Correlations between clinical and historical variables, and cerebral structural variables in people with mild intellectual disability and schizophrenia.

The increased prevalence of schizophrenia in the population with mildly intellectual disability (ID) remains unexplained. The present study explores several possibilities by examining historical/clinical findings in relation to structural neuroimaging findings in three groups: (1) comorbid mild ID and schizophrenia; (2) schizophrenia alone; and (3) mild ID alone. Information about clinical and historical variables was obtained from 101 subjects (39 with comorbidity, 34 with schizophrenia and 28 with mild ID), out of whom 68 (23, 25 and 20, respectively) had had a cerebral magnetic resonance imaging (MRI) scan. Although a number of significant correlations exist between clinical variables and structural MRI abnormalities in all three groups, no clearly predictive inter- or between-group differences emerged. More striking was the finding that showed small amygdalo-hippocampal size to be associated with a history of central nervous system injury, especially meningitis. These findings provide support for the view that cognitive impairment and comorbid psychosis can result from a common cause, such as meningitis or obstetric complications, possibly interacting with other factors, such as family history.

Neuroanatomy of comorbid schizophrenia and learning disability: a controlled study.

BACKGROUND: Reasons for the higher frequency of schizophrenia in learning-disabled populations are uncertain. We investigated the neuroanatomical basis for this phenomenon by structural magnetic resonance imaging (MRI) in patients with learning disability and schizophrenia, learning-disabled patients, and patients with schizophrenia. METHODS: Age-matched and sex-matched patients with learning disability (20 cases), schizophrenia (25), and both disorders (23) underwent MRI scans of the brain. Whole brain areas and specific regions of interest were examined. 29 normal controls were also scanned. FINDINGS: The scans of the group with both disorders were closely similar to those of the schizophrenic group, in terms of both general structures and the structure of the amygdala-hippocampus. However, the amygdala-hippocampus was significantly smaller on both sides than that of normal controls (left 4.1 vs 4.5 cm3, p=0.011; right 4.2 vs 4.99 cm3, p<0.0001). The brains of learning-disabled patients were generally smaller than those of the other three groups, but the amygdalohippocampal complexes were larger. INTERPRETATION: In terms of brain structure, patients with comorbid learning disability and schizophrenia resemble patients with schizophrenia and not those with learning disability. We suggest that the higher frequency of schizophrenia in learning-disabled patients is due to a greater tendency of schizophrenic patients to develop cognitive deficits, and that within the learning-disabled population there may be individuals whose deficits result from undiagnosed schizophrenia.

'Pfropfschizophrenie' revisited. Schizophrenia in people with mild learning disability.

BACKGROUND: It is reported that people with mild learning disability have a higher point prevalence of schizophrenia than the normal population, the reasons for which are unclear. METHOD: Thirty-nine subjects with mild learning disability and schizophrenia, 34 control subjects with schizophrenia and 28 control subjects with mild learning disability were seen. Interviews with relatives and carers were also conducted. Assessments were made of clinical variables, psychopathology, neurological 'soft' signs, IQ, memory and family history. Blood was taken for karyotypic analysis from comorbid subjects. RESULTS: The comorbid group had more negative symptoms, episodic memory deficits, soft neurological signs, epilepsy and receive more community supports than control subjects with schizophrenia. Comorbid subjects had a tendency to belong to multiply affected families and show high rates of chromosomal variants on routine karyotypic testing. CONCLUSIONS: Future work on the generality of schizophrenia should include people with premorbid learning disability, as a discrete subtype from whom valuable genetic aetiological clues may be obtained.

Disseminated Mycobacterium avium-intracellulare infection appearing as a panniculitis.

A 34-year-old woman had wide-spread panniculitis due to a disseminated infection with Mycobacteria avium-intracellulare. The patient had previously received treatment with high dosages of corticosteroids. Suppurative lesions teeming with acid-fast bacilli and without formation of granulomas were found in many organs, including the skin, mediastinum, spleen, liver, and gastrointestinal tract. Both the appearance of disseminated M avium-intracellular infection resembling panniculitis and the involvement of mediastinum have not previously been reported, to our knowledge.

Cytologic evaluation of ocular lesions.

Evaluation was made of ocular cytologic specimens from 59 patients with clinically suspicious lesions: 47 conjunctival scrapes, 10 vitreous fluid aspirates, 1 corneal scrape and 1 iris cyst aspirate. Tissue correlation was available for 30 of the 59 cases. A control group of 20 normal conjunctival scrapes was also evaluated. Cytomorphologic criteria for normal ocular specimens, inflammatory lesions, premalignant lesions and malignant lesions are presented. These lesions included dysplasia (seven cases), carcinoma in situ (four cases), squamous cell carcinoma (five cases), Meibomian gland carcinoma (three cases), basal cell carcinoma (two cases), metastatic adenocarcinoma (one case), melanoma (two cases) and retinoblastoma (one case). The remaining lesions were nonspecific inflammatory changes and normal variants. The results of this study indicate that cytologic examination of ocular specimens can be a valuable adjunct in the workup of suspected neoplastic eye lesions.