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We have examined gyral folding in a total of more than 500 subjects with first episode schizophrenia, subjects at high risk who do and do not become ill, people with learning disabilities (LD) with and without schizophrenia, and LD with schizotypal or autistic features, as well as appropriate healthy controls.
The gyrification index (GI), the ratio of the inner and outer cortical surface contours, was hand-traced bilaterally on every second 1.88-mm image slice throughout the brain in about 100 scans. We then developed an Automated-GI (A-GI) approach to determine cortical folding in pre-frontal lobes, and have applied this to the other scans.
Gyrification index values were significantly increased in the right temporal lobe of the schizophrenic patients. Right prefrontal lobe GI values were significantly increased in high risk individuals who subsequently developed schizophrenia (especially in BA 9 and 10). A-GI reduces the analysis time, improves repeatability, has low susceptibility to scanner noise and variability. Using A-GI we have replicated hand-traced results and also found a similar pattern of increased ‘gyrification’ in LD with schizophrenia or schizotypy but not LD alone or with autistic features.
Differences in fronto-temporal GI might reflect trait disconnectivity predictive of schizophrenia across a range of IQ levels. GI is however poorly understood and influenced by age, sex and volume measures. Further examination of sulco-gyral patterns is required to clarify this. A-GI could be usefully applied to MRI data sets of the brain in health and disease to address these issues.
Following reunification in Germany in 1990 the new states in the Federal Republic faced the task of restructuring and rebuilding the structures of complementary care for the chronically mentally ill. First and foremost, residential facilities had to be established that would correspond to and meet the currently high need for de-hospitalization by making different types of care and care concepts available. Five groups of patients with chronic schizophrenic psychoses (N = 245 patients) who live in different types of psychiatric care facilities (psychiatric nursing home, social therapeutic hostel, sheltered community residence) or at home, either with or without a family network, were studied. In addition to the sociodemographic data, the psychopathology and the extent of social disabilities were also surveyed, as well as data on the living situation and the subjective quality of life with an emphasis on ‘social relationships’, ‘recreation/leisure activities’, and ‘general independence’.
The five groups differed with regard to various sociodemographic and disorder-related variables, particularly with regard to the extent of social disabilities. Especially relevant, however, are the differences among the patient groups in the extent of daily social life and recreational/leisure activities that are partially reflected in their statements on the subjective quality of life. Primarily for the two groups of home residents, but also in part for the patients living in sheltered community care, social contacts are more or less limited to the residential situation and patients are more or less otherwise socially isolated. This is due among other things to the fact that patients who have been hospitalized for long periods do not as a rule return to their prior area of residence; thus, the available compensatory mediation of relationships with the social environment does not suffice. Demands for the further development of complementary systems of psychiatric care derive from these findings.
The analysis of standardized reports on the national legal situations on involuntary admission to psychiatric hospitals. This work revealed major cross-national differences, e.g. for basic conditions as well as for additional criteria for involuntary admission, time periods for making decisions, the association between involuntary placement and treatment, patients’ rights to register complaints, roles of relatives, and safeguard procedures of these processes.
One of the clinical results (established by the assessment of 2326 legally involuntary patients) was that in the different countries, between 39% and 71% of the patients found the admission right after one month, and between 46% and 86% after three months. Female patients, those living alone and those with a diagnosis of schizophrenia had more negative views. Adjusting for confounding factors, differences between countries were significant. The presentation will outline that a potential explanation of these differences is the extent to which national mental health legislation protects the rights and interests of the patients concerned.
Thus, the important, but complex link between coercive measures and legal aspects will be demonstrated. Further, the discussion section of this presentation will focus on legal issues which could be (cross-nationally) harmonized in the sensitive field of coercive treatment.
Patients suffering from psychotic disorders are the most common to be admitted to psychiatry departments and treated against their will. All patients in this study were included in the international project EUNOMIA, which is focused on the contemporary use of coercive measures in psychiatry. The purpose of this study was to compare the voluntary and involuntary admitted patients, measured as improvement of psychopathology and social functioning.
120 involuntary and 18 voluntary patients, who met the criteria for an F2 disorder and subjective felt coercion at the admission measured by the McArthur Scale were included. They were assesed three times, in the first week and at the end of first and third month after admission with Brief Psychiatric Rating Scale - BPRS and Global Assessment of Functioning - GAF Scale. Outcome was defined as a change in the total BPRS and GAF scores between first and third observation.
There was no significant difference in the total BPRS (voluntary T1 48.6±13.3, T3 35.5±10.2, and involuntary T1 50.5±12.8, T3 32.2±8.6) or GAF (voluntary T1 38.1±14.7, T3 63.6±10.3 and involuntary T1 29.8±12.8, T3 63.6±17.1) changes, (p<0,05). In the lenght of stay both groups significantly differ, voluntary 30.8±15.9 resp. involuntary 51.5±51.6 days.
Inpatients with schizophrenia who were treated involuntary, improved at the same level as the voluntary ones, however the lenght of hospital stay was shorter by voluntary patients.
Atomoxetine, a highly selective noradrenaline reuptake inhibitor, shows efficacy in the treatment of ADHD. Despite evidence that atomoxetine improved inhibitory control in animals and healthy volunteers, studies had yet to explore short-term cognitive effects in patients with ADHD.
The cognitive effects of a single oral dose of atomoxetine (60mg) were evaluated in n=22 adults with DSM-IV ADHD, using a within-subject placebo-controlled double-blind design. Assessment included the stop-signal test and Rapid Visual Information Processing test from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Cardiovascular responses were monitored. Normative cognitive data from 20 healthy volunteers were collected for comparison.
Atomoxetine was associated with shorter stop-signal reaction times (p<0.05) and lower numbers of commission errors (p<0.05) on the sustained attention task in the ADHD patients.
These findings suggest that atomoxetine exerts beneficial effects on aspects of inhibitory control in ADHD, which may belie the efficacy of this medication in the treatment of impulsive features of the disorder. These findings also have potential clinical implications for other impulse dysregulation disorders such as trichotillomania and Tourette's Syndrome.
Characteristics of DSM-IV attention-deficit/hyperactivity disorder (ADHD) in adults can also be found as part of other psychiatric disorders. This study investigated the specificity of adult ADHD features in relation to patients with borderline personality disorder (BPD), a syndrome which shares some of its intrinsic features with ADHD and often co-occurs with ADHD. A group of 20 adult patients selected on the basis of a diagnosis of ADHD and 20 patients selected on the basis of a diagnosis of BPD were assessed by the self-report Attention Deficit Scales for Adults (ADSA). The two groups were matched for age, verbal IQ and gender. Of the nine ADSA scales, seven showed significant inter-group differences, in particular involving attention, organisation and persistence. The ‘Consistency/Long-Term’ scale, which mainly reflects impaired task and goal persistence, was the best discriminator between the groups. Furthermore, ratings on this scale correlated significantly with the error score of a computer-administered task of spatial working memory, the performance of which has been reported to be impaired in patients with ADHD. The results provide further validation for the ADSA scales and support a previous claim that ‘long-term consistencies’, i.e., related to task and goal persistence, is ‘the centrepiece behavioural issue’ for adults with ADHD.
Available evidence suggests that, compared with women, men have earlier age of onset of schizophrenia, poorer course and medication response, fewer affective symptoms and worse premorbid social and intellectual functioning. However there is a lack of data concerning gender differences in patients treated against their will.
54 male and 65 female patients, who met the criteria for an F2 disorder according to the ICD-10 at the admission were included. They were assessed three times, in the first week and at the end of first and third month after admission. A broad range of structured assessment instruments has been used to assess psychopathology, social functioning, subjective quality of life, perceived coercion concerning admission, satisfaction with the treatment, socio-demographic characteristics, etc.
The results indicates that there is no significant difference when comparing changes in total scores in psychopathology, satisfaction with therapy and quality of life. But there is a gender discrepancy when comparing certain single items from the scales, e.g. men were more severely impaired in ratings of grandiosity and unusual thought content, while women manifesting slightly better social functioning. Also in some socio-demographic features, in the use of coercive measures and in the reasons why are they applied gender plays a role.
In the majority of observed aspects concerning involuntary treatment, we have not found radical differences when it comes to gender. However, there are distinct disparities mainly in social functioning sphere, particular quality of life components and the motives for using coercive measures.
The EUNOMIA international project focuses on the application of coercive measures in psychiatric treatment. The use of coercive measures to mentally ill people is a very sensitive topic. The type and frequency of this action is influenced by different cultural or legal traditions, general attitudes toward mentally ill people and the structure and quality of mental health care systems.
Presentation of the frequency and way of administration of coercive measures to psychiatric inpatients with acute mental illness in the Czech Republic.
All coercive measures used during hospitalization (restraint, seclusion, forced medication) were documented in detail in special form. The definition of coercive measures was following: Restraint - fixation of at least one limb for longer than 15 minutes. Forced medication – the use of restraint or high psychological pressure to administer medication.Seclusion -involuntary placement of the patient alone in a locked room.
We have evaluated the group of 202 involuntarily admitted patients and the group of 59 voluntarily admitted patients perceiving some coercion at admission.
Restraint, forced medication or/ and seclusion were used in 45,5% of involuntarily admitted patients. In 2/3 of these patients some coercive measure was repeated. In the group of voluntarily admitted patients coercive measures were used only marginally (5,1%).
The most frequent measure used was forced medication. Mainly typical antipsychotics and benzodiazepins were administered.
Presented results show the praxis with the use of coercive measures in the Czech Republic. The data were gathered within the EUNOMIA project.
Obsessive compulsive disorder (OCD) is a highly heritable neuropsychiatric disorder. Attempts to elucidate contributing genes have met with limited success. Intermediate markers of brain dysfunction (cognitive endophenotypes) may help focus the search for genetic contributions. Such markers should be present in people at risk of developing OCD in the absence of clinical symptoms. In prior work, OCD patients showed impairment on tests of response inhibition and cognitive flexibility (Chamberlain et al., 2005, 2006).
First-degree relatives of OCD patients, patient probands, and matched healthy volunteers without a family history of OCD undertook neuropsychological assessment (n=20 per group).
Compared to matched controls without a family history of OCD, unaffected first-degree relatives of OCD patients showed impaired response inhibition (p<0.05) and cognitive flexibility (p<0.05). These deficits were comparable to those in the patients themselves.
Brain-based cognitive markers of inhibitory functions may be of utility in the search for OCD endophenotypes. Examination of relationships between these abnormalities, genetics, and structural/functional brain changes, will help to elucidate aetiological contributions to OCD and putative spectrum disorders.
In the recent years, interest of researchers has been focused on exercise as a possible way to efficiently influence brain functions and plasticity. Several studies concluded that exercise can change brain morphology by affecting synapses, neurogenesis and angiogenesis and improve efficiency in working memory and executive performance. In schizophrenia, white matter integrity is compromised and to what extent exercise affects white matter integrity is unclear.
To investigate the effect of 6 months exercise therapy on white matter integrity in healthy controls and patients with schizophrenia.
A total of 33 patients with schizophrenia and 48 healthy controls, matched for demographic characteristics, were randomized into exercise or occupational therapy/life-as-usual. 3T-DTI data were acquired twice. After susceptibility-artifacts and ECC correction, TBSS was used for registration to standard space and computation of the FA-skeleton. The JHU-ICBM-tract atlas was used to define regions of interest (ROI) for the various fiber tracts. Mean FA values for the FA-skeleton within the separate tract ROIs were calculated. GLM-repeated measures design was done with time as within-subject factor, group and therapy as between-factors, and compliance as covariate.
Significant increases in FA were found for time by randomization in the left corticospinal tract (LCST) (F=4,15, p=0,045), left superior longitudinal fascicle (LSLF)(F=5,092, p=0,027) and forceps major (F=5,687, p=0,02).
Exercise positively affects FA of tracts involved in primary motor functions (LCST), regulation of motor behavior, spatial attention, oculomotor functions and transfer of somatosensory information (LSLF) as well as interhemispheric connections (Forceps major) in both groups.
Although neuroimaging studies suggest brain regional abnormalities in depressive disorders, it remains unclear whether abnormalities are present at illness onset or reflect disease progression.
We hypothesized that cerebral variations were present in adolescents with subthreshold depression known to be at high risk for later full-blown depression.
We examined brain structural and diffusion-weighted magnetic resonance images of adolescents with subthreshold depression.
The participants were extracted from the European IMAGEN study cohort of healthy adolescents recruited at age 14. Subthreshold depression was defined as a distinct period of abnormally depressed or irritable mood, or loss of interest, plus two or more depressive symptoms but without diagnosis of Major Depressive Episode. Comparisons were performed between adolescents meeting these criteria and control adolescents within the T1-weighted imaging modality (118 and 475 adolescents respectively) using voxel-based morphometry and the diffusion tensor imaging modality (89 ad 422 adolescents respectively) using tract-based spatial statistics. Whole brain analyses were performed with a statistical threshold set to p< 0.05 corrected for multiple comparisons.
Compared with controls, adolescents with subthreshold depression had smaller gray matter volume in caudate nuclei, medial frontal and cingulate cortices; smaller white matter volume in anterior limb of internal capsules, left forceps minor and right cingulum; and lower fractional anisotropy and higher radial diffusivity in the genu of corpus callosum.
The findings suggest that adolescents with subthreshold depression have volumetric and microstructural gray and white matter changes in the emotion regulation frontal-striatal-limbic network.
The role of forebrain serotonin (or 5-hydroxytryptamine, 5-HT) in the chemical neuromodulation of mammalian behaviour remains unclear. Two prominent hypotheses are that it is implicated primarily in (i) behavioural inhibition; or ii) aversive punishment, although distinguishing between these hypotheses is difficult because of intrinsic asymmetries in how these systems control behavior. Previous, apparently paradoxical, findings appear to show that 5-HT depletion both reduces and enhances the effects of aversive reinforcers in humans and rodents, suggesting independent modulations of dissociable neural systems. Evidence will be surveyed from experimental animals, using intra-cerebral treatments with a selective 5-HT neurotoxin, 5,7 dihydroxytryptamine, or microinfusions of selective 5-HT receptor agents, and from human volunteers using acute dietary depletion of tryptophan (ATD) or systemic treatments with serotonin re-uptake inhibitors, in order to address these distinctions. Central manipulations of 5-HT generally disrupt behavioural inhibition, including both impulsive and compulsive behaviour, although often with no effect on sensitive measures of response inhibition in the stop-signal reaction time task. Some evidence in humans using ATD suggests that the behavioral inhibition is greater for aversively motivated than appetitively motivated behavior. However, in direct comparisons of effects of local depletions of 5-HT in the orbitofrontal cortex and amygdala in the marmoset monkey, both forms of motivated behavior are impaired, especially in the anticipatory phase of behavioural response to impending appetitive or aversive reinforcers. These findings are related to a variety of neuropsychiatric disorders in which 5-HT dysregulation has been postulated, including depression, drug addiction and obsessive-compulsive disorder.
Stimulant dependence is commonly associated with decreases in cortical volume in inhibitory control regions, such as the orbitofrontal cortex (OFC). Obese individuals similarly show abnormalities in frontal gray matter, with volume reductions correlating with BMI. These structural deficits may contribute to underlying problems with impulsivity or self-control present in both groups.
Shared structural abnormalities relating to over-consumption of food or drugs of abuse could shed light on similar neurocognitive impairments associated with these behaviors (loss of control, poor decision-making), and could provide evidence for the classification of over-eating as an addictive disorder.
To identify overlapping regions of gray matter volume loss associated with both stimulant dependence and increased BMI, specifically in the OFC.
Structural MRI scans of stimulant dependent and healthy control individuals were compared using voxel based morphometry analysis. OFC volume was correlated with BMI in all participants, as well as years of drug use in stimulant dependent individuals.
Both stimulant use and BMI negatively correlated with bilateral OFC gray matter volume. Additionally, select OFC regions showed decreases relating to both variables, indicating an overlap between volume loss associated with years of use and BMI in both stimulant dependent and control individuals.
Overlapping decreases in OFC gray matter volume that correspond to both overeating and drug use severity indicate underlying commonalities between these two behaviors. This suggests there may be shared cognitive deficits maintained in the OFC, such as poor inhibitory control or decision-making abilities, that preclude these types of behaviors.
Invasive rodents detrimentally affect native bird species on many islands worldwide, and rodent eradication is a useful tool to safeguard endemic and threatened species. However, especially on tropical islands, rodent eradications can fail for various reasons, and it is unclear whether the temporary reduction of a rodent population during an unsuccessful eradication operation has beneficial effects on native birds. Here we examine the response of four endemic land bird species on subtropical Henderson Island in the Pitcairn Island Group, South Pacific Ocean, following an unsuccessful rodent eradication in 2011. We conducted point counts at 25 sampling locations in 14 survey periods between 2011 and 2015, and modelled the abundance trends of all species using binomial mixture models accounting for observer and environmental variation in detection probability. Henderson Reed Warbler Acrocephalus taiti more than doubled in abundance (2015 population estimate: 7,194-28,776), and Henderson Fruit Dove Ptilinopus insularis increased slightly between 2011 and 2015 (2015 population estimate: 4,476–10,072), while we detected no change in abundance of the Henderson Lorikeet Vini stepheni (2015 population estimate: 554–3014). Henderson Crake Zapornia atra increased to pre-eradication levels following anticipated mortality during the operation (2015 population estimate: 4,960–20,783). A temporary reduction of rat predation pressure and rat competition for fruit may have benefitted the reed warbler and the fruit dove, respectively. However, a long drought may have naturally suppressed bird populations prior to the rat eradication operation in 2011, potentially confounding the effects of temporary rat reduction and natural recovery. We therefore cannot unequivocally ascribe the population recovery to the temporary reduction of the rat population. We encourage robust monitoring of island biodiversity both before and after any management operation to better understand responses of endemic species to failed or successful operations.