First rank symptoms and neurological soft signs in schizophrenia

Neurological soft signs and schizophrenia

Neurological soft signs (NSS) are likely to represent abnormal neurodevelopment and aberration in neural maturation and connectivity. They may not be unique to schizophrenia, but they appear to be a trait characteristic in psychosis and therefore could serve as an objective measure for the assessment of serious psychiatric disorder in the prodromal phase, at onset, and along the course of the disease. Evidence so far proposes that NSS are independent of antipsychotic treatment and therefore constitute a trait symptom, independent of the illness stage and medication. Somatomotor and somatosensory regions, spatial orientation, and visual processing areas, cerebellum, and basal ganglia are implicated as possible structural substrates of NSS. Several studies have examined the relationship between NSS and schizophrenia positive, negative symptoms and deficit syndrome; however, results have been so far ambiguous. Neurocognitive symptoms have been moderately related to NSS suggesting that neurocognitive deficits may contribute to the construct of NSS. Regardless of the fact that NSS are not unique to schizophrenia but extend across to the schizotypy continuum, they may help identify individuals at risk of developing schizophrenia later in life.

The positive dimension of schizotypy is associated with a reduced attenuation and precision of self-generated touch

The brain predicts the sensory consequences of our movements and uses these predictions to attenuate the perception of self-generated sensations. Accordingly, self-generated touch feels weaker than an externally generated touch of identical intensity. In schizophrenia, this somatosensory attenuation is substantially reduced, suggesting that patients with positive symptoms fail to accurately predict and process self-generated touch. If an impaired prediction underlies the positive symptoms of schizophrenia, then a similar impairment should exist in healthy nonclinical individuals with high positive schizotypal traits. One hundred healthy participants (53 female), assessed for schizotypal traits, underwent a well-established psychophysics force discrimination task to quantify how they perceived self-generated and externally generated touch. The perceived intensity of tactile stimuli delivered to their left index finger (magnitude) and the ability to discriminate the stimuli (precision) was measured. We observed that higher positive schizotypal traits were associated with reduced somatosensory attenuation and poorer somatosensory precision of self-generated touch, both when treating schizotypy as a continuous or categorical variable. These effects were specific to positive schizotypy and were not observed for the negative or disorganized dimensions of schizotypy. The results suggest that positive schizotypal traits are associated with a reduced ability to predict and process self-generated touch. Given that the positive dimension of schizotypy represents the analogue of positive psychotic symptoms of schizophrenia, deficits in processing self-generated tactile information could indicate increased liability to schizophrenia.

Sex and gender associations with indicators of neurodevelopmental compromise in schizophrenia spectrum disorders

BACKGROUND

It has been proposed that sex and gender differences described in schizophrenia can be explained from a neurodevelopmental perspective.

AIM

In this study, we examined the associations of biological sex and gender role endorsement with putative indicators of neurodevelopmental compromise.

METHODS

We used the Bem Sex Role Inventory to calculate masculinity scores in 77 patients with a first episode of a schizophrenia spectrum disorder, and selected the following indicators of neurodevelopmental compromise: family history of schizophrenia, obstetric complications, premorbid functioning, neurological soft signs, and cognitive function. Secondary objectives included the moderating effects of age of onset of illness, substance use and negative symptoms on these associations.

RESULTS

There were no significant sex differences across any of the indicators of neurodevelopmental compromise. However, lower masculinity scores correlated significantly with poorer premorbid adjustment, sensory integration deficits and worse overall cognitive performance. Stepwise linear regression identified poorer premorbid adjustment in early adolescence and lower verbal learning scores as independent predictors of lower masculinity scores. In contrast to sex, gender showed several associations with indicators of neurodevelopmental compromise.

CONCLUSIONS

Lower masculinity scores may represent part of a phenotype for a neurodevelopmental anomaly that places some individuals on a pathway to schizophrenia.

Prevalence and associated factors of perceived stigma among medically ill patients on follow-up screened positive for depression in Ethiopia: facility-based cross-sectional study

BACKGROUND

Many people are familiar with the issues of stigma in mental health or HIV, but feeling stigma as an underlying factor for many medically ill-health conditions has not been examined.

METHODS

Institution-based cross-sectional study was conducted on patients followed for medical illnesses and having depression. We recruited 384 participants and who were interviewed by nurses using face-to-face interviews and a systematic random sampling technique applied. We used a perceived devaluation and discrimination, a 12-item tool that is used to measure outcome perceived stigma. Variables were coded and entered Epi Info V.3.5.3 and exported to SPSS V.20 for analysis. Statistical analysis parameters, such as descriptive and multivariate logistic regression, were used for data analysis. Adjusted ORs (AORs) with a 95% CI and p value <0.05 were declared significance.

RESULT

The prevalence of perceived stigma on a patient who followed for medical illness screened positive for depression was found to be around 66.3%. In the multivariate logistic regression, patients with hypertension 61% less likely ((AOR=0.39, 95% CI (0.17 to 0.89)) to have perceived stigma than with asthma and cardiac patients, patients completed higher education 2.15 times ((AOR=2.15; 95% CI 1.05 to 4.40)) more likely to have perceived stigma than which cannot read and write. Patients who had the previous admission with medical illness 1-2 times were 3.52 more likely (AOR=3.52, 95% CI (2.14 to 5.78)) perceived stigma than those who had no hospital admission. Patients who had the previous admission three times with medical illness were 6.1 more likely (AOR=6.1, 95% CI (2.32 to 16.07)) to have perceived stigma than those who had no previous hospital admission.

CONCLUSION

The prevalence of perceived stigma among patients who had on follow-up for medical illnesses was high. Educational status, history of previous hospital admission were considerably associated with higher perceived stigma.

Ranchi Institute of Neuro-Psychiatry and Allied Sciences: A pioneer in the field of psychiatry in India

Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS; Ranchi Indian Mental Hospital; Ranchi Manasik Aryogyashala) traces its origin from a lunatic asylum for Indian soldiers established at Munghyr in Bihar in 1795 and thus is the first mental hospital in India established by the British purely for Indian patients as well as the second oldest functioning mental hospital in India. The hospital made great strides in improving patients care and using modern methods of assessment and treatment as well as education and research during the tenure of Dr J E Dhunjibhoy the first Indian medical superintendent. As a result the mortality rate was the lowest among the mental hospitals in Indian. There was a shift from custodial care to curative treatment. Since 1930s psychiatric training was given to undergraduate medical students of Patna Medical College and subsequently from Darbhanga and Cuttack. The Institute was affiliated to Universities of London and Edinburgh for Diploma in Psychological Medicine in 1936. The thesis work of the first Indian MD (Psychiatry) was done at this institute. Subsequently many psychiatrists completed their MD (Psychiatry) under the guidance of Dr L.P. Verma at this institute. A number of staff and alumini of the institute held the post of President and office bearers of Indian Psychiatric Society (IPS), starting with Dr J.E. Dhunjibhoy, the first president of the IPS. The Institute declined in the 1980s but after intervention of the Supreme Court it was transformed into an autonomous institute. Under the new dispensation the institution is regaining its vitality. Care and facilities for inpatients has greatly improved. Laboratory and imaging services have been updated. Modern facilities for eye and dental surgery are available. Attendance in outpatient department and especially in satellite clinics is increasing. Postgraduate training in psychiatry, clinical psychology, psychiatric social work and psychiatric nursing has started and research is once again a priority.