Some markers of mirroring appear intact in schizophrenia: evidence from mu suppression

Although schizophrenia is associated with impairments in social cognition, the scope and neural correlates of these disturbances are largely unknown. In this study, we investigated whether schizophrenia patients show impaired functioning of the mirror neuron system (MNS), as indexed by electroencephalographic (EEG) mu (8–13 Hz) suppression, a hypothesized biomarker of MNS activity that is sensitive to the degree of social interaction depicted in visual stimuli. A total of 32 outpatients and 26 healthy controls completed an EEG paradigm that included six action observation or execution conditions that differed in their degrees of social interaction. Participants also completed a validated empathy questionnaire. Across both groups, we found a significant linear increase in mu suppression across the conditions involving greater levels of social engagement and interaction, but no significant group or interaction effects. Patients self-reported diminished empathic concern and perspective taking, which showed some moderate relations to mu suppression levels. Thus, the schizophrenia group showed generally intact modulation of MNS functioning at the electrophysiological level, despite self-reporting empathic disturbances. The disturbances commonly seen on self-report, performance, and neuroimaging measures of mentalizing in schizophrenia may largely reflect difficulties with higher-level inferential processes about others’ emotions, rather than a basic incapacity to share in these experiences.     

Neural correlates of deficient response inhibition in mentally disordered violent individuals

In this study, response inhibition and associated neural activation during a motor inhibition paradigm were investigated in (i) men with antisocial personality disorder (APD) with a history of violence (n = 14), (ii) men with schizophrenia with a history of violence (n = 12), (iii) men with schizophrenia without a history of violence (n = 12), and (iv) healthy control subjects (n = 14) using functional magnetic resonance imaging (fMRI). At the behavioural level, individuals with schizophrenia showed impaired performance across all conditions, whereas an increased error rate was seen in the APD group only during the conditions requiring inhibition. At the neural level, both violent groups showed reduced thalamic activity, compared with controls, in association with modulation of inhibition by task demands. In addition, the violent schizophrenia group, compared with controls, showed reduced activity in the caudate nucleus during the condition requiring inhibition. It is concluded that violence may not be specifically associated with impaired voluntary inhibition in schizophrenia but this is likely in APD. Reduced thalamic function, perhaps due to its known association with sensorimotor disturbances, is implicated in violent behaviour across both disorders. In addition, caudate dysfunction may contribute, given its role in timing and temporal processing as well as suppression of motor actions, to deficient inhibition and violent behaviour in schizophrenia.     

Die Behandlung paraphiler Störungen mit GnRH-Agonisten unter besonderer Berücksichtigung ethischer und rechtlicher Aspekte

Current guidelines recommend the use of antiandrogenic medication in addition to psychotherapeutic procedures in the treatment of patients and sexual offenders with severe paraphilic disorders and a high to very high risk of committing severe sexual offences. This article provides an overview about the current state of research concerning the effectiveness and possible side effects of antiandrogens and discusses the legal and ethical basis of using antiandrogens in the therapy of paraphilic disorders with a focus on gonadotropin-releasing hormone (GnRH) agonists. Meanwhile, a great deal of empirical evidence exists with respect to the effectiveness of GnRH agonists for lowering paraphilic sexual fantasies and behaviors; however, GnRH agonist treatment also still has a risk of mild to severe undesired side effects, e.?g. hypertension, hyperlipidemia, liver damage, bone demineralization and depression. Nevertheless, in German forensic psychiatric institutions a not insignificant proportion of patients are treated with antiandrogens and furthermore, in the last few years treatment with GnRH agonists has become more important. In Germany, GnRH agonists can only be used on a voluntary basis; however, in some European countries and North American states legal statutes for compulsory treatment also exist. This is clearly contrary to the recommendations of current international guidelines. In light of the fact that GnRH agonist treatment could violate basic human rights, the need for an ethically sound approach is even more important in the decision for therapy with GnRH agonists. This article provides some proposals for a treatment approach that is in line with current ethical and legal requirements.     

Selective phosphodiesterase type-5 inhibitor treatment of serotonergic reuptake inhibitor antidepressant-associated sexual dysfunction: a review of diagnosis,treatment, and relevance

Sexual dysfunction related to antidepressants, particularly serotonin reuptake inhibitors is a major cause of premature treatment discontinuation. This places patients at increased risk for recurrence, relapse, chronicity, and mortality (eg, suicide). The clinical assessment requires a comprehensive evaluation of sexual function, including libido, arousal, orgasm, and resolution prior to affective disorder, disturbances associated with the emergence of depression, and changes or dysfunctions associated with antidepressant treatment. Other factors to be included for evaluating sexual dysfunction include inquiry for concurrent medical conditions, somatic treatments, lifestyle risk factors, and response to antidepressants. Current treatment approaches to antidepressant-associated sexual dysfunction have relied on open-label reports, literature reviews, and clinical wisdom. Without double-blind, placebo-controlled studies to support them, too much non-evidence-based treatment may be offered to patients. Advances into nonadrenergic-noncholinergic novel signal transduction, specifically phosphodiesterase type-5 inhibitors, offer new opportunities for developing evidence-based treatments for this side effect and improving depression disease management outcomes.     

Pharmacologic management of sexual dysfunction: benefits and limitations

What is the current knowledge concerning the pharmacologic treatment of human sexual dysfunction? A number of interventions, including oral phophodiesterase inhibitors and intracorporeal agents with vasodilatory effects, are available to treat male erectile disorder. Serotonergic drugs have been shown to be effective in the treatment of rapid ejaculation. Various lines of research suggest that high dosages of androgenic agents may eventually have a role in the treatment of decreased libido in females. There may be a role for phophodiesterase inhibitors in the treatment of a subgroup of women with arousal disorders. Normal sexual function involves successful integration of biological, psychological, and interpersonal influences. Clinical psychiatry with its biopsychosocial model should incorporate the treatment of human sexual dysfunction within its purview.     

Clinical efficacy and potential mechanisms of neurofeedback

Although many psychological disorders have significant basis in neurobiological dysfunction, most treatment approaches either neglect biological aspects of the problem, or approach dysfunction through pharmacological treatment alone, which may expose individuals to negative side effects. In recent decades, neurofeedback has been promoted as an alternative approach to treating neurobiological dysfunction. Neurofeedback helps individuals gain control over subtle brain activity fluctuations through real-time rewards for pre-established target brainwave frequencies at specific cortical locations. This paper reviews the effectiveness of neurofeedback in a range of conditions, including ADHD, autism spectrum disorders, substance use, PTSD, and learning difficulties. Neurofeedback has emerged as superior or equivalent to either alternative or no treatment in many of the examined studies, suggesting it produces some effects worthy of further examination. In light of its potential to address neurobiological dysfunction directly, future research is suggested in order to refine protocols, as well as to establish effectiveness and efficacy. Potential mechanisms of neurofeedback are discussed, including global connectivity, neuroplasticity, and reinforcement of the default mode network, central executive network, and salience network.     

Pharmacological treatment effects on eye movement control

The increasing use of eye movement paradigms to assess the functional integrity of brain systems involved in sensorimotor and cognitive processing in clinical disorders requires greater attention to effects of pharmacological treatments on these systems. This is needed to better differentiate disease and medication effects in clinical samples, to learn about neurochemical systems relevant for identified disturbances, and to facilitate identification of oculomotor biomarkers of pharmacological effects. In this review, studies of pharmacologic treatment effects on eye movements in healthy individuals are summarized and the sensitivity of eye movements to a variety of pharmacological manipulations is established. Primary findings from these studies of healthy individuals involving mainly acute effects indicate that: (i) the most consistent finding across several classes of drugs, including benzodiazepines, first- and second- generation antipsychotics, anticholinergic agents, and anticonvulsant/mood stabilizing medications is a decrease in saccade and smooth pursuit velocity (or increase in saccades during pursuit); (ii) these oculomotor effects largely reflect the general sedating effects of these medications on central nervous system functioning and are often dose-dependent; (iii) in many cases changes in oculomotor functioning are more sensitive indicators of pharmacological effects than other measures; and (iv) other agents, including the antidepressant class of serotonergic reuptake inhibitors, direct serotonergic agonists, and stimulants including amphetamine and nicotine, do not appear to adversely impact oculomotor functions in healthy individuals and may well enhance aspects of saccade and pursuit performance. Pharmacological treatment effects on eye movements across several clinical disorders including schizophrenia, affective disorders, attention deficit hyperactivity disorder, Parkinson’s disease, and Huntington’s disease are also reviewed. While greater recognition and investigation into pharmacological treatment effects in these disorders is needed, both beneficial and adverse drug effects are identified. This raises the important caveat for oculomotor studies of neuropsychiatric disorders that performance differences from healthy individuals cannot be attributed to illness effects alone. In final sections of this review, studies are presented that illustrate the utility of eye movements for use as potential biomarkers in pharmacodynamic and pharmacogenetic studies. While more systematic studies are needed, we conclude that eye movement measurements hold significant promise as tools to investigate treatment effects on cognitive and sensorimotor processes in clinical populations and that their use may be helpful in speeding the drug development pathway for drugs targeting specific neural systems and in individualizing pharmacological treatments.     

Spatial and Selective Attention in the Cerebral Hemispheres in Depression, Mania, and Schizophrenia

Two tachistoscopic tests examining distinct aspects of attention were administered to normal subjects and patients with depression, mania, and schizophrenia. The first examined spatial attentional bias using happy-sad chimeric faces, known to elicit a perceptual bias to the left side of space in normal right-handers provided the right cerebral hemisphere is intact. The second used a lateralized version of the Stroop task, a traditional test of selective attention. Normals showed the expected leftward perceptual bias but showed equivalent susceptibility to the Stroop effect in both visual fields. As previously demonstrated with chimeric faces viewed in free vision, depression and mania were associated with weak and strong biases respectively with schizophrenics showing no bias to either side of space. The relationship between perceptual bias, as assessed by reaction time and absolute performance and the Stroop effect, showed differences according to diagnosis. This may be interpreted as evidence for the dissociability of attentional processes as well as lateralized differences in the pattern of cerebral activation in affective disorders and schizophrenia. The independence of performance variables on these tests in the schizophrenic group points to severe neuropsychological dysfunction.     

Sexual Side Effects of Antidepressant Medications: An Informed Consent Accountability Gap

Sexual side effects of antidepressant medications are far more common than initially reported, and their scope, quality, and duration remain poorly captured in the literature. Antidepressant treatment emergent sexual dysfunctions may decrease clients’ quality of life, complicate psychotherapy, and damage the treatment alliance. Potential damage to the treatment alliance is greatest when clients have not been adequately informed of risks related to sexual side effects. It had previously been assumed that sexual side effects always resolve shortly after medications are discontinued. Emerging evidence, however, suggests that in some individuals, sexual dysfunction side effects may persist indefinitely. The authors argue that all psychologists should be well-informed about sexual side effects risks of antidepressant medications, should routinely conduct a pre-medication baseline assessment of sexual functioning, and take an active role in the informed consent process.

Preliminary evidence for impaired rapid verb generation in schizophrenia

It has been hypothesized that nouns and verbs are processed within relatively separable semantic memory networks. Although abnormal semantic processing is a common feature of schizophrenia-spectrum disorders, no prior studies have specifically examined the comparability of noun and verb generation deficits in schizophrenia. In the current study, verb (action), noun (animal), and letter (f) fluency performance was evaluated in 22 inpatients with schizophrenia and 27 healthy comparison subjects. On average, individuals with schizophrenia performed approximately one standard deviation below the healthy comparison subjects on action, animal, and letter fluency. Action fluency-but not letter or animal fluency-was moderately correlated with tests of working memory, response inhibition, semantic memory, and cognitive flexibility. Findings suggest that verb- and noun-based fluency deficits are of comparable severity in schizophrenia, but that the impairment in verb generation may be driven by different underlying cognitive mechanisms. Further, hypothesis-driven research on the nature and extent of verb network disruption in schizophrenia appears warranted.     

Reproductive life events and sexual functioning in women: case reports

Are reproductive life events in women associated with an increased risk of sexual dysfunction? Female sexual dysfunction effects up to 40% of women in the United States between 18 and 59 years of age. Sexual dysfunction may be accompanied by fluctuations in gonadal hormone secretion, making women more vulnerable to sexual symptoms, especially during times of reproductive life events. Reproductive life events, such as the use of birth control pills, various phases of the menstrual cycles, postpartum and lactation states, and perimenopause, are highly correlated with changes in sex steroids. As an understanding of the role of sex steroids on sexual functioning is elucidated, clinicians will be able to offer more specific and effective treatment options for women during various phases of reproductive life. Several case studies are presented to illustrate the unique clinical considerations that a clinician must consider when treating the biologic component of female sexual dysfunction.     

Interpersonal sensitivity, partner support, patient-physician communication, and sexual functioning in men recovering from prostate carcinoma

Prostate carcinoma (PC) is the most commonly diagnosed cancer in men. Treatments for localized PC are associated with side effects including sexual dysfunction, which has been linked to decrements in health-related quality of life and elevated distress levels. In this study, we examined the relationship between 2 personality traits, interpersonal sensitivity and lack of sociability, assessed by the Inventory of Interpersonal Problems (IIP; Pilkonis, Kim, Proietti, & Barkham, 1996) and recovery of sexual functioning in 121 men (M age = 60.6 years) recently treated with radical prostatectomy. Interpersonal sensitivity refers to the predisposition to perceive and elicit criticism and rejection from others; lack of sociability refers to chronic difficulties taking the initiative in interpersonal situations. After adjusting for relevant covariates, interpersonal sensitivity, but not sociability, was significantly associated with lower levels of sexual functioning. Patient-physician communication and partner perceived social support were explored as mediators of this relationship. Although interpersonal sensitivity was significantly associated with both poorer patient-physician communication and lower levels of partner support, the results did not support mediation. This study provides preliminary evidence that certain IIP-assessed interpersonal styles may complicate the recovery of sexual functioning after surgical treatment for PC.     

Alcohol and human sexual behavior.

Despite the potential clinical significance of the relationship between alcohol consumption and human sexual responsiveness. the subject has received little systematic research attention. Clinical observations have suggested that alcohol abuse can lead to impotency disorders in males and sexual dysfunction in women. Alcohol has been associated with sex offences such as rape and pedophilia, increased sexual activity and extramarital affairs. However, correlation has been confused with cause, and unequivocal evidence of alcohol as the causal agent is lacking. Recent research using penile tumescence and vaginal pressure pulse as measures of sexual arousal has shown a significant negative linear relation between alcohol and sexual responsiveness in both men and women social drinkers. Findings that cognitive rather than pharmacological factors decisively influence alcohol's effects on sexual arousal, together with other psychosocial analyses, dispute the disinhibition hypothesis of alcohol's effects. A social learning analysis of alcohol's influence on sex is proposed.     

Quantitative measurement of handwriting in the assessment of drug-induced parkinsonism

Monitoring drug-induced side effects is especially important for patients who undergo treatment with antipsychotic medications, as these drugs often produce extrapyramidal side effects (EPS) resulting in movement abnormalities similar to parkinsonism. Scientists have developed several objective laboratory tests to measure and research drug-induced movement disorders, but equipment and tests are complex and costly and have not become accepted in large-scale, multi-site clinical trials. The goals of this study were to test whether a simple handwriting measure can discriminate between individuals with psychotropic-induced parkinsonism, Parkinson's disease, and healthy individuals, and to examine some of the psychometric properties of the measure. We examined pen movement kinematics during cursive writing of a standard word in 13 patients with idiopathic Parkinson's disease (PD), 10 schizophrenia patients with drug-induced parkinsonism (SZ), and 12 normal healthy control participants (NC). Participants were instructed to write the word "hello" in cursive twice, at three vertical height scales. Software was used for data acquisition and analysis of vertical stroke velocities, velocity scaling, and smoothness. There were four important results from this study: (1) both SZ patients with drug-induced EPS and PD participants exhibited impaired movement velocities and velocity scaling; (2) performance on the velocity scaling measure distinguished drug-induced EPS from normal with 90% accuracy; (3) SZ, but not PD participants displayed abnormalities in movement smoothness; and (4) there was a positive correlation between age and magnitude of the velocity scaling deficit in PD participants. This study demonstrates that kinematic analyses of pen movements during handwriting may be useful in detecting and monitoring subtle changes in motor control related to the adverse effects of psychotropic medications.     

I. Genotype-environment interaction in the schizophrenia spectrum: genetic liability and global family ratings in the Finnish Adoption Study

In the Finnish Adoption Study, a national sample of adoptees with high versus low genetic liability for schizophrenia spectrum disorders was indexed by DSM-III-R diagnoses of their biological, adopting-away mothers. The rearing-family environments of the adoptees were independently evaluated from global ratings of directly observed adoptive family relationships. The interaction of high genetic liability and dysfunction of the rearing families predicted highly significantly to schizophrenia spectrum disorder of the adoptees at 21-year follow-up. Either low genetic liability or healthy rearing protected against a spectrum outcomes for the adoptees. Initial adoptive parent diagnosis, as a proxy for rearing family dysfunction, predicted to adoptee outcome only as a trend.     

Perceptual organization in schizophrenia spectrum disorders: empirical research and theoretical implications

The research into perceptual organization in schizophrenia spectrum disorders has found evidence for and against a perceptual organization deficit and has interpreted the data from within several different theoretical frameworks. A synthesis of this evidence, however, reveals that this body of work has produced reliable evidence for deficits in schizophrenia, as well as for the clinical, stimulus, and task parameters associated with normal and abnormal performance. Recent models of cognition have also advanced understanding of the underlying pathophysiological processes of perceptual organization dysfunction in schizophrenia spectrum disorders. These suggest that deficits in perceptual organization may be one manifestation of a wider disturbance in the integration of contextually related information across space and time.     

Rational-emotive treatment for the sexual problems of couples

A rational-emotive approach to the treatment of sexual dysfunction is presented. It is asserted that the attitudes with which RET therapists approach sexual problems are as important in determining therapeutic outcome as are the techniques utilized in treating those problems. Regardless of whether one is treating disorders of desire, arousal, or orgasm, the rational-emotive sex therapist remains committed to the stoic position that is is not the unfortunate events in life but rather one's perceptions and evaluations of those events that cause distress. In this regard, the distinction between sexual dysfunction (unfortunate life events) and sexual disturbance (exaggeratedly negative perceptions and evaluations of those events) is emphasized. It is further asserted that only therapy regimens utilizing behavioral strategies within the context of what we have labeled elegant or preferential RET will adequately and comprehensively treat all sexual disorders.     

Neurophysiological evidence for disturbances of conflict processing in patients with schizophrenia

Deficits in cognition are a hallmark of schizophrenia. In the present study, the authors investigated the effects of schizophrenia on the neural correlates of conflict processing in a single-trial version of the Stroop task by using event-related brain potentials. Relative to matched controls, patients with schizophrenia showed increased Stroop interference in response time, but this effect was eliminated when the effect of response slowing was controlled. In controls, conflict processing was associated with a negative wave peaking between 400 and 500 ms (N450) and conflict sustained potential (SP) peaking between 600 and 800 ms after stimulus onset. In patients with schizophrenia, the amplitude of the N450 was significantly attenuated and the conflict SP was absent. These results provide evidence for the existence of altered neural processes associated with conflict processing that may be associated with dysfunction of the anterior cingulate and prefrontal cortex in patients with schizophrenia.     

Consummated mother-son incest in latency: a case report of an adult analysis

Reported cases of mother-son incest are very rare in the psychoanalytic literature; the fact of such incest, however, may not be so rare as has generally been believed. A detailed case report of the analysis of an adult with a history of severe physical, sexual, and verbal abuse, including consummated incest with his mother during latency, is considered in the context of other reported studies. The author raises some issues of resistance and countertransference that may influence the reporting, treatment, and perhaps even recognition of cases of mother-son incest.