Neural Basis of Ambivalence towards Ideal Self-Image in Schizophrenia

Objective@#Little has been explored about a reflection towards self-image in schizophrenia, though it can be related to heterogeneous symptoms of the illness. We identified the neural basis of ambivalence towards ideal self-image in patients with schizophrenia. @*Methods@#20 patients with schizophrenia and 20 healthy controls underwent functional MRI while the self-image reflection tasks of determining whether to agree with sentences describing their actual or ideal self-image that contained one of the adjective pairs with opposite valence. The interaction between the group and ideal ambivalence score was examined, and group differences in functional connectivity related to ambivalence towards ideal self-image were further studied. @*Results@#The interaction of group-by-ideal ambivalence score was shown in the dorsal anterior cingulate cortex and dorsolateral prefrontal cortex, where activities were positively correlated with the level of ideal self-image ambivalence in patients, but not in controls. Task-related decrease in functional connectivity was shown between the orbitofrontal cortex and cerebellum in patients. @*Conclusion@#The process of reflecting on ambivalent ideal self-image in schizophrenia may be related to aberrant prefrontal activity and connectivity. Abnormality in the prefrontal regions that take part in cognitive conflict monitoring and value judgment may underlie the pathophysiology of increased ambivalence towards ideal self-image.

The Relationship between Neuropsychiatric Symptoms and Default-Mode Network Connectivity in Alzheimer’s Disease

Objective@#Neuropsychiatric symptoms of dementia are prevalent and extremely burdening for the patient and caregivers, but the underlying mechanism of these symptoms has not been investigated. This study aimed to investigate the relationship between neuropsychiatric symptoms and default-mode functional connectivity in Alzheimer’s disease. @*Methods@#Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory. Functional magnetic resonance imaging was conducted on seventy patients with Alzheimer’s disease during rest. We conducted a seed-based functional connectivity analysis to identify anterior and posterior default-mode networks (DMN). Seeds were the medial prefrontal cortex (Montreal Neurological Institute 12, 51, 36; seed radius=3 mm) for the anterior DMN and the precuneus (Montreal Neurological Institute -6, -63, 27; seed radius=3 mm) for the posterior DMN We then correlated the scores on neuropsychiatric inventory syndromes (apathy, hyperactivity, affective, and psychosis syndrome) with maps of connectivity in the default-mode network. @*Results@#There was a significant correlation between decreased connectivity in the medial prefrontal cortex of the anterior defaultmode network and hyperactivity (agitation, irritability, aberrant motor behavior, euphoria, and disinhibition) syndrome (p<0.05, family wise error cluster-level corrected). @*Conclusion@#Our study demonstrated that hyperactivity syndrome is related to hypoconnected default-mode network in Alzheimer’s disease. This finding suggests that specific network alterations are associated with certain neuropsychiatric syndromes.

Comparative Study of Clinical Features between Early- and Late-Onset Schizophrenia in South Korea / 대한정신분열병학회지

OBJECTIVES: Late-onset schizophrenia (LOS, age at first onset ≥40 years) is characterized by including predominance of women, better premorbid social adjustment and lower severity of positive/negative symptoms. However, few studies have been conducted on LOS, especially in Asian countries. This study aimed to examine the clinical features of LOS in comparison with early-onset schizophrenia (EOS). METHODS: By retrospectively reviewing medical records, we assessed demographic data and clinical features of 76 LOS (20 males) and 357 EOS (144 males) who admitted to the psychiatric ward of a general hospital. RESULTS: The mean ages of onset were 47.3±5.1 (LOS) and 25.7±6.5 (EOS) years. There were significantly more women in LOS (73.7%) than EOS (59.6%). Significantly more LOS patients had a marital (88.2% vs. 25.8%) and employment history (28.9% vs. 13.1%) than EOS. Patients with LOS had fewer negative (14.3±9.0 vs. 19.9±9.3), general psychopathology score (36.9±11.1 vs. 42.3±13.9) than EOS patients. CONCLUSION: In line with previous studies, this study demonstrated that LOS patients have better premorbid social adjustment. Our finding also replicates previous findings that LOS patients differ from EOS in predominance of women and relative lack of negative symptoms. These results suggest that LOS may be a distinct subtype of schizophrenia.

Influence of Anhedonia and Self-Esteem on Daily-Life Decision-Making in Patients with Schizophrenia

OBJECTIVES: Decision-making in patients with schizophrenia has been known to be inefficient in both cognitive and affective aspects. The purpose of this study was to investigate the influence of anhedonia and self-esteem on the decision-making process in schizophrenia. METHODS: Twenty patients with schizophrenia and 21 healthy controls performed the ‘apparel purchase decision-making task’, during which they were asked to respond to the preference, fitness, and price suitability, before making the final purchase decision. Generalized estimating equation and correlation analysis were conducted to explore for the difference of decision making patterns and influential factors between the two groups. RESULTS: The patients showed lower odds ratio (OR) of the fitness on the apparel purchase decision than the controls [OR 0.190 ; 95% confidence interval (CI) 0.047–0.762, p = 0.019). In the patient group, there was no correlation between the number of purchased trials and the severity of anhedonia, but the number of purchased trials was negatively correlated with the Rosenberg Self-Esteem Scale score at a trend level (R = -0.436, p = 0.055). CONCLUSIONS: Patients with schizophrenia considered the fitness of clothes less than healthy controls on apparel purchasing decisions. Schizophrenia patients with lower self-esteem were intended to buy more clothes.

Severity of Comorbidities among Suicidal Attempters Classified by the Forms of Psychiatric Follow-up / 정신신체의학

OBJECTIVES: Suicide attempters have impaired decision making and are at high risk of reattempt. Therefore it is important to refer them to psychiatric treatment. Especially, People with medical comorbidity are at higher risk of suicidal attempt and mortality. The aim of this study was to investigate the characteristics of suicidal attempters and to analyze the influence of the medical comorbidity on decision to receive psychiatric treatment after visit to an emergency department. METHODS: One hundred and thirty two patients, who visited the emergency room of a general hospital in Gyeonggi-do between January, 2012 and December, 2012 were enrolled as the subjects of this study. After reviewing each subject's medical records retrospectively, demographic and clinical factors were analyzed. RESULTS: Regardless of the engagement type, either via admission or outpatient clinic, the determinant factors of psychiatric treatment engagement were psychiatric diagnosis, employment status, previous psychiatric treatment history, and previous attempt history. Comparison of severity of medical comorbidity(Charlson Comorbidity Index) showed that suicide attempters who received psychiatric treatment via admission or refused the treatment tended to have higher level of medical comorbidity than who received psychiatric treatment via outpatient department. CONCLUSIONS: Our findings showed that medical comorbidity of suicide attempters affected the decision to accept psychiatric treatment. All psychiatrists should evaluate the presence and the severity of medical comorbidity of the suicide attempters and consider implementing more intervention for the medically ill attempters who are willing to discharge against advice.

Characteristics of Ambivalence of Self-image in Patients with Schizophrenia / 대한정신분열병학회지

OBJECTIVES: Ambivalence of self-image is considered to be important in patients with schizophrenia since impairment of self-referential processing and increment in ambivalence are illness-related symptoms. This study aimed to evaluate quantitative and qualitative properties of ambivalence of self-image in patients with schizophrenia. METHODS: Twenty patients with schizophrenia and 20 normal controls performed a set of 'self-image reflection task' and then the level of ambivalence towards actual and ideal self-image were numerically scored. Ambivalence scores were compared between groups and correlation analyses with psychometric scales were done in each group. RESULTS: Patients with schizophrenia had higher level of ambivalence towards both actual and ideal self-image (p<0.001). Normal controls showed significant correlations with the scales representing level of self-concept clarity (r=-0.480, p=0.033), depression (r=0.479, p=0.033), and self-esteem (r=-0.555, p=0.011 ; R=-0.600, p=0.005) while the patients did not. CONCLUSION: Ambivalence towards one's self-image is more intense in patients with schizophrenia. This symptom may be considered to exist as an independent symptom in schizophrenia.

Characteristics of Social Perception and their Changes after Treatment in Patients with Schizophrenia Using the Idea of Reference Provoking Task / 대한정신분열병학회지

OBJECTIVES: Patients with schizophrenia often present idea of reference in social situations, but there has been a limitation in quantitatively measuring their reactions to the social stimuli. The aim of this study was to investigate behavioral characteristics of patients with schizophrenia in social situations in which idea of reference can be provoked. METHODS: Forty subjects with schizophrenia (21 males) and 26 healthy volunteers (17 males) performed the idea-of-reference-provoking task, which was composed of movie clips with scenes of two women sitting on a bench of 1 or 5 m away. The conditions consisted of "referential conversation", "non-referential conversation" or "no conversation". The reactions of the participants were rated by the questionnaires for self-referential perception, malevolent interpretation and anxiety reaction. RESULTS: There were significant group differences in the reactions on self-referential perception, malevolent interpretation and anxiety reaction. After the treatment, patients with schizophrenia showed improved scores of the reactions. In particular, score changes of malevolent interpretation and anxiety reaction in patients with schizophrenia were correlated with change of paranoia scale (rs=0.65, p<0.05 and rs =0.73, p<0.05, respectively). CONCLUSION: Patients with schizophrenia revealed self-referential bias and paranoid responses to social situations, which were improved after psychiatric treatment. Self-referential perceptions and paranoid responses may be state dependent rather than trait of schizophrenia.

Development of Korean Version of the Ambiguous Intentions Hostility Questionnaire(K-AIHQ) / 신경정신의학

OBJECTIVES: We studied the psychometric properties of a Korean version of the Ambiguous Intentions Hostility Questionnaire (K-AIHQ), which measures hostile social-cognitive biases for use in the research on paranoia. METHODS: The translation and back-translation of the AIHQ with concern for the cultural differences were done according to the standard procedure. A sample of 83 healthy volunteers completed the K-AIHQ. RESULTS: The scores of the K-AIHQ were comparable to the results of the original studies. The Paranoia Scale was correlated with the K-AIHQ, but Magical Ideation and Perceptual Aberration scales were not correlated with the K-AIHQ. The interrater reliabilities of the items in each situation were in the acceptable range. CONCLUSION: The KAIHQ seems to be a reliable and valid test to measure the hostile social cognitive biases of patients with paranoia.