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Abstract The objective of the present study was to explore whether the early course of illness including first onset of psychotic symptoms influences neuropsychological functioning and psychopathology in first-episode schizophrenics. Patients with a short prodromal period (n = 20) and patients with a long prodromal period (n = 20) and controls matched with regard to age, gender and education (n = 40) were administered a battery of standardized neuropsychological tests and psychopathological rating scales. The results indicate an overall difference in neuropsychological performance with the schizophrenic patients scoring lower than controls. Schizophrenic patients scored significantly lower in all subtests except in visual memory and abstraction/flexibility than controls. No significant difference between neuropsychological performance between patient samples was found. Psychopathology was more pronounced in the long prodromal period group rating higher on negative and affective symptoms compared with the short prodromal period group. The data suggests that neuropsychological deficits in first-episode schizophrenia are independent of the early course of schizophrenia, and although negative symptoms are associated with the length of the prodromal period, they do not imply greater neuropsychological impairment. [ABSTRACT FROM AUTHOR]

We studied 259 female inpatients with bipolar spectrum disorders, of whom 26 (10%) were schizoaffective. Of the remaining 233, 61 (27%) met our conservatively set criteria for index mixed expisodes (simultaneous presence of depressive and manic syndromes). These patients with rigorously defined mixed states were, in turn, about equally divided between psychotic and non-psychotic subgroups. The psychotic mixed patients ( n=32) were closer to the bipolar I pattern, and more often seem to come from a familial background of psychotic mood disorders; the nonpsychotic mixed patients ( n=29) conformed more closely to the bipolar II pattern, and more often had a hyperthymic and cyclothymic temperament and a family background of non-psychotic disorders and substance abuse. A three-way comparison between psychotic manic ( n=24), psychotic mixed ( n=32), and schizoaffective ( n=26) patients revealed few significant differences in temperamental, familial and course patterns. As expected, psychotic manic patients more often arose from a hyperthymic base and pursued a predominantly manic course; psychotic mixed patients were less likely to arise from such a base and more likely to pursue a mixed course. Finally, schizoaffective had earlier age at onset and longer duration of illness, suggesting that these patients had a more severe illness. Otherwise, interepisodic social adaptation was comparable in the three psychotic groups. The findings overall suggest that the presence of psychosis had relatively little impact on mixed states, which appear more based on temperamental characteristics. [ABSTRACT FROM AUTHOR]

The psychiatric literature contains numerous accounts of psychoses found worldwide that do not fit classic definitions of schizophrenia, manic-depression, or organic brain syndrome. These vaguely defined 'atypical psychoses' are under scrutiny because of growing knowledge and more rigorous methodology in descriptive and cross-cultural psychiatry. The authors trace the history of atypical psychosis concepts from the contributions of Kraepelin, Jaspers, and Freud to contemporary European and Anglo-American viewpoints. Studies of the atypical psychoses are reviewed in the light of current validation methods in psychiatry. Several methodologic problems plague this area: inadequate definitions, etiologic prejudice, poor premorbid and follow-up assessment, as well as certain naive notions about psychopathology in different cultures. Consequently, knowledge of atypical psychosis is limited and largely impractical. The authors suggest several possibilities for interpreting present and future evidence about these disorders and certain strategies for future studies. [ABSTRACT FROM AUTHOR]

Modified stricter criteria for DSM-III paranoia were fulfilled by 63 (37%) of 169 Heidelberg probands given a diagnosis of 'Case Record Paranoia' (CRP) during a 100-year period (1878-1977). Clinical findings were chiefly interpreted in light of the controversial issues of age, illness duration and type of delusional content pertinent to the formulation of a present-day valid definition for this disorder. With respect to diagnostic consistency over time, 56% of DSM-III paranoia cases with at least one further Heidelberg admission proved to be non-stable, non-consistency being overwhelmingly due to a change in a DSM-III schizophrenic direction. [ABSTRACT FROM AUTHOR]

A battery of neuropsychological tasks was used to study 62 schizophrenics, 67 melancholics, and 30 manics satisfying specific research diagnostic criteria, and 42 normal subjects. Two patterns of neuropsychological impairment among patients were identified by factor analysis. The first pattern of bifrontal, non-dominant hemisphere dysfunction was shared by schizophrenics and affectively ill patients, whereas the second pattern of dominant temporo-parietal-occipital impairment was most frequent in a subgroup of schizophrenics. These relationships remained after accounting for the effects of age, gender, handedness and drugs received at time of testing. [ABSTRACT FROM AUTHOR]

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The subclassification of schizophrenic disorders according to four diagnostic systems (DSM-III-R, ICD-10, the positive vs. negative dichtomy and Schneider's first rank symptoms) was compared over the long-term course of the disease in 148 narrowly defined schizophrenic patients. A total of 595 episodes were classified over a mean observation period of 23 years (range 10-50 years). Initially, paranoid/positive subtypes predominated, while later in the course episodes fulfilling the symptomatological criteria of residual/negative subtypes became more frequent. Disorganised/hebephrenic and catatonic subtypes were found to be rare. Some premorbid features were investigated as non-symptomatological validators for subclassification. Significant differences were found with regard to age at onset. Patients whose first episode was paranoid or positive had the highest age at onset. Patients with initial disorganised/hebephrenic or 'residual' episodes had the most unfavourable premorbid social adjustment, even when the influence of age at onset was discounted. The diagnostic systems investigated showed similarities and differences as a result of the underlying concepts. Methodological implications are discussed. [ABSTRACT FROM AUTHOR]

Analysis of the content of 61 interviews with keyworkers supporting chronically disabled patients in long-term care settings revealed a range of EE ratings and associated characteristics. Low-EE interviews were prevalent (n = 46), a finding not unlikely given the experience and training of the staff group sampled. High-EE (n = 15) relationships were characterised by less tolerance, inappropriate expectations of patient progress and frustration in the key worker. Criticism in both high- and low-EE interviews was most frequently focused on socially embarrassing or difficult behaviour and, to a slightly lesser extent, the clinical poverty syndrome. It was rarely directed at positive symptomatology. High levels of criticism were significantly related to regarding the patient's difficulties as within their control and having negative rather than positive expectations of their ability to manage on their own. The factors identified by the EE interview that influence the nature of the staff-patient relationship are discussed, and the clinical implications of the findings briefly considered. [ABSTRACT FROM AUTHOR]

Religious belief and psychiatric symptoms are distinct and separate phenomena. They occur in different realms of experience. However, they may occur individually or together and it may be difficult to decide which is which. When a person describes his own experience as religious and another observes this as mental illness they are unlikely to be commenting on precisely the same phenomena. The first person is describing an internal experience whilst the latter is inferring from observed behaviour. It is important for psychiatrists and mental health professionals to recognize that there is a spiritual dimension for their patients (and for themselves), and for pastoral theologians to form a concept of mental illness. The approach of phenomenological psychopathology is useful in making the distinction. [ABSTRACT FROM PUBLISHER]

The author reflects on the clinical implications of the changes in the "Diagnostic and Statistical Manual of Mental Disorder (DSM)-5" treatment of schizophrenia and other psychotic disorders in the U.S. He notes that the changes were made to facilitate clinical assessment and treatment. He emphasizes that the changes in the criteria for schizoaffective disorders diagnosis can reduce diagnostic rates. He also stresses the possibility to create a criteria for attenuated psychosis syndrome.

Background CCL22 is a chemokine that is highly expressed in the thymus and by myeloid cells and produced especially by activated (M2) macrophages and monocyte-derived dendritic cells. It is a potent chemoattractant for antigen-experienced, but not resting, T lymphocytes, and all Th cell subtypes express its receptor. CCL22 signaling through its receptor CCR4 has previously been studied in multiple sclerosis (MS), cancer, asthma and allergies, cardiovascular diseases and autoimmune diseases. Elevated cerebrospinal fluid levels of CCL22 have been reported in MS, and the involvement of CCL22 and CCR4 in the experimental autoimmune encephalomyelitis (EAE) model of MS has been consistently shown (Scheu et al. 2017). We have previously found in a small study of 37 patients with first-episode psychosis and 19 controls that the chemokine CCL22 was markedly elevated in patients with first-episode psychosis (FEP), and elevated CCL22 levels were associated with white matter changes in structural brain imaging and diffusion tensor imaging (Mäntylä et al. 2015). Here, CCL22 and 37 other cyto- and chemokines in a longitudinal study of patients with early psychosis and healthy controls. Methods We analyzed a panel of 38 cyto- and chemokines from serum samples in two longitudinal study samples consisting of young adult patients with clinical high-risk state (CHR; N=35), first-episode psychosis (FEP; N=129) and healthy controls (N=130). Patients were assessed at the time of their initial treatment contact and 12 months later, and controls were also assessed twice. Results We found CCL22 to be highly significantly elevated in patients with CHR and FEP compared to the controls and to remain elevated in a one-year follow-up. After systematic evaluation and adjustment for potential confounding factors like age, gender, BMI, antipsychotic medications, smoking and cannabis use, elevated CCL22 was still highly significantly associated with psychosis. In contrast, only modest or no changes were seen in other cyto- or chemokines. However, above patient median CCL22 levels were associated with marked changes in almost half of the other cyto- and chemokines, and this phenotype persists in the one-year follow-up, suggesting that elevated CCL22 is a biomarker of a high-inflammation phenotype. Moreover, CCL22 levels correlated with symptom severity at both time points. We are currently analyzing whether CCL22 levels are associated with brain structural changes, as measured by MRI and DTI, and these results will be presented in the meeting. Conclusions Our results suggest that CCL22 is a trait-like marker of a high-inflammation state in early psychosis. We are performing further studies to determine the mechanism causing CCL22 elevation. [ABSTRACT FROM AUTHOR]

Sex hormones, such as estrogens, progesterone, and testosterone, have a significant influence on brain, behavior, and cognitive functioning. The menstrual cycle has been a convenient model to examine how subtle fluctuations of these hormones can relate to emotional and cognitive functioning. The aim of the current paper is to provide a narrative review of studies investigating cognitive functioning in association with the menstrual cycle in biological females, with a focus on studies that have investigated cognitive functioning across the menstrual cycle in females with premenstrual mood disorders, such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). In line with previous reviews, the current review concluded that there is a lack of consistent findings regarding cognitive functioning across the menstrual cycle. Most studies focused on changes in levels of blood estrogen, and neglected to explore the role of other hormones, such as progesterone, on cognitive functioning. Cognitive research involving premenstrual disorders is in its infancy, and it remains unclear whether any cognitive disturbances that are identified may be attributed to negative experience of mood and psychological symptoms or be a more direct effect of hormonal dysregulation or sensitivity. Suggestions for future research are provided. [ABSTRACT FROM AUTHOR]

The article focuses on the multiple cognitive trap procedure to detect the hidden schizophrenia. The Minnesota Multiphasic Personality Inventory (MMPI) always has had great difficulty in detecting and evaluating schizophrenia. The major purpose of this study was to demonstrate that normal and patient groups matched for sex, race and age respond differentially to the content of the Hidden Schizophrenia Attitude Scale and, in addition, that normals are unable to duplicate the profiles of abnormals and abnormals are unable to duplicate the profiles of normals. In summary, the MMPI successfully identifies as schizophrenic less than two-thirds of hospitalized inpatients, and many of those identified subsequently are disqualified as false positives.

Psychotic disorders are associated with a multitude of immunological changes, including elevations of inflammatory cytokines and chemokines in blood and cerebrospinal fluid. The strongest genome-wide association signal in schizophrenia was shown to be accounted for by copy number variation in complement component 4 gene: variants causing higher expression of C4A are associated with higher risk of schizophrenia. It has been suggested that there is a specific high-inflammation subtype in 30%–40% of patients with schizophrenia and schizoaffective disorder and that these patients have more severe cognitive difficulties and brain structural abnormalities. However, systematic studies using modern immunological methods in patients with early psychosis and matched healthy controls are scarce. In particular, it would be important to study T-cell functions and the potential of microbial structures to elicit innate immune responses at cellular level. Studying central microglia activation using Positron Emission Tomography (PET) has become feasible with the advent of first- and second-generation translocator protein (TSPO) radioligands. Interestingly, recent studies using second-generation TSPO tracers in first-episode psychosis have found a reduced TSPO expression in psychosis, even in anti-psychotic naïve patients (Plavén-Sigray et al. 2018). The results may mean that the important functions of microglia in neuronal plasticity and synaptic function are disturbed, however additional work is required to examine these hypotheses. In this symposium, we present new results on glial imaging, immune cell functions in early psychosis, potential new biomarkers of a high-inflammation phenotype and their association with central microglia activation. Jaana Suvisaari presents results from a longitudinal study on early psychosis that detected a chemokine biomarker identifying patients who had a stable high-inflammation phenotype associated with more severe psychopathology. Jarno Honkanen presents results on peripheral immunity and immune response to LPS stimulation in early psychosis. Jarmo Hietala presents associations between brain TSPO binding and peripheral immune response and immune system biomarkers. Simon Cervenka presents associations between brain TSPO binding and peripheral and central markers for immune activation in psychosis, longitudinal TSPO PET data as well as methodological developments in TSPO quantification to increase sensitivity. References: Plavén-Sigray P, Matheson GJ, Collste K, Ashok AH, Coughlin JM, Howes OD, Mizrahi R, Pomper MG, Rusjan P, Veronese M, Wang Y, Cervenka S. Positron Emission Tomography Studies of the Glial Cell Marker Translocator Protein in Patients With Psychosis: A Meta-analysis Using Individual Participant Data. Biol Psychiatry. 2018;84:433–442. [ABSTRACT FROM AUTHOR]

Objective To overview the phenomenology, etiology, assessment, and treatment of psychotic-like symptoms in trauma-related disorders focusing on the proposed role of temporal lobe dysfunction. Method We describe the literature pertaining to (i) psychotic-like symptoms and temporal lobe dysfunction in trauma-related disorders and (ii) psychological testing profiles in trauma-related disorders. We define trauma-related disorders as borderline personality disorder, post-traumatic stress disorder, and the dissociative disorders. Our search terms were dissociative disorders, temporal lobe, trauma, post-traumatic stress disorder, borderline personality disorder, psychosis, and malingering. Results Trauma-related psychotic-like symptoms are common and can differ in phenomenology from primary psychotic symptoms. Hallucinations consist of auditory and nonauditory content that may or may not relate to traumatic content. Child voices are highly suggestive of complex dissociative disorders. Critically, not only do these symptoms resemble those seen in temporal lobe epilepsy, but the temporal lobe is implicated in trauma-related disorders, thus providing a plausible neurobiological explanation. Despite such evidence, these symptoms are frequently considered atypical and misdiagnosed. Indeed, common structured psychological assessment tools categorize these symptoms as possible indicators of invalid testing profiles. Conclusion Psychotic-like symptoms are common in trauma-related disorders, may be related to temporal lobe dysfunction, and are frequently misinterpreted. This may lead to ineffective treatment and inappropriate determinations of malingering in the forensic system. [ABSTRACT FROM AUTHOR]