Neuroradiological covariates of drug-induced parkinsonism and tardive dyskinesia in schizophrenia

Computed tomography study of pineal calcification in schizophrenia

Computed tomography studies concerning pineal calcification (PC) in schizophrenia have been conducted mainly by one author who correlated this calcification with several aspects of the illness. On the basis of these findings the aim of the present study was to analyze size and incidence of pineal gland calcification by CT in schizophrenics and healthy controls, and to verify the relationship between pineal calcification and age, and the possible correlation with psychopathologic variables. Pineal calcification was measured on CT scans of 87 schizophrenics and 46 controls divided into seven age subgroups of five years each. No significant differences in PC incidence and mean size between patients and controls were observed as far as the entire group was considered. PC size correlated with age both in schizophrenics and controls. We found a higher incidence of PC in schizophrenics in the age subgroup of 21-25 years, and a negative correlation with positive symptoms of schizophrenia in the overall group. These findings could suggest a premature calcific process in schizophrenics and a probable association with 'non-paranoid' aspects of the illness. Nevertheless the potential role of this process possibly related to some aspects of the altered neurodevelopment in schizophrenia is still unclear.

Elevated risks for amyotrophic lateral sclerosis and blood disorders in Ashkenazi schizophrenic pedigrees suggest new candidate genes in schizophrenia

Among relatives of Ashkenazi schizophrenic probands the rate of amyotrophic lateral sclerosis was 3/1,000, compared to expected population rates of approximately 2/100,000. Relative risk of bleeding disorders, including hematologic cancers, was increased more than three-fold compared to controls. Co-occurrence of motor neuron disease and blood dyscrasias, accompanied by psychosis, has long been recognized. A virally mediated autoimmune pathogenesis has been proposed. However, the familial co-occurrence of these three disease entities raises the possibility that the disease constellation be considered as a manifestation of a common underlying genetic defect. Such expansion of the spectrum of affectation might enhance the power of both candidate gene and linkage studies. Based on these findings the loci suggested as candidate regions in schizophrenia include a potential hot spot on chromosome 21q21-q22, involving the superoxide dismutase and amyloid precursor protein genes. Alternatively, genes on other chromosomes involved in the expression, transcription, or regulation of these genes, or associated with the illnesses of high frequency in these pedigrees are suggested. Candidates include the choroid plexus transport protein, transthyretin at 18q11.2-q12.1; the t(14;18)(q22;21) characterizing B-cell lymphoma-2, the most common form of hematologic cancer; and the 14q24 locus of early onset Alzheimer's disease, c-Fos, transforming growth factor beta 3, and heat shock protein A2. Expression of hematologic cancers and the suggested candidate genes are known to involve retinoid pathways, and retinoid disregulation has been proposed as a cause of schizophrenia.

Successful treatment of respiratory dyskinesia with picoTesla range magnetic fields

Respiratory dyskinesia, a syndrome characterized by an irregular respiratory rate, tachypnea, and grunting, is a serious complication of chronic neuroleptic therapy. It frequently occurs in elderly women and is commonly associated with clinical features of Tardive dyskinesia (TD). Respiratory dyskinesia initially was considered to be a rare complication of chronic neuroleptic treatment, but more recent reports indicate that respiratory abnormalities are common in patients treated with antipsychotic medications. The appropriate management of patients with respiratory dyskinesia has not been determined as the underlying pathophysiology is incompletely understood. We present a schizophrenic patient on long term antipsychotic therapy who presented with respiratory dyskinesia associated with symptoms of TD and tardive Tourette's syndrome which emerged coincident with an abrupt withdrawal of neuroleptic therapy. In this patient, external application of picoTesla range magnetic fields (MF) produced rapid attenuation in the severity of respiratory and motor dyskinesias. As the pineal gland is considered a magnetosensor and since exposure of experimental animals and humans to external MF alters melatonin secretion, we then propose that the beneficial effects of MF involve the mediation of the pineal gland which has been implicated previously in the pathophysiology of drug-induced movement disorders including TD.

Basal ganglia abnormalities in tardive dyskinesia. Possible relationship with duration of neuroleptic treatment

The purpose of the present study was to investigate CT abnormalities in tardive dyskinesia (TD) and to search for possible relationships with clinical data. A group of 30 psychotic patients (15 schizophrenic and 15 affective disorder) with TD was compared to a matched group of 30 psychiatric patients without TD and a matched group of 30 healthy controls. CT data were analyzed using two multivariate statistical methods [multidimensional scaling (MDS) and step-wise discriminant analysis]. MDS clearly separated both TD and non-TD groups from the healthy control group on the basis of CT parameters. Caudate left area reduction and left temporal sulci enlargement were the most important parameters that discriminated TD from non-TD patients. Only in TD-patients did caudate left area reduction and left temporal sulci enlargement correlate significantly with cumulative duration of psychiatric hospitalizations. The data of the present study support the findings of structural abnormalities in the caudate nucleus and in the temporal lobe of patients with TD. These abnormalities were especially marked in the left hemisphere. It is assumed that some factor related to longer psychiatric hospital treatment (e.g. neuroleptic intake) could account for these abnormalities.