Neuropsychological test profiles in schizophrenia and non-psychotic depression.

OBJECTIVE: The study examined to what degree schizophrenia is characterized by a neuropsychological (NP) test profile specific in shape and level compared with depression and normal functioning. METHOD: Fifty-three patients with schizophrenia, 45 with non-psychotic depression, and 50 normals were assessed with a comprehensive NP test battery and clinical instruments. NP test scores were factor analyzed into seven composite scores. RESULTS: Schizophrenia patients performed significantly below normals across all seven composite scores, whereas depression patients were impaired in two. Verbal memory was most impaired. Sixty-two percent of schizophrenia patients were moderately or severely impaired, the corresponding figure for depression was 28%. Impairment was moderately associated with IQ level and clinical symptom load in schizophrenia, but not in depression. CONCLUSION: Schizophrenia is characterized by deficits across a wide range of NP functions. Thirty-eight percent of the patients are within normal limits. A mild and limited NP disturbance is apparent in depression.

Cortisol level predicts executive and memory function in depression, symptom level predicts psychomotor speed.

OBJECTIVE: On a group level depression is related to hypercortisolism and to psychomotor retardation, executive dysfunction and memory impairment. However, intra-group heterogeneity is substantial. Why some are impaired while others remain in the normal range, is not clear. The present study aims at discerning the relative contribution of present symptom severity and hypercortisolism to impairment in the three domains of cognition. METHOD: Morning saliva cortisol was measured in 26 subjects with recurrent major depression prior to a neuropsychological examination with tests known to be sensitive to cognitive impairment in depression. RESULTS: Cortisol level correlated with executive dysfunction and post-encoding memory deficits, but not with processing speed. Depression level correlated with processing speed. These patterns remained significant after controlling for confounders through partial correlations. CONCLUSION: The association between cortisol and cognition is not an artifact of psychiatric symptom load. High level of saliva cortisol is associated with aspects of cognition that can be dissociated from psychomotor retardation, which is dependent on symptom load.

General psychopathology is more important for executive functioning than diagnosis.

OBJECTIVE: Impaired executive functioning (EF) has often been reported in patients with major depression or schizophrenia. We hypothesize that the variance in EF is more affected by level of general psychopathology than by diagnosis. METHOD: Forty-three patients with major depression and 47 with schizophrenia were included. EF was measured with Wisconsin Card Sorting Test, Stroop Colour Word Test, Paced Auditory Serial Addition Test, Digits Backwards and Controlled Oral Word Association Test. The level of general psychopathology was measured with Brief Psychiatric Rating Scale - Expanded and Positive and Negative Syndrome Scale, the General psychopathology subscale. RESULTS: The level of general psychopathology predicted more of the variance in EF than diagnosis. In multivariate analyses, the effect of general psychopathology on EF was more robust for adjustment for diagnosis than vice versa. CONCLUSION: Future research on cognitive functioning in psychiatric patients should include level of general psychopathology to avoid overemphasising effects of diagnoses.

Help-seeking behaviour in patients with anxiety disorder and depression.

OBJECTIVE: The objective of this study was to investigate help-seeking behaviour among persons with anxiety disorder and depression based on self-rating in a Norwegian population (the HUNT study). METHOD: Of the 92 100 inhabitants aged 20-89 years invited, 65 648 (71.3%) took part. Among them 60 869 (66.1%) persons delivered valid ratings on hospital anxiety and depression scale, and had answered the requested help for mental problems question. RESULTS: Among HUNT attenders 13% of those with depression and 25% with anxiety disorders had been help seekers. Help seeking was only non-significantly associated with demographic or other variables. CONCLUSION: Most persons with anxiety disorder and/or depression in the population had not sought help for their mental disorders, but the disparity between use and need of health service must not be overassessed. Improvement of the help-seeking rate for common mental disorder should have high priority in mental health politics.

Attention profile in schizophrenia compared with depression: differential effects of processing speed, selective attention and vigilance.

OBJECTIVE: The aim of the study is to investigate whether subjects with schizophrenia and major depression display attention deficits for different reasons. METHOD: Subjects with schizophrenia (n = 53), recurrent major depression (n = 50) and normal controls (n = 50) were administered with 11 measures of processing speed, selective attention and vigilance. Indices of basal speed, speeded attention, non-speeded attention and vigilance were computed. RESULTS: Both clinical groups were impaired on all chronometric tests. The schizophrenic subjects were also more impaired on speeded attention compared with basal processing speed. Only the schizophrenics were impaired on the non-speeded measures of selective attention. Compared with the schizophrenics, the depressives showed a decrement in vigilance. CONCLUSION: Reduced performance on attention tests in major depression is because of a non-specific speed reduction and loss of vigilance consistent with lack of effort. In addition to generally impaired processing speed, the schizophrenic subjects exposed a deficit in selective attention, indicating executive dysfunction.

Honig's model of working memory and brain activation: an fMRI study.

The present study investigated changes in neuronal activation with fMRI related to Honig's model of working memory, which is much less studied compared with other working memory models. In contrast to other studies which have applied recognition procedures, the primary aim with the present study was to examine brain activation when subjects had to continuously recall and forget items held in working memory. The results showed that the mid-ventrolateral frontal cortex was particularly activated in the left hemisphere, whereas the mid-dorsolateral frontal cortex was particularly activated in the right hemisphere during execution of the working memory task. The findings are discussed in relation to process- and domain-specific accounts of working memory.

[Health personnel and teachers admitted to psychiatric institutions]. / Helsepersonnel og laerere innlagt i psykiatriske institusjoner.

During the period 1985-89, 124 physicians were hospitalized in Norwegian psychiatric institutions. The physicians were compared with 91 nurses, 88 enrolled nurses and 110 teachers from three counties who were hospitalized during the same period. The overall rate of admission to psychiatric institutions seemed to be highest for the enrolled nurses and lowest for the teachers. There were few diagnostic differences between the groups. Relatively more of the female teachers were recruited from the middle age group (41-55 years), while the nurses and the enrolled nurses belonged most often to the youngest group (< or = 40 years). The results are discussed with regard to circumstances in the working situation which could possibly explain the differences between the professions as regards the number of admissions.

[Psychiatric disorders among nurses admitted to a psychiatric clinic]. / Psykiske lidelser hos sykepleiere innlagt i en psykiatrisk klinikk.

During 1985-89, 82 female and 13 male nurses were hospitalized in a psychiatric clinic, Modum Bads Nervesanatorium. The frequency of personality disorders and of drug and alcohol abuse, seems to be higher among male than among female nurses. The female nurses have been compared with a sample of assistant nurses and teachers of the same sex. There were no significant differences between the three groups as regards various demographical and clinical factors.

[A shipwreck and organization of the psychosocial support work]. / En båtulykke og organisering av det psykososiale støtteapparat.

During recent years attention has been drawn to the importance of psychosocial support to victims of accidents and disasters. Post-traumatic stress disorder seems to be more frequent than earlier believed, and early psychosocial assistance is thought to reduce the psychological effects of the traumatic experience. The authors describe the psychosocial work, as it was organized at Haukeland Hospital, after a shipwreck. Experiences with mobile medical teams with stress competence are also discussed.

[Mental disorders among physicians hospitalized in a psychiatric clinic]. / Psykiske lidelser hos leger innlagt i en psykiatrisk klinikk.

149 physicians were hospitalized in a psychiatric clinic, Modum Bads Nerve Sanatorium, during the period 1958-89. 122 of the physicians were men and 27 were women. The material is selected but is representative of non-psychotic voluntarily hospitalized physicians. More than 1/3 of the physicians had abuse problems, mainly drug abuse. The average age of the physicians was 46, and they had been practising for an average of 17 years at the time of hospitalization. 60% of them worked outside institutions. About 1/3 of them were specialists.

[Physicians hospitalized in psychiatric institutions in Norway]. / Leger innlagt i psykiatriske institusjoner i Norge.

In the period 1985-89, 124 physicians were hospitalized in Norwegian psychiatric institutions. 20-30 physicians are hospitalized every year. The overall rate of admission to psychiatric institutions seems to be relatively higher among other groups of the adult population than among physicians. The physicians suffer from schizophrenia less frequently than others do, and suffer more frequently from affective and other psychoses. Drug abuse is also a typical disorder among hospitalized physicians. 1/4 of the physicians were hospitalized in Modum Bads Nerve Sanatorium, and the author compares the material from this institution with that from the other 33 psychiatric institutions in Norway.

The development of clinical research in a psychiatric institution.

The author describes the development of the research activity at a psychiatric clinic near Oslo, Modum Bads Nervesanatorium, a psychotherpeutic-oriented institution treating patients with neuroses, substance abuse and character disorders. In 1985 an institute for clinical research was built as an independent unit within the hospital, and the influence of its activities upon the treatment is described in the article.