- Email: [email protected]
Attentional dysfunction in schizotypal personality disorder
FRIDAY, MAY 19
BIOL PSYCHIATRY 645 1995;37:593-683
186. SEROTONERGIC RESPONSIVITY IN COMPULSIVE PERSONALITY DISORDER
188. ATTENTIONAL DYSFUNCTION IN SCHIZOTYPAL PERSONALITY DISORDER
D.J. Stein l, R. Trestman 2, E. Coccaro -~, V. Mitropoulou 2, E. Hollander 2, & L. Siever 2
A. Bergman 1, S.L. Roitman 2, G. Osgood 2, B. Cornblatt 2, & L. Siever 2
tUniversity o f Stellenbosch, Tygerberg, South Africa; 2Mount Sinai School o f Medicine, N e w York, NY 10029; 3Eastern P A Psychiatric Institute, Philadelphia, P A 19129
1St. J o h n ' s University, Jamaica, NY; 2Mt. Sinai Medical Center, N e w York, NY 10029 and Bronx VA Medical Center, Bronx, NY 10468
Although impulsive and compulsive disorders may appear to lie at opposite ends of a phenomenological and neurobiological spectrum, there is also increasing evidence for their overlap. In particular, both impulsive and compulsive disorders may be characterized by dysregulation of harm assessment and serotonergic dysfunction. In this study, we compared serotonergic function, as assessed by prolactin response to fenfluramine, in male personality disorder patients with compulsive personality disorder (CPD) and other personality disorders (OPD). The two groups did not differ in age, depression, suicide history, or comorbid borderline personality disorder. However, CPD patients had significantly greater impulsive-aggressive scores than OPD patients and significantly blunted prolactin responses compared with OPD patients and normal controls. In the combined patient group, total CPD traits correlated positively with impulsive-aggression score, and inversely with prolactin response. These results support the hypothesis that impulsive and compulsive symptoms do not simply lie at polar ends of a phenomenological and neurobiological spectrum, but rather have a complex intersection.
There is evidence that the boundaries of schizophrenia extend beyond chronic psychotic forms to include milder schizophrenia-related personality disorders. Much of this research has focussed on establishing phenomenological, genetic, psychophysiological, and biological similarities between schizophrenia and schizotypal personality disorder (SPD). Attentional dysfunction has been reliably detected in schizophrenic populations as well as a variety of at-risk populations, suggesting that abnormal attention is a promising indicator of a biological susceptibility to schizophrenia; however, few studies have been conducted investigating attentional dysfunction in clinical SPD patients. The goal of this study was to examine the attentional functioning of SPD patients, patients with other personality disorders (OPD), and normal subjects assessed by the Continuous Performance Test Identical Pairs version (CPT-IP). Subjects (n = 65) were assessed as part of ongoing psychobiological studies of mood and personality disorders in two medical centers; 23 subjects had a DSM-IlI diagnosis of SPD; 32 subjects had a DSM-III diagnosis of a personality disorder other than SPD; and 10 subjects served as normal controls. For all groups, attentional functioning was measured with the Continuous Performance Test-Identical Pairs version (CPT-IP), which includes both a verbal condition (four digits) and spatial condition (nonsense shapes). Analyses of attentional functioning measured as d' indicate that SPD patients perform significantly worse than both OPD and normal subjects on the verbal condition (F[2,62] = 8.0, p < 0.001). In contrast, both SPD and OPD patients performed significantly worse than normal subjects on the spatial condition (F[2,61 ] ~ 4.0, p < 0.03). These results indicate that SPD patients, like schizophrenic patients, have a global attentional deficit including both spatial and verbal processing. In contrast, OPD patients appear to have a specific deficit involving spatial processing, which has also been previously reported in a sample of patients with affective disorders. These results support the notion of a schizophrenia spectrum, with disorders ranging from chronic schizophrenia to milder, schizophrenia-related personality traits.
187. CINGULATE AND RIGHT TEMPORAL GLUCOSE METABOLIC RATES CORRELATE WITH IMPULSIVE AGGRESSION IN CLOSED HEAD INJURY PATIENTS P. Andreason, J. Umhau, W. Williams, R. Momenan, M. Kerich, D. Rio, G.L. Brown, D. Hommer, & M. Linnoila NIH, N I A A A , DICBR, Laboratory o f Clinical Studies, Bethesda, M D 20892 Since the time of Phineas Gage, frontal h)be brain injury has been associated anecdotally with social disinhibition and increased impulsive aggression. Seven male patients, who had sustained a closed head injury that resulted in a qualitative increase in aggressive/impulsive behavior, and 11 male controls received 18F-2-fluoro-2-deoxyglucose (FDG) PET scans and were interviewed and rated using the Brown-Goodwin Life-time History of Aggression Scale (BG). Subjects performed an auditory performance task (CPT) for 30 minutes during the uptake of 5mCi FDG, IV. A time-activity curve was constructed via serial arterial bh×)d samples to calculate absolute glucose metabolic rates (CMRglu). Three 10-minute emission scans were acquired over the 30 minutes following the FDG uptake period on a Scanditronix 2048-15B scanner with 6 mm resolution. Analysis was performed by placing regions of interest over the mesial frontal area, the anterior cingulate, the orbital frontal area, and the right temporal lobe. Other regions were placed systematically to look empirically for group differences. Head-injured patients were more aggressive than controls (patients BG = 15.4, controls BG = 4.5, p = 0.0001). CMRglu group differences were present in the anterior cingulate (p = 0.02). Negative correlations of CMRglu and BG were significant in the anterior cingulate (p = 0.01 ), and right temporal regions (p = 0.02), and trend in the mesial frontal (p = 0.09). There were no global metabolic differences between patients and controls.
189. TRIAZOLAM AND DIPHENHYDRAMINE EFFECTS ON ECT S.K. Guthrie t, 2, J.C-Y. Sung l, J. Goodson 2, & A. Ramen 2 1College of Pharmacy, University o f Michigan, Ann Arbor, MI 48109-1065; 2Department o f Psychiatry, University o f Michigan, Ann Arbor, MI Insomnia is common in patients referred for ECT. Benzodiazepines may be withheld prior to ECT due to their antiseizure activity, even short halflife benztx:liazepines such as triazolam (TRZ). Another commonly used hypnotic, diphenhydramine (DPH), has no documented antiseizure activity. In this randomized, double-blind study, depressed patients receiving ECT took DPH (50 mg), TRZ, or placebo (PLB) on the evening prior to the second, third, and fourth ECT treatments. Older patients (O; _>65 years old; n = 12) received 0.125 mg TRZ and younger patients (Y; <65 years old; n = 8) received 0.25 mg TRZ. On the evening preceding study ECT sessions, the hours slept and the number of awakenings during the night were recorded. The duration of seizure during the study ECT was also recorded. Seizure duration data was analyzed using a two-way ANOVA,
BIOL PSYCHIATRY 645 1995;37:593-683
186. SEROTONERGIC RESPONSIVITY IN COMPULSIVE PERSONALITY DISORDER
188. ATTENTIONAL DYSFUNCTION IN SCHIZOTYPAL PERSONALITY DISORDER
D.J. Stein l, R. Trestman 2, E. Coccaro -~, V. Mitropoulou 2, E. Hollander 2, & L. Siever 2
A. Bergman 1, S.L. Roitman 2, G. Osgood 2, B. Cornblatt 2, & L. Siever 2
tUniversity o f Stellenbosch, Tygerberg, South Africa; 2Mount Sinai School o f Medicine, N e w York, NY 10029; 3Eastern P A Psychiatric Institute, Philadelphia, P A 19129
1St. J o h n ' s University, Jamaica, NY; 2Mt. Sinai Medical Center, N e w York, NY 10029 and Bronx VA Medical Center, Bronx, NY 10468
Although impulsive and compulsive disorders may appear to lie at opposite ends of a phenomenological and neurobiological spectrum, there is also increasing evidence for their overlap. In particular, both impulsive and compulsive disorders may be characterized by dysregulation of harm assessment and serotonergic dysfunction. In this study, we compared serotonergic function, as assessed by prolactin response to fenfluramine, in male personality disorder patients with compulsive personality disorder (CPD) and other personality disorders (OPD). The two groups did not differ in age, depression, suicide history, or comorbid borderline personality disorder. However, CPD patients had significantly greater impulsive-aggressive scores than OPD patients and significantly blunted prolactin responses compared with OPD patients and normal controls. In the combined patient group, total CPD traits correlated positively with impulsive-aggression score, and inversely with prolactin response. These results support the hypothesis that impulsive and compulsive symptoms do not simply lie at polar ends of a phenomenological and neurobiological spectrum, but rather have a complex intersection.
There is evidence that the boundaries of schizophrenia extend beyond chronic psychotic forms to include milder schizophrenia-related personality disorders. Much of this research has focussed on establishing phenomenological, genetic, psychophysiological, and biological similarities between schizophrenia and schizotypal personality disorder (SPD). Attentional dysfunction has been reliably detected in schizophrenic populations as well as a variety of at-risk populations, suggesting that abnormal attention is a promising indicator of a biological susceptibility to schizophrenia; however, few studies have been conducted investigating attentional dysfunction in clinical SPD patients. The goal of this study was to examine the attentional functioning of SPD patients, patients with other personality disorders (OPD), and normal subjects assessed by the Continuous Performance Test Identical Pairs version (CPT-IP). Subjects (n = 65) were assessed as part of ongoing psychobiological studies of mood and personality disorders in two medical centers; 23 subjects had a DSM-IlI diagnosis of SPD; 32 subjects had a DSM-III diagnosis of a personality disorder other than SPD; and 10 subjects served as normal controls. For all groups, attentional functioning was measured with the Continuous Performance Test-Identical Pairs version (CPT-IP), which includes both a verbal condition (four digits) and spatial condition (nonsense shapes). Analyses of attentional functioning measured as d' indicate that SPD patients perform significantly worse than both OPD and normal subjects on the verbal condition (F[2,62] = 8.0, p < 0.001). In contrast, both SPD and OPD patients performed significantly worse than normal subjects on the spatial condition (F[2,61 ] ~ 4.0, p < 0.03). These results indicate that SPD patients, like schizophrenic patients, have a global attentional deficit including both spatial and verbal processing. In contrast, OPD patients appear to have a specific deficit involving spatial processing, which has also been previously reported in a sample of patients with affective disorders. These results support the notion of a schizophrenia spectrum, with disorders ranging from chronic schizophrenia to milder, schizophrenia-related personality traits.
187. CINGULATE AND RIGHT TEMPORAL GLUCOSE METABOLIC RATES CORRELATE WITH IMPULSIVE AGGRESSION IN CLOSED HEAD INJURY PATIENTS P. Andreason, J. Umhau, W. Williams, R. Momenan, M. Kerich, D. Rio, G.L. Brown, D. Hommer, & M. Linnoila NIH, N I A A A , DICBR, Laboratory o f Clinical Studies, Bethesda, M D 20892 Since the time of Phineas Gage, frontal h)be brain injury has been associated anecdotally with social disinhibition and increased impulsive aggression. Seven male patients, who had sustained a closed head injury that resulted in a qualitative increase in aggressive/impulsive behavior, and 11 male controls received 18F-2-fluoro-2-deoxyglucose (FDG) PET scans and were interviewed and rated using the Brown-Goodwin Life-time History of Aggression Scale (BG). Subjects performed an auditory performance task (CPT) for 30 minutes during the uptake of 5mCi FDG, IV. A time-activity curve was constructed via serial arterial bh×)d samples to calculate absolute glucose metabolic rates (CMRglu). Three 10-minute emission scans were acquired over the 30 minutes following the FDG uptake period on a Scanditronix 2048-15B scanner with 6 mm resolution. Analysis was performed by placing regions of interest over the mesial frontal area, the anterior cingulate, the orbital frontal area, and the right temporal lobe. Other regions were placed systematically to look empirically for group differences. Head-injured patients were more aggressive than controls (patients BG = 15.4, controls BG = 4.5, p = 0.0001). CMRglu group differences were present in the anterior cingulate (p = 0.02). Negative correlations of CMRglu and BG were significant in the anterior cingulate (p = 0.01 ), and right temporal regions (p = 0.02), and trend in the mesial frontal (p = 0.09). There were no global metabolic differences between patients and controls.
189. TRIAZOLAM AND DIPHENHYDRAMINE EFFECTS ON ECT S.K. Guthrie t, 2, J.C-Y. Sung l, J. Goodson 2, & A. Ramen 2 1College of Pharmacy, University o f Michigan, Ann Arbor, MI 48109-1065; 2Department o f Psychiatry, University o f Michigan, Ann Arbor, MI Insomnia is common in patients referred for ECT. Benzodiazepines may be withheld prior to ECT due to their antiseizure activity, even short halflife benztx:liazepines such as triazolam (TRZ). Another commonly used hypnotic, diphenhydramine (DPH), has no documented antiseizure activity. In this randomized, double-blind study, depressed patients receiving ECT took DPH (50 mg), TRZ, or placebo (PLB) on the evening prior to the second, third, and fourth ECT treatments. Older patients (O; _>65 years old; n = 12) received 0.125 mg TRZ and younger patients (Y; <65 years old; n = 8) received 0.25 mg TRZ. On the evening preceding study ECT sessions, the hours slept and the number of awakenings during the night were recorded. The duration of seizure during the study ECT was also recorded. Seizure duration data was analyzed using a two-way ANOVA,