Tamás Tényi

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.

Use of antipsychotics in the management of schizophrenia during pregnancy

The rapid development of pharmacotherapy has resulted in a growing clinical importance for the treatment of the increasing number of women with schizophrenia during pregnancy. An evolving database on reproductive health safety factors for women with schizophrenia has begun to be of assistance in optimising clinical benefits for women with childbearing potential.Given the prevalence of antipsychotic use during pregnancy in women with schizophrenia, it is important for the clinician to have a prepared approach to the administration of these agents. In general, the use of psychotropic medication during pregnancy is indicated when risk to the fetus from exposure to this medication is outweighed by the risks of untreated psychiatric illness in the mother. The preponderance of evidence from registries to large health surveys indicate that treatment with antipsychotic medication confers either no or a small nonspecific risk for organ malformations.According to the relevant literature published on the safety of antipsychotic medication during pregnancy, the findings are encouraging; however, the currently available data are very limited. Until there are more controlled prospective data on the impact of drugs on fetal and later development, the clinician will continue to work in a state of potential uncertainty, weighing partially estimated risks against managing individual clinical problems. The aim for the clinician should be to provide the best information available regarding the scope of possible risks associated with the treatment of schizophrenia during pregnancy. On the basis of the available data, generalisation is impossible and recommendations should be made on a drug-by-drug basis. The risks and benefits must always be carefully weighed for each patient on an individual basis. Only a woman who is well enough to acknowledge her pregnancy and her mental illness can effectively weigh the relative and partially unknown risks of treatment with antipsychotic medication against the highly probable risks of illness exacerbation if untreated.

Depressive symptoms among obese children

The authors compare the appearance of depressive symptoms in 30 obese children in outpatient care and 30 normal-weight controls. The Montgomery-Asberg Depression Rating Scale showed a significantly higher rate of depression in the obese children (p<0.01). The results are interpreted in the light of the partially contradictory views in the literature. Reference is also made to the therapeutic aspects of the problem.

Urinary steroid metabolites and 11β-hydroxysteroid dehyrogenase activity in patients with unipolar recurrent major depression

BACKGROUND The aim of the present study was to obtain comprehensive information on steroid metabolism in depressed patients. METHODS 24-h urinary steroids were measured by gas chromatography in patients with unipolar recurrent major depression (URMD) compared to controls, and an index of relative activity of the 11beta-hydroxysteroid dehydrogenase (11beta-HSD) enzyme was calculated. RESULTS The levels of etiocholanolone (E) (p < 0.05), beta-cortolone (beta-CL) (p < 0.01) were significantly decreased, while levels of allo-tetrahydrocorticosterone (aTHB) (p < 0.05) and cortisol (F) (p < 0.01) were elevated in depressed women. The levels of dehydroepiandrosterone (DHEA) (p < 0.01), tetrahydrocorticosterone (THB) (p < 0.01), beta-CL (p < 0.01), and aTHB (p < 0.05) were found significantly decreased in depressed men. The index of 11beta-HSD activity (p < 0.01) was significantly decreased in patients in both sexes. LIMITATIONS The sample is limited to only urine samples of patient with URMD; the correlation between the severity of depression and F and DHEA was not analyzed. CONCLUSION Our investigations confirmed that URMD associated with altered steroid metabolism, which shows gender differences, pointing to the different stress sensibility of women. These differences may be the cause as well as the consequence of the major depression (MD).

Antipsychotic use in pregnancy. What are the best treatment options

SummaryBoth the rapid emergence of new antipsychotic medications and the increasing fertility rate among women with psychotic disorders have contributed to the growing clinical importance of the treatment of pregnant women who have psychotic illnesses. The treatment of this patient population must always take into consideration the effect of that treatment on the fetus. With regard to the high risk of decompensation during pregnancy and postpartum, continuous antipsychotic medication is needed using the minimum effective dose. The use of high-potency agents appears to be preferable for first-line management, as there are few data regarding the use of atypical agents such as clozapine in pregnancy. Guidelines for treating pregnant women with psychoses vary little from those for nonpregnant patients. Clinicians must always carefully weigh up the risks and benefits for each patient on an individual basis.

Minor physical anomalies in affective disorders. A review of the literature

BACKGROUND The increased frequency of MPAs may be external markers of abnormal brain development in affective disorders. METHODS A MEDLINE, psychInfo and Web of Science search was evaluated to collect all publications on the prevalence of minor physical anomalies in bipolar affective disorder and unipolar major depression. AIMS As reports on the prevalence of MPAs in affective disorders were controversial, were based on highly different number of patients and were evaluated by the use of scales with different sensitivities, we considered as important to review the current state of knowledge and to recommend directions to further research. RESULTS 14 publications on 12 studies were found after a careful literature search. 5 studies have dealt with the prevalence of MPAs in bipolar affective disorder, 3 have reported on examinations among patients with unipolar major depression, while 5 publications on 3 studies combined patients with bipolar affective disorder, schizoaffective disorder and unipolar major depression. 1 study was published on the prevalence of MPAs among mood disorders, without the differentiation of the data of patients with bipolar affective disorder and unipolar major depression. LIMITATIONS Few studies with relatively small size were published, there is no data on the distinction between bipolar I and bipolar II disorders. CONCLUSION The reviewed data suggest a higher probability of the role of an aberrant neurodevelopment in bipolar affective disorder and a smaller in unipolar major depression.

‘Clonal Pluralization of the Self’: A New Form of Delusional Misidentification Syndrome

The authors present a patient with paranoid schizophrenia, who has the delusion that he exists in plural numbers. The patient declares these doubles to be both psychologically and physically completely identical to him, and he believes ‘them’ to be in fact women. In connection with the case, the authors discuss the phenomena of reduplicative paramnesia and clonal pluralization, and they suggest introducing the psychopathological term ‘clonal pluralization of the self’ for the reported phenomenon.

Minor physical anomalies in Tourette syndrome

- Background and Objectives: The prevalence of minor physical anomalies (prenatal errors of morphogenesis) was evaluated in patients with Tourette syndrome to get indirect data on the possible role of aberrant neurodevelopment in the aetiology of Tourette syndrome. No published study is known on the minor physical anomaly prevalence in this recently intensively investigated disorder, and connecting to current opinions on a possible role of aberrant neurodevelopment in Tourette syndrome it seems important to introduce trait marker research focusing on brain maldevelopment. Methods: A scale developed by Mehes 1,2 was used to detect the presence or absence of 57 minor physical anomalies in 24 patients with Tourette syndrome and in 24 matched controls 21 boys and 3 girls were evaluated, the age of onset of illness among the Tourette patients was between the age of 5 and 13. Results: The mean value of all minor physical anomalies was significantly higher among the group of patients compared with controls. (Mann - Whitney U - value: 49, 50, -Z = - 4,92, p = 0,001) In the case of 7 minor physical anomalies we could demonstrate statistically significant differences between the Tourette and the control sample. In the case of 4 minor malformations (supernumary nipples, prominent forehead, tongue with smooth and rough spots, double posterior hair whorl) and of 3 phenogenetic variants (anti-mongoloid slant, inner epicanthic folds, high arched palate) a significantly higher frequency was observed compared with control individuals. However after Bonferroni correction for the Fishers Exact test, only double posterior hair whorl and high arched palate showed a significantly higher frequency compared to control children (p = 0.001). Conclusions: The overrepresentation of minor physical anomalies in Tourette syndrome can strongly support the view that this disorder is related to pathological factors operating early in development.

Antipsychotics and Breast-Feeding

Many women with mental illnesses would like to breast feed their infants. In light of the limited but rapidly growing data, it seems that in some cases the possible physiological and psychological benefits may outweigh putative risks.All antipsychotics are secreted into breast milk but the concentrations and effects vary. There is a subgroup of mothers with mental illnesses who want to breast feed their infants and who are receiving a single established antipsychotic drug (principally, haloperidol or chlorpromazine) at the lowest possible clinically effective dose. As a tentative conclusion, this group could experience benefits from being able to nurse which would outweigh the risk of exposing their babies to very small amounts of antipsychotic drugs. However, larger study groups with longer follow-up periods would be required to confirm this tentative conclusion.Those mothers who require 2 or more antipsychotic drugs simultaneously and those taking one drug, but at the upper end of the recommended dose range, should not be advised to breast feed. Safety considerations suggest that women taking atypical antipsychotics would be advised not to breast feed because of the limited experience with these agents.When mothers taking antipsychotic drugs do nurse, it is desirable to monitor drug concentrations in breast milk and in the infants themselves. Close monitoring of the infant is essential.

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.