Differing lateralized perceptual-motor patterns in schizophrenic and non-psychotic children

A neuropsychological assessment stressing lateralized perceptual-motor and cognitive abilities was administered to two groups of hospitalized child and adolescent psychiatric patients, 25 schizophrenics and 25 non-psychotics. The findings included an increased incidence of crossed eye-hand dominance in schizophrenics, poorer tactile sensory function in the right hands of schizophrenics than in the left hands, and lower Vocabulary and Similarities WISC subtest scores than Block Design and Object Assembly scores for schizophrenics. Right-left confusion was associated with finger agnosia for schizophrenics. The results supported the hypothesis that there may be left-hemisphere dysfunction in schizophrenia; however, no single pattern of dysfunction was apparent.     

Personality Trait Characteristics in Relation to Neuropsychological Dysfunction in Schizophrenia and Depression

Knowledge of the personality trait and psychopathology variables that differentiate neuropsychologically impaired and nonimpaired psychiatric patients has been limited relative to the study of higher cortical functions. This study reports findings from the Milton Clinical Multiaxial Inventory (MCMI) developed by Millon (1982) in a sample of hospitalized schizophrenics and depressives who also received the Luria-Nebraska Neuropsychological Battery. The principal findings indicate that neuropsychological dysfunction may be related to substance abuse, including its underlying personality dimensions, in schizophrenia, but only modest support is indicated for the construct of negative symptoms in schizophrenics with neuropsychological dysfunction. Further, the findings do not support the view that psychosis is a characteristic feature of depressives with impaired neuropsychological performance.     

Integrative neuropsychological characteristics of subcortical-frontal brain regions as a schizophrenia liability factor

In order to study neuropsychological characteristics of subcortical-frontal brain regions function and assessment of their relation with vulnerability to schizophrenia 59 patients and 23 controls were investigated using Luria's neuropsychological methods. The analysis established bilateral abnormalities of the function of prefrontal and profound frontal lobe zones in patients as compared with controls. These abnormalities were more predominate in the left hemisphere. Point biserial correlation coefficients of determined integrative neuropsychological indicators with liability to schizophrenia were 0.39 +/- 0.11 and 0.28 +/- 0.09, for the left and right brain zones respectively. The obtained data permits discussion of the integrative neuropsychological indicators of subcortical-frontal brain regions as potential markers of liability to schizophrenia and confirms the role of structural and functional brain asymmetry in the pathogenesis of schizophrenia.     

A comparison of implicit memory tests in schizophrenic patients and normal controls

The objective of the current study was to compare the performance of schizophrenic patients and normal controls on implicit memory tests. Two neuropsychological tasks were administered to 29 patients and normal participant samples. The implicit tests were: Word fragment completion and Word production from semantic categories. The priming score was the variable of interest. Priming effects are obtained in normal subjects and schizophrenia patients, regardless of the implicit test used. However, a dissociation in priming between normal and patient groups was observed, depending on the test used. For word fragment test, priming was identical between the two groups. However, for word production, priming obtained in schizophrenics was lower than priming in normal controls. Results confirm a dissociation effect in implicit memory tests. These results could be explained in the context of the Roediger and Blaxton (1987) distinction between data-driven and conceptually-driven processing. This evidence suggests that a complete neuropsychological assessment of memory in schizophrenia should include different kinds of implicit memory tests (procedural, perceptual, and conceptual tasks).     

Neuropsychological profile following suicide attempt by hanging: two adolescent case reports.

Hippocampal damage and amnesia following hypoxia and ischemia are described in the few published adult cases of suicide attempt by hanging. However, a recent review (Caine & Watson, 2000) suggests a variable pattern of brain involvement and neuropsychological impairments following hypoxic-ischemic injury that may or may not involve amnesia. To help clarify the impact of hanging on the developing brain, we examined neuropsychological functioning in two adolescents who survived suicide attempt by hanging. Despite differences in Glasgow Coma Scale (GCS), coma duration, and structural imaging findings, both patients had similar IQ (VIQ>PIQ) and presented with various combinations of deficits in expressive/receptive language, visual-constructional and perceptual ability, processing speed, attention, working memory, and/or executive functioning shortly after injury. In spite of their similarities, only one of the patients presented with classic amnesia symptoms in his early recovery. This patient was evaluated 1 year postinjury, and persistent deficits in processing speed and memory encoding were noted. Several hanging-related variables, including longer estimated hanging duration, greater weight, and severe airway edema, were thought to place this patient at increased risk for cognitive deficits. Clinical MRI scans of this patient obtained 6 weeks postinjury revealed mild volume loss as well as abnormalities in bilateral superior cortex. However, CT and MRI scans obtained throughout early recovery did not reveal overt evidence of injury to specific memory-related structures. Comprehensive neuropsychological evaluation of all adolescent survivors of suicide attempt by hanging is recommended, as a variety of postacute cognitive deficits were observed in these patients despite relatively short (相似文献   

Motoric indicators of laterality and determination of lateral dominance in schizophrenia

The literature suggests that schizophrenics exhibit reduced or reversed cerebral lateral dominance relative to normal control subjects. An hypothesis which predicted reduced or reversed cerebral laterality for schizophrenics was tested on 60 young, familially right-handed males, with 20 men in each of the following three groups: schizophrenic inpatients, nonschizophrenic psychiatric inpatient controls, and normal controls. The subjects were administered a battery of seven measures of cerebral laterality. The application of multivariate statistical techniques showed groups did not differ significantly in the degree or the direction of their cerebral lateral dominance. Also there were no significant correlations between the measures of laterality. The findings suggest that cerebral lateral dominance is not necessarily altered concomitantly with psychopathology but rather that it is a complex phenomenon which may not be reliably determined on the basis of simple behavioral characteristics.     

Emotional experience and expression in schizophrenia and depression.

The emotional responses of schizophrenic, depressed, and normal subjects and whether differences in the emotional responding of these groups depended on how emotional responses were elicited or measured were examined. Twenty-three blunted and 20 nonblunted schizophrenics, 17 unipolar depressed subjects, and 20 normal subjects were exposed to a series of affect-eliciting stimuli. The stimuli varied in valence (positive vs. negative) and in level of cognitive demand. Subjects reported their subjective experiences, and their facial expressions were videotaped. Blunted schizophrenics were the least facially expressive, although their reported subjective experiences did not differ from those of the other groups. The nonblunted schizophrenics were more responsive than the depressed subjects to the positive stimuli, although the two groups did not differ in their clinical ratings of affective flatness.     

Lateralized brain injury and behavior problems in children

This study investigated the types of behavior problems found in children with lateralized brain lesions. Children referred for neuropsychological assessment were assigned to dominant (DH) or nondominant (NDH) groups on the basis of history of neurological disease or injury, findings on neurological examination, functional and structural laboratory findings, and neuropsychological assessment. Over two-thirds fell into the clinical range of behavior problems by parental report on the Achenbach Child Behavior Checklist. Degrees of pathology were nearly equal. DH children showed more externalizing than internalizing symptomatology. NDH children showed more internalizing than externalizing behavior problems. Results are discussed in terms of symptom formation based on lateralization of lesion.     

Schizophrenia: A Neurodevelopmental Perspective

Diverse lines of research suggest that schizophrenia is a genetically influenced neurodevelopmental disorder. Family, twin, and adoption studies suggest that most cases of schizophrenia involve a genetic diathesis that is necessary but not sufficient for development of the disorder. Histological, neuroimaging, and neuropsychological findings converge in providing evidence for medial-temporal and frontal lobe dysfunction that likely predates the onset of psychosis. Behavioral phenomenology and neurobiology suggest that dopamine plays a crucial moderating role between these structural abnormalities and functional impairment. Recently, investigators have used animal models and clinical syndromes to integrate these findings into neurodevelopmental models of schizophrenia that hold great potential for yielding etiological insight.     

Comparative neuropsychology of adult obsessive-compulsive disorder and attention deficit/hyperactivity disorder: Implications for a novel executive overload model of OCD

Research implicates frontostriatal pathophysiology in both attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Nevertheless, ADHD is characterized with frontostriatal hypoactivity and OCD with hyperactivity. Furthermore, both disorders seem to lie on opposite ends of a clinical impulsive-compulsive continuum. While never having directly been compared, and despite these differences, OCD and ADHD appear to share similar neuropsychological impairments especially in executive functions. This study aimed at comparing adults with OCD and adults with ADHD on neuropsychological measures and behavioural impulsivity and OC measures. Thirty OCD, 30 ADHD, and 30 matched healthy control (HC) participants were administered a comprehensive neuropsychological battery and completed several questionnaires. The groups were compared on all neuropsychological and clinical measures and correlations between neuropsychological and clinical symptoms were computed. The ADHD and OCD groups performed more poorly than HC on all neuropsychological domains and most domain subtests. The ADHD group reported significantly higher impulsivity than the OCD group. OCD patients did not differ from HC on behavioural impulsivity. A unique dissociation was found between impulsivity and response inhibition where both clinical groups showed similar response inhibition deficit, but differed significantly on impulsivity. Moreover, a negative association between OC symptoms and response inhibition and a bias in self-perception of impulsivity was found only in the OCD group. We propose an executive overload model of OCD that views neuropsychological impairments in OCD as an epiphenomenon, according to which continuous attempts to control automatic processes are associated with obsessive thoughts overflow that causes an overload on the executive system.     

Anomalous dominance in sibling stutterers: Evidence from CT scan asymmetries, dichotic listening, neuropsychological testing, and handedness

Two left-handed siblings with developmental stuttering are comprehensively described. The methods of study included speech and language evaluation, neurological and neuropsychological examinations, dichotic listening, auditory evoked responses, electroencephalogram, and CT scan asymmetry measurements. The data from each sibling showed evidence of anomalous cerebral dominance on many of the variables investigated. The CT scan measurements showed atypical asymmetries, especially in the occipital regions. These findings support the theory that stuttering may be related to anomalous cerebral dominance, both on functional as well as structural bases. Implications of anomalous dominance and the resultant effect of hemispheric rivalry on speech fluency are discussed.     

Lack of awareness of neuropsychological deficit in cerebral small vessel disease: The relationship with executive and episodic memory functions

A common cause of neuropsychological impairment in older adults is cerebral small vessel disease (SVD), but little is known as to whether lack of awareness of neuropsychological impairment is a feature of this clinical condition. In this study, we investigated awareness deficits in a well‐phenotyped population of patients with SVD (n= 45; 21 with defined concomitant neuropsychological impairment) and made comparisons with 24 Alzheimer's disease (AD) patients and a further 80 control participants. Awareness of performance on a range of neuropsychological measures was examined based on the Brief Memory and Executive Test Battery (BMET) (Brookes, Hannesdottir, Lawrence, Morris, & Markus, 2012 ), exploring the relationship between awareness and memory and executive function. The results revealed significant awareness deficits in both the SVD and AD groups. When splitting the SVD group into those with or without concomitant neuropsychological impairment, only those with neuropsychological impairment showed reduced awareness. For the SVD group, executive function was significantly correlated with awareness but memory was not. By comparison, memory was significantly correlated with awareness in the AD group, with executive function showing a trend but remaining non‐significant. The results show that lack of awareness of deficit is a clinical feature of SVD and indicate that there are distinct neuropsychological associations with awareness deficit for SVD and AD.     

Differential diagnosis of steroid-dependent nephrotic syndrome with psychosis: Practical and ethical issues

The present case illustrates practical and ethical issues that can be encountered by clinical psychologists providing consultation services in medical settings. The neuropsychological consultation service was asked to evaluate a 22-year-old male with psychosis, steroid-dependent nephrotic syndrome, and a family history of schizophrenia. MRI revealedmarked cortical atrophy. Clinical findings were consistent with (1) steroid inducedapparent atrophy, which has been shown to be reversible with withdrawal of steroids; (2) uremia secondary to steroid withdrawal; (3) cortical atrophy, found in some schizophrenics; or (4) an atypical, diffuse degenerative disorder. Clinical interview and psychological testing revealed significant thought disorder, prominent delusions, somatic hallucinations, and mood disturbance. Deterioration in social and academic functioning was also present. Except for impaired attention and concentration, neuropsychological evaluation showed no clear evidence of brain-based dysfunction. Further, neuropsychological results effectively ruled out a degenerative process and were not consistent with a steroid effects profile. A conclusive differential diagnosis of steroid induced psychosis versus severe psychopathology would require withdrawal from steroids and antipsychotics. In addition to the practical and ethical issues of withholding antipsychotics, steroid withdrawal would require either dialysis or renal transplant surgery. Decision making regarding dialysis dependency and the possibility of postsurgical psychosis secondary to true psychopathology were salient issues to both the patient and the treatment team.     

Structural brain abnormalities in the major psychoses: a quantitative review of the evidence from computerized imaging

The neuroimaging literature on structural brain abnormalities in the major psychoses is quantitatively reviewed. The mean effect size for studies of lateral ventriculomegaly in schizophrenia (d = .70) corresponded to 43% nonoverlap between the distributions of schizophrenics and control Ss. Planimetry yielded larger effects than linear methods of ventricular size estimation. Although enlargement of the third ventricle was comparable to that of lateral ventriculomegaly (d = .66), it was found to be significantly greater after differences in measurement method were taken into account. The average cumulative length of hospitalization, adjusted for patients' age and duration of illness, predicted ventriculomegaly in schizophrenia. Studies on schizophrenia and affective disorder differed neither in the extent of reported ventriculomegaly nor in the amount of "cortical atrophy."     

The category test perseveration, loss of set, and memory scales: three new scales and their relationship to executive functioning measures

The Category Test (CT) is a neuropsychological measure that taps into multiple domains of complex reasoning but yields a single error score, limiting the use of the test. In this study, three new CT scales were developed to assess specific aspects of executive dysfunction: Perseveration, Failure to Maintain Cognitive Set, and Inability to Recall and Re-Initiate Past Behavior. The relationship of these scales to well-established neuropsychological measures was examined in head-injured individuals and schizophrenia patients. The CT Perseveration score was correlated with the Wisconsin Card Sorting Test (WCST) Perseverative Responses score, but also with measures from the Wechsler Memory Scale-Revised and the California Verbal Learning Test. The CT Memory score correlated with other memory measures, but also with the WCST Perseveration measure. Although future studies designed to test discriminant and convergent validity are warranted, these scales may be useful in determining specific aspects of impaired CT performance.     

Neurological and neuropsychological signs in obsessive compulsive disorder: interaction with behavioural treatment

The main aim of this study was to test the hypothesis that neurological soft signs and neuropsychological abnormalities associated with obsessive-compulsive disorder (OCD) predict poor response to behavioural treatment. The design permitted investigation of secondary hypotheses, regarding correlations among these neurological markers and levels of symptomatology, and their stability in relation to changes in levels of symptomatology. Thirty-five participants satisfying DSM-IV diagnostic criteria for OCD were assessed pre- and postbehavioural treatment using a scaled measure of symptom severity, and a battery of tests sensitive to neuropsychological deficits associated with OCD. Eighteen of the participants were also assessed on an inventory of neurological soft signs. Neither neuropsychological test deficits nor neurological soft signs pretreatment predicted response to behavioural treatment. Lower performance on neuropsychological tasks and symptom severity were both significantly correlated with levels of soft signs. Some neurological markers were less severe posttreatment, but these changes were not related to treatment response.     

Cerebral perfusion and neuropsychological follow up in mild traumatic brain injury: Acute versus chronic disturbances?

In a subgroup of patients with mild traumatic brain injury (TBI) residual symptoms, interfering with outcome and return to work, are found. With neuropsychological assessment cognitive deficits can be demonstrated although the pathological underpinnings of these cognitive deficits are not fully understood. As the admission computed tomography (CT) often is normal, perfusion CT imaging may be a useful indicator of brain dysfunction in the acute phase after injury in these patients.In the present study, directly after admission perfusion CT imaging was performed in mild TBI patients with follow-up neuropsychological assessment in those with complaints and a normal non-contrast CT. Neuropsychological tests comprised the 15 Words test Immediate Recall, Trailmaking test part B, Zoo Map test and the FEEST, which were dichotomized into normal and abnormal. Perfusion CT results of patients with normal neuropsychological test scores were compared to those with abnormal test scores.In total eighteen patients were included. Those with an abnormal score on the Zoo Map test had a significant lower CBV in the right frontal and the bilateral parieto-temporal white matter. Patients with an abnormal score on the FEEST had a significant higher MTT in the bilateral frontal white matter and a significant decreased CBF in the left parieto-temporal grey matter. No significant relation between the perfusion CT parameters and the 15 Words test and the Trailmaking test part B was present.In conclusion, impairments in executive functioning and emotion perception assessed with neuropsychological tests during follow up were related to differences in cerebral perfusion at admission in mild TBI. The pathophysiological concept of these findings is discussed.     

Pattern of familial psychoses--systematic and unsystematic schizophrenia and cycloid psychoses]

604 cases were examined, 309 of which were systematic schizophrenics, 191 were unsystematic schizophrenics and 104 cycloid psychotics. With the systematic schizophrenics the average period spent in hospital amounted to 16.9 years, with the unsystematic schizophrenics 13.8 years, with the cycloid psychotics 8.2 years. The systematic schizophrenics were discharged from hospital on average 1.5 times, the unsystematic 2.3 times, the cycloid psychotics 4.1 times. Of the systematic schizophrenics, 37.5% were never discharged after their first admittance to hospital, of the unsystematic 25.7%, of the cycloid psychotics 9.6%. Bipolar fluctuations were detected in 1.6% of the systematic schizophrenics, 49.7% of the unsystematic and 78.8% of the cycloid psychotics. 15.9% of the systematic schizophrenics had occurrences of psychoses in their family compared to 50.8% of the unsystematic and 22.1% of the cycloid psychotics. The systematic schizophrenics had 17.5% of their family ill, the unsystematic 69.6%, the cycloid psychotics 25.0%. Of the parents of the systematic schizophrenics 2.3% were ill, of the parents of the unsystematic schizophrenics 11.6%, of the parents of the cycloid psychotics 5.0%. Of the brothers and sisters of the systematic schizophrenics 2.4% were ill, of the unsystematic schizophrenics 10.9%, of the cycloid psychotics 3.0%. These variations in the pattern and occurrence of psychoses in the family seem to prove that the three groups of endogenous psychoses are genetically separable. There are also differentiating features inside the groups. Periodic catatonia in particular is characterized by the great number of psychotics in the family.     

The Draw-A-Person Test and Process-Reactive Schizophrenia

The Draw-A-Pcrson test was administered to three matched groups of 32 male Ss each: reactive schizophrenics, process schizophrenics, and normal control subjects. Patients were rated for prognosis using the Premorbid Subscale of the Phillips Scale. Drawings were rated by two judges on 80 diagnostic signs culled from the literature. No signs were found to significantly differentiate reactive and process schizophrenics, and only three signs significantly differentiated normals from schizophrenics. It was concluded that a sign approach to the DAP is insensitive to the reaction-process dimension of schizophrenia, and of only limited value in differentiating between normals and schizophrenics in general.