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Reduced [3H]flunitrazepam binding in cingulate cortex and hippocampus of postmortem schizophrenic brains: is selective loss of glutamatergic neurons associated with major psychoses?

UNLABELLED: Findings. Specific [3H]flunitrazepam binding to "neuronal"-type sites was significantly lower in anterior cingulate cortex, hippocampus, somatomotor cortex, cerebellar cortex, and globus pallidus in small postmortem samples of schizophrenic brains than in non-schizophrenic controls. Four of these five brain regions were reported by others to exhibit atrophy and/or neuronal loss in schizophrenia. INTERPRETATION: Selective loss of hippocampal pyramidal neurons in postmortem schizophrenic brains has been reported (11). Pyramidal neurons are known to be glutamatergic (14,26) and to exhibit high densities of benzodiazepine binding sites (25,31). Glutamatergic neurons are known to be abundant in most layers of the cerebral cortex, and most of these are pyramidal neurons (26). All layers of the cerebral cortex display high densities of benzodiazepine binding sites (24,25,31). The number of larger pyramidal cells is little affected in most layers of the anterior cingulate cortex, but the number of small neurons is significantly lower, particularly in layer II (10). Pyramidal neurons range in size from very large to very small, and many very small pyramidal cells are often counted, together with small "stellate" neurons, as "granule" cells (28). Further, non-pyramidal glutamatergic neurons are reportedly also found in cerebral cortex (26). Thus, it seems possible that the large reduction in [3H]flunitrazepam binding we find in anterior cingulate cortex reflects the selective loss of glutamatergic neurons. The hypothesis that selective loss of glutamatergic neurons form various brain regions is associated with major psychoses can be easily tested by immunohistochemical studies of these regions using glutamate- and GABA-specific antibodies.

Adult↗

Objectivation of latent psychoses.

A method--the flicker-frequency-analysis (FFA)--is reported by which it is possible to differentiate latent psychoses with neurotic sensation- and behaviour-disorders and "neuroses". The consecutive early treatment prevents irreversible lesions.

Adult↗

Are mental diseases brain diseases? The contribution of neuropathology to understanding of schizophrenic psychoses.

Nearly a century after the seminal contributions of Emil Kraepelin, the search for neuropathologic correlates of schizophrenic psychoses continues. A multitude of neuroanatomic and neurochemical findings has emerged in recent years, but many of these findings are not replicated or are difficult to interpret in light of methodologic problems. In this review replicated neuropathologic and neuroimaging studies are discussed. The hypothesis that emerges from these studies is that schizophrenia is a developmental abnormality affecting the connectivity of the prefrontal and medial temporal cortices.

Brain↗

Acute psychoses: a proposed diagnosis for ICD-11 and DSM-V.

This paper concerns the diagnostic classification of nonaffective acute remitting psychosis (NARP), which we also term acute brief psychosis. We argue that NARP can be delineated from both schizophrenia and the affective psychoses and considered as a single diagnosis. As indicated by the term NARP, four criteria would be central to the diagnosis: 1. nonaffective, 2. acute onset (over less than two weeks), 3. recovery within a brief duration (less than six months), and 4. psychosis broadly defined. We review the rationale and the empirical evidence for this proposed classification.

Acute Disease↗

Season of birth in infantile autism and other types of childhood psychoses.

Season of birth in 328 children with infantile autism and other types of childhood psychoses born between 1945 and 1980 was compared with that of a control population born in the same period. For some parts of the period (the years 1951-56, 1963-68 and 1975-80 combined) an excess of March born boys with infantile autism was found. For boys with autistic-like disorders, born in the same period a maximum occurred in November, while no seasonality was observed for a borderline sample.

Adolescent↗

Plasma cyclic AMP and cyclic GMP in childhood-onset psychoses.

Plasma cyclic AMP is a "second messenger" that may reflect levels of activity of important neurotransmitter receptors. Plasma cyclic AMP was measured in 18 patients with childhood autism, 7 patients with pervasive developmental disorder, and 12 age- and sex-matched healthy controls. Plasma cyclic AMP was significantly elevated by over 100% in both groups of patients with childhood-onset psychoses compared with controls. Plasma cyclic GMP, a nucleotide linked to different receptors, was not elevated, suggesting that the finding may be specific.

Adolescent↗

Mitochondrial involvement in schizophrenia and other functional psychoses.

Gene expression has been studied in post-mortem frontal cortex samples from patients who had suffered from schizophrenia and depressive illness. mRNA was extracted and characterised by translation and separation of the products by 2D gel electrophoresis. Post-mortem artefacts and the agonal experience did not affect the size distribution or amount of specific translation products. Four expression products were specifically reduced in samples from schizophrenics compared with normals. The expression of six products was altered in affective disorder, one in common with schizophrenia, two the same as in schizophrenia but increased. cDNA libraries were produced from the mRNA samples and 5 clones present at abnormal levels in schizophrenia identified by differential screening, isolated and sequenced. All the sequences encode mitochondrial transcripts; four encode mitochondrial rRNA and one the amino acid sequence of cytochrome oxidase sub-unit II. Increased cytochrome oxidase transcripts were found in a further set of mRNA extracts from schizophrenic patients including two who had not received neuroleptic medication. The effects of neuroleptic administration as exemplified by alpha-flupenthixol compared with the ineffective beta-flupenthixol were studied in experimental animals. It was found that 13 out of 28 clones whose levels were altered were mitochondrial in origin including rRNA, COX I & II and the NADH-Q reductase. Those encoding respiratory enzymes were at abnormally low levels as a result of alpha-flupenthixol administration. Measurements of the enzymic activity of cytochrome c oxidase in post-mortem frontal cortex of schizophrenics did not indicate any differences in overall activity but there was a decreased sensitivity to azide that was abolished by neuroleptics. Studies on NADH-cytochrome c reductase showed that schizophrenics whether medicated or not had a reduced rotenone sensitive activity that was compensated for by increased rotenone insensitive activity. We conclude that changes in mitochondrial gene expression are involved in schizophrenia and probably other functional psychoses.

Adult↗

[Personality disorders and schizophrenic psychoses].

We analysed two aspects of personality abnormality detected before the disorder became diagnostically apparent: potential genetic disposition, assessed using family and adoption studies, and premorbid constitution, which we outlined using retrospective and prospective studies. Current continuum models of the schizophrenic spectrum suggest that genetic disposition and premorbid constitution overlap to some extent, an area which ought to be better defined psychopathologically. In this overview, we determined a group of symptoms-bizarre behaviour, alogia, social withdrawal, and subclinical thought disorders-which are relevant for both schizotypal personality disorders and early schizophrenia. The topic of so-called reactive psychoses is examined to find an interface between personality abnormality and psychosis.

Genetic Predisposition to Disease↗

[Leukopenia associated with butyrophenones. A successful treatment of psychoses with pulsed administration of neuroleptics].

In the monotherapeutic treatment of an acute schizophrenic psychoses with butyrophenones (haloperidol and benperidol) we saw immediate leucopenic reactions when the medication was given every day. In literature the risk of butyrophenone-induced blood dyscrasias seems to be underestimated. Therefore we decided to report this single case evaluation. When benperidol (short elimination--half life period) was given every other day ("interval-therapy") the blood cell count of the leucocytes normalized. Furthermore, the amount of psychopathological abnormalities measured by the Brief Psychiatric Rating Scale decreased under this intermittent treatment.

Antipsychotic Agents↗

Household crowding and compliance with outpatient treatment in patients with non-affective functional psychoses in São Paulo, Brazil.

BACKGROUND: Compliance with outpatient treatment can reduce the use of psychiatric inpatient services by people with severe mental disorders. In developing countries, socio-economic factors may be associated with compliance with outpatient treatment. METHODS: A 2-year prospective cohort study was conducted of 99 patients with non-affective functional psychoses who were discharged from hospital. Standardized assessments were used for psychopathology, social functioning and use of psychiatric services. RESULTS: Forty-two patients (42.4%) missed all outpatient appointments for at least 2 consecutive months. Household crowding was the only variable associated with poor compliance, patients living in very crowded homes being more than twice as likely to show poor compliance as those living in less crowded homes. CONCLUSIONS: In large urban centres in developing countries, strategies to improve compliance with outpatient treatment targeted towards those living in overcrowded households may reduce use of psychiatric beds.

Adolescent↗

Mental health care for Asian, black and white patients with non-affective psychoses: pathways to the psychiatric hospital, in-patient and after-care.

BACKGROUND: This UK-based study compares the pathways to the psychiatric hospital and the provision of in-patient and after-care for Asian, black and white patients with non-affective psychoses. METHODS: Two overlapping samples of 120 patients, 40 from each ethnic group, were drawn; one on admission and the other at discharge. In addition to socio-demographic data, details were obtained on the pathways to care and the in-patient episode. An assessment of needs and service provision was undertaken 3 months post-discharge. Patient satisfaction was ascertained at each stage. RESULTS: Asian and especially black patients experienced more complex pathways and had higher levels of both involvement with the police and compulsory detention than their white counterparts. They were less likely to perceive themselves as having a psychiatric problem or as needing to go into hospital and expressed less satisfaction with the admission process. Black patients, as compared to Asian but especially white patients, were more often detained in hospital against their will, confined to the ward and treated within a secure environment. However, there were few differences in satisfaction with hospital care. Likewise, perceptions of unmet need, provision of after-care and satisfaction with services were similar across the ethnic groups. CONCLUSIONS: The implications of these findings are discussed. The potential of early intervention programmes and home treatment services to address the ethnic differentials identified in this study merit consideration.

Adolescent↗

Validity and reliability of leonhard's classification of endogenous psychoses: preliminary report on a prospective 25- to 30-year follow-up study.

A 25- to 30-year controlled follow-up investigation of endogenous psychoses started in 1997. The research program labeled "Budapest 2000" was initiated in 1967 as a controlled prospective study. The assessment of 108 patients and 24 normal control persons has so far been completed. With regard to the "middle groups" in the Leonhardian classification, diagnoses of bipolar manic-depressive psychosis, cycloid psychosis, periodic catatonia, systematic paraphrenia, systematic catatonia and hebephrenia proved to be valid in the long term. Revision of the category affect-laden paraphrenia seems to be called for.

Female↗

Developmental malformations in cerebral structures in "endogenous psychoses".

The last decades have revealed several structural deviances in patients with so called "endogenous psychoses". Reasonably well established are the enlargement of the lateral ventricles and subtle structural deficits in temporobasal and orbital frontal structures (hypofrontality) in a majority of schizophrenic patients. It is the aim of this investigation to examine the cytoarchitecture of these important central structures, namely the entorhinal region and the orbitofrontal cortex (Brodmann area 11) which have been under meticulous investigation in our laboratories over decades (for review: Beckmann, 2000).

Animals↗

A model of subjective quality of life for outpatients with schizophrenia and other psychoses.

This study investigated predictors of quality of life among persons with schizophrenia and other psychoses. On the basis of previous research, it was hypothesised that objective life circumstances, self-variables, psychopathology, activity level, satisfaction with daily activities, and satisfaction with medical care would be determinants of quality of life. 134 persons were investigated, and the analysis was based on Structural Equation Modelling (SEM). A model with two quality of life variables, General quality of life and Security, fitted the data best. A self-variable, Sense of self, and Satisfaction with daily activities, Psychopathology, and Satisfaction with medical care served as mediators and explained the variation in the quality of life variables. External to the mediators, and related to these, were Activity level, Educational level, and Independent living. In conclusion, a self-variable showed the strongest association with quality of life, but two aspects that should be feasible to influence in mental health care, daily activity and medical care, contributed to the subjects' self-rated quality of life. These results render a somewhat optimistic view on how to accomplish a better self-perceived quality of life among people with severe mental illness.

Activities of Daily Living↗

What risk factors tell us about the causes of schizophrenia and related psychoses.

Genetic, epidemiologic, and molecular studies concur that liability to schizophrenia is transmitted through the inheritance of a number of genes of relatively small effect, some of which are shared with other psychoses. Each of these susceptibility genes causes minor deviations that are relatively innocent in themselves, for example, increased lateral ventricular volume, schizotypal personality, or subtle cognitive difficulties. However, when an individual is unlucky enough to inherit several of these traits, their cumulative effect, often compounded by environmental hazards, propels that person over a threshold for the expression of frank psychosis. Early environmental risk factors for schizophrenia include urban and winter birth, fetal malnutrition and hypoxia, and possibly prenatal viral infections; these early hazards have only a modest risk-increasing effect, and operate in the context of genetic risk. Preschizophrenic children are more likely to have minor psychomotor and cognitive problems; low IQ has a linear relationship with risk for schizophrenia. However, schizophrenia is not simply a neurodevelopmental disorder, because risk factors have been identified that have their effects proximal to the onset of psychosis: drug abuse, immigrant status, and social adversity and isolation. Both genetic and environmental risk factors appear to operate across diagnostic categories and therefore support a dimensional model of psychosis.

Brain↗

Imbalance of hemispheric functions in the major psychoses: a study of handedness in the People's Republic of China.

A study of hand preference and eye dominance in schizophrenia, manic-depressive psychosis, and normal controls was carried out in the People's Republic of China. An excess of sinistrality was found in both men and women schizophrenics, but not in manic-depressive patients. Both the manic-depressive and schizophrenic psychoses are characterized by a significant excess of left eye dominance and by an increasing divergence between eye and hand dominance when compared to the controls. The major published studies investigating hand preference in psychopathology are reviewed, and possible interpretations of the conflicting findings are suggested.

Adolescent↗

Prolactin response to submaximal stimulation by TRH in nonaffective psychoses.

Nonaffective psychotic symptoms are heterogeneous and probably caused by mixed biopathology. A preliminary investigative tool to study pituitary dopamine activity, the prolactin response to submaximal stimulation by thyrotropin-releasing hormone (TRH) (mini-TRH test) was correlated in 20 subjects with nonaffective psychoses to positive psychotic symptoms as assessed by the Comprehensive Psychiatric Rating Scale psychosis subscale. A significant positive correlation was observed between the response and ratings of nonparanoid symptoms, especially nonparanoid delusions and disrupted thoughts. Because, in addition to pituitary dopamine activity, there is evidence to suggest that the response reflects extrapituitary dopamine activity as well, the results extend the evidence that nonparanoid acute productive psychotic symptoms may be associated with hypoactivity rather than with hyperactivity of brain dopaminergic systems.

Adult↗

Basal and haloperidol-stimulated prolactin and symptoms of nonaffective and affective psychoses in neuroleptic-free men.

The prolactin (PRL) response to 0.5 mg of intravenous haloperidol (HPL) IV may be a measure of tuberoinfundibular dopaminergic activity. Our earlier reports, using multidiagnostic strategies in schizophrenia, suggested that psychoses characterized by the absence of affective syndromes (Keks et al 1990) and the presence of thought disorder and passivity delusions (Keks et al 1992) are linked to blunted PRL responses. In this paper we evaluated the relationships between basal and HPL-stimulated PRL concentrations, and a number of potentially relevant symptom measures. Basal PRL was lower in patients without a depressive syndrome and suicidal ideation. Stimulated PRL was lower in patients without neurovegetative symptoms (versus patients with neurovegetative symptoms and controls), with depression (versus patients with no depression and controls) and those with disorder of associations (versus patients without association disturbance and controls). These findings can be interpreted as indicating a link between endocrine measures of dopaminergic function and a subtype of schizophrenic psychosis characterized by the presence of thinking disturbance in the absence of depression.

Adult↗