Duration of untreated psychosis and neuropsychological function in first episode psychosis.

PURPOSE: We investigated whether duration of untreated psychosis (DUP) prior to first presentation was associated with cognitive function in first episode psychosis (FEP) subjects. We predicted that longer DUP would be associated with greater neurocognitive impairment. METHOD: 180 subjects with schizophrenia (and 93 subjects with Other Psychoses) performed a neurocognitive battery assessing IQ, verbal learning, working memory, visual learning and speed of processing. DUP was defined as the number of days between first onset of psychotic symptoms and first contact with psychiatric services. RESULTS: Longer DUP was associated with impaired performance in verbal IQ (p=0.04), verbal learning (p=0.02), and verbal working memory (p=0.04) in FEP subjects with schizophrenia. These associations remained significant for verbal IQ when scores were corrected for age, gender, educational level and ethnicity. CONCLUSIONS: Longer DUP is associated with poorer neurocognitive ability in schizophrenia subjects at time of first presentation. Since this was a cross-sectional study we can not tell whether longer DUP was a cause or a consequence of the poorer performance.

Social cognition in frontal lobe epilepsy.

This study investigated the social cognitive functioning of patients with frontal lobe epilepsy (FLE), using a range of procedures that have shown impairments in patients following focal prefrontal brain lesions. Fourteen participants with FLE were compared with 14 healthy controls on story tests of theory of mind (ToM), faux pas appreciation, mental and physical state cartoon humor appreciation, facial emotional recognition, and the ability to perceive eye gaze expression. They were not impaired on story tests of ToM and showed only a trend toward impairment on a test of faux pas appreciation. They were impaired on humor appreciation, with both mental and physical state cartoons, and on their recognition of facial emotion and perception of eye gaze expression. Hence the patients with FLE exhibited impairments on tests of social cognition following a distinct pattern, with relatively preserved ToM, but impaired humor appreciation and ability to detect emotional expression.

A combined clinical, neuropsychological, and neuroanatomical study of adults with high functioning autism.

INTRODUCTION: Three hypotheses concerning associations between neuroanatomical abnormalities, neuropsychological impairments, and the behavioural manifestations of autism were investigated. The primary hypothesis was that the social interaction impairments diagnostic of autism are associated with deficits of socioemotional perception and abnormalities of the amygdala. One subsidiary hypothesis was that the learning and language impairments that occur in less able individuals with autism are associated with impaired memory, and with abnormalities of hippocampal regions. A second subsidiary hypothesis was that the repetitive behaviour diagnostic of autism is associated with executive deficits and with abnormalities of the prefrontal cortex. Associations between the neuroanatomical regions investigated were also examined. METHODS: Ten adult males with high functioning autism (HFA) were compared with 10 healthy controls matched for age, sex, verbal and nonverbal ability. Hypothesis-driven structural MRI and neuropsychological tests were used to collect neuroanatomical and neuropsychological data on all subjects. A version of the Wing Autism Diagnostic Interview Checklist was used to collect clinical data on the HFA subjects. RESULTS: Strong convergent evidence in support of the amygdala hypothesis was obtained, and preliminary support for the hippocampal/parahippocampal hypothesis. No clear evidence was obtained in support of the prefrontal hypothesis. Patterns of associations amongst volume measures within and between medial temporal and prefrontal regions suggest stronger within-region and weaker between-region associations in the HFA group compared with controls. CONCLUSIONS: These findings are discussed in terms of a model of autism in which selective abnormalities of the amygdala and hippocampus (in all cases) and of the parahippocampal gyrus (in lower functioning cases) are implicated, and in which a disruption of coordinated limbic and prefrontal activity may be critical.