[Life-threatening complication of schizophrenia]. / Lebensbedrohliche Komplikation bei Schizophrenie.

The Wernicke Encephalopathy (WE) as a result of a (sub)acute thiamine deficiency remains, unfortunately, still under-diagnosed, especially among non-alcoholics. It should be considered in each occurrence of delirium as well as in any ocular motor disorder and ataxia, in particular if there is a history of weight loss with or without gastrointestinal symptoms. In cases with suspected WE an immediate intravenous substitution of 3×200 mg/d is recommended.

Cognitive mechanisms underlying disorganization of thought in a genetic syndrome (47,XXY).

Because of the risk for development of psychopathology such as psychotic symptoms, it has been suggested that studying men with the XXY karyotype may help in the search for underlying cognitive, neural and genetic mechanisms. The aim of this study was to identify cognitive mechanisms that may contribute to disorganization of thought in XXY men. A group of 24 XXY men and two non-clinical control groups (N=20, N=18) participated in the study. The level of disorganization of thought was measured using the Schizotypal Personality Questionnaire. We assessed IQ, lateralization of verbal information processing and executive functions including inhibition and mental flexibility. XXY men with high levels of disorganization showed more severe impairments in mental flexibility and inhibition as compared to non-clinical controls and other XXY men. This subgroup also showed a stronger reduction in lateralization of verbal information processing. IQ measures did not differentiate XXY men with high versus low levels of disorganization. These findings indicate that executive impairments in the domains of inhibition and mental flexibility might play a role in the increased vulnerability for disorganized thought in the XXY group. Reduced lateralization of verbal information processing points to non-optimal cerebral specialization in the XXY group, especially in XXY men with high levels of disorganization. This fits with deficits in brain functions most vulnerable to such maturational disruptions, i.e. executive dysfunctions. Our findings are in line with those reported for schizophrenia patients with thought disorder. We speculate that the underlying mechanisms of thought disorder probably are deficit specific rather than disorder specific.

[Cause of a contusion of the eyeball]. / Ursache einer Contusio bulbi.

A 21-year-old man presented in the emergency department with noticeable deterioration of vision and a feeling of pressure in the right eye. He stated that he had injured his eye when a shot was fired while cleaning a blank cartridge pistol. Ultrasound examination revealed no evidence of intravitreal hemorrhage or detachment of the retina. Examination by computed tomography did not reveal the presence of a foreign body. The severely reduced visual acuity could most likely be attributed to a traumatic cataract. An in-depth psychiatric examination of the anamnesis revealed that the patient had deliberately injured himself with the weapon. The severe traumatic eye injury was the result of an unrecognized hebephrenic schizophrenia.

[Visuospatial context processing in untreated schizophrenic patients and relation to disorganization syndrome]. / Traitement du contexte visuospatial chez des patients schizophrènes non traités -- influence de la désorganisation.

AIM: Previous studies on schizophrenia have suggested that context-processing disturbances were one of the core cognitive deficits present in schizophrenia. Schizophrenic patients have a failure either of inhibition strategy and maintenance of visuospatial information (25) in condition of contextual interference. In the present study, we explored the performances of untreated schizophrenic patients with 2 tasks exploring detection and long term retention of complex visual features and field dependence-independence tasks were selected. These abilities involve temporary maintenance of visuospatial information and executive functioning of visual working memory system. Several studies have shown that cognitive deficit may depend on schizophrenic symptomatology. However results remain controversial in determining the specific influence of negative and positive symptomatologies as well as clinical disorganization. Our goal was to explore the processing of spatial context and its relation to disorganized syndrome. This study was approved by the local ethic committee. METHODOLOGY: Thirty-six schizophrenic patients were included according to DSM IV criteria (19 neuroleptic naïve, 17 unmedicated patients during more than 3 months). Thirty-six healthy controls were matched to patients for age, gender and level of education. Absence of axis 1 pathology was attested for controls with SCID-NP. Current symptomatology was evaluated by the Positive and Negative Syndrome Scale (PANSS) (14). Clinical disorganisation was evaluated with the disorganisation score established upon a factorial analysis of PANSS by Lepine and Lançon. Items selected to distinguish the disorganised group were abstraction, disorganization, orientation, and attention. PROCEDURE: Two tasks of embedded figures were administered individually to patients and controls. The Faverge task (Research of Figures-RF) (10) evaluates the ability to recognize the target from spatial complex geometrical figures. The Group Embedded Figure Task (GEFT - Oltman) assesses the detection and maintenance of visual target and its recognition within a complex figure. Performance between patients and controls were compared with the Student T test. The comparison of two clinical subgroups of disorganized and low disorganized patients and control group was performed with an ANOVA. Tuckey test was used for pairwise comparisons. RESULTS: We defined two subgroups of patients, disorganized patients (subscore 12, n=17) and low disorganized patients (subscore<12, n=19). Theses 2 subgroups were similar for age and level of education. Concerning the two tasks, there was no significant difference between schizophrenic patients and normal controls. The comparison between subgroups of disorganized and low disorganized patients, for RF task, showed a decrease of correct answers with disorganized patients (p<0.05). For GEFT task, disorganized patients had a decrease of correct answers p<0.01) and more errors (p<0.01) and omissions (p<0.05). The low disorganized patients exhibited for the two tests comparable performance to controls. The disorganized patients had a decrease of right answers (p<0.05) and more errors (p<0.05) than controls for GEFT task and no significant difference for RF. However, with IQ (evaluated with an abstract reasoning test) introduced as covariate, only correct answers for GEFT task remain significant (p<0.05). DISCUSSION: The weak performance of disorganized schizophrenic patients for two tasks RF and GEFT showed that treatment of visuospatial information was impaired in the first perceptive phase of selection and in the organization of information (RF), especially with the maintenance of visual information in memory (GEFT). By contrast, low disorganized patients demonstrated a correct analytic treatment of elementary processing and visuospatial working memory. CONCLUSION: The severity of disorganization influences the visuospatial context processing and visuospatial working memory. These results show the heterogeneity of cognitive functioning regarding to schizophrenic symptomatologies. This difficulty could be related to a problem of central executive functioning in the visuospatial component of working memory, possibly mediated by the dysfunction of dorsolateral prefrontal cortex.

Adult metachromatic leukodystrophy: disorganized schizophrenia-like symptoms and postpartum depression in 2 sisters.

We describe the cases of 2 sisters with adult metachromatic leukodystrophy (MLD). Whereas one sister presented with disorganized schizophrenia-like symptoms as the initial manifestation of MLD, the other remained symptom free except for a 4-week period of postpartum depression. In both patients, there was some residual activity of leukocyte arylsulfatase A (1.7% and 5.5% of normal), and a marked increase in urinary sulfatides was present, as measured by tandem mass spectrometry. An arylsulfatase A pseudodeficiency was therefore excluded. The most common mutations of the adult phenotype, Ile-179-Ser and Pro-426-Leu, were not found. In the literature, only 1 case of adult MLD manifesting as disorganized schizophrenia-like symptoms has been described, whereas postpartum depression has been so far unknown as a presenting symptom of MLD.

Theory of mind and the role of IQ in chronic disorganized schizophrenia.

BACKGROUND: Several studies have suggested a theory of mind (ToM) deficit in schizophrenic disorders. However, the role of interfering variables such as IQ, attention, memory, and severity of the disorder has remained ambiguous. METHODS: A theory of mind picture story comprising a sequencing task, a first and a second order false belief test, and a tactical deception test was given to a group of 23 patients with chronic disorganized schizophrenia and to 12 healthy control persons. In addition, a nonsocial picture story had to be sequenced. Severity of the psychopathology was measured by using the brief psychiatric rating scale (BPRS), IQ was estimated using the 'Mehrfachwahlwortschatztest' (MWT, multiple choice verbal comprehension test). RESULTS: The schizophrenic group was impaired relative to controls on the theory of mind task, but not on the sequencing task of the nonsocial picture story. However, when controlled for IQ, no such difference was found. These findings were neither related to severity, duration, nor age at onset of the disorder. CONCLUSIONS: Theory of mind deficits in schizophrenia may be related to domain general impairments, e.g., intelligence and working memory load, rather than reflecting a 'genuine' compromised mental state attribution similar to autistic spectrum disorders. Schizophrenic patients may, however, rather be impaired in how and when to apply strategic social reasoning. Further studies to investigate the nature of social deficiency in schizophrenia are warranted.

Correlation between clinical syndromes and neuropsychological tasks in unmedicated patients with recent onset schizophrenia.

The aim of this study is to circumscribe the cognitive deficits according to schizophrenic syndromes in a population of sub-acute untreated patients. We have studied the cross-sectional correlation between cognitive deficits and schizophrenic symptoms, in a group of 24 untreated patients (including 17 neuroleptic-naive patients) with recent onset of the disease. A task of alertness, a working memory (WM) test (including two levels of difficulty) and an abbreviated version of the Wisconsin Card Sorting Test (WCST) were selected. WM deficits and poor performance on the WCST were highly correlated with disorganized symptoms, modestly with the positive syndrome and not with the negative syndrome. Thus, disorganized symptoms, more than any other, appear to be related to the impairment of executive function and WM in recent onset unmedicated patients with schizophrenia.

[Acute life threatening catatonia--clinical significance and therapeutic possibilities]. / Akute lebensbedrohliche Katatonie (ALK)--klinische Bedeutung und therapeutische Möglichkeiten.

Malignant catatonia, associated with different somatic and psychiatric disorders, is a rare, life-threatening syndrome. Immediate recognition and adequate treatment are essential and may be life-saving. We describe a case of malignant catatonia and discuss the clinical implications. Additionally, we review the recent literature regarding epidemiology, nosology, current pathophysiological concepts, differential diagnosis, and treatment recommendations.

The syndrome of self-induced water intoxication in psychiatric patients.

This is a report on six psychiatric patients who indulged in excessive ingestion of water and subsequently developed tonic-clonic seizures in the course of the underlying mental disorders. On the basis of the DSM-III criteria, they were diagnosed as follows: schizophrenic disorder, 4; schizo-affective disorder, 1; borderline personality disorder, 1. The levels of serum electrolytes were estimated during five episodes of seizures in three patients. Hyponatremia was a consistent finding (serum sodium: mean = 120.6 mEq/liter). Plasma osmolality and plasma levels of arginine vasopressin (AVP) were determined during two episodes in two patients. The inappropriately high circulating levels of AVP relative to plasma hypoosmolality were documented. However, the response to the overnight fluid deprivation and acute water load during the period of no seizures in two patients revealed no evidence of the persistent SIADH, suggesting the temporal association of hyponatremic encephalopathy with inappropriate AVP secretion. It is not conclusive whether the transient SIADH is the cause or the consequence of hyponatremic encephalopathy, although a delusion or an auditory hallucination could play a critical role in drinking water excessively in three patients.

[Clinical features of alcoholism in patients with the heboid form of schizophrenia]. / O klinicheskikh osobennostiakh alkogolizma u bol'mykh s geboidnoi formoi shizofrenii

By means of a clinical and follow-up method the author studied 74 patients with adolescent slowly progressive psychopath-like schizophrenia and prevalence of alcohol abuse in the clinical picture. It was established that in the period of the active development of the process in the framework of a protracted schizophrenic attack there are no signs of chronic alcoholism. Massive alcohol abuse is a symptom of the main psychopath-like state limited in time by the period of an attack and disappears with the outcome of the attack. In a relatively sluggish development of schizophrenia it would be justified to speak of co-existence of 2 diseases where schizophrenia is the main and it sharply modifies the picture of chronic alcoholism. These patients demonstrate a shorter period in the formation of chronic alcoholism and a distinct prevalence of its somatic signs over the mental.

Delusional hyper-identifications of the Frégoli type. Organic pathogenetic contributors.

Seven patients with the Frégoli syndrome were described. These patients were studied clinically and by routine laboratory tests, electroencephalograms (standard and sleep recordings, sphenoidal electrodes), echoencephalograms, air-encephalograms, brain scanning, and psychological methods (Wechsler, Rey and Benton tests). The following basic conclusions were drawn: All patients were psychotic and in most cases schizophrenia constituted the nosological setting in which the Frégoli syndrome developed. The paranoid element was marked in all cases. All patients were single, young and, with one exception, male. Clinical evidence as well as electroencephalographic, air-ence-phalographic, echoencephalographic, and psychological findings suggest that a strong organic component contributes to the patho-genesis of the Frégoli syndrome.