FC07-03 - Neurological soft signs and morphological changes of basal ganglia and thalamus in patients with first-episode psychosis

Objectives

Minor motor and sensory deficits or neurological soft signs (NSS) are frequently found in individuals suffering from schizophrenia at any stage of their illness. The basal ganglia and the thalamus are accepted as being important for both motor control and integration of sensory input. However, whether NSS are related to structural alterations of these brain regions remains controversial.

Method

20 patients with a first-episode psychosis were investigated using high-resolution magnetic resonance imaging (MRI) at 3 Tesla. NSS were examined on the Heidelberg Scale after remission of acute symptoms and correlated with volume and shape of striatum, pallidum and thalamus by using sophisticated MRI analyses, namely VBM-DARTEL (volume) and FSL-FIRST (shape).

Results NSS scores in patients with schizophrenia were significantly associated with volumetric changes and surface alterations in all investigated areas. Associations remained significant when controlling for age, gender, education, medication and intracranial volume.

Conclusion

Our findings lend further support for an involvement of the basal ganglia and the thalamus in NSS.

[Non-cognitive symptoms and psychopharmacological treatment in demented nursing home residents]

Dementias, in particular Alzheimer's disease (AD), are the main reason for availing of nursing home care. In the course of the illness, the clinical picture is affected by cognitive decline and by other psychopathological, "non-cognitive" symptoms such as apathy, depression, delusions or agitation. Little attention has been paid to these symptoms, although they lead to an increase in strain on the patients and their relatives as well as complications in nursing care. Psychopathological symptoms were evaluated by using the Neuropsychiatric Inventory in 145 nursing home residents (age: 85 +/- 7 years, duration of stay: 35 +/- 48 months); the majority of them with moderate to severe dementia (GDS: 5 +/- 2; MMSE: 11 +/- 9). In addition, the Apathy Evaluation Scale was applied. To meet potential regional effects, residents were recruited in nursing homes in the areas around Heidelberg as well as Munster. 87% of the participants showed psychopathological symptoms of an at least moderate degree, depressive mood (52%), apathy (41%) and agitation (38%) being most frequent. General condition, nutritional status and care status were evaluated as 'good', likewise general health care. In contrast, only 27% were treated by psychiatrists. 70% received psychopharmacological treatment, mostly sedatives (44%), while antidementive drugs were used only in 11%. The findings underline the need of further information and advanced training.

Die Apathy Evaluation Scale: Erste Ergebnisse zu den psychometrischen Eigenschaften einer deutschsprachigen Übersetzung der Skala

Apathy is a common feature of a variety of different psychiatric, neurological, and medical disorders. It can be defined as lack of motivation affecting cognitive, emotional, and overt behavioural aspects. Despite being associated with other clinical disorders, apathy can also occur as an independent syndrome (e. g., after brain injuries), now depicting a primary loss of motivation. However, apathy is predominantly assessed within the scope of superordinate psychiatric disorders. As a syndrome-independent scale, the Apathy Evaluation Scale (AES) claims to assess levels of apathy in different disorders. The aim of the present study is to provide German speaking researchers with an authorized German translation of the AES (AES (D)). The scale was evaluated in a sample of 217 subjects, consisting of patients suffering from dementia (n=120), remission-phase schizophrenia (n=20), Parkinson's disease (n=12), stroke (n=28), as well as elderly healthy controls (n=37). Preliminary results concerning the factorial structure, item characteristics, reliability, and construct validity demonstrate favourable statistical properties and suggest that the AESD is comparable to its original. The scale seems well-suited to detect apathy in different clinical groups. Differences between informant sources (clinician interview, self-, and informant ratings) seem to be related to the severity of symptoms or expert practice.

Demenzkranke Menschen in individuell bedeutsamen Alltagssituationen

First outcomes of a current intervention study focussing on emotions of nursing home residents with mild, moderate and severe dementia are discussed in the present contribution. The aim of the study was to prove the effect from an individual approach in the care of people with dementia. By promoting individual everyday situations for each resident, positive emotions should be stimulated and individual well-being should be improved. Findings show the possibility to gain such individual everyday-situations for people with mild, moderate and severe dementia, which stimulate positive reactions and may be integrated into the care process. Of particular importance are those positive situations which focus on the communication between nurses and residents or in which the residents receive personal attention from nurses.

Das Heidelberger Instrument zur Erfassung von Lebensqualität bei Demenz (H.I. L.DE.)

The contribution is intended to describe the theoretical background and measurement approach of H.I.L.DE., a research project aimed to develop and validate a comprehensive assessment of quality of life in nursing home residents suffering from dementia. Proceeding from the assumption that emotions are felt even in advanced stages of dementia and can be interpreted on the basis of peoples' mimic expressions, three samples of participants were recruited from 11 nursing homes of varying maintenance: 121 nursing home residents suffering from dementia, 97 professional caregivers and 101 relatives participated in the first wave of this study. Operational definition of quality of life in H.I.L.DE. proceeds from the differentiation of eight dimensions of quality of life: physical environment, social environment, quality of care, behavioral competence, medical and functional status, cognitive status, psychopathology and behavior disturbances, and subjective experiences of physical and social environment and emotional well-being. Measures of the eight dimensions involve data from medical examination, interviews with residents, professional caregivers and relatives, ecopsychological assessment of physical environment and analysis of care documents. First results from the H.I.L.DE.-study are used as an illustration of the potentials of such a comprehensive approach to the measurement of quality of life.

Ungew�hnlicher Verlauf einer ?-Mannosidose mit Symptomen einer paranoid-halluzinatorischen Psychose

We report the case of a 27-year-old female with recurrent paranoid-hallucinatory episodes who was initially diagnosed as suffering from schizophrenic psychosis. After 10 years of treatment under this diagnosis, alpha-mannosidosis was identified to be the underlying cause of her psychiatric symptoms. alpha-Mannosidosis is a rare autosomal recessive lysosomal storage disorder associated with decreased activity of the enzyme mannosidase. In the present case, diagnosis was made late in the illness after failure of a response to antipsychotic treatment and with the patient additionally showing progressive cognitive decline. Only after extensive investigation was the diagnosis made by showing decreased alpha-mannosidase enzyme activity in serum and blood leukocytes. This case demonstrates that an unusual clinical course or striking symptom patterns, especially in association with somatic comorbidity, in psychotic patients should lead to diagnostic consideration of inherited metabolic disease.

[Working memory in healthy subjects and schizophrenics: studies using BOLD fMRT]

Functional magnetic resonance imaging uses the blood oxygen level-dependent effect (BOLD MRI) for noninvasive display of cerebral correlatives of cognitive function. The importance for the understanding of physiological and pathological processes is demonstrated by investigations of working memory in schizophrenics and healthy controls. Working memory is involved in processing rather than storage of information and therefore is linked to complex processes such as learning and problem solving. In schizophrenic psychosis, these functions are clearly restricted. Training effects in the working memory task follow an inverse U-shape function, suggesting that cerebral activation reaches a peak before economics of the brain find a more efficient method and activation decreases.

Functional, biochemical, and molecular investigations of renal kallikrein-kinin system in diabetic rats

A reduction of renal kallikrein has been found in non-insulin-treated diabetic individuals, suggesting that an impaired renal kallikrein-kinin system (KKS) contributes to the development of diabetic nephropathy. We analyzed relevant components of the renal KKS in non-insulin-treated streptozotocin (STZ)-induced diabetic rats. Twelve weeks after a single injection of STZ, rats were normotensive and displayed hyperglycemia, polyuria, proteinuria, and reduced glomerular filtration rate. Blood bradykinin (BK) levels and prekallikrein activity were significantly increased compared with controls. Renal kallikrein activity was reduced by 70%, whereas urinary BK levels were increased up to threefold. Renal kininases were decreased as indicated by a 3-fold reduction in renal angiotensin-converting enzyme activity and a 1.8-fold reduction in renal expression of neutral endopeptidase 24.11. Renal cortical expression of kininogen and B2 receptors was enhanced to 1.4 and 1. 8-fold, respectively. Our data suggest that increased urinary BK levels found in severely hyperglycemic STZ-diabetic rats are related to increased filtration of components of the plasma KKS and/or renal kininogen synthesis in combination with decreased renal kinin-degrading activity. Thus, despite reduced renal kallikrein synthesis, renal KKS is activated in the advanced stage of diabetic nephropathy.

Bradykinin excretion is increased in severely hyperglycemic streptozotocin-diabetic rats

The renal kallikrein-kinin system (KKS) was studied in pair-fed streptozotocin (STZ)-induced diabetic rats and compared with age-matched controls. Twelve weeks after STZ injection, rats were normotensive, showed hyperglycemia, proteinuria, polydipsia and reduced glomerular filtration rate (GFR) and body weight. The activities of urinary prekallikrein (PKLK) and kallikrein (KLK) were reduced accompanied by an up to 3-fold increase of bradykinin (BK) excretion compared to controls. The increased BK excretion suggests that the renal KKS in STZ-diabetes is activated and that the reduction in urinary PKLK and KLK activity may be due to an increased consumption of these enzymes or to a negative feedback mechanism. The stimulation of the renal KKS in STZ-diabetes could reflect an attempt of the organism to balance glomerular hypertension.