A postmortem quantitative study of iron in the globus pallidus of schizophrenic patients.

Several postmortem studies have reported the presence and probable overabundance of basal ganglia mineralization in schizophrenic patients. In order to study this problem in a quantitative fashion we analyzed the mineral content of the globus pallidus in 9 schizophrenic patients and 10 age-matched controls with a Loats computer image analysis system. No significant differences were noted between schizophrenic patients and controls in regard to gender, age, or mineral content of the globus pallidus. The mean content of iron per internal segment of globus pallidus was greater in schizophrenic patients, but the large variation and small number of patients in our sample may have accounted for the negative findings.

Murder and assault arrests of White House cases: clinical and demographic correlates of violence subsequent to civil commitment.

The authors studied arrest records and clinical data on 217 persons formerly hospitalized as "White House Cases" because they were psychotically preoccupied with prominent political figures. Prior arrest for violent crime was the variable most strongly associated with arrest for violent crime after hospital discharge. Male gender and a history of weapons possession were also correlated with future violence. For those with prior violent crime arrests, hospital incidents requiring seclusion were also associated with later violence. For those without prior arrests, subsequent violence was associated with threats, living outside Washington, and command hallucinations. For those previously arrested for nonviolent crimes, only persecutory delusions were associated with later violence.

Schizophrenic dementia. Clinical and computed axial tomography correlates.

Twenty-seven chronic schizophrenic patients and nine other psychiatric patients closely matched in education were compared on the Halstead-Reitan Battery and the Wechsler Adult Intelligence Scale (WAIS). The schizophrenic patients as a group showed significantly poorer performance on the WAIS (full scale: X +/- SD, 92.9 +/- 2.9 vs. 110.8 +/- 2.1, p less than .002) and the Halstead-Reitan Battery (HRB; Average Impairment Range = 2.1 +/- .2 vs. 1.12 +/- .06, p less than .003). In addition the schizophrenic patients did significantly worse than did nonschizophrenic patients on all WAIS subtests and scored in the impaired range on most HRB subtests. Computed axial tomography scans revealed large ventricles on nine schizophrenic patients and cortical atrophy on three others. Among schizophrenics, the enlarged ventricle group consistently scored the worst. No relationship was seen between neuropsychological test performance and degree of ongoing psychopathology as measured by the Brief Psychiatric Rating Scale. These findings are consistent with previous reports of cognitive impairment in schizophrenia and are discussed in terms of regional localization. They provide additional evidence that the impairment is related to the disease process and that structural abnormalities are associated with the more severe condition.

Schizophrenic births and viral diseases in two states.

In order to investigate a possible relationship between schizophrenic births and viral diseases, the birth month and year of all state hospital admissions for schizophrenia in Connecticut and Massachusetts from 1973-1974 were compared with the occurrence of reportable viral diseases for 1920-1955. Data was statistically examined by time series using spectral analysis. Statistically significant coherences were found between schizophrenic births and measles (both states), varicella-zoster (Connecticut) and polio (Connecticut). Influenza just missed statistical significance. No temporal relationship between schizophrenic births and rubella or mumps was found. The results are compared with similar studies in Minnesota and Finland. Definitive explanations for the observed relationships are precluded by the emerging complexity of virus-CNS interactions. A triggering of immune dysfunction by the infectious agents is proposed as the most reasonable explanation.

Intellectual function in primary affective disorder.

The possible effects of clinical depression on intellectual function were investigated in unipolar and bipolar patients. Ninety-six hospitalized depressed patients completed the Wechsler Adult Intelligence Scale (WAIS) on admission and 34 were retested on remission. The high average full scale IQs found remained relatively stable throughout, consistent with earlier studies indicating a limited relationship between intellectual function and clinical severity of depression. No evidence was found for retarded psychomotor activity in bipolar groups or increased psychomotor activity in unipolar groups on three WAIS subtests of psychomotor function, but full scale IQ increased slightly in hypomania.

Cognitive impairment associated with morphological brain abnormalities on computed tomography in chronic schizophrenic patients.

The Halstead-Reitan Battery (HRB), including the Wechsler Adult Intelligence Scale, was administered to 15 young chronic schizophrenic patients in an attempt to identify blindly those patients with evidence of morphological brain abnormalities on prior computed tomography (CT). The CT scan status of 12 of 15 (80 per cent) patients was correctly identified solely on the basis of neuropsychological testing. These results supported our hypothesis that impairment on the HRB in chronic schizophrenic patients was associated with morphological abnormalities on the CT scan, and that the positive and negative CT scans of these patients could be predicted accurately.

Denial and somatization as characteristics of bipolar depressed groups.

A group of 104 depressed patients (54 bipolar and 50 unipolar) completed the booklet form of the MMPI. In addition to the usual validity and clinical scales of the MMPI, 55 special scales, selected for relevancy to the affective disorders, also were included in the study. Inspection of the 11 of 68 MMPI scales on which the biopolar group had significantly higher mean scores than the unipolar group disclosed a patterning of scales suggestive of the use of denial and somatization. These results, coupled with those of other recent studies, suggest that socially desirable response sets and the use of denial and somatization on the MMPI are adaptive defenses in bipolar depressed groups.

Sulcal prominence in young chronic schizophrenic patients: CT scan findings associated with impairment on neuropsychological tests.

Four of 17 chronic schizophrenic (or chronic schizoaffective) patients between the ages of 20 and 35, in partial remission, and living in the community were found to have mildly or moderately prominent sulci, as disclosed by computerized tomography (CT scan). These four patients were matched for sex and age with four chronic schizophrenic (or schizoaffective) patients without sulcal prominence. The Halstead-Reitan battery (HRB) of neuropsychological tests, including the Wechsler Adult Intelligence Scale (WAIS), was administered to these eight patients with the examiner blind to results of the CT scan. Each of the four patients with sulcal prominence considerably exceeded an established cutoff score for brain impairment on the HRB, whereas only one of the control schizophrenics performed in the impaired range, and that just beyond the cutoff. The WAIS Verbal IQ, mneasured concurrently, was in the normal range for all subjects and similar for the two groups. These findings suggest that mild or moderate sulcal prominence on CT scans among young chronic schizophrenics is associated with impaired neuropsychological functioning.

Psychological characteristics corresponding to low versus high platelet monoamine oxidase activity.

From an original sample of 375 college students and employees studied for platelet MAO activity, 66 subjects representing the lower and upper deciles of the sample were contacted for further study, including administration of the booklet form of the MMPI. We analyzed what psychological characteristics might be associated with differences in MAO activity and attempted to cross-validate these characteristics by using them to predict the separability of low vs. high MAO subjects. Each subject was randomly assigned to one of two groups in which the low and high MAO subjects were balanced for sex. For 16 women in group A, a MAO scale discriminated low and high subjects with 100% accuracy. For 18 men in group A, a separate MAO scale discriminated with 94% accuracy. To cross-validate these results, the two scales were applied to another population; both discriminated low and high MAO women and men with a combined 97% accuracy. The thematic content of the two scales is discussed in the light of other reports on the psychological characteristics of low and high MAO subjects, including the apparent relationship between the scale content and the clinical features of bipolar affective disorder.

Prediction of antidepressant responses to imipramine.

45 patients hospitalized for depression who had received double-blind trials with imipramine were examined for possible associations between pretreatment responses to the Minnesota Multiphasic Personality Inventory (MMPI) and their behaviorally-rated responses to this drug. Each patient was randomly assigned to one of two groups with the restriction that the number of responders and nonresponders be balanced for sex. Results from the group A patients suggest that responders and nonresponders to imipramine were best identified by using two sex-specific, empirically-derived, MMPI scales. In contrast, 12 of 13 regular validity and clinical scales and all 49 of the selected special scales of the MMPI failed to separate responders from nonresponders. In the cross-validation study with the group B patients, we were able to predict female and male responders from nonresponders by the new imipramine response scale with accuracy rates of 93 and 100%, respectively. The implications of these results are discussed.

Prediction of antidepressant responses to lithium.

The authors studied 53 patients hospitalized for depression to evaluate possible associations between pretreatment responses to the Minnesota Multiphasic Personality Inventory and behaviorally rated responses to lithium. Patients were randomly assigned to two groups (A and B) in which responders and nonresponders were balanced for sex. For the 18 women in group A, a lithium response scale discriminated responders with 89% accuracy. For the 9 males, a separate scale discriminated responders with 100% accuracy. In a cross-validation, the two scales discriminated responders and nonresponders with 100% accuracy in group B. The empirical methodology of this study suggests an alternative to the theoretical-rational approach of predicting response to antidepressant drugs based on pretreatment depressive symptoms.