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RESUME Notre experience des allongements des membres inferieurs dans les inegalites de longueur des membres inferieurs et la securite donnee par les techniques chirurgicales actuelles developpees depuis plus de 30 ans nous ont incites a utiliser ces possibilites therapeutiques chez les sujets de petite taille, adolescents et adultes jeunes. En effet, notre societe nous renvoie a une image normee du corps, ceci ayant pour consequences d’entrainer parfois des difficultes d’ordre psychologiques et sociales chez les sujets porteurs d’une petite taille. Le traitement chirurgical permettra des allongements de 10 a 20 cm lorsque les aspects psychologiques de cette petite taille ont ete correctement cernes, ces patients en tireront alors un benefice reel. Faut-il encore definir les limites ethiques de cette chirurgie en differenciant bien les indications cosmetiques des indications therapeutiques vraies. Cette chirurgie reparatrice permettra alors de completer un traitement medical insuffisant ou de suppleer celui-ci lorsqu’il s’est avere impossible (par exemple achondroplasie).

To investigate the impact of various antipsychotic drugs on the 5-HT1A serotoninergic system, we performed a [F]4-(2-methoxyphenyl)-1-[2-(N-2-pirydynyl)-p-luorobenzamido]-ethyl-piperazine PET study in 19 schizophrenic patients treated with either aripiprazole, which has a partial agonist activity at 5-HT1A receptors, or second-generation antipsychotics (SGA) (olanzapine or risperidone), which do not demonstrate such property. We used a simplified reference tissue model to generate parametric images of [F]MPPF-binding potential (BPND). A significant reduction of [F]MPPF BPND was found in treated schizophrenic patients compared to age- and sex-matched healthy subjects. These modifications were mainly localized in the frontal and orbitofrontal cortex and may reflect either the pathophysiology of schizophrenia or medication effects. The schizophrenic patients treated with aripiprazole showed a reduction of global [F]MPPF BPND compared with healthy subjects and schizophrenic patients with SGA treatment. In addition, compared with matched controls, the reduction of regional [F]MPPF BPND was more marked in the schizophrenic patients treated with aripiprazole compared with those receiving SGA treatment, possibly reflecting the partial agonist of aripiprazole activity at 5-HT1A receptors.

Resume Les deficits du self monitoring dans la schizophrenie peuvent etre etudies grâce a des tests de « memoire de source » ou il est demande aux sujets de reconnaitre la source de mots qu’on leur a presentes prealablement selon differentes modalites. Des resultats obtenus a un test de fluence verbale, nous avons extrait une liste de mots courants a partir de laquelle nous avons construit par tri aleatoire deux tests de memoire de la source afin de comparer les performances de trois groupes : 30 patients schizophrenes, 22 patients presentant un episode depressif majeur et 24 volontaires sains. Les resultats aux tests de memoire de la source confirment les donnees de la litterature et montrent un deficit de reconnaissance de la source chez les patients schizophrenes presentant des symptomes positifs. Ce deficit semble specifique de la schizophrenie, aucune difference n’ayant ete observee entre les performances des deux autres groupes. Ce deficit est a type de confusion (ou inversion) entre les mots issus d’une source reelle, externe et ceux issus d’une source interne, imaginee. Ces resultats corroborent l’hypothese d’un deficit de reconnaissance de la source dans la schizophrenie.

Numerous authors have reported the existence of lateralised abnormalities towards the right side in patients with schizophrenia.In the present study, a manual line bisection task was used to assess the existence of a visuospatial bias in patients with schizophrenia as compared to healthy subjects and left unilateral neglect patients. In addition, we used a local cueing paradigm (consisting of a number placed on the right, on the left, or at both ends of the line).Healthy subjects showed a leftwards trend in the "no cue" condition (known as pseudoneglect) and neglect patients showed a right bias in all cue conditions. In contrast, patients with schizophrenia placed their manual estimation of the centre further to the left than healthy subjects in all cue conditions, reflecting neglect of the right side of the line. Moreover, like healthy subjects and neglect patients, patients with schizophrenia were affected by the local cueing.Hence, patients with schizophrenia show a bias in their spatial representation, which does not interfere with local context processing.

Several visuo-motor tasks can be used to demonstrate biases towards left hemispace in schizophrenic patients, suggesting a minor right hemineglect. Recent studies in neglect patients used a new number bisection task to highlight a lateralized defect in their visuo-spatial representation of numbers. To test a possible lateralized representational deficit in schizophrenia, we used the number bisection task in 11 schizophrenic patients compared to 11 healthy controls. Participants were required to orally indicate the central number of an interval orally presented. Whereas healthy subjects showed no significant bias, schizophrenic patients presented a significant leftward bias. Therefore, these results suggest an impairment in higher order representations of the number space in patients with schizophrenia, an impairment that is qualitatively similar to the deficit described in neglect patients.

Some auditory event-related potential (ERP) abnormalities characterize both patients with schizophrenia and subjects with schizotypal personality disorder. It was therefore hypothesized that subjects from the community with schizotypal traits might also present ERP abnormalities. In this study, we compared auditory ERP latencies and amplitudes in 13 subjects with high (H-SPQ) and 12 subjects with low (L-SPQ) scores on the Schizotypal Personality Questionnaire (SPQ), selected from 198 Tunisian students. Auditory ERPs were recorded at Fz, Cz, and Pz, with a standard oddball paradigm. Smaller P300 amplitudes and delayed P300 latencies were found in H-SPQ compared with L-SPQ participants. Confirming previous reports, our results suggest that reduced P300 amplitudes and delayed P300 latencies may be considered as vulnerability markers of the schizophrenia spectrum in nonclinical subjects from the community.

Resume Objectif. – Plusieurs travaux de validation du questionnaire de personnalite schizotypique de Raine (SPQ) ont ete effectues sur des populations issues de differents milieux socioculturels. L'objectif de notre travail etait de comparer les scores de schizotypie au SPQ entre deux populations estudiantines francaise et tunisienne. Methodologie. – C'est une etude transversale comparative, portant sur deux groupes d'etudiants : un premier groupe constitue de 198 etudiants de la ville de Monastir (Tunisie) et un deuxieme groupe comportant 232 etudiants de la ville de Lyon (France). Nous avons compare les scores totaux moyens et les scores moyens aux neuf sous-echelles du SPQ entre les deux groupes. Resultats. – Les scores totaux moyens etaient significativement plus eleves chez les etudiantes tunisiennes par rapport aux etudiantes francaises ( p = 0,005). Des scores significativement plus eleves etaient constates, dans la population tunisienne, aux sous-echelles : « anxiete sociale excessive » ( p = 0,001), « absence d'amis proches » ( p = 0,0001), « pauvrete des affects » ( p p p p = 0,003), qui s'integrent dans la dimension positive de la schizotypie. Conclusion. – Les differences mises en evidence dans ce travail evoquent la possibilite d'une influence socioculturelle dans l'expression de certains traits de la schizotypie.

This study improves the knowledge of early autistic symptomatology and research concerning (i) the significant differences in the behaviors of children with autistic disorder (AD) and children with a developmental delay (DD), and (ii) the influence of the cognitive delay on symptomatology.Two groups of 20 young children (7-42 months) were compared: children with AD, and those with DD. The groups were paired by chronological and developmental age. The comparison was extended to four subgroups composed according to age (younger and older children--24 months,24 months) and to the global development quotient (GDQ) (the more and less delayed). Each child was evaluated with the Infant Behavior Summarized Evaluation scale (IBSE).For the younger AD children, significant differences affected social communication and their adaptation to the environment (intolerance to frustration, resistance to change). For the older children (24 months), this study showed the rapid progression of the number of distinctive signs between AD and DD children according to age and/or developmental level.Cognitive delay has an important influence on the symptomatology at the moment of initial recognition of an autistic syndrome. This study is a complement for the fuller understanding of the nature and early diagnosis of disorders specific to autism at the earliest phases of development.

Resume Malgre des avancees recentes, l’impact des strategies therapeutiques medicamenteuses sur l’amelioration de l’autonomie sociale et des capacites de resolution de problemes interpersonnels des patients schizophrenes reste limite, avec des consequences en termes de reinsertion socioprofessionnelle. En effet, independamment des symptomes positifs, negatifs et/ou de desorganisation, le deficit fonctionnel des patients schizophrenes depend principalement de deficits cognitifs varies. Nos objectifs etaient de determiner l’impact d’une strategie de remediation des deficits cognitifs sur les capacites de resolution de problemes interpersonnels, l’autonomie sociale et les symptomes des patients schizophrenes. Trente patients schizophrenes ont participe a un programme constitue de 14 seances d’entrainement de 4 fonctions cognitives (attention/concentration, memoire topologique, raisonnement logique, fonctions executives) au moyen du logiciel REHACOM®. Les capacites d’attention soutenue, memoire et fonctions executives, ainsi que les capacites de resolution de problemes interpersonnels et l’autonomie sociale et enfin les symptomes etaient evalues au debut et a la fin des 14 seances de remediation. Les fonctions cognitives, les capacites de resolution de problemes interpersonnels, l’autonomie sociale et les symptomes ont ete significativement ameliores a l’issue des seances de remediation. Nos resultats confirment l’interet therapeutique d’une remediation cognitive chez 30 patients schizophrenes stabilises sur les plans clinique, therapeutique et fonctionnel. La question du maintien a long terme de ces ameliorations devra faire l’objet d’une evaluation ulterieure.

Objectif: Le premier objectif de ce travail est de confirmer que les patients souffrant de schizophrénie et leurs frères et sœurs non malades partagent un même déficit des fonctions exécutives, lorsqu'on les compare à des sujets témoins sains. Le deuxième objectif est d'étudier les relations entre les performances au test de classification catégorielle de cartes du Wisconsin (WCST) et la durée et l'intensité des symptômes cliniques, ainsi que les différentes dimensions cliniques. Méthode: Quatre-vingt dix sujets ont participé à cette étude, répartis en 3 groupes de 30: un groupe de patients souffrant de schizophrénie, un groupe formé de leurs frères et sœurs, et un groupe témoin. L'intensité des symptômes a été évaluée par l'échelle des symptômes positifs et négatifs (PANSS), et le fonctionnement social par l'échelle globale du fonctionnement (EGF). Le WCST a été administré aux 3 groupes. Résultats: Les patients souffrant de schizophrénie et leurs frères et soeurs présentaient des performances significativement plus faibles au WCST que celles des témoins. L'analyse statistique a montré que le groupe des patients présentait un déficit des performances au WCST significativement plus important que les 2 autres groupes. Les frères et sœurs présentaient également des performances significativement plus faibles que celles des témoins. D'autre part, aucune relation significative n'a été trouvée entre la performance au WCST et les autres variables, notamment l'âge, le sexe, le niveau d'instruction, la durée de la maladie, le traitement, et les différents scores PANSS et EGF. Conclusion: Les patients souffrant de schizophrénie et leurs frères et sœurs non malades partagent les mêmes déficits des fonctions exécutives. Ces résultats suggèrent que les performances au WCST peuvent être considérées comme un marqueur de vulnérabilité à la schizophrénie chez les frères et sœurs de patients atteints de schizophrénie.

Auditory hallucinations have been associated with a disruption in monitoring one's own speech suggesting an autonoetic agnosia in schizophrenia. This deficit can be measured by a source monitoring task. Low frequency transcranial magnetic stimulations (rTMS) applied to the left temporoparietal cortex can inhibit cortical areas involved both in autonoetic agnosia (which means 'the inability to identify self-generated mental events') and in auditory hallucinations (AH) phenomena. Although improvements in AH have been repeatedly reported following rTMS treatment, effects on autonoetic agnosia measured by source monitoring have never been investigated. We aimed to investigate the relation between improvements in AH and source monitoring performance after rTMS treatment. Twenty four right-handed refractory schizophrenic patients with hallucinations randomly received sham or active 10.0001-Hz rTMS to the left temporoparietal cortex and performed 2 source monitoring tasks requiring discrimination between silent- and overt-reading words before and after rTMS sessions. Compared to sham, active rTMS significantly improved AH. Source monitoring performances and the improvements tended to correlate, which would support a specific relation between autonoetic agnosia and auditory hallucinations.

Background: Impaired facial expression recognition in schizophrenia patients contributes to abnormal social functioning and may predict functional outcome in these patients. Facial expression processing involves individual neural networks that have been shown to malfunction in schizophrenia. Whether these patients have a selective deficit in facial expression recognition or a more global impairment in face processing remains controversial. Objective: To investigate whether patients with schizophrenia exhibit a selective impairment in facial emotional expression recognition, compared with patients with major depression and healthy control subjects. Methods: We studied performance in facial expression recognition and facial sex recognition paradigms, using original morphed faces, in a population with schizophrenia ( n = 29) and compared their scores with those of depression patients ( n = 20) and control subjects ( n = 20). Results: Schizophrenia patients achieved lower scores than both other groups in the expression recognition task, particularly in fear and disgust recognition. Sex recognition was unimpaired. Conclusion: Facial expression recognition is impaired in schizophrenia, whereas sex recognition is preserved, which highly suggests an abnormal processing of changeable facial features in this disease. A dysfunction of the top-down retrograde modulation coming from limbic and paralimbic structures on visual areas is hypothesized.

Objectif: Confirmer l'hypothese selon laquelle les psychotropes, surtout les neuroleptiques, le lithium et les antidepresseurs sont incrimines comme etant une cause de la mort subite impreveue de patients psychiatriques en raison de leur cardiotoxicite, particulierement en presence de lesions cardiaques cachees. Methode: Nous avons procede a un examen pathologique complet de 14 patients psychiatriques qui sont morts subitement de facon inattendue entre 1980 et 1999. Resultats: Les neuroloptique etaient presents dans 13 cas, les antidepresseurs dans 9 et les anxiolytiques dans 5. Les psychotropes etaient combines chez tous les patients sauf 1. Chez tous les 14 patients, les analyses toxicologiques ont eimine la surdose comme cause de deces. Lors de l'autopsie, le cerveau et les organes abdominaux etaient normaux. Chez 13 patients, les lesions suivantes ont ete trouvees dans le coeur et les poumons: cardiomyopathic dilatee (6 patients), hypertrophie du ventricule pauche (2 patients, dont 1 avait aussi un prolapsus valvulaire nitral et des anormalies du faisceau de His), cardiopathie arymogenique du ventricule droit (1 patient), pericardite (1 patient), prolapsus valvulaire mitral (1 patient), embranchement musculaire sur l'artere interventricolaire anterieure (1 patient), et le syndrome de Mendelson (1 patient). Dans 1 cas, aucun changement n'a ete observe. La plupart des medicaments qui ont ete pris immediatement avant la mort peuvent provoquer l'arythmie soit en prolongeant l'espace QI, ce qui peut entrainer des torsdes de pointes, soit en elargissant les complexes QRS, ou qui peut mener a un phenomene de remtree et a une fibrillation ventriculaire. Conclusions: Nos resultats indiquent que les effets arythmogeniques des psychotropes peuvent etre exacertes lorsque des lesions cardiaques cachees preexistantes sont presentes et qu'ils peuvent entrainer la mort subite. Les patients desraient etre systematiquement evaltes pour depister les lesions cardiaques avant de sommenver tout traitement a un psychotrope. La dose efficace minimale devnait etre utilisee.

Background Enhanced ability to reliably identify risk factors for suicidal behavior permits more focused decisions concerning treatment interventions and support services, with potential reduction in lives lost to suicide. Methods This study followed 980 patients at high risk for suicide in a multicenter prospective study for 2 years after randomization to clozapine or olanzapine. A priori predictors related to diagnosis, treatment resistance, and clinical constructs of disease symptoms were evaluated as possible predictors of subsequent suicide-related events. Results Ten baseline univariate predictors were identified. Historical predictors were diagnosis of schizoaffective disorder, history or current use at baseline of alcohol or substance abuse, cigarette smoking, number of lifetime suicide attempts, and the number of hospitalizations in the previous 36 months to prevent suicide. Predictive clinical features included greater baseline scores on the InterSePT scale for suicidal thinking, the Covi Anxiety Scale, the Calgary Depression Scale (CDS), and severity of Parkinsonism. Subsequent multivariate analysis revealed the number of hospitalizations in the previous 36 months, baseline CDS, severity of Parkinson’s, history of substance abuse, and lifetime suicide attempts. Clozapine, in general, was more effective than olanzapine in decreasing the risk of suicidality, regardless of risk factors present. Conclusions This is the first prospective analysis of predictors of suicide risk in a large schizophrenic and schizoaffective population judged to be at high risk for suicide. Assessment of these risk factors may aid clinicians in evaluating risk for suicidal behaviors so that appropriate interventions can be made.

Le trouble de personnalite schizotypique presente de tres nombreux points communs avec la schizophrenie, tant sur le plan clinique, ou il evoque une forme attenuee de la maladie, que sur les plans epidemiologique, neuropsychologique, electrophysiologique et neurobiologique. Ces similitudes laissent penser que ce trouble de personnalite, ou seulement certaines des dimensions cliniques qui le composent, pourrait constituer un veritable “marqueur” clinique de vulnerabilite a la schizophrenie definissant ainsi des sujets a haut risque “clinique ou psychometrique”. De ce fait, il pourrait s’agir d’un outil prometteur pour la comprehension des mecanismes etiopathogeniques qui sous-tendent l’apparition d’une schizophrenie, y compris en l’absence d’un risque “familial ou genetique” de schizophrenie (apparentes de premier degre de patients schizophrenes). Dans cet article, nous nous proposons de passer en revue les principales etudes realisees jusqu’a ce jour concernant les aspects historique, clinique, epidemiologique, neuropsychologique, electrophysiologique et neurobiologique du trouble de personnalite schizotypique.

This study examines the area of eye movement dysfunctions as an indicator of vulnerability to schizophrenia. Eye movement performance was investigated with three different paradigms: Smooth Pursuit Eye Movements (SPEM); Visually Guided Saccades (VGS); and Antisaccades (AS) in 21 clinically stable patients with schizophrenia, 21 of their healthy, biological full siblings and 21 healthy control subjects. The three groups did not differ on VGS performance, whereas both patients and their siblings showed lower SPEM gain, an increased catch-up Saccades (CUS) rate, reduced AS accuracy and an increased number of AS errors in comparison to control subjects. In addition, patients with schizophrenia exhibited increased AS latency. Among the patients with schizophrenia, eye movement abnormalities did not correlate with age, gender, clinical state or duration of illness. These data suggest that abnormalities of SPEM and AS may represent neurobiological markers of the vulnerability to schizophrenia in individuals at high genetic risk for the disease.

Objective: The possibility that delusions of influence could be related to abnormal recognition of one’s own actions was investigated in persons with schizophrenia. Method: Schizophrenic patients with (N=6) and without (N=18) delusions of influence were compared with normal subjects (N=29) on an action recognition task. The image of a virtual right hand holding a joystick was presented to the subjects through a mirror so that the image was superimposed on their real hand holding a real joystick. Subjects executed discrete movements in different directions. Angular biases and temporal delays were randomly introduced in some trials, such that the movement of the virtual hand departed from the movement executed by the subjects. After each trial, subjects were asked whether the movement they saw was their own. Results: Compared with normal subjects, both patient groups made significantly more recognition errors in trials with temporal delays. In trials with angular biases, the error rate of patients with delusions of influence significantly differed from that of comparison subjects and from that of patients without delusions of influence. Conclusions: The findings support the hypothesis that delusions of influence are associated with a quantifiable difficulty in correct self-attribution of actions. This difficulty may be related to a specific impairment of a neural action attribution system.

Clinical expectations in schizophrenia treatment have greatly increased since the introduction of new atypical antipsychotics, but the choice of therapeutic strategy has become more complex and reference guidelines are scarce. This paper summarizes the consensus of a broad range of professionals after long-term commercialization in France of an atypical antipsychotic, amisulpride. Participants were from psychiatric hospitals, private clinics, out-patients settings and research; all were experienced with the drug. Discussions focused on the practical use of amisulpride, as, in addition to the double-blind trials information, it may be useful for psychiatrists of other countries to intuitively understand the therapeutic properties of amisulpride. The topics selected include acute psychotic episodes, short- and long-term follow-up, feasibility of treating the initial phase, the elderly and switching treatments. The French experience emphasizes the central role of amisulpride as a first-line treatment of schizophrenia.

Previous studies of executive/attentional functions have found impairments in nonpsychotic first-degree relatives of patients with schizophrenia. The aims of this study were: (1) to replicate these findings by three laboratory measures of attention/information processing - a continuous performance test (DS-CPT), a forced-choice span of apprehension task (SPAN), and a digit symbol substitution test (DSST), and by a series of neuropsychological tests sensitive to prefrontal cortical damage - Trail Making A and B, verbal fluency (VFT), Stroop Color and Word Test (Stroop), and Wisconsin Card Sorting Test (WCST); (2) to investigate whether such executive/attentional deficits are associated with schizotypal traits assessed using the social anhedonia, physical anhedonia, perceptual aberration and magical ideation scales (Chapman, L.J., Chapman, J.P., Raulin, M.L. 1976. Scales for physical and social anhedonia. J. Abnorm. Psychol. 85, 374-382; Chapman, L.J., Chapman, J.P., Raulin, M.L., 1978. Body-image aberration in schizophrenia. J. Abnorm. Psychol. 87, 399-407; Eckblad, M., Chapman, L.J., 1983. Magical ideation as an indicator of schizotypy. J. Consult. Clin. Psychol. 51, 215-225). In both patient and relative groups, performance was significantly poorer on the DSST, VFT and Trail B, and the reaction time on the SPAN was significantly longer. These neuropsychological impairments were present as much in siblings as in parents of schizophrenic patients; age did not appear to cancel differences between the relative and control groups. In the relative group, the four scores of schizotypy were at an intermediate level between those of patient and control groups, and the social anhedonia and perceptual aberration scores tended to be significantly different between the relative and the control groups. Only two significant correlations were found between the neuropsychological performance and the measures of schizotypy.

There is a challenge to understand schizophrenia cognitive deficits in terms of a common unifying hypothesis (i.e., context-processing deficit). We suggest that analysis of a low level of cognition, such as the natural tendency to adapt pointing movement time to the task difficulty, could provide the basis for understanding higher level processing, in the sense of context processing. In the present study, three-dimensional visually guided pointing movements were compared among patients with schizophrenia and healthy control subjects. Seventeen patients with schizophrenia and 13 controls, all right-handed, performed pointing movements on adversely sized targets displayed on a touch-screen. Results showed that, under this experimental procedure, the speed/accuracy trade-off was respected by the two groups, in that controls and patients achieved a constant level of precision whereas they increased reaction time and movement time when target size decreased. In addition, we provide a measurement of the pointin...

This study was aimed at confirming that auditory event related potential (ERP) abnormalities are indicators of vulnerability to schizophrenia. Auditory ERP performances were assessed at Fz, Cz, and Pz, with an oddball paradigm, in 21 clinically stable patients with schizophrenia, 21 of their healthy biological full siblings and 21 control subjects. The evoked response did not differ between the three groups on N200 waves. Compared to controls, patients with schizophrenia exhibited reduced amplitudes of N100 and P300, and prolonged latency of P300, while their siblings showed prolonged latency of P200 and P300. Among the patients with schizophrenia, ERP abnormalities did not correlate with age, clinical state, duration of illness or antipsychotic treatments. Although other conditions also accounted for alterations of the same type, ERP abnormalities may represent a neurobiological marker of the genetic vulnerability to schizophrenia, independent of phenotypic expression.

Several studies have shown subtle neuropsychological deficits in healthy relatives of schizophrenic patients. However, older relatives and parents have been less frequently assessed than younger adult relatives and siblings. Furthermore, some areas of neuropsychological functioning such as memory and learning have been little studied. Thirty-seven 22–70-year-old non-psychotic parents and siblings of schizophrenic patients were compared to 37 healthy control subjects on a battery of neuropsychological tests (Trail Making, parts A and B, verbal fluency, Wisconsin Card Sorting Test, and four subtests of the Wechsler Memory Scale-Revised: logical memory, design reproduction, verbal paired associates and digit span). Relatives did not differ from control subjects on Wisconsin Card Sorting Test performance and on visual memory, but were significantly impaired on verbal fluency; more subtle deficits were found on Trail Making, part B, digit span and paired associates. A higher proportion of relatives than control subjects showed impairment on verbal fluency and verbal memory. These neuropsychological weaknesses were present as much in siblings as in parents of schizophrenic patients, and age did not cancel differences between relatives and control subjects. Thus, these subtle deficits seem to be potential phenotypic markers of schizophrenia.

Event-related potentials (ERPs) have been widely examined in schizophrenic patients. However, although neuroleptic medication could be a potentially confounding variable, studies with unmedicated patients are relatively scarce. The present work was undertaken to determine whether ERP abnormalities persist in stabilized schizophrenic patients after drug withdrawal. In addition, ERP amplitudes and latencies were compared with clinical ratings (the Positive and Negative Syndrome Scale, PANSS) by means of Spearman rank order correlation coefficients. The P300 and N200 responses to rare tones and the P200 and N100 responses to frequent tones were recorded in 20 clinically stabilized drug-free schizophrenic patients and 19 age-matched control subjects during a two-tone discrimination task. Major findings were that the schizophrenic patients had reduced P300, N200 and N100 amplitudes and an increased P300 latency. The P300 amplitude was negatively correlated with age in patients. The P200 latency was negatively correlated with the PANSS positive syndrome score. The ERP abnormalities shown in this study appear to be enduring traits of the disorder as they persist in stabilized patients even after drug withdrawal.

Summer birth has been associated with the deficit Schizophrenia syndrome, while DSM-IV schizophrenia is associated with winter birth. We confirm these monthly differences in a Tunisian sample of patients with schizophrenia, with a summer birth peak (n=34 deficit patients) and an expected winter birth peak (n=46 non-deficit patients).

In a double-blind-crossover-study, 10 patients with schizophrenia, 10 of their unaffected siblings and 9 healthy controls randomly received metabolic stressor and placebo. A significant HVA plasma elevation in response to stress was found in siblings whose response was intermediate to that of patients and controls. Only siblings additionally displayed an exaggerated 5HIAA response.

Several studies using the University of Pennsylvania Smell Identification Test (UPSIT), which requires forced choice olfactory identifications, have reported olfactory identification deficits in patients with schizophrenia. This report examines the possible links between olfactory identification (usually attributed to the orbitofrontal cortex) and executive functions (usually attributed to dorsolateral prefrontal cortex) in 24 male patients with schizophrenia and 21 male comparison subjects. Olfactory performance was investigated under two conditions: spontaneous identification and forced choice identification. Executive function was assessed with the Wisconsin Card Sorting Test (WCST). Compared with controls, patients with schizophrenia exhibited a higher average number of cigarettes smoked per day, lower spontaneous identification scores on olfactory performance, and a higher percentage of perseverative errors on the WCST; there was a significant relationship between the two performance measures. Simpson-Angus scores, neuroleptic drug treatment levels, and scores on the Positive and Negative Syndrome Scale were not correlated with either olfactory measure. The lack of correlation between the forced choice olfactory identification score and the WCST score is consistent with findings in previous studies that used the UPSIT. By contrast, use of a spontaneous identification condition to assess olfactory performance did produce a significant association with WCST performance.

Regional brain protein synthesis was evaluated with positron emission tomography (PET) and L-(S-[11C]methyl)methionine ([11C]MET) in depressive patients, before and 3 h after an electroconvulsive shock (ECS), when energy supply is restored, and in healthy volunteers. Depressive patients presented apparent lower protein synthesis than normals, in agreement with known reduction of cerebral activity. In contrast, ECS resulted in a significant increase (56%, P

Background: Clinical and pharmacologic studies report a relative or absolute serotonergic deficiency in major depression; however, the variability of clinical characteristics of illness has led to controversial results. In the present work, we looked for a possible relationship between i) biochemical values that indirectly reflect aminergic neurons activity and clinical characteristics and ii) their evolution and the early clinical outcome under antidepressive therapies (ATs). Methods: Platelet serotonin content, platelet monoamine oxydase activity, and urinary biopterins were measured in 27 depressed patients before and during four different ATs (paroxetine, viloxazine, moclobemide, or electroconvulsive therapy). Depressive symptomatology and its evolution under ATs were quantified using three clinical rating scales. Results: A severe symptomatology, high serotonin (5-HT) platelet content, and high or low urinary B could represent risk factors leading to a smaller or delayed response to an AT. Furthermore, the early improvement under ATs was negatively correlated to pretreatment 5-HT platelet content. Conclusions: Determination of 5-HT level could be useful in the choice of an AT.

ResumenEn dos pruebas de memoria de la fuente, los pacientes con esquizofrenia que tienen alucinaciones (n = 30) muestran deterioro comparado con los que no las tienen (n = 31) en el reconocimiento de elementos internos generados por ellos mismos y los atribuyen erróneamente a un acontecimiento externo. No muestran deterioro en el reconocimiento de acontecimientos de dos fuentes internas. Los resultados apoyan un déficit del control de la fuente selectivo en la aparición de las alucinaciones auditivas.

International audience; The abilities to attribute an action to its proper agent and to understand its meaning when it is produced by someone else are basic aspects of human social communication. Several psychiatric syndromes, such as schizophrenia, seem to lead to a dysfunction of the awareness of one's own action as well as of recognition of actions performed by others. Such syndromes offer a framework for studying the determinants of agency, the ability to correctly attribute actions to their veridical source. Thirty normal subjects and 30 schizophrenic patients with and without hallucinations and/or delusional experiences were required to execute simple finger and wrist movements, without direct visual control of their hand. The image of either their own hand or an alien hand executing the same or a different movement was presented on a TV-screen in real time. The task for the subjects was to discriminate whether the hand presented on the screen was their own or not. Hallucinating and deluded schizophrenic patients were more impaired in discriminating their own hand from the alien one than the non-hallucinating ones, and tended to misattribute the alien hand to themselves. Results are discussed according to a model of action control. A tentative description of the mechanisms leading to action consciousness is proposed.

SummaryIn vivo NMR 31p spectroscopy is a non invasive, non ionizing method of exploration of energy and phospholipid metabolism in the brain. This study consisted of comparing 31p spectra in five patients with Senile Dementia of Alzheimer Type (SDAT) with those of four controls of similar ages. Abnormal phosphonionocsters (PME) concentrations, either high or low, were found in the patients, but statistical analysis did not elicit any significant difference relative to controls.

Previous studies have suggested a right hemineglect in schizophrenia, however few assessed possible visual-perceptual implication in this lateralized anomaly. A manual line bisection without (i.e., lines presented on their own) or with a local cueing paradigm (i.e., a number placed at one or both ends of the line) and the Motor-free Visual Perceptual Test-Vertical format (MVPT-V) were used to assess the visual-perceptual abilities of healthy controls, schizophrenia and depressed patients. Whereas healthy controls and depressed patients showed a non-significant leftward bias in manual line bisection, schizophrenia patients bisected significantly to the left of the true centre of the line. Interestingly, the pattern of performances in response to the local cueing paradigm was similar in depressed and schizophrenia patients such that both groups demonstrated a significant change in their bisection performance only in response to a cue placed at the right extremity of the line (control performance was modified by cues at either end of the line). Finally, in the MVPT-V, schizophrenia patients were impaired relative to the other two groups, especially in the spatial working memory and visual closure categories. These results suggest that: 1/a deficit towards the right hemifield, consistent with a mild form of right hemineglect, can be observed in schizophrenia; 2/lateralized anomalies could also be observed in depression using an appropriate tool such as manual line bisection; 3/performances in the MVPT-V suggested that a simple visual-perceptual deficit could not explain the lateralized anomaly observed in the manual line bisection, as it is the case in the hemineglect syndrome.

This study's first objective was to confirm that patients with schizophrenia and their nonmentally ill siblings share the same impaired executive function when compared to healthy control subjects. The second objective was to study the relation between Wisconsin card sorting task (WCST) performance and the persistence and severity of clinical symptoms, as well as different clinical dimensions.Ninety subjects were involved in this study, divided in 3 groups of 30 each: one group of patients with schizophrenia, one group of their siblings, and a control group. Symptom severity was assessed with the Positive and Negative Syndrome Scale (PANSS), and social functioning was measured by the Global functioning scale (GFS). The WCST was administered to all 3 groups.Patients with schizophrenia and their siblings had a significantly lower WCST performance than control subjects. Statistical analysis showed that the patient group had a significantly greater impaired WCST performance than the 2 other groups. Siblings also had a significantly lower performance than the control subjects. Furthermore, no significant relation was found between WCST performance and other variables, including age, gender, education, illness duration, treatment, and different PANSS and GFS scores.Patients with schizophrenia and their nonmentally ill siblings share the same impaired executive function. These findings suggest that WCST performance can be considered a schizophrenia vulnerability marker in siblings of patients with schizophrenia.

In two source memory tests, hallucinating patients with schizophrenia (N = 30), compared to non-hallucinating (N = 31), are impaired in recognizing internal self-generated items and misattribute them to an external event. They are not impaired in recognizing events from two internal sources. Results support a selective source-monitoring deficit in the occurrence of auditory hallucinations.

International audience; We used facial affect labeling and matching tasks to study effects of (1) emotion and (2) identity on facial affect processing in patients with remitted schizophrenia (n=30) compared with healthy controls (n=30). The patients (1) had a specific deficit for labeling facial affects of sadness and anger but not happiness, disgust and fear; they (2) performed as well as controls in matching facial affects in one face but were impaired in matching facial affects in two different faces. The patients' impairment in facial affect processing may be emotion-specific. The effects of identity on facial affect processing are discussed in the light of several hypotheses (a deficit of context processing, a global-local processing impairment or a selective attention deficit), and may be related to frontal, prefrontal or amygdala dysfunctions.

Background Almost a quarter of patients with schizophrenia present with resistant auditory verbal hallucinations (AVH), a phenomenon that may relate to activation of brain areas underlying speech perception. Repetitive transcranial magnetic stimulation (rTMS) at 1 Hz reduces cortical activation, and recent results have shown that 1-Hz left temporoparietal rTMS may reduce AVH. The aim of this study was to replicate recent data and investigate whether low-frequency rTMS with a high total stimulation number delivered in a shorter 5-day block produces similar benefit. Methods Ten right-handed schizophrenia patients with resistant AVH received 5 days of active rTMS and 5 days of sham rTMS (2,000 stimulations per day at 90% of motor threshold) over the left temporoparietal cortex in a double-blind crossover design. The two weeks of stimulation were separated by a 1-week washout period. Results AVH were robustly improved (56%) by 5 days active rTMS, whereas no variation was observed after sham. Seven patients were responders to active treatment, five of whom maintained improvement for at least 2 months. Conclusions These data confirm the efficiency of low-frequency rTMS applied to the left temporoparietal cortex, compared with sham stimulation, in reducing resistant AVH. This improvement can be obtained in only 5 days without serious initial adverse events.

Schizotypal personality disorder is considered as a marquer of schizophrenia proneness. In opposition at other self report measures of schizotypal personality disorder, the "Schizotypal Personality Questionnaire" (SPQ) developed by Raine, assesses all nine features of this disorder. The aims of this study is to present the validation on the French version of the SPQ on Tunisian student sample. It consists on a transversal study directed from April to may 2000. The sample was compound of 198 healthy and voluntary students from the medical university of Monastir. The questionnaire has a high internal reliability (SPQ total: Cronbach's alpha = 0.91; SPQ nine subscales: Cronbach's alpha = 0.59 to 0.74). The ten percent high and low cutoffs for the top and the bottom ten percents of SPQ scores were respectively 42/74 and 10/74 for women, 42/74 and 7/74 for men and 42/74 et 9/74 for total sample. A principal component analysis revealed two main factors or dimensions of schizotypal personality disorder in our sample: positive dimension (made up of ideas of reference, magical thinking and unusual perceptual experiences) and a negative dimension (made up of no close friends, social anxiety and blunted affect). Our results were closely similar to these found by Raine and, other validation studies with SPQ. However some sociocultural aspects were found in our study.

Left temporoparietal repetitive transcranial magnetic stimulation (rTMS) reportedly diminishes verbal hallucinations. A 21-year-old schizophrenic man, who had killed his mother in the belief that she was a demon, failed to respond to combined treatment with a variety of antipsychotic agents. His persistent hallucinations consisted of two voices (God and the Devil). As an adjunct to continued antipsychotic medication, the patient received a course of rTMS: 10 sessions of 1-Hz stimulations near Wernicke's area. After rTMS, the patient's hallucinations grew less intrusive and he no longer required isolation. Although the improvement could be a delayed effect of medication, further trials of rTMS in cases of this type appear justified.

The InterSePT Scale for Suicidal Thinking (ISST) is a 12-item instrument for the assessment of current suicidal ideation in patients with schizophrenia and schizoaffective disorders. We report the psychometric characteristics of this new scale based on two studies.In Study 1, 22 inpatients with schizophrenia and schizoaffective disorders, who had recently attempted suicide or engaged in suicidal ideation, were rated by three trained independent raters to examine interrater reliability. In Study 2, a total of 980 patients with schizophrenia or schizoaffective disorder with a history of suicidal ideation in the past 36 months were enrolled in a 2-year industry-sponsored suicide prevention study. At baseline, these patients were administered the ISST and the Clinical Global Impression Scale for Severity of Suicidality (CGI-SS) by the Principal Investigator (PI) and by a blinded rater (BR), who also administered the Positive and Negative Symptom Scale (PANSS), the Calgary Depression Scale (CDS), and the Scale of Functioning (SOF). Indices of internal reliability, construct and discriminant validity were examined.The intraclass correlation coefficient (ICC) for the total ISST score for the 22 subjects in Study 1 was 0.90 and mean weighted item kappa coefficients ranged from 0.66 to 0.92. In Study 2, internal reliability (Cronbach alpha) was high, ranging from 0.86 to 0.89 for the individual items, and the overall Cronbach alpha coefficient for all items was 0.88. The ISST (PI) total score was highly correlated with the CGI-SS by the blind rater (r = 0.61, p0.0001). ISST total scores significantly differentiated the different levels of CGI-SS (F = 519.2; p0.0001). Results of construct and discriminant validity analyses are also presented.The ISST is a reliable and valid instrument for the assessment of current suicidal thinking in patients with schizophrenia and schizoaffective disorder by both clinicians and researchers.

A double-blind, multinational study was conducted to compare the efficacy and safety of fluvoxamine and fluoxetine in outpatients with major depressive episode; 184 patients were randomised to fluvoxamine (100 mg/day) or fluoxetine (20 mg/day) for 6 weeks. Both drugs were effective and there were no statistically significant differences between them in the area under the curve of change from baseline in the Hamilton depression rating scale (HAMD) total score. However, the percentage of HAMD responders (>or= 50% decrease in HAMD total score) at week 2, the clinical global improvement severity of illness score at week 2 and the depression subscale of the irritability, depression and anxiety scale at weeks 1, 2 and 4, all showed significant advantages for fluvoxamine. During the last 2 weeks, fluvoxamine was significantly more effective in improving the HAMD sleep disturbance scale. Both drugs were well tolerated and there were no marked differences in their side effect profiles which were typical of SSRIs. Fluvoxamine and fluoxetine have similar efficacy and safety profiles in the treatment of major depressive episode; the findings of this study indicate that fluvoxamine may have a faster onset of action with respect to resolution of depressive symptoms and result in a better improvement in sleep quality.

Depressive symptoms frequently occur during the course of schizophrenia. This study explored the relationships between the schizophrenia symptomatology and three measures of depression. Eighty-one drug-free inpatients with acute schizophrenia were assessed with the positive and negative syndrome scale (PANSS), the Calgary depression scale for schizophrenia (CDSS), and the Hamilton rating scale for depression (HAM-D). The depressive subscale of PANSS (PANSS-D) was also considered as a third scale for measuring depression. A principal component analysis (PCA) of PANSS items identified five clinical dimensions of schizophrenia called 'negative', 'positive', 'anxio-depressive', 'excitement', and 'disorganisation and others'. Our anxio-depressive dimension (PANSS-ad) was strictly identical with the PANSS-D. Scores on CDSS and HAM-D were highly inter-correlated and highly correlated with the PANSS-ad. Furthermore, while scores on CDSS were correlated only with this dimension, scores at HAM-D were also positively correlated with the negative dimension and negatively correlated with the excitement dimension. In conclusion, our results suggest that PANSS evaluation itself may be sufficient to give a correct approximation of the depression in patients with schizophrenia. However, depression scales are of course needed to assess specifically depressive symptoms in patients with schizophrenia; hence, the CDSS could be a more specific instrument than HAM-D.

Patients with schizophrenia demonstrate impairments indicative of an inability to accurately monitor internally generated images. Motor imagery measures the ability to generate internal images of intended but not executed motor movements. Ten patients with schizophrenia completed actual and imagined versions of a pointing task with a well defined speed-accuracy trade-off function. For controls, movement time increases as target size decreases for both actual and imagined movements. Despite showing the expected speed-accuracy trade-off for actual movements, the imagined movements of schizophrenics showed no reliable relationship to target size. This was true for each patient and appeared to be independent of symptom profile. These results suggest that patients with schizophrenia are unable to generate accurate internal images of their own motor movements.

The literature suggests that cannabis use and schizotypal traits both constitute risk factors for the later development of schizophrenia. However, their interrelationships remain to be evaluated. The present study examined the association between cannabis use and schizotypal traits in 232 healthy students who ranged in age from 18 to 25 years. All the students had completed the Schizotypal Personality Questionnaire and four of the Chapman Psychosis Proneness Scales: the Magical Ideation Scale; the Perceptual Aberration Scale; the Revised Physical Anhedonia Scale; and the Revised Social Anhedonia Scale. Subjects were divided into three groups according to cannabis use typology: those who had never used cannabis, those who were past or occasional users, and those who were regular users. Higher scores on the Schizotypal Personality Questionnaire and the Magical Ideation Scale characterized the regular and past or occasional users compared with those who had never used cannabis. The co-occurrence of cannabis use and schizotypal traits appeared to be independent of anxiety and depression dimensions. These data suggest that cannabis use and schizotypal traits have to be jointly considered in further longitudinal studies of schizophrenia risk factors.

International audience; It has been proposed that an impairment in gaze determination is responsible for the paranoid symptoms reported in schizophrenia. To address this, we examined the gaze discrimination system in schizophrenia. Thirty-two patients suffering from schizophrenia (20 patients with persecutory delusions and 12 patients without such delusions) were compared to 32 control subjects on two specific tasks. In the first task, the subjects had to determine whether 130 portraits were looking right or left. In the second task the subjects were asked to determine whether or not 130 portraits were looking at them. The absolute threshold of difference used to investigate the influence of instruction on gaze discrimination did not show any difference between patients with schizophrenia, whatever paranoid or not, and control subjects. Paranoid patients, as well as controls, displayed a significantly finer discrimination threshold in the right vs. left judgment than in the self vs. non-self judgment. Subjects with schizophrenia were able to discriminate gaze direction in the two tasks, but they took significantly more time in the task requiring to determine the presence or the absence of a mutual gaze contact than in the other one, whereas controls took the same duration to elicit both tasks. These data are consistent with those reporting that perceptual abilities are spared in schizophrenia while delusions are related to an impairment of a higher level of analysis.

This study was aimed, first, at detecting neuropsychological markers that assess vulnerability to schizophrenia in siblings of patients with schizophrenia, and second, at exploring possible relationships between markers. For these purposes, performances were assessed in 18 clinically stabilized patients with schizophrenia, 18 of their unaffected full siblings, and 15 controls on attentional abilities (the Degraded Stimuli-Continuous Performance Task [DS-CPT] and the Span of Apprehension [SOA] task) and on executive functions (the Wisconsin Card Sorting Test [WCST]). Both patients and siblings were impaired on the three tasks, leading to the conclusion that these poor performances may represent markers of genetic vulnerability to schizophrenia. Furthermore, significant relationships were found between DS-CPT and WCST performance in patients only, suggesting a possible implication of prefrontal brain areas for the two tasks. In spite of the lack of similar relationships between DS-CPT and WCST in siblings, this raises the question of a putative role of prefrontal areas in vulnerability to schizophrenia.

The nature of saccadic abnormalities in schizophrenia was investigated in three different paradigms: (1) the visually guided saccade; (2) the antisaccade; and (3) the remembered saccade paradigm. Subjects comprised 14 schizophrenic patients and 14 normal volunteers. Deficits in the schizophrenic group were observed in the antisaccade and remembered saccade tasks, both of which were characterized by increased latency and reduced gain. Moreover, in the antisaccade task, schizophrenic patients showed an increased number of errors compared with control subjects. Saccadic abnormalities in the patients were correlated with impaired performance on the Wisconsin Card Sorting Test. These data suggest that schizophrenic patients have difficulty in inhibiting reflexive saccades and in producing voluntary saccades. The implications of these findings for a prefrontal cortex dysfunction involved in oculomotor control in schizophrenia are discussed.

The aim of this study was to investigate whether non-psychotic relatives of schizophrenic probands have deficits in sustained attention as measured by the Continuous Performance Test, Identical Pairs version (CPT-IP) and whether such deficits are associated with negative schizotypal personality disorders. The study subjects were 23 schizophrenic probands, 45 of their first-degree relatives and 36 normal controls. For each subject, attention was assessed during five conditions (2 standard, 2 slow, 1 easy) of visual stimuli (numbers and shapes). Schizotypy status was determined with the physical anhedonia and social anhedonia scales of Chapman et al. (Chapman, L.J., Chapman, J.P., Raulin, M.L., 1976. Scales for physical and social anhedonia. Journal of Abnormal Psychology 42, 374-382). The CPT-IP sensitive index d' in the standard shape condition was significantly lower in schizophrenics and in their relatives than in controls. For all d' values, the percentage of impaired first-degree relatives was at an intermediate level between patients and control individuals. Furthermore, the schizophrenic probands made more random errors in the standard and in the slow number conditions than the other two groups. None of the schizotypy measures correlated with the CPT-IP deficits. These results suggest that spatial sustained attention deficit may be a vulnerability marker for schizophrenia; however, this deficit and the negative dimension of schizotypal personality disorders may be distinct traits.

The present study was aimed at investigating whether schizophrenic patients are impaired in monitoring their own speech. In particular, we attempted to assess their ability to discriminate between overt and covert speech in a reading task, in order to verify whether they can correctly recollect the modality in which an internally generated action is produced. Subjects were asked to read either silently or aloud, items from a list of words. After a delay of 5 min, they were required to indicate in a new list which words had been read previously (either silently or overtly), or had never been presented during the reading task. With respect to normal controls, schizophrenic patients showed a significant bias to report that they had read aloud words which they had actually read silently, or which were absent during the reading task. The results are discussed in relation to recent neuroimaging studies on inner and overt speech in hallucinating schizophrenic patients. Our data favour the hypothesis that the inability to correctly discriminate between inner and overt speech may play a role in the onset of schizophrenic hallucinations.

In this study, we investigated the ability of schizophrenic patients to produce predictive saccades in response to a visual target moving with predictable timing and location. The performance of visually guided saccades and predictive saccades (gain and latency) were analyzed in a group of 12 schizophrenic patients as compared with a group of ten control subjects. Our main finding was an enhancement of the predictive tracking ability in schizophrenics. In particular, the predictive tracking built-up and became installed as a steady pattern of highly anticipatory saccades (in terms of percentage of negative latency saccades) much faster in the schizophrenic group than in the control group. These data are discussed in terms of an involvement of the fronto-striatal system in this specific enhancement of predictive saccade behavior in schizophrenia.

Interpersonal communication is largely dependent on interpretation of facial expression and emotion. Difficulties in face processing, and more specifically in gaze discrimination, have been described in schizophrenic patients. According to Baron-Cohen (Mindblindness. M.I.T. Press, Cambridge, MA, 1995), gaze discrimination relies on the functioning of a specific cognitive module, the Eye Direction Detector (EDD). It has been proposed [Rosse et al. (1994) Gaze discrimination in patients with schizophrenia: preliminary report. American Journal of Psychiatry 151, 919-921] that an impairment in gaze discrimination is present in schizophrenia, and plays a fundamental role in inducing the paranoid symptoms reported by many patients. However, in the previous studies, gaze direction detection and interpretation of gaze have never been completely dissociated. The present experiment attempts to test the schizophrenics' skill in a simple gaze direction detection task. A series of photographic portraits of models looking at different directions have been presented to 22 schizophrenic patients and 36 control subjects. For each portrait subjects were asked to determine whether gaze was directed to the right or to the left by pressing a keyboard key. A forced choice paradigm was used. No differences were reported between schizophrenic patients and control subjects. That is, in the present paradigm, schizophrenic patients did not show any specific impairment in detecting the direction of gaze of the portraits. The results are discussed according to the notion that a dissociation is present in schizophrenia between implicit and explicit processes. The present case illustrates how the more automatic elementary functions, such as the detection of gaze direction, may be spared in schizophrenic patients, whereas explicit cognitive functions are likely more affected.