Patterns of recovery of autonomic dysfunctions and neurocognitive deficits in schizophrenics after acute psychotic episodes.

In this study, the authors aimed to identify patterns of autonomic dysfunction and neurocognitive deficit recovery. The authors performed laboratory assessments on 66 patients with schizophrenia immediately after an acute psychotic episode and 6, 12, and 18 months later. Shortly after the psychotic episode, the patients displayed cardiovascular hyperarousal at rest, cardiovascular and electrodermal hyporeactivity during 2 Continuous Performance Tasks (CPTs) and deficits in 2 behavioral CPT measures (i.e., reaction time and omission error rate) compared with 29 normal controls. In the subsequent postpsychotic course, changes indicative of a process of recovery occurred in all measurement areas, although with regard to autonomic hyporeactivity amelioration was limited to a subgroup of schizophrenics with complete and persistent symptomatic remission. Neurocognitive improvement in CPTs did not appear to depend on unimpaired autonomic reactivity mechanisms.

[What are the physical complaints without pathological clinical signs in patients with diabetes mellitus?]. / Wie lassen sich Körperbeschwerden bei Patienten mit Diabetes mellitus ohne pathologische klinische Befunde verstehen?

UNLABELLED: In previous research it was found that patients with diabetes mellitus suffer from multiple physical symptoms even early in their disease course. Such complaints may relate to blood glucose levels or can be understood as a sign of distress in respect to the diagnosis of a chronic disease. PURPOSE: This study was performed to evaluate in a cross-sectional analysis all the symptoms that patients may complain of and to relate these symptoms to a possible dysfunction of the autonomic nervous system. METHOD: We assessed the complaints of 66 patients with diabetes mellitus and compared these variables with those of patients with psychological disturbances (n = 794) or somatic disease (n = 162). The symptoms were recorded by means of several questionnaires such as the "Giessener Beschwerdebogen" (GBB), "the Freiburger Persönlichkeitsinventar" (FPI), the German version of the State Trait Anxiety Inventory (STAI) and the German version of the State Trait Anger Expression Inventory (STAXI). The autonomic nervous system was assessed using resting and mental stress conditions in a subset of patients with diabetes mellitus (n = 29) and psychological disturbances (n = 44). RESULTS: Patients suffering from diabetes mellitus and psychological disturbances showed a tendency to higher scores in GBB, STAI and STAXI. As far as psychological disturbances are concerned, the complaints experienced by patients with diabetes mellitus were found to be similar to those with somatic diseases. Both groups, however, rate clearly below those with psychological disturbances. The results of autonomic testing showed a significant disturbance in patients with diabetes mellitus with reduced sensitivity of the baroreceptor indicating autonomic neuropathy. CONCLUSION: Some of the physical complaints of patients with diabetes mellitus can be understood in connection with autonomic dysfunction. Moreover, an explicitly psychological view of these complaints may not be correct.

Autonomic cardiovascular regulation in obesity.

Obese persons suffer from an increased mortality risk supposedly due to cardiovascular disorders related to either continuously lowered parasympathetic or altered sympathetic activation. Our cross-sectional correlation study establishes the relationship between obesity and autonomic regulation as well as salivary cortisol levels. Three patient cohorts were sampled, covering ranges of body mass index (BMI) of 27-32 (n=17), 33-39 (n=13) and above 40 kg/m(2)(n=12), and stratified for age, sex and menopausal status. Autonomic cardiovascular regulation was assessed by use of heart rate variability and continuous blood pressure recordings. Spectral analytical calculation (discrete Fourier transformation) yields indices of sympathetic and parasympathetic activation and baroreflex sensitivity. Morning salivary cortisol was concurrently collected. Contrary to expectation, BMI and waist/hip ratio (WHR) were inversely correlated with sympathetic activity. This was true for resting conditions (r=-0.48, P<0.001; r=-0.33, P<0.05 for BMI and WHR respectively) and for mental challenge (r=-0.42, P<0.01 for BMI). Resting baroreflex sensitivity was strongly related to the degree of obesity at rest (BMI: r=-0.35, P<0.05) and for mental challenge (r=-0.53, P<0.001). Salivary cortisol correlated significantly with waist circumference (r=-0.34, P=0.05). With increasing weight, no overstimulation was found but a depression in sympathetic and parasympathetic activity together with a significant reduction in baroreflex functioning and in salivary cortisol levels.

Early autonomic dysfunction in patients with diabetes mellitus assessed by spectral analysis of heart rate and blood pressure variability.

Patients with diabetes mellitus (DM) often have alterations of the autonomic nervous system (ANS), even early in their disease course. Previous research has not evaluated whether these changes may have consequences on adaptation mechanisms in DM, e.g. to mental stress. We therefore evaluated whether patients with DM who already had early alterations of the ANS reacted with an abnormal regulatory pattern to mental stress. We used the spectral analysis technique, known to be valuable and reliable in the investigation of disturbances of the ANS. We investigated 34 patients with DM without clinical evidence of ANS dysfunction (e.g. orthostatic hypotension) and 44 normal control subjects (NC group). No patients on medication known to alter ANS responses were accepted. The investigation consisted of a resting state evaluation and a mental stress task (BonnDet). In basal values, only the 21 patients with type 2 DM were different in respect to body mass index and systolic blood pressure. In the study parameters we found significantly lower values in resting and mental stress spectral power of mid-frequency band (known to represent predominantly sympathetic influences) and of high-frequency and respiration bands (known to represent parasympathetic influences) in patients with DM (types 1 and 2) compared with NC group (5.3 +/- 1.2 ms2 vs. 6.1 +/- 1.3 ms2, and 5.5 +/- 1.6 ms2 vs. 6.2 +/- 1.5 ms2, and 4.6 +/- 1.7 ms2 vs. 6.2 +/- 1.5 ms2, for resting values respectively; 4.7 +/- 1.4 ms2 vs. 5.9 +/- 1.2 ms2, and 4.6 +/- 1.9 ms2 vs. 5.6 +/- 1.7 ms2, and 3.7 +/- 2.1 ms2 vs. 5.6 +/- 1.7 ms2, for stress values respectively; M/F ratio 6/26 vs. 30/14). These differences remained significant even when controlled for age, sex, and body weight. However, patients with DM type 2 (and significantly higher body weight) showed only significant values in mental stress modulus values. There were no specific group effects in the patients with DM in adaptation mechanisms to mental stress compared with the NC group. These findings demonstrate that power spectral examinations at rest are sufficiently reliable to diagnose early alterations in ANS in patients with DM. The spectral analysis technique is sensitive and reliable in investigation of ANS in patients with DM without clinically symptomatic autonomic dysfunction.

[Physical and psychological status of 60-70-year-old citizens of Bern with neurotic symptoms in childhood--a study over more than 50 years (Emmental cohort)]. / Körperliches und psychisches Befinden bei 60-70jährigen Bernerinnen und Bernern mit neurotischen Symptomen im Kindesalter--Eine Untersuchung über mehr als 50 Jahre (Emmental-Kohorte).

The present study was undertaken to assess the influence of childhood variables (physical and emotional) to later well-being in a group of rural Swiss (Emmental Cohort). Our study is the first prospective cohort over a time period of more than 50 years. It includes 1537 children who were listed and assessed in 1942 (T1) because they had difficulties in school or were otherwise behaviorally disturbed. In 1995 (T2) more than 60% of the initial population could be reassessed by our study group. We found more subjects at T2 who had been rated as intelligent at T1. More subjects responding to T2 belonged to a higher social class, were more anxious, and had more psychosocial problems at T1. Social income at T2 is correlated to the social class at T1. More subjects have died since who were rated at T1 as being less intelligent, less neurotical, and having higher psychosocial problems. Twice as many men died than women. The emotional situation at T2 is significantly correlated to psychological well-being at T1. The somatic complaints at T2 correlate significantly to neurotic symptoms in childhood (T1). The more intelligent the children were rated at T1, the less emotional and somatic complaints were voiced at T2 and the better the psychic well-being was rated (T2). In addition, the former social milieu (T1) significantly determined somatic and psychological complaints at T2. Our data discern a significant correlation between actual status and former childhood variables more than 50 years later in a rural Swiss cohort (Emmental Cohort).

A weighted time budget approach for the assessment of cognitive and social activities.

An instrument designed to assess potentially challenging cognitive and social activities in a wide range of both psychiatric and normal study populations is described in this paper. The technique used combines traditional time budget approaches with an additional, significant component, i.e. a rating indicating the amount of challenge for each activity that is sampled. Separate ratings reflecting the subject's and the interviewer's perspective are generated. Along with a detailed description of this weighted time budget instrument, preliminary data regarding practicality, reliability and validity are reported. An analysis based on time budget interviews with 30 schizophrenic patients showed overall interrater agreement to average 84% (kappa = 0.72). In a study with a possible bearing on the concurrent validity of the instrument, relapsing schizophrenics significantly differed from stable subjects in weighted time budget indices.

Signal detection indices in schizophrenics on a visual, auditory, and bimodal Continuous Performance Test.

Signal detection indices (perceptual sensitivity) were calculated to compare performance of 24 male schizophrenic inpatients and 24 controls (12 alcoholics and 12 normals) on 4 different CPT-tests. A standard version (St) employed 1 target (P = 0.166) and 5 nontargets. In condition V stimuli were presented visually, in condition A acoustically and in condition VA bimodally (1 target (P = 0.333) and 1 nontarget). Compared to controls schizophrenics exhibited lower levels of perceptual sensitivity in all 4 conditions. They were especially impaired when stimuli were presented either acoustically or when they had to monitor 2 modalities simultaneously. Perceptual sensitivity of schizophrenics was significantly lower in conditions V, A, and VA than in condition St. For controls only condition VA led to lower values. Because St was always presented first, the possible explanation that vigilance decrement over time is responsible for the lowered perceptual sensitivity had to be ruled out. It could be shown that schizophrenics did not differ in sensitivity between conditions being later in task sequence. Controls, however, showed a slight decrement over time. Thus our finding should to a large extent be attributed to different task requirements. Response criterion beta yielded inconsistent results.

Reduction of schizophrenic deficits by cognitive training: an evaluative study.

The significance of training programmes was assessed in reducing cognitive deficits in schizophrenics. In a controlled clinical trial, which included 15 experimental and 15 comparison subjects, training was shown to be effective with regard to more complex cognitive functions rather than on an elementary level. Results are discussed with regard to theoretical and practical implications.

Spontaneous fluctuations of electrical skin conductance and the actual clinical state in schizophrenics.

The present paper examines in a group of 48 schizophrenics, whether spontaneous fluctuations (SF) in electrical skin conductance show a relationship to psychiatric symptomatology. Subjects participated in an experiment that delivered nonsignal auditory stimuli. Their clinical state was assessed by the Brief Psychiatric Rating Scale (BPRS) and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE). An additional set of factors with a possible influence on SF rates was also taken into account. A stepwise regression analysis showed BPRS Activation and NOSIE Manifest Psychosis to be of significance, the BPRS subscale displaying a positive and the NOSIE subtest a negative partial correlation to SF frequency. Results are discussed with regard to their implication for experiments using tonic electrodermal measurement; they are also compared with the literature on phasic electrodermal arousal.