Ronald L. Green

Brain size, head size, and intelligence quotient in monozygotic twins

Many studies of monozygotic (MZ) twins have revealed evidence of genetic influences on intellectual functions and their derangement in certain neurologic and psychiatric diseases afflicting the forebrain. Relatively little is known about genetic influences on the size and shape of the human forebrain and its gross morphologic subdivisions. Using MRI and quantitative image analysis techniques, we examined neuroanatomic similarities in MZ twins and their relationship to head size and intelligence quotient (IQ). ANOVA were carried out using each measure as the dependent variable and genotype, birth order, and sex, separately, as between-subject factors. Pairwise correlations between measures were also computed. We found significant effects of genotype but not birth order for the following neuroanatomic measures: forebrain volume (raw, p ≤ 0.0001; normalized by body weight, p = 0.0003); cortical surface area (raw, p = 0.002; normalized, p = 0.001); and callosal area (raw, p ≤ 0.0001; normalized by forebrain volume, p = 0.02). We also found significant effects of genotype but not birth order for head circumference (raw, p = 0.0002; normalized, p ≤ 0.0001) and full-scale IQ (p = 0.001). There were no significant sex effects except for raw head circumference (p = 0.03). Significant correlations were observed among forebrain volume, cortical surface area, and callosal area and between each brain measure and head circumference. There was no significant correlation between IQ and any brain measure or head circumference. These results indicate that: 1) forebrain volume, cortical surface area, and callosal area are similar in MZ twins; and 2) these brain measures are tightly correlated with one another and with head circumference but not with IQ in young, healthy adults.

The caudal infrasylvian surface in dyslexia: Novel magnetic resonance imaging–based findings

Objective: To detect anatomic abnormalities of auditory association cortex in dyslexia by measuring the area of the perisylvian region known as the caudal infrasylvian surface(s) (cIS) in dyslexic and control subjects. Background: Several quantitative morphometric investigations of cortical areas in dyslexia have focused on the cIS, which encompasses the supratemporal plane and the inferior bank of the posterior ascending ramus of the sylvian fissure. Inconsistencies in the results of these studies may be attributable in part to the use of measurement methods that do not account fully for surface undulations of the cIS. Methods: The authors used an MRI-based surface reconstruction technique that models the curvature of the cerebral cortex in three dimensions to obtain whole-hemisphere and regional surface area estimates. Measurements were obtained in both hemispheres of eight right-handed male dyslexic subjects and eight right-handed male control subjects. Results: The cIS area of dyslexic subjects was significantly larger than that of control subjects, and this result was not attributable to a difference in whole-hemisphere surface area. Neither the dyslexic nor control subjects showed a left or right asymmetry in this region, although there was a trend toward less variance of the asymmetry scores in dyslexic subjects. Conclusions: The gross anatomic organization of this region is different in dyslexic subjects, and elucidation of the precise nature of these differences may be aided by surface modeling techniques.

Psychiatrists and psychiatric rehabilitation.

Interventions that focus directly on functional impairments related to mental illnesses are termed psychiatric rehabilitation. Research demonstrates that rehabilitation services are increasingly able to help adults with psychiatric disabilities achieve the functional outcomes they desire, particularly in the areas of housing and employment. To support the community lives of adults with severe mental illnesses, psychiatrists must stay current with advances in this field and know how to integrate psychiatric rehabilitation with other interventions. This article reviews the concept of psychiatric rehabilitation, current approaches in the field, the psychiatrists role in these services, and implications for psychiatric training and continuing education.

Improving depression care in a psychiatry resident psychopharmacology clinic: measurement, monitoring, feedback and education

Objective Better outcomes for major depressive disorder (MDD) are associated with proactive treatment, including timely follow-up, systematic assessment and treatment changes for inadequate improvement. The effectiveness of an intervention to facilitate proactive treatment for MDD in a resident psychopharmacology clinic was studied. Methods A quality improvement program with administrative process changes to improve flow and a 40-week pre/post study to evaluate the effect of education and feedback was conducted. A systematic assessment and reengineered scheduling system were implemented. During the first 20 weeks, baseline data were collected; during the second 20 weeks, feedback to residents and attending psychiatrists about adherence to evidence-based treatment recommendations was added. Results Reengineering our system to improve flow was successful. By linking outcomes collection to completion of billing sheets, outcomes at 90% of visits for MDD throughout the 40-week study was assessed. By centralising our scheduling system, the percentage of active-phase patients with MDD seen for follow-up within 6 weeks was improved from 19% to 59%. In response to feedback, residents did not make significant changes to their overall practice patterns. Patient outcomes did not improve as a result of feedback to residents. Residents did improve their practice patterns for a subset of patients including those without comorbid psychiatric disorders and those whose depressive episodes had lasted <1 year. Conclusions Improving administrative processes for the treatment of patients with MDD resulted in rapid changes that were associated with improvements in the delivery of evidence-based care. Feedback to residents was more difficult and less successful.

Procedural Validity of an Abbreviated Version of the SADS/RDC Diagnostic Process

Formal diagnostic systems such as the Research Diagnostic Criteria (RDC) and standardized diagnostic interviews such as the Schedule for Affective Disorders and Schizophrenia (SADS) have enhanced clinical psychiatric research over the past decade. Because of the cost and time factors, however, they are not routinely used in most clinical settings. The availability of reliable alternatives compatible with clinical practice would encourage more psychiatrists to engage in clinical research. This study describes the nature and procedural validity of two such alternatives based on the RDC. Acceptably accurate, less costly research diagnostic processes can be incorporated into clinically oriented short-term acute inpatient units.

Linking neuroimaging and cognitive neuropsychiatry

Introduction. The continuing goal of cognitive neuropsychiatry will be to shed light on the nature of psychiatric disorders. Methods. We reviewed recently the yield of a variety of experimental approaches, including cognitive studies, of schizophrenia, one of psychiatrys most difficult challenges. Results. We discussed the constraints of contemporary experimental methods which limit our ability to develop an integrated view of the pathological processes that underlie schizophrenia. Conclusions. An integrated model of the underlying nature of major psychiatric disorders, such as schizophrenia, will have to await, among other developments, the union of cognitive experimental methods with imaging techniques with the requisite temporal and spatial resolution, and the capacity to detect changes in brain form and function that reflect accommodations to the disorders.

A Comparison of Longitudinal and Block Rotations for a Psychiatric Resident Consultation-Liaison Experience

ObjectiveConsultation-liaison psychiatry (CLPsych) is a required experience for psychiatry residents. There is considerable variation in the structure of the experience. We sought to compare a longitudinal and block design for a CLPsych residency experience.MethodsThis research was conducted in the context of a naturalist transition from a longitudinal CLPsych rotation design to a block rotation design. We surveyed residents from both models regarding their views of the CLPsych psychiatry experience. We also compared the scores on the Psychiatric Resident in Training Examination (PRITE). Lastly, we surveyed physicians who requested and received psychiatric consultations.ResultsResidents trained in the block CLPsych model reported a better education and clinical care compared longitudinal model. They also had better scores on the CLPsych section of the PRITE exam. Physicians receiving psychiatric consultations reported better overall quality of consults in the block model.ConclusionsIt appears that block CL psychiatry experiences may be better than longitudinal ones. Programs should consider this design in psychiatry residency education.