Three clinical syndromes of schizophrenia in untreated subjects: relation to brain glucose activity measured by positron emission tomography (PET).

A number of studies of chronically ill, medicated patients have found that the clinical symptoms of schizophrenia segregate into three syndromes which can be labelled poverty, disorganization, and reality distortion. It has been previously found that each of these syndromes is associated with a specific pattern of perfusion (rCBF) in paralimbic and association cortex and in related subcortical nuclei. We replicated the symptom factors in 20 untreated subjects.

Toward a brain map of auditory hallucinations.

Objective: This study asks whether auditory hallucinations are reflected in a distinctive metabolic map of the brain.

Method: Regional brain metabolism was measured by positron emission tomography with [18F]-fluorodeoxyglucose in 12 DSM-III schizophrenic patients who experienced auditory hallucinations during glucose uptake and 10 who did not. All patients were free of neuroleptics and 19 had never been treated with neuroleptics.

MR characteristics of meningioma subtypes at 1.5 tesla.

Analysis of MR signal characteristics and histopathologic findings confirms the strong correlation between meningioma subtype and observed signal intensity (SI) changes in 24 patients imaged at 1.5 T. On T2-weighted images, 90% of fibroblastic and transitional tumors were hypointense relative to cerebral cortex (SI intermediate greater than SI T2-weighted images); conversely, 66% of meningothelial subtypes displayed persistent hyperintensity (SI intermediate less than or equal to SI T2-weighted images), and the remaining one-third demonstrated mixed high-signal changes.

Apomorphine effects on brain metabolism in neuroleptic-naive schizophrenic patients.

Since neuroleptic treatment produces a significant increase in striatal metabolism relative to cortical metabolism, we wished to determine whether the dopamine agonist apomorphine (APO) might have the opposite effect, and whether it would discriminate schizophrenic patients from healthy controls. Eleven neuroleptic-naive schizophrenic patients (diagnosed according to DSM-III) and eight normal subjects were compared with respect to cerebral accumulation of 18F-fluorodeoxyglucose measured by positron emission tomography following APO, 0.75 mg/70 kg (weight adjusted), or saline.

Substance abuse and schizophrenia: effect on symptoms but not on neurocognitive function.

The authors compare symptoms and neuropsychological test performance in DSM-III schizophrenic patients who reported prior substance abuse (N = 38) with those in patients who reported no such abuse (N = 25) to determine the impact of substance abuse on the psychopathology of schizophrenia. Positive and negative symptom scores were derived from the Schedule for Affective Disorders and Schizophrenia. Sixty neuropsychological measures drawn from commonly used tests of intelligence, memory, learning, fluency, and problem solving were calculated.

Regional brain metabolism during auditory hallucinations in chronic schizophrenia.

Regions of the brain involved in language and attention were studied using [18F]-fluorodeoxy-glucose in PET. In nine chronic DSM-III schizophrenic patients who had persistent auditory hallucinations, ten who had recovered from hallucinations and ten normal controls. In none of the regions examined was metabolic activity significantly different in hallucinating patients compared with that in other groups.

Neuroleptic drug effects on cognitive function in schizophrenia.

Neuropsychological test performance was compared in 37 neuroleptic treated DSM-III schizophrenic patients, 27 untreated schizophrenic patients, and 27 normal controls. Neuroleptic treated patients performed significantly less well than untreated patients at recalling a complex figure, at planning on a mazes test, and had poorer fine motor coordination. Controls and untreated patients performed equally well on these tests.

The ovoid lesion: a new MR observation in patients with multiple sclerosis.

We investigated the frequency of oval-shaped, high-signal-intensity lesions oriented perpendicular to the anteroposterior axis of the brain on abnormal, axial T2-weighted MR brain scans in 59 patients with clinically documented multiple sclerosis. This finding, not heretofore described in patients with multiple sclerosis, was observed in 86% of patients, and correlates with the neuropathologic description of demyelination in multiple sclerosis.

Seasonal variations in prolactin levels in schizophrenia.

As part of an ongoing longitudinal study of drug-free schizophrenic patients, we serially sampled resting early morning prolactin levels in 10 subjects. In a preliminary analysis, these levels were compared to those found in matched normal control subjects over a 4-year period. Both control and schizophrenic subjects showed a marked annual variation in prolactin levels.

Effect of neuroleptics on altered cerebral glucose metabolism in schizophrenia.

This study examines whether the duration of treatment with antipsychotic drugs influences the regional distribution of cerebral [18F]2-fluoro-2-deoxy-D-glucose utilization as measured by positron emission tomography. Two groups of schizophrenic patients are compared with normal volunteers (n = 10). One group (n = 5) consisted of patients treated for one year, and the second (n = 12) of patients medicated for four to 14 years (mean +/- SD duration, 7.

Longitudinal growth hormone studies in schizophrenia.

The growth hormone (GH) response to apomorphine hydrochloride (APO) was examined monthly in 12 schizophrenic patients on drug holiday for up to 22 months and compared with age- and sex-matched controls. There was more variability in the response of patients than controls on the first trial and on several subsequent challenges. Patients' and controls' GH responses to an APO challenge did not distinguish them from each other on the first trial.

Sensitization and tolerance to apomorphine in men: yawning, growth hormone, nausea, and hyperthermia.

This study investigated whether the indices of dopaminergic function, yawning and growth hormone release induced by apomorphine, as well as the drug-induced nausea and hyperthermia, show sensitization or tolerance to repeated injections. Five normal volunteers received 12 injections of apomorphine hydrochloride (0.75 mg/70 kg) every 2 weeks.

Magnetic resonance imaging of central nervous system defects in Usher's syndrome.

With the use of magnetic resonance imaging, seven patients with type II Usher's syndrome were evaluated for CNS defects. The goals of this study were to confirm the presence of CNS defects previously detected by computed tomography (CT) scans in patients with Usher's syndrome while seeking additional anatomic defects in the posterior fossa employing a potentially more sensitive procedure using magnetic resonance imaging. Findings of CNS lesions in both the midbrain (high-signal-intensity lesions) and the cerebellum (vermian atrophy) necessitate further characterization of these defects in terms of their progressive nature and clinical significance for patients with Usher's syndrome.

Elevated postmortem monoamine oxidase B activity in the caudate nucleus in Huntington's disease compared to schizophrenics and controls.

Activity (Vmax) of monoamine oxidase (MAO) B in necropsy samples from the head of the caudate nucleus was 260% higher in patients dying with Huntington's disease (HD) than in controls (P less than 0.05). No differences in MAO A enzyme kinetics were found.

The relationship between syndrome and personality disorder in DSM-III: experience with 2,462 patients.

The authors studied the relationship between DSM-III axis I and axis II diagnoses in 2,462 medical center patients. Personality disorders were most commonly associated with substance use disorders and with the anxiety and somatoform disorders traditionally classified as neuroses. There was a particularly strong connection between antisocial personality disorder and substance abuse.

Clinical judgments in the decision to commit. Psychiatric discretion and the law.

Judicial decisions and statutory reforms point to a return to psychiatric discretion when clinical needs and patients' rights must be balanced. In seeking to commit patients, psychiatrists have been accused of contravening the legal rights of their patients by applying criteria other than those prescribed by law. This study examined the factors involved in the psychiatrists' decisions to seek commitment or to release 90 voluntarily hospitalized patients; we found psychiatrists' decisions to be appropriately correlated to legal criteria and legally relevant clinical and psychosocial factors.

Medical students' learning as primary therapists or as participant/observers in a psychiatric clerkship.

The authors assessed two different inpatient models of clinical clerkships in psychiatry on the basis of both an examination assessing amount of learning and a survey of student attitudes. One clerkship model placed the third-year medical student in the role of primary therapist; the other model assigned each student to join a psychiatrist as a participant/observer. No overall difference in objective assessment of learning was found between the two groups of students, and student attitudes generally favored the participant/observer model.

Central catecholamine metabolism in vivo and the cognitive and motor deficits in Parkinson's disease.

Cerebrospinal fluid levels of homovanillic acid (HVA) in unmedicated patients with Parkinson's disease were 45% of levels in control subjects. Levels of 3-methoxy-4-hydroxyphenylglycol (MHPG) and platelet monoamine oxidase activity (MAO) did not differ. Within the Parkinson's disease group platelet MAO B activity correlated with HVA (an MAO B substrate) but not MHPG (an MAO A substrate).

Insomnia: II. Assessment and treatment of chronic insomnia.

Evidence for non-pharmacological effects of hypnotics on sleep is presented. This suggests that behavioural variables may be involved in the regulation of sleep onset in insomnia. Chronic 'true' insomnia is described in terms of precipitating events: fixed behavioural patterns which perpetuate it and the disordered timing of electrophysiological and hormonal events.

Insomnia: I. Classification, assessment and pharmaceutical treatment.

Insomnia is a public health problem because of its high prevalence, the risk of hypnotic drug abuse, and self medication combined with alcohol and other nonprescription chemicals. Clinical experience has given rise to a descriptive classification of the insomnias many of which are secondary to medical disease. The information now available allows us to suggest a systematic approach to the assessment of insomnia emphasizing its history, events associated with sleep onset, observable behaviour and experience associated with interruptions in sleep.

Growth hormone responses to graded doses of apomorphine HCl in schizophrenia.

Growth hormone (GH) responses to graded doses of apomorphine HCl (APO) were established in 14 normal males, ages 18-50, and 10 drug-free schizophrenic (SCZ) subjects; 99% confidence intervals were calculated for normal subjects' GH responses to graded doses of APO. Patients' GH peak levels were found to be outside the interval only when they had positive symptoms of psychosis. When they are actively psychotic, the schizophrenics' GH response to small doses of APO is more sensitive than that of normals.