The structure of the corpus callosum in obsessive compulsive disorder.

Abnormal brain connectivity has recently been reported in obsessive compulsive disorder (OCD). However, structural differences in the corpus callosum (CC), the primary structure connecting the two hemispheres, have not been extensively studied. In this case-control study, we recruited 30 patients with OCD and 30 healthy control subjects carefully matched for age, sex and handedness. Combining surface-based mesh-modeling and voxel-based morphometry (VBM), we compared callosal thickness and white matter (WM) density in patients and controls. We investigated associations between callosal structure and cortical gray matter (GM) density, and we related CC measures to neuropsychological performance in OCD. OCD patients showed small anterior and posterior callosal regions compared to healthy control subjects. In the OCD group, anterior callosal thickness was positively correlated with GM density of the right mid-dorso-lateral prefrontal (BA 9/46) area, while posterior callosal thickness was positively correlated with GM density in the left supramarginal gyrus (BA 40). Moreover, posterior callosal WM density was positively correlated with verbal memory, visuo-spatial memory, verbal fluency, and visuo-spatial reasoning performances. Callosal attributes were related to GM density in cortical areas innervated by the CC, and were also related to performance in cognitive domains impaired in the disorder. The CC may therefore be integrally involved in OCD.

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Quetiapine fumarate for schizophrenia and bipolar disorder in young patients.

During the past decade, there has been a substantial increase in the prescribing of antipsychotics to young patients for a variety of pediatric psychiatric disorders. Quetiapine (Seroquel®) received its initial indication from the U.S. Food and Drug Administration for treatment of schizophrenia in 1997, and it received its second indication for the treatment of mania-associated bipolar disorder in 2004. Currently, in young patients, authorized quetiapine indications are schizophrenia in individuals aged 13 or older and manic episodes associated with bipolar I disorder in children 10 to 17 years old. Quetiapine has different pharmacological actions and acts as an antagonist for following receptors: D(2) receptor, serotonin 5-HT(2A) also known as α(1)-adrenoceptor, histamine 1 receptor and muscarinic acetylcholine receptor. Several studies have shown its favorable profile of effectiveness and tolerability in young bipolar and schizophrenic patients. However, the current data make it very clear that the risks and benefits of this drug need to be weighed individually for each patient.

BDNF Val66Met polymorphism is associated with aggressive behavior in schizophrenia.

Brain-derived neurotrophic factor (BDNF) gene variants may potentially influence behaviour. In order to test this hypothesis, we investigated the relationship between BDNF Val66Met polymorphism and aggressive behaviour in a population of schizophrenic patients. Our results showed that increased number of BDNF Met alleles was associated with increased aggressive behaviour.

Allelic frequencies of 3' Ig heavy chain locus enhancer HS1,2-A associated with Ig levels in patients with schizophrenia.

Infectious and autoimmune pathogenic hypotheses of schizophrenia have been proposed, prompting searches for antibodies against viruses or brain structures, and for altered levels of immunoglobulins. Previous experiments have shown that allele frequencies of the Ig heavy chain 3' enhancer HS1,2*A are associated with several autoimmune diseases, suggesting a possible correlation between HS1,2 alleles and Ig production. To test this, we analyzed levels of serum Igs and HS1,2*A genotypes in two independent cohorts, one of 88 schizophrenic inpatients (24 women) and a second of 133 healthy subjects (59 women). Both groups were similar in the frequency of individuals with altered serum concentration of Ig classes and IgG subclasses (schizophrenia panel-80 percent; controls-68 percent). With the possible exception of a stabilizing effect of olanzapine, no psychopharmacological drug consumed during the month prior to serum sampling in the schizophrenia group significantly affected Ig levels. In both patient and control cohorts, an increased frequency of the HS1,2*2A allele corresponded to increased Ig plasma levels, while an increased frequency of the HS1,2*1A allele corresponded to decreased Ig plasma levels. EMSA analysis with nuclear extracts from human B cells showed that the transcription factor SP1 bound to the polymorphic region of both HS1,2*1A and HS1,2*2A while NF-kB bound only to the HS1,2*2A. We predict that differences in transcription factor binding sites in the two allelic variants of the 3' IgH enhancer HS1,2 may provide a mechanism by which differences in Ig expression are affected.

Serial color-word test predicts outcome of pharmacological treatment for panic disorder.

A group of 50 outpatients with Panic Disorder were given the Serial Color-Word Test at the beginning of a standard pharmacological treatment (selective serotonin reuptake inhibitors and benzodiazepines). A single treating psychiatrist, blind to test results, judged therapy outcome at a 5-mo. follow-up. Among the main types of adaptation to conflict assessed by the test (Stabilized, Cumulative, Dissociative, and Cumulative-Dissociative), the Stabilized pattern predicted a good therapy outcome. Response to therapy among the patients with a Stabilized pattern was judged as more often good and less often moderate or poor, compared with the members of the other three adaptation classes (p=.004), and specifically with the patients resorting to a Cumulative strategy (p=.005).

Patterns of adaptation and school performance: a pilot study.

A group of 34 pupils from two school classes (Class 8, M = 13.1 yr., SD=0.5) were administered the Serial Color-Word Test to assess the pattern of adaptation during repeated exposure to the Stroop task (5 massed trials). The typological classification, centered on measures of linear (R) and nonlinear (V) change of reading times, employed norms derived from the medians of the group. The Stabilized primary pattern (low R and low V) corresponded to higher grades, compared with the other 3 primary patterns. Concerning the secondary classification across trials (based on the R and V of the 5 Rs, and on the R and V of the 5 Vs), better school performance was found among subjects with a linear increase of linear changes across trials (high R of the 5 Rs; CR pattern), compared with subjects with a nonlinear increase of linear changes (high V of the 5 Rs; DR and CDR patterns).

Patterns of adaptation and directions of aggression.

A group of 85 nonclinical women volunteers were given the Serial Color-Word Test and the Personality Deviance Scale to verify whether different patterns of adaptation to the Stroop task correspond to significant differences in directing aggression. It was predicted that subjects with the Dissociative pattern, i.e., high values of nonlinear changes in reading times, would score lower on Intropunitiveness than subjects with the Cumulative pattern, i.e., high values of linear changes in reading times. The hypothesis was confirmed (p = .005). No other significant intergroup difference was found, aside from a slightly higher mean score of Extrapunitiveness in the Cumulative group, compared with that for the Stabilized one (p = .04).

Patterns of adaptation in asthma and psoriasis.

Patterns of adaptation to a conflict situation were explored by means of the repeated confrontation with the Stroop task (Serial Color-Word Test) in two clinical groups: bronchial asthma (n=40) and psoriasis (n=28). The respective psychosomatic component of each of these syndromes was expected to correspond to peculiar patterns of adaptation. Differences between asthma and psoriasis patients were statistically significant. Asthma was characterized by patterns with high values of nonlinear change, both within each subtest (Primary Types) and across the five subtests (Secondary Types). Psoriatic patients were classified most often as having the C(V) type (high linear increase of nonlinear changes across the subtests) and showed some more ITA+ types, i.e., within the first subtest, longer reading time at the beginning, followed by uniformly faster times.

Self-report of basic symptoms among psychotic and nonpsychotic subjects.

Basic symptoms, as defined and described by the Bonn Scale, were assessed by means of a new self-report inventory, the Rome Basic Disorders Scale. On all the subscales, psychiatric outpatients (n = 105; most frequent diagnoses: Schizophrenia, Anxiety Disorders, and Mood Disorders) scored significantly higher (p < .001) than nonclinical controls (n = 105). Psychiatric patients with at least one diagnosis on the psychotic sets of Foulds' hierarchical inventory (n = 45), compared with the rest of the psychiatric sample (n = 60), had significantly higher scores on nearly all subscales. Two groups of inpatients with Schizophrenia (n = 20) and Mood Disorders (n = 20) were tested on Day 2 and 9 of hospitalization in an emergency ward. Schizophrenic patients had significantly higher scores on most of the subscales, but only on Day 9; on Day 2 depressed and manic patients scored significantly higher on four subscales. Until now basic symptoms had not been studied during the intrapsychotic phase, mainly because of their transformation into first-rank symptoms; present findings suggest that basic symptoms are active also at the height of the psychotic breakdown and that they are more responsive to treatment in Depression and Mania than in Schizophrenia.

Perceptual defense mechanisms in Crohn's disease and panic disorder.

The defense organization of Crohn's disease and Panic Disorder was studied with a well-validated tachistoscopic paradigm, the Defense Mechanism Test. Three sex- and age-matched groups of 34 subjects (Crohn, Panic, and Nonclinical) were compared on the main codings of defense. Crohn patients were characterized by stereotypy and lack of recognition of the threat. The Panic group presented clearly higher frequencies of protocols with repression, isolation, and disappearance of the threat. Especially was the strongest variant of isolation, barrier-isolation, typical of the defensive substructure of panic patients.

Perceptual defenses and self-rated personality disorders: a multivariate analysis.

The relationships between defense mechanisms and personality disorders were explored by means of the Defense Mechanism Test and Millon's Inventory-II in a group of 100 psychiatric nonpsychotic outpatients. Only few significant positive nonparametric correlations were found, concerning barrier isolation, intro-aggression, and lateness of the threat. Also multiple regression analysis evidenced few significant results and mostly in the negative direction. The unpredicted findings may have been partly determined by a general elevation of personality scale scores (due to the emotional distress of psychiatric), leading to a loss of interindividual differences.

Patterns of adaptation to conflict in bulimia and temporo-mandibular joint disorder.

Two age- and education-matched groups of 45 women, respectively, with the diagnoses of Bulimia and of Temporo-mandibular Joint Disorder, were administered the Serial Color-Word Test, to assess differences in the pattern of adaptation to conflict (the latter being represented by the Stroop task). Three types of norms (clinical, nonclinical and based on reading times) and the functions derived from a previous cluster analysis were employed. Comparisons utilizing clinical norms and cluster analytical functions did not significantly differentiate between groups. According to both nonclinical norms and norms based on reading times, the two clinical groups were significantly different concerning the distribution of adaptation patterns. Bulimic patients resorted more often to the Dissociative pattern (high nonlinear change of reading times), while temporomandibular patients were characterized by the Cumulative pattern (high linear change) and, secondarily, by the Cumulative-Dissociative pattern (high linear and nonlinear change). Intergroup differences were more marked when employing the new norms based on reading times.

Percept-genesis of the mother-child separation theme among panic and asthma patients.

A stimulus portraying a mother figure who is leaving a baby alone on the floor (Separation Theme) was presented tachistoscopically at increasing exposure times, according to the method of the Defense Mechanism Test, to three sex-matched groups of 31 normal subjects, 31 patients with bronchial asthma, and 31 patients with Panic Disorder and Agoraphobia. The frequency of several codings was significantly higher in both clinical groups compared with normal controls. Asthma patients were characterized by reports of the child seen as a statue and of contact or fusion between mother and child. Agoraphobic patients employed different strategies, centered on the mother rather than on the child and mainly represented by the denial of mother's action, e.g., she is not leaving, she is entering. The findings support the hypothesis of a difference in defensive organization between neurotic and psychosomatic patients.

A multivariate study of the Serial Color-Word Test.

Patterns of adaptation to a conflict situation (the Stroop task) were assessed with the Serial Color-Word Test. A cluster analysis was performed on 859 protocols, adopting a six-cluster solution. A subsequent discriminant function analysis cross-validated the usefulness of the test's variables in predicting the cluster assignments. The distribution of 3 different diagnostic groups (psychotic, neurotic-psychosomatic, and general population) showed significant differences across the 6 clusters, thereby contributing to the external validation of the test. The 6 new complex patterns of adaptation described may now be employed in clinical research, alongside the traditional ones.

General cognitive abilities and patterns of adaptation: for Serial Color-Word Test norms based on reading times.

In a pool of 859 clinical and nonclinical Serial Color-Word Test protocols, significant positive correlations were observed between reading times on the Stroop task and measures of linear and nonlinear change. Especially nonlinear change, both within and between the five subtests, showed high correlations with reading times. To derive new time-related norms, the sample was divided into five time groups of the same size and stratified medians were calculated for each of the variables of the test. The new classification procedure should permit an assessment of patterns of adaptation less dependent on the general level of perceptual-cognitive functioning.

Foulds' hierarchy: validation of predictions in psychiatric and dermatological patients.

Foulds' inclusive non-reflexive law of symptom formation has been hitherto confirmed only on psychiatric or non-clinical persons. Given that respectively a yes-bias and a high frequency of non-classified patients may have inflated the rate of confirming protocols in these groups, a validation study was conducted with the Delusions-Symptoms-States Inventory (DSSI) on 188 psychiatric and 295 dermatological patients. Although non-classified patients were not included in the study (thus lowering the number of conforming patterns), both samples showed percentages of patterns conforming to Foulds' law which were above 85 per cent. No significant intergroup difference was found. The rate of conforming patterns in both groups was lower for members of the two psychotic classes (61-77 per cent). Foulds further hypothesized that the number of pathological sets within a given class grows if there is allocation into a superordinate class. This assumption was confirmed in both groups and for most of the inter-class comparisons. Suggestions were advanced to clarify the issue of the time span to be covered by Foulds' pyramid, to refine the instructions and the response format of the DSSI, and to include into the pyramid further relevant disturbances.

Further comments on psoriasis and personality disorders.

Fukunishi and Berger have recently criticized a paper on psoriasis by Rubino, Sonnino, Pezzarossa, Ciani, and Bassi. Their criticisms are analyzed and further data are presented, showing significantly higher frequencies of elevated scores on personality scales in patients with psoriasis, also when another dermatologic disfiguring condition (chronic urticaria) is taken as control.

Percept-genetic codings of defense in chronic schizophrenia.

Hitherto available studies on the percept-genetic defensive organization of Schizophrenia have not distinguished between acute and chronic stages of the disorder. The present research with the Defense Mechanism Test included 30 chronic inpatients with several years of hospitalization and with acceptable perceptual thresholds. Compared with 30 sex- and age-matched nonschizophrenic psychiatric control patients, schizophrenics resorted significantly more often to (a) regression, (b) disappearance of the peripheral figure, (c) introjection (wrong sex attribution to the hero), and (d) significantly less often to the most mature variants of repression. In a further comparison of a subgroup of 16 women schizophrenic patients and a matched group of melancholic inpatients, the findings on regression, introjection, and repression were replicated.

Styles of regulation in the bipolar spectrum.

Styles of regulation were assessed with the Serial Color-Word Test in a group of 35 compensated DSM-III--R bipolar patients (Bipolar) and in 3 control groups: Major Depression (n = 35), Schizophrenia (n = 50), and self-rated Personality Disorder (n = 40). On several measures of nonlinear change (V), patients in the Bipolar group had mean scores between those of the Personality Disorder and the Schizophrenic groups, and overlapped with those of the Major Depression group. Patients in the Bipolar group with clearcut temperaments (hyperthymic or depressive) were significantly more dissociative and less stabilized than other patients in the same group. A further group of nonclinical subjects with hyperthymic temperament (n = 20) was significantly more dissociative than the Personality Disorder group.