Referral rates and barriers to lung transplantation based on pulmonary function criteria in interstitial lung diseases: a retrospective cohort study

BACKGROUND

Interstitial lung diseases (ILD) unresponsive to medical therapy often require lung transplantation (LTx), which prolongs quality of life and survival. Ideal timing for referral for LTx remains challenging, with late referral associated with significant morbidity and mortality. Among other criteria, patients with ILD should be considered for LTx if forced vital capacity (FVC) is less than 80% or diffusion capacity for carbon monoxide (DLCO) is less than 40%. However, data on referral rates are lacking.

OBJECTIVES

To evaluate referral rates for LTx based on pulmonary function tests (PFTs) and identify barriers associated with non-referral.

DESIGN

A single-center retrospective cohort study.

METHODS

The study consisted of ILD patients who performed PFT between 2014 and 2020. Patients with FVC < 80% or a DLCO < 40% were included in the study. Patients with absolute contraindications to LTx were excluded. Referral rates were computed, and a comparison was made between referred and non-referred subjects.

RESULTS

Out of 114 ILD patients meeting criteria for referral to LTx, 35 were referred (30.7%), and 7 proceeded to undergo LTx. Median time from PFT to referral for assessment was 255 days [interquartile range (IQR) 35-1077]. Median time from referral to LTx was 89 days (IQR 59-143). Referred patients were younger (p = 0.003), had lower FVC (p < 0.001), DLCO (p < 0.001), and a higher rate of pulmonary hypertension (p = 0.04). Relatively better PFT, and older age, were significantly associated with non-referral of patients.

CONCLUSION

There is under-referral of ILD patients who are eligible for LTx, which is associated with severe disease and missed opportunities for LTx. Further research is required to validate these findings.

Persistent Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia in Patients Treated With Anti-CD20 Monoclonal Antibodies

We report 8 cases of persistent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia in patients previously treated with anti-CD20 monoclonal antibodies. Polymerase chain reaction of nasopharyngeal swabs for SARS-CoV-2 was negative in most cases; viral cell cultures confirmed that viable SARS-Co-2 virus was present. Four patients were treated with anti-SARS-CoV-2 hyperimmune globulins with rapid resolution of disease.

Timing of Lung Transplant Referral in Patients with Severe COVID-19 Lung Injury Supported by ECMO

Severe respiratory failure caused by COVID-19 often requires mechanical ventilation, including extracorporeal membrane oxygenation (ECMO). In rare cases, lung transplantation (LTx) may be considered as a last resort. However, uncertainties remain about patient selection and optimal timing for referral and listing. This retrospective study analyzed patients with severe COVID-19 who were supported by veno-venous ECMO and listed for LTx between July 2020 and June 2022. Out of the 20 patients in the study population, four who underwent LTx were excluded. The clinical characteristics of the remaining 16 patients were compared, including nine who recovered and seven who died while awaiting LTx. The median duration from hospitalization to listing was 85.5 days, and the median duration on the waitlist was 25.5 days. Younger age was significantly associated with a higher likelihood of recovery without LTx after a median of 59 days on ECMO, compared to those who died at a median of 99 days. In patients with severe COVID-19-induced lung damage supported by ECMO, referral to LTx should be delayed for 8-10 weeks after ECMO initiation, particularly for younger patients who have a higher probability of spontaneous recovery and may not require LTx.

[Prospective description of the course of psychopathological symptoms in schizophrenia: evaluation of the short form of the Eppendorf Schizophrenia Inventory]

BACKGROUND

The Eppendorf Schizophrenia Inventory (ESI-K) is a self-assessment procedure which can now be considered as the standard procedure in the diagnostics of schizophrenia. It has been evaluated in many studies and is widely used in research and clinical treatment. In contrast little is known about the psychometric characteristics of the short form of the ESI (ESI-K) which was designed in particular for prospective descriptive courses.

MATERIALS AND METHODS

The ESI-K was completed for 40 patients with schizophrenia undergoing complete inpatient psychiatric treatment together with the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impressions (CGI) form and the Nurses' Observation Scale for Inpatient Evaluation (NOSIE). Of the patients 31 participated in a total of 4 measurements at 1-week intervals.

RESULTS

The reliability (Cronbachs α) of the ESI-K was high at all measurement time points and was comparable to the reliability of the standard version. The reliability of the PANSS was roughly the same level but that of the NOSIE was poor. The ESI-K correlated in particular with cognitive syndrome and the positive syndrome of the PANSS. All four instruments showed a decrease in scores over the observational time period which indicated a decline in the psychopathological symptoms.

CONCLUSIONS

The ESI-K is a valid time-saving procedure for documentation of the course of symptoms in patients with schizophrenia. It reflects clinically relevant aspects from the spectrum of psychotic symptoms.

Osteosarcoma in children aged less than five years at diagnosis: Experience of the Cooperative Osteosarcoma Study Group

9554

Background: The incidence of osteosarcoma considerably varies with age and preschool children are reported to be extremely rarely affected. This study was conducted to investigate presentation, treatment, and outcome in very young children with osteosarcoma. Patients and Methods: The authors retrospectively analyzed the collected data of 2,706 consecutive patients with newly diagnosed high-grade osteosacroma of bone registered in the COSS studies between 1976 and 2005; and identified 28 patients (1%) aged less than five years at diagnosis. Demographic, diagnostic, tumor, and treatment related variables; response and survival data of these 28 patients were analyzed. Results: Of the 28 (male, N = 16; female, N = 12) identified toddlers (two years, N = 4; three years, N = 10; four years, N = 14), 27 presented with a high-grade central osteosarcoma of an extremity (femur, N = 12; humerus, N = 10; tibia, N = 5) and one with a secondary osteosarcoma of the orbit. The size of the primary extremity tumor was large in 74% of patients. Primary metastases were detected in 4/28 children. All 28 patients received multiagent chemotherapy, and 13 of the 21 analyzed tumors responded well to neoadjuvant chemotherapy (>90% necrosis). Limb sparing surgery was feasible in 11 children, whereas ablative procedures were performed in 14 patients. A macroscopically complete surgical remission of all clinically detectable tumors was achieved in 24/28 patients during front line therapy. With a median follow-up of 1.7 years (4.2 years for survivors), 15/28 patients were alive. Outcome was poorer for the 28 toddlers compared to the 2,678 older patients (5-year event free survival 43% ± 10% vs. 56% ± 1%)(P = 0.02). Conclusion: Osteosarcoma is extremely rare in preschool children. These young patients often have large tumors which may require mutilating resections. Despite the high rate of ablative surgery, the prognosis, however, may be poorer compared to older patients.

No significant financial relationships to disclose.

[Evaluation of subjective experience of cognitive deficit in patients with schizophrenia using the Eppendorf Schizophrenia Inventory]

Presented is a new questionnaire--Eppendorf Schizophrenia Inventory (ESI)--for evaluation of subjective experience of cognitive dysfunction characteristic of schizophrenia and data that confirmed reliability and diagnostic validity of the ESI. The ESI is suggested to be an additional method of psychopathological diagnosis of schizophrenic disorders.

Identifizierung möglicher Kennparameter der „mimischen Desintegration“ bei schizophrenen Patienten mittels einer Gesichts-EMG-Methode

The aim of this study was to identify signs of "mimic disintegration" in schizophrenics using a facial electromyographic (EMG) method. We compared a group of 20 unmedicated schizophrenics with a group of 20 healthy subjects, measuring the activity of three joy-relevant facial muscles (zygomaticus major, orbicularis oculi, levator labii superioris) and two nonjoy-relevant facial muscles (frontalis, corrugator supercilii) as control muscles during two consecutive presentations of an erotic slide from the International Affective Picture System.

RESULT

Schizophrenics show significantly less activity of joy-relevant facial muscles and a lower smile frequency than healthy subjects. Two signs of mimic disintegration" could be identified: 1. undefined mimic reactions and 2. lack of mimic consistency.

CONCLUSION

Facial EMG is a state-of-the-art method for analyzing possible signs of mimic disintegration as described by Heimann and Spoerri. We suggest further examination of the two mimic disintegration signs regarding other emotions, necessarily including more facial muscles in the testing.

Eppendorfer Schizophrenie-Inventar (ESI) vs. Frankfurter Beschwerde-Fragebogen (FBF)

This study is the first to directly compare two clinical questionnaires which are both aimed at self-experienced cognitive dysfunctions of schizophrenia: Eppendorf Schizophrenia Inventory (ESI) and Frankfurt Complaint Questionnaire (FCQ). Evaluated were (a) diagnostic validity, (b) psychometric properties, (c) scale intercorrelations, and (d) factor analytic stability. Ad (a): schizophrenic subjects (n=36) show highly significant increases in the ESI scales and sum score when compared to other clinical groups (patients with depression, alcohol dependence, or obsessive-compulsive disorder, n>30, respectively); on the other hand, the FCQ yields no systematic group differences. Ad (b): mean of reliability coefficients (Cronbach alpha) of the ESI scales is r(tt)=0.86, mean of reliability coefficients of the FCQ scales is significantly lower. Ad (c): the mean intercorrelation between ESI and FCQ scales amounts to r(xy)=0.56 (minimum 0.29, maximum 0.73), corresponding to an average shared variance of about 31%. Ad (d): factor analysis yielded an ESI factor and a FBF factor; one-way ANOVA with the factor scores confirms the diagnostic validity of the ESI.

CONCLUSIONS

ESI and FCQ measure essentially different aspects of schizophrenic psychopathology. Regarding reliability and diagnostic validity, the ESI is superior to the FCQ.

Impact of present and past antipsychotic side effects on attitude toward typical antipsychotic treatment and adherence

OBJECTIVE

(1) determine which antipsychotic side effects (SE) schizophrenic patients consider the most distressing during treatment with typical antipsychotics, (2) measure the impact of actual and past SE on patients' attitude toward antipsychotics and (3) assess the influence of both on adherence.

METHODS

The 213 schizophrenics, treated with conventional antipsychotics, were recruited in two psychiatric hospitals in Hamburg. Subjects were assessed about type and severity of present and past side effects and their attitude and adherence to antipsychotic treatment.

RESULTS

The 82 (39%) patients presented present SE while 131 (61%) did not. Sexual dysfunctions (P < 0.001), extrapyramidal (P < 0.05) and psychic side effects (P < 0.05) were rated as significantly subjectively more distressing than sedation or vegetative side effects. Patients presenting with present SE compared with patients without present SE had a significantly more negative general attitude toward antipsychotics (P < 0.05), were more doubtful about their efficacy (P < 0.01) and were less likely to encourage a relative to take such a medication in case of need (P < 0.001). A regression analysis indicated that nonadherence was mainly influenced by negative general and efficacy attitudes toward antipsychotics and the experience of past or present antipsychotic side effects.

CONCLUSIONS

All antipsychotic side effects, present or past, can have a durable negative impact on patient's attitude toward antipsychotic treatment and adherence. Non-adherence is mainly determined, among other factors, by these negative attitudes, which are partly influenced by the experience of past or present antipsychotic-induced side effects.

[The vigilance paradigm in schizophrenia research - studies on the Continuous Performance Test (CPT)]

Deficits in vigilance/sustained attention of schizophrenic subjects have been a main topic of neuropsychological schizophrenia research for many years. The degraded stimulus Continuous Performance Test (ds-CPT) is the standard paradigm for measuring vigilance. Measurement of vigilance requires the observation of the course of perceptual sensitivity over time. The present review shows that from a theoretical point of view it is possible to show vigilance deficits (as a decrease of sensitivity) with the ds-CPT if certain conditions are given. However, only in a few schizophrenia studies the course of sensitivity over time was evaluated, while in most studies merely the level of sensitivity was analysed. Results presented in this review suggest that level and course of sensitivity are largely independent variables. Vigilance can be operationalised adequately only when considering the course of sensitivity over time. Therefore there still is a considerable need for research on the meaning of vigilance deficits for manifestation, course and treatment of schizophrenia.

Overexpression of the HER-2/neu oncogene in pancreatic adenocarcinoma

Novel systemic treatments are needed in pancreatic cancer. The authors sought to establish the frequency of overexpression of the HER-2/neu oncogene in patients with pancreatic adenocarcinoma to determine the potential role of trastuzumab (Herceptin) as a therapeutic agent in this disease. Tumor specimens from patients with pancreatic adenocarcinoma were analyzed by staining for p185HER2 protein using the DAKO immunohistochemical assay. Patients with and without HER-2/neu overexpression by immunohistochemistry were compared with respect to clinical and pathologic characteristics. HER-2/neu gene amplification was also evaluated by fluorescence in situ hybridization (FISH). Thirty-two of 154 patients (21%) had pancreatic adenocarcinoma that demonstrated HER-2/neu overexpression by immunohistochemistry. At initial diagnosis, 16% of resectable cancers, 17% of locally advanced cancers, and 26% of metastatic cancers were determined to have HER-2/neu overexpression. Three of 11 (27%) patients with HER-2/neu overexpression by immunohistochemistry had gene amplification by FISH. HER-2/neu overexpression occurs in a subset of pancreatic cancer. Evaluation of the efficacy of trastuzumab for patients with pancreatic cancer who overexpress HER-2/neu appears indicated.

Effects of cerebral hemispheric laterality on the span of apprehension of schizophrenic and healthy subjects

The effects of hemispheric laterality on a forced-choice Span of Apprehension (SoA) task were investigated. Forty-eight adult schizophrenic inpatients were recruited. A control group of healthy subjects was put together using the matched-pairs method with age, gender, and education as control variables. SoA performance was determined separately for the left and right visual field (VF), respectively. No SoA group differences were found; in both groups, the hit percentage was higher in the right VF. However, in the schizophrenic group, the left VF performance showed significant negative correlations with psychopathologic symptoms (especially auditory verbal hallucinations). In a subsample of patients receiving atypical neuroleptic drugs, the daily dosage correlated negatively with left VF performance. In general, young subjects performed better than old subjects (both VFs), males performed better than females, and subjects with high education performed better than subjects with low education (right VF).

Schizophrenic disorders among Turkish migrants in Germany. A controlled clinical study

Several studies have implied cultural differences in the psychopathology of schizophrenia between migrants and natives. In a diagnostically strictly controlled study, including comparison of diagnosis with a Turkish-speaking psychiatrist, 74 patients of Turkish and 48 of German origin, all with a diagnosis of schizophrenic disorder, were compared using PANSS and HAM-D. The Turkish sample showed higher depression and hostile excitement, even in the subsample of those with paranoid schizophrenia, and no differences in positive, negative or cognitive symptoms. The similarities especially concerning core symptoms reflect evidence from cross-cultural studies on schizophrenia. In conclusion this study shows main differences in psychopathology between psychotic migrants and natives, as discussed in the literature, may be mainly due to diagnostic differences.

Relationship between cannabis use, schizotypal traits, and cognitive function in healthy subjects

This research examined the relationship between cannabis use and schizotypal features. A sample of cannabis users (n = 20) was compared with a matched control group (n = 20). All participants were male students of the University of Hamburg. Subjects completed the Perceptual Aberration Scale and the Schizotypal Personality Questionnaire. A Negative Priming procedure and the Trail Making Test were carried out. A urine sample was obtained from each subject. Cannabis users exceeded controls in schizotypy scores and showed impaired neuropsychological parameters. Only within the cannabis group schizotypy scores correlated with neuropsychological parameters. Furthermore, cannabis users reported more often high-risk factors than controls. These findings indicate that among cannabis users there is an increased number of subjects with schizotypal features; schizotypal subjects seem to be more likely to use cannabis than the general population. Therefore, cannabis use may be a vulnerability indicator for schizophrenia.

Improvement of schizophrenic patients' subjective well-being under atypical antipsychotic drugs

Recent research indicates that subjective well-being is a major determinant of medication compliance in schizophrenia. However, it is yet unresolved whether atypical neuroleptics differ regarding subjective side-effects. A self-report instrument has been constructed to evaluate 'subjective well-being under neuroleptics' (SWN). The primary aims of the present study were to develop a short form of the SWN and to investigate the extent to which the atypical antipsychotic improves the patient's subjective well-being. The short form of the SWN was constructed following an item analysis based on data from 212 schizophrenic patients medicated with either typical or atypical antipsychotics. The short form of the SWN showed sufficient internal consistency and good construct validity. The SWN was only moderately correlated with positive and negative syndrome scale (PANSS) scores or changes in psychopathology (r=-0.20 to -0.37). SWN-ratings in patients receiving olanzapine were superior compared to those of patients medicated with either clozapine or risperidone on three of five domains of well-being. Clozapine reduced global psychiatric symptoms significantly more than risperidone. It is concluded that the assessment of subjective well-being under antipsychotic treatment provides an independent outcome measure which is relevant to compliance.

Characteristic subjective experiences of schizophrenia

The purpose of the study was to identify subjective experiences that are characteristic of schizophrenia. A questionnaire for self-assessment of disturbances in several cognitive-perceptual areas (the Eppendorf Schizophrenia Inventory) was constructed and administered to first episode schizophrenia patients (SCHf; n = 45), negative-syndrome schizophrenia patients (SCHn; n = 45), remitted schizophrenia subjects (SCHr; n = 24), depressive patients (DEP; n = 43), alcoholic patients (ALC; n = 48), obsessive-compulsive patients (OCD; n = 46), and healthy controls (CON; n = 57). Comparisons between the SCHf, SCHn, DEP, ALC, and OCD groups and a subsequent factor analysis revealed four schizophrenia-specific dimensions: Attention and Speech Impairment (AS), Ideas of Reference (IR), Auditory Uncertainty (AU), and Deviant Perception (DP). Further analyses suggested that the AS syndrome represents a mediating vulnerability factor, while IR, AU, and DP probably are reversible episode indicators. The results may contribute to the refinement of the measurement of specific prepsychotic signs, thus facilitating the development of early intervention approaches.

Psychopathological syndromes of schizophrenia: evaluation of the dimensional structure of the positive and negative syndrome scale

The Positive and Negative Syndrome Scale (PANSS) was originally designed as a rating system that provides balanced representation of positive and negative symptom features. Evidence from recent factor-analytic studies suggests that a five-dimensional solution appears to best fit the psychopathological data as assessed with the PANSS. To investigate the dimensional structure, we administered the PANSS to 253 inpatients with schizophrenia. In accordance with former studies, principal components analyses yielded five orthogonal dimensions: hostile excitement; negative, cognitive, and positive syndrome; and depression. When compared with questionnaires measuring subjective nonpsychotic experiences of schizophrenia, paranoid mood, and depression, the correlation pattern verifies the PANSS components. In addition, we investigated a subsample of 70 male patients with a Continuous Performance Test (CPT), a Span of Apprehension Task, and a Modality Shift Effect (MSE) paradigm; the CPT was significantly associated with the cognitive syndrome, and the MSE correlated with the negative syndrome.

The role of HER-2 expression in predicting response to therapy in breast cancer

HER-2 expression may have predictive value regarding response to therapeutic interventions in breast cancer. A number of reports describe the interaction of HER-2 overexpression and tamoxifen, but data are inconclusive. Chemotherapy trials have supported an interaction between HER-2 overexpression and chemotherapy sensitivity (cyclophosphamide/methotrexate/5-fluorouracil resistance and doxorubicin sensitivity) which is compelling. More recently, HER-2 has been the target for Food and Drug Administration-approved antibody therapy, trastuzumab (Herceptin; Genentech, Inc, South San Francisco, CA). The Clinical Trials Assay, a scoring system for tumor material, has been used successfully in the trastuzumab clinical development program. As many of the early studies evaluating the role of HER-2 were retrospective, controlled prospective studies are needed to best determine the value of trastuzumab in the adjuvant clinical setting.

[Differences between psychopathological evaluation in German and Turkish language of Turkish immigrants]

The elevated rate of schizophrenia among migrants has been explained, among others, with misdiagnosis due to symptoms' being misinterpreted as psychotic. Previous studies have shown both higher and lower rates of psychotic symptoms of these patients when interviewed in their mother tongues, compared to being interviewed in the second language. In this study, 91 patients of Turkish origin and 50 of German origin with a paranoid-hallucinatory syndrome at admission were examined by an one interviewer each of Turkish and German origins using a standardized psychopathological instrument. In spite of comparative samples, correlation of psychopathological evaluation as well as diagnostic agreement between the two interviewers was significantly higher in the German patient group. Within the Turkish patient group, correlation was higher for those with good German language knowledge than for those with poor knowledge, yet only on a few items and without an effect on diagnostic agreement. The greatest difficulties lie in the evaluation of delusions. In spite of higher disagreement on psychopathology, the potential misdiagnoses cannot sufficiently explain the higher rate of schizophrenia among migrants.

[The Eppendorf Schizophrenia Inventory (ESI). Development and evaluation of a questionnaire for assessment of characteristic self perception of cognitive dysfunctions by schizophrenic patients]

This study explored characteristic subjective experiences of schizophrenia. A questionnaire for self-assessment of disturbances in several cognitive and perceptual areas (the Eppendorf Schizophrenia Inventory, or ESI) was constructed and administered to first-episode schizophrenics (SCHe, n = 45), negative syndrome schizophrenics (SCHn, n = 45), remitted schizophrenics (SCHr, n = 24), depressives (DEP, n = 43), alcoholics (ALK, n = 48), obsessive-compulsive patients (ZWA, n = 46), and healthy controls (KON, n = 57). Comparisons between the SCHe, SCHn, DEP, ALK, and ZWA groups and a subsequent factor analysis revealed four schizophrenia-specific dimensions: attention and speech impairment (AS), ideas of reference (IR), auditory uncertainty (AU), and deviant perception (DP). Further analyses suggested that the AS syndrome may represent a mediating vulnerability factor while IR, AU, and DP probably are reversible episode indicators. The results may contribute to refinements in the measurement of specific prepsychotic signs, thus facilitating the development of early intervention approaches.

Differential sustained attention/vigilance changes over time in schizophrenics and controls during a degraded stimulus Continuous Performance Test

The Continuous Performance Test (CPT) is a widely used procedure for sustained attention/vigilance measurement. However, though the key index of vigilance impairment is the decrement of sensitivity over time during the test period, only few studies have examined whether schizophrenics show a larger drop in CPT performance than do healthy controls. 48 schizophrenic inpatients and 48 controls were investigated with the Munich CPT (480 visual stimuli, 25% target stimuli, one stimulus per second). Stimuli were degraded by randomly inverting 40%, 41%, 42%, or 43% of the pixels. Results were calculated separately for three consecutive trial sections. Additionally, PANSS ratings, medication, and other clinical data were documented. Schizophrenics show a vigilance decrement over time, controls show a vigilance increase. Differential vigilance changes were not related to the level of stimulus degradation. Schizophrenics performed worse than controls only at the lowest degradation level. While overall sensitivity correlated negatively with the dose of atypical neuroleptics and benzodiazepines, vigilance shifts over time correlated negatively with the dose of typical neuroleptics. Furthermore, sensitivity was related to the cognitive PANSS syndrome, number of admissions/duration of illness. Differential sensitivity decrements of schizophrenics and controls can be shown if suited CPT procedures are used. The need for basic research on experimental conditions of the CPT as well as examination of the relationship between sustained attention/vigilance decrements and clinical features of schizophrenia is suggested.

Potential for misdiagnosis among Turkish migrants with psychotic disorders: a clinical controlled study in Germany

OBJECTIVE

The elevated rate of schizophrenia among migrants has been explained in part by possible misdiagnosis. In this study an attempt is made to quantify the extent of potential misdiagnosis among migrants in comparison to non-migrants.

METHOD

One hundred patients of Turkish origin (Tr-Pat) and a control group of 50 patients of German origin (G-Pat), all with a paranoid-hallucinatory syndrome upon admission, were examined by an interviewer of Turkish origin (Tr-Int), an interviewer of German origin (G-Int) and the clinician. The diagnostic evaluation was then compared.

RESULTS

Nineteen per cent of Tr-Pat and 4% of G-Pat showed diagnostic disagreement between the three raters, while in 8% of Tr-Pat and 0% of G-Pat the two research diagnoses disagreed. In Tr-Pat with 'bad' German knowledge showed tendentially more (29%) diagnostic disagreement than Tr-Pat with 'good' German knowledge (17%).

CONCLUSION

The rate of potential misdiagnosis is higher among migrants, yet not strongly correlated to poor second language proficiency.

Impact of ethnicity on the prevalence of psychiatric disorders among migrants in Germany

OBJECTIVES

Studies on psychiatric disorders among migrants have described higher rates, especially of schizophrenia. Some evidence points to the possibility of misdiagnosis for this higher rate; other studies point to the underrepresentation of migrants in psychiatric services, leading to artefactual epidemiological data.

METHODS

All admission records of migrants to a psychiatric clinic from 1993 to 1995 were assessed for diagnosis, symptomatology and treatment.

RESULTS

Admissions of 408 migrants, 8.1% of total admission, were assessed. Of these, 38.7% received a diagnosis of a schizophrenic disorder, significantly more than the other clinic patients. The mean age at admission was 34.0 years, at onset of illness 28.6 years and at time of migration 20.4 years. Only 8.3% were mentally ill at the time of migration. Language problems correlated with the diagnosis of a schizophrenic disorder.

CONCLUSION

An underrepresentation of migrants shows differences in the use of psychiatric services. Some evidence from the mental status and reported language problems may explain the higher rate of schizophrenia due to misdiagnosis.

[Endosteal hyperostosis--differential diagnosis and possible therapeutic outlook]

A case report on a 42-year old man with an osteosclerotic bone disorder is presented. Physical examination and radiological findings are in favour of endosteal hyperostosis. Differential diagnoses are discussed.

Schizophrenia-specific basic symptoms. A successful replication

Several investigations showed that the Frankfurt Complaint Questionnaire (FCQ) has no diagnostic specificity. However, in a preceding study two new FCQ subscales were developed: FCQ-S, sensitive to schizophrenia, and FCQ-A, sensitive to alcoholism. The aim of the present study was to replicate the diagnostic sensitivity of those subscales. Four groups were considered: schizophrenics with marked negative symptoms (n = 25); schizophrenics with no or mild negative symptoms (n = 25); alcoholics (n = 25); patients with obsessive-compulsive disorder (n = 15). FCQ original subscales and total score did not differ between groups. As expected, in FCQ-S both schizophrenic groups had significantly higher scores than the other groups; FCQ-A failed to show group differences but was significantly related to alcoholism markers.

Reduced cognitive inhibition in schizotypy

OBJECTIVES

The relationship between negative priming and the positive symptoms of schizotypy was investigated. It was hypothesized that high schizotypes would display less negative priming than low schizotypes. A further important aim of the study was to disentangle the modalities involved in negative priming performance, since a reduction in negative priming, as revealed by schizophrenics and schizotypes, might reflect a failure to actively inhibit irrelevant information (cognitive inhibition) as well as dyslexia or a general slowness in information processing.

DESIGN

A paper test based on the German version of the Stroop test was used to measure negative priming. A baseline condition of the test, colour word reading, that has proven to be a valid indicator of dyslexia was used to measure the influence of reading disturbances on negative priming. Additionally, a priming condition, termed inverted priming, in which the target of a stimulus is identical with the distractor in the subsequent stimulus, was employed.

METHODS

Fifty healthy adults were drawn from the general population. After neuropsychological assessment participants completed a battery of schizotypal questionnaires. Correlational analyses and mean comparisons were used to investigate the relationship between neuropsychological data and schizotypy.

RESULTS

Results suggest that reduced negative priming is related to positive schizotypy. Reduced negative priming in high schizotypes was unrelated to dyslexia, and found unlikely to be affected by deficits in early processing. The inverted priming condition produced comparatively fewer errors in high schizotypes.

CONCLUSIONS

Results support the hypothesis that reduced cognitive inhibition may underlie positive schizotypal symptomatology.

[Consumption patterns and motivation for use of addictive drugs in schizophrenic patients]

In particular studies conducted in the U.S. display a tendency for schizophrenics to combine hallucinogens and amphetamines, whereas other studies report on a combination of psychotropic substances with a similar range of action. Influencing negative symptoms is reported to be the motivation for consumption. A total of 222 patients with a schizophrenic disorder (F2) and addiction (F1) were examined. The main substance was alcohol (F10.1 or F10.2; 52.2%), followed by cannabis (F12; 25%), opiates (F11; 4.1%), sedatives or hypnotics (F13; 2.7%) and cocaine (F16; 0.5%). A multiple drug use (F19) is reported by 14% of them. The most frequent combination was alcohol and cannabis, whereas hallucinogens and amphetamines were only rarely combined. Actual multiple consumption was reported by 55% of the patients, while lifetime multiple consumption applied to 72%. The motivation seems to be an unspecified sedation of unpleasant affective symptoms of schizophrenia. The most frequently seen combinations do not correlate with the reports published in the literature. The great variations in motivation seem to mainly reflect the importance of the availability of the substance.

[Dimensional structure of the German version of the Brief Psychiatric Rating Scale (BPRS)]

Since the early 1960s the Brief Psychiatric Rating Scale (BPRS) has been one of the most frequently used standardized methods in international psychiatric research. The BPRS is used mainly for the rating of psychopathological symptoms of schizophrenic subjects. According to the results of factorial analyses, the original version of the BPRS is divided into five subscales, which have been preserved in the German translation. The validity of this original scale structure for the German BPRS version has not been investigated, however. A principal-components analysis of the 18 BPRS items carried out on the data of 301 schizophrenics yielded four factors that are comparable with four of the original subscales: Thought disturbance, Hostility/suspiciousness, Anxiety/depression, and Anergia. These results are compared with earlier findings and similarities and differences are discussed.

[Validity of assessment of schizophrenic basic symptoms]

A study on the concept and measurement of the basic disorders of schizophrenia is presented. A total of 151 male adult psychiatric inpatients (51 with a dual diagnosis of schizophrenia and alcoholism, 50 schizophrenics and 50 alcoholics) were included. The aims of this study were: (1) the replication of the previous finding that the Frankfurt Complaint Questionnaire (FBF) contains items that discriminate between schizophrenia and alcoholism; (2) an empirical comparison between FBF and the Bonn Scale for the Assessment of Basic Symptoms (BSABS); (3) testing the relationship between basic and negative versus positive symptoms, as measured by the Positive and Negative Syndrome Scale (PANSS). Regarding (1), the former result was replicated. Regarding (2), FBF subscales and BSABS categories were shown to be significantly but weakly related, even if identical symptoms were included in the inquiry. Regarding (3), FBF and BSABS were found to be more closely related to negative than to positive PANSS items. Theoretical implications and consequences for further research are discussed.

Biofeedback-induced voluntary reduction of respiratory resistance in severe bronchial asthma

Attempts to reduce asthmatic symptoms with respiratory resistance (Ros) biofeedback yielded heterogeneous results. The nature of treatment effects remained unclear (e.g. unspecific relaxation, visceral learning); little is known about clinical long-term effects. The present study investigated the suitability of a statistical single-case approach for an adequate evaluation. A female asthmatic underwent 12 Ros biofeedback sessions. Several breathing parameters were recorded during all sessions and pre/post investigations. The clinical course was observed with symptom diaries for 100 days. The subject achieved considerable voluntary control over her Ros, this control was based upon the expiratory flow. In general, the effects on the clinical course were weak; however, asthmatic attacks decreased in the follow-up period. Careful analyses of physiological, psychophysiological, and course variables allowed the identification of the main processes underlying the biofeedback effects. Further studies should investigate the worth of the expiratory flow as feedback variable.

Interoception of respiratory resistance in asthmatic patients

The interoception of respiratory obstruction was investigated in three different experimental or quasi-experimental studies. In two experiments of the first study, the psychophysics of the perception of externally added flow resistive loads were examined by using a signal detection approach. Asthmatic patients displayed a decreased sensitivity in the discrimination of such loads. The second study assessed the individual consistency of dyspnea ratings at different levels of bronchoconstriction provoked by allergic agents. A great variation in subjects' ability to discriminate consistently between various levels of airway resistance was observed. This ability was found to be relevant for coping with asthma. In the third study the visceral perception hypothesis of J. Brener was examined. This theory states that biofeedback training of voluntary control of respiratory resistance is accompanied by an improvement in perception of airway obstruction. No specific effect on load perception resulted from this training. The results of these three studies are of specific relevance to symptom perception in asthmatic patients. Further experimental studies should be directed towards the interoception of real bronchoconstriction instead of the perception of added loads which only partially models the clinical situation.

Psychopathology in patients with schizophrenia and substance abuse: a comparative clinical study

In a 3-month epidemiologic survey at the Psychiatric Clinic of the University Hospital Hamburg-Eppendorf, a total of 372 patients between 18 and 60 years of age were screened with a variety of clinical psychiatric tests. Of the entire group, a subgroup of 180 patients was placed into one of four index groups: schizophrenics with first-rank symptoms and with (n=47) or without (n=52) concomitant past or acute use of psychotropic substances; alcoholics (n=63), and patients with alcoholic psychosis (n=18). In almost all areas examined, the group of schizophrenics with substance abuse was revealed to be a severely disturbed subgroup of schizophrenics with a long history of disease. Particularly with respect to psychopathology, there was an increase in depressive and suicidal tendencies.

[Basic symptoms in schizophrenia and alcoholism. A methodological comparative study]

The results of a study on the subjective basic symptoms associated with schizophrenia and drug abuse (especially alcoholism) are presented. A total of 242 psychiatric inpatients (74 with a dual diagnosis of schizophrenia and drug consumption, 81 schizophrenics, and 87 alcoholics) were included. The three groups did not differ with regard to the general score of subjective basic symptoms measured by the Frankfurt Complaint Questionnaire (Frankfurter Beschwerde-Fragebogen, FBF). Further analyses showed that the FBF statements are only partly typical for schizophrenia; another part is connected with alcoholism. Two new scales ("FBF-S" and "FBF-A") were created from the schizophrenia-typical items and the alcoholism-typical items, respectively. In "FBF-S" schizophrenics (with and without alcoholism) had higher scores than patients suffering from alcoholism alone; in "FBF-A" alcoholics (with and without schizophrenia) reached higher scores than schizophrenic patients. Consistent correlations with independent parameters of psychosis and alcoholism confirm the validity of "FBF-S" and "FBF-A". It is concluded that the FBF's capacity to discriminate different diagnoses can be improved and that the model of basic disturbances must be re-evaluated.