The correlation between white matter integrity and pragmatic language processing in first episode schizophrenia.

OBJECTIVE: Higher-order language disturbances could be the result of white matter tract abnormalities. The study explores the relationship between white matter and pragmatic skills in first-episode schizophrenia. METHODS: Thirty-four first-episode patients with schizophrenia and 32 healthy subjects participated in a pragmatic language and Diffusion Tensor Imaging study, where fractional anisotropy of the arcuate fasciculus, corpus callosum and cingulum was correlated with the Polish version of the Right Hemisphere Language Battery. RESULTS: The patients showed reduced fractional anisotropy in the right arcuate fasciculus, left anterior cingulum bundle and left forceps minor. Among the first episode patients, reduced understanding of written metaphors correlated with reduced fractional anisotropy of left forceps minor, and greater explanation of written and picture metaphors correlated with reduced fractional anisotropy of the left anterior cingulum. CONCLUSIONS: The white matter dysfunctions may underlie the pragmatic language impairment in schizophrenia. Our results shed further light on the functional neuroanatomical basis of pragmatic language use by patients with schizophrenia.

Higher-order language dysfunctions as a possible neurolinguistic endophenotype for schizophrenia: Evidence from patients and their unaffected first degree relatives.

The purpose of the study was to examine the presence of pragmatic dysfunctions in first episode (FE) subjects and their healthy first degree relatives as a potential endophenotype for schizophrenia. Thirty-four FE patients, 34 parents of the patients (REL) and 32 healthy controls (HC) took part in the study. Pragmatic language functions were evaluated with the Right Hemisphere Language Battery, attention and executive functions were controlled, as well as age and education level. The parents differed from HC but not from their FE offspring with regard to overall level of language and communication and the general knowledge component of language processing. The FE participants differed from HC in comprehension of inferred meaning, emotional prosody, discourse dimensions, overall level of language and communication, language processing with regard to general knowledge and communication competences. The FE participants differed from REL regarding discourse dimensions. Our findings suggest that pragmatic dysfunctions may act as vulnerability markers of schizophrenia; their assessment may help in the diagnosis of early stages of the illness and in understanding its pathophysiology. In future research the adoptive and biological parents of schizophrenia patients should be compared to elucidate which language failures reflect genetic vulnerability and which ones environmental factors.

Evaluation of white matter structure changes, as assessed in tractography, and cognitive dysfunctions in patients with early onset schizophrenia and their first-degree relatives. / Ocena zaburzen struktury istoty bialej ocenianych w badaniach traktograficznych i zaburzen pamieci operacyjnej u chorych na schizofrenie o wczesnym poczatku i ich krewnych pierwszego stopnia.

OBJECTIVES: The aim of the project was to assess the differences in the white matter (WM) fiber structure between patients with early onset schizophrenia (EOS), their first degree relatives and controls using Fractional Anisotropy (FA), and an independent evaluation of the severity of working memory disturbances in the study groups. METHODS: The study included 20 patients diagnosed with paranoid EOS (diagnosed before the age of 18), a group of 20 parents of patients, matched for gender, and 18 healthy controls. All study participants were examined with Diffusion Tensor Imaging (DTI,1.5 T) and selected neuropsychological tests to assess working memory, immediate memory and attention (Trail Making Test parts A and B: TMT-A and TMT-B, Digit Span Forward and Backward). RESULTS: No significant differences in FA parameters were found between the analyzed groups. The group of patients took significantly longer to perform the TMT-A and TMT-B than the control group, and achieved worse outcomes in Digit Span tests. The relatives of the patients achieved lower scores in Digit Span tests and needed more time to perform TMT-B compared to controls. There were no significant differences between all groups in terms of the number of errors when performing TMT-A and TMT-B. CONCLUSIONS: The results of our study indicate a reduction in the capacity of immediate memory, working memory, cognitive plasticity and divided attention, both in EOS patients and their first degree relatives compared to healthy subjects. The reported neuropsychological deficits were not reflected in WM integrity, as assessed with FA.

Trichotillomania and trichophagia - diagnosis, treatment, prevention. The attempt to establish guidelines of treatment in Poland.

Trichotillomania is a disorder characterised by inability to control over pulling own hair from various parts of a body resulting in noticeable hair loss. Due to its long-term, progressive course, untreated trichotillomania can lead to disturbances in the functioning of patients and complications which are dangerous to life and health. Due to the ambiguous nature of the symptoms, they often remain unrecognised by clinicians. Most patients are afraid of revealing symptoms and reluctantly seek for professional help. In our opinion, it is necessary to increase the awareness of the disorder of physicians of different specialties to improve the detection, treatment efficacy and to prevent dangerous complications of trichotillomania. This paper summarises the current state of knowledge on the epidemiology, aetiology, clinical presentation, and treatment of trichotillomania. It is also an attempt to create guidelines in all cases of suspected trichotillomania - adapted to Polish conditions. It also highlights the importance of a multidisciplinary treatment as a condition of effectiveness of the therapy and prevention of relapse.

Trichotillomania, trichophagia, trichobezoar - summary of three cases. Endoscopic follow up scheme in trichotillomania.

AIM: Trichotillomania is a lack of control of one's hair pulling. It is estimated that about 1% of population develops trichotillomania. In up to 20% of patients with trichotillomania swollowing follows hair pulling. Trichobezoar forms in about 30% of patients with trichofagia. MATERIAL AND METHODS: In 2008-2014 3 patients were operated on trichobezoar. One patient has had a history of trichotillomania. On admission abdominal X-ray and ultrasonography revealed abdominal mass. Diagnosis was confirmed in abdominal computed tomography. RESULTS: All three trichobezoars were evacuated from the intestinal tract during laparotomy with wide gastric wall opening. In one case - Rapunzel syndrome - hair mass was evacuated also from the duodenum and small bowel. All patients were referred to psychiatrist after finishing of the surgical treatment. CONCLUSIONS: In patients operated for trichobezoar as well as other patients with trichotillomania control of hair accumulation in the gastrointestinal tract remains a problem. Authors propose endoscopic follow up scheme in 6, 12, and 24 months after the surgery as well as for other patients with trichotillomania.