Psychotic Signs Research Articles

All Roads to Schizophrenia Lead to Dopamine Supersensitivity and Elevated Dopamine D2High Receptors

The dopamine D2 receptor is the common target for antipsychotics, and the antipsychotic clinical doses correlate with their affinities for this receptor. Antipsychotics quickly enter the brain to occupy 60-80% of brain D2 receptors in patients (the agonist aripiprazole occupies up to 90%), with most clinical improvement occurring within a few days. The D2 receptor can exist in a state of high-affinity (D2(High) ) or in a state of low-affinity for dopamine (D2Low). The present aim is to review why individuals with schizophrenia are generally supersensitive to dopamine-like drugs such as amphetamine or methyphenidate, and whether the D2(High) state is a common basis for dopamine supersensitivity in the animal models of schizophrenia. All animal models of schizophrenia reveal elevations in D2(High) receptors. These models include brain lesions, sensitization by drugs (amphetamine, phencyclidine, cocaine, corticosterone), birth injury, social isolation, and gene deletions in pathways for NMDA, dopamine, GABA, acetylcholine, and norepinephrine. These multiple abnormal pathways converge to a final common pathway of dopamine supersensitivity and elevated D2(High) receptors, presumably responsible for psychotic symptoms. Although antipsychotics alleviate psychosis and reverse the elevation of D2(High) receptors, long-term antipsychotics can further enhance dopamine supersensitivity in patients. Therefore, switching from a traditional antipsychotic to an agonist antipsychotic (aripiprazole) can result in psychotic signs and symptoms. Clozapine and quetiapine do not elicit parkinsonism or tardive dyskinesia because they are released from D2 within 12 to 24 h. Traditional antipsychotics remain attached to D2 receptors for days, preventing relapse, but allowing accumulation that can lead to tardive dyskinesia. Future goals include imaging D2(High) receptors and desensitizing them in early-stage psychosis.

Bipolar Disorder and Pregnancy: Maintaining Psychiatric Stability in the Real World of Obstetric and Psychiatric Complications

This article describes complex, real-life issues faced by a woman with bipolar I disorder who wished to bear a healthy child while remaining psychiatrically well. The therapeutic issues include balancing treatment decisions that affect fetal and maternal risks. The authors address the importance of carefully considering the patient’s history of response to medications when evaluating risks to maternal and fetal health. They discuss the role of the psychiatrist as a part of the treatment team faced with unpredictable but not unexpected complexities, such as miscarriage, abnormal or questionable prenatal screening tests, gestational diabetes, and the emergence of fetal decelerations, preterm labor, and psychiatric decompensation. The article presents and evaluates treatment decisions made in the setting of multiple obstetric and psychiatric complications that do not clearly fit published algorithms. The importance of incorporating family and social supports as an integral part of the treatment plan is emphasized.

Corpus callosum atrophy and psychosis: a case report

Corpus callosum atrophy and psychosis: a case report A 31-year-old male patient was hospitalized in our hospital due to the compulsory treatment desicion of the related court because of the guilt of “murder”. The patient had been treated in intensive care unit due to head trauma because of a traffic accident, in 2001. The patient had had no complaints or disease until this accident. After his treatment for head trauma, psychotic signs as persecution delusions had appeared. He had killed his aunt because of his persecution delusions as he believed his aunt had been hostile to and would harm him. In his cranial MRI, thinning-atrophy in all parts of corpus callosum was observed. He was diagnosed with “psychotic disorder due to head trauma, with delusions”, according to DSM-IV TR. This case is found interesting because of the time relation between head trauma and psychosis and corpus callosum atrophy detected after the head trauma.

Dopamine D2 Receptors as Treatment Targets in Schizophrenia

The antipsychotic effectiveness of chlorpromazine and haloperidol started a search for their therapeutic targets. The antipsychotic receptor target turned out to be a dopamine receptor, now cloned as the dopamine D2 receptor. The D2 receptor is the common target for antipsychotics. Antipsychotic clinical doses correlate with their affinities for this receptor. Therapeutic doses of antipsychotics occupy 60 to 80% of brain D2 receptors in patients, but aripiprazole occupies up to 90%. While antipsychotics may take up to six hours to occupy D2 receptors, much clinical improvement occurs within a few days. The receptor has high- and low-affinity states. The D2High state is functional for dopamine-like agonists such as aripiprazole. Most individuals with schizophrenia are supersensitive to dopamine. Animal models of psychosis show that a variety of risk factors, genetic and nongenetic, are associated with behavioral supersensitivity to dopamine, reflected in elevated levels of dopamine D2High receptors. Although antipsychotics such as haloperidol alleviate psychosis and reverse the elevation of D2High receptors, long-term use of traditional antipsychotics can further enhance dopamine supersensitivity in patients. Therefore, switching from a traditional antipsychotic to an agonist antipsychotic such as aripiprazole can result in the emergence of psychotic signs and symptoms. Clozapine and quetiapine do not elicit parkinsonism and rarely result in tardive dyskinesia because they are released from D2 within 12 to 24 hours. Traditional antipsychotics remain attached to D2 receptors for days, preventing relapse, but allowing accumulation that can lead to tardive dyskinesia. Future goals include imaging D2High receptors and desensitizing them in early-stage psychosis.

Somatic Delusion or Recurrent Pulmonary Embolism?

To the Editor: Somatic delusions are common, often subtle, mood-congruent manifestations of major depressive disorder with psychotic features.1 This is a presentation and discussion of a patient with somatic delusions of chest pain that presented a challenge in differentiating thromboembolus from delusion. Case report. Mr A, a 32-year-old recently unemployed and homeless man with a history of cocaine dependence and major depressive disorder, was transferred from the internal medicine ward (where he was treated for pulmonary embolism [PE] for 1 week) to a dual diagnosis inpatient unit in December 2008 for evaluation and management of depressed mood, suicidal ideation, neurovegetative symptoms, and cocaine dependence. On our initial evaluation, the patient reported a 6-week history of progressively depressed mood, suicidal ideation, sleep disturbances, weight loss, and guilt. He also reported 10 years of daily cocaine use, but denied use during the month prior to admission. He displayed paranoia and obsessive thoughts, but showed neither perceptual disturbances nor delusions. We continued anticoagulant dosing: subcutaneous enoxaparin 90 mg every 12 h was administered until the international normalized ratio (INR) was at goal 2.0–3.0; warfarin 5 mg po qhs was administered and continued to maintain therapeutic INR. On hospital day 2, the patient reported chest pain. The vital signs and physical exam were unremarkable. Electrocardiography and laboratory evaluation revealed no abnormalities. The suspicion of pulmonary embolism was low. Further evaluation revealed paranoia, impaired reality testing, and affective blunting consistent with the psychotic features of a major depressive episode (DSM-IV-TR criteria). We initiated aripiprazole (45 mg daily) and citalopram (20 mg daily) therapy. He continued reporting chest pain and displayed the other psychotic signs and symptoms for the next 6–7 days. By hospital day 10, he reported no chest pain, showed no paranoia, displayed more appropriate affect, and reported improved mood. The patient agreed that recurrent PE was unlikely in a well-appearing, therapeutically anticoagulated individual. We discharged the patient on hospital day 14 to an inpatient rehabilitation program. Medical illness is common in patients with psychiatric disease, particularly in patients with co-occurring substance use disorders.2 Psychiatrists often evaluate symptoms and complaints in the setting of acute psychosis, which may complicate the diagnostic assessment. Bunce et al3 showed that most psychiatric inpatients are unable to communicate their physical symptoms adequately with physicians. The recent diagnosis of PE in this patient increased his likelihood of redeveloping thromboembolus; however, evaluation showed a low likelihood of PE. We reconsidered the new onset chest pain complaint in the setting of worsening paranoia, blunted affect, and impaired reality testing. The clinical data and scenario were consistent with a somatic delusion of chest pain. It is important to consider the extent to which his recent PE influenced the chest pain delusion. Somatic delusions may be related to gross misperceptions of bodily functioning4; this patient's recent experience with chest pain possibly influenced the delusional content. Finally, whether the dysfunctional hypothalamic pituitary axis in psychotic depression1 was further influenced (and worsened) by the acute stress of pulmonary embolism and sudden risk of death in a young man remains unknown.

Somatic Delusion or Recurrent Pulmonary Embolism? A Case Report

To the Editor: Somatic delusions are common, often subtle, mood-congruent manifestations of major depressive disorder with psychotic features.1 This is a presentation and discussion of a patient with somatic delusions of chest pain that presented a challenge in differentiating thromboembolus from delusion. Case report. Mr A, a 32-year-old recently unemployed and homeless man with a history of cocaine dependence and major depressive disorder, was transferred from the internal medicine ward (where he was treated for pulmonary embolism [PE] for 1 week) to a dual diagnosis inpatient unit in December 2008 for evaluation and management of depressed mood, suicidal ideation, neurovegetative symptoms, and cocaine dependence. On our initial evaluation, the patient reported a 6-week history of progressively depressed mood, suicidal ideation, sleep disturbances, weight loss, and guilt. He also reported 10 years of daily cocaine use, but denied use during the month prior to admission. He displayed paranoia and obsessive thoughts, but showed neither perceptual disturbances nor delusions. We continued anticoagulant dosing: subcutaneous enoxaparin 90 mg every 12 h was administered until the international normalized ratio (INR) was at goal 2.0–3.0; warfarin 5 mg po qhs was administered and continued to maintain therapeutic INR. On hospital day 2, the patient reported chest pain. The vital signs and physical exam were unremarkable. Electrocardiography and laboratory evaluation revealed no abnormalities. The suspicion of pulmonary embolism was low. Further evaluation revealed paranoia, impaired reality testing, and affective blunting consistent with the psychotic features of a major depressive episode (DSM-IV-TR criteria). We initiated aripiprazole (45 mg daily) and citalopram (20 mg daily) therapy. He continued reporting chest pain and displayed the other psychotic signs and symptoms for the next 6–7 days. By hospital day 10, he reported no chest pain, showed no paranoia, displayed more appropriate affect, and reported improved mood. The patient agreed that recurrent PE was unlikely in a well-appearing, therapeutically anticoagulated individual. We discharged the patient on hospital day 14 to an inpatient rehabilitation program. Medical illness is common in patients with psychiatric disease, particularly in patients with co-occurring substance use disorders.2 Psychiatrists often evaluate symptoms and complaints in the setting of acute psychosis, which may complicate the diagnostic assessment. Bunce et al3 showed that most psychiatric inpatients are unable to communicate their physical symptoms adequately with physicians. The recent diagnosis of PE in this patient increased his likelihood of redeveloping thromboembolus; however, evaluation showed a low likelihood of PE. We reconsidered the new onset chest pain complaint in the setting of worsening paranoia, blunted affect, and impaired reality testing. The clinical data and scenario were consistent with a somatic delusion of chest pain. It is important to consider the extent to which his recent PE influenced the chest pain delusion. Somatic delusions may be related to gross misperceptions of bodily functioning4; this patient's recent experience with chest pain possibly influenced the delusional content. Finally, whether the dysfunctional hypothalamic pituitary axis in psychotic depression1 was further influenced (and worsened) by the acute stress of pulmonary embolism and sudden risk of death in a young man remains unknown.

Schizotypy and brain structure: a voxel-based morphometry study

Schizotypy is conceptualized as a subclinical manifestation of the same underlying biological factors that give rise to schizophrenia and other schizophrenia spectrum disorders. Individuals with psychometric schizotypy (PS) experience subthreshold psychotic signs and can be psychometrically identified among the general population. Previous research using magnetic resonance imaging (MRI) has shown gray-matter volume (GMV) abnormalities in chronic schizophrenia, in subjects with an at-risk mental state (ARMS) and in individuals with schizotypal personality disorder (SPD). However, to date, no studies have investigated the neuroanatomical correlates of PS. Six hundred first- and second-year university students completed the Community Assessment of Psychic Experiences (CAPE), a self-report instrument on psychosis proneness measuring attenuated positive psychotic experiences. A total of 38 subjects with high and low PS were identified and subsequently scanned with MRI. Voxel-based morphometry (VBM) was applied to examine GMV differences between subjects with high and low positive PS. Subjects with high positive PS showed larger global volumes compared to subjects with low PS, and larger regional volumes in the medial posterior cingulate cortex (PCC) and the precuneus. There were no regions where GMV was greater in low than in high positive PS subjects. These regions, the PCC and precuneus, have also been sites of volumetric differences in MRI studies of ARMS subjects and schizophrenia, suggesting that psychotic or psychotic-like experiences may have common neuroanatomical correlates across schizophrenia spectrum disorders.

P03-27 Effects of topiramate in prevention of obesity in schizophrenic patients treated by olanzapine

Aims:Schizophrenic patients treated with atypical antipsychotics commonly suffer weight gain. Additive flow of using these drugs lead to more researches to solve this problem. Weight gain is associated not only with several medical conditions (such as hypertension, diabetes, cardiovascular disease, etc) but also may be related to treatment noncompliance. Topiramate is an anticonvulsant drug that has been used in psychiatric disorders and also leads to weight reduce. Many researches have been studied this effect of topiramate and positive outcomes of weight reduce without creation or development of psychotic signs have already been reported. as there is no approved therapeutic dose of topiramate for appropriate weight loss and also no study referred to its prophylactic effect of weight gain in these patients, in this study we proceed to check forenamed subjects.Method:Forty - eight schizophrenic patients treated with olanzapine in beginning of hospitalization in Ibn-e-Sina Hospital were selected and randomly placed in four groups: placebo, 50, 100, 200 mg topiramate daily was added to their treatment regimen. Patients were followed for 12 weeks for body weight changes, BMI, waist and wrist diameters. Data were analyzed by SPSS software.Results:Only BMI and waist diameter had significant difference in patients treated with 200 mg topiramate daily in compare with placebo group in 12th week. other data had no significant difference in handling.Conclusion:Prophylactic treatment of obesity in schizophrenic patients with topiramate is effective in 200 mg daily dosage and no significant adverse effects were found.

Les variables associées à la décision d’hospitalisation

The psychiatric assessment conducted in a psychiatric emergency service and the subsequent admission decisions have major psychological, physical and fiscal effects on patients, families and the community. Despite the importance of the task, there is no agreement on the areas of clinical assessment the psychiatric emergency service should focus on. The purpose of this study was to identify important variables that influence admission decisions in psychiatric emergency services in order to provide information facilitating the development of assessment guidelines for use in the psychiatric emergency services. Residents at the psychiatric emergency service rated prospectively 326 patients (sex ratio: 1.91, mean age: 34.55 years (S.D. = 11.68), unemployment: 74.5%, low educational level: 60.7%; low socioeconomic level: 77.9%, married: 29.4%, rural residence: 51.8%, of the 326 patients, 218 (66.9 %) were hospitalized) on 12 clinical and demographic variables, including gender, marital status, socioeconomic level, unemployment, danger to self, danger to others, referred to by psychiatric physicians, self referred, psychotic signs, current diagnostic of major mental illness, involuntary consultation, and previous hospitalisation. First, a chi square analyse was conducted on the 12 variables to determine whether they significantly differentiated patients admitted from those released. A p value below 0.05 was used. Next, a binary logistic regression procedure was employed to develop a model for an admission depending on five variables. The SPSS software program was used for these analyses. The model's performance was evaluated in two ways: the proportion of cases correctly classified and the level of signification of the Hosmer–Lemeshow test. A logistic regression produced a model with five variables that significantly predicted admission, in order of importance they were danger to self, psychotic signs, current diagnostic of major mental illness, involuntary consultation, and danger to others. The model correctly classified 93.9 percent of the cases. The level of signification of the Hosmer–Lemeshow test was 0,724 (chi-square = 5.307, ddl = 8). A review of results of similar studies in other populations shows that these findings are supported in the literature. As a result, these five variables should be included in admission Guidelines for emergency psychiatric services staff. In this study, the admission decisions were usually justified.

Atypical Antipsychotics: Mechanism of Action

Atypical Antipsychotics: Mechanism of Action

Psychosis of Alzheimer's disease: clinical characteristics and history

The concept of psychosis of Alzheimer's disease and dementia is developed with respect to prevalence, incidence, clinical characteristics, clinical course, and potential response to treatment. Psychosis frequently occurs subsequent to the onset of dementia. Published prevalence estimates of psychosis in patients with AD range from 10 to 73% with an overall median of 34% within clinic populations, and from 7 to 20% in community and clinical trials populations depending on definitions used. Among people with AD who have no psychotic symptoms there appears to be an annualized incidence of psychosis of about 20% in outpatients, and a much higher rate in nursing home patients. Female gender, somewhat greater cognitive impairment among outpatients, somewhat lesser cognitive impairment among nursing home patients, and physical aggression are more associated with psychotic signs and symptoms than not. Right frontal hypometabolism and greater frontal neuropsychological deficits occur in AD patients with psychosis in comparison to those without. Among nursing home patients with dementia who have clinically significant agitation, the substantial majority have delusions or hallucinations. Among patients in nursing homes with dementia and psychosis, nearly two-thirds have persistent symptoms over at least 12 weeks, and among outpatient studies, hallucinations and delusions may persist in approximately 40–50% over periods of 3 months to one year. There is some evidence that psychotic symptoms improve modestly with antipsychotic medication treatment. There is sufficient descriptive and empirical research to support the validity of a syndrome of psychosis of Alzheimer's disease.

The development of schizophrenia in late adolescence.

Adolescence is an unusual psychologic time. A recent psychodevelopmental approach to psychosis attempted to show how psychotic signs might arise from typical features of adolescence; for example, delusions appear to reflect common adolescent themes of attachment and autonomy. This psychodevelopmental approach emphasizes how normal adolescents grow out of a natural egocentricity and idealism through learning about others; this theory converges with more recent neurologic theories. (Such neurologic theories agree that mentalizing-for others abilities are a crucial mechanism whereby the suspected neurologic problems of psychosis translate into the symptoms.) A psychodevelopmental account implies a therapeutic priority would be reattaching psychosis sufferers with their peer group, perhaps through work placement schemes. It also recommends cognitive work directing self-consciousness into understanding other people. Psychodevelopmental approaches offer a useful theoretic background for psychologic interventions with young "at risk" people.

Kahlbaum's catatonia revisited.

Modern psychiatric nosologies separate catatonia along the lines of presumed etiology: bipolar, major depression, schizophrenia and due to a general medical condition. The presence of catatonia has always held diagnostic and prognostic value. Kahlbaum's description of catatonia includes careful documentation of phenomenology and the course of the illness. Since there were no effective treatments in his time, Kahlbaum was documenting the natural history of the illness. A review of classic studies of the natural history of catatonia demonstrates that the syndrome is episodic, may have few other psychotic signs, may have periods of remission and may, in some cases, be associated with the disorganized subtype of schizophrenia. The literature of the past 100 years supports the validity of Kahlbaum's description for a subset of patients with catatonia.

Management of psychosis in Parkinson's disease.

Psychosis is quite common in Parkinson's disease (approximately 25% of patients) and therefore constitutes a serious public health problem. All patients suffering from idiopathic Parkinson's disease, and especially elderly and demented patients, are at risk of developing delusions or hallucinations. The most prominent psychotogenic factors are dopaminomimetic agents, which may induce dopamine hypersensitivity in the frontal and limbic dopamine projection regions, and consequently, either directly or indirectly, elicit psychotic signs and symptoms. A Parkinson's disease-related cholinergic deficit in combination with an age-related further loss of cholinergic integrity also plays a prominent role. Psychosis in Parkinson's disease patients appears to be a more important contributor to caregiver distress than motor parkinsonism. Psychosis therefore probably represents the single greatest risk factor for nursing home placement. Typical antipsychotic drugs, because of their selective dopamine receptor antagonistic effects, can reduce psychotic signs but at the cost of an increase in parkinsonism. As a consequence of a non-selective antagonism at both serotonergic and dopaminergic receptors, atypical antipsychotic drugs are associated with fewer extrapyramidal side-effects. On the other hand, hypersensitivity to these agents may induce delirium or a malignant neuroleptic syndrome. Atypical antipsychotic agents such as clozapine, quetiapine and olanzapine should therefore be started at very low doses that are increased gradually. Cholinomimetic therapy may prove to be helpful in the prevention and treatment of psychotic manifestations in Parkinson's disease patients, given the effects observed in patients suffering from dementia with Lewy bodies.

Second-generation antipsychotics in the emergency care setting. A prospective naturalistic study

The objective of this subject was to examine the impact of the replacement of standard neuroleptics with atypical antipsychotic agents in an intensive psychiatric care unit. A mirror-image study was conducted. Cases admitted in the first semester of the year (when most of patients were treated with standard neuroleptics) were compared to cases admitted in the second semester of the year, when atypical antipsychotic agents were routinely utilized as first line treatment of patients with psychotic signs. Cases admitted in the first semester received a significantly higher daily dosage of antipsychotic drugs and more frequently received anticholinergics. In the second semester, a significantly higher number of patients received anticonvulsants, in particular valproate and gabapentin. There was no significant difference between the two groups of cases in the number of patients treated with antipsychotics, benzodiazepines, lithium, and carbamazepine and in the mean daily dose of benzodiazepines, lithium, carbamazepine, or valproate on the first day of hospitalization, the day of evaluation, and on discharge. On discharge, similar percentages of patients went home, were transferred to other Psychiatric Intensive Care Units (PICUs) or to private clinics, or left our PICU against medical advice. The length of hospitalization was similar in the two groups. There was no significant difference in the rate of aggressive or violent behavior registered in the two groups of cases. The risk of increasing violence rates, lengthening hospitalization, and facilitating patients’ non-compliance should not be major concerns for physicians prescribing second-generation antipsychotics in the emergency care setting. Since these drugs have been shown to have at least similar efficacy (or greater efficacy in the case of clozapine) in the treatment of psychotic disorders as typical neuroleptics and to have a better side-effects profile, they should become first line treatment for patients with psychotic signs admitted to emergency care psychiatric facilities.

Delirium tremens and related clilnical states:| Psychopathology, cerebral pathophysiology and psychochemistry: A two‐component hypothesis concerning etiology and pathogenesis

Clinically, patients with Delirium Tremens (DT) and acute alcohol hallucinosis (impending DT) appear excited with vivid false perception. Cerebral blood flow and eeg correspondingly point to hyperexcitability in the CNS during these conditions. Clinical trials with barbital treatment in alcohol withdrawal shows that the amount of drug and the drug plasma concentration is the same no matter whether the physical signs of withdrawal are accompanied by hallucinations and clouding of consciousness. The psychotic signs in DT and acute alcoholic hallucinosis develops after many years of alcoholism as does seizures. We hypothesize that physical withdrawal is determined by the degree of physical dependence developed during the most recent drinking period whereas the psychotic signs and seizures are due to a cumulated CNS hyperactivity developed over many years of repeated alcohol intoxication and withdrawal. Changes of electrolyte concentrations in plasma or CSF do not play an important role in the pathogenesis of DT and related clinical states except that changes in calcium and inorganic phosphate metabolism indirectly point to changes in membrane excitability. A new model for a study of rapidly repeated intoxication and withdrawal episodes in rats has shown that repetition of episodes augments the convulsive component of withdrawal whereas the non-convulsive signs are dependent on the most recent episode only. The augmentation of the convulsive component correlates with regional differences in brain glucose consumption. Furthermore, synaptic proteins and acidic phospholipids may be involved in the development of CNS hyperexcitability during alcohol withdrawal. In conclusion both clinical and experimental studies indicate that severe alcohol withdrawal reactions may consist of two components: 1) Physical withdrawal signs determined by recent physical dependence. 2) A long term cumulated CNS hyperexcitability relating to seizures and psychotic signs during withdrawal. This state is elicited by alcohol withdrawal but it represents a cumulated and permanent or long lasting CNS dysfunction in alcoholics. The precise biochemical/pathophysiological mechanisms for the development of the two-component dysfunction still remain to be clarified in detail.

Psykosocial tilpasning hos hjertekirurgiske patienter III: Perioden umiddelbart efter operationen

Open heart surgery is accompanied by a high incidence of psychological complications. Systematic research is necessary for clarification of the patients' emotional reactions in the pre-and postoperative period. In a previous paper, patients and design of the authors' investigation of psychosocial aspects of open heart surgery were described. The present paper focuses on the immediate postoperative period. Three out of thirty patients showed psychotic signs after the operation. Before the operation these patients appeared anxious, but they did not verbalise their anxiety. This affirms the need for supportive intervention to patients who are objectively anxious but subjectively denying to be so. No evidence was seen that so-called “active” patients had a more complicated course of disease. In the intensive ward the main discomfort was attributed to the inability to speak and the feeling of total dependency. The contact with the staff was most important for the quality of the patients' experiences and realit...

Sex difference in age at onset of schizophrenia

• The age at onset of schizophrenia was determined in 100 male and 100 female patients who unequivocally met DSM-III criteria for the illness. Three different indexes of onset were used: first treatment, first hospitalization, and the immediate family's first awareness of psychotic symptoms and signs. The mean age at onset of the male patients was approximately five years earlier than that of the female patients according to all three criteria. About nine of ten male patients, compared with only two of three female patients, became schizophrenic before the age of 30 years. The onset of psychosis after the age of 35 years occurred in 17% of women and in only 2% of men. About 10% of women gave no evidence of psychosis until after the age of 40 years. The reason for the sex difference is not readily apparent, but it could be a valuable clue to some of the causes of schizophrenia.

Correlates of cerebral event-related slow potentials and psychopathology.

The study explored associations between the cerebral event-related slow potentials (ERSP) and psychiatric symptoms and syndromes as reflected by the Present State Examination (PSE) in 36 randomly selected psychiatric in-patients. Independent raters measured the readiness potential (RP), contingent negative variation (CNV) and post-imperative negative variation (PINV) in terms of their amplitude and duration. The 360 individual PSE items were grouped into units of analysis (UA) and further collapsed into groups of units of analysis (GUA). Canonical correlations were computed between two sets of variables (psychological and electrophysiological). Kendall's rank-order correlation was used as the main statistical approach. Some psychotic signs were associated with increased PINV amplitude. Obsessive thoughts, ideas of reference and verbal hallucinations correlated with longer PINV duration. Hopelessness and suicidal thoughts (affect-laden thoughts) as well as first-rank Schneiderian symptoms (FRS) were negatively correlated with CNV amplitude. The results support the hypothesis that CNV and PINV, alone or in combination, can be used to indicate the presence or absence of identifiable psychiatric symptoms and syndromes. The implications of electrophysiological correlates of psychopathology for psychiatric nosology and for the validity of psychiatric symptoms and syndromes were discussed.

Development of children's behavior problems.

This study examined the development of behavior problems of white boys and girls in kindergarten through eighth grade (N = 2,991). Data included general information and ratings by teachers on the Behavior Problem Checklist, a 55-item scale that measures five dimensions of psychopathology. Results indicated two patterns of development. One trend was for conduct problems, personality problems, inadequacy-immaturity, and psychotic signs to increase from kindergarten to about the third grade, decline from the third to sixth grade, and to level off from the sixth through eighth grade. The other trend was for socialized delinquency to increase to about the third grade and to remain level through the eighth grade. Boys experienced more behavior problems than girls on four of the five Checklist dimensions, and youngsters from the lower social classes were more maladjusted than their counterparts from the higher socioeconomic groups.