[Risperidone-induced symptomatic hyperprolactinemia in youth with schizophrenia: efficacy and tolerability of cabergoline treatment]. / Iperprolattinemia sintomatica da risperidone in pazienti giovani affetti da schizofrenia e trattamento con cabergolina: studio di efficacia e tollerabilità.

OBJECTIVES: The aim of our study is to evaluate, in youth schizophrenic responders outpatients coming to the SMILE (Service for Monitoring and for early Intervention Looking at the fight against the onset of mental Even psychological suffering of youths of the Psychiatric Department of the University of L'Aquila), the efficacy and tolerability of a low dose of cabergoline, in the treatment of risperidone-induced symptomatic hyperprolactinemia. MATERIALS AND METHODS: Ten schizophrenic young patients (6 male and 4 female; mean age: 23.3 +/- 0.5 years) who were clinical responders to risperidone treatment and showed symptomatic hyperprolactinemia, were treated with low dosage of cabergoline, 0.125 to 0.250 mg/week for 16 weeks. Plasma prolactin level, clinical symptomatology of hyperprolactinemia (UKU) and psychopathology (PANSS) was assessed at baseline and for three times (4, 8 and 16 week) along the follow-up of the study. RESULTS: After cabergoline treatment, the mean decrease in plasma prolactin levels was statistically significant (p < 0.05) for the global sample of youths with schizophrenia. Nine of these patients showed remission of clinical signs of hyperprolactinemia with normalization of prolactin values. No side effect was observed neither patients' psychopathological worsening. CONCLUSIONS: Our data confirm previous studies results, suggesting that low-dose cabergoline treatment of risperidone-induced symptomatic hyperprolactinemia may be safe and clinically effective in a relevant number of schizophrenic patients. Our sample didn't show any side-effects associated to cabergoline use, neither any cardiopulmonary complications as recently reported in literature data. These therapeutic strategies seem to be not influencing psychopathological outcome and for such reason could be a good strategy in clinical practice for the treatment of youths with schizophrenia especially when the efficacy of risperidone is so good to not indicate its withdrawal.

[First episode psychoses: psychosocial, interpersonal and cognitive bases for a therapeutic approach]. / Le psicosi all'esordio: le basi psicosociali, interpersonali e cognitive per un razionale approccio terapeutico.

The occurrence of psychotic symptoms in first episode psychoses is the ultimate stage of a series of behavioural, cognitive and psychosocial signs. Among these, only a small set are pathognomonics, but more importantly, they continue to operate and to modify the clinical picture. The instability of diagnosis and outcome require a large series of multimodal and atheoretical treatment approaches. Interventions should be flexible, acceptable, intrinsically effective and evidence based. Clinical and therapeutic decisional algorithms will be presented to be adopted in mental health services for people at first episode psychoses.

[Symptoms and social functioning features in chronic schizophrenia are aggregate in a tripartite structure]. / Le caratteristiche sintomatologiche e di funzionamento sociale nella schizofrenia cronica si aggregano in una struttura tripartitica.

OBJECTIVE: To verify the association between schizophrenic symptoms and multidimensional variables of social functioning and to look for a possible classification based on an empirical classification outcome oriented. DESIGN: Forty chronic schizophrenic patients, with a diagnosis ascertained through clinical interview and diagnostic criteria were enrolled in the study. SETTING: All patients were followed in a State Mental Health center and were assessed in a stabilized phase of illness. PRINCIPAL OUTCOME MEASURES: Psychopathological assessment was made with PANSS and CGI. Psychosocial assessment was made with Life Skills Profile and Global Functioning Scale. RESULTS: A pervasive correlation among symptoms and psychosocial variables emerged suggesting a unitary concept of behavior related to diagnosis. Factor analysis revealed 2 main components able to explain the 79% of variance. Cluster analysis separated the patients in 3 different groups showing that clinical symptoms are aggregated with specific variables of social functioning. CONCLUSION: Schizophrenic symptoms and social functioning are organized in a tripartite structure. It suggests the existence of three different syndromes that are outcome oriented, and compatible with an unitary concept of schizophrenia.

Sensorimotor gating and habituation evoked by electro-cutaneous stimulation in schizophrenia.

The present study has been performed in order to evaluate two relevant phenomena related to startle reflex (SR) evoked by electro-cutaneous stimulation in schizophrenic patients: 1) the effect of different interstimulus intervals on R1, R2 magnitude and on R2 latency in schizophrenia in order to verify if the gating effect influences all blink reflex (BR) parameters and 2) to replicate and extend our previous data on SR habituation. Our data have confirmed the existence of an impairment of habituation and an abnormal facilitatory effect of R1 component of BR in schizophrenics compared to healthy controls. The present study provides further evidence of specific defective mechanisms of information processing in schizophrenia. The methodology used for SR paradigm appears to be founded on a sound research basis and represents an advantageous paradigm for assessing attentional variables of information processing in mental disorders.

Magnetic resonance imaging findings of amygdala-anterior hippocampus shrinkage in male patients with schizophrenia.

Recent magnetic resonance imaging (MRI) studies found abnormalities of medial temporal lobe and basal ganglia structures. We used an inversion recovery (IR) protocol with the assistance of the Talairach atlas to identify neuroanatomical regions of interest in 19 male schizophrenic patients and 14 matched control subjects. The patient group showed smaller amygdala-hippocampus volume as compared with normal control subjects. This finding was more pronounced for the left side, although no diagnosis X side interaction was present. Third ventricle volume was also enlarged in schizophrenic patients. Trends toward an overall reduction of basal ganglia (striatum and lenticular nucleus) and limbic structures and toward an increase in ventricle-brain ratio were also seen. The study confirms previous evidence of mesial temporal lobe shrinkage, more evident on the left side in a group of relapsing noninstitutionalized male schizophrenic patients.

Acoustic and electrically elicited startle reaction: similar patterns of habituation and reflex modifications in humans.

The present study was performed in order to verify two relevant phenomena related to Startle Reaction in normal subjects: 1) the response habituation, that consists of an exponential decrement of the R2 component of Blink Reflex after repeated identical stimuli, and 2) the modification of R1 magnitude, R2 magnitude and latency when the startle eliciting stimulus is preceded by a warning stimulus. Our data confirm: 1) that habituation is independent of paradigm and type of stimulation (acoustic vs electrocutaneous), and 2) an electrical prestimulus has a facilitatory effect on the R2 latency of the electrically elicited Blink Reflex onset with an inhibition of R2 magnitude. The present study support the view of a systemic supramodal central mechanism of information processing and sensorial gating with super-imposable effects on the different sensorial pathways.

Startle reflex habituation in functional psychoses: a controlled study.

The habituation of the startle reflex in a paradigm using electrical stimulation was studied in 17 psychotic patients and 18 healthy controls. The magnitude of the R2 component of the blink reflex differed between the groups (ANOVA, F = 5.81; P = 0.022) and during the course of trials (F = 25.72; P < 0.0001). Furthermore a statistically significant interaction of diagnosis x trials (F = 3.34; P = 0.022) emerged suggesting that an impairment in habituation of startle is present in patients but not in healthy controls despite a comparable reactivity.

Neuropsychological and clinical correlates of temporal lobe anatomy in schizophrenia.

Twenty-five DSM-III schizophrenic patients were assessed neuromorphologically and neuropsychologically. Reduced temporal lobes were found through magnetic resonance imaging (MRI) evaluation. In addition, in order to look for the neuropsychological correlates of temporal anatomy in schizophrenia, patients were divided into cognitive normal and abnormal schizophrenics, according to their Luria Nebraska Neuropsychological Battery profile. The latter group had statistically significant temporal lobe abnormalities as assessed by MRI, irrespective of medication, clinical picture or any other relevant variables. The implication of such findings in the light of the diaschisis model is discussed.

Neurological soft signs as predictors of central nervous system involvement in HIV-1 infection.

There is increasing evidence in the literature to suggest that HIV-1 infection involves the central nervous system (CNS) as a result of its direct neurotropic properties. In order to find predictors of neurological dysfunction in HIV-1 infection 20 seropositive patients were studied. Data support the notion that neurological soft signs correlate with the stage of infection that may be considered an informative predictor of CNS involvement during the course of HIV-1 infection.

Temporal lobe structure by magnetic resonance in bipolar affective disorders and schizophrenia.

Sixteen bipolar and 10 schizophrenic patients, all male, underwent magnetic resonance imaging scans. Areas derived from five coronal sections were measured separately and then summed to obtain an estimate of temporal lobe volumes. Schizophrenics showed a reduction of temporal lobe areas in those sections corresponding to the hippocampal region. This finding was more pronounced for the left side, although no diagnosis by side interaction was present. Temporal lobe volume was also reduced in schizophrenics. When a lateralized difference was present, the right temporal lobe was larger than the left in both patient groups.

Neurological soft signs in schizophrenia.

A standardised clinical examination which focused on neurological soft signs (NSS) was used by a neurologist blind to diagnosis to assess the presence of neurological soft signs. A comparison of NSS score was made among three groups of subjects consisting of 58 DSM-III schizophrenics, 31 of their healthy first-degree relatives and 38 normal controls. The schizophrenic group had significantly higher NSS total scores than normal controls but did not differ significantly from their first-degree relatives' group. The relatives' group showed higher NSS total scores than did normal controls although to a lesser extent than schizophrenics.

Dementia in schizophrenia. Magnetic resonance and clinical correlates.

Thirty-nine patients with a chronic schizophrenic disorder and 29 healthy control subjects were examined by means of multiplanar magnetic resonance imaging. Schizophrenics as a group showed increased ventricular brain ratio and reduced corpus callosum area. When patients were grouped according to their performance on the Luria-Nebraska Neuropsychological Battery (LNNB), a distinct subgroup of six patients emerged. These patients failed to perform neuropsychological testing, due to their inability to fulfill the instructions, despite often repeated full explanations of the test procedures; four of these patients had enlarged lateral ventricles and all met operational criteria for Kraepelin's dementia praecox. Two other patients subgroups were categorized as LNNB normal and abnormal. These two subgroups showed lesser brain abnormalities and lower negative symptom scores than the former.

Visuospatial impairment in depression: a controlled ECT study.

In order to study the effect of bilateral electroconvulsive therapy (ECT) on visuospatial function in depression, a comparison was made between the performance of 20 ECT-treated patients and 20 healthy controls on a battery of neuropsychological tests including the Complex Figure Test (CFT) and the Mini-Mental State Examination (MMSE). The CFT but not the MMSE performances of depressives vs controls were impaired in pre-ECT testing. While ECT does not affect visuospatial performance, cognitive deficits are unveiled by MMSE. Possible meanings of these findings are discussed.

Reduced temporal lobe areas in schizophrenia: preliminary evidences from a controlled multiplanar magnetic resonance imaging study.

Seventeen young patients with relapsing schizophrenia and 13 normal controls matched for age, gender, and educational level underwent magnetic resonance imaging (MRI) scans. Three sagittal, eight axial, and seven coronal images were obtained for all subjects. Schizophrenic patients showed a reduction of brain tissue in the temporal lobes. Among the several brain structures identified, left temporal lobe area, but not ventricular brain ratio (VBR), discriminated between the two groups. As VBR has been reported to be increased in the more severe forms of schizophrenia, temporal lobe abnormalities may characterize the less severe cases of schizophrenia.