Anatomical substrates of cognitive and clinical dimensions in first episode schizophrenia

OBJECTIVE

To explore gray (GM) and white matter (WM) abnormalities and the relationships with neuropsychopathology in first-episode schizophrenia (FES).

METHOD

Nineteen patients with first episode of non-affective psychosis and 18 controls underwent a magnetic resonance voxel-based morphometry. Additionally, WM fractional anisotropy (FA) was calculated. For correlative analysis, symptoms and neuropsychological performances were scored by PANSS and by a comprehensive neuropsychological assessment respectively.

RESULTS

Patients showed significantly decreased volume of left temporal lobe and disarray of all major WM tracts. Disorganized PANSS factor was inversely related to left cerebellar GM volume (corrected P = 0.03) and to WM FA of the left cerebellum, inferior fronto-occipital fasciculi (IFOF), and inferior longitudinal fasciculi (corrected P < 0.05). PANSS negative factor was inversely related to FA in the IFOF and superior longitudinal fasciculi (corrected P < 0.05). Impairment in facial emotion identification showed associations with temporo-occipital GM volume decrease (corrected P = 0.003) and WM disarray of superior and middle temporal gyri, anterior thalamic radiation, and superior longitudinal fasciculi (corrected P < 0.05). Speed of processing and visual memory correlated with WM abnormalities in fronto-temporal tracts.

CONCLUSION

These results confirm how the structural development of key brain regions is related to neuropsychopathological dysfunction in FES, consistently with a neurodevelopmentally derived misconnection syndrome.

Neuropsychological patterns underlying anosognosia in people with cognitive impairment

AIMS

To investigate, in a group of subjects with cognitive impairment, the relationship between anosognosia, in each dimension of insight, and neuropsychological domains.

METHODS

Two hundred and seventy-one subjects affected by cognitive impairment were consecutively enrolled. Anosognosia was evaluated by means of the Clinical Insight Rating Scale (CIRS). The general level of cognitive impairment was evaluated by means of the Mini-Mental State Examination, while 8 cognitive domains were examined by means of neuropsychological tests.

RESULTS

The number of subjects with anosognosia evaluated by means of the CIRS total score as well as those with anosognosia divided according to the reason for visit was higher in moderately cognitively impaired subjects than in mildly cognitively impaired subjects (p < 0.001). A relationship between anosognosia and neuropsychological scores was only found in mild cognitive impairment, with subjects with anosognosia displaying significantly lower Raven's Colored Progressive Matrices Test and Rey Auditory Verbal Learning Test-delayed recall scores than subjects without anosognosia.

CONCLUSIONS

Our study suggests that the relationship between the severity of cognitive deficits and anosognosia in subjects with cognitive impairment is partial and depends on the specific domain of unawareness. Furthermore, in the early phase of cognitive impairment, the presence of specific cognitive deficits suggests that the nature of anosognosia is domain-specific.

Brain structural abnormalities in first episode psychosis: A multimodal analysis

Introduction

White matter abnormalities play a prominent role in the pathogenesis of schizophrenia. Diffusion tensor imaging (DTI) studies showed a widespread decrease in fractional anisotropy (FA) in psychotic disorders.

Aims

To examine white and grey matter abnormalities in first episode psychosis (FEP).

Methods

We obtained T1-weighted and DTI magnetic resonance images (1.5 T) from 8 right-handed drug-naïve FEP patients and 8 healthy controls. The DTI data set was used to calculate FA maps; we carried-out optimized voxel-based morphometry (VBM) analysis of grey matter (GM) and FA maps using SPM2.

Patients were assessed with a neuropsychological battery comprising the Trail Making Test, the Stroop Colour Word Test, the Wisconsin Card Sorting Test and a test of Facial Affect recognition.

Results

The voxelwise analysis showed decreased FA in the superior longitudinal and inferior fronto-occipital fasciculi, bilaterally, and in the left uncinate fasciculus. We observed reduced GM volume in the left frontal cortex (Brodmann areas [BA] 47, 13, 11, 10, and 9) and in right frontal (BA6), temporal (BA34) and occipital (BA 18, 19, and 30) cortex.

Neuropsychological assessment showed impaired executive function and deficit in facial affect recognition.

Conclusion

Our findings showed fronto-temporal disconnectivity in FEP and structural alterations in both cortical and subcortical regions.

Neuroanatomical findings are consistent with patients’ neuropsychological performance.

Further studies to establish a relationship between white and grey matter disarray on one hand and neuropsychological testing are needed.

A woman lost in the cemetery: A case of time-limited amnesia

A 43-year-old woman one day experienced a dissociative fugue which she could not recall. She was married, nulliparous, with no history of dissociative disorder or other psychiatric disorders. She had been sexually abused during late childhood-early adolescence. She was examined thoroughly from both psychiatric and medical standpoints to exclude organic causes for her condition. Magnetic Resonance Imaging showed only some non-specific abnormalities. On personality tests, a histrionic structure of personality emerged, with obsessive and narcissistic traits accompanied by rigidity and anxiety, dysphoria and high risk for depression; some impairment was found in executive function tests. Final diagnosis was one of dissociative fugue. In fact, organic traits were not sufficient to establish a diagnosis of Transient Global Amnesia.

Suicide among the elderly in Italy: a descriptive epidemiological study (1969 to 1994)

Data regarding the elderly suicide trend in Italy between 1969 and 1994 were analyzed from an epidemiological point of view in order to verify hypotheses on suicide risk factors in old age. The data were obtained from the National Register of the Institute of Health (Italy) and were standardized at 1971 for age and sex. For the purposes of the study, only data for people aged 70 years and over were considered. The elderly suicide rate increased from 274 per 1,000,000 in 1969 to 354.7 per 1,000,000 in 1994 in males and from 59.7 per 1,000,000 in 1969 to 82.1 per 1,000,000 in 1994 in females. In the three macroareas (northern, central, and southern regions, indicated as N, C, and S), it is possible to observe different trends. In both genders, N and C rates are the highest in Italy (tending to be similar), while S rates are lower and distinct from the others. The most marked increase was observed in the S male rate, whereas N and C rates show a remission after the rate increase in 1980. The most important finding to emerge from this study is the interruption in the tendency for suicide rates to increase in recent years (dating back to the mid-1980s) and the nonuniformity of the nationwide distribution of suicides.