Wolfgang Gaebel

Facial Expression and Emotional Face Recognition in Schizophrenia and Depression

SummaryTwenty-three acute schizophrenics, 21 acute major depressives (Research Diagnostic Criteria), and 15 normal controls participated in a study on facial expression and emotional face recognition. Under clinical conditions, spontaneous facial expression was assessed according to the affective flattening section of the Scale for the Assessment of Negative Symptoms. Under experimental laboratory conditions involuntary (emotioneliciting interview) and voluntary facial expression (imitation and simulation of six basic emotions) were recorded on videotape, from which a raterbased analysis of intensity or correctness of facial activity was obtained. Emotional face recognition was also assessed under experimental conditions using the same stimulus material. All subjects were assessed twice (within 4 weeks), controlling for change of the psychopathological status in the patient groups. In schizophrenics, neuroleptic drug influence was controlled by random allocation to treatment with either haloperidol or perazine. The main findings were that schizophrenics and depressives are characterized by different quantitative, qualitative, and temporal patterns of affect-related dysfunctions. In particular, schizophrenics demonstrated a trait-like deficit in affect recognition and in their spontaneous and voluntary facial activity, irrespective of medication, drug type and dosage, or extrapyramidal side-effects. In depressives a stable deficit could be demonstrated only in their involuntary expression under emotion-eliciting interview conditions, whereas in the postacute phase a reduction in their voluntary expression became apparent. Differences in patterns of affect-related behavioral deficits may reflect dysfunctions in different underlying psychobiological systems.

Intermittent versus maintenance neuroleptic long-term treatment in Schizophrenia—2-year results of a German multicenter study

Abstract The paper presents the 2-year results of a multicenter study on the comparative efficacy of different neuroleptic long-term treatment strategies in 364 schizophrenic outpatients carried out by the German Neuroleptic Treatment Study (ANI) Group. Three randomly assigned open neuroleptic treatments were compared: standard prophylactic maintenance medication, and two types of intermittent treatment (early intervention and neuroleptic crisis intervention). Although relapserates were significantly lower under early intervention (49%) than under crisis intervention (63%), those under maintenance treatment were by far the lowest (23%). Dropout and rehospitalization rates under both intermittent treatment strategies were also significantly less favorable than under maintenance treatment, whereas psychopathology, social adjustment, subjective wellbeing, and side-effects were not significantly different between treatment strategies. Cumulative neuroleptic dosage was significantly lower under intermittent treatment, even when inpatient treatment in a case of rehospitalization was considered. In conclusion, prophylactic maintenance medication turns out again to be the best treatment for most of the patients.

Depressive syndromes in schizophrenic patients under neuroleptic therapy

SummarySchizophrenic outpatients (=364) were assigned at random to three different treatment strategies: (1) continuous medication with neuroleptic drugs, (2) intermittent medication with crisis intervention and (3) intermittent medication with early intervention. Depressive syndromes were rated according to three different scales for depressive syndromes (Brief Psychiatric Rating Scale anxious depression factor, Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie/depression, and the self-rating Paranoid Depression Scale) after 1 and 2 years of treatment. No differences in depression scores were found between the three treatment strategies. Comparisons between patients treated with neuroleptic drugs at the time and patients without neuroleptics revealed significantly higher depression scores in the neuroleptics group in most comparisons. No differences were found between patients treated with low versus high potency neuroleptics and between oral versus depot neuroleptics. However, depression correlated with extrapyramidal symptoms.

Ventricle size and P300 in schizophrenia

SummaryBoth ventricular enlargement and reduced P3 amplitudes are consistent findings in schizophrenic patients, suggesting that the two measures reflect a common underlying pathophysiological process in schizophrenia. Investigating 14 stabilized schizophrenic outpatients, a relationship between the size of the lateral ventricles as well as of the third ventricle on CT scans and the auditory event-related P3 amplitude was, however, not found. This negative result suggests that ventricular enlargement and reduced P3 amplitudes in schizophrenics reflect different pathophysiological processes. It is assumed that the P3 amplitude is related rather to abnormalities in the temporal lobe of schizophrenic patients.

Multidimensional study of the outcome of schizophrenic patients 1 year after clinic discharge

SummarySeveral dimensions of the outcome of 86 schizophrenic patients were recorded 1 year after discharge from inpatient index-treatment to complete a prospective study concerning the course of illness (rehospitalization, symptoms, employment and social contacts). When compared with 75 psychiatric patients of other diagnostic groups, no differences were found other than a significantly longer average rehospitalization stay for the schizophrenic patients. Taking prognostic categories and the regularity of neuroleptic therapy conducted during follow-up into account, it was established that the social outcome status of schizophrenic patients is substantially determined by the original level at the time of index-treatment. In contrast, the rate of relapse and readmission depend significantly upon the continuity of neuroleptic treatment. More complex analyses show that particularly for patients already hospitalized several times, successful relapse prophylactic treatment also has a favorable influence upon the patients symptoms in the sense of a more stable remission. This could be related to the finding that the more chronic patients apparently exhibit a delayed remission when they undergo a relapse. The findings are interpreted to the effect that continuous neuroleptic maintenance therapy is advantageous to the majority of the patients, and should be applied, in view of the fact that alternative therapy procedures such as neuroleptic interval strategies have not yet been sufficiently evaluated.

Prognosis of the course of schizophrenic psychoses compared to other psychiatric illnesses

SummaryIn a prospectively designed study of the course of illness of 161 hospitalized psychiatric patients, data regarding outcome could be obtained for 93% 1 year after clinic discharge. It was possible to reexamine 67% of the patients by means of direct interviews. No significant differences appeared in the comparison of the course of illness outcomes (symptoms, rehospitalization, occupation and social contacts) of patients with schizophrenic psychoses, affective psychoses, neuroses or a group of mixed other diagnoses (predominantly alcohol dependency). For the group of neuroses there was a particularly striking discrepancy between the self- and the observer-ratings at the time of discharge from inpatient index-treatment. From this finding and from the comparatively more intense prominence of depressive symptoms at the time of follow-up, one can presume that there has been insufficient after-care treatment of this patient group considering the recorded treatment data. This seems to hold true for the group of alcohol dependents as well. In contrast, the after-care treatment of patients with affective and schizophrenic psychoses seems more likely to be ensured today. Despite this, however, for the latter the close link between the rate of relapse and the rate of rehospitalization can apparently scarcely be influenced.

Subklassifikation schizophrener Patienten und Prädiktion des Spätdyskinesierisikos mittels ereigniskorrelierter Potentiale

Zahlreiche Studien legen eine Subklassifikation schizophrener Patienten in eine Gruppe, die auf dem Boden einer genetisch bedingten Vulnerabilitat, und eine, die auf dem Boden einer mehr exogen bedingten Vulnerabilitat erkrankt ist, nahe [7, 8, 9, 14]. Zudem gibt es Hinweise, das Patienten mit hirnstrukturellen, vermutlich exogen bedingten Auffalligkeiten ein erhohtes und Patienten mit familiarer Belastung vergleichsweise ein niedriges Spatdyskinesierisiko aufweisen, obwohl die Literatur hierzu keineswegs konsistent ist [1, 2, Review bei 3]. Als Ursache fur eine exogen bedingte Vulnerabilitat sind u. a. pranatale Hirnentwicklungsstorungen zu diskutieren. In mehreren post mortem Untersuchungen an Schizophrenie- Gehirnen sind jeweils bei einer Untergruppe morphologische Auffalligkeiten im medialen Temporalbereich gefunden worden. Diese bestanden u. a. in einer reduzierten Neuronenzahl und einer Fehlanordnung hippokampaler Pyramidenzellen und werden auf Storungen der fotalen Neuroblastenwanderung zuruckgefuhrt. Als mogliche Ursache fur die Storung der Neuroblastenwanderung werden exogene Faktoren wie virale Infektionen der Mutter im 2. Trimenon diskutiert, ein Zusammenhang, den mehrere Arbeiten nahelegen [5, 10].