Efficacy of Electroconvulsive Therapy in Treatment Resistant Schizophreinia : A double-blind study

BACKGROUND

ECT, though not favoured in the West for treating schizophrenia, is regularly practiced in India for this indication, particularly in poorly responding/treatment resistant cases.Therefore, its role in treatment-resistant schizophrenia is a subject of systematic investigation.

AIM

To compare the effectiveness and safety of Electroconvulsive therapy (ECT) in a group of treatment-resistant schizophrenia patients with a control group.

METHOD

Eligible and consenting patients were randomly allocated to the ECT or Sham ECT groups. Both received antipsychotic drugs.Twenty-five patients completed the study (ECT, n= IS; Sham ECT, n= 10).The study was conducted in a double-blind manner. Clinical change was assessed weekly with BPRS, CGI and adverse event measures.ANOVA for repeated measures and other post-hoc comparisons were used for data analysis.

RESULTS

ECT treated patients improved significantly over successive weeks (p< 0.002) after 6 ECTs, whereas the group receiving sham-ECT did not In both the groups, however, CGI scores did not change significantly, suggesting a dissociated response pattern. ECT was associated with greater relief among carers and lower rehospitalization.

CONCLUSION

ECT augmentation may well have a significant impact on the clinical course of patients with treatment resistance schizophrenia. It is unclear, but possible, that these changes may be reinforced and maintained by maintenance ECTs. Replication of the present investigation and further studies on maintenance ECT would be rewarding.

Pharmacokinetics of valproic acid in patients with bipolar disorder

The pharmacokinetics of valproic acid (VPA) were studied in nine patients with bipolar disorder who were receiving VPA as prophylactic therapy, following the full daily dose (400-1500 mg), on which the patients had been maintained for at least the past 3 months. The data from our study showed that the pharmacokinetics of valproate followed a two compartment open model. A time lag of 1-2 h was observed in each patient, followed by rapid absorption, with the peak concentrations being recorded approximately 4 h after drug administration. The average 12 h trough concentration was found to be 54.73+/-11.96 microg/ml. The plasma level decline was biphasic with a terminal half-life of 14.2+/-6.39 h. Total plasma clearance was 0.095+/-0.035 ml/min/kg. The steady-state apparent volume of distribution was found to be 0.11+/-0.05 l/kg. A positive correlation (r = 0.69) was found between the dose (mg/kg) and steady-state serum concentration (Css) of VPA and all patients, except one, had their Css above 50 microg/ml. Most of the pharmacokinetic parameters in this study involving euthymic bipolar patients on long-term VPA monotherapy were found to be in agreement with those reported in literature on seizure disorder patients on similar regime; however, the plasma elimination half-life appears to be prolonged in bipolar patients.

Cognitive development: no stages please--we're British

British cognitive developmental psychology is characterized by its interest in philosophical questions, its preference for linking basic research to applied issues in education and cognitive disorders, and its willingness to learn both methodologically and theoretically from work in animal psychology and in physiology more generally. It has also been influenced profoundly by Jean Piaget's cognitive stage theory although in general British work has focused on demonstrating early strengths, rather than early deficits, in infant and child cognition. Following an overview of British work that encompasses past and present interests, issues and challenges for the future are highlighted. While the perspectives of the founding members of the British Psychological Society (BPS), as outlined by Edgell (1947), are still apparent in British research in cognitive developmental psychology today, it is argued that future cognitive work must become even more interdisciplinary and that the symbiotic relationship between research in adult cognition and in cognitive development needs greater recognition.

Cerebral white matter lesions in bipolar affective disorder: relationship to outcome

BACKGROUND

Twenty per cent of patients with bipolar affective disorder suffer an illness that responds inadequately to treatment and has a poor outcome. Many patients, but not all, with bipolar disorder show white matter abnormalities on T(2)-weighted magnetic resonance imaging (MRI).

AIMS

To explore the hypothesis that white matter abnormalities on MRI are seen more frequently in subjects whose illness has a poor outcome compared with those with a good outcome or controls.

METHOD

Two groups of age- and gender-matched patients with bipolar disorder (14 with a good outcome and 15 with a poor outcome) and 15 controls, aged 20-65 years, were studied. Axial T(2)-weighted MRI scans were examined for the presence and severity of white matter abnormalities.

RESULTS

Significantly more poor outcome group members had deep subcortical punctate, but not periventricular, white matter hyperintensities than the good outcome group (P:=0.035) or controls (P:=0.003) and these abnormalities were of greater severity (P:=0.030 and P:<0.014, respectively).

CONCLUSIONS

Subcortical white matter lesions are associated with poor outcome bipolar disorder.

Phonological awareness of syllables, rhymes, and phonemes in deaf children

Phonological awareness is important for reading development in hearing children, in whom it develops at the three consecutive levels of the syllable, rhyme, and phoneme. Deaf children typically have literacy difficulties, and previous research has been equivocal about whether deaf children can develop phonological awareness. Three experiments are presented that investigate the phonological skills of deaf children (mean age 11 years) at the three linguistic levels of syllable, rhyme, and phoneme. The first experiment showed that deaf children's syllable awareness can be equivalent to that of chronological age-matched hearing controls. In the second experiment, deaf children's ability to make rhyme judgements was above chance, but poorer than that of younger reading-matched hearing controls. The third experiment showed that deaf children could phonologically recode nonsense words at a level above chance, suggesting that they could draw on phonemic skills in certain conditions. We conclude that deaf children can develop phonological awareness, but that their phonological skills lag those of hearing children and may develop in different ways. Differences between our tasks and those used in other studies are discussed.

Carbamazepine and valproate monotherapy: feasibility, relative safety and efficacy, and therapeutic drug monitoring in manic disorder

RATIONALE

Search for alternatives to lithium therapy for mood disorders commenced with anticonvulsants, carbamazepine (CBZ) and valproic acid (VPA), in the late 1970s. The comparative safety and efficacy data of CBZ and VPA monotherapy in patients with bipolar disorder remain to be established.

OBJECTIVES

The main objectives of the study were to assess the relative antimanic efficacy and safety of CBZ and VPA; to study the feasibility of using either, as a first line anti-manic agent; to investigate and generate clinically relevant parameters involving therapeutic drug monitoring of the two drugs.

METHODS

After a 2-day screening period, suitable patients (n = 30) were randomly assigned to treatment with CBZ or VPA. Both the drugs were started with an average dose of approximately 20 mg/kg body weight per day. Further increment in dose was carried out at weekly intervals, guided by clinical improvement, serum levels and treatment emergent adverse events. The primary efficacy measure in the protocol was defined as a change from baseline to endpoint in total score on the Young Mania Rating Scale. A favourable clinical response was defined a priori as a decrease of more than 50% from baseline in Young Mania Rating Scale total score.

RESULTS

Both CBZ and VPA were found to be efficacious as single first-line anti-manic agents, however VPA proved to be better. Using the intent-to-treat analysis, the VPA group showed a significant fall in YMRS total scores after week 1 while the CBZ group showed a significant fall after week 2. In the primary efficacy analysis, valproate group experienced significantly greater mean improvement in Young Mania Rating Scale total score than the CBZ group. Of the VPA treated patients, 73% showed a favourable clinical response while 53% of the patients on CBZ responded favourably. In the CBZ group, significantly more patients received rescue medication during the week 2 and the requirement was quantitatively more as compared to the VPA group. The steady state serum concentration (Css) of CBZ ranged from 3 to 9 micrograms/ml; however, it did not appear to correlate with the dose or clinical response. The Css of VPA ranged from 50 to 100 micrograms/ml; a linear correlation was found between the dose and serum levels of VPA as well as between weekly rise in serum levels and clinical response. Weekly dose escalations of VPA also correlated positively with corresponding rise in serum levels. Significantly more patients in the CBZ group reported adverse events, including nausea, vomiting and dizziness, than VPA.

CONCLUSIONS

The findings from this study suggest that both CBZ and VPA monotherapy is feasible for treatment of acute mania; however, VPA is more efficacious in terms of its early onset of action, lesser requirement for rescue medication and better tolerability. Further work needs to be undertaken to characterise the manic patients in terms of their differential psychopharmacologic response profile.

Phonological representations, reading development and dyslexia: towards a cross-linguistic theoretical framework

This paper attempts to integrate recent research findings in phonological development, reading development and dyslexia into a coherent theoretical framework that can provide a developmental account of reading and reading difficulties across languages. It is proposed that the factors governing phonological development across languages are similar, but that important differences in the speed and level of phonological development are found following the acquisition of alphabetic literacy. The causal framework offered is at the level of a cognitive model, which may prove useful in organizing future cross-linguistic developmental work.

Orthographic analogies and phonological priming: a comment on Bowey, Vaughan, and Hansen (1998)

J. A. Bowey, L. Vaughan, and J. Hansen (1998, Journal of Experimental Child Psychology, 68, 108-133) carried out two experiments on 6- and 7-year-old children's use of orthographic analogies in word reading. They reported that, following apparently stringent controls for phonological priming effects, beginning analogies (beak-bean) were more frequent in this age group than rime (beak-peak) analogies. From this, they concluded that beginning readers do not reliably use orthographic rimes in reading, even in the clue word task (p. 129). However, the clue word task was not used in this study. This comment highlights two problems with Bowey et al.'s paper. The first is a theoretical one, and the second is methodological. Firstly, Bowey et al. base their investigation on a misunderstanding of U. Goswami and P. E. Bryant's (1990, Phonological skills and learning to read, Hillsdale, NJ: Erlbaum) claims about the role of rhyme and analogy in beginning reading. Secondly, methodological weaknesses, in particular unintended intralist priming effects, seriously limit the conclusions that can be drawn from Bowey et al.'s booklet analogy task.

Phonological awareness deficits in developmental dyslexia and the phonological representations hypothesis

The claim that the well-documented difficulties shown by dyslexic children in phonological awareness tasks may arise from deficits in the accuracy and the segmental organization of the phonological representations of words in their mental lexicons is receiving increasing interest from researchers. In this experiment, two versions of the phonological representations hypothesis were investigated by using a picture naming task and a battery of phonological measures at three linguistic levels (syllable, onset-rime, phoneme). The picture naming task was used to identify words for which dyslexic and control children had accurate vs inaccurate phonological representations, and performance in the phonological awareness tasks was then compared for the words which had precise vs imprecise representations. Findings indicated that frequency effects in the phonological awareness tasks at all levels disappeared for dyslexic and control children once representational quality was taken into account, and that the availability of sublexical units for analysis appeared to differ according to (1) the accuracy and retrieval of the phonological representation and (2) the linguistic level tapped by the phonological awareness task.

Picture naming deficits in developmental dyslexia: the phonological representations hypothesis

The picture and word naming performance of developmental dyslexics was compared to the picture and word naming performance of non-dyslexic ("garden variety") poor readers, reading age, and chronological age-matched controls. The stimulus list used for both tasks was systematically manipulated for word length and word frequency. In order to examine picture naming errors in more depth, an object name recognition test assessed each subject's vocabulary knowledge of those names which they were unable to spontaneously label in the picture naming task. Findings indicated that the dyslexic and the garden variety poor readers exhibited a picture naming deficit relative to both chronological and reading age-matched controls. Findings also indicated that both groups of impaired readers obtained superior scores in the word naming task than in the picture naming task, while both groups of controls showed no difference in performance across tasks. The dyslexics' picture naming errors, but not those of the garden variety poor readers, were particularly marked on polysyllabic and/or low frequency words, indicating a possible phonological basis to the picture naming deficit of the dyslexic children. These children also recognized significantly more unnamed target words than all comparison groups, suggesting a particular difficulty in retrieving the phonological codes of known picture names rather than a vocabulary deficit. Results are discussed in terms of dyslexics' difficulty in encoding full segmental phonological representations of names in long-term memory and/or in processing these representations in order to generate required names on demand.

A NOR-associated repetitive element present in the genome of two Salmo species (Salmo salar and Salmo trutta)

A repetitive element was isolated from the genome of Atlantic salmon. Nucleotide sequence analysis revealed the existence of variant monomers that range in length from approximately 200 to 230 bp. Repeat monomers contain regions of cryptic simplicity, internal repetition, and long direct repeats with deletions and insertions between individual units. The repetitive element was shown to have a tandem unit arrangement and was estimated to occupy between two and three percent of the Atlantic salmon genome. Southern blot analysis revealed the repetitive element to be unique to Atlantic salmon and brown trout species. In situ hybridization analysis showed this element to be localized at the main nucleolar organizer region bearing chromosomes of Atlantic salmon (Salmo salar), AS cell line (derived from S. salar), and brown trout (Salmo trutta).

Cloning, characterization and chromosomal location of a satellite DNA from the Pacific oyster, Crassostrea gigas

We report the cloning and characterization of a high-copy-number, tandem-repeat satellite DNA sequence from the genome of the Pacific oyster, Crassostrea gigas (Cg). The monomeric unit was found to be 166 (+/- 2) bp in length with 79-94% homology between monomers of the array. The sequence is A+T-rich (60%) and lacks internal repetition and substructural features. The repeat was estimated to account for 1-4% of the Cg genome. Fluorescence in situ hybridization (FISH) studies mapped the repeat to two distinct heterochromatic regions of two pairs of homologous chromosomes on Cg embryonic metaphases. Also, the number of metaphase chromosomes containing this repeat varied with the ploidy of the cell.

Hysterical neurosis--a follow-up study

Hysterical neurosis, though infrequently diagnosed in the West, is still one of the commonest mental disorders in India. In this study, 38 women with an index diagnosis of hysterical neurosis were evaluated after a period of 5 years; 63% of the patients remained totally asymptomatic. The premorbid hysterical personality alone showed significant relationship with the outcome.

The influence of orthographic consistency on reading development: word recognition in English and German children

Groups of 7, 8, and 9-year-old children who were learning to read in English and German were given three different continuous reading tasks: a numeral reading task, a number word reading task, and a nonsense word reading task. The nonsense words could be read by analogy to the number words. Whereas reading time and error rates in numeral and number word reading were very similar across the two orthographies, the German children showed a big advantage in reading the nonsense words. This pattern of results is interpreted as evidence for the initial adoption of different strategies for word recognition in the two orthographies. German children appear to rely on assembling pronunciations via grapheme-phoneme conversion, and English children appear to rely more on some kind of direct recognition strategy. A model of reading development that takes account of orthographic consistency is proposed.

Not all nonwords are alike: implications for reading development and theory

Three experiments were designed to examine children's and adults' ability to pronounce consonant-vowel-consonant (CVC) nonsense words. Some of the nonwords, like tain and goach, shared their VC unit with a number of real words. Other nonwords, like goan and taich, shared their VC unit with few or no real words. Pooling across items, the very same grapheme-phoneme correspondences occurred in the two types of nonwords. First graders, good and poor third grade readers, and adults all performed better on the nonwords with the more common VC units than on the nonwords with the less common VC units. Although readers appeared to use VC units in the pronunciation of nonwords, we did not find evidence for use of initial CV units. Implications of the results for reading development, dyslexia, and models of nonword pronunciation are discussed.

Higher-order structure and relational reasoning: contrasting analogical and thematic relations

A popular explanation of younger children's success in analogy tasks is that lower-level associative reasoning strategies are used. Younger children are said to have a primarily associative understanding of analogy, with the ability to coordinate sets of relations largely emerging later in development (Goldman, Pellegrino, Parseghian, & Sallis, 1982; Sternberg & Nigro, 1980). One way of testing the associative claim is to pit young children's emergent analogical abilities against thematic (associative) relations, which are known to play an important role in the knowledge structures of young children. The present experiments presented 4-, 5- and 9-year-old children with a:b::c:d analogies in a picture choice format, offering a choice between Analogy and Thematic responses. Only the Analogy responses were correct in terms of the higher-order structure of the analogies. The results showed that the Analogy responses were consistently preferred to the Thematic responses by children of all ages. It is concluded that analogy is an important building block for learning from an early age.

Melting chocolate and melting snowmen: analogical reasoning and causal relations

Children's performance in the classical a:b::c:d analogy task is traditionally very poor prior to the Piagetian stage of formal operations. The interpretation has been that the ability to reason about higher-order relations (the relations between the a:b and c:d parts of the analogy) is late-developing. However, an alternative possibility is that the relations used to date in the analogies are too difficult for younger children. Two experiments presented children aged 3, 4 and 6 years with a:b::c:d analogies which were based on relations of physical causality such as melting and cutting, for example chocolate bar:melted chocolate::snowman:melted snowman. Understanding of these particular causal relations is known to develop between the ages of 3 and 4 years. It was found that even 3-year-olds could solve the classical analogies if they understood the causal relations on which they were based.

Phonological priming and orthographic analogies in reading

Recent work has demonstrated that children can use orthographic analogies between the spelling patterns in words to help in decoding new words (e.g., using beak to read peak; Goswami, 1986, 1988). However, one objection has been that these analogy effects may be due to phonological priming. Two experiments examined the phonological priming alternative. In Experiment 1, a single word reading task compared the use of analogies to read words that shared both orthography and phonology (e.g., most-post), that shared orthography only (e.g., most-cost), or that shared phonology only (e.g. most-toast--the phonological priming condition). Limited effects of phonological priming were found. Experiment 2 then presented the same words embedded in prose passages--"real reading." While the orthographic analogy effect remained robust, the small phonological priming effect disappeared. It is argued that phonological priming is an insufficient explanation of the analogy effect at the single word level, and plays no role in the use of analogies in story reading.

A special link between rhyming skill and the use of orthographic analogies by beginning readers

The existence of a strong correlation between phonological awareness and the development of reading has long been known. More recently, it has been shown that pre-reading rhyming skills are the best predictor of later reading ability that we have. One reason for this relationship may be that children who have put words into rhyming categories before they begin school may be quick to realize that these words also tend to share the same spelling patterns, and may then use such similarities in spelling to make predictions (analogies) about how new written words will sound. The present study tests one aspect of this hypothesis, which is that children who make more analogies in reading are also better at rhyming than children who do not. Evidence consistent with this prediction is presented.

Electroconvulsive therapy in neuroleptic-induced parkinsonism

The effect of electroconvulsive therapy (ECT) on the severity of neuroleptic-induced parkinsonism was studied in nine schizophrenic inpatients in a longitudinal triphasic design: neuroleptics-neuroleptics plus ECT-neuroleptics. The results suggest that ECT has a true antiparkinsonian potential. The role of ECT in the treatment of Parkinson's disease, especially with therapy-resistant patients complicated with on-off symptoms, is highlighted.