Psychosis, neurosis and epilepsy. Developmental and gender-related effects and their aetiological contribution

It is generally accepted that in mammalian evolution from rodents to primates, including man, aggressiveness, and more particularly intra-species aggression related to the assertion of dominance in the social hierarchy of the group, is a characteristic of the male (Gray, 1971). There is also an increasing body of evidence which shows that mammalian behaviour patterns are basically female and that male patterns are determined by the action of the sex hormone testosterone on neural structures during critical phases of intra-uterine development (Seymour Levine, 1966). Ounsted and Taylor (1972) have proposed that the X chromosome is sexually neutral, essentially equivalent to an autosome, and that its role in sexual differentiation lies in that it maintains ovarian function in the female. The Y chromosome is sex-determining by causing potential autosomal and X-coded information to become manifest in the phenotype. This is achieved in part by determining the development of foetal testosterone during a critical phase of foetal life. In the absence of testosterone the fundamental female morphology would be established in either sex.

Neuroleptics reverse attention asymmetries in schizophrenic patients

Discussions of hemispheric asymmetry in psychopathology are often confounded by the effects of medication. We examined the effect of neuroleptic drugs on attention asymmetries in acutely psychotic patients admitted for the first time to a psychiatric hospital before the initiation of drug treatment and again after a period of treatment with neuroleptics. Overall performance did not change significantly; however, attention asymmetry was clearly related to the medication status of the patient: unmedicated patients showed inattention to the right hemispace, which changed to more prominent left-sided inattention when medicated. A longer time on medication or a higher daily dose were associated with a shift of inattention from the right to left hemispace. This suggests that neuroleptics may normalize left hemisphere performance, at the expense of deteriorated right hemisphere performance.

Statistical quantitative EEG studies of depression, mania, schizophrenia and normals

The EEG characteristics of 63 depressive psychotics, 75 manics and 53 schizophrenic patients, consecutive admissions satisfying research criteria, are presented. Statistical comparisons between the psychotic groups and of each psychotic group against 60 normal controls (all dextral) were undertaken for power, coherence and phase characteristics in the 8-13 Hz frequency band. The characteristic EEG-myogenic power spectra for frequencies up to 60 Hz, expressed as the log of the right/left parietal and temporal power ratios for the four groups are also graphically displayed. The results suggest the presence of increasing disorganization of the right hemisphere (least in depression, intermediate in mania and maximal in schizophrenia) together with left hemisphere disorganization (in both mania and schizophrenia; again maximal in schizophrenia).

A source-imaging (low-resolution electromagnetic tomography) study of the EEGs from unmedicated males with depression

Imaging studies and quantitative EEG have often, but not consistently, implicated the right hemisphere and the left prefrontal cortex in depression. To help clarify this picture, a spatial filter shown to be effective for enhancing differences between EEG populations was combined with an electrical tomographic approach called low-resolution electromagnetic tomography and used to compare the source-current densities from a group of 25 male subjects with depression and a group of 65 matched controls. To elicit differences, comparisons were made during resting conditions and during verbal and spatial cognitive challenges to the subjects. Estimates of the source-current density were derived from 43-electrode recordings of the EEG reduced to the delta, alpha and beta frequency bands. The depressed subjects were unmedicated and selected according to DSM IV criteria. Regions of significantly increased current density in depression compared to controls were generally right hemispheric, while regions of significantly decreased current density were generally frontal and left hemispheric. A within-group comparison of the depressed subjects during the two cognitive challenges suggested a left anterior functional hypoactivation in depression. Retrospective classification of the two groups indicated that the spatial challenge best separated the groups irrespective of frequency band.

Influence of gender in schizophrenia as related to other psychopathological syndromes

The evidence indicating that the forms of schizophrenia in men and women represent different morbid states is reviewed. Age of onset and gender are considered to be of fundamental importance in determining the different symptomatological and evolutionary features of the syndrome in the two sexes. Early-onset forms in males are associated with chronicity, absence of familial predisposition for psychosis, and the presence of structural cerebral pathology specifically involving the dominant hemisphere. Later onset forms in females are characterized by more florid symptoms, more affective features, more familial psychosis, and more favorable outcome with no or less pronounced structural cerebral involvement. It is argued that these differential characteristics derive from the differential hemispheric organization of the male and female brain--which also determines the male susceptibility to other psychopathological syndromes such as psychopathy and sexual deviations as well as the excess in women of schizoaffective states, affective disorders, and late-onset schizophrenia.

Quantitative EEG studies of pedophilia

Ninety six pedophiles, whose sexual orientation was confirmed by phallometric response to sexual stimuli, were investigated with quantitative EEG and compared to age- and sex-matched healthy controls. The EEG analysis showed a pattern of increased frontal delta, theta and alpha power (especially during verbal processing) and a pattern of reduced interhemispheric and increased intrahemispheric-interhemispheric coherence, right and left (only during verbal processing), an effect that was restricted to those who showed maximal erotic arousal for sexual partners aged 6-12 years. These findings will be discussed in the context of recent studies which suggest that sexual deviations in the male relate to altered dominant hemispheric functions with disruption of frontal interhemispheric relationships.

Sex differences in functional connectivity in first-episode and chronic schizophrenia patients

OBJECTIVE

There has been consistent evidence for a lower incidence and milder course of schizophrenia in women, yet there have been very few investigations of sex differences in brain function in this disorder. This study used a new high-temporal-resolution measure of functional brain connectivity to test the prediction that female patients would show relatively greater inter- and intrahemispheric connectivity than male patients, particularly in the early stage of schizophrenia.

METHOD

Forty patients with chronic schizophrenia (20 women and 20 men) and 24 patients with first-episode schizophrenia (12 women and 12 men) and their respective matched comparison groups completed a conventional auditory oddball task. Phase synchronous gamma (40 Hz) activity was extracted from EEG recording during the task and time-locked to the oddball (target) stimuli.

RESULTS

Chronic schizophrenia subjects showed a reduction in global functional connectivity (lower gamma phase synchrony) relative to their matched healthy subjects. Unexpectedly, this reduction was most apparent in female patients. By contrast, while first-episode patients showed a general reduction in the speed of frontal connectivity, the speed of global connectivity was relatively faster in female patients.

CONCLUSIONS

This is the first study to investigate sex differences in schizophrenia that used the functional connectivity measure of gamma phase synchrony. The results suggest that in female patients with schizophrenia, additional breakdowns in brain network connectivity may develop with illness chronicity.

Imbalance of hemispheric functions in the major psychoses: a study of handedness in the People's Republic of China

A study of hand preference and eye dominance in schizophrenia, manic-depressive psychosis, and normal controls was carried out in the People's Republic of China. An excess of sinistrality was found in both men and women schizophrenics, but not in manic-depressive patients. Both the manic-depressive and schizophrenic psychoses are characterized by a significant excess of left eye dominance and by an increasing divergence between eye and hand dominance when compared to the controls. The major published studies investigating hand preference in psychopathology are reviewed, and possible interpretations of the conflicting findings are suggested.

Spatial patterns in the background EEG underlying mental disease in man

The spatial patterns underlying differences in the background EEGs of schizophrenic, manic and depressed patients and a group of normal controls has been examined during the eyes open and eyes closed resting conditions and during 3 cognitive tasks. The method of principal-component analysis was used to extract spatial patterns which are common to the EEGs of 2 groups but which account for maximally different proportions of the combined variances. The common spatial patterns in all possible pairings of the groups were used to extract variance-related feature vectors from the individual EEG epochs in the 2 groups and the means of these vectors were subjected to statistical analyses. The results of these analyses indicate that there are significant differences in the EEGs from all 4 of the groups. The spatial patterns underlying the features which are significantly different in each comparison are shown graphically and used to suggest which brain regions might be implicated in each of the psychiatric conditions and how these are affected by the cognitive condition. The main results are that the EEGs in the schizophrenic group can be characterized by left-sided hyperactivity, in the depressed group by right-sided hyperactivity and in the manic group by bilateral hyperactivity and that these characteristics are best elicited by different cognitive states.

Schizophrenia: sex differences

This paper reports epidemiological findings which support the hypothesis that the influence of gender on schizophrenia is a significant, transcultural phenomenon. Male/female differences in the illness are discussed with particular attention to age of onset, chronicity and prodromal personality characteristics. Evidence is presented indicating additional male/female contrasts in the incidence of birth complications, seasonality of birth, and birth order. The author refers to cognitive as well as neurobiological differences between the sexes in the general population which can elucidate differences in the nature and expression of schizophrenia.

Asymmetrical olfactory acuity and neuroleptic treatment in schizophrenia

Uni-rhinal olfactory acuity in schizophrenia was investigated in two experiments. The first assessed the presence of a predicted atypical asymmetry of nostril laterality and the second assessed the effect of antipsychotic treatment on the asymmetry. Although olfactory identification impairment has been well documented in schizophrenia, olfactory acuity has been neglected. This may be an oversight as cerebral structures of the mesial temporal lobe important to olfactory perception have often been implicated in the pathophysiology of schizophrenia and it is thus reasonable to postulate a primary impairment of olfactory acuity in schizophrenia. In addition, unmedicated patients with schizophrenia have exhibited asymmetrical laterality favouring the right over the left hemisphere in studies of visual, haptic, and auditory perception, and the few published prospective treatment studies have suggested a reversal of this asymmetry with first generation neuroleptic treatments. In experiment 1 a generalization of the perceptual asymmetry to olfactory acuity was examined by measurement of n-butanol olfactory thresholds with the Connecticut Chemosensory Perception Exam (CCPE) in an unmedicated sample of 17 patients with schizophrenia and 17 age, gender, and handedness matched normal controls. The patient sample showed an asymmetrical impairment of the left nostril that was not apparent in the normal control sample. In experiment 2, the CCPE was administered to a new sample of 10 patients with schizophrenia before and after neuroleptic treatment. The asymmetry observed in experiment 1 was replicated, and the relative advantage of the right nostril shifted to a relative advantage of the left nostril over the course of 8weeks of treatment. Results are discussed in relation to cerebral aspects of schizophrenia and potential implications to cognitive change from treatment.

Whether ionizing radiation is a risk factor for schizophrenia spectrum disorders?

The neural diathesis-stressor hypothesis of schizophrenia, where neurobiological genetic predisposition to schizophrenia can be provoked by environmental stressors is considered as a model of the effects of exposure to ionizing radiation. Analysis of information from electronic databases (MEDLINE, PsycINFO, EMBASE, Current Contents, Elsevier BIOBASE) and hand-made search was carried out. There are comparable reports on increases in schizophrenia spectrum disorders following exposure to ionizing radiation as a result of atomic bombing, nuclear weapons testing, the Chernobyl accident, environmental contamination by radioactive waste, radiotherapy, and also in areas with high natural radioactive background. The results of experimental radioneurobiological studies support the hypothesis of schizophrenia as a neurodegenerative disease. Exposure to ionizing radiation causes brain damage with limbic (cortical-limbic) system dysfunction and impairment of informative processes at the molecular level that can trigger schizophrenia in predisposed individuals or cause schizophrenia-like disorders. It is supposed that ionizing radiation can be proposed as a risk factor for schizophrenia spectrum disorders. The hypothesis that ionizing radiation is a risk factor for schizophrenia spectrum disorders can be tested using data from the Chernobyl accident aftermath. Implementation of a study on schizophrenia spectrum disorders in Chernobyl accident victims is of significance for both clinical medicine and neuroscience.

Electrodermal dissociation of chronic fatigue and depression: evidence for distinct physiological mechanisms

Chronic fatigue syndrome (CFS) has an estimated prevalence between 0.5% and 3%, yet its diagnosis remains contentious. CFS is characterized by subjective symptoms that can be difficult to verify; moreover, depression is a commonly reported CFS complaint, whereas fatigue is a common symptom of depression. Our primary goal was dissociation of these disorders using psychophysiological methods. As previous research has implicated the autonomic nervous system in CFS, we conducted what we believe to be the first analysis of bilateral electrodermal and skin temperature responses of dextral females in a cross-modal orienting task, to investigate differences between these two patient groups and controls. A multivariate analysis of variance (MANOVA) examining three measures of electrodermal activity revealed prestimulus tonic skin conductance levels (SCLs) were markedly lower for the CFS group, with no difference between controls and depressives. Concurrent skin temperature levels were higher for the CFS group than the other two groups. These findings indicate that, despite overtly similar cognitive and symptom profiles, depression and CFS patients can be differentiated with psychophysiological measures. This study adds to the growing body of evidence demonstrating that CFS and depression have distinct neurobiological profiles, consistent with unique aetiologies.

Menstrual effects on asymmetrical olfactory acuity

Gender specific discrepancies on psychometric examination are often interpreted to reflect static differences in cerebral hemisphere specialization, but dynamic alterations relating to circulating gonadal hormones may also be relevant after puberty. The often cited inference of a right hemisphere advantage in males and left hemisphere advantage in females derived from small but reliable differences on spatial tasks and verbal tasks, for example, may to some extent relate to gender-specific differences in circulating gonadal hormones. Performance fluctuations on other higher order cognitive tasks through the menstrual cycle tend to support a temporal association between alterations in cerebral laterality and hormone fluctuations. A potential left hemisphere advantage after menstruation when estrogen and progesterone levels are high in contrast to a right hemisphere advantage at menstruation when estrogen and progesterone levels are low has also received support from shifts in visual field perception. The present investigation continues this line of work by measurement of prospective changes in unirhinal olfactory acuity in the menstrual, ovulatory, and midluteal phases of the menstrual cycle in 11 healthy women who agreed to blood assays of estradiol and progesterone prior to completing a modified version of the Connecticut Chemosensory Perception Exam (CCPE). The CCPE detection of n-butanol showed a clear pattern of changes over the menstrual cycle marked by an asymmetry favoring the right nostril during menstruation when estradiol and progesterone levels were low, an asymmetry favoring the left nostril during ovulation when estradiol levels were high and progresterone levels were low, and an absence of asymmetry during the midluteal phase when estradiol levels decreased and progesterone levels increased. Preliminary correlation analyses revealed a potential competitive influence of estradiol and progesterone on this apparent shift in cerebral laterality. There is thus sufficient evidence to conclude that dynamic changes in relative cerebral hemisphere advantages have a temporal relation to fluctuations in circulating gonadal hormones and to suggest the value of additional investigation of more specific causal relations.

A source-imaging (low-resolution electromagnetic tomography) study of the EEGs from unmedicated men with schizophrenia

Imaging studies and quantitative electroencephalography (EEG) have often, but not consistently, implicated the left hemisphere and the prefrontal cortex in schizophrenia. To help clarify this picture, a spatial filter shown to be effective for enhancing differences between EEG populations was combined with low-resolution electromagnetic tomography and used to compare the source-current densities from a group of 57 male subjects with schizophrenia and a group of 65 matched controls. To elicit differences, comparisons were made during resting conditions and during verbal and spatial cognitive challenges to the subjects. Estimates of the source-current density were derived from 43-electrode recordings of the EEG reduced to the delta, alpha and beta frequency bands. The patients were unmedicated and were selected according to DSM-IV criteria. As a group, they were severe, chronic states with both deficit negative and superimposed florid psychotic symptomatology. The results confirm that schizophrenia is a left-hemispheric disorder centered in the temporal and frontal lobes. They also suggest that, in schizophrenia, functions normally performed by these regions in controls are assumed by homologous regions in the opposite hemispheres.

Neuropsychology and psychopathology: a progress report

This paper summarizes and discusses the contributions of neuropsychological assessment to various forms of psychopathology. Emphasis is placed upon studies done with the Halstead-Reitan battery and the Wechsler Adult Intelligence Scale, but studies done with other neuropsychological test procedures are also reviewed. The conclusions reached are that neuropsychological tests are sensitive to functional regional brain disorganization in psychopathology, and that they are useful in the diagnostic process for a number of disorders including schizophrenia, psychopathy, mood disorders, and other psychiatric conditions.

Low-resolution electrical tomography of the brain during psychometrically matched verbal and spatial cognitive tasks

EEGs were recorded from 75 normal, young, female subjects during psychometrically matched verbal (WF) and spatial (DL) cognitive tasks to elicit the differences in the electrical source distribution inside the brain. Recordings were obtained using 43 EEG and 3 guard electrodes then visually edited and spatially filtered to remove extracerebral artifacts. Twenty 1-sec artifact-free epochs were obtained and analyzed from 42 and 60 subjects during WF and DL respectively. Of these subjects, 20 were placed in a training set and the remainder into a test set. The baseline for the comparison of the two tasks was established by factoring the average cross-spectral matrices of the training-set EEGs, computed in the theta, alpha, and beta frequency bands into spatial patterns common to the two tasks. Only those spatial patterns that contributed to the correct classification of subjects in the test set were included in the source analysis. The source-current density distributions were obtained using the LORETA-KEY algorithm. The results show that the source-current density distribution is related to the putative functional activity in the brain in all three frequency bands. The electrical effects of the tasks are both most highly localized and lateralized in the theta band. The effects in the alpha and beta bands are much more generalized and are strongly lateralized only during one and the other of the tasks respectively. The conclusion is that WF is mainly a left central and bilateral frontal cerebral process while DL is mainly a right central and bilateral posterior cerebral process.