Search

This article is part of the ISPS (International Society for the Psychological Treatment of the Schizophrenias and other Psychoses) task force report on the PORT (Patients Outcome Research Team) recommendations for treatment of schizophrenia. It reviews psychological treatment approaches in psychosis to date and assesses recent trends. The most influential therapies have been psychoanalytic/psychodynamic, cognitive behavioral (CBT), and supportive therapy.

In this study we addressed the question of the extent to which irregularities in genetic diversity might separate patients with major psychiatric disorders from healthy controls. Genetic diversity was quantified per gene through multidimensional “gene vectors” assembled from 4-8 polymorphic SNPs located within each of 100 candidate genes. The number of different genotypic patterns observed per gene was called the gene’s “diversity index”. Our sample was comprised of 1,698 subjects from Central Europe (1,431 psychiatric patients, 267 healthy controls), all genotyped for 549 specifically selected SNPs. The evaluation of the diversity indices of the 100 candidate genes resulted in a mean value of 109.4±82.8, ranging from 18 to 476. Highly significant deviations from “normal” diversity values were detected for (1) major depression (n=596): a significant reduction (p

Background Parents and their children often disagree on the existence and severity of psychopathological symptoms, especially in major depressive disorder (MDD). Discrepant estimations pose a problem for the validity of diagnoses and illness severity with major implications for treatment evaluation. Methods 118 adolescents aged 13–18 years and their parents were interviewed and their reports were compared regarding the presence of a MDD diagnosis. In addition, severity ratings of depression symptoms reported in the Children's Depression Rating Scale-Revised (CDRS-R) were compared between parents and their offspring using multivariate analyses and polynomial regressions. The association between borderline features, functional impairment, and treatment history variables with parent-child agreement was assessed. Results In 38% of the cases, parents and adolescents agreed on DSM-IV diagnostic MDD criteria, while in 53%, only the adolescent endorsed criteria for a MDD. A MDD that was endorsed by parents and adolescents was characterized by higher depression severity, higher number of previous treatments, and higher functional impairment. Using a polynomial approach, neither age nor borderline tendencies were associated with agreement. Limitations We did not differentiate between mother's versus father's reports and borderline features were assessed by self-report only. Conclusions Adolescents and their parents gave differing reports of the existence and severity of depressive symptoms. The high discrepancy levels combined with the uncertainty of previously published findings due to methodological challenges are concerning. Clinicians and researchers need to consider discrepancies in agreement in relation to diagnosis and illness severity in the context of their clinical and research decisions.

Introduction Recent research suggests that traumatized patients are characterized by disrupted resting‐state functional connectivity. We examined whether neural networks involved in resting‐state change over the course of a phase‐oriented inpatient treatment for complex traumatized and dissociative disorder patients. We also investigated associations between these network alterations and clinical symptoms and emotion regulation skills. Methods Pre‐ and post‐treatment, electroencephalography (EEG) was recorded during resting‐state in patients (n = 23) with a complex dissociative disorder (CDD) or complex posttraumatic stress disorder (cPTSD). Patients also completed clinical and emotion regulation questionnaires. To reduce variance in the collected data, patients were exclusively tested as one prototypical dissociative part referred to as Apparently Normal Part (ANP). Functional network connectivity was examined and compared with a matched healthy control group (n = 37), also measured twice. Results Prior to treatment and compared with controls, patients had a significantly lower functional connectivity strength within eyes‐open and eyes‐closed resting‐state networks in the theta and alpha frequency band. Following treatment, functional connectivity strength within these networks was comparable to the control group and comprised areas belonging to the default mode network (DMN) and prefrontal as well as anterior cingulate control regions. Treatment‐related network normalizations in the theta frequency band were associated with a self‐reported increase in the use of cognitive reappraisal strategies and reduction in emotion regulation difficulties. Conclusion Phase‐oriented trauma treatment can strengthen resting‐state network connectivity and can increase the capacity of complex traumatized and dissociative patients as ANP to handle emotional challenges effectively., We examined whether neural networks involved in resting‐state change over the course of an inpatient treatment for complex traumatized and dissociative disorder patients. Prior to treatment and compared with matched‐healthy controls, patients revealed a significantly lower functional network connectivity between regions belonging to the DMN and prefrontal and anterior cingulate areas. Trauma treatment normalized patients' networks, and these changes were associated with an enhanced emotion regulation capacity.

In dem Beitrag «Mendelismus bei Psychosen, speziell bei der Schizophrenie» setzt sich Paul Eugen Bleuler (1857–1939) mit Rudins Schrift «Zur Vererbung und Neuentstehung der Dementia praecox» auseinander.

In adults, anxious depression has been identified as a more severe form of major depressive disorder (MDD), associated with higher depression severity, more suicidal ideation and worse treatment outcome. Research in pediatric depression, however, has been sparse. 126 children and adolescents aged 8-18 years with a primary diagnosis of MDD were categorized into a MDD-only group and an anxious depression group based on clinically elevated scores on the Beck Anxiety Inventory. One-third of the sample was classified as having anxious depression with females being overrepresented in the anxious depressed compared to the MDD-only group. 42.2% of the anxious depressed youth met diagnostic criteria for a comorbid anxiety disorder. Anxious depressed youth were more likely to suffer recurrent depressive episodes, showed higher depression severity and a unique pattern of depressive symptoms characterized by more severe sleep problems, more somatic complaints, more severely depressed mood and more frequent suicidal ideations. Scores on a suicidal ideation scale were increased even when controlling for overall depression severity. However, when comparing depressed patients with and without comorbid anxiety disorders, no differences in depression severity, symptom patterns or suicidal ideations were observed. The results indicate that high anxiety levels in depressed youth are clinically relevant, and given the increase in suicidal ideation, anxiety symptoms during depressive episodes should routinely be screened in clinical practice even in the absence of a fully formed comorbid anxiety disorder.

Objectives: We investigated whether patients with complex interpersonal trauma engage neural networks that are commonly activated during cognitive reappraisal and responding naturally to affect-laden images. In this naturalistic study, we examined whether trauma treatment not only reduces symptoms but also changes neural networks involved in emotional control. Methods: Before and after eight weeks of phase-oriented inpatient trauma treatment, patients (n = 28) with complex posttraumatic stress disorder (cPTSD) and complex dissociative disorders (CDD) performed a cognitive reappraisal task while electroencephalography (EEG) was registered. Patients were measured as a prototypical dissociative part that aims to fulfill daily life goals while avoiding traumatic memories and associated dissociative parts. Matched healthy controls (n = 38) were measured twice as well. We examined task-related functional connectivity and assessed self-reports of clinical symptoms and emotion regulation skills. Results: Prior to treatment and compared to controls, patients showed hypoconnectivity within neural networks involved in emotional downregulation while reappraising affect-eliciting pictures as well as viewing neutral and affect-eliciting pictures. Following treatment, connectivity became normalized in these networks comprising regions associated with cognitive control and memory. Additionally, patients showed a treatment-related reduction of negative but not of positive dissociative symptoms. Conclusions: This is the first study demonstrating that trauma-focused treatment was associated with favorable changes in neural networks involved in emotional control. Emotional overregulation manifesting as negative dissociative symptoms was reduced but not emotional underregulation, manifesting as positive dissociative symptoms. Keywords: Complex trauma, Dissociation, Electroencephalography, Functional brain network, Network-based statistic, Trauma treatment, Emotion regulation

Lino Castle - An interior design concept to improve inpatient treatment in child and adolescent psychiatry Abstract. Only very few data exist concerning hospital architecture in psychiatry/child and adolescent psychiatry. Previous data suggest that architectural improvements do reduce the application of coercive measures as well as reducing aggressive behavior, endangerment of self and others, and provoking changes in the kind and frequency of medication. In order to improve the overall hospital environment of inpatient treatment, the Center for Child and Adolescent Psychiatry and Psychotherapy of Clienia Littenheid AG developed a spatial and communication concept named "Lino Castle." In cooperation with patients, their parents as well as members of the multidisciplinary team, we implemented a concept that serves to ameliorate the recovery process of the children and adolescents. "Lino Castle" is deeply rooted in the history of the local village and aims to allow patients to feel at ease for the duration of their stay. It hosts seven characters that serve as guardians and protectors of the individual wards and represent various types of disorders and emotional states. The respective architectural concept grew out of the storyline of "Lino Castle" and combines colors, forms, materials, graphics, and furniture to ensure an environment conducive to healing and reduced anxiety. With the implementation of "Lino Castle," we observed that the number of admissions and hospital occupancy increased significantly, whereas the length of stay and the ratio of involuntary admissions in closed wards decreased. We presume that this turn of events is due to higher commitment, acceptance, and less aggressive behavior in the patients, and to higher motivation and work satisfaction in the staff.Zusammenfassung. Es gibt nur wenige Daten über Krankenhausarchitektur in psychiatrischen Kliniken. Die bisherigen Daten weisen darauf hin, dass architektonische Verbesserungen die Anwendung von Zwangsmaßnahmen verringern und zu einer Verminderung von aggressivem Verhalten, Selbst- und Fremdgefährdung und einer Veränderung in der Art und Häufigkeit einer Medikation führen. Mit dem Ziel, die Krankenhausumgebung der stationären Behandlung zu verbessern, hat das Zentrum für Kinder- und Jugendpsychiatrie und -psychotherapie der Clienia Littenheid AG das Raum- und Kommunikationskonzept „Burg Lino“ entwickelt. Gemeinsam mit den Patientinnen und Patienten, ihren Eltern und den Mitarbeitenden des multidisziplinären Teams entstand ein Konzept, das den Genesungsprozess von Kindern und Jugendlichen unterstützen und ihnen den stationären Aufenthalt erleichtern soll. Das architektonische Raumkonzept leitet sich aus der Geschichte von „Burg Lino“ ab und vereinigt Farben, Formen, Materialien, Grafiken und Möbel, um einen Genesungsprozess anzustoßen und eine angstreduzierende Umgebung zu schaffen. Mit Umsetzung von „Burg Lino“ stellten wir eine signifikante Zunahme stationärer Aufnahmen und der Belegung fest. Die Verweildauern und der Anteil der Behandlungstage unfreiwilliger Aufnahmen im fakultativ geschlossenen Bereich nahmen hingegen ab. Wir vermuten, dass diese Veränderungen Folge eines höheren Commitments, einer höheren Akzeptanz und geringeren Aggressivität bei den Patienten sowie einer höheren Motivation und Zufriedenheit bei den Mitarbeitenden ist.

Interview mit Prof. Dr. med. Anita Riecher-Rossler anlasslich der Verleihung des Constance Pascale – Helen Boyle Prize durch die European Psychiatric Association (EPA).

Suicide is a worldwide phenomenon. This review is based on a literature search of the World Health Organization (WHO) databases and PubMed. According to the WHO, in 2015, about 800,000 suicides were documented worldwide, and globally 78% of all completed suicides occur in low- and middle-income countries. Overall, suicides account for 1.4% of premature deaths worldwide. Differences arise between regions and countries with respect to the age, gender, and socioeconomic status of the individual and the respective country, method of suicide, and access to health care. During the second and third decades of life, suicide is the second leading cause of death. Completed suicides are three times more common in males than females; for suicide attempts, an inverse ratio can be found. Suicide attempts are up to 30 times more common compared to suicides; they are however important predictors of repeated attempts as well as completed suicides. Overall, suicide rates vary among the sexes and across lifetimes, whereas methods differ according to countries. The most commonly used methods are hanging, self-poisoning with pesticides, and use of firearms. The majority of suicides worldwide are related to psychiatric diseases. Among those, depression, substance use, and psychosis constitute the most relevant risk factors, but also anxiety, personality-, eating- and trauma-related disorders as well as organic mental disorders significantly add to unnatural causes of death compared to the general population. Overall, the matter at hand is relatively complex and a significant amount of underreporting is likely to be present. Nevertheless, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is reported by the media. Suicidality represents a major societal and health care problem; it thus should be given a high priority in many realms.

Only very few data exist concerning hospital architecture in psychiatry/child and adolescent psychiatry. Previous data suggest that architectural improvements do reduce the application of coercive measures as well as reducing aggressive behavior, endangerment of self and others, and provoking changes in the kind and frequency of medication. In order to improve the overall hospital environment of inpatient treatment, the Center for Child and Adolescent Psychiatry and Psychotherapy of Clienia Littenheid AG developed a spatial and communication concept named “Lino Castle.” In cooperation with patients, their parents as well as members of the multidisciplinary team, we implemented a concept that serves to ameliorate the recovery process of the children and adolescents. “Lino Castle” is deeply rooted in the history of the local village and aims to allow patients to feel at ease for the duration of their stay. It hosts seven characters that serve as guardians and protectors of the individual wards and represent various types of disorders and emotional states. The respective architectural concept grew out of the storyline of “Lino Castle” and combines colors, forms, materials, graphics, and furniture to ensure an environment conducive to healing and reduced anxiety. With the implementation of “Lino Castle,” we observed that the number of admissions and hospital occupancy increased significantly, whereas the length of stay and the ratio of involuntary admissions in closed wards decreased. We presume that this turn of events is due to higher commitment, acceptance, and less aggressive behavior in the patients, and to higher motivation and work satisfaction in the staff. Es gibt nur wenige Daten über Krankenhausarchitektur in psychiatrischen Kliniken. Die bisherigen Daten weisen darauf hin, dass architektonische Verbesserungen die Anwendung von Zwangsmaßnahmen verringern und zu einer Verminderung von aggressivem Verhalten, Selbst- und Fremdgefährdung und einer Veränderung in der Art und Häufigkeit einer Medikation führen. Mit dem Ziel, die Krankenhausumgebung der stationären Behandlung zu verbessern, hat das Zentrum für Kinder- und Jugendpsychiatrie und -psychotherapie der Clienia Littenheid AG das Raum- und Kommunikationskonzept „Burg Lino“ entwickelt. Gemeinsam mit den Patientinnen und Patienten, ihren Eltern und den Mitarbeitenden des multidisziplinären Teams entstand ein Konzept, das den Genesungsprozess von Kindern und Jugendlichen unterstützen und ihnen den stationären Aufenthalt erleichtern soll. Das architektonische Raumkonzept leitet sich aus der Geschichte von „Burg Lino“ ab und vereinigt Farben, Formen, Materialien, Grafiken und Möbel, um einen Genesungsprozess anzustoßen und eine angstreduzierende Umgebung zu schaffen. Mit Umsetzung von „Burg Lino“ stellten wir eine signifikante Zunahme stationärer Aufnahmen und der Belegung fest. Die Verweildauern und der Anteil der Behandlungstage unfreiwilliger Aufnahmen im fakultativ geschlossenen Bereich nahmen hingegen ab. Wir vermuten, dass diese Veränderungen Folge eines höheren Commitments, einer höheren Akzeptanz und geringeren Aggressivität bei den Patienten sowie einer höheren Motivation und Zufriedenheit bei den Mitarbeitenden ist.

Zusammenfassung. Suizidversuche und Suizide finden üblicherweise im Rahmen psychischer Erkrankungen statt. Als besonders gefährdet gelten Menschen mit Depressionen, Psychosen, Abhängigkeitserkrankungen, Persönlichkeits- und Traumafolgestörungen. Oft suchen sie vor einer Handlung Kontakt zum Gesundheitswesen. Wichtig ist daher, das Augenmerk bei bestimmten Konstellationen auf die mögliche Gefährdung zu richten und diese aktiv anzusprechen. Diese präventive Tätigkeit findet in der Grundversorgung statt. Modelle und Hilfsmittel zur Einschätzung von Suizidalität, deren Einsatz sinnvoll sein kann, werden vorgestellt. Von übergreifender Bedeutung sind Empathie, die knappe Ressource Zeit und die situationsabhängige Über- oder Einweisung an Fachkollegen/innen oder Kliniken.

Chronisch Erkrankte müssen sich mit zahlreichen Themen auseinandersetzen, die Krankheit selbst ist nur eines davon. Im Umgang erfordert dies einen Paradigmenwechsel im Gesundheitswesen: Es sind andere Haltungen und Interventionen als in der Akutmedizin gefordert. Krankheitsbewältigung ist kein einmaliger, endender Prozess, sondern durchläuft diverse Phasen, die sich wiederholen können (trajectory model). Somatisch Tätige unterstützen durch Kenntnis der allgemeinen und spezifischen Belastungsfaktoren (körperliche, emotionale, soziale Symptome/Einschränkungen), durch emotionale Zuwendung und Empathie, durch Respektieren des Individuums als Experten der eigenen Erkrankung sowie durch Aktivierung von Ressourcen und Selbstwirksamkeit. Wissen und Erfahrung der Behandler bestimmen die Grenzen im Umgang mit chronisch Erkrankten. Diese gilt es zu erkennen, um eigener Überforderung vorzubeugen. Hilfreich ist, Fachärzte/innen für Psychiatrie und Psychotherapie, Supervisionen oder Balintgruppen in Anspruch zu nehmen.

Background Neurological soft signs (NSS) represent minor neurological signs which indicate non-specific cerebral dysfunction. Numerous studies have confirmed their presence in schizophrenia across all stages of the disease. NSS have been looked at as an endophenotype or a trait phenomenon for many decades. However, during the past years studies increasingly reported on fluctuations of the NSS scores. To shade further light on the question whether NSS represent a state or a trait component or both, a review of longitudinal studies on schizophrenia patients was performed, because only measurements at two or more points in time can answer the question at hand. Methods A search of studies which had assessed NSS in adult schizophrenia patients and included at least one follow-up examination was undertaken. Studies which had been published between January 1966 and June 2017 and listed in relevant databases were included. Due to the fact, that ongoing brain maturation lasts until adulthood and is paralleled by a loss of those NSS which are present in childhood, studies on teenagers were excluded. Results Twenty-nine follow-up studies were identified which overall used well-known instruments for the investigation of NSS. Patients were at different disease stages. All expressed abnormally increased NSS, however to different extents. An NSS reduction during the course was detected in most first episode patients and those with a remitting course whereas chronically ill patients exhibited stable or increasing NSS scores. The change over time could for the most part be attributed to changes in the motor system subscales and to a lesser amount to sensory integration scales. As opposed to the earlier notion that medication evokes or worsens NSS, studies largely agreed on a positive interrelation between medication response and improvement of NSS. The type of antipsychotic was of small importance and when side-effects were commented on there was a weak relationship with NSS. On the other hand, studies gave some hints at relationships between NSS and symptoms, i.e. negative and cognitive symptoms. Discussion The reviewed studies confirmed the presence of abnormal, i.e. elevated NSS in patients diagnosed with schizophrenia. Studies disagreed on the amount of abnormalities in NSS. However, subgroups emerged with either stable or fluctuating properties of NSS. The latter speaks very much in favor of a state-trait dichotomy being present in NSS and thus challenges the view that NSS depict an endophenotype.

Neurological soft signs (NSS) - i.e. discrete deficits of sensory and motor function - are frequently found in schizophrenia and vary with psychopathological symptoms in the course of the disorder. Hence, persistence of NSS herald chronicity in first episode schizophrenia. To investigate the cerebral correlates of persisting NSS over time, 20 patients with first-episode schizophrenia underwent T1 magnetic resonance imaging (MRI) after remission of the acute symptoms and after 1 year of follow-up. NSS were rated on the Heidelberg Scale. Twenty age- and gender-matched control subjects were scanned once. Longitudinal gray matter (GM) changes were measured by using tensor based morphometry (TBM). At follow-up, patients demonstrated significantly decreased NSS scores. For further analysis, the patient sample was dichotomized into patients with decreasing NSS scores and patients with persistently increased scores, respectively. While patients with decreasing NSS exhibited only localized changes within the left frontal lobe, cerebellum, and cingulate gyrus, patients with persistently increased scores showed pronounced GM reductions of the sub-lobar claustrum, cingulate gyrus, cerebellum, frontal lobe, and middle frontal gyrus. Results were confirmed after correction for multiple comparisons. These findings support the hypothesis that persisting NSS refer to progressive cerebral changes in first-episode schizophrenia. Since NSS can be assessed in any clinical environment, this association facilitates the prospect that NSS can help to establish prognosis in first-episode patients with schizophrenia.

The acceleration of aluminum particles with a 5μm diameter in the flow field behind an incident shock wave was investigated experimentally in a 10-m long and 70 mm inner diameter shock tube. By means of instantaneous Laser Doppler Velocimetry (LDV) the velocity of the particles was observed directly. The light scattered by the moving particles is Doppler shifted and sent to the laser Doppler velocimeter. The velocimeter essentially consists of a phase-stabilized Michelson interferometer used as a sensitive spectrometer. An electro-optical circuit ensures the phase stabilization that results in a voltage signal independent of the scattered light intensity and proportional to the mean velocity of the particles at the measurement point. Because of the very short response time (1μs) of the LDV system used here, the latter gives a continuous real-time signal of the particle acceleration. To avoid particle oxidation the particles were accelerated by a high-speed nitrogen gas flow. From the measured velocity the dimensionless drag coefficient was calculated. The drag coefficient is related to the fluid dynamic force exerted by the gas on the particles. The experimental data were compared to theoretical models from the literature. A significant deviation between the model and the experimental data was observed. This deviation is supposed to be induced by the shock wave, which hits the particles and breaks them into pieces of a smaller diameter. Further experiments will be carried out in the future to check the size distribution of the particles after the shock has gone past them.

BackgroundAlthough minor motor and sensory deficits, or neurological soft signs (NSS), are a well-established finding in schizophrenia, the cerebral changes underlying these signs are only partly understood. We therefore investigated the cerebral correlates of NSS by using magnetic resonance imaging (MRI) in patients with schizophrenia and healthy controls.MethodForty-two patients, all receiving atypical neuroleptics, with first-episode schizophrenia or schizophreniform disorder and 22 healthy controls matched for age and gender were included. NSS were examined on the Heidelberg Scale after remission of the acute symptoms before discharge and correlated to density values by using optimized voxel-based morphometry (VBM).ResultsNSS scores were significantly higher in patients than healthy controls. Within the patient group NSS were significantly associated with reduced grey or white-matter densities in the pre- and post-central gyrus, pre-motor area, middle and inferior frontal gyri, cerebellum, caudate nucleus and thalamus. These associations did not apply for the control group, in whom only the associations between NSS and reduced frontal gyri densities could be confirmed.ConclusionsThe pattern of cerebral changes associated with NSS clearly supports the model of ‘cognitive dysmetria’ with a disrupted cortico-cerebellar-thalamic-cortical circuit in schizophrenia. The variety of sites may correspond with the clinical diversity of NSS, which comprises both motor and sensory signs, and with the putative heterogeneity of the pathogenetic changes involved. That the respective associations did not apply for the healthy control group indicates that NSS in patients and controls refer to different pathogenetic factors.

The great majority of suicides and suicide attempts are related to mental illness. Special risk has been attributed to depression, psychosis, substance use, personality, and trauma-related disorders. Many affected persons seek medical attention prior to taking action. Primary care therefor plays an outstanding role in suicide prevention. Doctors should pay attention to potential risk constellations and actively address the issue. This paper presents possibly helpful models and instruments for everyday use. Most importantly, however, professionals’ empathy and time are required as well as appropriate decisions concerning a referral to a psychiatrist or psychiatric inpatient treatment.

The expression and perception of expressed emotion (EE) in schizophrenic patients and their relatives are likely to differ. The presented exploratory study compares the two views. EE in relatives of 25 chronic schizophrenic patients was assessed using an extended version of the Five-Minute Speech Sample (FMSS). Patients rated their relatives with the Perceived Criticism Scale (PCS), the Family Emotional Involvement and Criticism Scale (FEICS), and a German questionnaire on family atmosphere (FEF). Forty-eight percent of relatives were rated high in EE, due to criticism in all cases but one. Patients' assessments of the whole family on the FEICS and FEF criticism subscales were related to their relatives' EE status. Correlations between the self-rating instruments were moderate to good. As the patients' and the relatives' views corresponded with regard to the criticism domain, the application of a self-rating instrument may be a simple and useful tool for clinical and research purposes.

Spumaretroviruses or foamy viruses constitute a distinct subfamily of retroviruses. The biology of foamy viruses within the authentic host, their mode of transmission, and disease potential in the authentic host or after zoonotic transmission into human or other species are almost unknown. Using feline foamy virus (FFV) as model system, we established modular enzyme-linked immunosorbent assays (ELISA) suited to determine feline IgG and IgM antibody responses against structural and non-structural FFV proteins. We validated the ELISAs with standard reference sera. In 99 cats admitted to a Swiss veterinary hospital, overall FFV Gag antibody prevalence was 36%, reactivity against Env and the non-structural protein Bet each was about 25%, and 19% of the sera were directed against all three FFV antigens. With one exception, all Bet- and/or Env-positive sera were also positive for Gag. In this small epidemiological pilot study, FFV antibodies were not significantly associated with clinical disease.

Recent studies indicate that morphological and functional abnormalities of the cerebellum are associated with schizophrenia. Since the cerebellum is crucial for motor coordination, one may ask whether the respective changes are associated with motor dysfunction in the disease. To test these hypotheses in a clinical study, we investigated cerebellar volumes derived from volumetric magnetic resonance imaging of 37 first-episode patients with schizophrenia, schizophreniform or schizoaffective disorder and 18 healthy controls matched for age, gender and handedness. To control for potential interindividual differences in head size, intracranial volume was entered as a covariate. Neurological soft signs (NSS) were examined after remission of acute symptoms. Compared with the controls, patients had significantly smaller cerebellar volumes for both hemispheres. Furthermore, NSS in patients were inversely correlated with tissue volume of the right cerebellar hemisphere partialling for intracranial volume. No associations were detected between cerebellar volumes and psychopathological measures obtained at hospital admission when patients were in the acute psychotic state or after remission, treatment duration until remission, treatment response or prognostic factors, respectively. These findings support the hypothesis of cerebellar involvement in schizophrenia and indicate that the respective changes are associated with NSS.

Background. Morphometric studies on the corpus callosum (CC) in schizophrenia have yielded contradictory results. The aim of the present study was to investigate magnetic resonance imaging (MRI) abnormalities of the CC in first-episode patients with schizophrenic psychoses.Method. We assessed volumetric MRI in 31 patients with diagnoses of schizophrenia, schizophreniform or schizoaffective disorder (DSM-IV) and a maximum exposure to neuroleptics of 2 weeks. As a control group, 12 healthy age- and sex-matched individuals were included in the study. A whole body scanner at 1.5 Tesla was used to obtain 3D T1- and T2-weighted MR datasets. The data were evaluated semi-automatically (intracranial volume, total brain volume) and manually (CC) with the software NMRwin.Results. Patients had smaller CC and CC subdivisions than controls. Schizophrenic and unaffected women exhibited larger total CC and rostral subdivisions than men in both groups. Handedness did not exert an influence.Conclusions. Our findings are in line with other in vivo morphometric studies on the CC in schizophrenia. The larger CC area in women may reflect general gender-related differences in CC size as described in healthy individuals.

Relatives of first-episode and chronic schizophrenic and depressed patients were examined with respect to their expressed emotion (EE) status. The two aims of the study were to (1) investigate whether relatives of first-episode patients differed from family members of chronic patients, and (2) whether EE indices of relatives of schizophrenic patients were comparable to those of depressed subjects. Twenty patients of each diagnostic group (DSM-III-R and DSM-IV) were included, i.e. a total of 80 patients. The EE status of key relatives was assessed with the Five-Minute Speech Sample on the basis of critical comments and emotional overinvolvement. Additionally, the new criterion ‘covert criticism’ was applied to detect indirect expressions of critique. Relatives of first-episode and chronic patients of both diagnostic groups did not differ significantly regarding their EE status; in first-episode patients, 52.5% of relatives were classified high EE; in chronic patients, 45%. Moreover, EE indices of relatives of schizophrenic and depressed patients were comparable. Analysis revealed 52.5 and 45% high-EE relatives in the depression and the schizophrenia subsamples, respectively. Thus, the overall incidence of high-EE relatives was comparable to numbers reported in the literature. In our study EE status of relatives was not disease-specific, and it was independent of chronicity of illness.

Neurological soft signs (NSS) comprise subtle deficits in sensory integration, motor coordination, and sequencing of complex motor acts, which are typically observed in the majority of schizophrenia patients, including chronic cases and neuroleptic-naïve first-episode patients. However, recent studies clearly demonstrate that NSS are not a static feature of schizophrenia but vary in the clinical course of the disorder. This effect was investigated in a meta-analysis based on 17 longitudinal studies published between 1992 and 2012. Studies included between 10 and 93 patients with schizophrenia spectrum disorders (total number 787) with follow-up periods between 2 and 208 weeks. Beside the Neurological Examination Scale, the Cambridge Neurological Inventory and the Heidelberg NSS Scale were used to assess NSS. All but three studies found NSS to decrease in parallel with remission of psychopathological symptoms. This effect was more pronounced in patients with a remitting compared to a non-remitting, chronic course (Cohen's d 0.81 vs. 0.15) and was significantly correlated with length of the follow-up period (r = -0.64) but not with age (r = 0.28). NSS scores did not decrease to the level typically observed in healthy controls. From a clinical perspective, NSS may therefore be used to identify subjects at risk to develop schizophrenia and to monitor disease progression.

Patients suffering form chronic diseases have to deal with several problems, the illness itself only being one of them. Health care providers have to undergo a paradigm shift to be able to meet the new challenges which differ from those in acute care. From the patient's perspective, coping with a chronic disease is not a limited process, but encompasses different, often recurring phases (trajectory model). The treating physician's support may comprise the offering of information on general and specific stress factors (physical, emotional, social), empathy, respecting the individual's expertise and activating a patient's resources and self-efficacy. The amount of support given is limited by the treating physician's expert knowledge in this area. Physicians should respect their own limits and involve specialists, supervision or Balint groups.Chronisch Erkrankte müssen sich mit zahlreichen Themen auseinandersetzen, die Krankheit selbst ist nur eines davon. Im Umgang erfordert dies einen Paradigmenwechsel im Gesundheitswesen: Es sind andere Haltungen und Interventionen als in der Akutmedizin gefordert. Krankheitsbewältigung ist kein einmaliger, endender Prozess, sondern durchläuft diverse Phasen, die sich wiederholen können (trajectory model). Somatisch Tätige unterstützen durch Kenntnis der allgemeinen und spezifischen Belastungsfaktoren (körperliche, emotionale, soziale Symptome/Einschränkungen), durch emotionale Zuwendung und Empathie, durch Respektieren des Individuums als Experten der eigenen Erkrankung sowie durch Aktivierung von Ressourcen und Selbstwirksamkeit. Wissen und Erfahrung der Behandler bestimmen die Grenzen im Umgang mit chronisch Erkrankten. Diese gilt es zu erkennen, um eigener Überforderung vorzubeugen. Hilfreich ist, Fachärzte/innen für Psychiatrie und Psychotherapie, Supervisionen oder Balintgruppen in Anspruch zu nehmen.Les malades présentant une affection chronique doivent faire face à de multiples problèmes en plus de leur maladie de base. Cela requiert un changement de paradigme du système médical: Les attitudes et les interventions doivent différer de celles de la médecine d'urgence. La prise en charge de la maladie ne se fait pas et ne se termine pas en une fois, mais se réalise en diverses phases qui peuvent se répéter. Le soutien du médecin traitant peut comporter une information sur les facteurs de stress généraux et spécifiques (physiques, émotionnels, sociaux), ceci par empathie, en respectant l'expérience individuelle et en activant les ressources et le potentiel d'efficacité du malade. Le degré d'intervention du médecin traitant peut être limité grâce à son expertise dans ce domaine. Les médecins traitants devraient respecter leurs limites et se faire aider lorsque nécessaire. A cet égard peuvent être particulièrement utiles les psychiatres et les psychothérapeutes, ainsi que la participation à des groupes supervisés ou des à des groupes Balint.

Schizophrenia is a serious brain disease of uncertain etiology. A role for retroviruses in the etiopathogenesis of some cases of schizophrenia has been postulated on the basis of clinical and epidemiological observations. We found sequences homologous to retroviral pol genes in the cell-free cerebrospinal fluids (CSFs) of 10 of 35 (29%) individuals with recent-onset schizophrenia or schizoaffective disorder. Retroviral sequences also were identified in the CSFs of 1 of 20 individuals with chronic schizophrenia. However, retroviral sequences were not identified in any of the CSFs obtained from 22 individuals with noninflammatory neurological diseases or from 30 individuals without evidence of neurological or psychiatric diseases (χ 2 = 19.25, P < 0.001). The nucleotide sequences identified in the CSFs of the individuals with schizophrenia or schizoaffective disorder were related to those of the human endogenous retroviral (HERV)-W family of endogenous retroviruses and to other retroviruses in the murine leukemia virus genus. Transcription of RNA homologous to members of the HERV-W family of retroviruses also was found to be up-regulated differentially in the frontal cortex regions of brains obtained postmortem from individuals with schizophrenia, as compared with corresponding tissue from individuals without psychiatric diseases. The transcriptional activation of certain retroviral elements within the central nervous system may be associated with the development of schizophrenia in at least some individuals. The further characterization of retroviral elements within the central nervous system of individuals with schizophrenia might lead to improved methods for the diagnosis and management of this disorder.

The frontal hypothesis of aging predicts an age-related decline in cognitive functions requiring inhibitory or attentional regulation. In Alzheimer's disease, preattentive gating out of redundant information is impaired. Our study aimed to examine changes associated with physiological aging in both pre- and early attentive inhibition of recurrent acoustic information. Using a passive double-click paradigm, we recorded mid-latency (P30-P50) and late-latency (N100 and P200) evoked potentials in healthy young (26 ± 5 years) and healthy elderly subjects (72 ± 5 years). Physiological aging did not affect auditory gating in amplitude measures. Both age groups exhibited clear inhibition in preattentive P50 and attention-modulated (N100) components, whereas P30 was not attenuated. Irrespective of age, the magnitude of inhibition differed significantly, being most pronounced for N100 gating. Inhibition of redundant information seems to be preserved with physiological aging. Early attentive N100 gating showed the maximum effect. Further studies are warranted to evaluate sensory gating as a suitable biomarker of underlying neurodegenerative disease.

Neuroimaging techniques such as magnetization transfer imaging allow the detection of microstructural alterations of tissue, and for this reason have been applied to the study of disorders such as schizophrenia. However, they are also sensitive to partial volume effects arising from mixed compartments, such as those comprising cerebral spinal fluid, which makes separate evaluation of volumetric and structural alterations difficult. Ensuing regional differences in the distribution of data and signal-to-noise ratio add further potential bias to their assessment. In the present study we simultaneously applied tissue segmentation, statistical imputation, and nonparametric inference to address these issues and improve the validity of statistical inference. In a case study of N = 32 schizophrenic patients matched to the same number of controls, we compared a standard voxel-based analysis with one supplemented by the imputation technique. We were able to replicate significant results in the imputed analysis and even extend them in the areas not excluded by excessive partial volume effects. Application of segmentation algorithms in this dataset also suggested that partial volume effects from spinal fluid potentially affect inference in most cortical gray matter, unless remedial steps are undertaken. Refined imputation methods may be particularly attractive in future research settings characterized by large samples and the availability of adequate computational resources.

Neurological soft signs (NSS) comprise a broad range of minor motor and sensory deficits which are frequently found in schizophrenia. However, the cerebral changes underlying NSS are only partly understood. We therefore investigated the cerebral correlates of NSS by using magnetic resonance imaging (MRI) in 102 patients with first episode schizophrenia. NSS were assessed after remission of acute psychotic symptoms using the Heidelberg scale (HS), which consists of five NSS subscales ("motor coordination", "complex motor tasks", "orientation", "integrative functions", and "hard signs"). Correlations between NSS scores and cerebral changes were established by optimized voxel-based morphometry. NSS total scores were significantly associated with reduced gray matter densities in the precentral and postcentral gyri, the inferior parietal lobule and the inferior occipital gyrus. Both of the NSS subscales "motor coordination" and "complex motor tasks", referred to motor strip changes but showed differential correlations with parietal, insular, cerebellar or frontal sites, respectively. The NSS subscales "orientation" and "integrative functions" were associated with left frontal, parietal, and occipital changes or bihemispheric frontal changes, respectively. The NSS subscale "hard signs" was associated with deficits in the right cerebellum and right parastriate cortex. Repeated analyses for white matter changes revealed similar results. These findings confirm the associations between NSS and cerebral changes in areas important for motor and sensory functioning. This variety of cerebral sites corresponds to the heterogeneity of NSS and are consistent with the hypothesis that NSS reflect both a rather generalized cerebral dysfunction and localized deficits specific for particular signs.

Objective The inability to adequately suppress the second of two identical stimuli is called sensory gating deficit and can be studied by recording evoked potentials to auditory stimuli, e.g. the P50 and the N100. It has been considered the physiological correlate of schizophrenia patients' perception of being flooded by sensory impressions. According to the notion that the gating deficit constitutes a genetic trait, we expected to demonstrate the phenomenon in first-episode schizophrenia patients by using Magnetencephalography (MEG). Methods Eighteen inpatients in remission of their first psychotic episode and 24 healthy, age- and sex-matched control subjects participated in the study. Diagnoses, psychopathology, and handedness were assessed with established instruments. Stimulation was performed with the double click paradigm (ISI 500 ms, ITI 9–10 s). MEG recordings of 15 patients and 18 controls entered further analyses with the software BESA for spatio-temporal source analyses and statistical analyses with MATLAB. Results Neither P50 nor N100 responses differed statistically between the groups, which means that gating was not impaired in this sample of first-episode schizophrenia patients. Conclusions These results are not in line with the majority of studies on sensory gating in schizophrenia, however, studies on first-episode patients are scarce. The most likely reasons for not observing a gating deficit in our study are patients' first-episode status and atypical antipsychotic medication.