R. Niethammer

Structural and functional correlates of subsyndromes in chronic schizophrenia.

Recent psychopathological studies consistently identified a delusional, a negative, and a disorganized subsyndrome in chronic schizophrenia. The aim of our studies was to investigate the subsyndromes with respect to their underlying cerebral changes using computed tomography (CT) and positron emission tomography (PET). In a CT study 50 DSM III schizophrenics were subgrouped according to four factors identified by a factor analysis of BPRS ratings. This procedure identified three chronic clusters (delusional ideation, negative symptoms, and disorganization) and one cluster with a remitting course of the disorder. Both the negative and the delusional subsyndrome were associated with a widening of the frontal interhemispheric fissure. Disorganization was associated with neurological soft signs, an increased ventricle brain ratio, and width of the 3rd ventricle. The same subgrouping was applied in a 18F-deoxyglucose PET study of 79 neuroleptic free DSM III schizophrenic patients and 47 healthy controls. The delusional subsyndrome was associated with a decreased hippocampal function, while the negative subsyndrome showed a prominent hypofrontality and left temporal cortex changes. Both the delusional and the negative subsyndrome were associated with a decreased activity in the medial frontal gyrus in comparison to the other schizophrenic patients and the healthy controls. The disorganized subsyndrome was characterized by an overactivity in the parietal cortex and motor strip and a decreased activity in the corpus callosum. These findings support the differentiation of three subsyndromes in chronic schizophrenia. The subsyndromes seem to be characterized by deviant patterns of cerebral alterations, rather than deficits in a single location.

Kognitive Verhaltenstherapie in und mit Gruppen – Ein Behandlungsprogramm für depressive Patienten in stationärer Behandlung

Cognitive-Behavioral Psychotherapy with and within Groups – A Treatment Program for Depressed Inpatients Background: Extensive research of cognitive behavioral therapy shows that it is an effective treatment for unipolar major depression. As the setting (e.g. inpatient vs. outpatient treatment) can influence therapeutic outcome, it is argued that modifications on treatment programs should take such settings into account. The modified treatment programs should then be evaluated within these settings. Based on these arguments, a group psychotherapy program was set up combining disorder-specific components (increasing pleasant activities and modification of dysfunctional thoughts) with a group psychotherapy approach that is more open regarding individual treatment goals. Method: The treatment program was evaluated within a naturalistic single group design. Patients who were hospitalized for unipolar major depression and took part on a therapy group were assessed pre- and post-therapy and at a 6-months follow- up. Results: 71 inpatients participated in 9 therapy groups and completed the program. Only a small number of patients (13.3%) dropped out before the end of treatment, which was interpreted as a high acceptance. The pre-post changes in degree of depressiveness (BDI, HAMD) and the 6-month follow-up results were similar to those of other controlled studies. Discussion: The advantages and disadvantages of a group psychotherapy approach are discussed, together with the limitations of the study.