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Impaired frontal lobe function in schizophrenia is familial
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AGE DISORIENTATION IN CHRONICALLY INSTITUTIONALIZED AFFECTIVE D I S O R D E R PATIENTS: SIMILARITY TO SCHIZOPHRENIA P.D. Harvey*, J. Lombardi, L. White, M. Parrella, P. Powchik, M. Davidson Department of Psychiatry, Mt. Sinai School of Medicine, New York, N Y lO029, USA Studies of chronic schizophrenic patients have found that 20-30% of these patients misstate their age by 5 years or more and that these patients are notable because of global intellectual impairments and changes in the structures of their cerebal cortex. It is not clear if these deficits are specific to schizophrenia, because chronic mood disorder patients were not previously studied. Thirty-two patients with mood disorders who had been hospitalized for more than 10 consecutive years were examined. Six (19%) of the patients were age-disoriented and those patients manifested global intellectual impairment (mean M M S E = 1 6 ) compared to the age-oriented patients (mean M MSE = 23). No differences in premorbid functioning or treatment history were found. The prevalence of age disorientation and its association with global cognitive impairment were completely consistent with earlier studies of chronic schizophrenic patients. Previous continuum conceptions of psychotic disorders have suggested that affective disorders and schizophrenia may exist on a continuum marked by differences in affect expression and gender distribution. These data suggest that outcome is another crucial dimension to consider, in that poor outcome cases may be very similar across the affective/ schizophrenic nosological distinction.
MEMORY FUNCTIONS IN CHRONIC SCHIZOPHRENIC PATIENTS: AGE RELATED CHANGES K.M. P u t n a m , P.D. Harvey*, L. White, M. Parrella, P. Powchik, M. D a v i d s o n
Department of Psychiatry, Mt. Sinai School of Medicine, New York, N Y 10029, USA Memory impairments in schizophrenia have begun to attract more research attention, because of their potential to identify regional brain dysfunction. Since memory functions change with age in nonclinical populations, studies of aging in schizophrenia can delineate typical age-related changes from the influences of schizophrenia. Twenty-five geriatric chronic inpatients (mean age=76) were compared to 25 younger chronic inpatients (mean age = 45) on a memory battery that examined serial learning and delayed recall (CVLT), recall vs recognition memory (Calev test), and implicit vs explicit learning. Multitrial serial learning, recall memory, and explicit memory performance all declined significantly (p<0.01), while recognition memory and implicit learning did not change with age. Geriatric
patients generated significantly more false recognitions on both the CVLT and the recognition memory component of the Calev test, although they did not produce spontaneous confabulations on the recall memory tests. MMSE total scores were also unassociated with recognition performance and implicit memory functions, although they strongly predicted the number of false recognitions and failures in recall memory and explicit learning procedures. These data suggest that the memory failures in schizophrenia share features with anterograde amnestic conditions and do not resemble the memory impairments in Alzheimer's Disease. Age-related changes in schizophrenia are consistent with those seen in normal aging, again supporting the idea that the global cognitive impairment seen in many of these patients is an intrinsic feature of the illness for a subgroup.
IMPAIRED FRONTAL LOBE F U N C T I O N IN SCHIZOPHRENIA IS FAMILIAL J o n a t h a n S.E. Hellewell*, J.F. William D e a k i n
University of Manchester Department of Psychiatry, Withington Hospital, West Didsbury, Manchester M20 8LR, UK We have investigated whether genetic mechanisms mediate the impaired performance of schizophrenic subjects on tests of frontal and temporal lobe function. Sample: 80 familial schizophrenics, 84 unaffected relatives, 35 unaffected control subjects. On 60% trials in the antisaccade paradigm, schizophrenic subjects failed to suppress reflexive saccades to a distractor light. Error rate in controls was 18%, while relatives showed a bimodal distribution with a mean rate of 40%. This task requires intact frontal lobe function. Schizophrenics and relatives were impaired on other tests of frontal lobe function (verbal fluency, cognitive estimation, sequencing, trail-making). However, only the schizophrenic group impaired on tests of temporal lobe function (verbal and non-verbal learning, recall and recognition). Multiple regression analyses using antisaccade error rate, verbal fluency and trail B indicated that each contributed unique variance to the discrimination between groups. The performance of 16 obligate carriers (relatives with both a child with schizophrenia and a parent or sibling) on tests of frontal lobe function was worse than that of the relatives as a whole. We propose that the endophenotype for schizophrenia is disordered development of frontal cortex which is manifest in some relatives while an additional process affecting temporal lobe function is necessary for the development of the psychosis.
M E M O R Y IMPAIRMENTS IN S C H I Z O P H R E N I A - - EVIDENCE FOR DEFICITS IN E N C O D I N G A N D P O S T - E N C O D I N G PROCESSES J o n a t h a n S.E. Hellewell*, J.F. William D e a k i n
University of Manchester Department of Psychiatry, Withington Hospital, West Didsbury, Manchester M20 8LR, UK
AGE DISORIENTATION IN CHRONICALLY INSTITUTIONALIZED AFFECTIVE D I S O R D E R PATIENTS: SIMILARITY TO SCHIZOPHRENIA P.D. Harvey*, J. Lombardi, L. White, M. Parrella, P. Powchik, M. Davidson Department of Psychiatry, Mt. Sinai School of Medicine, New York, N Y lO029, USA Studies of chronic schizophrenic patients have found that 20-30% of these patients misstate their age by 5 years or more and that these patients are notable because of global intellectual impairments and changes in the structures of their cerebal cortex. It is not clear if these deficits are specific to schizophrenia, because chronic mood disorder patients were not previously studied. Thirty-two patients with mood disorders who had been hospitalized for more than 10 consecutive years were examined. Six (19%) of the patients were age-disoriented and those patients manifested global intellectual impairment (mean M M S E = 1 6 ) compared to the age-oriented patients (mean M MSE = 23). No differences in premorbid functioning or treatment history were found. The prevalence of age disorientation and its association with global cognitive impairment were completely consistent with earlier studies of chronic schizophrenic patients. Previous continuum conceptions of psychotic disorders have suggested that affective disorders and schizophrenia may exist on a continuum marked by differences in affect expression and gender distribution. These data suggest that outcome is another crucial dimension to consider, in that poor outcome cases may be very similar across the affective/ schizophrenic nosological distinction.
MEMORY FUNCTIONS IN CHRONIC SCHIZOPHRENIC PATIENTS: AGE RELATED CHANGES K.M. P u t n a m , P.D. Harvey*, L. White, M. Parrella, P. Powchik, M. D a v i d s o n
Department of Psychiatry, Mt. Sinai School of Medicine, New York, N Y 10029, USA Memory impairments in schizophrenia have begun to attract more research attention, because of their potential to identify regional brain dysfunction. Since memory functions change with age in nonclinical populations, studies of aging in schizophrenia can delineate typical age-related changes from the influences of schizophrenia. Twenty-five geriatric chronic inpatients (mean age=76) were compared to 25 younger chronic inpatients (mean age = 45) on a memory battery that examined serial learning and delayed recall (CVLT), recall vs recognition memory (Calev test), and implicit vs explicit learning. Multitrial serial learning, recall memory, and explicit memory performance all declined significantly (p<0.01), while recognition memory and implicit learning did not change with age. Geriatric
patients generated significantly more false recognitions on both the CVLT and the recognition memory component of the Calev test, although they did not produce spontaneous confabulations on the recall memory tests. MMSE total scores were also unassociated with recognition performance and implicit memory functions, although they strongly predicted the number of false recognitions and failures in recall memory and explicit learning procedures. These data suggest that the memory failures in schizophrenia share features with anterograde amnestic conditions and do not resemble the memory impairments in Alzheimer's Disease. Age-related changes in schizophrenia are consistent with those seen in normal aging, again supporting the idea that the global cognitive impairment seen in many of these patients is an intrinsic feature of the illness for a subgroup.
IMPAIRED FRONTAL LOBE F U N C T I O N IN SCHIZOPHRENIA IS FAMILIAL J o n a t h a n S.E. Hellewell*, J.F. William D e a k i n
University of Manchester Department of Psychiatry, Withington Hospital, West Didsbury, Manchester M20 8LR, UK We have investigated whether genetic mechanisms mediate the impaired performance of schizophrenic subjects on tests of frontal and temporal lobe function. Sample: 80 familial schizophrenics, 84 unaffected relatives, 35 unaffected control subjects. On 60% trials in the antisaccade paradigm, schizophrenic subjects failed to suppress reflexive saccades to a distractor light. Error rate in controls was 18%, while relatives showed a bimodal distribution with a mean rate of 40%. This task requires intact frontal lobe function. Schizophrenics and relatives were impaired on other tests of frontal lobe function (verbal fluency, cognitive estimation, sequencing, trail-making). However, only the schizophrenic group impaired on tests of temporal lobe function (verbal and non-verbal learning, recall and recognition). Multiple regression analyses using antisaccade error rate, verbal fluency and trail B indicated that each contributed unique variance to the discrimination between groups. The performance of 16 obligate carriers (relatives with both a child with schizophrenia and a parent or sibling) on tests of frontal lobe function was worse than that of the relatives as a whole. We propose that the endophenotype for schizophrenia is disordered development of frontal cortex which is manifest in some relatives while an additional process affecting temporal lobe function is necessary for the development of the psychosis.
M E M O R Y IMPAIRMENTS IN S C H I Z O P H R E N I A - - EVIDENCE FOR DEFICITS IN E N C O D I N G A N D P O S T - E N C O D I N G PROCESSES J o n a t h a n S.E. Hellewell*, J.F. William D e a k i n
University of Manchester Department of Psychiatry, Withington Hospital, West Didsbury, Manchester M20 8LR, UK