Enlarged temporal integration window in schizophrenia indicated by the double-flash illusion.

INTRODUCTION: In the present study we were interested in the processing of audio-visual integration in schizophrenia compared to healthy controls. The amount of sound-induced double-flash illusions served as an indicator of audio-visual integration. We expected an altered integration as well as a different window of temporal integration for patients. METHODS: Fifteen schizophrenia patients and 15 healthy volunteers matched for age and gender were included in this study. We used stimuli with eight different temporal delays (stimulus onset asynchronys (SOAs) 25, 50, 75, 100, 125, 150, 200 and 300 ms) to induce a double-flash illusion. Group differences and the widths of temporal integration windows were calculated on percentages of reported double-flash illusions. RESULTS: Patients showed significantly more illusions (ca. 36-44% vs. 9-16% in control subjects) for SOAs 150-300. The temporal integration window for control participants went from SOAs 25 to 200 whereas for patients integration was found across all included temporal delays. We found no significant relationship between the amount of illusions and either illness severity, chlorpromazine equivalent doses or duration of illness in patients. CONCLUSIONS: Our results are interpreted in favour of an enlarged temporal integration window for audio-visual stimuli in schizophrenia patients, which is consistent with previous research.

Beyond childhood: psychiatric comorbidities and social background of adults with Asperger syndrome.

BACKGROUND: Over the past few years, our knowledge about Asperger syndrome (AS) has increased enormously. Although it used to be a syndrome mainly encountered in childhood and adolescent psychiatry, it is now increasingly recognized in adult psychiatry. Nevertheless, little is known about psychiatric comorbidities and life course of adults with AS. The current study aimed to gain an insight into comorbidities and the development of the social situation of adults with AS. SUBJECTS AND METHODS: We investigated psychiatric comorbidities, psychiatric history, professional background, partnerships, and children in 50 adults with AS (34 men and 16 women) over a broad age range (20-62 years). RESULTS: Seventy percent of adults with AS had at least one psychiatric comorbiditiy. Most frequent comorbidities were depression and anxiety disorders. Obsessive-compulsive disorder and alcohol abuse/dependence were also observed. Many adults had previously been treated with psychopharmacological or psychotherapeutic interventions. Although most adults had a high-level school leaving certificate and had gone on to complete training/university studies, less than half were currently in employment. Fourteen adults were living in a partnership and 10 had children. CONCLUSIONS: Adults with AS often have psychiatric comorbidities, indicating lower levels of mental health. Additionally, they seem to have severe limitations concerning professional success, despite having a good school education. Their family situation is also impaired with regard to starting a family. These considerable limitations in the life of adults with AS may help to understand their specific problems, and emphasize the importance of developing specific treatments for improving their mental health and social integration.

Is synesthesia more common in patients with Asperger syndrome?

There is increasing evidence from case reports that synesthesia is more common in individuals with autism spectrum conditions (ASC). Further, genes related to synesthesia have also been found to be linked to ASC and, similar to synaesthetes, individuals with ASC show altered brain connectivity and unusual brain activation during sensory processing. However, up to now a systematic investigation of whether synesthesia is more common in ASC patients is missing. The aim of the current pilot study was to test this hypothesis by investigating a group of patients diagnosed with Asperger Syndrome (AS) using questionnaires and standard consistency tests in order to classify them as grapheme-color synaesthetes. The results indicate that there are indeed many more grapheme-color synaesthetes among AS patients. This finding is discussed in relation to different theories regarding the development of synesthesia as well as altered sensory processing in autism.

Asperger Syndrome: a frequent comorbidity in first diagnosed adult ADHD patients?

BACKGROUND: Because adult ADHD is often accompanied by psychiatric comorbidities, the diagnostic process should include a thorough investigation for comorbid disorders. Asperger-Syndrome is rarely reported in adult ADHD and commonly little attention is paid to this possible comorbidity. SUBJECTS AND METHODS: We investigated 53 adult ADHD-patients which visited our out patient clinic for first ADHD-diagnosis (17 females, 36 males; range of age: 18-56 years) for the frequency of a comorbid Asperger-Syndrome. Diagnosis of this autism-spectrum disorder was confirmed by applying the appropriate DSM-IV-criteria. Additionally we tested the power of the two screening-instruments "Autism-spectrum quotient" (AQ) and "Empathy quotient" (EQ) by Baron-Cohen for screening Asperger-Syndrome in adult ADHD. RESULTS: Eight ADHD-patients were diagnosed with a comorbid Asperger-Syndrome (15.1%). The difference in AQ- and EQ-scores between pure ADHD-patients and comorbid patients was analysed, showing significantly higher scores in AQ and significant lower scores in EQ in comorbid patients. CONCLUSIONS: Results show that the frequency of Asperger-Syndrome seems to be substantially increased in adult ADHD (versus the prevalence of 0.06% in the general population), indicating that investigators of adult ADHD should also be attentive to autism-spectrum disorders. Especially the AQ seems to be a potential screening instrument for Asperger-Syndrome in adult ADHD-patients.

Alcohol and drug dependence in adults with attention-deficit/hyperactivity disorder: data from Germany

Background and Objectives: The objective of the present study was to obtain information about the prevalence of addiction disorders in ADHD patients in a German study population, to compare the prevalence of addiction disorders in ADHD patients to that in the normal population according to the German Epidemiological Addiction Survey, and to determine which drugs are consumed most by ADHD patients. Participants: The sample consisted of 61 patients (average age 35.11 +/- 9.33 years) from our ADHD consultation who were consecutively included in our study over a periodof 12 months. Measurements: We diagnosed ADHD according to DSM-IV-R and by assessing the WURS-k, CAARS and BROWN ADD scales. For diagnosing addiction we conducted the EuropASI, the IDCL, the QOD and the FTNA. For differential diagnosis we assessed the SCL-K. Results: About half of our study population of ADHD patients were diagnosed with a dependence disorder (50.8%, n = 31). Twenty one dot three percent (n = 13) were suffering froman alcohol dependence, 13.1% (n = 8) from a substance use disorder (SUD) and 18% (n = 11) from a combination of both addictions. The drug consumed most commonly by ADHD patients was cannabis. Alcohol and substance abuse commenced significantly earlier in patients with ADHD than in patients with addiction disorders without comorbid ADHD. Conclusions: Our data show that the risk of developing a dependence disorder is elevatedin ADHD patients. Clinicians should bear in mind that the characteristics of a dependencein ADHD patients are clinically more pronounced and that an addiction in ADHD patients starts earlier than usually expected (AU)

Word recognition memory in adults with attention-deficit/hyperactivity disorder as reflected by event-related potentials.

OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is increasingly diagnosed in adults. In this study we address the question whether there are impairments in recognition memory. METHODS: In the present study 13 adults diagnosed with ADHD according to DSM-IV and 13 healthy controls were examined with respect to event-related potentials (ERPs) in a visual continuous word recognition paradigm to gain information about recognition memory effects in these patients. RESULTS: The amplitude of one attention-related ERP component, the N1, was significantly increased for the ADHD adults compared with the healthy controls in the occipital electrodes. The ERPs for the second presentation were significantly more positive than the ERPs for the first presentation. This effect did not significantly differ between groups. CONCLUSION: Neuronal activity related to an early attentional mechanism appears to be enhanced in ADHD patients. Concerning the early or the late part of the old/new effect ADHD patients show no difference which suggests that there are no differences with respect to recollection and familiarity-based recognition processes.

Reduced P300 and P600 amplitude in the hollow-mask illusion in patients with schizophrenia.

Illusions provide a useful tool to study the mechanisms by which top-down and bottom-up processes interact in perception. Patients suffering from schizophrenia are not as subject to the hollow-mask illusion as healthy controls, since studies have shown that controls perceive a hollow mask as a normal face, while patients with schizophrenia do not. This insusceptibility to the illusion is indicating a weakened top-down processing in schizophrenia and little is understood about the neurobiology of this phenomenon. We used event-related potentials to investigate the hollow-mask illusion in patients with schizophrenia and healthy controls. We hypothesized that there would be a visible reduction of top-down processing in the patients' group and that this reduction would occur in the late stages of processing. We found significantly decreased amplitudes in the P300 and P600 components in the patients' group, indicating that visual information does not benefit from frontal, parietal or temporal activity for perceiving incoming stimuli. We propose that a deficit in functional connectivity may be responsible for impaired top-down visual processing in schizophrenia. These data further the understanding of the time course of top-down processing in patients with schizophrenia.

Pathological Internet use and psychiatric disorders: Across-sectional study on psychiatric phenomenology and clinical relevance of Internet dependency

Background and Objectives: With the Cyberspace’s exponential growth of influence questions arise about its mental impacts. The presented study examines the question whether the dependent use of the Internet can be understood as an impulse control disorder, an addiction or as a symptom of other psychiatric conditions. Methods: Internet dependent patients seeking for psychiatric assistance and fulfilling the criteria for pathological Internet use (PIU) were examined with the Structured Clinical Interview according to DSM-IV (SCID), and a variety of questionnaires including the Barratt Impulsiveness Scale (BIS), the Beck Depression Inventory (BDI) and the Dissociative Experience Scale (DES). The patient group was compared to a matched group of healthy controls. Results: The adult patient-group consisted of 25 subjects, 76% male, with a mean age of 29.36 years. Average time spent in Cyberspace was 6.47 h/d, mostly in online-role playing games. According to SCID I and BDI, 19 patients (76%) suffered from a depressive syndrome, with 10 cases of major depressive disorder (40%) and 8 cases of adjustment disorder with depression (32%). Six patients (24%) suffered from a comorbidanxiety disorder. Compared to controls, the patient group presented significantly higher levels of depression (BDI), impulsivity (BIS) and dissociation (DES). Conclusions: PIU shares common psychopathological features and comorbidities with substance related disorders. Therefore, it might be seen as a diagnostic entity in itself in aspectrum of behavioural and substance dependencies. Especially Internet role play may contain an addictive potential for adolescents and adults with subclinical psychopathology (AU)

Neuronal correlates of ADHD in adults with evidence for compensation strategies--a functional MRI study with a Go/No-Go paradigm.

OBJECTIVE: Response inhibition impairment is one of the most characteristic symptoms of attention-deficit/hyperactivity disorder (ADHD). Thus functional magnetic resonance imaging (fMRI) during a Go/No-Go task seems to be an ideal tool for examining neuronal correlates of inhibitory control deficits in ADHD. Prior studies have shown frontostriatal abnormalities in children and adolescents. The aim of our study was to investigate whether adults with ADHD would still show abnormal brain activation in prefrontal brain regions during motor response inhibition tasks. METHODS: fMRI was used to compare brain activation in 15 untreated adult patients with ADHD and 15 healthy reference volunteers during performance of a Go/No-Go task. RESULTS: In contrast to various other studies with children and adolescents with ADHD, we found no significant difference in the activity of anterior cingulate cortex (ACC) or other frontostriatal structures between ADHD and healthy adults. Significantly enhanced activity was found in the parietal cortex, which is known to play an important role in building up attention. CONCLUSION: We hypothesize that the enhanced activity is due to the ability of adult ADHD patients to compensate their deficits for a short time, which is demonstrated in our study by equal task performance in both groups.

Impaired top-down processes in schizophrenia: a DCM study of ERPs.

Perception is not simply based on a hierarchical organization of the brain; it arises from an interplay between inputs from the environment and internal predictions of these inputs. It is an active process which involves an interaction between bottom-up information coming from the senses and feedback connections coming from higher-order cortical areas. In our experiment, we use the hollow-mask illusion to investigate the strength of top-down processes in schizophrenic patients and healthy controls. By using dynamic causal modelling (DCM) on functional magnetic resonance tomography (fMRI) data, we have presented evidence to suggest that patients with schizophrenia are less constrained by top-down processes during perception (Dima, D., Roiser, J.P., Dietrich, D.E., Bonnemann, C., Lanfermann, H., Emrich, H.M., Dillo, W., 2009. Understanding why patients with schizophrenia do not perceive the hollow-mask illusion using dynamic causal modeling. Neuroimage 46, 1180-1186). In this study, we re-address this issue by using DCM on event-related potentials (ERPs) data. Our aim was to validate our previous findings by conducting the same connectivity analysis--DCM--on data obtained from a different neuroimaging method. Our results confirm our initial hypothesis that top-down influences are constrained in schizophrenia, especially in perceptual tasks that require top-down control, like the hollow-mask illusion.

Asperger's syndrome in adulthood.

INTRODUCTION: Asperger's syndrome is one of the autism spectrum disorders. Affected individuals display considerably impaired capacity for social interaction, unusual special interests, and a tendency towards ritualized behavior. METHODS: The etiology, symptoms, diagnosis, and treatment of Asperger's syndrome in adulthood are outlined on the basis of a selective literature review via Medline and information in relevant reference books. Furthermore, the authors report their personal experience at a special clinic for adults. RESULTS: Asperger's syndrome in adulthood can be diagnosed by thorough anamnesis, heteroanamnesis-with emphasis on childhood-and painstaking clinical examination. The considerable psychosocial impairments affect the patients' professional, social, and private lives. The precise etiology is still unknown, but a multifactorial origin with genetic, neurobiological, and psychosocial components appears probable. Although no specific, empirically tested treatment concepts have yet been established, psychotherapeutic elements (structuring and directive interventions) seem to be helpful, together with pharmacotherapy-if indicated-in the presence of comorbidity. CONCLUSIONS: Asperger's syndrome should be included in the differential diagnosis of adults who display the corresponding symptoms. The etiopathogenesis and treatment of Asperger's syndrome in adulthood should be further investigated.

Understanding why patients with schizophrenia do not perceive the hollow-mask illusion using dynamic causal modelling.

Patients suffering from schizophrenia are less susceptible to various visual illusions. For example, healthy participants perceive a hollow mask as a normal face, presumably due to the strength of constraining top-down influences, while patients with schizophrenia do not (Schneider, U., Leweke, F.M., Sternemann, U., Weber, M.M., Emrich, H.M., 1996. Visual 3D illusion: a systems-theoretical approach to psychosis. Eur. Arch. Psychiatry Clin. Neurosci. 246, 256-260; Scheider, U., Borsutzky, M., Seifert, J., Leweke, F.M., Huber, T.J., Rollnik J.D., Emrich, H.M., 2002. Reduced binocular depth inversion in schizophrenic patients. Schizophrenia Research 53, 101-108.; Emrich, H.M., Leweke, F.M., Schneider, U., 1997. Towards a cannabinoid hypothesis of schizophrenia: cognitive impairments due to a dysregulation of the endogenous cannabinoid system. Pharmacol. Biochem. Behav. 56, 803-807). However the neural mechanisms underpinning this effect remain poorly understood. We used functional magnetic resonance imaging to investigate the hollow-mask illusion in schizophrenic patients and healthy controls. The primary aim of this study was to use measures of effective connectivity arising from dynamic causal modelling (DCM) to explain differences in both the perception of the hollow-mask illusion and associated differences in neural responses between patients with schizophrenia and controls, which we hypothesised would be associated with difference in the influences of top-down and bottom-up processes between the groups. Consistent with this explanation, we identified differences between the two groups in effective connectivity. In particular, there was a strengthening of bottom-up processes, and weakening of top-down ones, during the presentation of 'hollow' faces for the patients. In contrast, the controls exhibited a strengthening of top-down processes when perceiving the same stimuli. These findings suggest that schizophrenic patients rely on stimulus-driven processing and are less able to employ conceptually-driven top-down strategies during perception, where incoming sensory data are constrained with reference to a generative model that entails stored information from past experience.

Effective methylphenidate treatment of an adult Aspergers Syndrome and a comorbid ADHD: a clinical investigation with fMRI.

OBJECTIVE: Aspergers Syndrome can present as comorbid with attention-deficit/hyperactivity disorder (ADHD). Very few cases of the assessment and treatment of this comorbidity in adulthood are described in the research literature. METHOD: A 26-year-old patient as suffering from ADHD in combination with Aspergers Syndrome is diagnosed. Treatment is started with methylphenidate (MPH), and the patient's clinical response is observed, psychological tests concerning attention are analyzed, and a functional magnetic resonance imaging (fMRI) examination is performed during an attention-task. RESULTS: On the functional magnetic resonance imaging, a reduction of cerebral activity bilaterally in the parietal lobe under the influence of MPH is detected. CONCLUSION: Besides the neurophysiological findings, this case reports the complex impairment caused by the combination of AD/HD with Aspergers Syndrome and the broad social and behavioral benefits of treatment with MPH for this comorbidity.