Boys-Specific Text-Comprehension Enhancement With Dual Visual-Auditory Text Presentation Among 12-14 Years-Old Students.

Quality of language comprehension determines performance in all kinds of activities including academics. Processing of words initially develops as auditory, and gradually extends to visual as children learn to read. School failure is highly related to listening and reading comprehension problems. In this study we analyzed sex-differences in comprehension of texts in Spanish (standardized reading test PROLEC-R) in three modalities (visual, auditory, and both simultaneously: dual-modality) presented to 12-14-years old students, native in Spanish. We controlled relevant cognitive variables such as attention (d2), phonological and semantic fluency (FAS) and speed of processing (WISC subtest Coding). Girls' comprehension was similar in the three modalities of presentation, however boys were importantly benefited by dual-modality as compared to boys exposed only to visual or auditory text presentation. With respect to the relation of text comprehension and school performance, students with low grades in Spanish showed low auditory comprehension. Interestingly, visual and dual modalities preserved comprehension levels in these low skilled students. Our results suggest that the use of visual-text support during auditory language presentation could be beneficial for low school performance students, especially boys, and encourage future research to evaluate the implementation in classes of the rapidly developing technology of simultaneous speech transcription, that could be, in addition, beneficial to non-native students, especially those recently incorporated into school or newly arrived in a country from abroad.

Cognitive impairments in patients with first episode psychosis: The relationship between neurophysiological and neuropsychological assessments.

Cognitive deficits in schizophrenia have been widely reported. Neurophysiological and neuropsychological assessments have been conducted to study these impairments. Event-related potentials (ERPs) are relevant markers of cognitive deficits in schizophrenia, and reductions in specific ERP components have been found. The MATRICS Consensus Cognitive Battery (MCCB) was developed to obtain a consensus battery for the assessment of cognitive deficits in schizophrenia. Here, we aimed to study modulations of several ERP components in first episode psychosis (FEP). We also examined neuropsychological deficits using the MCCB, and correlations between ERP and MCCB impairments. Thirty-eight FEP patients were compared to thirty-eight healthy controls. The following ERP components were examined: P1, N1, MMN, P2, early-P3 and late-P3. We used an auditory three-stimulus oddball paradigm, with standard (60%), target (20%) and distractor (20%) stimuli. FEP patients showed significantly lower amplitudes of P2, early-P3 and late-P3 components. FEP patients also showed significant deficits in all the MCCB cognitive domains. Finally, correlational analyses found strong associations between amplitudes of P2, early-P3 and late-P3 components and MCCB tests for attention and speed of processing. These findings indicate that deficits in late auditory ERP components are present in FEP, whereas early components are preserved. These reductions in late ERP components were related to attentional deficits in FEP as assessed by MCCB. These findings indicate that MCCB is a valid battery for studying cognitive impairments in the initial stages of schizophrenia, and highlight the utility of converging neurophysiological and neuropsychological measures to examine attentional impairments in schizophrenia.

Single Case Study: Neuropsychological Functioning in a Patient Diagnosed with Intermittent Explosive Disorder Pre and Post Neurosurgery.

Intermittent explosive disorder (IED) is characterized by a difficulty to resist the urge to carry out a recognized harmful behavior. The central symptom is aggressiveness, expressed in isolated episodes. Executive function impairments are habitually found in impulse control disorders. Neuropsychology of impulsivity is related to dysfunctions in the orbito-frontal cortex, dorsolateral cortex and anterior-cingulated regions, being consequently involved in cognitive mechanisms of inhibition. Lesions in those areas are common in IED. In the most severe cases of IED, surgical procedures are required for treatment. In this study, we examined JML; a patient suffering from a severe case of IED. He experienced frequent episodes of auto and heteroaggression and multiple psychiatric admissions, and thus stereotactic surgery was the recommended treatment. The procedure consisted of an electrode situated lateral to the lateral ventricle, targeting the projections between frontal and subcortical affected regions. We aimed to study the neuropsychological functioning of JML, before and after electrode implantation. Our results suggested that surgery in IED improves cognitive performance at some levels. JML significantly improved his cognitive flexibility, measured with WCST, and alternate attention assessed with CPT and TMT-B tests, after electrode implantation. Cognitive flexibility deficits may be also related to increased aggressiveness. Therefore, improvements at this level may involve a reduction of impulsivity and aggressive behavior.

Single case study: neuropsychological functioning in a patient diagnosed with intermittent explosive disorder pre and post neurosurgery

Intermittent explosive disorder (IED) is characterized by a difficulty to resist the urge to carry out a recognized harmful behavior. The central symptom is aggressiveness, expressed in isolated episodes. Executive function impairments are habitually found in impulse control disorders. Neuropsychology of impulsivity is related to dysfunctions in the orbitofrontal cortex, dorsolateral cortex and anterior-cingulated regions, being consequently involved in cognitive mechanisms of inhibition. Lesions in those areas are common in IED. In the most severe cases of IED, surgical procedures are required for treatment. In this study, we examined JML; a patient suffering from a severe case of IED. He experienced frequent episodes of auto and heteroaggression and multiple psychiatric admissions, and thus stereotactic surgery was the recommended treatment. The procedure consisted of an electrode situated lateral to the lateral ventricle, targeting the projections between frontal and subcortical affected regions. We aimed to study the neuropsychological functioning of JML, before and after electrode implantation. Our results suggested that surgery in IED improves cognitive performance at some levels. JML significantly improved his cognitive flexibility, measured with WCST, and alternate attention assessed with CPT and TMT-B tests, after electrode implantation. Cognitive flexibility deficits may be also related to increased aggressiveness. Therefore, improvements at this level may involve a reduction of impulsivity and aggressive behavior (AU)

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Changes on the Modulation of the Startle Reflex in Alcohol-Dependent Patients after 12 Weeks of a Cognitive-Behavioral Intervention.

AIMS: Little is known about changes in the modulation of the startle reflex when patients go through an alcohol-dependence treatment in an outpatient facility. In the current study, the affective modulation of the cue-related startle reflex has been used to evaluate changes in the emotional processing of alcohol-related stimuli that occurred after a standard cognitive-behavioral intervention, and to assess the outcome of this intervention. We hypothesized a 'normalization' of the startle inhibition for the alcohol-related cues during the period of treatment. We also assumed that higher startle inhibition at baseline elicited by alcohol cues would predict the relapse on alcohol consumption during treatment. PARTICIPANTS: A total of 98 alcohol-dependent subjects were included who fulfilled DSM-IV criteria for alcohol dependence. A control group of 72 subjects was selected to match demographic characteristics. MEASUREMENTS: All patients received a standard cognitive-behavioral therapy once a week throughout the study period. FINDINGS: Results show that the startle response differed significantly after 12 weeks of treatment for alcohol-related, neutral and aversive stimuli between alcohol-dependent patients and controls. Low startle responses at baseline to alcohol cues predicted relapse. CONCLUSIONS: These results may indicate that the startle reflex is referred to enduring and permanent processes of cue reactivity, and that the emotional processing of alcohol-associated cues assessed with the affect-modulated startle reflex is less altered by interventions attempting to influence explicit cognitions. Furthermore, lower values of the baseline startle reflex elicited by alcohol-associated stimuli were associated with higher probability of relapse on alcohol use.

Esquizofrenia y disociación: el trauma infantil en la etiología de los síntomas / Schizophrenia and dissociation: childhood trauma in the etiology of symptoms

Introducción: En los últimos 10 años han surgido múltiples estudios que vinculan las experiencias traumáticas en la infancia con la esquizofrenia. Hay autores que postulan un subtipo de esquizofrenia de origen traumático cuyos síntomas estarían mediados por mecanismos disociativos. Observación: Presentamos el caso de una joven de 22 años con antecedentes de polivictimización durante la infancia. A los 14 años inició un cuadro clínico caracterizado por sintomatología ansiosa y depresiva y realizó un primer intento de suicidio. Posteriormente se instauraron conductas autolesivas acompañadas de síntomas disociativos, alucinaciones visuales y auditivas e ideación delirante. Actualmente, y a lo largo de los 8 años de evolución, los síntomas positivos se han mantenido a pesar de múltiples tratamientos antipsicóticos. La paciente cumple los criterios DSM IV para esquizofrenia y trastorno límite de la personalidad. Las pruebas psicométricas aplicadas indican elevada disociación; las capacidades cognitivas están preservadas, con ausencia de trastornos formales del pensamiento y de síntomas negativos, y presenta un aceptable ajuste social. Discusión: El trauma infantil se asocia a los síntomas psicóticos, al trastorno límite de personalidad y a los síntomas disociativos. Diversos estudios muestran la imposibilidad de distinguir las alucinaciones de origen psicótico de las disociativas o de las del trastorno por estrés postraumático Es necesario contemplar la posibilidad de que los síntomas que presentan los pacientes esquizofrénicos con antecedentes de trauma infantil tengan un componente disociativo. Enfatizamos el indagar sistemáticamente sobre los antecedentes de abusos en la infancia y la presencia de síntomas disociativos en los pacientes con esquizofrenia (AU)

We report the case of a 22-year-old woman with history of childhood trauma. At 14 years old, she began with a clinical syndrome, characterized by anxiety and depression and made the first suicide attempt. She continued with repeated self-harm behavior and suicide attempts, showing dissociative symptoms, visual and auditory hallucinations, and prejudiced elusions. The current examinations indicate high dissociation, preserved cognitive abilities, absence of formal thought disorder and negative symptoms, and acceptable social adjustment. Discussion: The childhood trauma has been associated with psychotic symptoms, with the borderline personality disorder and with the dissociative symptoms. Diverse studies showed the inability to distinguish the psychotic hallucinations from the dissociative hallucinations or from the post-traumatic flashbacks. Some of the symptoms of schizophrenic patients with a history of childhood abuse are likely to have a dissociative component. The childhood trauma history and the presence of dissociative symptoms should be explored in all patients with schizophrenia (AU)

Comorbilidad del trastorno por estrés postraumático en pacientes con trastorno mental grave. Implicaciones clínicas / Comorbidity of post-traumatic stress disorder in patients with severe mental illness. Clinical implications

El trastorno por estrés postraumático (TEPT) aparece de forma comórbida con el trastorno mental grave (TMG) en el 16–48% de los casos, una cifra mucho más alta que en la población general (7,8–9,2%). Aunque en estos pacientes con enfermedad psiquiátrica primaria grave el diagnóstico del TEPT es muy frecuentemente obviado. Hay varias hipótesis etiopatogénicas que explicarían la alta prevalencia de TEPT en pacientes con TMG: diátesis del propio trauma; alto riesgo de exposición a situaciones traumáticas; predisposición genética para la psicosis en un grupo de pacientes con TEPT, y efecto del propio tratamiento antidopaminérgico. Las repercusiones del TEPT en pacientes con TMG están bien documentadas en la bibliografía. Los pacientes con TEPT presentan síntomas psiquiátricos más severos, más trastornos por abuso de alcohol y otras sustancias, tienen un mayor número de visitas y hospitalizaciones psiquiátricas, una menor integración laboral, una peor adherencia al tratamiento farmacológico, más conductas de riesgo, intentos de suicidio y autolesiones, y una función cognitiva más pobre. Los antidepresivos, en especial los inhibidores selectivos de la recaptación de serotonina, y la terapia cognitivo conductual serían los tratamientos de elección en el TEPT. Los últimos estudios indican que la terapia cognitivo conductual podría ser también útil en los síntomas postraumáticos de pacientes afectados de TMG. En la práctica clínica es recomendable realizar de forma sistemática una valoración de los traumas sufridos e indagar acerca de la existencia de síntomas postraumáticos en las entrevistas clínicas (AU)

Posttraumatic stress disorder (PTSD) appears by comorbid severe mental illness (SMI) in 16%–48% of cases, higher than in the general population (7.8% to 9.2%). Although these patients with severe primary psychiatric diagnosis of PTSD is often missed. Several etiopathogenic hypotheses could explain the high prevalence of PTSD in patients with SMI: diathesis trauma itself, a high risk of exposure to trauma, genetic predisposition to psychosis in a group of patients with PTSD and antidopaminergic effect of treatment itself. The impact of PTSD in patients with SMI is well documented in the literature. PTSD patients with more severe psychiatric symptoms, more alcohol use disorders and other substances, have a greater number of visits and psychiatric hospitalizations, lower work integration, poorer adherence to drug treatment, more risk behaviours, suicide attempts and self-harm, and poorer cognitive function. Antidepressants especially selective serotonin reuptake of serotonin and cognitive behavioral therapy would be the treatments of choice in PTSD. Recent studies indicate that cognitive behavioral therapy may also be useful in post-traumatic symptoms of patients with SMI. In clinical practice it is advisable to systematically perform an assessment of the traumas and investigate the existence of PTSD symptoms in clinical interviews (AU)

Trauma infantil y esquizofrenia / Childhood trauma and schizophrenia

Introducción: La prevalencia de antecedentes de trauma en la psicobiografía de los pacientes psicóticos es alta, hasta el punto de que algunos autores defienden que hay un subgrupo de esquizofrenia, la esquizofrenia traumática inducida, que se caracterizaría por la preponderancia de los síntomas psicóticos positivos. Observación clínica: Presentamos el caso de una paciente joven que sufrió abusos sexuales repetidos en su infancia y que desarrolló, a los 19 años, una esquizofrenia. El inicio de la enfermedad fue con alucinaciones auditivas sobre el abusador, sintomatología depresiva e ideación delirante de autorreferencia y de control del pensamiento que obligó a un ingreso hospitalario. Durante los 7 años de curso de la enfermedad, siempre presentó alucinaciones auditivas, cenestésicas y visuales, en ocasiones relacionadas con los abusos y en otras, no. Destaca también la ausencia de síntomas negativos. Discusión: La alta prevalencia de trauma infantil en pacientes psicóticos hace pensar en que el abuso grave podría ser uno de los factores ambientales que influyen en el desarrollo de la esquizofrenia. Una delas consecuencias de este hecho es la necesidad de indagar de forma sistemática en las posibles experiencias traumáticas en la biografía de cualquier paciente que se nos presente con sintomatología psicótica (AU)

Introduction: The prevalence of a history of trauma in the psychobiography of psychotic patients is high, and some authors argue for the existence of a subtype of schizophrenia, trauma-induced schizophrenia, characterized by a preponderance ofpositive psychotic symptoms.Case report: We report the case of a Young female patient who suffered repeated sexual abuse in childhood and developed schizophrenia at the age of nineteen. The presenting symptoms of the disease consisted of auditory hallucinations that spoke of her abuser, depressive symptoms and delusional ideationand thought control, leading to hospitalization. During the 7-year course of the disease, the patient has always experienced auditory, visual and kinesthetic hallucinations, sometimes -but not always- related to abuse. A striking feature is the absence of negative symptoms. Discussion: The high prevalence of childhood trauma in psychotic patients suggests that serious abuse could be one of the environmental factors influencing the development of schizophrenia. One consequence of this finding is the need to routinely investigate any traumatic experiences in the life of any patient with psychotic symptoms (AU)