Hallucinogenic drug induced states resemble acute endogenous psychoses: results of an empirical study

Clinical evidence suggests that hallucinogenic drug-induced altered states of consciousness (ASCs) and the incipient, acute stages of endogenous psychoses share many common phenomenological features. The aim of our study was to assess hallucinogen-like phenomena in endogenous psychotic patients using standardised methods. We examined 93 endogenous psychotic patients, 50 healthy controls and a small group of drug induced psychotic patients (n = 7) with two ASC self-assessment scales (questionnaire APZ = Abnormer Psychischer Zustand = Altered State of Consciousness [Dittrich et al, 1985]; and questionnaire OAV = Abbreviation of the three subscales: Oceanic Boundlessness/Angst = Dread of Ego Dissolution/Visionary Restructuralisation [Bodmer 1989]). Patients were examined shortly after remission of their last acute psychotic episode and they answered the questionnaires referring to the early phase of this episode. Differences in the questionnaire scores were significant between psychotic patients and controls. Drug induced patients had numerically higher scores than endogenous psychotic patients, however these differences were only significant for the APZ total score and the undifferentiated items of the APZ, but not for the three APZ subscale and the OAV scores. More than 50% of the endogenous psychotic patients answered 26% of the APZ-and 43% of the OAV-items with “yes”. The OAV total score and the OSE (Ozeanische Selbstentgrenzung = oceanic boundlessness) scores of both questionnaires correlated significantly with BPRS Factor 3 (thought disturbance). Our results support the hypothesis that hallucinogen-like experiences represent common phenomena during the acute stages of endogenous psychoses. Remarkably, these phenomena include subjectively pleasant experiences of the OSE dimension. In the routine clinical assessment of endogenous psychotic patients experiences of this dimension may be more easily overlooked than the negative experiences of the AIA dimension (AIA: Angst vor der Ich-Auflösung = dread of ego dissolution).

Altered Relationships Between rCBF in Different Brain Regions of Never-Treated Schizophrenics

Aim of this study was to investigate the relations between regiona cerebral blood flow (rCBF) of different brain regions in acute schizophrenia and following neuroleptic treatment.

Methods: Twenty-two never-treated, acute schizophrenic patients were examined with HMPAO brain SPECT and assessed psychopathological-ly, and reexamined following neuroleptic treatment (over 96.8 days) and psychopathological remission. rCBF was determined by region/cerebel-lar count quotients obtained from 98 irregular regions of interest (ROIs), summed up to 11 ROIs on each hemisphere. In acute schizophrenics, interregional rCBF correlations of each ROI to every other ROI were compared to the interregional correlations following neuroleptic treatment and to those of controls.

Results: All significant correlations of rCBF ratios of different brain regions were exclusively positive in controls and patients. In controls, all ROIs of one hemisphere except the mesial temporal ROI correlated significantly to its contralateral ROI. Each hemisphere showed significant frontal-temporal correlations, as well as cortical-subcortical and some cortico-limbic. In contrast, in acute schizophrenics nearly every ROI correlated significantly with every other ROI, without a grouping or relation of the rCBF of certain ROIs as in controls. After neuroleptic treatment and clinical improvement, this diffuse pattern of correlations remained.

Conclusions: These results indicate differences in the neuronal interplay between regions in schizophrenic and healthy subjects. In never-treated schizophrenics, diffuse interregional rCBF correlations can be seen as a sign of change and dysfunction of the systems regulating specificity and diversity of the neuronal functions. Neuroleptic therapy and psychopathologic remission showed no normalizing effect on interregional correlations.

CS04-01 - Conceptual history of classification

In most of the somatic disciplines of medicine there is no doubt about the importance of diagnosis for patient care, research, teaching and regulatory affairs. In psychiatry however, the status of diagnosis has been antiguous for long times. In this paper the reasons for this difference will be discussed in the light of the historical development of diagnosis and classification in the beginnings of modern psychiatry. Especially during the period of antipsychiatric reasoning it was even regarded as harmful and dangerous for patients for be diagnosed in a scientific terminology. As a consequence the research in the field of mental disorder was hindered and blurred, and in addition also the scientific basis of our discipline was questioned. The American Psychiatric Association published in 1952 the „Diagnostic and Statistical Manual of Mental Disorders” (DSM-I), which was the first official manual of mental disorders to contain a glossary of descriptions of the diagnostic categories. A major breakthrough was the publication of DSM-III in 1980, which was not only characterized by explicit criteria for inclusion and exclusion, but also by strictly defined algorithms and by systematic field trials during the development of the manual. The DSM-approach to diagnosis in psychiatry became of major importance for research and practice in our field. Later, ICD-9 was transformed into ICD-10 by WHO with a certain tendency to adopt the basic principles of the DSM-system. Contemporary psychiatry is completely ruled by these two schemes of operationalized diagnosis. Advantages and disadvantages of this approach to classification for patient care, research and administration as well as possible alternatives and future directions will be analyzed. Special attention is given to the question, whether psychopathology and phenomenology are still relevant as methodological elements in psychiatry, even in an era of major progress of neurobiology in the sense of natural sciences.

A search for components in human body odour that attract females of Aedes aegypti

In a new type of wind tunnel, mosquitoes fly upwind towards host odour sources and towards human skin wash extracts obtained by rubbing the skin with a pad soaked in ethanol. We used this behavioural response as a bioassay to identify attractants in liquid chromatography fractions of such extracts. L-Lactic acid is a major constituent of skin wash extracts and it is a necessary component for the extract's effectiveness. As a single stimulus, however, L-lactic acid is only slightly effective. This indicates that the extract's high degree of effectiveness is based on a synergism of L-lactic acid and other odour components. The separation of the extract by liquid chromatography revealed three distinct regions of active fractions, only one of which contained L-lactic acid. The components of the other two regions have not yet been determined. A combination of fractions in these two regions together with L-lactic acid is as attractive as the complete extract.

Verhaltenssucht

Until recently knowledge was limited with respect to clinically relevant excessive reward-seeking behaviour such as pathological gambling, excessive shopping, and excessive working which meet diagnostic criteria of dependent behaviour. To date there is no consistent concept for diagnosis or treatment of excessive reward-seeking behaviour, and its classification is uncertain. However, the high number of subjects seeking treatment emphasises the importance of a clear conceptualisation of the so-called behavioural addictions and their successful treatment. Excessive reward-seeking behaviour may be used to regulate negative emotions. We suggest that, comparable to drug addiction, excessive reward-seeking behaviour can alleviate negative mood states and may be used as an (inadequate) stress coping strategy at the expense of active coping strategies. In the course of a pathological development, behavioural addiction may become the only available behavioural resource to cope with challenging developmental steps or social stress factors such as loneliness or anxiety.

Desulfosporosinus lacus sp. nov., a sulfate-reducing bacterium isolated from pristine freshwater lake sediments

A novel sulfate-reducing bacterium was isolated from pristine sediments of Lake Stechlin, Germany. This strain, STP12T, was found to contain predominantlyc-type cytochromes and to reduce sulfate, sulfite and thiosulfate using lactate as an electron donor. Although STP12Tcould not utilize elemental sulfur as an electron acceptor, it could support growth by dissimilatory Fe(III) reduction. In a comparison of 16S rRNA gene sequences, STP12Twas 96.7 % similar toDesulfosporosinus auripigmentiDSM 13351T, 96.5 % similar toDesulfosporosinus meridieiDSM 13257Tand 96.4 % similar toDesulfosporosinus orientisDSM 765T. DNA–DNA hybridization experiments revealed that strain STP12Tshows only 32 % reassociation with the type strain of the type species of the genus,D. orientisDSM 765T. These data, considered in conjunction with strain-specific differences in heavy metal tolerance, cell-wall chemotaxonomy and riboprint patterns, support recognition of strain STP12T(=DSM 15449T=JCM 12239T) as the type strain of a distinct and novel species within the genusDesulfosporosinus,Desulfosporosinus lacussp. nov.

[Cognitive impairment after accidental high-dose corticosteroid therapy]

Synthetic glucocorticosteroids can induce various severe mental disorders. Persisting cognitive disorder represents a rare complication of corticoid therapy involving memory, concentration, attention, or occupational performance. We observed the effects of a 20-day self-induced high-dose corticosteroid treatment on the cognitive functions in a 54-year-old patient. Having excluded dementia due to other organic causes, we examined the patient neuropsychologically immediately at the end of the steroid therapy and at follow-up (1, 2, 4, and 6 months). The initial tests showed seriously impaired functioning of concentration, attention, learning, and memory as well as of common ability to solve problems. The follow-up tests up to 6 months revealed an improvement of concentration and attention, but there were still serious deficits of the declarative memory with a high confabulating tendency. Our results confirm those of human experimental studies that exogenous steroids can cause serious persisting specific cognitive disorders especially of the declarative, hippocampus-dependent memory.

[Regulation on preventive detention according to section sign 66 of the German Penal Code. Principles and differential indication compared with the regulation according to section sign 63 of the German Penal code]

Preventive detention is imposed by court order if a dangerous criminal shows a disposition to relapse. The negative criminal prognosis should be given by a psychiatric expert based on considerations about the criminal's personality traits. Matters of preventive detention are important for forensic psychiatry, but so far have rarely been discussed. This article presents related problems and offers-under special consideration of problematic personality traits or personality disorders-practical guidelines for expert testimony. Our considerations should serve as a thought-provoking stimulus for further psychiatric discussions about this topic.

Affective disorders, personality and personality disorders

OBJECTIVE

The article deals with the complex conceptual history and current concepts on the relationship between personality, personality disorders and affective disorders. It is discussed whether these concepts represent distinct clinical entities or whether they lie on a continuum.

METHOD

We reviewed the classical literature from the 19th and the first half of the 20th centuries as well as analysed recent empirical data in order to summarize the current knowledge on this topic with respect to its historical origin. As a particular example, the position of the depressive personality disorder is evaluated.

RESULTS

Considerable heterogeneity can be seen, both theoretically and empirically. The two major concepts are based either on a continuum model or favour distinct clinical entities, corresponding to a more dimensional or category-orientated recording method.

CONCLUSION

The relationship between personality disorders and affective disorders is still unclear and is a highly debated issue. There is as yet no consensus, but a certain shift to dimensional models can be recognized.

[Personality disorders and schizophrenic psychoses]

We analysed two aspects of personality abnormality detected before the disorder became diagnostically apparent: potential genetic disposition, assessed using family and adoption studies, and premorbid constitution, which we outlined using retrospective and prospective studies. Current continuum models of the schizophrenic spectrum suggest that genetic disposition and premorbid constitution overlap to some extent, an area which ought to be better defined psychopathologically. In this overview, we determined a group of symptoms-bizarre behaviour, alogia, social withdrawal, and subclinical thought disorders-which are relevant for both schizotypal personality disorders and early schizophrenia. The topic of so-called reactive psychoses is examined to find an interface between personality abnormality and psychosis.

[Personality and personality disorders II. The Specificity of the DAPP-model as a diagnostic system for personality disorders]

The 'Dimensional Assessment of Personality Pathology - Basic Questionnaire' (DAPP) measures 18 traits to provide a systematic representation of the overall domain of personality disorders (PD). The present study investigated the relationships between DAPP personality profiles and dimensional assessments of DSM-IV PD in general population subjects (n = 156), and a sample of 220 nonpsychotic psychiatric patients (including n = 67 PD patients). Using nonmetric multidimensional scaling models the similarities between the 18 DAPP-factors and the dimensional scores of the 12 DSM-IV PD (inclusive appendix) were graphically represented in a 2-dimensional similarity-system. Here each DSM-IV PD dimension could be described by a distinct profile of DAPP-factors. Overall results support the assumption that PD can be represented by a dimensional system of personality traits with sufficient sensitivity and specificity.

[Personality and personality disorders I. Universality and sensitivity of dimensional personality models as diagnostic systems for personality disorders]

OBJECTIVE

A dimensional diagnostic system for personality disorders (PD) postulates continuous transitions from normal to disordered personalities (continuity hypothesis) and universal validity of basic personality dimensions (universal hypothesis). In the present study three dimensional personality models that claim to provide a systematic representation of the overall domain of personality disorders were compared: the Big-Five model proposed by Costa and McCrae, the psychobiological model proposed by Cloninger and colleagues, and the "Dimensional Assessment of Personal Pathology (DAPP)" model proposed by Livesley and colleagues.

METHOD

The "Six Factor Test" (SFT) measuring the Big-Five factors of personality, the "Temperament and Character Inventory (TCI)" measuring 4 temperament and 3 character dimensions, and the DAPP measuring 18 basic traits and 4 second ordered factors were administered to general population subjects (n = 156), and a clinical sample (n = 220) including a subsample of 69 patients with at least one diagnosis of DSM-IV PD. Group comparisons, regression analyses, and facet theoretical analyses were conducted.

RESULTS

The nonmetric similarity analyses of the three personality models show a nearly identical radex-representation of the second ordered factors in the non-clinical and clinical sample reflecting an universal validity of 4 basic personality dimensions and confirming the universal hypothesis. In comparison with the BIG-Five concept and the psychobiological model the DAPP model seems to be more sensitive to differentiate PD patients from controls with a reclassification rate of 94.5 %.

CONCLUSIONS

The Big-Five model, the DAPP and the TCI represent a substantially similar domain despite their different conceptualization. However, the DAPP was more sensitive to differences between PD patients and controls, offered a more comprehensive account of PD, and could differentiate the two groups more effectively.

[Continuous mental disorder as a prerequisite for the loss of legal capacity]

German civil law differentiates between continuous and temporary mental disorder. Loss of legal capacity can only be ascertained if a continuous mental disorder is evident. Considering the far-reaching consequences of the loss of legal capacity, careful distinction between these two groups of disorders is necessary, but clear legal guidelines and unequivocal psychiatric statements are still lacking. The solution given here can assure the quality of expert testimony by taking into account the current diagnostic conventions of ICD-10 research criteria as well as relevant knowledge about clinical course and therapy of psychiatric disorders.

Effects of the hallucinogen psilocybin on covert orienting of visual attention in humans

Hallucinogenic drug-induced states are considered as models for acute schizophrenic disorders (experimental psychoses). In a double-blind study with healthy volunteers we investigated the influence of the serotonergic hallucinogen psilocybin, the ecstasy-like drug 3,4-methylenedioxyethylamphetamine (MDE), the stimulant d- methamphetamine and placebo on covert orienting of spatial attention (n = 8 in each group). Reaction times were prolonged after ingestion of psilocybin > MDE, but not after d-methamphetamine. In addition, subjects on psilocybin exhibited particularly slow reaction times in invalid trials at short cue target intervals and failure of response inhibition in valid trials at long cue target intervals for right visual field targets. Despite some methodological limitations, these results are in line with both bilateral impairment of disengagement of attention and a lateralized impairment of inhibition of return (IOR) in productive psychotic states. Additional investigations with larger samples, different hallucinogenic substances (serotonergic agonists vs. NMDA antagonists) and different dose regimens are needed in order to further explore the suggested relationship between visuospatial attentional dysfunction and acute psychotic conditions.

[Mental incapacity and incapacity to make a decision and their status for determining legal guardianship]

The juridical guidelines for legal capacity demand the distinction between continuous and temporary mental disorders. A case report illustrates the problematic nature of this distinction. In addition the parallels to legal requirements for guardianship are discussed.

[Chronic neurotoxic damage in ecstasy (MDMA) users. Review of the current state of research]

The popular dance drug ecstasy (3,4-methylenedioxymethamphetamine, or MDMA, and some analogues) causes selective and persistent neurotoxic damage of the central serotonergic system in laboratory animals. Serotonin plays a role in numerous functional systems in the CNS. Consequently, various abnormalities including psychiatric, vegetative, neuroendocrine, and cognitive disorders might be expected in humans following damage of the central serotonergic system. In recent years, the questions of possible functional disorders following ecstasy-induced neurotoxicity were addressed in several cross-sectional studies with drug users. In this review we summarize and evaluate the quality of design of these studies. Despite large methodological problems, evidence accumulates in favor of persisting brain damage in ecstasy users resulting in subtle cognitive deterioration. Findings of relatively low memory performance associated with heavy ecstasy use are highly consistent across different studies and user populations. In addition, low performance in tests of higher executive function were reported in some but not all studies. The important questions about progression, persistence, or reversibility of damage after long periods of abstinence have to be addressed in future studies with longitudinal design.

Affect regulation in borderline personality disorder: experimental findings from psychophysiology and functional neuroimaging

BACKGROUND

Intense and rapidly changing mood states are a major feature of borderline personality disorder (BPD), which is thought to arise from affective vulnerability.

OBJECTIVE

There have been only a few studies investigating affective processing in BPD, and particularly neither psychophysiological nor neurofunctional correlates of abnormal emotional processing have been identified so far.

METHODS

Studies are reported using psychophysiological or functional neuroimaging methodology.

RESULTS

The psychophysiological study did not indicate a general emotional hyperresponsiveness in BPD. Low autonomic arousal seemed to reflect dissociative states in borderline subjects experiencing intense emotions. In the functional magnetic resonance imaging study enhanced amygdala activation was found in BPD, and it is suggested to reflect the intense and slowly subsiding emotions commonly observed in response to even low-level stressors.

CONCLUSIONS

Implications for psychotherapy are discussed.

[Personality, accentuated traits and personality disorders. A contribution to dimensional diagnosis of personality disorders]

A dimensional diagnostic system for personality disorders (PD) postulates continuous transition from normal to disordered personalities (continuity hypothesis) and universal validity of basic personality dimensions (universal hypothesis). The present study investigates the validity of Leonhard's concept of attenuated personalities that define a conceptual link between normal personality dimensions and PD. Nine possible continuous transitions between three conceptual levels (Big Five personality factors, nine attenuated personality traits, nine PD) were tested by questionnaire data obtained from a mentally healthy (n = 166) and a clinical sample (n = 78). Both samples differed significantly in nearly all variables. However, they showed substantial similarity concerning the (in)validity of single continua and the complex structure of all variables as analyzed by multidimensional scaling. The concept of attenuated personalities could be validated for six out of nine tested continua and can be recommended for application in dimensional models of personality and personality disorders.

[A symptom oriented approach to evaluate legal capacity under account of the term will]

After summarising the legal requirements of contractual capacity, an attempt is made to define the term will with psychiatric conceptualisations. Possible restrictions of a free declaration of will are outlined. Symptoms, which possibly influence cognitive preconditions of will and personal values, are taken into account. Our considerations are supposed to improve orientation in this complex field and to contribute to the communication between psychiatric expert and the court. However, the analysis of each individual case remains essential.

[Self-help on the internet. Chances and risks of communication in electronic networks]

The worldwide web is used for self-help purposes by an increasing number of patients with a variety of mental disorders. The benefits and dangers of applying the internet in psychiatry are discussed based on a case report concerning a female with post traumatic stress and multiple personality disorders who visited a chat-room in the internet with two of her 48 supernumerary identities. During one stage of her history, she displayed an excessive use of the internet which must be considered a symptom of mental disorder rather than a distinct disease entity, viz. "internet addiction".

Microbial communities in the chemocline of a hypersaline deep-sea basin (Urania basin, Mediterranean Sea)

The Urania basin is a hypersaline sulfidic brine lake at the bottom of the eastern Mediterranean Sea. Since this basin is located at a depth of approximately 3,500 m below the sea surface, it receives only a small amount of phytoplankton organic carbon. In the present study, the bacterial assemblages at the interface between the hypersaline brine and the overlaying seawater were investigated. The sulfide concentration increased from 0 to 10 mM within a vertical interval of 5 m across the interface. Within this chemocline, the total bacterial cell counts and the exoenzyme activities were elevated. Employing 11 cultivation methods, we isolated a total of 70 bacterial strains. The 16S ribosomal DNA sequences of 32 of the strains were identical to environmental sequences detected in the chemocline by culture-independent molecular methods. These strains were identified as flavobacteria, Alteromonas macleodii, and Halomonas aquamarina. All 70 strains could grow chemoorganoheterotrophically under oxic conditions. Sixty-six strains grew on peptone, casein hydrolysate, and yeast extract, whereas only 15 strains did not utilize polymeric carbohydrates. Twenty-one of the isolates could grow both chemoorganotrophically and chemolithotrophically. While the most probable numbers in most cases ranged between 0.006 and 4.3% of the total cell counts, an unusually high value of 54% was determined above the chemocline with media containing amino acids as the carbon and energy source. Our results indicate that culturable bacteria thriving at the oxic-anoxic interface of the Urania basin differ considerably from the chemolithoautotrophic bacteria typical of other chemocline habitats.

Monoalkylether phospholipids in the sulfate-reducing bacteria Desulfosarcina variabilis and Desulforhabdus amnigenus

In this study, cellular lipid compositions of two mesophilic sulfate-reducing bacteria were analyzed by high performance liquid chromatography-mass spectrometry (HPLC-MS). In Desulfosarcina variabilis and Desulforhabdus amnigenus, alkylether-containing phospholipids were detected which had previously only been found in significant amounts in deeply branching hyperthermophilic bacteria and archaea. Combining information from HPLC-MS analysis and chemical degradation experiments, ether lipids were identified as 1-alkyl-2-acyl-phosphatidyl ethanolamines, glycerols and cholines. In Desulforhabdus amnigenus, n-penta-, n-hexa- and n-heptadecyl ethers were present (in order of decreasing abundance), whereas Desulfosarcina variabilis solely contained n-hexadecyl ether side chains.

[The startle reflex in schizophrenia research]

Abnormalities of attention and information processing are described as important features of schizophrenia. Theoretically, they may reflect deficiencies in central mechanisms of inhibition and selection. These deficiencies are believed to lead to cognitive fragmentation in patients with schizophrenia. Findings of an impaired prepulse-inhibition (PPI) and habituation of the startle reflex in patients with schizophrenia are thought to represent preattentive, i.e., automatic attention deficits. Other paradigms with attentional instructions help to detect and to quantify deficits in controlled attentional functions. The PPI of the auditory startle blink reflex-mediated primarily by brainstem structures--is regulated by cortico-striato-pallido-pontine influences and by neurotransmitters involved in the pathogenesis of schizophrenia. An animal model of PPI provides the possibility to test neurobiological hypotheses in schizophrenia and to screen substances for their potential antipsychotic properties. Because reduction of PPI also occurs in other neuropsychiatric disorders, further studies are required to develop new paradigms of startle modification with findings of higher specificity and probable diagnostic relevance in patients with schizophrenia.

Psychophysiological responses in ADHD boys with and without conduct disorder: implications for adult antisocial behavior

OBJECTIVE

Several studies have demonstrated that the presence of attention-deficit/hyperactivity disorder (ADHD) in childhood increases the risk of antisocial behavior developing in adulthood. However, because previous research did not consider comorbid conduct disorder (CD), the question of whether ADHD by itself or only the association of ADHD with CD implies a risk of adult antisocial behavior developing is still under discussion.

METHOD

Because several characteristics of psychophysiological response had been shown to be associated with future increased likelihood of adult antisocial behavior, autonomic arousal as well as electrodermal responses to orienting and aversive stimuli were assessed in 26 boys with ADHD+CD compared with 21 boys with ADHD alone and 21 controls.

RESULTS

Boys with a comorbid condition of ADHD+CD showed a decrement of autonomic responses and a more rapid habituation to orienting and aversive startling stimuli compared with age-matched children with ADHD alone.

CONCLUSIONS

Boys with ADHD+CD show a psychophysiological response pattern that is very similar to that reported in antisocial personalities. These findings give further support for a high persistence of antisocial behavior from childhood to adulthood, while no evidence was found that ADHD itself is associated with a predisposition to antisocial behavior.

Ping-pong gaze in combined intoxication with tranylcypromine, thioridazine, and clomipramine

OBJECTIVE

This paper reports the occurrence of ping-pong gaze, a neuro-ophthalmological syndrome usually related to severe structural brain damage, in a patient intoxicated with tranylcypromine, thioridazine, and clomipramine.

BACKGROUND

Although there have been some reports about the occurence of Ping-pong gaze after intoxications, it is usually related to severe bilateral hemispheric brain damage following stroke or traumatic injuries.

METHOD

We report the case of a 56-year old woman who developed a neurotoxic syndrome with coma, hyperthermia, muscular rigidity, myoclonic jerks and tachycardia following an intoxication. Additionally rhythmic and pendular conjugate horizontal eye movements could be observed for three days, so that the diagnosis of ping-pong gaze was made.

RESULTS

A treatment with dantrolene lead to complete remission of the neurotoxic syndrome with no signs of neurological or physical deficits. At the stage of regaining consciousness the eye movements became normal.

CONCLUSION

In our case the combined intoxication with an monoamine oxidase inhibitor, a neuroleptic and a tricyclic agent lead to a neurotoxic syndrome and the occurrence of a rare neuro-ophthalmological syndrome usually related to bilateral hemispheric brain dysfunction.

[Etiological and therapeutic aspects of schizoid and schizotypal personality disorder]

Following the introduction to the history of the concepts of abnormal personality, with regard to the schizoid and schizotypal forms, we present their systematic assessment in the modern classification systems.Both, the schizoid and schizotypal forms, are usually considered as schizophrenia-spectrum disorders. Biological and clinical data indicate relations to other axis-I disorders as well. However there are few systematic and strictly controlled studies on the psychotherapeutic and pharmacological treatment of schizotypal and schizoid personality disorders. Basic theoretic assumptions concerning both treatment concepts - for personality disorders in general, and especially in schizoid and schizotypal personality disorder - are given. Finally the role of neuroleptics and antidepressants for schizophrenia-spectrum disorders is discussed. New possibilities may emerge from the use of the recently developed atypical drugs, but further research in randomised studies is needed. Current prospective studies on early detected schizophrenia-spectrum disorders will broaden our knowledge about prevention and therapy.

Evidence of abnormal amygdala functioning in borderline personality disorder: a functional MRI study

BACKGROUND

Intense and rapidly changing mood states are a major feature of borderline personality disorder (BPD); however, there have only been a few studies investigating affective processing in BPD, and in particular no neurofunctional correlates of abnormal emotional processing have been identified so far.

METHODS

Six female BPD patients without additional major psychiatric disorder and six age-matched female control subjects underwent functional magnetic resonance imaging (fMRI) to measure regional cerebral hemodynamic changes following brain activity when viewing 12 standardized emotionally aversive slides compared to 12 neutral slides, which were presented in random order.

RESULTS

Our main finding was that BPD subjects but not control subjects were characterized by an elevated blood oxygenation level dependent fMRI signal in the amygdala on both sides. In addition, activation of the medial and inferolateral prefrontal cortex was seen in BPD patients. Both groups showed activation in the temporo-occipital cortex including the fusiform gyrus in BPD subjects but not in control subjects.

CONCLUSIONS

Enhanced amygdala activation in BPD is suggested to reflect the intense and slowly subsiding emotions commonly observed in response to even low-level stressors. Borderline subjects' perceptual cortex may be modulated through the amygdala leading to increased attention to emotionally relevant environmental stimuli.

Emotion in criminal offenders with psychopathy and borderline personality disorder

BACKGROUND

Criminal offenders with a diagnosis of psychopathy or borderline personality disorder (BPD) share an impulsive nature but tend to differ in their style of emotional response. This study aims to use multiple psychophysiologic measures to compare emotional responses to unpleasant and pleasant stimuli.

METHODS

Twenty-five psychopaths as defined by the Hare Psychopathy Checklist and 18 subjects with BPD from 2 high-security forensic treatment facilities were included in the study along with 24 control subjects. Electrodermal response was used as an indicator of emotional arousal, modulation of the startle reflex as a measure of valence, and electromyographic activity of the corrugator muscle as an index of emotional expression.

RESULTS

Compared with controls, psychopaths were characterized by decreased electrodermal responsiveness, less facial expression, and the absence of affective startle modulation. A higher percentage of psychopaths showed no startle reflex. Subjects with BPD showed a response pattern very similar to that of controls, ie, they showed comparable autonomic arousal, and their startle responses were strongest to unpleasant slides and weakest to pleasant slides. However, corrugator electromyographic activity in subjects with BPD demonstrated little facial modulation when they viewed either pleasant or unpleasant slides.

CONCLUSIONS

The results support the theory that psychopaths are characterized by a pronounced lack of fear in response to aversive events. Furthermore, the results suggest a general deficit in processing affective information, regardless of whether stimuli are negative or positive. Emotional hyporesponsiveness was specific to psychopaths, since results for offenders with BPD indicate a widely adequate processing of emotional stimuli.

Emotional responses in patients with borderline as compared with avoidant personality disorder

The aim of this study was to assess psychophysiological affect correlates, in addition to the usual self-report in borderline personality disorder (BPD) compared with avoidant personality disorder (APD) and normal controls (NCs), when responding to standardized experimental stimuli. In 24 BPD female patients, 23 APD female patients, and 27 female NCs, skin conductance response (SCR), heart rate (HR) change, and startle response were recorded while the subjects viewed slides with emotional content. Neither the self-report nor the psychophysiological data supported the hypothesis that affective responses of BPD individuals are generally stronger than those with APD. BPD patients showed no potentiation of the affective modulation of the startle reflex and their electrodermal reactivity was lower than in either the APD subjects or the NCs. The hypothesis of a general affective hyperresponsivity could not be confirmed. Low somatic arousal in BPD can interfere with the anticipation of signal stimuli and may explain the exaggerated openness borderline personalities show to stimuli, particularly in interpersonal situations.

[The internet as a delusional topic in paranoid schizophrenia]

Two patients with paranoid schizophrenia had delusions involving the internet. Additionally, one of them experienced computer databases as being distributed to other people in a phenomenologically similar way to that encountered in thought broadcasting. The presented cases illustrate the historical association of the contents of delusions in schizophrenia.

Circumplex models for the similarity relationships between higher-order factors of personality and personality disorders: an empirical analysis

Similarity relationships between personality factors and personality disorders (PDs) are usually described within the conceptual framework of the "big five" model. Recently, two-dimensional circumplex models have been suggested as alternatives, such as the interpersonal circle, the multifacet circumplex, and the circumplex of premorbid personality types. The present study is an empirical investigation of the similarity relationships between the big five, the 11 DSM-III-R personality disorders and four subaffective disorders. This was performed in a sample of 165 psychiatric inpatients. We tested the extent to which the relationships could be adequately represented in two dimensions and which circumplex model can be supported by the empirical configuration. Results obtained by principal-components analysis (PCA) strongly confirm the circumplex of premorbid personality, and to some extent the multifacet circumplex. However, the interpersonal circle cannot be confirmed.

[Impulse control and affect regulation in personality disorders]

In borderline and antisocial personality disorder there is a close interaction between affect dysregulation and impulse control disorder. Different approaches are presented that focus on affective responses to experimental stimuli in these personality disorders. Results suggest that in borderline personality disorder intense emotional responses occur in the context of specific stressors, in particular fear of being abandoned. Evidence for a general emotional hyperreactivity was not found; on the contrary, female borderline subjects rather showed reduced emotional arousal. Regarding the psychopathic subtype of antisocial personality disorder, results provided strong support for the theory of emotional detachment, which may predispose to violence through a lack of feeling of fear or also of compassion which could counteract violent impulses. Consequences for psychotherapy in BPD are considered.

[Posttraumatic stress disorder in patients with neurogenic amnesia for the traumatic event]

The development of symptoms of posttraumatic stress disorder (PTSD) in patients with neurogenic amnesia for the traumatic event is recorded in 2 own patients and in 19 cases from the clinical literature. With a single exception, all patients were accident victims with closed head injuries. Only about three quarters of the patients completely fulfilled DSM-III-R criteria of PTSD. Nineteen patients displayed involuntary conscious memories of aspects of the traumatic event (presenting as recurrent intrusive thoughts, images or dreams) co-existent with a complete or partial lack of voluntary conscious memories of the trauma, suggesting that different memory systems and distinct brain mechanisms subserve these phenomena. The said clinical observations are discussed against the background of current neuropsychological models of multiple memory systems. The recorded cases demonstrate that declarative episodic memory is not necessary for symptoms of PTSD to emerge, whereas preserved functions of non-declarative memory systems represent a sufficient condition for the development of PTSD symptoms.