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Biomedical subjects

A M Mortimer

Publications and source records attributed to A M Mortimer.

At least 19 recordsLinked to original sources
PubMed2007

Relationship between estrogen and schizophrenia.

There is a wealth of historical and circumstantial evidence to suggest that female patients with schizophrenia may suffer from a deficit in estrogenic function. The prolactin-inducing properties of most antipsychotic drugs, and subsequent negative feedback on estrogen levels, is in keeping with this. The functions of estrogen, its complex receptor organization and its numerous actions are the focus of ongoing research activity. Of particular interest are its neuroprotective properties, particularly with regard to cognitive impairment, and its involvement with neurotransmitter systems, which are the substrate for psychotropic drugs. Estrogen has now been used as an adjunct to standard antipsychotic medication in quite a few studies of female schizophrenia patients. However, most of these are not double-blind, randomized, controlled trials. Only two relatively small double-blind, randomized clinical trials returned positive results: one long-term study that selected for hypoestrogenism reported negative findings. Furthermore, recent evidence of the risks of long-term hormone replacement therapy is of concern. The advent of specific estrogen receptor modulators, which may avoid excess risks of cancer and cardiovascular events, will have little to add to schizophrenia treatment if estrogen is, essentially, devoid of any specific antipsychotic or adjuvant mechanism of action relevant to the pathophysiology of this disorder.

Antipsychotic Agents↗
PubMed2006

Fear of venepuncture as a barrier to testing for blood-borne infection and use of an oral fluid test as an alternative to venepuncture in a genitourinary medicine clinic.

OBJECTIVE: A survey of 505 consecutive patients attending a UK genitourinary medicine clinic (GUM) included a psychometric tool to compute a fear of venepuncture (FOV) score, responses to the offer of venepuncture and to alternative testing. METHOD: An oral fluid test (OFT) was available to test for blood-borne infection (BBI). Completed fear scores were provided by 299 (59%) patients routinely offered venepuncture, of whom 72 (24%) who did not have venepuncture had higher fear scores compared with 227 (76%) who had venepuncture (p<0.001). RESULTS: Both FOV and female sex were independent predictors of not having venepuncture. CONCLUSIONS: FOV is an important barrier to uptake of venepuncture. FOV may not always be recognised by health carers. OFT is an acceptable alternative test for some patients with needle aversion who decline venepuncture.

Ambulatory Care↗
PubMed2005

A longitudinal analysis of memory in patients with schizophrenia.

Memory deficits are widely reported in patients with schizophrenia, but uncertainties remain about the extent and the longitudinal course of these deficits. Twenty-eight patients with a DSM-IV diagnosis of schizophrenia were tested on multiple aspects of memory at baseline, 9- and 18-month follow-up. Measures included: digit span, the Rivermead Behavioural Memory test (RBMT) battery, the Graded Naming Test (GNT) and several computerized memory tests from the Cambridge Automated Neuropsychological Testing Battery (CANTAB). A group of healthy controls (N=17) was tested on the CANTAB battery at baseline and 9-month follow up. The patients performed significantly poorer than controls on all CANTAB measures; however, there was no difference in change between groups over a 9-month period. Within-group patient comparisons revealed that symptoms reduced significantly over the study period, but had no association with memory. Significant improvements were observed for patients on two verbal memory tasks: the GNT and digit span, but not on any other measure. Interestingly, these were the only two tests on which patients were within normal limits at baseline. This study shows that patients with schizophrenia have deficits in multiple aspects of memory which remain stable over long periods of time. In addition, patients showed a tendency to improve on memory tasks which contained a verbal component.

Adolescent↗
PubMed2000

Lexical knowledge degradation in schizophrenia.

This study documents a severe picture naming impairment in a series of 22 chronically hospitalised schizophrenics. The pattern and level of naming impairment were comparable in degree and type to that seen neurological patients with left hemisphere lesions. This deficit was further examined to determine whether it conformed to a disorder affecting access to the lexical representations or some degradation of the stored representations themselves. Patient naming was examined twice (18months apart) for evidence of consistency and for word frequency effects. The pattern of individual patient performance on these criteria showed that the majority had storage disorders; access disorders alone occurred in only a small minority of patients. A subset of 11 of the same patients that were tested on three occasions (across 30months) showed the same pattern but further indicated that when access problems are present, they reflect difficulty with deliberate, rather than automatic, access to the lexicon.

Adult↗
PubMed2000

Somatic treatment of psychotic depression: review and recommendations for practice.

The diagnosis, classification, and course of psychotic major depression (PMD) is considered with regard to its status as a distinct syndrome. Several factors, especially biological markers, suggest, although as yet do not confirm, that PMD is distinct from nonpsychotic major depression (NPMD), particularly for the purposes of treatment. This article provides a critical review of somatic treatments for PMD, with attention to problems of inadequate treatment, as well as underused and more recently introduced treatments. The somatic treatment options reviewed include (1) combined antidepressant (AD) and antipsychotic (AP) therapy with tricyclic antidepressants (TCAs) and typical APs; (2) electroconvulsive therapy (ECT); (3) amoxapine; (4) selective serotonin reuptake inhibitors (SSRIs), alone and in combination; (5) several atypical APs, alone and in combination; (6) mood stabilizers and anticonvulsants; and (7) some experimental treatments and surgery. A comprehensive treatment algorithm (heuristic) is presented, which draws on some previous guidelines and the critical review. This heuristic is conservative in its aims, but forward-looking in its recommendations. The status of the TCA plus typical AP regime is challenged as the default first-line treatment, and preferable alternatives are discussed. ECT has been shown to be at least as effective in short-term treatment and should be considered more frequently, especially in severe presentations and as a maintenance treatment. Some single compounds should be considered as first-line monotherapies in less severe cases. For cases in which combined AD+AP regimes are instituted, SSRIs and atypical APs should be used before older classes of drugs are considered. These recommendations aim to minimize the number of treatments used and unwanted effects experienced.

Antidepressive Agents↗
PubMed1998

Reduced dendritic spine density on cerebral cortical pyramidal neurons in schizophrenia.

OBJECTIVE: A pilot study of the density of dendritic spines on pyramidal neurons in layer III of human temporal and frontal cerebral neocortex in schizophrenia. METHODS: Postmortem material from a group of eight prospectively diagnosed schizophrenic patients, five archive schizophrenic patients, 11 non-schizophrenic controls, and one patient with schizophrenia-like psychosis, thought to be due to substance misuse, was impregnated with a rapid Golgi method. Spines were counted on the dendrites of pyramidal neurons in temporal and frontal association areas, of which the soma was in layer III (which take part in corticocortical connectivity) and which met strict criteria for impregnation quality. Altogether 25 blocks were studied in the schizophrenic group and 21 in the controls. If more than one block was examined from a single area, the counts for that area were averaged. All measurements were made blind: diagnoses were only disclosed by a third party after measurements were completed. Possible confounding affects of coexisting Alzheimer's disease were taken into account, as were the effects of age at death and postmortem interval. RESULTS: There was a significant (p<0.001) reduction in the numerical density of spines in schizophrenia (276/mm in control temporal cortex and 112/mm in schizophrenic patients, and 299 and 101 respectively in the frontal cortex). An analysis of variance, taking out effects of age at death and postmortem interval, which might have explained the low spine density for some of the schizophrenic patients, did not affect the significance of the results. CONCLUSION: The results support the concept of there being a defect in the fine structure of dendrites of pyramidal neurons, involving loss of spines, in schizophrenia and may help to explain the loss of cortical volume without loss of neurons in this condition, although the effect of neuroleptic drugs cannot be ruled out.

Adult↗
PubMed1997

Cognitive function in schizophrenia--do neuroleptics make a difference?

Valid cognitive deficits in schizophrenia are now well characterised: general poor performance with disproportionate deficits in aspects of memory and executive function. Symptomatology, motivation, institutionalization, etc. cannot explain these deficits, which are of considerable importance for both the testing of theoretical models of schizophrenia and the determination of patients' functional outcome. The receptor blocking properties of neuroleptic treatments afford them the potential for interacting with monoaminergic, indoleaminergic, and cholinergic arousal systems in the brain and, hence, for modifying cognitive processes. However, the effects of conventional neuroleptics on cognition in schizophrenia are minor according to numerous studies. Atypical neuroleptics may, owing to their novel mechanisms of action, have the capacity to remediate cognitive impairment in schizophrenia: there is some evidence that clozapine has a "cognitive sparing" effect, but further research is needed in this area, particularly with other new drugs. Future studies should employ more appropriate methodology, particularly in terms of psychological/neurophysiological sophistication, patient evaluation, and applicability to real life, and should be hypothesis driven rather than purely empirical.

Animals↗
PubMed1996

Semantic memory is impaired in schizophrenia.

Memory is emerging as a key area of neuropsychological deficit in schizophrenia, with evidence suggesting that the impairment is restricted to long-term memory. Semantic memory, the component of long-term memory containing stored representations of the meanings of words and knowledge about the world, was examined in 46 schizophrenic patients and 40 normal controls using a recently devised battery of tests. Evidence of semantic memory impairment was found which was wide ranging and substantial; in some cases it approached the levels seen in a group of 22 patients with mild-to-moderate Alzheimer's disease. Both group analysis and a more detailed examination of two single cases suggested that semantic memory impairment represents a disproportionate and possibly specific neuropsychological deficit in schizophrenia.

Adolescent↗
PubMed1993

Memory in schizophrenia: what is impaired and what is preserved?

This study assesses the pattern of long-term memory performance in a sample of 12 schizophrenic patients who were selected on the basis of showing a memory deficit in the absence of gross overall intellectual impairment. When compared with 12 control subjects matched for age, sex and estimated premorbid IQ, presence of an episodic memory deficit was confirmed for both prose recall and forced-choice word and face recognition. Semantic memory was assessed using the sentence verification task developed by Collins and Quillian, an unpaced category judgement task, and the Mill Hill Vocabulary Scale. The schizophrenic patients were slower on sentence verification and they made significantly more errors in all three tasks. Procedural tasks included pursuit rotor performance, speed of repeatedly assembling a jigsaw puzzle and rate of improvement in reading transformed script. Here, while the schizophrenic patients showed poor overall performance on the pursuit rotor and jigsaw learning, their rate of learning on all three procedural tasks was comparable with that of the controls. When examined on two implicit memory tasks involving biasing of spelling of homophones and word stem completion, the patients showed a normal degree of priming in both. Implications for the nature of the memory deficit in schizophrenia are discussed.

Adolescent↗
PubMed1992

Memory impairment in schizophrenia: its extent, affiliations and neuropsychological character.

In a sample of 60 schizophrenic patients encompassing all grades of severity and chronicity memory impairment was found to be prevalent, often substantial, and disproportionate to the overall level of intellectual impairment. The deficits were not easily attributable to poor cooperation, attention or motivation; nor were they related to neuroleptic or anticholinergic medication. Memory impairment was significantly associated with severity and chronicity of illness and also with negative symptoms and formal thought disorder. There was evidence from the sample as a whole, and from a more detailed examination of five patients with relatively isolated deficits, that schizophrenic memory impairment conformed to the pattern seen in the classical amnesic syndrome. Additionally, there was preliminary evidence for a marked deficit in semantic memory.

Adult↗
PubMed1991

Motor, volitional and behavioural disorders in schizophrenia. 1: Assessment using the Modified Rogers Scale.

The assessment of catatonic symptoms, unlike that of other schizophrenia symptoms, has not acquired accuracy and phenomenological rigour, and their distinction from extrapyramidal side-effects is not always easy. The Modified Rogers Scale can rate abnormalities in movement, volition, speech, and overall behaviour in schizophrenia. It is detailed, reliable and valid, and permits the isolation of a score for non-extrapyramidal and hence presumably catatonic phenomena.

Arousal↗
PubMed1991

Motor, volitional and behavioural disorders in schizophrenia. 2: The 'conflict of paradigms' hypothesis.

An alternative to the conventional separation of extrapyramidal and catatonic symptoms exists in the 'conflict of paradigms' hypothesis, which proposes that there is a relative rather than absolute distinction between the two. The hypothesis predicts that a clinical association should exist between extrapyramidal and catatonic symptoms in schizophrenia. After rating 75 schizophrenic patients, a highly significant correlation between scores on the two classes of disorder was indeed found. This was composed of separate correlations between tardive dyskinesia and 'positive' catatonic phenomena, and Parkinsonism and 'negative' catatonic phenomena. The associations were not easily attributable to confounding factors and they were supported by factor analysis.

Adult↗
PubMed1990

Amnesic syndrome in schizophrenia.

Memory impairment is not usually considered to form part of the clinical picture of schizophrenia, except perhaps in severely deteriorated patients. In a survey of 60 patients encompassing all grades of severity and chronicity poor memory performance was found to be common, sometimes substantial, and disproportionately pronounced compared to the degree of general intellectual impairment. Although associated with severity and chronicity of illness, impaired memory was by no means confined to old, institutionalized, or markedly deteriorated patients. The pattern of deficit appeared to resemble that of the classic amnesic syndrome rather than that seen in Alzheimer-type dementia.

Adolescent↗
PubMed1990

Changes in the use of the Mental Health Act 1983 four years from its inception in Leeds Eastern Health Authority.

The origins of recent mental health legislation are briefly reviewed. Practices in the spirit rather than the letter of the 1983 Act are compared by studying one hundred periods of detention at its inception and another hundred four years later. There had been little change, and improvement only in rates of use of emergency powers and very short Section 2s.

Commitment of Persons with Psychiatric Disorders↗