Cerebellar hypoactivity in frequent marijuana users

It is uncertain whether frequent marijuana use adversely affects human brain function. Using PET, regional cerebral blood flow was compared in frequent marijuana users and comparable, non-using controls after at least 26 h of monitored abstention by all subjects. Marijuana users showed substantially lower brain blood flow than controls in a large region of posterior cerebellum, indicating altered brain function in frequent marijuana users. A cerebellar locus of some chronic and acute effects of marijuana is plausible, e.g. the cerebellum has been linked to an internal timing system, and alterations of time sense are common following marijuana smoking.

Cognitive correlates of the negative, disorganized, and psychotic symptom dimensions of schizophrenia

Knowledge of the relationship between specific cognitive abnormalities and the clinical symptoms of schizophrenia could give insight into the nature of their underlying pathophysiology. Composite scores were generated for negative, disorganized, and psychotic symptom ratings in 134 patients with schizophrenia (DSM-IV criteria). Partial correlations (each composite corrected for the others) were computed with neuropsychological measures. Negative symptoms were related to poor performance on tests of verbal learning and memory, verbal fluency, visual memory, and visual-motor sequencing. Disorganized symptoms were correlated with lower verbal IQ and poor concept attainment. Psychotic symptoms had no significant relationship with cognitive deficit.

Association between cytochrome P4502D6 (CYP2D6) genotype, antipsychotic exposure, and abnormal involuntary movement scale (AIMS) score

Antipsychotic metabolism cosegregates with the polymorphic cytochrome P4502D6 (CYP2D6) hepatic enzyme. Approximately 5-10% of Caucasians show impaired metabolism associated with nonfunctional alleles. Genotyping determines the number of functional alleles, which is phenotypically not possible. The aim of this study was to investigate associations between CYP2D6 genotype, antipsychotic exposure, and abnormal involuntary movement scale (AIMS) score. Schizophrenic patients (DSM-IV) were genotyped for CYP2D6*1, *3, and *4 alleles by nested polymerase chain reaction. A complete history, including psychiatric symptoms, medications and AIMS score was obtained. Antipsychotic exposure was recorded in dose years [(chlorpromazine equivalents x years)/100]. A linear regression model used AIMS scores as the dependent variable. Genotype, gender, antipsychotic exposure, and interactions were independent variables. The results of the 31 patients studied showed: 20 were homozygous for the *1 allele (*1/*1) and 11 were heterozygous for the *1 allele (i.e. *1/*3 or *4). Age, sex, age of onset, treatment duration, antipsychotic exposure, and AIMS scores did not differ between groups. The interaction between dose years and genotype was significant (P < 0.0055), demonstrating that for (*1/*1) patients, the magnitude of antipsychotic exposure had a greater effect on AIMS score (slope = 0.044) compared with (*1/*3 or *4) patients (slope = 0.001). These results suggest patients with a *3 or *4 allele may have a higher risk for developing antipsychotic induced abnormal movements.

Personality change disorder in children and adolescents following traumatic brain injury

The occurrence of personality change due to traumatic brain injury (PC), and its clinical and neuroimaging correlates were investigated. Ninety-four children, ages 5 through 14 at the time of hospitalization following traumatic brain injury (TBI; severe TBI N = 37; mild-moderate TBI N = 57), were assessed. Standardized psychiatric, adaptive functioning, cognitive functioning, family functioning, family psychiatric history, severity of injury, and neuroimaging assessments were conducted. The Neuropsychiatric Rating Schedule (NPRS) was used to establish a diagnosis of PC. Approximately 40% of consecutively hospitalized severe TBI participants had ongoing persistent PC an average of 2 years postinjury. An additional approximately 20% had a history of a remitted and more transient PC. PC occurred in 5% of mild-moderate TBI but was always transient. Interrater reliability for the diagnosis of PC was good (Kappa = .70). In severe TBI participants, persistent PC was significantly associated with severity of injury, particularly impaired consciousness over 100 hr, adaptive and intellectual functioning decrements, and concurrent diagnosis of secondary attention deficit hyperactivity disorder, but was not significantly related to any psychosocial adversity variables. These findings suggest that PC is a frequent diagnosis following severe TBI in children and adolescents, but is much less common following mild-moderate TBI.

Charting patients' course: a comparison of statistics used to summarize patient course in longitudinal and repeated measures studies

Investigators conducting longitudinal studies of psychiatric illnesses often analyze data based on psychiatric symptom scales that were administered at multiple time points. This study examines the statistical properties of seven indices that summarize patient long-term course. These indices can be used to compare differences between two or more groups or to test for changes in symptoms over time. They may also be treated as outcome measures and correlated with other clinical variables.The performance of each of the seven indices was assessed using data from two large ongoing studies of psychiatric patients: a longitudinal study of affective disorders and a longitudinal study of first-episode psychosis. These two datasets were subjected to bootstrapping techniques in order to calculate both type I error rates and statistical power for each summary statistic. Of the seven indices, Kendall's tau performed the best as a measure of patients' symptom course. Kendall's tau appears to offer more statistical power to detect change in course, yet its average type I error rate was comparable to the other indices.

Effects of frequent marijuana use on brain tissue volume and composition

To investigate CNS effects of frequent marijuana use, brain tissue volume and composition were measured using magnetic resonance imaging (MRI) in 18 current, frequent, young adult marijuana users and 13 comparable, non-using controls. Automated image analysis techniques were used to measure global and regional brain volumes, including, for most regions, separate measures of gray and white matter. The marijuana users showed no evidence of cerebral atrophy or global or regional changes in tissue volumes. Volumes of ventricular CSF were not higher in marijuana users than controls, but were, in fact, lower. There were no clinically significant abnormalities in any subject's MRI. Sex differences were detected in several global volume measures.

The cerebellum plays a role in conscious episodic memory retrieval

The cerebellum has traditionally been considered to be primarily dedicated to motor functions. Its phylogenetic development and connectivity suggest, however, that it also may play a role in cognitive processes in the human brain. In order to examine a potential cognitive role for the cerebellum in human beings, a positron emission tomography (PET) study was conducted during a "pure thought experiment": subjects intentionally recalled a specific past personal experience (consciously retrieved episodic memory). Since there was no motor or sensory input or output, the design eliminated the possibility that cerebellar changes in blood flow were due to motor activity. During silent recall of a consciously retrieved episodic memory, activations were observed in the right lateral cerebellum, left medial dorsal thalamus, medial and left orbital frontal cortex, anterior cingulate, and a left parietal region. These activations confirm a cognitive role for the cerebellum, which may participate in an interactive cortical-cerebellar network that initiates and monitors the conscious retrieval of episodic memory.

Conjugal loss and syndromal depression in a sample of elders aged 70 years or older

OBJECTIVE

The goal of this study was to describe the association between conjugal loss and both syndromal depression and depressive symptoms in a prospective cohort study of people aged 70 years or older.

METHOD

A measure of syndromal depression, the shortform Composite International Diagnostic Interview (CIDI), and a revised version of the Center for Epidemiologic Studies--Depression Scale (CES-D Scale) were administered to a group of 5,449 elders in a longitudinal cohort study. The authors compared the rates of syndromal depression (CIDI diagnosis) and depressive symptoms (six CES-D Scale symptoms) in married participants and those who lost spouses between the first and second waves of assessment.

RESULTS

The rate of syndromal depression in the newly bereaved was nearly nine times as high as the rate for married individuals, and the rate of depressive symptoms was nearly four times as high. The percentage of the bereaved respondents who had scores above threshold on the revised CES-D Scale was higher for those interviewed up to 2 years after loss of a spouse than for married respondents. Age, sex, prior psychiatric history, and the expectedness of the death did not differ between depressed and nondepressed newly bereaved subjects.

CONCLUSIONS

Recent bereavement is a significant risk factor for syndromal depression in the elderly. Some widows and widowers experienced high levels of depressive symptoms up to 2 years after the loss of their spouses. Neither demographic variables nor variables concerning the nature of the spouse's death predicted bereavement-related depression.

Caudate size in first-episode neuroleptic-naive schizophrenic patients measured using an artificial neural network

BACKGROUND

Structural brain imaging studies have demonstrated an increase in caudate volume in schizophrenic patients medicated with typical neuroleptics and a volume decrease following treatment with atypical neuroleptics. The measurement of striatal volume in patients who have never been treated with neuroleptics may indicate whether these changes are superimposed on intrinsic basal ganglia pathology in schizophrenia or are solely neuroleptic-induced.

METHODS

We studied 36 first-episode, neuroleptic-naive schizophrenic patients and 43 control subjects using an artificial neural network (ANN) to identify and measure the caudate nucleus. The resulting volumes were analyzed using an ANCOVA controlling for intracranial volume, age, gender, and socioeconomic status.

RESULTS

The mean volume difference between the caudate nuclei of patients and control subjects was .297 mL, the caudate nuclei of the patients being smaller than those of controls. When we covaried for intracranial volume, this was a statistically significant difference in caudate volume (n = 79; df = 1,75; F = 4.18; p > .04).

CONCLUSIONS

Caudate nuclei of neuroleptic naive schizophrenic patients are significantly smaller than those of controls. This suggests that patients suffering from schizophrenia may have intrinsic pathology of the caudate nucleus, in addition to the pathology observed as a consequence of chronic neuroleptic treatment.

Longitudinal study of cognitive function in first-episode and recent-onset schizophrenia

OBJECTIVE

Whether cognitive function in schizophrenia deteriorates, improves, or remains stable is a crucial question. Few studies have examined the longitudinal stability of cognitive function and the relationship between cognitive performance and clinical symptoms over time in a cohort of well-treated patients with schizophrenia.

METHOD

In the present study, 54 patients with first-episode and recent-onset schizophrenia completed a comprehensive cognitive test battery and were rated on symptom measures at index hospitalization and again after 5 years.

RESULTS

Performance IQ and full-scale IQ significantly improved, whereas verbal IQ did not change. Group performance improved on some of the neuropsychological tests, including the Circle A letter-cancellation task, free recall of logical memory test score, and the Wisconsin Card Sorting Test. Mean finger-tapping performance worsened over time, whereas performance on other neuropsychological tests did not change. Negative, psychotic, and disorganized symptoms significantly improved over the time period. Changes in negative symptoms were correlated with performance changes in verbal IQ and full-scale IQ but not performance IQ. Improvement in verbal cognition was observed when negative symptoms improved. Psychotic and disorganized symptom dimensions were not correlated with any IQ measure.

CONCLUSIONS

These results indicate that in a cohort of young patients receiving neuroleptic treatment early in their illness, cognitive performance does not deteriorate--and may improve. Only one of the three symptom dimensions--negative--was associated with change in cognitive performance. This study supports the view that negative symptoms are associated with a poor long-term cognitive outcome and may be closely related to the primary cognitive deficit in schizophrenia.

Cluster headaches: association with anxiety disorders and memory deficits

OBJECTIVE

To estimate the frequency of mood and anxiety disorders and to assess memory and executive functions among a representative group of patients with episodic cluster headache (ECH) during the course of an acute episode.

METHODS

We compared 21 patients with ECH with 21 patients with tension headache (TH) matched for age, sex, and educational level. Psychiatric diagnosis was made by a semi-structured interview and Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria. Quantitative measures of depression and anxiety were obtained using the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale (HARS). In addition, all patients received a neuropsychological evaluation to assess basic memory and executive functions.

RESULTS

Of the 21 patients with ECH, 5 (24%) met DSM-IV criteria for an anxiety disorder during the year before the episode. Panic disorder was diagnosed in two patients (10%). The remaining three patients (14%) met criteria for generalized anxiety disorder. Of the 21 patients with TH, 2 (10%) met diagnostic criteria for an adjustment disorder with depressed mood, and 1 (5%) met criteria for an adjustment disorder with mixed anxiety and depressed mood. HARS scores were higher among patients with ECH (Kruskal-Wallis, chi2 = 4.3, df = 1, p = 0.03). ECH patients also showed significantly lower Auditory Verbal Learning Test scores (Kruskal-Wallis, chi2 = 6.5, df = 1, p = 0.01).

CONCLUSIONS

When compared with a group of patients with TH, ECH patients showed a higher frequency of anxiety disorders during the year before the onset of headaches and significantly greater HARS scores during the episode. In addition, patients with ECH were selectively impaired in verbal memory.

Change in basal ganglia volume over 2 years in patients with schizophrenia: typical versus atypical neuroleptics

OBJECTIVE

For many years, it has been assumed that medications affect brain chemistry and physiology but not structure. Recent reports suggest that neuroleptic medication changes basal ganglia volume. To explore this possibility, the authors assessed for basal ganglia volume change in individuals who had their basal ganglia structures delineated and measured on magnetic resonance scans at the beginning and end of a 2-year period and who received neuroleptic medication during this time.

METHOD

The basal ganglia volumes of 23 male patients with schizophrenia spectrum disorders were measured from manual traces delineating the caudate and lenticular nucleus on magnetic resonance images at admission and 2 years later. Patients' neuroleptic exposure was calculated over the 2 years by using a dose-year formula.

RESULTS

During the 2-year period, mean basal ganglia volume of patients receiving predominantly typical neuroleptics increased, while the opposite was observed for patients receiving mostly atypical neuroleptics. Correlation analysis for the entire group showed a positive relationship between the 2-year exposure to typical neuroleptic medication and change in basal ganglia volume and the reverse for exposure to atypical neuroleptics.

CONCLUSIONS

In this group, basal ganglia volume increased following exposure to typical neuroleptics and decreased following exposure to atypical neuroleptics.

Generalized cognitive deficits in schizophrenia: a study of first-episode patients

BACKGROUND

Cognitive impairment is recognized as a core characteristic of schizophrenia. There has always been a debate about the nature, selectivity, and time of onset of these deficits in relationship to the onset of illness and treatment factors. To our knowledge, the present study represents the largest sample of mostly neuroleptic-naive patients with first-episode schizophrenia that has been reported to date.

METHODS

A group of 94 patients experiencing their first episode of schizophrenic illness and 305 normal comparison subjects were administered a comprehensive clinical and neuropsychological evaluation. Seventy-three patients were neuroleptic naive, 14 had received treatment for less than 1 week, and the remaining 7 had been medicated for less than 2 weeks.

RESULTS

Patients performed significantly worse than the comparison subjects on every neuropsychological variable except those assessing savings scores (ie, forgetting over time). Twenty-five of 30 tests had an effect size (ES) greater than 0.75 when the 2 groups were compared. An ES analysis within the schizophrenia group revealed that the greatest relative impairments were on the Wechsler Adult Intelligence Scale-Revised digit symbol (ES, -0.52) and comprehension (ES, -0.42) subscales.

CONCLUSIONS

Our findings are in concert with others demonstrating that significant cognitive impairment across multiple ability domains is a core characteristic of schizophrenia and is not caused by chronic illness, treatment, or institutionalization. The ES analysis emphasizes that patients with schizophrenia have a generalized deficit that is not easily explained by a single anatomical region or ability area.

[Internal knee injuries in children]

Although children are injured everyday through accidents, road traffic, leisure or sports activities, internal lesions of the knee joint due to the trauma are rare. Diagnose and therapy follow rather empirical than analytical patterns. A retrospective, controlled study evaluates and recommends ways of treatment. Traumatic internal lesions of the knee where analysed in 76 children up to age 16. The pattern of injury changed with increasing age, the trauma remaining the same. Most common where injuries to the anterior cruciate ligament (ACL). Main cause where sports activities. Operative treatment seems to be the appropriate treatment. Osseous avulsions of the cruciates and collateral ligaments showed good results after transosseous refixation with a suture. Suturing of intraligamentous ACL-ruptures as well as patellar ligaments plasty showed unsatisfactory results. Secondary lesions due to instability of the knee where also observed in children. Children cannot self estimate the severity of the injury so subjective statements are insecure. Trauma, surgery, pain and immobilisation cause a marked malfunction of the sensor-motor system which is effectively treated by physiotherapy.

The 35% CO2 inhalation procedure: test-retest reliability

The subjective response to a single-breath, 35% carbon dioxide challenge test shows promise as a tool for the study of panic disorder and may comprise a trait marker for that disorder. Little has been done to measure the reliability of test results, however. Subjects took a single breath at 35% CO2 and completed a self-rating of anxiety symptoms immediately thereafter. This procedure was repeated after a mean interval of 29 days. One group, considered at high risk for panic disorder, consisted of well, first-degree relatives of individuals treated for panic disorder. The control group included well subjects at high risk for affective disorder and subjects who had family histories negative for both affective disorder and panic disorder. On both testing occasions, subjects at high risk for panic disorder had symptom scores that were significantly higher than those of control subjects. Group differences in the portions who experienced a panic attack were dependent on the symptom threshold used to define an attack. A lower threshold was optimal with the second testing and a single, positive test result appeared to be more meaningful than a single negative result. The majority of individual symptom ratings were highly correlated across tests. Ratings for "smothering sensations," in particular, correlated highly across tests and consistently discriminated high-risk from control subjects. The sources of test result variability are unclear and warrant more investigation before the tests can be clinically useful. Research efforts should seek optimal thresholds to define positive test results within given data sets.

Impaired glucose tolerance and abnormal movements in patients with schizophrenia

OBJECTIVE

Diabetes mellitus has been implicated as a risk factor for tardive dyskinesia. The authors examined the association between abnormal movements and impaired glucose metabolism, which often precedes the development of overt diabetes, in patients with schizophrenia.

METHOD

Twenty-one patients with DSM-IV schizophrenia receiving neuroleptic medication were given oral glucose tolerance tests involving serial glucose and insulin levels. These values were analyzed in relationship to abnormal involuntary movement ratings.

RESULTS

Patients with impaired glucose tolerance had higher mean abnormal movement scores than those without glucose intolerance, but this difference was not statistically significant. There was, however, an association between the magnitude of the fasting insulin level and abnormal movements after the authors controlled for fasting glucose level. Additionally, the fasting glucose level predicted abnormal movements after the authors controlled for age.

CONCLUSIONS

Hyperinsulinemia and hyperglycemia associated with insulin resistance may potentially contribute to the pathogenesis of tardive dyskinesia. Findings from this small cross-sectional study suggest a possible relationship that requires clarification through larger, longitudinal studies.

Polarity sequence, depression, and chronicity in bipolar I disorder

Five independent studies show that polarity sequence is associated with prognosis in bipolar I disorder. Episodes in which major depression precedes mania (DMI) lead to higher morbidity than biphasic episodes which begin with mania (MDI). However, little is known about the prognostic significance of polarity sequence for long-term outcome. This study examined polarity sequence across multiple episodes among 165 bipolar I patients followed prospectively for up to 15 years as part of the NIMH Collaborative Study of Depression. Episodes beginning with major depression were significantly longer than those beginning with mania for the first three prospectively observed episodes when pooling all episode types-monophasic, biphasic, and polyphasic. Furthermore, affective polarity at onset for the first prospectively observed episode was associated with polarity at onset for the remaining three episodes. Patients whose first prospectively observed episode began with depression had higher overall morbidity during the entire follow-up period.

Maternal plasma homocysteine, placenta status and docosahexaenoic acid concentration in erythrocyte phospholipids of the newborn

The enhanced transport of long-chain polyunsaturated fatty acids, in particular docosahexaenoic acid (22:6 omega-3) (DHA), to the fetus is a placental function important for adequate membrane phospholipid formation and herewith decisive for the quality of fetal CNS myelination. A compromised placental function is correlated with signs of vascular pathology. As elevated plasma total homocysteine (tHcy) concentrations are considered an independent risk for premature occlusive vascular disease, the influence of maternal plasma tHcy concentrations on placental function was indirectly studied, determining the DHA content in erythrocyte membrane phospholipids of the newborn. A total of 60 unselected pregnant women (age range: 21 to 39 years) were investigated at delivery. Gestational age ranged from 26 to 41 weeks. Prior to delivery a placental ultrasound scan was performed. Complete sets of data could be obtained from 43 mothers and their offspring. tHcy concentrations were determined in the plasma of cord and maternal blood. The fatty acid pattern of erythrocyte membrane phospholipids was determined in the mothers and their newborns. Z-scores of the birth weights ranged from -3.4 to 2.1 and of the placental weights from -3.8 to 4.7. The mean maternal plasma tHcy concentration was 6.29 +/- 3.34 micromol/l ranging from below our limit of detection up to 15 micromol/l. These maternal concentrations were correlated with those of their infants (r = 0.71; P < 0.0001). The tHcy concentrations were significantly higher in mothers with pregnancies complicated by gestosis or placental calcifications. The Z-scores of birth weights as well as placental weights showed a significant negative correlation with maternal plasma tHcy concentrations. The mean DHA percentage of total fatty acids in erythrocyte phospholipids was 3.2 +/- 2.2% in the mothers and 3.4 +/- 2.3% in their newborns. Most importantly the maternal plasma tHcy levels and the erythrocyte phospholipid DHA concentrations of their offspring were significantly correlated (r = -0.51; P < 0.0003).

CONCLUSION

In this study, total homocysteine concentrations were elevated in the plasma of pregnant women with signs of placental vasculopathy. Maternal plasma total homocysteine concentrations were positively correlated with erythrocyte phospholipid docosahexaenoic acid of their offspring and may be an indicator for the integrity of placental vascular function. The nutritional status as well as predisposing genetic factors of pregnant mothers need to be investigated more thoroughly.

Correlating and predicting psychiatric symptom ratings: Spearman's r versus Kendall's tau correlation

Simple correlations play a large role in the analysis of psychiatric data. They are used to predict outcome, validate new instruments, establish treatment efficacy and find symptom patterns. Researchers and data analysts often face a question about which correlation coefficient to use in a study but are often unaware of the strengths and weaknesses of the alternative correlation measures. The presence of outliers, nonconstant variance, skewed distributions and unequal n are common in psychiatric data and this poses severe problems for many classic statistical methods. We compare Pearson, Spearman and Kendall's correlation coefficients using a large sample of subjects with schizophrenia spectrum disorders who were evaluated with 7 different psychiatric rating scales. Samples sizes ranging from 8 to 50 were evaluated using bootstrapping methods. The criteria for evaluation of the correlations were the type I error rates, power, bias and confidence interval width. Pearson's r did not always control for false positives at the nominal rate and was often unstable. Spearman's r performed better than Pearson's but provided a biased estimate of the true correlation. Spearman's r was also difficult to interpret. Our results suggest that Kendall's tau(b) has many advantages over Pearson's and Spearman's r; when applied to psychiatric data, tau(b) maintained adequate control of type I errors, was nearly as powerful as Pearson's r, provided much tighter confidence intervals and had a clear interpretation.

[The guideline clearing programme of the self-governmental bodies in the German health care system--a project to promote quality assurance in medicine]

Within the German health system guidelines are increasing considered as a meaningful and necessary aid to decision making. In this context the effectiveness of guidelines essentially depends on their methodical quality. Because of the fact that most of the German-language guidelines introduced within the past years show obvious methodological defects, the Agency for Quality in Medicine developed within the last two years the following programme for quality-assurance and promotion of guidelines: 1. Definition of quality policies for clinical practice guidelines in Germany 2. Establishment of quality demands for guidelines 3. Methods and instruments for quality promotion of guideline programmes 4. Measures to promote and check the quality of guidelines ("German Guidelines Clearinghouse") The following article reports on background, aims, instruments, method development and acceptance of the programme.

Improving tissue classification in MRI: a three-dimensional multispectral discriminant analysis method with automated training class selection

PURPOSE

To improve the reliability, accuracy, and computational efficiency of tissue classification with multispectral sequences [T1, T2, and proton density (PD)], we developed an automated method for identifying training classes to be used in a discriminant function analysis. We compared it with a supervised operator-dependent method, evaluating its reliability and validity. We also developed a fuzzy (continuous) classification to correct for partial voluming.

METHOD

Images were obtained on a 1.5 T GE Signa MR scanner using three pulse sequences that were co-registered. Training classes for the discriminant analysis were obtained in two ways. The operator-dependent method involved defining circular ROIs containing 5-15 voxels that represented "pure" samples of gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF), using a total of 150-300 voxels for each tissue type. The automated method involved selecting a large number of samples of brain tissue with sufficiently low variance and randomly placed throughout the brain ("plugs"), partitioning these samples into GM, WM, and CSF, and minimizing the amount of variance within each partition of samples to optimize its "purity." The purity of the plug was estimated by calculating the variance of 8 voxels in all modalities (T1, T2, and PD). We also compared "sharp" (discrete) measurements (which classified tissue only as GM, WM, or CSF) and "fuzzy" (continuous) measurements (which corrected for partial voluming by weighting the classification based on the mixture of tissue types in each voxel).

RESULTS

Reliability was compared for the operator-dependent and automated methods as well as for the fuzzy versus sharp classification. The automated sharp classifications consistently had the highest interrater and intrarater reliability. Validity was assessed in three ways: reproducibility of measurements when the same individuals were scanned on multiple occasions, sensitivity of the method to detecting changes associated with aging, and agreement between the automated segmentation values and those produced through expert manual segmentation. The sharp automated classification emerged as slightly superior to the other three methods according to each of these validators. Its reproducibility index (intraclass r) was 0.97, 0.98, and 0.98 for total CSF, total GM, and total WM, respectively. Its correlations with age were 0.54, -0.61, and -0.53, respectively. Its percent agreement with the expert manually segmented tissue for the three tissue types was 93, 90, and 94%, respectively.

CONCLUSION

Automated identification of training classes for discriminant analysis was clearly superior to a method that required operator intervention. A sharp (discrete) classification into three tissue types was also slightly superior to one that used "fuzzy" classification to produce continuous measurements to correct for partial voluming. This multispectral automated discriminant analysis method produces a computationally efficient, reliable, and valid method for classifying brain tissue into GM, WM, and CSF. It corrects some of the problems with reliability and computational inefficiency previously observed for operator-dependent approaches to segmentation.

Cognitive outcome in children and adolescents following severe traumatic brain injury: influence of psychosocial, psychiatric, and injury-related variables

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than psychiatric or psychosocial factors as correlates of cognitive outcomes. We addressed this concern by recruiting a consecutive series (N = 24) of children age 5 through 14 years who suffered a severe TBI, a matched group who sustained a mild TBI, and a second matched group who sustained an orthopedic injury. Standardized intellectual, memory, psychiatric, family functioning, family psychiatric history, neurological, and neuroimaging assessments were conducted at an average of 2 years following injury. Severe TBI, when compared to mild TBI and orthopedic injury, was associated with significant decrements in intellectual and memory function. A principal components analysis of independent variables that showed significant (p < .05) bivariate correlations with the outcome measures yielded a neuropsychiatric factor encompassing severity of TBI indices and postinjury psychiatric disorders and a psychosocial disadvantage factor. Both factors were independently and significantly related to intellectual and memory function outcome. Postinjury psychiatric disorders added significantly to severity indices and family functioning and family psychiatric history added significantly to socioeconomic status in explaining several specific cognitive outcomes. These results may help to define subgroups of children who will require more intensive services following their injuries.

[An online information system "LEITLINIEN-IN-FO"--a contribution to quality management in health care]

An online-information service contianing clinical practice guidelines ("LEITLINIEN-INFO"--available via) based on similar programs from Scotland and Canada--was developed by the German Guidelines Clearinghouse (Agency for Quality in Medicine, Cologne). The service focuses on continuing medical education regarding guideline methodology and tools for critical appraisal of guidelines. It contains guideline appraisal reports developed in cooperation with the German Cochrane-Center. Special importance is given to a hyperlink collection of German and international guideline-data-bases. Backgrounds, aims, and structures of the information program are discussed.

Relationship between patient variables and plasma clozapine concentrations: a dosing nomogram

BACKGROUND

Previous work has suggested factors such as gender, smoking behavior, dose, and age affect the amount of drug a patient requires to achieve a desired plasma concentration of clozapine. Plasma clozapine concentrations ranging from 350 to 504 ng/mL in treatment-refractory schizophrenics and schizoaffective patients produce response rates ranging approximately 55-80%. Without the aid of clozapine plasma concentration monitoring, 3-6 months are recommended for a therapeutic clozapine trial. Data suggest that the lag time to response can be reduced by administering a dose that produces a therapeutic clozapine concentration.

METHODS

To generate a clozapine dosing nomogram to predict clozapine steady-state plasma concentrations, a cohort of 71 patients was collected via retrospective chart review and/or patient interview. Clozapine steady-state plasma concentrations and demographic variables were obtained. Multiple-linear regression was utilized to examine the relationship between the plasma clozapine concentration and the independent variables.

RESULTS

The dosing model that optimally predicted steady-state clozapine plasma concentrations included the variables dose (mg/day), smoking (yes = 0 and no = 1), gender, and a dose-gender interaction variable. The model explained 47% of the variance in the clozapine concentrations (F = 14.42, p < .001, r2 = .47). Two equations, one for male subjects, i.e., clozapine (ng/mL) = 111 (smoke) + 0.464 (dose) + 145, and one for female subjects, i.e., clozapine (ng/mL) = 111 (smoke) + 1.590 (dose)-149, were derived to predict clozapine steady-state plasma concentrations to serve as a clozapine dosing guide for clinicians.

CONCLUSIONS

A clozapine dosing nomogram was constructed as a clinical aid to facilitate clozapine dosing.

Posttraumatic stress symptomatology after childhood traumatic brain injury

The purpose of this study was to quantify and to identify predictors of posttraumatic stress disorder (PTSD) symptomatology after traumatic brain injury (TBI). Fifty children aged 6 to 14 years, hospitalized after TBI, were assessed soon after TBI regarding injury severity and preinjury psychiatric, socioeconomic, family functioning, and family psychiatric history status; neuroimaging was also analyzed. Psychiatric assessments were repeated 3, 6, 12, and 24 months after TBI. Only 2 of 46 (4%) subjects with at least one follow-up assessment developed PTSD. However, the frequency with which subjects experienced at least one PTSD symptom ranged from 68% in the first 3 months to 12% at 2 years in assessed children. The presence of an internalizing disorder at time of injury followed by greater injury severity were the most consistent predictors of PTSD symptomatology. It is apparent, therefore, that PTSD and subsyndromal posttraumatic stress disturbances occur despite neurogenic amnesia. These problems should be treated, particularly if symptoms persist beyond 3 months.

Factors associated with suicide attempts among patients with schizophrenia

This study explored the association between psychosocial variables and symptoms among patients with schizophrenia-spectrum disorders who have attempted suicide and those who have not attempted suicide. Of 336 patients with a DSM-III-R diagnosis of schizophrenia or schizoaffective disorder who were consecutively evaluated at a university-affiliated clinical research center, 98, or 29.2 percent, reported one or more suicide attempts. Compared with patients who had not attempted suicide, patients who had made an attempt had a greater number of lifetime depressive episodes, an earlier age of onset of their illness, and an earlier age at first hospitalization.

Corpus callosum shape and size in male patients with schizophrenia

BACKGROUND

Corpus callosum (CC) morphology has recently been investigated in schizophrenia using refined imaging and analytic techniques; however, methodological problems and small sample sizes have led to inconsistent findings.

METHODS

This study used a large sample of male schizophrenics (n = 79) and male controls (n = 65) to investigate size and shape of the CC on midsagittal magnetic resonance images. Size was determined by tracing the area of the CC, and shape was determined using a landmark-based analysis. In addition, the relationship between CC morphology and phenomenologic variables such as age of onset, length of illness, exposure to medications, and symptom severity was explored.

RESULTS

After controlling for age, height, and parental socioeconomic status, there was a main effect of diagnosis on CC size (F = 5.05, df = 1,139, p < .03), with patients' CCs being significantly smaller. No difference was found between patients and controls in CC shape (F = 1.07, df = 18,125, p > .38) or orientation (F = 0.79, df = 18,125, p > .70), using a landmark-based technique. Finally, there was a significant inverse correlation between size of CC and severity of negative symptoms.

CONCLUSIONS

These findings support previous studies that have found a decrease in size of the CC in patients with schizophrenia. Moreover, the decrement in volume is generalized, not regional, and is related to the severity of negative symptoms.

Two-year outcome in first-episode schizophrenia: predictive value of symptoms for quality of life

OBJECTIVE

Many studies have validated the grouping of schizophrenic symptoms into three independent dimensions: negative, psychotic, and disorganized. Negative symptoms are considered to be an important prognostic indicator, but this clinical observation requires further empirical study, especially with respect to psychosocial functioning. When present at the onset of the first episode, negative symptoms suggest that the patient will develop significant psychosocial impairment. The predictive values of the psychotic and disorganized symptom dimensions, on the other hand, have been less certain.

METHOD

In this study of 50 first-episode schizophrenic patients, who were mostly neuroleptic-naive at intake, the authors examined the relationship between the severity of these three symptom dimensions (measured by using the Scale for the Assessment of Negative Symptoms and the Scale for the Assessment of Positive Symptoms) at index hospitalization and quality of life at 2-year follow-up.

RESULTS

Negative symptom severity was positively and significantly correlated with later occupational impairment, financial dependence on others, impaired relationships with friends, impaired ability to enjoy recreational activities, and global assessment of functioning. The magnitudes of correlation between the levels of psychotic symptoms or disorganized symptoms and 2-year quality of life measures were comparatively lower. Analyses using multivariate regression statistics also revealed similar findings.

CONCLUSIONS

Severity of negative symptoms at index hospitalization may be a portent of poor outcome. In general, severity of psychotic or disorganized symptoms at intake does not appear to predict subsequent quality of life.

Adaptive functioning following traumatic brain injury and orthopedic injury: a controlled study

OBJECTIVE

To study adaptive functioning after severe traumatic brain injury (TBI).

DESIGN

Case-control study.

SETTING

A university hospital and three regional and four community hospitals.

SUBJECTS

A consecutive series (n=24) of children age 5 through 14 years who suffered severe TBI were individually matched to subjects who sustained a mild TBI and to a second group who sustained an orthopedic injury with no evidence of TBI.

MAIN OUTCOME MEASURES

Standardized adaptive functioning, intellectual, psychiatric, and neuroimaging assessments were conducted on average 2 years after injury.

RESULTS

Severe TBI was associated with significantly (p < .05) lower Vineland Adaptive Behavior composite, communication, and socialization standard scores and lower Child Behavior Checklist parent-rated social competence scores compared with children with orthopedic injury. Severe TBI and mild TBI subjects were significantly (p < .05) more impaired than orthopedic subjects on teacher-rated adaptive function. Family functioning, psychiatric disorder in the child, and IQ were significant variables, explaining between 22% and 47% of the variance in adaptive functioning outcomes.

CONCLUSIONS

Severe TBI is associated with significant deficits in child adaptive functioning. This association appears to be mediated by family dysfunction, child psychiatric disorder, and intellectual deficits.

Attention-deficit hyperactivity symptomatology after traumatic brain injury: a prospective study

OBJECTIVE

To study prospectively the course of attention-deficit hyperactivity (ADH) symptomatology in children and adolescents after traumatic brain injury (TBI). It was hypothesized that ADH symptomatology would be significantly related to severity of injury.

METHOD

Subjects were children (n = 50) aged 6 to 14 years at the time they were hospitalized after TBI. The study used a prospective follow-up design. Assessments of preinjury psychiatric, behavioral, socioeconomic, family functioning, and family psychiatric history status were conducted. Severity of injury was assessed by standard clinical scales, and neuroimaging was analyzed.

RESULTS

The main finding of this study was that change in ADH symptomatology in the first 2 years after TBI in children and adolescents was significantly related to severity of injury. Overall ADH symptomatology during the study was significantly related to a measure of family dysfunction when family psychiatric history, socioeconomic status, and severity of injury were controlled.

CONCLUSION

The presence of a positive "dose-response" relationship between severity of injury and change in ADH symptoms, present from the 3-month assessment, was consistent with an effect directly related to brain damage.

Psychiatric disorders in children and adolescents after severe traumatic brain injury: a controlled study

OBJECTIVE

To study psychiatric and behavioral morbidity associated with severe traumatic brain injury (TBI).

METHOD

A consecutive series (n = 24) of children aged 5 through 14 years who suffered a severe TBI were matched to subjects who sustained a mild TBI and to a second matched group who sustained an orthopedic injury with no evidence of TBI. Standardized psychiatric, behavioral, and neuroimaging assessments were conducted on average 2 years after injury.

RESULTS

Severe TBI was associated with a significantly higher rate of current "novel" psychiatric disorders (15/24; 63%) compared with children with mild TBI (5/24; 21%) and orthopedic injury (1/24; 4%). Higher effect sizes were evident for child and adolesent self-report of internalizing symptoms rather than externalizing symptoms, for parents' report of overall behavior and internalizing symptoms rather than externalizing symptoms, and for teachers' reports of overall behavior and externalizing symptoms rather than internalizing symptoms.

CONCLUSIONS

Severe TBI is a profound risk factor for the development of a psychiatric disorder. Survivors should be assessed for organic personality syndrome, which is the most common psychiatric disorder after this type of injury.

An efficient procedure for permutation tests in imaging research

Recent interest in hypothesis testing on functional imaging data has spurred the development of several statistical techniques. The purpose of this paper is to provide a method to reduce the computational intensity associated with randomization tests of positron emission tomography imaging data. We discuss the advantages and disadvantages of traditional distributional hypothesis testing versus the advantages and disadvantages of randomization tests. A method for reducing the computational intensity of randomization uses a conjunction of updating and sequenching and results in significantly reduced processing. The running times of randomization methods are compared.

Morphometry in schizophrenia revisited: height and its relationship to pre-morbid function

BACKGROUND

Morphometry, the measurement of forms, is an ancient practice. In particular, schizophrenic somatology was popular early in this century, but has been essentially absent from the literature for over 30 years. More recently, evidence has grown to support the notion that aberrant neurodevelopment may play a role in the pathophysiology of schizophrenia. Is the body, like the brain, affected by abnormal development in these patients?

METHODS

To evaluate global deficit in development and its relationship to pre-morbid function, height was compared in a large group (N = 226) of male schizophrenics and a group of healthy male controls (N = 142) equivalent in parental socio-economic status. Patients in the lower quartile of height were compared to those in the upper quartile of height.

RESULTS

The patient group had a mean height of 177.1 cm, which was significantly shorter than the mean height of the control group of 179.4 (P < 0.003). Those in the lower quartile had significantly poorer pre-morbid function as measured by: (1) psychosocial adjustment using the pre-morbid adjustment scales for childhood and adolescence/young adulthood, and (2) cognitive function using measures of school performance such as grades and need for special education. In addition, these measures of pre-morbid function correlated significantly with height when analysed using the entire sample.

CONCLUSIONS

These findings provide further support to the idea that abnormal development may play a key role in the pathophysiology of schizophrenia. Furthermore, this is manifested as a global deficit in growth and function resulting in smaller stature, poorer social skills, and deficits in cognitive abilities.

No difference in hippocampus volume detected on magnetic resonance imaging in autistic individuals

Neuropathological and animal studies have implicated the hippocampus as having a potential role in autism. Current imaging methods are well suited to the detailed measurement of the volume of the hippocampus, which has received little attention in previous imaging studies in autism. We report the results of a magnetic resonance imaging (MRI) study of 35 autistic and 36 control subjects. Detailed (1.5 mm) MRI did not reveal differences in the volume of the hippocampus in autistic individuals.

The Neuropsychiatric Rating Schedule: reliability and validity

OBJECTIVE

To evaluate reliability and validity for the Neuropsychiatric Rating Schedule (NPRS) interview designed to permit diagnosis of organic personality syndrome (OPS) or personality change due to a general medical condition (PC).

METHOD

Subjects from prospective (n = 50) and retrospective (n = 72) studies of traumatic brain injury were aged 6 through 18 years. Parents and children were informants for the NPRS. Convergent and discriminant validity of subtypes of OPS/PC were assessed against standard scales completed by parents and teachers. Interrater reliability data (n = 20), test-retest reliability data (n = 42), as well as sensitivity-to-change data (n = 37) were collected.

RESULTS

All subtypes of OPS/PC were diagnosed, but apathy and paranoia subtypes were rare. Rating scale data supported convergent validity of OPS/PC subtypes generated with the NPRS. Affective instability, rage/aggression, and inappropriate social judgment were moderately to highly correlated, but apathy and paranoia could be discriminated from each of these subtypes. Interrater agreement for NPRS items was fair to excellent for all but one item (paranoia). Test-retest reliability was fair to good, and sensitivity to change was demonstrated.

CONCLUSION

The NPRS generated reliable and valid diagnoses of the common subtypes of OPS/PC.

The effects of anabolic steroids on driving performance as assessed by the Iowa Driver Simulator

The effect of physiologic (100 mg/wk) and supraphysiologic (250 and 500 mg/wk) doses of testosterone cypionate (TC) on automobile driving were studied using the Iowa Driver Simulator. Six normal subject volunteers were studied off TC and on TC once steady-state concentrations were achieved after at least three weeks of dosing. Despite the administration of supraphysiologic testosterone doses, an increase in aggressive driving behavior was not detected. Likewise, corresponding psychometric testing using the Buss-Durkee Hostility Inventory to assess aggression was unable to detect any change in aggression in the test subjects. Although aggressive driving behavior may be increased by testosterone administration, the drug itself may not be responsible for these effects. Supraphysiologic doses greater than 500 mg/wk and a semi-controlled research environment may be necessary to produce this effect since case reports of AAS abuse causing altered driving behavior may be multifactorial in nature.

A method to determine activation thresholds in fMRI paradigms

Determining meaningful activation thresholds in functional magnetic resonance imaging (fMRI) paradigms is complicated by several factors. These include the time-series nature of the data, the influence of physiological rhythms (e.g. respiration) and vacillations introduced by the experimental design (e.g. cueing). We present an empirical threshold for each subject and each fMRI experiment that takes these factors into account. The method requires an additional fMRI data set as similar to the experimental paradigm as possible without dichotomously varying the experimental task of interest. A letter fluency task was used to illustrate this method. This technique differs from classical methods since the Pearson correlation probability values tabulated from statistical theory are not used. Rather each subject defines his or her own set of threshold probability values for correlations. It is against these empirical thresholds, not Pearson's, that an experimental fMRI correlation is assessed.

An MRI study of autism: the cerebellum revisited

We addressed the controversies surrounding the size of the neocerebellar vermis in autism and examined cerebellar size in light of recent reports of enlarged brain size in this disorder. In this study we use detailed MRI (1.5 mm) to examine the area of cerebellar lobules I through V and VI and VII and the volume of the total cerebellum in 35 autistic subjects and 36 controls. No abnormalities in the size of cerebellar lobules VI and VII in autistic individuals were detected, but the volume of the total cerebellum was significantly increased. We conclude that selective neocerebellar size abnormalities are not present in autistic individuals. Enlarged total cerebellar volume detected in this study is consistent with previous reports of regional brain enlargement in autism and also consistent with theories hypothesizing that the primary defect in autism is the result of abnormal development of a distributed neural network involving a number of regions of the brain.

An MRI study of the corpus callosum in autism

OBJECTIVE

The purpose of this study was to examine the size of subregions of the corpus callosum in autistic individuals.

METHOD

The areas of three subregions (anterior, body, and posterior) of the corpus callosum were examined on midsagittal magnetic resonance images of 35 autistic subjects whose mean age was 18 years and 36 healthy comparison subjects matched on age and IQ.

RESULTS

After controlling for total brain volume, gender, and performance IQ, the authors detected a significantly smaller size of the body and posterior subregions of the corpus callosum in the autistic individuals.

CONCLUSIONS

In the context of recent reports of increased brain size in autism, several possible mechanisms are considered in exploring the significance of a smaller relative size of the corpus callosum in autism.

Bladder dysfunction in schizophrenia

In schizophrenic patients with incontinence our previous urodynamic studies showed detrusor hyperreflexia in some cases. Many schizophrenic patients have brain abnormalities similar to those associated with urge incontinence and detrusor hyperreflexia in neurological patients. We therefore propose bladder dysfunction and incontinence as previously unrecognized neurobiological correlates of schizophrenia. To clarify this concept our first step, the present study, was a patient survey for urinary problems. Incontinence was more prevalent in schizophrenic patients than in a comparison group of mood disorder patients at the same hospitals. Urge incontinence and leakage of any type were related closely to psychiatric diagnosis. These data, like our pilot urodynamic studies, suggest that incontinence represents detrusor hyperreflexia in a significant subset of schizophrenic patients. Prospective urodynamic studies will be needed to test our proposal directly.

Factors that influence effect size in 15O PET studies: a meta-analytic review

The PET literature is growing exponentially, creating a need and an opportunity to perform a meta-analytic review consolidating the published information. This study describes the use of effect size as an index in PET studies and discusses how this measure can be used for comparing findings across studies, laboratories, and paradigms. In comparing studies across laboratories it is essential to know how the methods employed affect the results and conclusions drawn. This study also compared effect size for two different methods of tracer delivery in 15O PET studies ([15O]H2O bolus injection versus inhalation of [15O]CO2), whether averaged versus single-scan conditions were used, and the data analytic strategy employed. The effect sizes observed across studies were consistently large with a median effect size of 8.55, indicating that the phenomena investigated in 15O PET studies are strong. The largest peak activation reported in a study was found to be affected by variability in sample size, data analytic strategy, and repeat versus single-scan conditions. However, the impact of these factors was not examined on smaller or less intense peaks. Minimal standards for reporting statistical results are discussed.

Broader autism phenotype: evidence from a family history study of multiple-incidence autism families

OBJECTIVE

Studies of families ascertained through a single autistic proband suggest that the genetic liability for autism may be expressed in nonautistic relatives in a phenotype that is milder but qualitatively similar to the defining features of autism. The objective of this study was to examine behaviors that may define this broader phenotype in relatives ascertained through two autistic siblings.

METHOD

The authors used a semistructured family history interview to compare the rates of social and communication deficits and stereotyped behaviors in relatives ascertained through two autistic siblings (families with multiple-incidence autism; 25 families) with the rates in relatives of Down syndrome probands (30 families).

RESULTS

Higher rates of social and communication deficits and stereotyped behaviors were found in the relatives in the families with multiple-incidence autism.

CONCLUSIONS

These data suggest that further studies should be undertaken to delineate the boundaries of the broader autism phenotype and that this broader phenotype should be included in some future genetic analyses of this disorder.

The Iowa Longitudinal Study of Recent Onset Psychosis: one-year follow-up of first episode patients

The natural history of schizophrenia remains unclear. One strategy to further inform this area is to prospectively evaluate individuals early in the course of the disorder, both in terms of symptomatic and psychosocial/occupational functioning. Subjects were recruited into the study if they were in the midst of their first psychiatric hospitalization for a non-'organic' psychotic disorder. Subjects were extensively evaluated at index with semi-structured interviews including the Comprehensive Assessment of Symptoms and History (CASH), and followed at 6-month intervals. Data are presented on 35 subjects who were followed through 1 year. There was a significant improvement in overall symptomatology during index hospitalization, but this was accounted for primarily by improvement of positive symptoms, with negative symptoms remaining prominent. No further improvement was noted between discharge and 1-year follow-up in any of the symptom measures. Employment, interpersonal relationships, and sexual activity remained markedly impaired throughout the follow-up period. These data demonstrate that; (1) negative symptoms are prominent and stable early in the course of the disorder; (2) symptom severity at discharge from index hospitalization is predictive of symptom severity at 1 year; and (3) despite substantial overall symptomatic improvement during the first hospitalization, psychosocial and occupational functioning were found to be markedly impaired at 1-year follow-up.

The life course of schizophrenia: age and symptom dimensions

The life course of schizophrenia has eluded description for several reasons, including fluctuations in diagnostic criteria over the past century, and dramatic changes in treatment and expectations of the mentally ill. This study compared symptoms within a group of patients spanning ages 14 through 73. The three symptom dimensions (psychotic, disorganized and negative) were examined separately in relation to age. Using a multivariate analysis, the effects of age, sex and institutional status were found to have main effects for symptom severity with no interaction effects. The effect of age was significant in the negative direction for positive and disorganized symptoms. Age was specifically associated with decreased hallucinations, delusions, bizarre behavior and inappropriate affect. There was no age effect for formal thought disorder, nor was there an age effect for negative symptoms. Institutionalization was associated with greater symptom severity in all dimensions. Male gender was associated with greater severity of negative symptoms. We conclude that psychotic and disorganized symptoms are likely to be of lesser severity in older patients with schizophrenia, while negative symptoms tend to persist. Clinically, these findings suggest that medications targeting negative symptoms may confer the greatest benefit in treating the older patient with schizophrenia.

Cerebellar size and cognition: correlations with IQ, verbal memory and motor dexterity

The objective of this study was to examine the structure/function relationship between in vivo cerebellar size and higher cognitive function in a sample of healthy young subjects. The design of the study involved correlation of in vivo cerebellar volume measurements with measures of general intelligence (WAIS-R V&P FSIQ, Vocabulary, Block Design, and Digit Span subtests), motor dexterity (Halstead-Reitan Finger Tapping), verbal (WMS Logical Memory), and visual (Rey-Osterrieth Figure) memory covaring for cerebrum size. A similar analysis was performed using left temporal lobe volumes as a control region. The sample consisted of 62 healthy subjects (30 females, 32 males) enrolled as controls at the MHCRC at the University of Iowa Hospitals and Clinics. This independent sample does not overlap with the groups studied in our previous report on the relationship between cerebellar and brain size and IQ. Cerebellar and total brain size were estimated through automatic, atlas-based volume measurements using MR images obtained with a T1-weighted three-dimensional SPGR sequence on a 1.5-T GE Signa scanner and locally developed software. Cerebellar volume significantly correlated with Finger Tapping (left hand: r = 0.218, p < 0.05; right hand: r = 0.211, p < 0.05) and with memory retention of complex narrative material (r = 0.27, p < 0.02). Cerebellar volume correlated with general intelligence in the expected direction (r = 0.19, p < 0.07). This study confirms previous work indicating that the cerebellum may make a contribution to several aspects of cognition. Cerebellar volume significantly correlated with the ability to retain already encoded information in the verbal domain and with fine motor dexterity. Cerebellar volume positively correlated with general but the relationship did not reach statistical significance. The structural/functional relationship between cerebellum and verbal memory abilities is consistent with evolutionary theory for the phylogenetical increase in the size of the cerebellum.