Motor learning and performance in schizophrenia and aging: two different patterns of decline

Psychomotor slowing has consistently been observed in schizophrenia, however research on motor learning in schizophrenia is limited. Additionally, motor learning in schizophrenia has never been compared with the waning of motor learning abilities in the elderly. Therefore, in an extensive study, 30 individuals with schizophrenia, 30 healthy age-matched controls and 30 elderly participants were compared on sensorimotor learning tasks including sequence learning and adaptation (both explicit and implicit), as well as tracking and aiming. This paper presents new findings on an explicit motor sequence learning task, an explicit verbal learning task and a simple aiming task and summarizes all previously published findings of this large investigation. Individuals with schizophrenia and elderly had slower Movement Time (MT)s compared with controls in all tasks, however both groups improved over time. Elderly participants learned slower on tracking and explicit sequence learning while individuals with schizophrenia adapted slower and to a lesser extent to movement perturbations in adaptation tasks and performed less well on cognitive tests including the verbal learning task. Results suggest that motor slowing is present in schizophrenia and the elderly, however both groups show significant but different motor skill learning. Cognitive deficits seem to interfere with motor learning and performance in schizophrenia while task complexity and decreased movement precision interferes with motor learning in the elderly, reflecting different underlying patterns of decline in these conditions. In addition, evidence for motor slowing together with impaired implicit adaptation supports the influence of cerebellum and the cerebello-thalamo-cortical-cerebellar (CTCC) circuits in schizophrenia, important for further understanding the pathophysiology of the disorder.

The effect of the cultural formulation interview on therapeutic working alliance: a study protocol

Background

The Cultural Formulation Interview (CFI) is designed to improve understanding of patients' mental health care needs. The lack of empirical evidence on the impact and effectiveness of CFI use in clarifying people's perspectives, experiences, context, and identity, and in preventing cultural misunderstandings between migrant patients and clinicians, inspired this study. The objective is to examine the effect of the CFI on the strength of therapeutic working alliances, and the potential mediating or moderating role of perceived empathy.

Materials and methods

A multicenter randomized controlled trial will be conducted, involving migrant patients, their confidants, and clinicians. The CFI will be administered in the intervention group, but not in the control group. Validated questionnaires will be used to assess therapeutic working alliances and perceived empathy. T-tests and linear regression analyses will be conducted to investigate between-group differences and possible mediating or moderating effects.

Results

This study will indicate whether or not the CFI strengthens the therapeutic working alliance between patients and clinicians, as moderated and/or mediated by perceived empathy.

Discussion

Research on the effect and impact of using the CFI in mental health care for migrant patients is important to clarify whether its use strengthens the therapeutic working alliance with clinicians. This can lead to a reduction in cultural misunderstandings and improve mental health care for migrant patients. The results may also be important for the implementation of the CFI as a standard of care.

Ethics and dissemination

This research protocol was tailored to the needs of patients in collaboration with experts by experience. It was approved by the Ethical Review Board of the Tilburg Law School and registered in the Clinical Trials Register under number NCT05788315. Positive results may stimulate further implementation of the CFI in clinical practice, and contribute to improving the impact of the CFI on the therapeutic working alliances.

[Does ECT raise the risk of a recurrent stroke?]

BACKGROUND

As the guidelines and evidence for the use of electroconvulsive therapy (ECT) in patients with a recent or past history of stroke are unclear, ECT tends to be avoided in this population.

AIM

To give a systematic review the literature on the risk and incidence of cerebrovascular accidents after ECT in these patients.

METHOD

A systematic literature search was performed according to the PRISMA guidelines in PubMed and in the Cochrane Library. Publications in which ECT was applied in patients with a history of stroke were included by using specific MeSH terms.

RESULTS

The following 19 articles met the criteria for review: 1 wide-scale prospective study, 1 small-scale prospective study with a control group, 3 small-scale retrospective studies, and 14 case reports. In the vast longitudinal Danish study, ECT was not associated with an elevated risk of recurrent stroke. Similarly, none of the other studies found the risk to be raised.

CONCLUSION

Despite the limited number of prospective studies and the methodological discrepancies in the reports, ECT does not seem to be associated with an elevated risk of recurrent stroke. This review supports the safe use of ECT in patients with a recent or past history of stroke, if prior neurologic and cardiovascular assessments are being performed, as well as monitoring during the treatment.

Impaired Sensorimotor Adaption in Schizophrenia in Comparison to Age-Matched and Elderly Controls

BACKGROUND

The "cognitive dysmetria hypothesis" of schizophrenia proposes a disrupted communication between the cerebellum and cerebral cortex, resulting in sensorimotor and cognitive symptoms. Sensorimotor adaptation relies strongly on the function of the cerebellum.

OBJECTIVES

This study investigated whether sensorimotor adaptation is reduced in schizophrenia compared with age-matched and elderly healthy controls.

METHODS

Twenty-nine stably treated patients with schizophrenia, 30 age-matched, and 30 elderly controls were tested in three motor adaptation tasks in which visual movement feedback was unexpectedly altered. In the "rotation adaptation task" the perturbation consisted of a rotation (30° clockwise), in the "gain adaptation task" the extent of the movement feedback was reduced (by a factor of 0.7) and in the "vertical reversal task," up- and downward pen movements were reversed by 180°.

RESULTS

Patients with schizophrenia adapted to the perturbations, but their movement times and errors were substantially larger than controls. Unexpectedly, the magnitude of adaptation was significantly smaller in schizophrenia than elderly participants. The impairment already occurred during the first adaptation trials, pointing to a decline in explicit strategy use. Additionally, post-adaptation aftereffects provided strong evidence for impaired implicit adaptation learning. Both negative and positive schizophrenia symptom severities were correlated with indices of the amount of adaptation and its aftereffects.

CONCLUSIONS

Both explicit and implicit components of sensorimotor adaptation learning were reduced in patients with schizophrenia, adding to the evidence for a role of the cerebellum in the pathophysiology of schizophrenia. Elderly individuals outperformed schizophrenia patients in the adaptation learning tasks.

[Barriers in mental health care for asylum seekers]

Background  Despite high prevalence of psychopathology, the use of mental health services by asylum seekers seems low. Barriers to care may play an important role in this. Aim  To explore the barriers in mental health care for adult and adolescent asylum seekers and their care providers in high-income countries. Method  A narrative literature review, based on a systematic evaluation of the current scientific literature. Results  In a narrative synthesis of the results, we identified the following six categories of barriers: lack of knowledge of the healthcare system, language barriers, discrepant beliefs and expectations of mental healthcare, lack of trust towards authority, and structural difficulties. Conclusion  Six thematic barriers were retained. Different interventions are possible to address these barriers. Further research into needs and interventions is recommended, with specific attention to the Belgian and Dutch context.

[Between response and resistance: pseudo-resistance during treatment of major depressive disorder]

BACKGROUND

Although the efficacy of antidepressants has been clearly established, 30-60% of patients with major depressive disorder (MDD) appear to have a poor response. However, many patients labeled with treatment-resistant depression actually have pseudo-resistance due to suboptimal approach.

AIM

To provide an overview of the causes of pseudo-resistance, as well as the interventions to counteract it in patients with MDD.

METHOD

A literature search was conducted using the PubMed, Embase, and Web of Science databases.

RESULTS

The causes of pseudo-resistance can be multiple and can be attributed to both the clinician (inappropriate prescribing behavior, misdiagnosis or incomplete diagnosis) and the patient (ultra-fast metabolism, poor medication adherence, comorbidity). Advice and interventions to prevent pseudo-resistance must therefore be targeted to the clinician (knowledge of clinical guidelines, simplified dosage schedules, correct diagnosis, interventions to improve poor medication adherence), as well as the patient (personalized psychoeducation, social support, care management).

CONCLUSION

Pseudo-resistance is a multifactorial phenomenon that requires complex intervention strategies. In addition to adequate treatment provided by the clinician, personalized psychoeducation, good patient support and intensive follow-up of, as well as open communication with the patient are also required.

The associations between childhood trauma and work functioning in adult workers with and without depressive and anxiety disorders

BACKGROUND

To examine the association between childhood trauma and work functioning, and to elucidate to what extent this association can be accounted for by depression and/or anxiety.

METHODS

Data of 1,649 working participants were derived from the Netherlands Study of Depression and Anxiety (NESDA, n = 2,981). Childhood trauma (emotional neglect, psychological, physical, and sexual abuse before age 16) was assessed with a structured interview and work functioning, in terms of absenteeism and presenteeism, with the Health and Labor Questionnaire Short Form (SF-HLQ) and the World Health Organization Disability Assessment Schedule II (WHODAS-II), respectively. Depressive and/or anxiety disorders were assessed with the Composite Interview Diagnostic Instrument (CIDI). Mediation analyses were conducted.

RESULTS

At baseline, 44.8% reported to have experienced childhood trauma. Workers with the highest childhood trauma level showed significantly (p < 0.001) more absenteeism as well as more presenteeism. Mediation analyses revealed that indirect effects between the childhood trauma index and both work indices were significantly mediated by current depressive disorder (p = 0.023 and p < 0.001, respectively) and current comorbid depression-anxiety (p = 0.020 and p < 0.001, respectively), with the latter accounting for the largest effects (PM = 0.23 and PM = 0.29, respectively). No significant mediating role in this relationship was found for current anxiety disorder and remitted depressive and/or anxiety disorder.

CONCLUSIONS

Persons with childhood trauma have significantly reduced work functioning in terms of absenteeism and presenteeism. This seems to be largely accounted for by current depressive disorders and current comorbid depression-anxiety.

The use of atypical antipsychotics in the treatment of catatonia

Purpose

Evidence indicates that classical antipsychotics may aggravate non-malignant and malignant catatonia (MC). Atypical antipsychotics are less likely to cause movement disorders than classical antipsychotics and they are being frequently prescribed in disorders that can be associated with catatonia. Therefore, the important question that arises is whether atypical antipsychotics have a role to play in the treatment of catatonia.

Materials and methods

A Medline search was performed to locate papers on the use of atypical antipsychotics in catatonia published between 1970 and 31st December 2004.

Results

The literature on the use of atypical antipsychotics in catatonia consists of case reports and retrospective studies. In most cases of non-MC a reduction of the catatonic symptoms is reported upon treatment with atypical antipsychotics. Cases of MC relate mainly to the neuroleptic malignant syndrome (NMS), which is considered as an iatrogenic stuporous variant of MC caused by antipsychotics.

Conclusion

There are indications that atypical antipsychotics may be useful in non-MC. As a consequence, one should not only focus on the possible extrapyramidal and autonomic side effects of these drugs, but also on the possible beneficial effects on certain brain functions and on the catatonic symptomatology. However, randomized controlled trials are needed to evaluate the effect of these drugs, and caution is advisable, since cases of NMS have been linked to treatment with atypical antipsychotics. There is no evidence to prescribe atypical antipsychotics in MC.

[Effectiveness of anti-stigma interventions regarding severe mental illness: a systematic literature review]

Stigma is one of the greatest challenges facing people with severe mental illness (smi) and can have profound psychological, social and professional consequences.<br/> AIM: To systematically review the evidence of effectiveness of anti-stigma interventions (anti-stigma campaigns and specific interventions to reduce public stigma and self-stigma) for people with smi and to make recommendations for clinical practice.<br/> METHOD: A systematic literature search for individual studies and reviews concerning the efficacy of interventions that reduce stigma for people with smi.<br/> RESULTS: Anti-stigma interventions have small-to-medium effects. Although head-to-head comparisons do not show a clear advantage for educational or contact interventions, results suggest that the elements of contact, recovery and continuity (for public stigma) and psycho-education (for self-stigma) may yield the greatest effects. Due to the short follow-up period of most studies, there is limited evidence on the long-term effectiveness of these interventions. More specifically, it remains unknown whether these interventions lead to changes in actual behavior.<br/> CONCLUSION: Anti-stigma interventions have limited effects on knowledge, attitudes and behavior. Several methodological shortcomings, as well as short follow-up periods in most studies, preclude making firm conclusions.

The Relationship Between Childhood Trauma and the Response to Group Cognitive-Behavioural Therapy for Chronic Fatigue Syndrome

OBJECTIVE

To examine the relationship between childhood trauma and the response to group cognitive-behavioural therapy (GCBT) for chronic fatigue syndrome (CFS).

METHODS

A single cohort study conducted in an outpatient university referral center for CFS including a well-documented sample of adult patients meeting the CDC criteria for CFS and having received 9 to 12 months of GCBT. A mixed effect model was adopted to examine the impact of childhood trauma on the treatment response in general and over time. The main outcome measures were changes in fatigue, as assessed with the Checklist Individual Strength (total score), and physical functioning, as gauged with the Short Form 36 Health Survey subscale, with the scales being completed at baseline, immediately after treatment completion and after 1 year.

RESULTS

We included 105 patients with CFS. Childhood trauma was not significantly associated with the response to GCBT over time on level of fatigue or physical functioning.

CONCLUSION

Childhood trauma does not seem to have an effect on the treatment response to dedicated GCBT for CFS sufferers over time. Therefore, in the allocation of patients to this kind of treatment, a history of childhood trauma should not be seen as prohibitive.

[Il faut imaginer Sisyphe heureux. The special position of the existential dimension in humanistic psychiatry]

The models used in theoretical and practical psychiatry mostly encompass, with varying accents, the biological, psychological and social dimension. However, humanistic psychiatry concerns the existence as a whole. What about the care for the existential dimension?<br/> AIM: To explore and to describe the existential dimension in psychiatry as containing the biopsychosocial aspects and continuously in interaction with them.<br/> METHOD: Personal reflection of three senior authors, also in exchange with authors who have accompanied us during our professional life.<br/> RESULTS: The existential dimension should be included as a special, encompassing dimension in the models used in psychiatry. In humanistic psychiatry every intervention, whether biomedical or psychosocial, should be situated in an existential perspective. Care for the existential dimension surpasses the dichotomy biomedical-psychosocial.<br/> CONCLUSION: Not respecting the existential dimension induces shortcomings towards patients and harms a truly humanistic psychiatry.

Performance of the Psychotic Depression Assessment Scale as a Predictor of ECT Outcome

OBJECTIVES

The presence of psychotic symptoms is an important predictor of responsiveness to electroconvulsive therapy (ECT). This study investigates whether a continuous severity measure, the Psychotic Depression Assessment Scale (PDAS), is a more accurate predictor.

METHODS

Depression severity was assessed before and after the ECT course using the Montgomery-Asberg Depression Rating Scale (MADRS) in 31 patients with psychotic depression and 34 depressed patients without psychotic symptoms. Logistic regression models for MADRS response and remission were fitted, with either the PDAS total score or the dichotomous predictors "absence/presence of psychotic symptoms" as the independent variables. Age, episode duration, and treatment resistance were added as covariates.

RESULTS

Both the asserted presence of psychotic symptoms and a higher PDAS total score reflected MADRS response (areas under the curve, 0.83 and 0.85, respectively), with MADRS remission also being predicted by the presence of psychotic symptoms and higher PDAS scores (areas under the curves, 0.86 and 0.84, respectively). Age was a contributor to these prediction models, with response and remission rates being highest in the older patients. Psychotic Depression Assessment Scale scores decreased significantly during ECT: at end point, 81.5% of the patients showed significant response and 63.9% had achieved remission.

CONCLUSIONS

The PDAS indeed accurately predicts response to and remission after ECT in (psychotic) depression and most pronouncedly so in older patients but seems to have no clear advantage over simply verifying the presence of psychotic symptoms. This could be the consequence of a ceiling effect, as ECT was extremely effective in patients with psychotic depression.ClinicalTrials.gov: Identifier: NCT02562846.

Metacognitive functioning in bipolar disorder versus controls and its correlations with neurocognitive functioning in a cross-sectional design

INTRODUCTION

Metacognition is an important factor in the development and persistence of bipolar disorder. One of the most striking examples of impairment in metacognitive functioning in bipolar disorder is the lack of insight these patients have in their disorder. Despite its importance, research regarding metacognition in bipolar disorder is scarce. Furthermore, the neurocognitive basis of metacognitive functioning is unknown.

METHODS

The current study included 29 patients with bipolar disorder and 29 age, educational level and gender matched healthy controls. All the participants filled in a metacognition questionnaire that examined their metacognitive beliefs. In addition, it was tested how well they estimated their performance on a neurocognitive test-battery beforehand (metacognitive knowledge) and afterwards (metacognitive experience).

RESULTS

Bipolar disorder patients showed maladaptive metacognitive beliefs in comparison with the healthy controls. They also showed impaired metacognitive knowledge and experience. That is, they overestimated their own cognitive performance. However, the latter result was also true for the healthy controls. In addition, metacognition had neurocognitive correlates. However, for the bipolar patients, depressive symptomatology had an important effect on this relationship and on metacognition in general.

CONCLUSION

Maladaptive metacognitive skills are related to depression in bipolar disorder. A more healthy metacognitive thinking should be promoted. An effective training for this could be a therapy that includes various elements, from basic cognitive- to higher order metacognitive training.

[Psychosis due to idiopathic basal ganglia calcification]

Idiopathic basal ganglia calcification is a rare neuropathological syndrome characterised by symmetrical and bilateral calcifications found primarily in the basal ganglia. Psychosis is describedas an acute presentation of idiopathic ganglia calcification. We describe the development of psychosis in a 48-year-old man, initially hospitalised on the neurology ward due to syncope. A ct scan of the brain showed bilateral, symmetrical calcification of the basal ganglia and nucleus dentatus. Laboratory research excluded other pathological disorders. The patient was referred to a psychiatric ward, where the administration of risperidone led to alleviation of his mental state. This case report underlines the importance of an accurate, comprehensive differential diagnosis and the associated significance of neuroimaging.

The longitudinal course of cognitive insight and mood in bipolar disorder

Cognitive insight or the ability to be self-reflective and to retain from being over-confident in own beliefs is an upcoming topic in research regarding psychiatric disorders. In bipolar disorder investigations are scarce and an important lacuna is the unexamined longitudinal relationship between cognitive insight and mood. Therefore, in this study the level of cognitive insight, mania and depression were assessed in a total of 56 patients with bipolar disorder at baseline, four months and eight months follow-up. In addition, the cognitive insight of 35 healthy controls was assessed at baseline and at four months follow-up. The current research shows that self-reflectiveness and self-certainty remained stable over time in bipolar disorder. The improvement of mood did not affect the course of cognitive insight. However, at baseline higher levels of depression were correlated with more self-reflectiveness. In addition, self-reflectiveness was higher for bipolar disorder patients in comparison with the healthy controls. Our results could imply that higher levels of self-reflectiveness are a specific characteristic in bipolar disorder that is independent from an improvement in mood.

Distinguishing Subgroups Based on Psychomotor Functioning among Patients with Major Depressive Disorder

BACKGROUND

Retardation and agitation are symptoms of major depressive disorder (MDD), and their presence could play a role in determining clinically meaningful depressive subtypes such as nonmelancholic depression (NMD) and melancholic depression (MD). In this project, we explored whether three depression subgroups (NMD, MD with psychotic symptoms, and MD without psychotic symptoms) could be distinguished based on objective measures of psychomotor functioning.

METHODS

Sixty-nine patients with MDD underwent extensive clinical and psychomotor testing prior to treatment with electroconvulsive therapy. Psychomotor functioning was assessed subjectively using the Core Assessment of Psychomotor Change (CORE) and objectively by means of both 24-h actigraphy and performance on a fine motor drawing task.

RESULTS

The daytime activity levels measured by actigraphy were significantly lower (F = 7.1, p = 0.0004) in MD patients both with and without psychotic symptoms than in those with NMD. No objective psychomotor variable was able to distinguish between melancholic patients with and those without psychotic symptoms.

CONCLUSIONS

The depression subtypes NMD, MD with psychotic symptoms, and MD without psychotic symptoms are not marked by increasing psychomotor retardation, possibly because psychomotor disturbance in MD with psychotic symptoms often consists of agitation rather than retardation, or a mixture of the two. However, psychomotor functioning as measured by actigraphy can be used to distinguish between NMD patients and MD patients.

Differential Effects of Inflammatory and Psychosocial Stress on Mood, Hypothalamic-Pituitary-Adrenal Axis, and Inflammation in Remitted Depression

BACKGROUND/AIMS

Major depressive disorder (MDD) is highly recurrent. This may be due to increased stress sensitivity after remission. Both inflammatory and psychosocial stressors are implicated in the pathogenesis of MDD, but the additive or differential effect is unclear.

METHODS

We conducted a single-blind placebo-controlled study to investigate the effects of inflammatory stress (i.e., typhoid vaccination), psychosocial stress (i.e., Trier Social Stress Test [TSST]), or a combination of both in women (25-45 years old) with (partially) remitted recurrent MDD (n = 21) and healthy female controls (n = 18). We evaluated the effect on mood measured by the Profile of Mood States, markers of the hypothalamic-pituitary-adrenal (HPA) axis activity, and inflammatory system activation. The study was performed during 2 testing days, separated by a washout of 7-14 days. In a crossover design, subjects received one of the interventions on one day and placebo on the other.

RESULTS

A lowering of mood was seen in patients (β [95% CI] = -4.79 [-6.82 to -2.75], p < 0.001) only after vaccination, but not after the TSST or the combination; this effect was not observed in controls. Controls experienced a significantly different response on adrenocorticotropic hormone (ACTH) after vaccination, with a general rise in ACTH not observed in patients. In both groups, the TSST activated the HPA axis and suppressed the inflammatory parameters.

CONCLUSIONS

There is a differential effect of inflammatory and psychosocial stress on mood and HPA axis activation in patients with remitted recurrent MDD. This may be an interesting treatment target in MDD.

Structural and Functional Brain Abnormalities Associated With Exposure to Different Childhood Trauma Subtypes: A Systematic Review of Neuroimaging Findings

Background: Childhood trauma subtypes sexual abuse, physical abuse, emotional maltreatment, and neglect may have differential effects on the brain that persist into adulthood. A systematic review of neuroimaging findings supporting these differential effects is as yet lacking. Objectives: The present systematic review aims to summarize the findings of controlled neuroimaging trials regarding long-term differential effects of trauma subtypes on the human brain. Methods: A systematic literature search was performed using the PubMed and PsycINFO databases from January 2017 up to and including January 2018. Additional papers were identified by a manual search in the reference lists of selected papers and of relevant review articles retrieved by the initial database search. Studies were then assessed for eligibility by the first author. Only original human studies directly comparing neuroimaging findings of exposed and unexposed individuals to well-defined emotional, physical or sexual childhood maltreatment while controlling for the effects of other subtypes were included. A visual summary of extracted data was made for neuroimaging modalities for which comparison between trauma subtypes was feasible, taking the studies' numbers and sample sizes into account. Results: The systematic literature search yielded 25 publications. Sexual abuse was associated with structural deficits in the reward circuit and genitosensory cortex and amygdalar hyperreactivity during sad autobiographic memory recall. Emotional maltreatment correlated with abnormalities in fronto-limbic socioemotional networks. In neglected individuals, white matter integrity and connectivity were disturbed in several brain networks involved in a variety of functions. Other abnormalities, such as reduced frontal cortical volume, were common to all maltreatment types. Conclusions: There is some evidence for long-term differential effects of trauma subtypes on the human brain. The observed alterations may result from both protective adaptation of and damage to the brain following exposure to threatening life events. Though promising, the current evidence is incomplete, with few brain regions and neuroimaging modalities having been investigated in all subtypes. The comparability of the available evidence is further limited by the heterogeneity of study populations regarding gender, age and comorbid psychopathology. Future neuroimaging studies should take this potentially differential role of childhood trauma subtypes into account.

Differential effects of childhood trauma subtypes on fatigue and physical functioning in chronic fatigue syndrome

OBJECTIVE

There is wide consensus that childhood trauma plays an important role in the aetiology of chronic fatigue syndrome (CFS). The current study examines the differential effects of childhood trauma subtypes on fatigue and physical functioning in individuals suffering from CFS.

METHODS

Participants were 155 well-documented adult, predominantly female CFS patients receiving treatment at the outpatient treatment centre for CFS of the Antwerp University Hospital in Belgium. Stepwise regression analyses were conducted with outcomes of the total score of the Checklist Individual Strength (CIS) measuring fatigue and the scores on the physical functioning subscale of the Medical Outcomes Short Form 36 Health Status Survey (SF-36) as the dependent variables, and the scores on the five subscales of the Traumatic Experiences Checklist (TEC) as the independent variables.

RESULTS

The patients' fatigue (β=1.38; p=0.025) and physical functioning scores (β=-1.79; p=0.034) were significantly predicted by childhood sexual harassment. There were no significant effects of emotional neglect, emotional abuse, bodily threat, or sexual abuse during childhood.

CONCLUSION

Of the childhood trauma subtypes investigated, sexual harassment emerged as the most important predictor of fatigue and poor physical functioning in the CFS patients assessed. These findings have to be taken into account in further clinical research and in the assessment and treatment of individuals coping with chronic fatigue syndrome.

How self-reflection and self-certainty are related to neurocognitive functioning: an examination of cognitive insight in bipolar disorder

INTRODUCTION

The pattern of associations between clinical insight, cognitive insight, and neurocognitive functioning was assessed in bipolar disorder patients.

METHODS

Data from 42 bipolar disorder patients were examined. Cognitive insight was measured using the Beck Cognitive Insight Scale (BCIS). The BCIS is a 15-item self-report instrument consisting of two subscales, self-reflectiveness and self-certainty. Clinical insight was measured by the use of the item G12 of the Positive and Negative Syndrome Scale. Neurocognitive functioning was assessed using the International Society for Bipolar Disorders-Battery for Assessment of Neurocognition.

RESULTS

Correlation analyses revealed significant positive associations between self-reflectiveness and speed of processing, attention, working memory, visual learning, and reasoning and problem solving. The subscale self-certainty was negatively correlated to working memory, however, this correlation disappeared when we controlled for confounding variables. No correlations between clinical insight and neurocognition were found. In addition, there was no association between cognitive insight and clinical insight.

CONCLUSION

Better neurocognitive functioning was more related to higher levels of self-reflectiveness than to diminished self-certainty.

Impact of childhood trauma on postpartum depression: a prospective study

Studies on the impact of childhood trauma on postpartum depression show inconsistencies and methodological limitations. The present study examines the effect of childhood trauma on depression 12 and 24 weeks after childbirth, while controlling for history of depression, depression symptoms during pregnancy and type D personality. During the third trimester of pregnancy, 210 women completed self-report questionnaires assessing depression (current and/or past episodes), childhood trauma and type D personality, of whom 187 participated in the postpartum follow-up, with depression symptoms being reassessed at 12 and 24 weeks after delivery with three depression outcome measures. Eventually, 183 participants were retained for analysis. Results indicated no predictive value of childhood trauma on postpartum depression in the univariate analyses, nor after controlling for previous depression, depression symptoms during pregnancy and type D personality. However, past depression and depression symptoms during pregnancy did independently and convincingly predict postpartum depression, especially at 12 weeks and to a lesser extent at 24 weeks following childbirth. Overall, we found no significant association between childhood trauma and postpartum depression. Past depression and depression symptoms during pregnancy are more relevant factors to assess before childbirth.

[Instrumental registration of psychomotor symptoms in schizophrenia: has the time come to use the technique in clinical practice?]

BACKGROUND

In clinical practice, psychomotor deficits are currently assessed by means of observation scales. However, instrumental (including mechanical and electronic) measurement techniques might also be valuable in clinical practice.

AIM

To discuss the added value of using instrumental registration of psychomotor functioning into clinical practice.

METHOD

We investigated the main pros and cons of instrumental registration by searching the literature systematically and we discuss our findings using concrete examples.

RESULTS

Compared to observation scales, instrumental registration yields more reliable and sensitive information about the psychomotor functioning of patients. Another advantage of instrumental registration is that it gives us an opportunity to study affected sub-processes and underlying mechanisms. However, the validity of these measurements depends on whether instrumental registration can adequately reflect aspects of a movement that can be observed clinically.

CONCLUSION

Clinical practice could benefit substantially from using instrumental registration of psychomotor disturbances in schizophrenia. However, more time and money needs to be invested in research before the new technique is fully validated and ready for use in clinical practice.

[Measuring alexithymia in fibromyalgia: the need for a multimodal measurement method to replace the TAS-20]

BACKGROUND

In an earlier publication that investigated alexithymia in fibromyalgia, we showed the Toronto Alexithymia Scale was the only instrument being used to measure alexithymia.

AIM

To find out which instruments are currently available for measuring alexithymia, to compare the psychometric properties of these instruments and to decide whether some of the test methods involved should be used to give extra value to alexithymia research.

METHOD

We conducted a systematic review of the literature in Medline/PubMed with a number of search terms. We selected articles relating to psychometric properties of the tests performed and decided whether they could be influenced by negative affect.

RESULTS

We found that 14 different instruments were used to measure alexithymia. From our evaluation we excluded tests which had weak psychometric properties or had been inadequately assessed. There remained three observation scales and two self-report questionnaires, which had been adequately validated and whose relative strengths and weaknesses were compared.

CONCLUSION

In view of these findings, we recommend that in studies of alexithymia in fibromyalgia a multimodal measurement method should be used rather than only the tas-20.

Stable schizophrenia patients learn equally well as age-matched controls and better than elderly controls in two sensorimotor rotary pursuit tasks

OBJECTIVE

To compare sensorimotor performance and learning in stable schizophrenia patients, healthy age- and sex-matched controls and elderly controls on two variations of the rotary pursuit: circle pursuit (true motor learning) and figure pursuit (motor and sequence learning).

METHOD

In the circle pursuit, a target circle, rotating with increasing speed along a predictable circular path on the computer screen, must be followed by a cursor controlled by a pen on a writing tablet. In the eight-trial figure pursuit, subjects learn to draw a complex figure by pursuing the target circle that moves along an invisible trajectory between and around several goals. Tasks were administered thrice (day 1, day 2, day 7) to 30 patients with stable schizophrenia (S), 30 healthy age- and sex-matched controls (C), and 30 elderly participants (>65 years; E) and recorded with a digitizing tablet and pressure-sensitive pen. The outcome measure accuracy (% of time that cursor is within the target) was used to assess performance.

RESULTS

We observed significant group differences in accuracy, both in circle and figure pursuit tasks (E < S < C, p < 0.01). Strong learning effects were found in each group. Learning curves were similar in circle pursuit but differed between groups in figure pursuit. When corrected for group differences in starting level, the learning gains over the three sessions of schizophrenia patients and age-matched controls were equal and both were larger than those of the elderly controls.

CONCLUSION

Despite the reduced sensorimotor performance that was found in the schizophrenia patients, their sensorimotor learning seems to be preserved. The relevance of this finding for the evaluation of procedural learning in schizophrenia is discussed. The better performance and learning rate of the patients compared to the elderly controls was unexpected and deserves further study.

[Psychometric properties of the Hospital Ethical Climate Survey: a cross-sectional study among Belgian psychiatric nurses]

BACKGROUND

The task of caring for psychiatric patients is so complex that it often leads to ethical dilemmas. The ethical climate on a ward is a crucial factor. This is the first study about the ethical climate in mental healthcare.

AIM

To investigate whether the only instrument currently available for measuring the ethical climate in general hospitals, namely the 'Hospital Ethical Climate Survey' (HECS), is a reliable and valid instrument for use on psychiatric wards.

METHOD

A cross-sectional study was performed in a psychiatric hospital in Belgium. All 320 nurses were invited to participate (response rate = 265). The factor structure of the HECS was examined by means of explorative principal component analysis (PCA) and confirmatory factor analysis (CFA). The reliability of the constructed scale and subscales was investigated.

RESULTS

Five factors were identified. The structure of these factors in the translated list was almost identical to the structure obtained with the original instrument and its underlying theoretical basis. Items relating to several other allied healthcare professions were added. This addition widened the subscale 'relationship with physician' so that it included 'relationship with other disciplines' (medical and allied healthcare workers).

CONCLUSION

The reliability of the instrument appeared to be good and yielded scores comparable to those obtained as a result of earlier research performed in general hospitals. The setting for our investigation produced a significantly higher main score for the ethical climate than did previous studies.

Preserved Learning during the Symbol-Digit Substitution Test in Patients with Schizophrenia, Age-Matched Controls, and Elderly

OBJECTIVE

Speed of processing, one of the main cognitive deficits in schizophrenia is most frequently measured with a digit-symbol-coding test. Performance on this test is additionally affected by writing speed and the rate at which symbol-digit relationships are learned, two factors that may be impaired in schizophrenia. This study aims to investigate the effects of sensorimotor speed, short-term learning, and long-term learning on task performance in schizophrenia. In addition, the study aims to explore differences in learning effects between patients with schizophrenia and elderly individuals.

METHODS

Patients with schizophrenia (N = 30) were compared with age-matched healthy controls (N = 30) and healthy elderly volunteers (N = 30) during the Symbol-Digit Substitution Test (SDST). The task was administered on a digitizing tablet, allowing precise measurements of the time taken to write each digit (writing time) and the time to decode symbols into their corresponding digits (matching time). The SDST was administered on three separate days (day 1, day 2, day 7). Symbol-digit repetitions during the task represented short-term learning and repeating the task on different days represented long-term learning.

RESULTS

The repetition of the same symbol-digit combinations within one test and the repetition of the test over days resulted in significant decreases in matching time. Interestingly, these short-term and long-term learning effects were about equal among the three groups. Individual participants showed a large variation in the rate of short-term learning. In general, patients with schizophrenia had the longest matching time whereas the elderly had the longest writing time. Writing time remained the same over repeated testing.

CONCLUSION

The rate of learning and sensorimotor speed was found to have a substantial influence on the SDST score. However, a large individual variation in learning rate should be taken into account in the interpretation of task scores for processing speed. Equal learning rates among the three groups suggest that unintentional learning in schizophrenia and in the elderly is preserved. These findings are important for the design of rehabilitation programs for schizophrenia.

[Alexithymia in fibromyalgia: prevalence]

BACKGROUND

In fibromyalgia, problems of affect regulation are considered important. Alexithymia, too, is related to disturbed affect regulation. Recognising alexithymia is important with regard to the doctor-patient relationship, the pitfalls in this relationship and the therapeutic strategy.

AIM

To look into the prevalence of alexithymia in fibromyalgia and find out which measures were used.

METHOD

We reviewed the literature systematically using Medline, PubMed and Cochrane and key words.

RESULTS

We found 11 relevant studies which revealed a significantly high prevalence of alexithymia in fibromyalgia patients, namely between 15 and 52%, whereas the prevalence in the general population was only 6 to 8%. All of these studies used the Toronto Alexithymia Scale (20-item or 26-item version) as the only test for alexithymia. Male fibromyalgia patients were not examined adequately, nor were patients in a residential setting. Three studies used patients with a painful chronic condition as a control group, but we did not find any studies that involved psychiatric control groups.

CONCLUSION

In view of the high prevalence of alexithymia and the implications of this for therapy, we recommend that patients with fibromyalgia should be screened systematically for alexithymia. Further research involving male patients and residential fibromyalgia patients is required and future studies will have to include psychiatric control groups.

Effect of modafinil on cognitive functions in alcohol dependent patients: a randomized, placebo-controlled trial

Cognitive deficits are highly prevalent in alcohol-dependent (AD) patients and may have a detrimental impact on treatment response and treatment outcome. Enhancing cognitive functions may improve treatment success. Modafinil is a promising compound in this respect. Therefore, a randomized double-blind placebo-controlled trial was conducted with modafinil (300 mg/d) or placebo in 83 AD patients for 10 weeks. Various cognitive functions (digit span task, Tower of London task, Stroop task) were measured at baseline, during and after treatment. Compared to placebo, modafinil improved verbal short-term memory (number of forward digit spans) (p=0.030), but modafinil exerted a negative effect on the working memory score of the digit span task (p=0.003). However, subgroup analyses revealed that modafinil did improve both working memory and verbal short-term memory in AD patients with a poor working memory ability at baseline (25% worst performers), whereas no significant treatment effect of modafinil was found on these two dependent variables in patients with good working memory skills at baseline (25% best performers). No effect of modafinil was found on measures of planning (Tower of London task) and selective attention (Stroop task). Further research is needed to better understand the relationship between cognitive remediation and treatment outcome in order to design targeted treatments.

Effect of modafinil on impulsivity and relapse in alcohol dependent patients: a randomized, placebo-controlled trial

Poor impulse control plays an important role in the development, course and relapse of substance use disorders. Therefore, improving impulse control may represent a promising approach in the treatment of alcohol dependence. This study aimed to test the effect of modafinil on impulse control and alcohol use in alcohol dependent patients (ADP) in a randomized, double-blind, placebo-controlled trial. Eighty-three abstinent ADP were randomized to 10 weeks modafinil (300 mg/d) or placebo. Alcohol use was quantified using the timeline follow-back method and was assessed until 6 months after treatment discontinuation. Impulsivity was assessed using self-report questionnaires (Barratt Impulsiveness Scale; State Impulsivity questionnaire) and neurocognitive tasks (Stop Signal Task; Delay Discounting Task) administered before, during and after treatment. Modafinil significantly improved self-report measures of state impulsivity, but had no effect on percentage of abstinent days or percentage of heavy drinking days, nor on the behavioral measures of impulsivity. However, subgroup analysis revealed that modafinil prolonged the time to relapse (p=.022) and tended to increase the percentage of abstinent days (p=.066) in ADP with poor response inhibition at baseline, whereas modafinil increased the percentage of heavy drinking days (p=.003) and reduced the percentage of abstinent days (p=.002) in patients with better baseline response inhibition. Overall results do not favor the use of modafinil in order to reduce relapse or relapse severity in ADP, and caution is required in prescribing modafinil to a non-selected sample of ADP. Further research on the effect of modafinil in ADP with poor baseline response inhibition is warranted.

Bupropion for the treatment of seasonal affective disorder

INTRODUCTION

Seasonal affective disorder (SAD) is a psychiatric illness with recurring depressive episodes during particular seasons, mostly winter. Bupropion is effective in the preventive treatment of SAD and is probably also effective in the acute treatment of SAD.

AREAS COVERED

This review covers the pharmacokinetics and pharmacodynamics of bupropion. The authors also evaluate bupropion's clinical efficacy as well as its safety and tolerability.

EXPERT OPINION

Bupropion is available in an immediate release formulation, as well as a sustained release formulation and an extended release (XR) formulation. The XR formulation is recommended for SAD due to its ease of use and is the only formulation currently used as a therapy. Due to the predictable nature of SAD, the use of bupropion XR is considered a relevant treatment option. Bupropion's efficacy is shown in three trials that started in autumn at a time when SAD symptoms were not yet present although treatment effects were relatively small compared with a placebo. Bupropion was also shown to have efficacy in an open-label study. That being said, in order to reach definitive conclusions about its efficacy with acute treatment of SAD, more placebo-controlled trials are needed.

The impact of high-frequency repetitive transcranial magnetic stimulation on fine motor functions in medication-resistant major depression

OBJECTIVES

Although high-frequency repetitive transcranial magnetic stimulation (HF-rTMS) over the left dorsolateral prefrontal cortex (DLPFC) has been reported to improve mood symptoms in major depressive disorder (MDD), research on its impact on psychomotor symptoms is scarce. This study assessed the psychomotor effects of 1 and 10 sessions, respectively, of HF-rTMS over the left DLPFC.

METHODS

Ten HF-rTMS sessions were applied in 21 medication-free MDD patients over a 2-week period. At the beginning, one placebo (sham)-controlled rTMS session was also applied in a cross-over, single-blind design. Psychomotor variables were digitally recorded during completion of a Fitts' task, at baseline, after the first and second real/sham session and at the end point.

RESULTS

The total 10-session treatment period resulted in a decrease of depression severity. One HF-rTMS session resulted in improvements on the Fitts' task, without a difference between active and sham stimulation, however. No further improvements occurred from session 2 to session 10.

CONCLUSIONS

No evidence was provided to link the observed psychomotor improvements to HF-rTMS stimulation, as a practice effect could have impacted the significant psychomotor outcomes.

The relationship between impulsivity and craving in alcohol dependent patients

RATIONALE

Impulsivity and craving are both associated with higher relapse rates and a worse prognosis in patients with a substance use disorder, but the relationship between these two phenomena has been largely ignored in the field of alcohol use disorders.

OBJECTIVES

The primary aim of this study was to investigate the relationship between different dimensions of impulsivity and different forms of self-reported craving. Additionally, the influence of the severity of alcohol dependence on impulsivity, craving, and on their relationship was exploed.

METHODS

Impulsivity and craving levels were investigated in 87 abstinent alcohol-dependent (AD) patients using a broad range of self-report questionnaires and behavioral impulsivity measures. Alcohol use was measured by means of the timeline followback method.

RESULTS

Higher scores of emotional craving (Alcohol Urge Questionnaire-AUQ) were significantly related to higher self-reported impulsivity (Barratt Impulsiveness Scale, version 11) and to higher cognitive impulsivity (information sampling task). Additionally, exploratory analyses suggest that these relationships are more pronounced in severe AD patients compared to less severe AD patients. No significant relationships were found between emotional craving (AUQ) and motor impulsivity (stop signal task) or delay discounting and between obsessive-compulsive craving (Obsessive Compulsive Drinking Scale) and measures of impulsivity.

CONCLUSIONS

Emotional craving is related to self-reported impulsivity and to cognitive impulsivity. These relationships seem to be more pronounced in AD patients with severe alcohol dependence. Further research is needed to explore the effect of this relationship on treatment outcome and relapse.

Less cognitive and neurological deficits in schizophrenia patients carrying risk variant in ZNF804A

BACKGROUND

The rs1344706 single nucleotide polymorphism in the ZNF804A gene is a common variant with strong evidence for association with schizophrenia. Recent studies show an association of rs1344706 with cognitive functioning, and there is some evidence suggesting that the risk allele may increase susceptibility for a subtype of schizophrenia with relatively spared cognition.

METHODS

We tested the effect of rs1344706 genotype in 89 schizophrenia patients on 3 basic cognitive domains (working memory, processing speed and attention) shown to be severely impaired in schizophrenia. Also we investigated the effect of rs1344706 on the severity of neurological soft signs, subtle impairments in motor and sensory functions highly frequent in schizophrenia patients. Neurological soft signs and cognitive deficits are central features of schizophrenia and are tightly linked with clinical, social and functional outcome.

RESULTS

Our results show an association of higher rs1344706 risk allele load with improved performance on processing speed and with fewer neurological soft signs.

CONCLUSIONS

Together with other studies, our findings suggest that ZNF804A is associated with a subtype of schizophrenia with better cognitive and neurological functioning. Discovery of the specific pathways through which ZNF804A is exerting this effect may lead to better prevention, diagnosis and treatment for a specific group of schizophrenia patients.

Impact of one HF-rTMS session on fine motor function in right-handed healthy female subjects: a comparison of stimulation over the left versus the right dorsolateral prefrontal cortex

BACKGROUND

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive tool to investigate neural conduction in motor processes. Most rTMS research has been conducted by targeting the primary motor cortex. Several studies have also found increased psychomotor speed after rTMS of the dorsolateral prefrontal cortex (DLPFC). However, these studies were mainly performed in psychiatric patients, only targeting the left DLPFC, and often without sham control. Moreover, psychomotor speed is mostly measured based on tasks that also require higher executive functions.

METHODS

Here, we examined the lateralized effect of one sham-controlled high-frequency rTMS session applied to the left or right DLPFC on fine motor function in 36 healthy right-handed females, using the Fitts' paradigm.

RESULTS

We found a significant improvement in psychomotor speed only after actively stimulating the right DLPFC.

CONCLUSION

Our results support the assumption of a right prefrontal neural network implicated in visuomotor behavior and performance processes, and that the improvement in psychomotor speed is not a secondary effect of decreased mood.

The gender paradox in suicidal behavior and its impact on the suicidal process

BACKGROUND

An important gender difference has been reported regarding suicidal behavior with an overrepresentation of females in nonfatal suicidal behavior and a preponderance of males in completed suicide, also known as the 'gender paradox of suicidal behavior'. The concept of a 'suicidal process' classifies suicidal behavior chronologically; this process starts with suicidal ideation and then implies a progression of suicidality ranging from suicidal ideation over plans to suicide attempts and finally fatal suicide.

AIMS/METHODS

The current paper aims to deepen the knowledge on the gender paradox by collecting and discussing the recent literature on this topic: the most relevant, impacting gender-related factors will be discussed within the suicidal process concept.

RESULTS

Several factors had a gender-dependent impact on suicidal behavior: psychosocial life stressors such as stressful life events but also sociodemographical or socio-economical factors, and sexual abuse. The gender differences in psychiatric (co)morbidity and in response to or attitude towards antidepressant treatment also appear to have an impact. Furthermore, not only suicide methods but also the gender-dependent variation in reporting suicide has an influence. Finally, the gender differences in help seeking behavior as well as region-dependent cultural beliefs and societal attitudes are discussed.

CONCLUSIONS

Especially life-events seem to exert an important influence at the beginning of a suicidal process, whereas the other factors occur at a further stage in the process, however without a fixed chronology. Also, the duration of the suicidal process is much shorter in male than in females. Finally, some implications with regard to clinical practice and suicide prevention are suggested.

[Antidepressants and the risk of bleeding]

BACKGROUND

By blocking the serotonin transporter system antidepressants can, in theory, result in bleedings. However, we do not yet know how great the risk of bleeding is and what the clinical implications are.

AIM

To assess how great the risk of bleeding is and what the clinical implications are.

METHOD

Using keywords 'antidepressants' and 'bleeding' we searched the relevant literature up to March 2011 to find out what the risk of bleeding were for users of antidepressants.

RESULTS

34 studies met our selection criteria. Most studies reported upper gastrointestinal bleeding and hemorrhagic cerebrovascular accidents (CVA). Antidepressants with high serotonin affinity can slightly increase the risk of upper gastrointestinal bleeding. Antidepressants do not increase the risk for hemorrhagic CVA. Very little information is available about other types of bleeding.

CONCLUSION

Our systematic review of the literature shows that antidepressants are relatively safe as far as bleeding is concerned. Precautions can be taken in the case of high risk patients.

[ADHD and addiction: a complicated liaison]

BACKGROUND

The presence of ADHD has been linked to a 100% increase in a person's chance of developing a substance use disorder. The prevalence of childhood and adult ADHD in substance-abusing populations has been estimated to be three times higher than in the general population. In addiction centres ADHD is often unrecognized and untreated.

AIM

To describe the obstacles to the diagnosis and treatment of ADHD in addicts.

METHOD

Using a historical approach, we analysed the evolution of the diagnostic descriptions of the two disorders, giving attention to the influence of social change and scientific research.

RESULTS

The two disorders have developed in remarkably similar ways; people have been and still are much inclined to make moral judgments about these disorders than about other psychic disorders. Neurobiological research has added a extra dimension to the debate on topics such as impulsivity, personal responsibility and free will.

CONCLUSION

It is only recently that ADHD has been recognised as having a place in addiction treatment and, as a result, there is a growing need for explanatory models.

[Neuro-endocrine correlates of burnout]

BACKGROUND

The symptoms of burnout are similar to those of depression on the one hand and chronic fatigue syndrome on the other hand. However, the neuro-endocrine correlates of these two syndromes are the opposite, the former being a hyperfunction of the hypothalamic-hypophysial-cortical axis (HPA) and the latter being a hypofunction of the hpa-axis.

AIM

To find out, via a systematic review of the literature, whether burnout is associated with either a hyperfunction or a hypofunction of the HPA-axis.

METHOD

We searched PubMed using the following search terms: 'burnout syndrome and burnout', 'adrenocorticotropic hormone', 'corticotropin releasing factor', 'hypothalamic pituitary adrenal axis' and 'cortisol'. We retrieved 16 original articles en one meta-analysis were included in the study.

RESULTS

Functional stress testing showed hypersuppression of the HPA-axis after dexamethasone. Basal cortisol values were found to be less conclusive, although a meta-analysis pointed to a negative association between burnout and cortisol. We did not find any studies that were carried out with the help of physiological, physical or psychological stress factors in burnout.

CONCLUSION

Burnout is associated primarily with a hypofunction of the HPA-axis, which is a neuro-endocrine characteristic of exhaustion, rather than of depression. However, further studies involving functional stress testing are needed in order to map the neuro-endocrine profile fully and to clarify the link with the deregulation of the immune system.

Psychomotor function and response inhibition in chronic fatigue syndrome

Most research points to cognitive slowing in chronic fatigue syndrome (CFS), although there have been negative reports. The present study is one of few that examines fine motor processing and the inhibition of automatic responses in a well-characterised CFS population. A total of 35 female CFS patients without current major depression and 25 female controls performed two computerised figure-copying tasks. The cognitive and fine motor processing of visual-spatial information was measured by recording reaction time (RT) and movement time (MT), respectively. The inhibition of automatic responses was assessed by introducing 'conflicting patterns' (i.e., patterns that were difficult to draw from the preferred left to right). A multivariate general linear model was adopted for the statistical analysis of the movement recordings. As a result, CFS was significantly associated with longer RT and MT in the pooled and in the task-specific analyses. However, there was no interaction between disease status and conflicting character of the patterns. In conclusion, these performance data on the figure-copying tasks provide confirmatory evidence for psychomotor slowing in CFS, but not for a disturbed inhibition of automatic responses. Computerised figure-copying tasks may be promising tools for use in neurobiological research and clinical trials in CFS.

Ziprasidone vs olanzapine in recent-onset schizophrenia and schizoaffective disorder: results of an 8-week double-blind randomized controlled trial

INTRODUCTION

Head-to-head comparisons of antipsychotics have predominantly included patients with chronic conditions. The aim of the present study was to compare the efficacy and tolerability of ziprasidone and olanzapine in patients with recent-onset schizophrenia.

METHODS

The study was an 8-week, double-blind, parallel-group, randomized, controlled multicenter trial (NCT00145444). Seventy-six patients with schizophreniform disorder, schizophrenia or schizoaffective disorder (diagnosis < 5 y), and a maximum lifetime antipsychotic treatment < 16 weeks participated in the study. Efficacy of ziprasidone (80-160 mg/d) and olanzapine 10-20 mg was measured using the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression (CGI) Scale, the Calgary Depression Scale for Schizophrenia (CDSS), and the Heinrich Quality of Life Scale (HQLS); tolerability assessments included laboratory assessments, body weight, and electroencephalogram.

RESULTS

Olanzapine (n = 34) and ziprasidone (n = 39) showed equal efficacy as measured by the PANSS, CDSS, CGI, and HQLS. However, mean weight gain was significantly higher in the olanzapine group (6.8 vs 0.1 kg, P < .001). Ziprasidone was associated with decreasing levels of triglycerides, cholesterol, and transaminases, while these parameters increased in the olanzapine group (all P values < .05). There were no significant differences in fasting glucose and prolactin levels or in cardiac or sexual side effects. Patients on ziprasidone used biperiden for extrapyramidal side effects more frequently (P < .05).

DISCUSSION

The results of this study indicate that ziprasidone and olanzapine have comparable therapeutic efficacy but differ in their side effect profile. However, there is a risk of a type II error with this sample size. Clinically significant weight gain and laboratory abnormalities appear early after initiating treatment and are more prominent with olanzapine, while more patients on ziprasidone received anticholinergic drugs to treat extrapyramidal symptoms.

[Antipsychotic agents in the treatment of somatoform disorders; a review]

BACKGROUND

Antipsychotics are regularly prescribed in the treatment of somatoform disorders. Up till now there has not been any systematic review of the literature on this subject.

AIM

To provide a review of the literature on the use of antipsychotic agents in patients with somatoform disorders.

METHOD

Publications listed in PubMed database were retrieved and studied. The search terms used were the somatoform disorders and functional disorders in combination with 'antipsychotic agent' and all individual antipsychotics.

RESULTS

L-sulpiride was effective in the treatment of functional dyspepsia in four randomised, controlled trials (rcts). There is only limited evidence for the effectiveness of flupentixolmelitracen in the treatment of functional dyspepsia and of amisulprid in the treatment of glossodynia. The other studies report the ineffectiveness of antipsychotics (in the treatment of body dysmorphic disorder) or they are methodologically poor studies which do suggest a slight positive effect (in fibromyalgia and in hypochondria).

CONCLUSION

Recommendations about the effectiveness of antipsychotics in the treatment of somatoform disorders need to be differentiated according to the type of subcategory. There have been very few RCTs and typical antipsychotics have been studied more than atypical antipsychotics. Antipsychotics have proved effective in the treatment of functional dyspepsia.

Effects on cognitive functioning after olanzapine-ziprasidone crossover in recent-onset schizophrenia

INTRODUCTION

To enhance functional outcome in schizophrenia improvement of cognitive symptoms is crucial.

EXPERIMENTAL PROCEDURES

Using a comprehensive test battery, this follow-up examines cognitive effects in patients with recent-onset schizophrenia after a change of medication following insufficient clinical response and intolerance.

RESULTS

After eight weeks cognitive outcomes had not improved in the patients having switched from olanzapine to ziprasidone (n=11; mean dose 136 mg) nor in those having switched from ziprasidone to olanzapine (n=10; mean 16 mg), while the symptoms of patients maintaining olanzapine (n=18; mean 10.9 mg) or ziprasidone (n=18; mean 88.9 mg) treatment had not improved further.

DISCUSSION

The findings suggest that also in early-stage schizophrenia the antipsychotics tested affect cognitive symptoms similarly.

The impact of perfectionism and anxiety traits on action monitoring in major depressive disorder

Perfectionism and anxiety features are involved in the clinical presentation and neurobiology of major depressive disorder (MDD). In MDD, cognitive control mechanisms such as action monitoring can adequately be investigated applying electrophysiological registrations of the error-related negativity (ERN) and error positivity (Pe). It is also known that traits of perfectionism and anxiety influence ERN amplitudes in healthy subjects. The current study explores the impact of perfectionism and anxiety traits on action monitoring in MDD. A total of 39 MDD patients performed a flankers task during an event-related potential (ERP) session and completed the multidimensional perfectionism scale (MPS) with its concern over mistakes (CM) and doubt about actions (DA) subscales and the trait form of the State Trait Anxiety Inventory. Multiple regression analyses with stepwise backward elimination revealed MPS-DA to be a significant predictor (R²:0.22) for the ERN outcomes, and overall MPS (R²:0.13) and MPS-CM scores (R²:0.18) to have significant predictive value for the Pe amplitudes. Anxiety traits did not have a predictive capacity for the ERPs. MPS-DA clearly affected the ERN, and overall MPS and MPS-CM influenced the Pe, whereas no predictive capacity was found for anxiety traits. The manifest impact of perfectionism on patients’ error-related ERPs may contribute to our understanding of the action-monitoring process and the functional significance of the Pe in MDD. The divergent findings for perfectionism and anxiety features also indicate that the wide range of various affective personality styles might exert a different effect on action monitoring in MDD, awaiting further investigation.

[Comorbid anxiety disorders and alcohol-related disorders in a population of bipolar I disorder: investigation in a Flemish population]

BACKGROUND

Bipolar I disorder (bp i) is a very debilitating psychiatric disorder which is frequently associated with comorbid psychiatric and somatic disorders. Many studies in other countries show strongly elevated prevalences of anxiety disorders and alcohol-related disorders in the bp i population, but so far no data on this topic are available with regard to the Flemish population.

AIM

To determine the prevalence of anxiety disorders and alcohol-related disorders in a Flemish population of bp i outpatients in remission and to find out whether comorbidity of these disorders is linked to the onset of the disorder at a younger age.

METHOD

Sixty-nine bp i patients in remission were given structured interviews at home and the results were compared with the Belgian prevalence reported in the European Study of the Epidemiology of Mental Disorders (esemed) project. results Both the prevalence of the alcohol-related disorders (15 of 69 patients or 21.7%) and the prevalence of anxiety disorders (17 patients or 24.6%) were elevated compared to the general population (8.1 and 13.2% respectively). Among the anxiety disorders the prevalence was elevated for panic disorder, social phobia and post-traumatic stress disorder. No significant association was found between the comorbidity and the patient's age at the onset of the illness.

CONCLUSION

The prevalence of anxiety disorders and alcohol-related disorders in an outpatient population of Flemish patients with bp i in remission is elevated.

[Modafinil in psychiatric disorders: the promising state reconsidered]

BACKGROUND

For more than two decades psychiatrists have known about and have promoted modafinil, a very promising stimulant that boosts wakefulness in cases of narcolepsy and also enhances cognitive functions. At present, however, we must conclude that modafinil is hardly ever used to treat illness other than narcolepsy.

AIM

To review current attitudes and practice with regard to the use and efficacy of modafinil in the treatment of psychiatric disorders.

METHOD

Relevant placebo-controlled studies were retrieved via PubMed (Medline) and Web of Science.

RESULTS

Modafinil is used experimentally to treat ADHD, mood disorders, schizophrenia and substance-dependence. Compared to placebo, modafinil achieves positive but mainly variable results on different clinical and cognitive measures. It achieves results very rapidly, within a week, but over a period of time the results stabilise.

CONCLUSION

Modafinil is particularly successful in the treatment of ADHD, depression and cocaine-dependency on measures of attention and hyperactivity, fatigue and cocaine-use respectively. There is a need for further placebo-controlled trials with longer follow-up periods and larger sample size in order to ensure the safety of the product and to refine its area of efficacy.

A cognitive neuropsychiatric analysis of psychomotor symptoms in major depression and schizophrenia

A cognitive neuropsychiatric analysis will be proposed by presenting recent research on -1-motor control, and -2-action monitoring in two psychiatric disorders i.e. major depression and schizophrenia. Motor control is best studied from the broader cognitive neuropsychological perspective of action control. Even very simple actions implicate quite diverse brain activities reflecting the cognitive processes of planning, selection, visuomotor integration, timing, force adjustment, and action monitoring. The extent to which deficits in these cognitive processes cause slowed or stereotypic actions can be experimentally studied in clinical settings by means of graphic tasks, as will be illustrated. A central process in motor/action control is error monitoring. The last decade research on this higher cognitive control process has been booming, also because the detection of errors is accompanied by a clear peak in the EEG, known as the error-related negativity (ERN). Deficient error monitoring has been observed in several psychiatric disorders. ERN studies in major depression and schizophrenia will be discussed. Psychiatric disorders can best be understood by considering three perspectives, i.e. psychopathology, cognitive neuropsychology and neuroscience. The findings support the view that cognitive neuropsychiatry should involve the combined study of psychiatric symptoms, cognitive dimensions and neurological structures.

Psychomotor changes in major depressive disorder during sertraline treatment

BACKGROUND

There is a relative scarcity of studies on major depressive disorder that use objective assessment methods to explore the psychomotor effects of antidepressants. Striatal dopaminergic disturbances are known to be involved in the pathogenesis of major depressive disorder that is associated with psychomotor retardation. Because of its additional dopaminergic mechanism, the psychomotor effects of the selective serotonin reuptake inhibitor sertraline merit further exploration.

METHODS

In 19 patients diagnosed with a current major depressive episode, clinical variables and graphic motor activity were assessed applying digitized figure copying tasks during a 6-week regimen of sertraline. Patients' baseline and weekly psychomotor performance was compared with the outcomes of 22 healthy, unmedicated controls.

RESULTS

Patients' psychomotor slowing had improved after 6 weeks on sertraline as reflected by reductions in initiation and movement times on the simple line and figure copying tasks and decreased initiation times for the complex figure copying task relative to their baseline outcomes.

CONCLUSIONS

The current study found evidence pointing to potential beneficial effects of sertraline after a 6-week treatment period in the lower-order cognitive and motor components involved in the graphic motor performance of depressed patients. The present findings are discussed in terms of the mechanism of action of sertraline.