Schizophrenia Spectrum Disorders Group Research Articles

Transdiagnostic psychiatric symptoms related to visual evoked potential abnormalities

Visual processing abnormalities have been reported across a range of psychotic and mood disorders, but are typically examined within a particular disorder. The current study used a novel transdiagnostic approach to examine diagnostic classes, clinician-rated current symptoms, and self-reported personality traits in relation to visual processing abnormalities. We examined transient visual-evoked potentials (VEPs) from 48 adults (56% female), representing a wide range of psychotic and mood disorders, as well as individuals with no history of psychiatric disorder. Stimuli were low contrast check arrays presented on green and red backgrounds. Pairwise comparisons between individuals with schizophrenia-spectrum disorders (SSD), chronic mood disorders (CMD), and nonpsychiatric controls (NC) revealed no overall differences for either P1 or N1 amplitude. However, there was a significant interaction with the color background in which the NC group showed a significant increase in P1 amplitude to the red, vs. green, background, while the SSD group showed no change. This was related to an increase in social anhedonia and general negative symptoms. Stepwise regressions across the entire sample revealed that individuals with greater apathy and/or eccentric behavior had a reduced P1 amplitude. These relationships provide clues for uncovering the underlying causal pathology for these transdiagnostic symptoms.

Functional deterioration from the premorbid period to 2 years after the first episode of psychosis in early-onset psychosis.

The aim of the study was to analyze changes in functional adjustment from childhood to 2 years after the first episode of psychosis (FEP) in patients with early-onset schizophrenia spectrum disorders (SSD) and affective psychoses (AFP) and a good or intermediate level of premorbid adjustment. We followed 106 adolescents (aged 12-17 years) with FEP for 2 years after recruitment. Premorbid adjustment in childhood was assessed in 98 patients with the childhood subscale of the Cannon-Spoor Premorbid Adjustment Scale (c-PAS). Global functioning was assessed 2 years after the FEP with the Children's Global Assessment Scale (c-GAS) or the Global Assessment of Functioning scale (GAF), as appropriate. Functional deterioration was defined as a downward shift in the level of functional adjustment from childhood to 2 years after the FEP. In patients with good or intermediate premorbid adjustment, functional deterioration was observed in 28.2 % (26.5 % of the AFP group, 29.4 % of the SSD group). Longer duration of untreated psychosis (Beta = 0.01; P = 0.01) and higher symptom severity at the FEP, as measured with the Clinical Global Impression Scale (Beta = 1.12; P = 0.02), significantly predicted the presence of functional deterioration, accounting for 21.4 % of the variance. Irrespective of diagnosis (SSD or AFP), almost one-third of adolescents with FEP and good or intermediate premorbid adjustment showed functional deterioration from the premorbid period to 2 years after the FEP.

Schizophrenia or a group of endogenous diseases? The past and the present

A critical analysis of the main concepts of schizophrenia (from the Kraepelin paradigm to the current studies attempted to «destruct» schizophrenia as nosologically independent disease) is presented. In author's opinion, the elimination of schizophrenia may lead to negative consequences as in aspect of clinical practice (the diagnosis of schizophrenia provides information about disease course, clinical and social outcomes) as well as in aspect of denial of autochthonous (endogenous) origin of mental disorders that fall under this definition. Based on the current level of knowledge, manifestation of these disorders can't be well explained by the adverse effects of situational, psychogenic or somatogenic factors. The restriction of the definition of schizophrenia («process» schizophrenia) should be brought about by the elimination of a group of schizophrenia spectrum disorders (schizotypal disorder, schizoaffective disorder, delusional psychosis).

Basal ganglia and thalamic morphology in schizophrenia and bipolar disorder

In this study, we examined the morphology of the basal ganglia and thalamus in bipolar disorder (BP), schizophrenia-spectrum disorders (SCZ-S), and healthy controls (HC) with particular interest in differences related to the absence or presence of psychosis. Volumetric and shape analyses of the basal ganglia and thalamus were performed in 33 BP individuals [12 without history of psychotic features (NPBP) and 21 with history of psychotic features (PBP)], 32 SCZ-S individuals [28 with SCZ and 4 with schizoaffective disorder], and 27 HC using FreeSurfer-initiated large deformation diffeomorphic metric mapping. Significant volume differences were found in the caudate and globus pallidus, with volumes smallest in the NPBP group. Shape abnormalities showing inward deformation of superior regions of the caudate were observed in BP (and especially in NPBP) compared with HC. Shape differences were also found in the globus pallidus and putamen when comparing BP and SCZ-S groups. No significant differences were seen in the nucleus accumbens and thalamus. In summary, structural abnormalities in the caudate and globus pallidus are present in BP and SCZ-S. Differences were more apparent in the NPBP subgroup. The findings herein highlight the potential importance of separately examining BP subgroups in neuroimaging studies.

Neurological Soft Signs Discriminate Schizophrenia from Bipolar Disorder

Although neurological soft signs have been consistently described in patients with schizophrenia, their diagnostic specificity is not well clarified. To test the hypothesis that neurological soft signs are specifically related to schizophrenia, we examined 305 subjects (patients with schizophrenia-spectrum disorder, n=167; patients with bipolar I disorder, n=88; controls, n=50). Neurological soft signs were assessed using the Neurological Evaluation Scale (NES). Multiple logistic regression analysis was used to compute the diagnostic predictive power of neurological soft signs. Patients in the schizophrenia-spectrum disorder group were found to have significantly greater neurological impairment (NES total score=23.9, standard deviation [SD] 11.2) than those in the bipolar disorder group (NES total score=18.2, SD 7.6; p<0.001). Neurological functioning was closely associated with psychopathology (all p<0.001). The NES total score reliably distinguished patients with schizophrenia spectrum disorders from those with bipolar disorder in 68.7% of the cases (p<0.001). Moreover, a particular set of neurological soft signs showed specificity for the schizophrenia-spectrum disorder diagnostic group. Our findings suggest that schizophrenia and bipolar disorder can be distinguished in terms of neurological impairment. Furthermore, we recommend the utility of neurological soft signs as a useful, quantifiable, sensitive, and inexpensive tool for the diagnostic work-up of schizophrenia.

EPA-0882 - Prediction of diagnosis of early-onset schizophrenia spectrum disorders using support vector machines

Diagnosis of schizophrenia spectrum disorders (SSD) may be difficult in clinical practice, particularly during the first episodes of early-onset psychosis (FE-EOP). To develop a Support Vector Machine (SVM) algorithm as a predictive tool for diagnostic outcome in patients with FE-EOP, based on clinical and biomedical data at the emergence of the illness. Two-year, prospective longitudinal study, where 81 patients (9-17 years of age) with a FE-EOP and stable diagnosis at follow-up and 41 age and sex-matched healthy controls (HC) were included. Structured diagnostic interviews, clinical and cognitive scales, a MRI scan and biochemical tests were conducted at baseline. Three SVM classification algorithms were developed (SSD vs HC group, non-SSD vs HC group, and SSD vs non-SSD group). Jackknifing was used to validate the algorithms and to calculate performance estimates. Enhanced-Recursive Feature Elimination was performed in order to gain information about the predictive weight for diagnosis of each variable. The SSD-versus-non-SSD classifier achieved an overall accuracy of 83.1%, sensitivity of 86.6% and specificity of 77.8%. The variables during a FE-EOP with higher predictive value for a diagnosis of SSD were clinical variables such as negative symptoms preceding or during the psychotic onset, poor insight and duration of illness until first psychiatric contact. Biochemical, neuroimaging, and cognitive variables at baseline did not provide any additional predictive value. SVM may serve as a predictive tool for early diagnosis of SSD during a FE-EOP. The most discriminative variables during a FE-EOP for a future diagnosis of SSD are clinical variables.

The magnocellular visual pathway and facial emotion misattribution errors in schizophrenia

Many individuals with schizophrenia show impairment in labeling the emotion depicted by faces, and tend to ascribe anger or fear to neutral expressions. Preliminary research has linked some of these difficulties to dysfunction in the magnocellular (M) visual pathway, which has direct projections to subcortical emotion processing regions. The current study attempted to clarify these relationships using a novel paradigm that included a red background. Diffuse red light is known to suppress the M-pathway in nonpsychiatric adults, and there is preliminary evidence that it may have the opposite (stimulating) effect in schizophrenia-spectrum disorders (SSDs). Twenty-five individuals with SSDs were compared with 31 nonpsychiatric controls using a facial emotion identification task depicting happy, angry, fearful, and sad emotions on red, green, and gray backgrounds. There was a robust interaction of group by change in errors to the red (vs. green) background for misattributing fear expressions as depicting anger (p=.001, ή(2)=.18). Specifically, controls showed a significant decrease in this type of error with the red background (p=.003, d=0.77), while the SSD group tended to increase this type of error (p=.07, d=0.54). These findings suggest that the well-established M-pathway abnormalities in SSDs may contribute to the heightened misperception of other emotions such as anger, which in turn may cause social misperceptions in the environment and elicit symptoms such as paranoia and social withdrawal. As the ventral striatum plays a primary role in identifying anger and receives efferent input from the M-pathway, it may serve as the neuroanatomical substrate in the perception of anger.

P02-186 - Prevalence of violent committed acts by inpatients in forensic setting department of psychiatry -in kosova

The aimIn this study we evaluated the prevalence of committed acts in the group of male inpatients in forensic setting with major mental disorder and past history of aggressive behavior in community.MethodologyIn the study we included 80 male inpatients, 41 of them have meet DSM-IV criteria for Personality Disorder, 28 were psychotic, 11 were Drug/alcohol abusers. Past aggressive history was collected from patient interviews and reviews of clinicalforensic records and collateral source of documents.ResultsThe inpatients were adults with mean age 35,22±10,50 in Schizophrenia spectrum disorders group and the mean duration of the illness was 11,7±9,48, Personality disorders group with mean age 31,35±9,85 and mean duration of illness 10,70±8,34, Drug/alcohol abusers with mean age 19,1±8,6 and mean duration of illness 4,5±2,6.Personality disorder and Drug/alcohol abuser group of inpatients offenders were more prevalent on homicide acts 40%, and threatening 35%, while Schizophrenia spectrum disorder inpatients were more prevalent in domestic violence 49,2%, threatening acts committing with 33,3% and homicide prevalence 7,9%.ConclusionThe studies until now showed that the prevalence of Schizophrenia in the homicide offenders is around 6%. Despite this, the prevalence of Personality disorder or of Drug/alcohol abuse is higher: 10% to 38% respectively. Our results showed the same results with prevalence of Schizophrenia spectrum disorder in homicide with 7,9%, and respectively Personality disorder with homicide prevalence 40%.

Premorbid IQ and adult schizophrenia spectrum disorder: Verbal Performance subtests

The present prospective high-risk study examined associations between childhood scores on five Wechsler Intelligence Scale for Children (WISC) subtests (vocabulary, similarities, block design, object assembly, and mazes) and later development of schizophrenia spectrum disorders (SSD). The sample comprised 244 high-risk or control children who were administered the WISC subtests at age 10 to 13 years in 1972. Adult psychiatric data were gathered from psychiatric interviews in 1992–93 and from the Danish Psychiatric Central Register in 2007. Thirty-two participants had developed SSD, 79 other psychiatric disorders (OPD), and 133 had no diagnosis (ND). The SSD group obtained lower scores than the ND group on all subtests and IQs, but when adjusted for sex and parental social status only significantly lower scores on similarities, object assembly, mazes, and total IQ. Compared with the ND group, the OPD group obtained significantly lower scores on similarities, vocabulary, verbal IQ, and total IQ. The only significant difference between the SSD and OPD groups was on object assembly (OPD performed at the level of ND). The results suggest a premorbid deficit in general intelligence in individuals who later develop SSD. The results for the OPD group support recent studies demonstrating that premorbid IQ deficits may characterize a wide range of psychiatric disorders.

PW01-191 - Hyperhomocysteinemia in children and adolescents with psychotic and mood disorders

The aim of our study was to get information about serum level of homocysteine (Hcy) for patients with schizophrenia spectrum, patients with affective disorders and in control group.MethodsFor the studies, we have used 225 patients from Children's Psychiatric Hospital. 82 of all selection were with schizophrenia spectrum disorders, 27 patients with affective disorders and 116 patients came from control group.Patients were selected according to their diagnosis (in line with ICD-10) and current clinical status. Each diagnosis and clinical status was coded depending on its severity and course of disease.The level of Hcy was stated by isocratic HPLC system with fluorometric detection (Shimadzu LC-20, model RF-10AxL).ResultsCorrelation of Hcy concentration between schizophrenia's spectrum disorders and control group was r = -0.39 (p&lt; 0.001; t = 22.99).Mean level of Hcy was 11.94 μmol/L for patients with schizophrenia's spectrum disorders and 11.55 μmol/L for patients with affective disorders versus 7.47 μmol/L in control.It has been found that the highest level of Hcy in the group of schizophrenia spectrum disorders has been seen in patients with episodic-recurrent course of disease, especially with pronounced affect. For the group with affective disorders the highest level was seen in patients with depressive symptoms with anxiety and mixed affective disorders (r = 0.58; p&lt; 0.001; t = 12.77).ConclusionsObtained data are indicative of potential link among the level of Hcy and schizophrenia, and that the level of Hcy is inwrought with affective disorders and anxiety in the course of disease.

Behaviour problems in institutionalised people with intellectual disability and schizophrenia spectrum disorders

Background Although our understanding of dual diagnosis has improved, a deficit still exists in our knowledge of how schizophrenia spectrum disorders (SSD) manifest themselves in individuals with intellectual disability (ID). In addition, little is known about the relationship between behaviour problems and psychopathology in this population.Method Utilising the Behavior Problems Inventory (BPI), three areas of problem behaviour (self-injurious, stereotyped, and aggressive/destructive) were assessed in 58 individuals with ID divided into three groups (with SSD, with a diagnosis of psychopathology other than SSD, and with ID only) and a total BPI score was calculated for each.Results The SSD group was unique when compared to the Control group (ID only) for frequency of stereotyped behaviours. Further, severity of stereotyped behaviours in the SSD group was unique compared to the Psychopathology and Control groups.Conclusion The SSD group was unique compared to the other two groups, particularly for severity of stereotyped behaviours. Many specific behavioural differences were also related to either SSD or general psychopathology.

Growth trajectory during early life and risk of adult schizophrenia

Growth abnormalities have been suggested as a precursor to schizophrenia, but previous studies have not assessed growth patterns using repeated measures. To assess the association between early life/later childhood growth patterns and risk of schizophrenia. Using prospectively collected data from a birth cohort (born 1959-1967), measurements of height, weight and body mass index (BMI) were analysed to compare growth patterns during early life and later childhood between 70 individuals with schizophrenia-spectrum disorder (SSD) and 7710 without. For women, growth in the SSD group was approximately 1 cm/year slower during early life (P < 0.01); no association was observed for men. Later childhood growth was not associated with SSD. Weight patterns were not associated with SSD, whereas slower change in BMI was observed among the SSD group during later childhood. The association between slower growth in early life and schizophrenia in women suggests that factors responsible for regulating growth might be important in the pathogenesis of the disorder.

Schizotypal disorder and schizophrenia: A profile analysis of neuropsychological functioning in Japanese patients

This study compares neuropsychological functioning in a Japanese schizophrenia spectrum disorder group and a group of healthy Japanese volunteers. Participants were 37 patients diagnosed with schizophrenia, 28 schizotypal patients, and 99 psychiatrically-normal volunteers. A wide range of cognitive measures were examined. All participants completed a Japanese version of a neuropsychological battery assessing executive function, working memory, processing speed, language, verbal memory, and spatial organization. Comparisons of neuropsychological function demonstrated similarities and differences between patients diagnosed with schizotypal disorder and those diagnosed with schizophrenia. Impairments in verbal memory, language, and processing speed were common to both patient groups and may represent a vulnerability to schizophrenia. Impairments in aspects of working memory, spatial organization and executive function were preferentially observed in schizophrenia and may be features of the overt manifestation of psychosis. Possible differences in the contributions of prefrontal and temporo-limbic structures provide direction for further studies.

Sustained Attention, Visual Processing Speed, and IQ in Children and Adolescents with Schizophrenia Spectrum Disorder and Psychosis Not otherwise Specified

To investigate the cognitive functioning of children and adolescents with Schizophrenia Spectrum disorders and Psychosis Not Otherwise Specified, 22 child and adolescent psychiatric inpatients and day-hospital patients at a state psychiatric hospital with Schizophrenia Spectrum disorders, 30 with Psychosis Not Otherwise Specified, and 130 with other psychiatric disorders, ages 8 to 17 years, were administered the Wechsler Intelligence Scale for Children-III for psychological assessment at admission. The Performance IQs of the ADHD and the Conduct Disorder and Oppositional Defiant Disorder groups were significantly higher than those of the Schizophrenia Spectrum and the Psychosis Not Otherwise Specified groups, and the Full Scale IQs of the Conduct Disorder and Oppositional Defiant Disorder group were significantly higher than those of the Schizophrenia Spectrum group and the Psychosis Not Otherwise Specified group. The Coding scores of the ADHD group were significantly higher than those of the Schizophrenia Spectrum, the Psychosis Not Otherwise Specified, and the Bipolar Disorder groups. There was a significant negative correlation between age and Digit Span for the Schizophrenia Spectrum disorders group.

Cerebral dominance and schizophrenia‐spectrum disorders in adults with intellectual disability

AbstractStudies of the general population without intellectual disability have suggested an association between atypical handedness and schizophrenia‐spectrum disorders (SSDs). Mixed handedness is taken as an index of diminished cerebral dominance or laterality. The present study addressed the question of whether such findings extend to the neurodevelopmentally ‘at risk’ population of adults with intellectual disability and SSDs compared with appropriate controls. Fourteen patients with a dual diagnosis of intellectual disability and SSD were compared with 14 controls with intellectual disability alone. Assessments of self‐reported hand preference and relative hand skill were completed. Self‐report of hand preference revealed highly significantly greater mixed‐handedness in the SSD group. Furthermore, relative hand skill performance was significantly diminished for the dominant hand. The discrepancy between dominant and non‐dominant hand functioning was lower in the SSD group and this association was highly significant. The results of the present study support the usefulness of such detailed laterality assessment in this population. Mixed laterality, over and above that of the population with general intellectual disability and developmental disorder, was associated with SSD. These results are consistent with the neurodevelopmental hypothesis of schizophrenia and its cognitive neuropsychiatric/neuropsychological sequelae.

Cerebral dominance and schizophrenia-spectrum disorders in adults with intellectual disability

Studies of the general population without intellectual disability have suggested an association between atypical handedness and schizophrenia-spectrum disorders (SSDs). Mixed handedness is taken as an index of diminished cerebral dominance or laterality. The present study addressed the question of whether such findings extend to the neurodevelopmentally 'at risk' population of adults with intellectual disability and SSDs compared with appropriate controls. Fourteen patients with a dual diagnosis of intellectual disability and SSD were compared with 14 controls with intellectual disability alone. Assessments of self-reported hand preference and relative hand skill were completed. Self-report of hand preference revealed highly significantly greater mixed-handedness in the SSD group. Furthermore, relative hand skill performance was significantly diminished for the dominant hand. The discrepancy between dominant and non-dominant hand functioning was lower in the SSD group and this association was highly significant. The results of the present study support the usefulness of such detailed laterality assessment in this population. Mixed laterality, over and above that of the population with general intellectual disability and developmental disorder, was associated with SSD. These results are consistent with the neurodevelopmental hypothesis of schizophrenia and its cognitive neuropsychiatric/neuropsychological sequelae.

Occurrence and clinical correlates of psychiatric comorbidity in patients with psychotic disorders.

The aim of this study was to explore patterns and clinical correlates of psychiatric comorbidity in patients with schizophrenia spectrum disorders and mood spectrum disorders with psychotic features. Ninety-six consecutively hospitalized patients with current psychotic symptoms were recruited and included in this study. Index episode psychotic diagnosis and psychiatric comorbidity were assessed using the Structured Clinical Interview for DSM-III-R-Patient Version (SCID-P). Psychopathology was assessed by the SCID-P, Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms, and Hopkins Symptom Checklist. Awareness of illness was assessed with the Scale to Assess Unawareness of Mental Disorders. The total lifetime prevalence of psychiatric comorbidity in the entire cohort was 57.3% (58.1% in schizophrenia spectrum disorders and 56.9% in mood spectrum psychoses). Overall, panic disorder (24%), obsessive-compulsive disorder (24%), social phobia (17.7%), substance abuse (11.5%), alcohol abuse (10.4%), and simple phobia (7.3%) were the most frequent comorbidities. Within the group of mood spectrum disorders, negative symptoms were found to be more frequent among patients with psychiatric comorbidity than among those without comorbidity, while such a difference was not detected within the group of schizophrenia spectrum disorders. Social phobia, substance abuse disorder, and panic disorder comorbidity showed the greatest association with psychotic features. An association between earlier age at first hospitalization and comorbidity was found only in patients with unipolar psychotic depression. Patient self-reported psychopathology was more severe in schizophrenia spectrum patients with comorbidity than in those without, while such a difference was less pronounced in mood spectrum psychoses. These findings suggest that psychiatric comorbidity is a relevant phenomenon in psychoses and is likely to negatively affect the phenomenology of psychotic illness. Further studies in larger psychotic populations are needed to gain more insight into the clinical and therapeutic implications of psychiatric comorbidity in psychoses.