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Reduction of cingulate gray matter density in poor outcome bipolar illness.
Structural brain abnormalities are associated with poor outcome unipolar depressive disorder. Gray matter density can be assessed with an automated, operator independent analysis (SPM99). We thus compared 11 poor outcome bipolar patients with 15 age-, sex- and IQ-matched healthy volunteers with a standard neuropsychological examination and an Elscint 2.0 Tesla MRI scanner. At the time of examination, patients were neither hypomanic nor significantly depressed, but were significantly impaired on the McGlashan scale. Their memory function was characterized by reduced performance in the California verbal learning and digit-symbol substitution tests. Statistical parametric mapping revealed abnormal gray matter density, mainly in fronto-limbic cortex, but particularly widespread in cingulate cortex. Although causality of these changes is difficult to resolve, the results offer useful insights into the neural correlates of severe bipolar disorder.
Obstetric complications in DSM-III schizophrenics and their siblings.
Blind to the adult diagnosis, the birth records of 27 patients fulfilling DSM-III criteria for schizophrenia and those of their healthy siblings were examined. A significant excess of obstetric complications was seen in the schizophrenic subjects.
Postexercise motor evoked potentials in depressed patients, recovered depressed patients, and controls.
We hypothesized that impaired postexercise motor evoked potential (MEP) facilitation in depressed patients would reverse with recovery from depression. Transcranial magnetic stimulation and exercise of the thenar muscles were used to examine the 10 controls, 10 medicated depressed patients, and 10 medicated recovered patients. Depressed patients showed reduced mean postexercise facilitation compared to both controls (p = 0.005) and recovered patients (p = 0.012). Controls and recovered patients had similar mean postexercise MEPs (p = 0.45). This is consistent with other evidence of reversibility of abnormal findings following recovery from depression.
Single-photon emission computed tomography with 99mTc-exametazime in unmedicated schizophrenic patients.
We examined 20 actively psychotic unmedicated schizophrenic patients and 20 matched control subjects by using single-photon emission, computed tomography (SPECT) with 99mtechnetium-exametazime. Patients showed a hyperfrontal pattern of tracer uptake with significant relative increases in superior prefrontal cortex. This abnormality was less pronounced in patients with higher symptom scores for psychomotor poverty. In addition, patients showed associations between certain schizophrenic syndrome scores, such as psychomotor poverty, disorganization, and reality distortion, and tracer uptake to a number of cortical and subcortical brain regions. This syndrome-related pattern of tracer uptake was, at least in part, consistent with similar associations previously reported in chronically medicated schizophrenic patients. SPECT therefore provides a readily available method to examine the relationship between symptom pattern and regional brain metabolism in psychotic patients. Any observed patterns of association will depend on the current mental and medication status of the patients examined.
The split-dose technique for the study of psychological and pharmacological activation with the cerebral blood flow marker 99m-Tc-exametazime and single photon emission computed tomography (SPECT): reproducibility and rater reliability
Single photon emission cornputed tomography 99m-Tc-labelled Exametazime has been used in the study of regional cerebral blood flow (rCBF) in organic and functional brain diseases. In order to extend its use to the dynamic imaging of rCBF changes during psychological and pharmacological activation, a split-dose technique using repeat injection of Exametazime has been developed. In the present study 54 patients with various brain disorders and controls were examined twice in the same imaging session., on both occasions under baseline conditions. Regional isotope uptake was most effectively normalised using whole slice counts. Split-dose repetition errors across diagnostic categories ranged from 2% to 20% for different regions of interest. The error due to repeated image analysis was examined and compared with inter-rater error, and also with the effect of immediate and delayed re-scanning. The most important predictor of reproducibility was a large size of the region of interest, with slightly poorer results in organic disease than in controls. It is concluded that the proposed split-dose technique yields repeatable and reliable measures of regional isotope uptake which should allow for hte detetion of regional changes in blood flow observed during functional activation.
Single photon emission computed tomography in a patient with unilateral auditory hallucinations
We report a patient with right unilateral auditory hallucinations in association with right-sided hearing loss and tinnitus, a degree of anxiety and depression leading to self-poisoning, and delusional elaboration of the sensory experiences. Poor performance in visuospatial neuropsychological tests sensitive to frontal lobe damage, and poor performance on a visuospatial recognition memory test at 12 s delay were associated with a relative reduction of regional cerebral tracer uptake in mainly right anterior cingulate and right posterior temporal cortex.
Calcium antagonists and multi‐infarct dementia: A trial involving sequential NMR and psychometric assessment
A double‐blind placebo‐controlled trial of the calcium antagonist Nimodipine in 10 patients with multi‐infarct dementia (MID) shows that there is no improvement when compared with 10 patients on placebo assessed by clinical ratings and sequential NMR imaging. The value of repeated NMR imaging in measuring changes in MID is described. Copyright © 1988 John Wiley & Sons, Ltd.
Realist approaches to psychopathology. A critique
A conceptual unity of science can be achieved either by universal methodological criteria (critical rationalism), or by the assumption of an homogenous reality from which models, hypotheses, and theories are naturally derived (realism). In this paper realist approaches to psychology and psychopathology are evaluated with particular reference to Jaspers' General Psychopathology. Realism is found to obscure real differences between causal analysis and the analysis of meaningful connections.