Róbert Herold

Schizophrenics Show a Failure in the Decoding of Violations of Conversational Implicatures

Objectives: Recent approaches to the ‘theory of mind’ and pragmatics support that, if we did not have any idea about what other people know, we could hardly use language effectively. Successful communication (the pragmatic aspect of language) depends on inferring the beliefs and intentions of the partner in the conversation. Such successful communication is linguistically realized in part by cohesion and in part by abiding by the maxims derived from the cooperative principle. However, the violations of the Gricean implicatures are generally used in everyday language, mainly to point at a hidden, most commonly negative opinion on others. We hypothesize that schizophrenics have difficulties in the decoding of these violations, as the core deficit in this disorder is around social cognition, theory of mind and pragmatic language use. Material and Method: We have examined 26 paranoid schizophrenic patients and 26 normal control subjects by using 4 ‘question and answer’ vignettes, where the Gricean maxim of relevance was violated to express a hidden, negative opinion by one partner during the communicative act. The subjects were asked to judge these opinions and were evaluated by the investigators on a score from 0 to 2 points. In a pilot study, interrater reliability was judged to be satisfactory. The data were analysed statistically by parametric and non-parametric tests. Results: Statistical analyses of our data have shown that schizophrenics made significantly more mistakes during the decoding of the violated maxim as compared with controls (p < 0.0001), reflecting on the difficulties during the correct exploration of the social context, i.e. recognition of the speaker’s hidden opinion. Conclusion: We conclude that patients with schizophrenia fail to decode intentional violations of conversational implicatures. These results point at a dysfunctional pragmatic language use among schizophrenic patients.

Disconnection Mechanism and Regional Cortical Atrophy Contribute to Impaired Processing of Facial Expressions and Theory of Mind in Multiple Sclerosis: A Structural MRI Study

Successful socialization requires the ability of understanding of others’ mental states. This ability called as mentalization (Theory of Mind) may become deficient and contribute to everyday life difficulties in multiple sclerosis. We aimed to explore the impact of brain pathology on mentalization performance in multiple sclerosis. Mentalization performance of 49 patients with multiple sclerosis was compared to 24 age- and gender matched healthy controls. T1- and T2-weighted three-dimensional brain MRI images were acquired at 3Tesla from patients with multiple sclerosis and 18 gender- and age matched healthy controls. We assessed overall brain cortical thickness in patients with multiple sclerosis and the scanned healthy controls, and measured the total and regional T1 and T2 white matter lesion volumes in patients with multiple sclerosis. Performances in tests of recognition of mental states and emotions from facial expressions and eye gazes correlated with both total T1-lesion load and regional T1-lesion load of association fiber tracts interconnecting cortical regions related to visual and emotion processing (genu and splenium of corpus callosum, right inferior longitudinal fasciculus, right inferior fronto-occipital fasciculus, uncinate fasciculus). Both of these tests showed correlations with specific cortical areas involved in emotion recognition from facial expressions (right and left fusiform face area, frontal eye filed), processing of emotions (right entorhinal cortex) and socially relevant information (left temporal pole). Thus, both disconnection mechanism due to white matter lesions and cortical thinning of specific brain areas may result in cognitive deficit in multiple sclerosis affecting emotion and mental state processing from facial expressions and contributing to everyday and social life difficulties of these patients.

Temperament and psychopathological syndromes specific susceptibility for rubber hand illusion

The aim of this study is to explore individual capacity for self-integration, susceptibility to the Rubber Hand Illusion (RHI) and the role of temperament factors in the emergence of body schema and body image dissociation. The RHI factors, proprioceptive drift, body ownership and body disownership were assessed in 48 university students. Personality and psychiatric vulnerability were measured by the Temperament and Character Inventory (TCI-R) and the Symptom Checklist-90-R (SCL-90-R). Our study pointed to the fact that the extent of behaviourally defined proprioceptive drift was associated with temperament factors, especially with Novelty Seeking and Harm Avoidance. Further, the ownership was associated with Symptom Checklist factors, especially with elevated Interpersonal Sensitivity and vulnerability to Schizotypy and Paranoid Ideation and elevated disownership score was found in the case of elevated Schizotypy, including a depersonalisation feeling when the RHI was induced. The RHI may be considered as a conflicting situation, in which a way to cope with incongruent multimodal, visual, haptic and proprioceptive stimulation provides an opportunity to test body integration and embodiment processes in healthy participants and patients without disadvantageous outcomes. The results support and replenish the two opposite processing models of the RHI with a third, temperament-based procedural mechanism.

Delusions of Pregnancy with Post-Partum Onset: An Integrated, Individualized View

Background and Objectives: Bizarre hypochondriacal delusion is an im- portant content of delusion of pregnancy during post-partum period. Methods: Here we report two cases with postpartum delusion of pregnancy; one with pre-existing schizophrenia and another one with family history of pseudocyesis and schizoaffective disorder but with no pre-existing psychiatric illness. Results: Nosological, phenomenological and aetiological issues are discussed. In the context of novel deficit-and motivational theories of delusion formation we provide an in- tegrated view of the reported cases. Conclusions: The complexity of the delusion of pregnancy should be considered in the treatment planning-particularly in the post-partum period.

Minor physical anomalies are more common among the first-degree unaffected relatives of schizophrenia patients – Results with the Méhes Scale

Minor physical anomalies are external markers of abnormal brain development,so the more common appearance of these signs among the relatives of schizophrenia patients can confirm minor physical anomalies as intermediate phenotypes. The aim of the present study was to investigate the rate and topological profile of minor physical anomalies in the first-degree unaffected relatives of patients with schizophrenia compared to matched normal control subjects. Using a list of 57 minor physical anomalies (the Méhes Scale), 20 relatives of patients with the diagnosis of schizophrenia and as a comparison 20 matched normal control subjects were examined. Minor physical anomalies were more common in the head and mouth regions among the relatives of schizophrenia patients compared to normal controls. By the differentiation of minor malformations and phenogenetic variants, we have found that only phenogenetic variants were more common in the relatives of schizophrenia patients compared to the control group, however individual analyses showed, that one minor malformation (flat forehead) was more prevalent in the relative group. The results can promote the concept, that minor physical anomalies can be endophenotypic markers of the illness.

Tics status: A movement disorder emergency

We describe a case of an 18-years-old boy with GTS, who developed severe, continuous, disabling tics after an arbitrary and abrupt withdrawal of haloperidol, tiapride and clonazepam therapy. This exacerbation considered as tics status lasted for weeks despite of intravenous re-administration of these drugs and interfered with sleeping; therefore, propofol and midazolam sedation, and later relaxation with artificial ventilation were applied for an immediate relief. Changing the medication to olanzapine and levetiracetam in parallel to sedation was effective to improve the motor symptoms to the baseline level. As far as the authors are aware, our case is the first published tics status case lasting for weeks and requiring sedation, intubation, and relaxation.

Effectiveness of intramuscular aripiprazole injection in patients with catatonia: report on three cases.

In the recent literature, orally administered aripiprazole, a second generation antipsychotic, was demonstrated to be eff ective in the resolution of catatonia. Our present paper is the fi rst report of three cases of catatonia where intramuscularly administered high doses of aripiprazole were found to be eff ective in resolving severe catatonic states, independent of the features, or of the origin of catatonia, presenting either in schizophrenia or in major depression. On the basis of the unique mechanism of action of the drug and based on our clinical experience, we recommend the use of high doses of intramuscular aripiprazole as an alternative treatment for catatonia, when benzodiazepines or electroconvulsive therapy are not eff ective or not proposed.

Theory of Mind in Depressive Disorders: A Review of the Literature

Background: Theory of mind (ToM) is the ability to infer the mental states of others in order to understand and predict their behaviour. This ability is thought to be essential to social functioning and interpersonal relationships. As major depression is characterized by considerable social and interpersonal difficulties, exploration of the quality of ToM functioning can be particularly relevant in this and in related disorders. We aim to review the current state of research on ToM in depressive disorders in order to find out the extent to which ToM impairment is associated with these illnesses. Methods: An internet database search was carried out to collect all publications on the subject. Results: A total of 32 publications in English met our inclusion criteria: (a) 17 studies on ToM in major depression, (b) 4 studies on ToM in psychotic depression, (c) 3 studies on ToM in dysphoria or mild depression, (d) 4 studies on ToM in euthymic major depression, (e) 2 studies on ToM in chronic versus episodic depression, and (f) 2 studies on ToM in another psychiatric disorder with comorbid major depression. Conclusions: Despite an increased interest in the research of the topic in recent years, no firm conclusions can be drawn, as the reviewed articles present some conflicting results. Acutely depressed patients have been found to be impaired on tasks involving both ToM social-perceptual and social-cognitive components. On the other hand, a number of studies have not reported significant between-group differences between depressed patients and healthy controls or have found minimal differences. Further research is needed in order to confirm and extend these results.

Not Just the Demographic Change – The Impact of Trends in Risk Factor Prevalences on the Prediction of Future Cases of Myocardial Infarction

Background Previous predictions of population morbidity consider demographic changes only. To model future morbidity, however, changes in prevalences of risk factors should be considered. We calculated the number of incident cases of first myocardial infarction (MI) in Mecklenburg-Western Pomerania in 2017 considering the effects of demographic changes and trends in the prevalences of major risk factors simultaneously. Methods Data basis of the analysis were two population-based cohorts of the German Study of Health in Pomerania (SHIP-baseline [1997–2001] and the 5-year follow-up and SHIP-Trend-baseline [2008–2011] respectively). SHIP-baseline data were used to calculate the initial coefficients for major risk factors for MI with a Poisson regression model. The dependent variable was the number of incident cases of MI between SHIP-baseline and SHIP-5-year follow-up. Explanatory variables were sex, age, a validated diagnosis of hypertension and/or diabetes, smoking, waist circumference (WC), increased blood levels of triglycerides (TG) and low-density-lipoprotein cholesterol (LDL), and low blood levels of high-density-lipoprotein cholesterol (HDL). Applying the coefficients determined for SHIP baseline to risk factor prevalences, derived from the new cohort SHIP-Trend together with population forecast data, we calculated the projected number of incident cases of MI in 2017. Results Except for WC and smoking in females, prevalences of risk factors in SHIP-Trend-baseline were lower compared to SHIP-baseline. Based on demographic changes only, the calculated incidence of MI for 2017 compared to the reference year 2006 yields an increase of MI (males: +11.5%, females: +8.0%). However, a decrease of MI (males: -23.7%, females: -17.1%) is shown considering the changes in the prevalences of risk factors in the projection. Conclusions The predicted number of incident cases of MI shows large differences between models with and without considering changes in the prevalences of major risk factors. Hence, the prediction of incident MI should preferably not only be based on demographic changes.

P01-44 - Euthymic bipolar patients’ deficits in in social cognition tasks

Objectives Theory of mind (ToM) has been proved to play a crucial role in social cognition and functioning. In our study, higher order mentalization performance of euthymic bipolar I patients were compared with that of healthy controls. The impact of demographic data, course of the disorder and patients’ current functioning were also considered while interpreting mentalization data. Methods The mentalizing performance (computerized faux pas task and false irony task), neurocognitive functioning, and IQ of twenty-three euthymic bipolar I patients and 31 matched (IQ, age) healthy controls were examined. In the patients group, the age at onset, the occurrence of psychotic symptoms, age, education, current employment status, and global functioning were also taken into account. Results Bipolar patients scored significantly lower in false irony tasks than healthy controls (p Conclusion Our results showed impaired performance in faux pas and irony tasks, which correlates with the number of previous episodes. Additionally, the impairment of ToM functions predicts a worse functional outcome.