Cavum septum pellucidum in schizophrenia: clinical and neuropsychological correlates.

Increased frequency of cavum septum pellucidum (CSP) has been inconsistently observed in schizophrenia, and little is known about its functional implications. We investigated whether patients with schizophrenia were more likely than healthy controls to have CSP, and among patients assessed the relationship between CSP, psychiatric symptoms, and selected neuropsychological functions. Seventy-seven patients with diagnoses of DSM-IV schizophrenia spectrum disorders and 55 healthy controls were studied and completed a 1.5 T MRI scan. Two raters, blind to group membership, determined the presence, length and grade of the CSP. A subset of participants also underwent neuropsychological testing. A CSP of at least 1 mm in length was present in 68.8% of patients and 76.4% of controls, and the groups did not differ significantly with respect to presence or absence, length, overall size, or percent with an abnormally large CSP (> or =6 mm). Patients with an abnormally large CSP demonstrated poorer performance on measures of verbal learning and memory than patients with smaller CSP. Among patients, CSP length was significantly correlated with negative symptoms, verbal learning, and sentence comprehension. Among patients with abnormally large CSP, CSP length was correlated with reaction time on two conditions of a Continuous Performance Test. CSP, while prevalent, was not more frequent in our sample of patients with schizophrenia, and had few associations with symptom severity or neuropsychological deficits.

Hepatitis C treatment for people with severe mental illness.

Over 4 million people in the United States are chronically infected with hepatitis C virus (HCV), and, if untreated, over 20% of these will progress to more serious disease. Persons with severe mental illness (SMI) have markedly elevated rates of HCV infection, but treatment of persons with SMI and HCV has been controversial. Effective antiviral treatment is available, but side effects include depression and other neuropsychiatric symptoms. This article reviews the available data on neuropsychiatric side effects of interferon (IFN) treatment, discusses the limitations of the current research, and makes recommendations regarding HCV treatment in persons with SMI.

Case report of 3 patients with severe mental illness and chronic hepatitis C virus infection treated with interferon-alpha.

We report on three patients with hepatitis C virus infection, severe mental illness, and substance use disorders that we treated successfully with interferon and ribavirin. This population has historically been refused such treatment on the grounds that they were unlikely to be adherent to treatment or would experience untoward psychiatric side effects. These case reports add support to the growing body of evidence that persons with severe mental illness and substance use disorders can be successfully treated for hepatitis C with careful monitoring and psychiatric oversight.

The STIRR model of best practices for blood-borne diseases among clients with serious mental illness.

OBJECTIVE: Persons with severe mental illness have a markedly elevated risk of several blood-borne infections, including HIV, hepatitis B, and hepatitis C. Prevention, early detection, and treatment of these disorders are crucial interventions for high-risk populations. However, because of a number of barriers, most clients with severe mental illness do not receive these basic best-practice services. The authors describe a public health model intervention designed to deliver basic best-practice services for blood-borne diseases, as specified by the Centers for Disease Control and Prevention, to clients with severe mental illness and co-occurring substance use disorders. METHODS: The intervention, called STIRR (for screen, test, immunize, reduce risk, and refer), is brief (requiring approximately one hour per client) and is delivered at the site of mental health care by a mobile team of specialists. Clients are provided with risk screening, testing for HIV and hepatitis, immunization for hepatitis A and B, risk-reduction counseling, and treatment referral for blood-borne infections. Also described is a pilot study to evaluate this model in two publicly funded community mental health centers. RESULTS: At the first site, 137 (79 percent) of clients with severe mental illness were tested and immunized. At the second site, more than two-thirds of the clients of a dual diagnosis team participated (67 clients, or 68 percent). Intervention costs per client ranged from 194 dollars to 262 dollars. CONCLUSION: S: The STIRR approach has the potential to provide a basic, best-practice package of interventions for high-risk clients with severe mental illness.

Apathy in schizophrenia: reduced frontal lobe volume and neuropsychological deficits.

OBJECTIVE: Apathy is a common negative symptom in schizophrenia. The authors investigated neuropsychological performance and regional brain volumes in schizophrenia patients with high versus low levels of apathy. METHOD: Schizophrenia patients with low apathy levels (N=18) and high apathy levels (N=20) and 12 healthy comparison subjects completed neuropsychological testing as well as magnetic resonance imaging scanning to obtain lobar volumes after total intracranial volume was controlled. RESULTS: The high apathy group scored lower than comparison subjects on rapid visuomotor sequencing and verbal learning/recall. The high apathy group had lower performance IQ scores than the low apathy and comparison groups. Only the high apathy group showed significantly reduced bilateral frontal lobe volumes relative to comparison subjects; both schizophrenia patient groups showed bilateral temporal lobe volume reductions. CONCLUSIONS: The present findings are consistent with studies in other disorders showing frontal lobe involvement in apathy.