Perception of affective prosody in patients at an early stage of relapsing-remitting multiple sclerosis.

Cognitive dysfunction is well known in patients suffering from multiple sclerosis (MS) and has been described for many years. Cognitive impairment, memory, and attention deficits seem to be features of advanced MS stages, whereas depression and emotional instability already occur in early stages of the disease. However, little is known about processing of affective prosody in patients in early stages of relapsing-remitting MS (RRMS). In this study, tests assessing attention, memory, and processing of affective prosody were administered to 25 adult patients with a diagnosis of RRMS at an early stage and to 25 healthy controls (HC). Early stages of the disease were defined as being diagnosed with RRMS in the last 2 years and having an Expanded Disability Status Scale (EDSS) of 2 or lower. Patients and HC were comparable in intelligence quotient (IQ), educational level, age, handedness, and gender. Patients with early stages of RRMS performed below the control group with respect to the subtests 'discrimination of affective prosody' and 'matching of affective prosody to facial expression' for the emotion 'angry' of the 'Tübingen Affect Battery'. These deficits were not related to executive performance. Our findings suggest that emotional prosody comprehension is deficient in young patients with early stages of RRMS. Deficits in discriminating affective prosody early in the disease may make misunderstandings and poor communication more likely. This might negatively influence interpersonal relationships and quality of life in patients with RRMS.

Theory of mind and empathy in patients at an early stage of relapsing remitting multiple sclerosis.

INTRODUCTION: Early after having been diagnosed with relapsing remitting multiple sclerosis (RRMS), young patients coping with the new situation require good social support and interactions. Successful social interaction is critically dependent upon the ability to understand the minds of others and their feelings. Social cognition refers to the ability to understand the mind of others. Theory of mind (ToM) defines the capability to reason about mental states of others. Empathy describes the ability to have insight into emotional stages and feelings of others. Despite the knowledge of cognitive impairment, which can have profound effects on patients daily activities and quality of life in advanced stages of multiple sclerosis, little is known concerning social cognition in early stages of RRMS. METHODS: In this analysis, tests assessing executive functions (working memory, set shifting and inhibition) and instruments measuring theory of mind (the Movie for the Assessment of Social Cognition - MASC) and empathy (Baron-Cohen's Empathy Quotient) were administered to 25 young adult patients at an early stage of RRMS and to 25 healthy controls (HC). Patients and HC were carefully matched according to intellectual level, age, gender, handedness and education. An early stage of the disease was defined as being diagnosed with RRMS in the last 2 years and having an EDSS of 2 or lower. RESULTS: Patients had significantly more incorrect responses ("missing") ToM (P<0.04). Moreover, patients showed a significantly lower level of empathy in the self-rating questionnaire (P<0.02). Of the cognitive tests and depression, ToM and Empathy Quotient (EQ) scores were only significantly correlated with the interference score of the stroop test. CONCLUSIONS: Our findings suggest that theory of mind and empathy are deficient even at early stages of RRMS. Deficits in theory of mind and empathy might negatively influence interpersonal relationships in patients with RRMS.

The effects of acute tryptophan depletion on reactive aggression in adults with attention-deficit/hyperactivity disorder (ADHD) and healthy controls.

BACKGROUND: The neurotransmitter serotonin (5-HT) has been linked to the underlying neurobiology of aggressive behavior, particularly with evidence from studies in animals and humans. However, the underlying neurobiology of aggression remains unclear in the context of attention-deficit/hyperactivity disorder (ADHD), a disorder known to be associated with aggression and impulsivity. We investigated the effects of acute tryptophan depletion (ATD), and the resulting diminished central nervous serotonergic neurotransmission, on reactive aggression in healthy controls and adults with ADHD. METHODOLOGY/PRINCIPAL FINDINGS: Twenty male patients with ADHD and twenty healthy male controls were subjected to ATD with an amino acid (AA) beverage that lacked tryptophan (TRP, the physiological precursor of 5-HT) and a TRP-balanced AA beverage (BAL) in a double-blind, within-subject crossover-study over two study days. We assessed reactive aggression 3.25 hours after ATD/BAL intake using a point-subtraction aggression game (PSAG) in which participants played for points against a fictitious opponent. Point subtraction was taken as a measure for reactive aggression. Lowered rates of reactive aggression were found in the ADHD group under ATD after low provocation (LP), with controls showing the opposite effect. In patients with ADHD, trait-impulsivity was negatively correlated with the ATD effect on reactive aggression after LP. Statistical power was limited due to large standard deviations observed in the data on point subtraction, which may limit the use of this particular paradigm in adults with ADHD. CONCLUSIONS/SIGNIFICANCE: Together with previous findings, the data provide preliminary evidence of an inverse association between trait-impulsivity and the ATD effect on reactive aggression after LP (as assessed by the PSAG) in patients with ADHD and that this relationship can be found in both adolescents and adults. Because of limited statistical power larger sample sizes are needed to find main effects of ATD/BAL administration on reactive aggression in adults with ADHD.

Methylphenidate-induced psychosis in adult attention-deficit/hyperactivity disorder: report of 3 new cases and review of the literature.

OBJECTIVE: We present 3 new cases of psychotic symptoms in patients with adult attention-deficit/hyperactivity disorder while regularly treated with a stimulant therapy with methylphenidate. METHODS: Existing literature about this theme is reviewed, and potential mechanisms are discussed. RESULTS AND CONCLUSIONS: Medication with methylphenidate should be avoided in patients with vulnerability to schizophrenia and in drug addiction, but reported cases without these risk factors demonstrate that a careful and regular psychiatric monitoring is essential in all patients treated with methylphenidate.

Perception of affective prosody in major depression: a link to executive functions?

Major depression is associated with impairments of executive functions and affect perception deficits, both being linked to dysfunction of fronto-subcortical networks. So far, little is known about the relationship between cognitive and affective deficits in major depression. In the present investigation, affect perception and executive functions were assessed in 29 patients with a diagnosis of major depression (Dep) and 29 healthy controls (HC). Both groups were comparable on IQ, age, and gender distribution. Depressed patients showed deficits of perception of affective prosody, which were significantly related to inhibition, set shifting, and working memory. Our findings suggest a significant association between cognitive deficits and affect perception impairments in major depression, which may be of considerable clinical relevance and might be addressed in treatment approaches. Future studies are desirable to investigate the nature of the association in more detail.

Social cognition in alcoholism: a link to prefrontal cortex dysfunction?

AIMS: Alcoholism is associated with a range of cognitive deficits. These deficits might be explained by the 'frontal lobe hypothesis' which suggests a specific vulnerability of the prefrontal cortex (PFC) to the neurotoxic effects of alcohol. Social cognition is thought to be processed in the PFC, but so far only few studies have addressed the issue of social cognition deficits in alcoholism. This review aims to evaluate the deficits in social cognition in alcoholic patients. In addition an outline for future perspectives is given. METHODS: Medline and Psyclit searches were performed for a 30-year period (1977-2007). RESULTS: Alcoholism is associated clearly with social cognition impairments which include emotional face and prosody perception problems, theory of mind deficits and humour processing difficulties. CONCLUSIONS: In summary, the social cognition impairments are consistent with the frontal lobe hypothesis of alcoholism. Future studies should focus on (i) the delineation of the basic cognitive processes which underlie social cognition deficits; and (ii) their relevance as predictors of treatment outcome in alcoholism.

Proverb interpretation changes in aging.

Recent investigations have emphasized the involvement of fronto-subcortical networks to proverb comprehension. Although the prefrontal cortex is thought to be affected by normal aging, relatively little work has been carried out to investigate potential effects of aging on proverb comprehension. In the present investigation participants in three age groups were assessed on a proverb comprehension task and a range of executive function tasks. The older group showed impairment in selecting correct interpretations from alternatives. They also showed executive function deficits, as reflected by reduced working memory and deficient set shifting and inhibition abilities. The findings of the present investigation showed proverb comprehension deficits in normal aging which appeared to be related to reduced executive skills.

Humor processing, mentalizing, and executive function in normal aging.

Recent investigations have emphasized the importance of the prefrontal cortex for humor processing. Although the prefrontal cortex is thought to be affected by normal aging, relatively little work has been carried out to investigate the effects of aging on humor processing. In the present investigation participants in three age groups were assessed on a humor comprehension task. They then answered mentalistic and nonmentalistic questions. Executive tasks were also administered. The older group selected significantly fewer correct punchlines from alternatives than the other groups. They were also poorer at answering mentalistic questions, but did not differ significantly for nonmentalistic questions. The findings of the present investigation showed altered in humor processing in normal aging, and this appeared to be related to mentalizing ability.

Neuropsychological deficits after mechanical aortic valve replacement.

BACKGROUND AND AIM OF THE STUDY: Studies using transcranial Doppler monitoring have identified high-intensity transient signals (HITS) after mechanical valve replacement. Although cognitive dysfunction in relation to HITS was reported in some studies, the current data basis is inconsistent. The study aim was to investigate the long-term effects of HITS on cognitive function. METHODS: Forty patients who had undergone mechanical valve replacement (mean 5.3 years previously) participated in the study. HITS-measurements were performed on the day of neuropsychological assessment. Patients were allocated to HITS-high and HITS-low groups on the basis of the median HITS-rate. Both patient groups completed a neuropsychological test battery and were compared to healthy controls. RESULTS: Both patient groups showed verbal and visual memory deficits in comparison with controls. The HITS-high group scored lower on verbal memory compared to the HITS-low group. In addition, the HITS-high group showed executive deficits when compared to the HITS-low group and controls. The significant effects with respect to verbal memory and executive functions remained after extracorporeal circulation time differences were controlled for. CONCLUSION: The study results imply that heart valve replacement with mechanical prostheses may be associated with mild cognitive impairment. The differential impairment pattern of the high- and low-HITS groups further suggests that the number of HITS may be of critical importance. The observed memory impairments were consistent with the view that cognitive dysfunction after valve replacement may be due to temporal lobe dysfunction. However, future studies are required to investigate the association of number of HITS, cerebral changes and cognitive function in further detail.

Processing of affective stimuli in alcoholism.

Investigations of neuropsychological functioning in alcoholism have revealed executive and memory deficits which have been interpreted in the light of the "frontal lobe hypothesis" which asserts that the frontal lobes are particularly vulnerable to the toxic effects of alcohol. Inspite of the known involvement of the orbitofrontal cortex in the processing of affective stimuli, only few studies concerning affective processing in alcoholism have been conducted so far. Alcoholics and healthy controls were compared by using a comprehensive neuropsychological test battery which included the measurement of facial affect as well as affective prosody perception. Analysis revealed impairments of alcoholics with respect to naming prosody with incongruent semantic content and matching affective prosody to facial expression. Alcoholics showed deficits of affective prosody processing which became evident in ambiguous situations in which no additional cues could be used simultaneously for the interpretation of emotional prosody. These deficits could contribute to interpersonal problem solving and should thus be considered in the therapy of alcoholism.