T.R.E. Barnes

Cognitive functioning and symptomatology in chronic schizophrenia

Chronic schizophrenic patients in a long stay hospital were found to have low levels of intelligence (mean IQ of 80), which was attributed to the effects of substantial intellectual deterioration on below average pre-morbid levels of functioning. Patients with the lowest IQ scores had the least severe positive symptoms but symptomatology was not related to age or extent of intellectual decline. Speed of functioning was relatively more impaired than level of intellectual functioning, with cognitive speed being more affected than motor speed. The severity of negative but not positive symptoms was significantly related to the severity of bradyphrenia (cognitive slowing), a result which would be consistent with the notion of a subcortical pathology in patients with Type II schizophrenia.

Four behavioural syndromes of schizophrenia

BACKGROUNDnA complementary approach to defining symptomatic subtypes of schizophrenia is to identify characteristic patterns of problem behaviours associated with the capacity of patients to function in the community.nnnMETHODnIn a large epidemiological survey, patients fulfilling Feighner criteria for schizophrenia were identified by key informants and assessed using the MRC Social Behaviour Schedule (SBS) and the Manchester Scale. An exploratory factor analysis was used to extract behavioural syndromes from the SBS data in order to compare the syndrome profiles in community, acute and long-stay subgroups and to examine their associations with symptoms and social functioning.nnnRESULTSnFour behavioural syndromes were identified: Thought disturbance, Social withdrawal, Depressed behaviour and Anti-social behaviour, which distinguished between the patient subgroups and had significant differential relationships to symptoms and social functioning variables.nnnCONCLUSIONSnThe evaluation of disability in schizophrenia and effectiveness of treatment interventions is incomplete without an assessment of problem behaviours.

Psychomotor seizures presenting with hypnagogic visual hallucinations.

A 72-year-old widow complained of seeing visions 5-6 nights per week on falling asleep. At the age of 28 she had had a road traffic accident, sustaining a closed head injury with momentary loss of consciousness; 10 min later she experienced her first vision of a person. There was a further head injury 3 months later. The first of five brief psychiatric admissions occurred 6 months after the road traffic accident and schizophrenia was diagnosed when the patient was 34 years old. The psychiatric episodes were of acute onset with perplexity, incongruous emotional responses, confused and disordered talk and capricious impulsive behaviour. The patient recalled that several of the episodes were accompanied by visions. Rapid resolution of her symptoms occurred with antipsychotic medication. The patient had remained well on antipsychotic medication (trifluoperazine 5 mg twice daily) for 26 years except for an admission to hospital in 1977 after her medication had been stopped by her general practitioner.