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Biomedical subjects

Jim Mintz

Publications and source records attributed to Jim Mintz.

At least 55 records · Page 3Linked to original sources
PubMed2005

Clinical utility of magnetic resonance imaging radiographs for suspected organic syndromes in adult psychiatry.

OBJECTIVE: In psychiatric practice, adult patients are most commonly referred for magnetic resonance imaging (MRI) to screen for suspected organic medical diseases of the central nervous system that can mimic psychiatric syndromes. We identified the most common signs and symptoms prompting MRIs to establish the predictive value of these signs and symptoms for clinically pertinent organic syndromes. METHOD: This study was a retrospective chart review of psychiatric patients at the Veterans Affairs Greater Los Angeles Health Care Center (Los Angeles, Calif.) who were referred for MRI of the brain between 1996 and 2002. Patients referred for evaluation of dementia were excluded. The specific indications leading clinicians to obtain MRI were identified and grouped. In order to offset the uncertain significance of many MRI findings, for this study, the predictive value of each indication was calculated based on the percentage of patients in whom clinical management changed in response to MRI findings rather than on the percentage with any abnormal MRI results. RESULTS: Of 253 patients who had MRIs, 38 (15%) incurred some degree of treatment modification as a result of MRI findings, including 6 patients in whom MRI identified a medical condition that became the focus of treatment. Six indications appeared most likely to prompt clinicians to obtain MRIs. Because pertinent results were associated with each of these indications, statistical evaluation did not reveal significant differences in their predictive values (chi(2) = 4.32, df = 5, p = .505). CONCLUSIONS: Unlike prior studies showing no value to screening radioimaging, this study shows MRI can be a useful screening test among patients suspected of having organic psychiatric disorders and that the common indications for MRI employed at one institution were predictive.

Adult↗
PubMed2004

Paracontrast and metacontrast in schizophrenia: clarifying the mechanism for visual masking deficits.

Schizophrenic patients consistently demonstrate performance deficits on visual masking procedures. Visual masking can occur through two distinctly different mechanisms: interruption and integration. One highly effective way to limit the masking mechanism to interruption is to use a mask that surrounds, but does not spatially overlap, the target. These procedures are called paracontrast and metacontrast (for forward and backward masking, respectively). Despite their clear advantages for interpretation, paracontrast and metacontrast have not been used previously in schizophrenia. In the present study, we examined the reliability of the paracontrast and metacontrast procedures by administering these tasks to 103 schizophrenic patients and 49 normal control subjects. In addition, we compared the results to those from a low-energy masking condition, which is an alternative way to limit masking to interruption. Patients showed deficits on both the paracontrast and metacontrast procedures. The deficits in paracontrast and metacontrast were comparable to those seen previously with low-energy masking. These results suggest that the paracontrast/metacontrast procedure and the procedure using a low-energy mask are roughly equally sensitive to deficits in early visual processing among schizophrenic patients. These results bolster previous conclusions that schizophrenic patients show deficits on visual masking tasks even when masking on those tasks occurs entirely through the interruption mechanism.

Adolescent↗
PubMed2004

Neurocognitive function in clinically stable men with bipolar I disorder or schizophrenia and normal control subjects.

BACKGROUND: Patients with bipolar disorder and schizophrenia have been shown to have neurocognitive deficits when compared with control subjects. The degree and pattern of impairment between psychiatric groups have rarely been compared, especially when subjects are psychiatrically stable. METHODS: Using a standard neurocognitive battery, we compared euthymic outpatients with bipolar disorder (n = 40), stable patients with schizophrenia (n = 20), and subjects with no psychiatric disorder (n = 22). The neurocognitive domains assessed included executive functioning, verbal memory, visual memory, procedural learning, visuoconstructive ability, and language functions. Effect sizes were calculated for each cognitive domain across groups. RESULTS: Stable schizophrenic subjects demonstrated a generalized cognitive impairment across most domains compared with control subjects, with average effect sizes of .9. Euthymic bipolar subjects were significantly impaired compared with control subjects only in executive functioning (Wisconsin Card Sorting Task) and verbal memory (California Verbal Learning Test) domains (effect sizes in the .8-.9 range). Performance on the executive function measures was bimodal among bipolar subjects, suggesting two subgroups: one with relatively normal and one with impaired executive functioning. No significant differences between the bipolar patient group and control subjects were observed in visuoconstructive ability, procedural learning, or language function. CONCLUSIONS: Both euthymic bipolar subjects and relatively stable schizophrenic subjects differed from control subjects in neurocognitive function. Among schizophrenic subjects, a generalized cognitive impairment was observed, and the degree of impairment was greater in the schizophrenic compared with the bipolar subjects. Subjects with bipolar disorder were impaired in two specific domains (verbal memory and executive function). Furthermore, within the bipolar group there was a subset with relatively normal executive functioning and a subset with significant impairment. Possible reasons for the persistence of these neurocognitive deficits in some subjects with bipolar disorder during periods of euthymia are reviewed.

Adult↗
PubMed2004

Schizophrenia as one extreme of a sexually selected fitness indicator.

Schizophrenia remains an evolutionary paradox. Its delusions, hallucinations and other symptoms begin in adolescence or early adulthood and so devastate sexual relationships and reproductive success that selection should have eliminated the disorder long ago. Yet it persists as a moderately heritable disorder at a global 1% prevalence--too high for new mutations at a few genetic loci. We suggest that schizophrenia persists and involves many loci because it is the unattractive, low-fitness extreme of a highly variable mental trait that evolved as a fitness ("good genes") indicator through mutual mate choice. Here we show that this hypothesis explains many key features of schizophrenia and predicts that some families carry modifier alleles that increase the indicator's neurodevelopmental sensitivity to heritable fitness and condition. Such alleles increase the extent to which high-fitness family members develop impressive courtship abilities and achieve high reproductive success, but also increase the extent to which low-fitness family members develop schizophrenia. Here we introduce this fitness indicator model of schizophrenia, discuss its explanatory power, explain how it resolves the evolutionary paradox, discuss its implications for gene hunting, and identify some empirically testable predictions as directions for further research.

Biological Evolution↗
PubMed2004

The timing of negative symptom exacerbations in relationship to positive symptom exacerbations in the early course of schizophrenia.

Although positive and negative symptoms appear to represent independent symptom dimensions of psychopathology when evaluated cross-sectionally among individuals with schizophrenia, it is not known if exacerbations of symptoms on these two dimensions are independent. This prospective longitudinal study examined the temporal relationship between the positive and negative symptom exacerbations among 48 recent-onset schizophrenia or schizoaffective patients who received symptom ratings every 2 weeks on the Brief Psychiatric Rating Scale. Patients were followed for a period of at least 1 year and a mean of 3 years. To examine the temporal relationship between positive and negative symptoms, six time periods were defined in relation to psychotic exacerbation or relapse (e.g., prodromal, concurrent, post-psychotic) and used to compare the timing of positive and negative symptom exacerbations. A substantial proportion of patients had exacerbations of positive symptoms (77%) and negative (42%) symptoms. Negative symptom exacerbations occurred simultaneously with positive symptom exacerbations to a significantly greater extent than expected by chance, and occurred less frequently than expected by chance during the time period most temporally removed from positive symptom exacerbations. Results suggest that the timing of some negative symptom exacerbations is linked to that of positive symptom exacerbations during the early course of schizophrenia.

Adult↗
PubMed2004

A network-based system to improve care for schizophrenia: the Medical Informatics Network Tool (MINT).

The Medical Informatics Network Tool (MINT) is a software system that supports the management of care for chronic illness. It is designed to improve clinical information, facilitate teamwork, and allow management of health care quality. MINT includes a browser interface for entry and organization of data and preparation of real-time reports. It includes personal computer-based applications that interact with clinicians. MINT is being used in a project to improve the treatment of schizophrenia. At each patient visit, a nurse briefly assesses symptoms, side effects, and other key problems and enters this information into MINT. When the physician subsequently opens the patient's electronic medical record, a window appears with the assessment information, a messaging interface, and access to treatment guidelines. Clinicians and managers receive reports regarding the quality of patients' treatment. To date, MINT has been used with more than 165 patients and 29 psychiatrists and has supported practices that are consistent with improvements in the quality of care.

Decision Support Systems, Clinical↗
PubMed2004

Antipsychotic and anticholinergic effects on two types of spatial memory in schizophrenia.

Spatial memory is of interest in schizophrenia because of widespread impairments in adaptive functioning, including independent living skills. Short-term spatial memory is impaired in this disease, whereas spatial reference memory, a longer-term spatial memory, has not been evaluated. Animal studies have demonstrated that anticholinergics impair short-term spatial memory but not spatial reference memory. The effects of haloperidol and risperidone on these two types of spatial memory were evaluated in a double-blind randomized comparison in inpatients with schizophrenia. It was predicted that risperidone would have a greater beneficial effect on spatial working memory than haloperidol. Computerized measures of spatial working memory and spatial reference memory were developed based on animal assessment of these functions. Subjects with schizophrenia were assessed during a medication-free period and again following 4 weeks of fixed-dose treatment. Risperidone, compared to haloperidol, improved spatial working memory performance, an effect that became nonsignificant when benztropine co-treatment was controlled. There were no treatment effects on spatial reference memory performance. Consistent with animal studies, benztropine impaired spatial working memory but not spatial reference memory. The relative benefits of risperidone on spatial working memory performance were largely explained by differential benztropine treatment for the haloperidol-treated subjects.

Adult↗
PubMed2004

Do the siblings of schizophrenia patients demonstrate affect perception deficits?

Affect perception deficits have been extensively documented in schizophrenia and are associated with the social dysfunction that is characteristic of this disorder. The two previous studies examined facial affect perception in genetically at-risk samples and yielded mixed results. The current study was designed to provide a rigorous test of affect perception abilities among schizophrenia patients (n=58), their biological siblings without psychosis (n=51), and nonpsychiatric controls (n=49). Participants completed three measures of affect perception, including facial, vocal, and combined modality. Schizophrenia patients performed significantly worse than controls on two of the three affect perception tests as well as a composite index based on all three tests. The performance of the sibling group fell between the patient and control groups on each of the affect perception tests. However, group differences achieved statistical significance only for the composite index with the siblings performing significantly worse than controls and significantly better than the schizophrenia group. These findings demonstrate that subtle deficits in affect perception are detectable in the unaffected siblings of schizophrenia patients when multiple measures of different types of affect perception abilities are used in combination.

Adult↗
PubMed2004

Neurochemistry of late-life major depression: a pilot two-dimensional MR spectroscopic study.

PURPOSE: To evaluate a two-dimensional localized chemical shift correlated spectroscopy (L-COSY) sequence in elderly patients with major depression. MATERIALS AND METHODS: A total of 33 healthy elderly subjects and 15 elderly patients with major depression were investigated. A voxel size of 3 x 3 x 3 cm3 was chosen in the dorsolateral prefrontal region with predominantly white matter, with the use of three slice-selective radiofrequency (RF) pulses (90 degrees , 180 degrees , and 90 degrees). A chemical shift-selective (CHESS) sequence was used prior to volume localization for the presaturation of water. The two-dimensional raw data matrix consisted of 1024 complex points along the detection period (t2), and 100 increments along the evolution period (t1), resulting in a total acquisition time of approximately 27 minutes per acquisition. The metabolite ratios were calculated using the two-dimensional peak volumes with respect to the diagonal peak volume of total creatine (Cr) at 3.0 ppm. RESULTS: In the 33 elderly subjects, the mean ratio of choline (Cho) to Cr was 10% higher in men compared to women (P < 0.05), consistent with earlier findings obtained by one-dimensional MRS. When the metabolite ratios were compared in a subsample of 16 elderly female controls and 12 depressed female patients, the depressed geriatric patients had higher levels of myoinositol (mI), phosphoethanolamine (PE), and glutamate/glutamine (Glx) than the controls, although the differences were not statistically significant. CONCLUSION: Our pilot study shows the feasibility of performing two-dimensional L-COSY successfully in elderly subjects and patients with late-life mood disorders. These findings are consistent with and expand on our earlier findings in major depressive disorder (MDD) detected with one-dimensional MRS.

Aged↗
PubMed2004

Executive dysfunction and visuospatial ability among depressed elders in a community setting.

Visuospatial ability is frequently compromised among elderly depressed patients, but it is unclear whether the impairment is a consequence of a visuospatial memory deficit or of an executive dysfunction that impacts visuospatial ability. The Boston Qualitative Scoring System is a method of scoring the Rey-Osterrieth Complex Figure (ROCF) that assesses the process used to draw the figure, the executive aspect of the task, as well as the accuracy and location of the completed elements. The hypotheses that executive scores as measured by the BQSS would separate diagnostic groups and that executive function would mediate the relationship between depression and nonverbal recall were tested using a between groups design with elderly depressed volunteers (N = 31) and healthy controls (N = 31). Participants were screened for other Axis I disorders with the Structured Clinical Interview for DSM-IV Diagnosis, diagnosed for major depression per DSM-IV criteria, and administered the ROCF. The copy and recall drawings were scored using BQSS criteria, and scores were grouped into executive and drawing scores from both copy and recall phases. Executive scores during the copy phase and drawing scores from the recall phase separated the diagnostic groups [F(1,59), = 4.14, P = .05] and [F(1,59) = 6.88, P = .01], respectively. Follow-up ANCOVAS showed that copy Planning, the score that quantified the process by which the figure was drawn, separated the diagnostic groups. Planning also mediated the association between depression and the percent of the figure recalled after the short delay (Z = 1.84, P < .05). The significance of the depression-to-recall pathway was eliminated when Planning was controlled for, but Planning remained related to percent recalled [B = -6.90, P < .007]. A dimension of executive dysfunction, represented here by Planning, may be one underlying source of the observed decline in nonverbal recall among elderly depressed patients. This result is consistent with the theory that dysfunction of the prefrontal cortex is a critical feature of late-life depression.

Aged↗
PubMed2004

The dexamethasone suppression test as a predictor of suicidal behavior in unipolar depression.

BACKGROUND: Non-suppression on the dexamethasone suppression test (DST) in unipolar depression has been found to be associated with completed suicide, with less consistent data for attempted suicide and hospitalizations for suicidality. The purpose of this study was to examine DST non-suppression as a predictor of these three aspects of suicidal behavior. METHODS: Records were reviewed for 101 patients who met criteria for major depressive disorder and/or dysthymic disorder and had a DST performed. All patients were treated naturalistically and were followed for an average of 2 years. DST suppressors and non-suppressors were compared with respect to three outcomes: (1) completed suicide; (2) attempted suicide; and (3) hospitalizations for suicidality. RESULTS: DST non-suppressors were significantly more likely to have completed suicide or be hospitalized for suicidality than DST suppressors, with a non-significant trend for attempts. Total suicidal events were also significantly more frequent in the non-suppressor group. LIMITATIONS: Axis II diagnoses and severity of illness were not assessed. Knowledge of DST results may have influenced the decision to hospitalize patients. CONCLUSIONS: DST non-suppression identifies unipolar depressed patients with a higher risk for future suicide completion or hospitalization for suicidality. Performance of DST upon initiation of treatment may be a useful adjunct in identifying suicidal risk.

Adult↗
PubMed2004

Heterogeneous age-related breakdown of white matter structural integrity: implications for cortical "disconnection" in aging and Alzheimer's disease.

Human and non-human primate data suggest that the structural integrity of myelin sheaths deteriorates during normal aging, especially in the late-myelinating association regions and may result in "disconnection" of widely distributed neural networks. Magnetic resonance imaging (MRI) was used to assess the heterogeneity of this process and its impact on brain aging and Alzheimer's disease (AD) by evaluating early- and later-myelinating regions of the corpus callosum, the splenium (Scc) and genu (Gcc), respectively. Calculated transverse relaxation rates (R2), an indirect measure of white matter structural integrity for the Gcc and Scc, were examined. The relationship between age and R2 differed in the two regions. A quadratic (inverted U) function with an accelerating rate of decline beginning at age 31 best represented the Gcc pattern while the Scc decline was three-fold smaller, gradual, and linear. These data suggest that the severity of age-related myelin breakdown is regionally heterogeneous, consistent with the hypothesis that differences in myelin properties make later-myelinating regions more susceptible to this process. In AD this process is globally exacerbated, consistent with an extracellular deleterious process such as amyloid beta-peptide toxicity. Non-invasive measures such as R2 may be useful in primary prevention studies of AD.

Adolescent↗
PubMed2004

Brain metabolites and cognitive function among older depressed and healthy individuals using 2D MR spectroscopy.

Brain metabolites of choline (Ch) and myo-Inisotol (mI) have been reported as elevated among geriatric depressed patients. Two-dimensional (2D) magnetic resonance spectroscopy (MRS) provides estimates of Ch, mI, and creatine (Cr) similar to one-dimensional MRS, and it also estimates the resonances of the Ch-containing compounds of phosphoethanolamine (Pe) and phosphocholine (PCh). In this cross-sectional geriatric study, 14 depressed patients and 14 healthy volunteers who were comparable in age, gender, education, comorbid medical burden, and Mini-Mental State Examination (MMSE) scores completed 2D MRS and a neurocognitive battery. A voxel in the left dorsolateral cortex, which was comprised of approximately 60% white matter, was used to estimate the CR ratios of Ch, PCh, Pe, and mI. Composite scores for cognitive function were developed for verbal learning, recall, recognition, executive function, hypothesis generation, and processing speed. Among nondepressed subjects, cognition was positively correlated with Ch/Cr and mI/Cr and negatively correlated with PCh/Cr in four domains of verbal learning, recognition, recall, and hypothesis generation. In contrast, depressed patients did not have consistent relationships between Ch/Cr, mI/Cr, and PCh/Cr and cognition. There was a significant difference in the overall pattern of associations between the four metabolites and verbal learning and processing speed in depressed patients compared to healthy controls. The attenuated relationship between metabolites and specific cognitive domains in patients with late-life MDD suggests that the level of cognitive performance observed during depressive episodes may be associated with changes in biochemistry within the frontostriatal neuronal circuitry.

Age Factors↗
PubMed2004

Validity of the Boston qualitative scoring system for the Rey-Osterrieth complex figure among depressed elderly patients.

A recent qualitative scoring method for the Rey-Osterrieth Complex Figure (ROCF), the Boston Qualitative Scoring System (BQSS), purports to assess visuospatial organization, visual memory and executive function by using multiple series of scores with well-defined criteria. The first objective of this study was to determine whether the BQSS cores correlated with scores derived from the tradition Osterrieth scoring method and which method was more efficient at separating the diagnostics groups. The second objective was to correlate the BQSS executive scores to other nonverbal and verbal tests of executive function, working memory, processing speed, and episodic memory to determine what cognitive abilities the BQSS scores were measuring. The subjects, older depressed patients and healthy controls, were free of any clinical sign of incipient dementia or comorbid neurological disease. Their ROCF drawings were scored using both the Osterrieth and BQSS methods. The BQSS summary drawing scores correlated well with the Osterrieth summary scores for the copy and short-delay recall phases, the percent retained over the delay period and recognition. The BQSS executive scores for Planning, which included both copy and recall phases, correlated with Matrix Reasoning indicating that they assessed nonverbal reasoning but they did not correlate with other traditional executive tests. Planning also contributed to the separation of diagnostics groups and was the most effective score for predicting the percent of the ROCF retained over a short delay. The remaining executive scores did not show a pattern of correlations with other nonverbal executive or working memory scores that would satisfy concerns regarding their interpretation or internal validity when used in an older and/or depressed population. No differences emerged between the two scoring methods in their efficiency for predicting depression.

Aged↗
PubMed2004

Quantifying age-related myelin breakdown with MRI: novel therapeutic targets for preventing cognitive decline and Alzheimer's disease.

Myelin plays an essential role in brain structure and function and the human brain is uniquely dependent on the elaboration of this late invention of evolution. Our brain has the most extensive and protracted process of myelination that extends to approximately age 50 in cortical regions that have the highest risk for developing Alzheimer's disease (AD) pathology. This myelin-centered model of the human brain asserts that unique vulnerabilities of myelin, especially late-developed myelin, and the oligodendrocytes that produce it are directly pertinent to many uniquely human neuropsychiatric diseases including late-life neurodegenerative disorders such as AD. Magnetic resonance imaging (MRI) technology permits the in vivo assessment of the roughly quadratic (inverted U) lifelong trajectory of human myelin development and its subsequent breakdown. There is close agreement between neuropsychology, neuropathology, and imaging measures suggesting that the process of myelin breakdown begins in adulthood, accelerates as aging progresses, and underlies both age-related cognitive declines and the most powerful risk factor of dementia-causing disorders such as AD: age. This myelin-centered model together with the technology that makes it possible to measure the trajectory of myelin breakdown provide a framework for developing novel treatments, as well as assessing efficacy of currently available treatments, intended to slow or reverse the breakdown process in both clinically healthy as well as symptomatic populations. Such treatments can be expected to have a wide spectrum of efficacy and impact multiple human disease processes including potentially slowing brain aging and thus provide opportunities for primary prevention of age-related degenerative disorders such as AD.

Adult↗
PubMed2004

Chart review of the impact of attention-deficit/hyperactivity disorder comorbidity on response to lithium or divalproex sodium in adolescent mania.

PURPOSE: Although adolescent onset of bipolar disorder is common, the optimal treatment approach for mania in this age group remains understudied. Comorbid attention-deficit/hyperactivity disorder (ADHD) has been reported to predict lithium resistance in adolescents with bipolar disorder. Little is known about response to dival-proex sodium in adolescents with bipolar disorder comorbid with ADHD. This study was conducted to evaluate comparative response rates to lithium and divalproex sodium in adolescent mania with and without this comorbidity. METHOD: Medical records were reviewed for 42 patients (ages 12-19 years) who were hospitalized for acute mania and discharged with a diagnosis of DSM-III-R or DSM-IV bipolar disorder on either lithium (N = 29) or divalproex sodium (N = 13) treatment. A clinician blinded to treatment status rated improvement on the basis of abstracted notes in each case utilizing the Clinical Global Impressions Scale modified for use in bipolar illness (CGI-BP). Response was defined as a discharge CGI-BP overall change score of 1 or 2 (much or very much improved). Data were collected from January 1992 through May 1999. RESULTS: 36/42 (85.7%) patients presented with mixed mania, and 14/41 (34.1%) patients had a history of ADHD. The overall response rate was 80.9% (34/42). 92.6% (25/27) of patients without ADHD were responders versus 57.1% (8/14) of subjects with comorbid ADHD (p =.007). There were no significant differences in response rates for lithium versus divalproex sodium in subjects with and without ADHD. CONCLUSION: These retrospective data suggest overall equivalent response rates for lithium and divalproex sodium in predominantly mixed adolescent mania. However, a history of ADHD was associated with a significantly diminished acute response to both divalproex sodium and lithium as a primary treatment for the manic phase of bipolar disorder.

Adolescent↗