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IntroductionPituitary enlargement has been reported in individuals with schizophrenic psychosis or an at-risk mental state for psychosis (ARMS). In a previous study, our group could show pituitary volume increase in first episode and ARMS patients with later transition to psychosis (ARMS-T). However, there are no longitudinal studies on this issue so far. We therefore examined longitudinally whether transition to psychosis would be accompanied by a further increase of pituitary volume in antipsychotic-naïve ARMS patients.MethodsMagnetic resonance imaging (MRI) data were acquired from 23 antipsychotic-naïve individuals with an ARMS. Ten subjects developed psychosis (ARMS-T) and 13 did not (ARMS-NT). ARMS-T were re-scanned after the onset of psychosis, and ARMS-NT were re-scanned at the end of the study period.ResultsThere was no significant difference of the pituitary volume between ARMS-T and ARMS-NT in our sample, and there were no significant pituitary volume changes over time.DiscussionLongitudinally, we could not detect any further volumetric changes in the pituitary volume with transition to psychosis.ConclusionsThis, together with the result of our previous study, could indicate that the perceived level of stress in ARMS patients is constantly high from very early onward.

Introduction Unrealistic optimism refers to the pervasive tendency of healthy individuals to underestimate their likelihood of future misfortune, including illness. The phenomenon shares a qualitative resemblance with anosognosia, a neurological disorder characterized by a deficient appreciation of manifest current illness or impairment. Unrealistic optimism and anosognosia have been independently associated with a region of right inferior frontal gyrus, the pars opercularis. Moreover, anosognosia is temporarily abolished by vestibular stimulation, particularly by irrigation of the left (but not right) ear with cold water, a procedure known to activate the right inferior frontal region. We therefore hypothesized that left caloric stimulation would attenuate unrealistic optimism in healthy participants. Methods Thirty-one healthy right-handed adults underwent cold-water caloric vestibular stimulation of both ears in succession. During each stimulation episode, and at baseline, participants estimated their own relative risk of contracting a series of illnesses in the future. Results Compared to baseline, average risk estimates were significantly higher during left-ear stimulation, whereas they remained unchanged during right-ear stimulation. Unrealistic optimism was thus reduced selectively during cold caloric stimulation of the left ear. Conclusions Our results point to a unitary mechanism underlying both anosognosia and unrealistic optimism, and suggest that unrealistic optimism is a form of subclinical anosognosia for prospective symptoms.

Hintergrund: In Basel haben wir verschiedene Studien zur Verbesserung der Methodik zur Fruherkennung von Psychosen (FePsy) durchgefuhrt. Methodik: Vom 01.03.2000 bis 29.02.2004 wurden 234 Individuen mithilfe des Basler Screening Instruments fur Psychosen (BSIP) gescreent. Bei 10 6 Patienten konnte ein Risikostatus fur Psychosen diagnostiziert werden, 53 davon konnten bis zu 7 Jahre (Mittel 5. 4 Jahre) nachuntersucht werden. Die weiteren Untersuchungen erfolgten u.a. mit einem spezifisch entwickelten Anamnese - Instrument, verschiedenen Skalen zur Psychopathologie, Untersuchungen der Neuropsychologie u n d Feinmotorik , klinische m und quantitative m EEG, MRI des Gehirns, Labor. Ergebnisse: Allein auf der Basis des BSIP konnte eine relativ zuverlassige Vorher sage getroffen werden: 21 (39.6 % ) der als „ Risikopatienten “Identifizierten entwickelten innerhalb der Beobachtungszeit tatsachlich eine Psychose. Post hoc konnte durch spezifischere Gewichtung der Psychopathologie und Einbezug neuropsychologischer Untersuchungen die Vorhersagegenauigkeit auf 81 % gesteigert werden. Die anderen oben genannten Verfahren konnen offensichtlich zur weiteren Verbesserung der Pradiktion beitragen. Schlussfolgerungen: Die Risikoabklarung fur Psychose sollte stufenweise und unter Einbezug verschiedener Untersuchungsebenen erfolgen. Background: We have conducted various studies in Basel with the aim of improving the methods for the early detection of psychosis (Fruherkennung von Psychosen, FePsy).Methods: From 1.3.2000 to 29.2.2004 234 individuals were screened using the Basel Screening Instrument for Psychosis (BSIP). 106 patients were identified as at risk for psychosis; out of these 53 remained in follow-up for up to 7 years (mean 5.4 years). The assessments were done with a specifically developed instrument for history taking, various scales for the psychopathology, assessments of neuropsychology and fine motor functioning, clinical and quantitative EEG, MRI of the brain, laboratory etc.Results: Based on the BSIP alone, a relatively reliable prediction was possible: 21 (39.6 %) of the individuals identified as at risk developed psychosis within the follow-up time. Post-hoc prediction could be improved to 81 % by weighting psychopathology and including neuropsychology. Including the other domains obviously allows further improvements of prediction.Conclusions: The risk for psychosis should be assessed in a stepwise procedure. In a first step, a clinically oriented screening should be conducted. If an at-risk status is found, further assessments in various domains should be done in a specialised centre.

It is unclear yet whether cannabis use is a moderating or causal factor contributing to grey matter alterations in schizophrenia and the development of psychotic symptoms. We therefore systematically reviewed structural brain imaging and post mortem studies addressing the effects of cannabis use on brain structure in psychosis. Studies with schizophrenia (SCZ) and first episode psychosis (FEP) patients as well as individuals at genetic (GHR) or clinical high risk for psychosis (ARMS) were included. We identified 15 structural magnetic resonance imaging (MRI) (12 cross sectional / 3 longitudinal) and 4 post mortem studies. The total number of subjects encompassed 601 schizophrenia or first episode psychosis patients, 255 individuals at clinical or genetic high risk for psychosis and 397 healthy controls. We found evidence for consistent brain structural abnormalities in cannabinoid 1 (CB1) receptor enhanced brain areas as the cingulate and prefrontal cortices and the cerebellum. As these effects have not consistently been reported in studies examining non-psychotic and healthy samples, psychosis patients and subjects at risk for psychosis might be particularly vulnerable to brain volume loss due to cannabis exposure

Background Studies examining the influence of duration of untreated psychosis (DUP) or duration of untreated illness (DUI) on cognition vary with regard to results and methods. This study is the first in this field to include an at risk mental state with later transition to psychosis (ARMS-T) sample and to analyse how the DUI relates to their cognitive functioning. Because methodological operationalization of cognitive functioning in previous studies is highly heterogeneous, we aimed to compare different approaches. Method 60 first episode psychosis (FEP) patients and 24 ARMS-T patients were examined. Associations between DUP, DUI and neurocognitive performance were tested by three different operationalizations of cognition: as the raw outcome measure of different neuropsychological tests, as outcome scores which were normed on a sample of 75 healthy participants, and as the deterioration index (DI). Results There were no significant correlations between DUP or DUI and outcome of neuropsychological tests in both normed and raw scores. When adjusted for covariates, DUP and DUI also did not significantly predict any cognitive performance. There was no significant relationship between DUP or DUI and the DI index. However, longer DUP and DUI were significantly associated with stronger negative symptoms. Conclusions This study could not confirm an association between duration of untreated psychosis or duration of untreated illness and neurocognitive performance in the ARMS-T and FEP samples. This could be because schizophrenic psychoses are neurodevelopmental disorders in which most cognitive deficits exist long before the onset of psychiatric symptoms.

Neurological soft signs (NSS) are more common in schizophrenic psychoses and in genetically high-risk individuals than in healthy controls. But nothing is known so far regarding individuals with a clinical at-risk mental state (ARMS). The goals of our study therefore were (a) to compare the NSS frequency in ARMS individuals to that of first-episode psychosis (FEP) patients and (b) to test whether NSS could predict the transition to psychosis. Neurological soft signs were assessed using a shortened version of the Neurological Evaluation Scale (NES). Fifty-three ARMS individuals (16 with later transition to psychosis=ARMS-T, and 37 without transition=ARMS-NT) and 27 FEP patients were recruited through the Basel Early Detection Clinic FePsy. Of the FEP patients 37% showed NSS. We found no significant differences between FEP and ARMS-T patients or between ARMS-NT and ARMS-T. Our findings of NSS being present already before transition to psychosis to the same extent as after transition provide further support to the neurodevelopmental hypothesis of schizophrenic psychoses. Furthermore, our findings might indicate that ARMS-NT individuals also suffer from some sort of neurodevelopmental abnormalities.

BACKGROUND: Meta-analyses suggest that schizophrenia patients with a history of cannabis use have less impaired cognitive functioning compared to patients without cannabis use. AIMS: The objective of this study was to assess the association between recency and frequency of cannabis use and cognitive functioning in at-risk mental state for psychosis (ARMS) and first episode psychosis (FEP) individuals. METHODS: One hundred thirty-six participants completed a cognitive test battery and were assessed for current and past cannabis use. Analyses of covariance models were applied to evaluate the main effects of cannabis use and patient group (ARMS vs. FEP) as well as their interactions on cognitive functioning. RESULTS: No differences were observed in cognitive performance between current, former, and never users, and there were no significant interactions between cannabis use and patient group. Furthermore, within the group of current cannabis users, the frequency of cannabis use was not significantly associated with cognitive functioning. CONCLUSION: The results of the present study do not support the notion that FEP patients and ARMS individuals with a history of cannabis use have less impaired cognitive functioning compared to those without cannabis use.

As cannabis use is more frequent in patients with psychosis than in the general population and is known to be a risk factor for psychosis, the question arises whether cannabis contributes to recently detected brain volume reductions in schizophrenic psychoses. This study is the first to investigate how cannabis use is related to the cingulum volume, a brain region involved in the pathogenesis of schizophrenia, in a sample of both at-risk mental state (ARMS) and first episode psychosis (FEP) subjects. A cross-sectional magnetic resonance imaging (MRI) study of manually traced cingulum in 23 FEP and 37 ARMS subjects was performed. Cannabis use was assessed with the Basel Interview for Psychosis. By using repeated measures analyses of covariance, we investigated whether current cannabis use is associated with the cingulum volume, correcting for age, gender, alcohol consumption, whole brain volume and antipsychotic medication. There was a significant three-way interaction between region (anterior/posterior cingulum), hemisphere (left/right cingulum) and cannabis use (yes/no). Post-hoc analyses revealed that this was due to a significant negative effect of cannabis use on the volume of the posterior cingulum which was independent of the hemisphere and diagnostic group and all other covariates we controlled for. In the anterior cingulum, we found a significant negative effect only for the left hemisphere, which was again independent of the diagnostic group. Overall, we found negative associations of current cannabis use with grey matter volume of the cingulate cortex, a region rich in cannabinoid CB1 receptors. As this finding has not been consistently found in healthy controls, it might suggest that both ARMS and FEP subjects are particularly sensitive to exogenous activation of these receptors.

Unrealistic optimism (UO) refers to the tendency of healthy people to underestimate their risk of future misfortune. Just as left-ear caloric irrigation attenuates anosognosia (denial of manifest illness) in clinical patients, we found that it also reduces UO about future health risks in healthy individuals. This finding demonstrates asymmetric hemispheric involvement in emotion regulation and self-evaluation, and suggests that a similar neuropsychological process underpins anosognosia and healthy optimism.

We report the case of a 40-year-old right-handed German-speaking man who presented with ischemic stroke in the territories of the right superior cerebellar artery and posterior inferior cerebellar artery. The objective of the present study was to investigate the consequences of this cerebellar damage with regard to higher cognitive functions. On admission to the stroke unit, the patient presented with dysarthria, right-sided appendicular ataxia, gait ataxia, and right-sided horizontal nystagmus (National Institutes of Health Stroke Scale, NIHSS, score 4). When examined 10 days after his stroke using a set of neuropsychological tests, he showed a marked deficit in the ability to remember when and in which context he had previously encountered verbal material. This aspect of memory, so-called ‘source memory’, is known to be mediated mainly by frontal and medial temporal structures. The present case suggests the existence of a strong functional connectivity between cerebellum and cortical regions underlying specific memory processes.

There is converging evidence, from various independent areas of neuroscience, for a functional specialization of the left and right cerebral hemispheres for positive and negative emotions, respectively ("valence theory" of emotional processing). One subfield, however, has produced mixed results, i.e. work on the detection of parafoveally presented positively or negatively emotional words by healthy subjects. Right or left visual field advantages were described and interpreted as reflecting the superiority of either the left hemisphere (LH) for linguistic material, or of the right hemisphere (RH) for highly emotional stimuli. Here we show that 48 healthy, right-handed participants' performance on a lateralized lexical decision task depends on their individual inclination to bisect a line to the left or right of the objective center. Only those with a bisection bias to the right showed the LH advantage for word detection known from the neuropsychological literature. Negative emotional words were processed with comparable accuracy in the two visual fields. However, a recognition advantage for negative over positive emotional words was found exclusively for those participants with a leftward line bisection bias. These results suggest that in work on functional hemispheric differences state variables like stimulus lateralization and word emotionality may be less decisive than the trait variable of lateral hemispatial attention. We propose a cautious reconsideration of the concept of "hemisphericity," which once emphasized individual differences in baseline hemispheric arousal, but was later dismissed in a reaction to oversimplifications in popular science accounts.