis and to 16 matched schizophrenic controls. The patients with disordered water homeostasis tended to obtain poorer scores than the controls throughout, the differences being statistically significant for two of the tests (Wechsler Memory Scale Visual Reproduction and Trial Marking Test part A). These results were not ascribable to differences in the duration of the illness, premorbid IQ, medication, or electroconvulsive therapy received, or prominence of any particular symptoms. The results suggest the co-existence of disordered water homeostasis and cognitive impairment in a subset of schizophrenic patients.

Is puerperal psychosis bipolar mood disorder?: A phenomenological comparison

The most widely held current view on puerperal psychosis (PP) is that it is a mood disorder; some researchers have even suggested that it may be linked to bipolar mood disorder (BMD). To compare the phenomena of PP and BMD, 20 patients with PP were compared with 20 concurrent age-matched women with BMD, using the Structured Clinical Interview for DSM-III-R (SCID). To exclude patients with possible unipolar disorder, subjects with depression were not considered for inclusion in the study. A significantly greater proportion of the PP group experienced delusions of control, auditory hallucinations, blunted affect, and emotional turmoil. Seven (35%) of the PP patients fulfilled DSM-III-R criteria for BMD. These results do not support the hypothesis that PP and BMD are the same illness. Further research is necessary to explore the possibility of a link between these two conditions.

Cognitive change after treatment for neurosyphilis: Correlation with CSF laboratory measures

The decision to re-treat a patient with neurosyphilis is usually based on the clinical response, cerebrospinal fluid (CSF), cell count, and CSF protein concentration. The value of the CSF Venereal Disease Research Laboratory (VDRL) test on its own as a marker for treatment response in neurosyphilis has not been established. To assess the usefulness of CSF markers for continuing infection, 12 patients with neurosyphilis were reevaluated 1 year after treatment. Change in cognitive functioning, as assessed by the Mini-mental State Examination (MMSE), was correlated with the CSF cell count, protein content, IgG index, and VDRL test titer at follow-up. A significant negative correlation was obtained between 1 year improvement in MMSE score and CSF VDRL titers at both the 6- and the 12-month follow-up examinations, and with the 6-month CSF protein concentration. These findings suggest that the CSF VDRL titer may be an indicator of continued Treponema pallidum activity in patients without obvious clinical deterioration.

Serotonergic agents in the treatment of hypothalamic obesity syndrome: A case report

The hypothalamic obesity syndrome is characterized by hyperphagia and excessive weight gain in the presence of demonstrable hypothalamic injury. There have been no previous reports describing the use of serotonergic agents in this condition. We report on a patient with severe hyperphagia and obesity secondary to a hypothalamic lesion, who was treated with consecutive courses of fluoxetine and fenfluramine. Neither treatment resulted in a reduction in food intake or weight. Treatment of hypothalamic obesity with serotonergic agents appears to be of little value, probably because they exert their effect via intact serotonergic-sensitive hypothalamic nuclei.