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Suicidal behavior in schizophrenia
Schizophrenia
BIOL PSYCHIATRY
199o~27:41A- 179A
121 A
179 SEX DIFFERENCES IN NEUROCOGNITION OF
SCHIZOPHRENIA Gretchen L. Haas, Ph.D. (by invitation), John A. Sweeney, Ph.D. (by invita"~)n), John G. Keilp, Ph.D. (by invitation), Denise A. Hien, M.A. (by invitation), Alien J. Frances, M.D. Payne Whitney Clinic, CorneU University Medical College, New York, NF 10021. Gender differences in the onset and course of schizophrenia suggest a more benign form of disorder among females. Little is known about determinants of such gender-related heterogeneity of the disorder. One hundred five male and 81 female inpatients with DSM-III-R (SCID) schizophrenia, schizoaffective, and schizophreniform disorders were compared on clinical, neuroanatomic, and neurocognitive measurements. Males had an earlier age of onset of psychotic symptoms (p < 0.03), earlier age of first medication (p < 0.05), and more severe negative symptoms (p < 0.05). r~emales presented with more severe formal thought disorder on admission (p < 0.05) and I~etter global functioning at both admission and discharge (p < 0.05). Males showed a trend for greater ventricular enlargement (p < 0.09) and greater impahnlent on specific dimensions of neuropsycbological functioning, tapping verbal memory (p < 0.05). Results indicate gender differences in clinical symptomatology and neurocognitive and neuroanatomic abnormalities of schizophrenia. These findings suggest that the clinical and neurocognitive correlates of schizophrenia may differ for the two genders.
180 PSYCHOBIOLOGY OF SUICIDE iN SCHIZOPHRENIA John A. Sweeney, Ph.D., Gretchen L. Haas, Ph.D., Peter J. Weiden, M.D., J. John Mann, M.D. Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA 15213. Epidemiological studies indicate that 10% of schizophrenics die by suicide. Limited understanding of the causes of this phenomenon hampers clinical efforts to identify high-risk patients. Patients (n - 10) who had made a suicide attempt within 3 years (intent to die with serious medical injury) demonstrated fewer negative symptoms, better performance on a range of neuropsychological tests, fewer eye movement impairments, and smaller third ventricles on CT scan. Greater severity of hallucinations despite higher levels of neuroleptic medication suggests greater treatment resistance in s~.hizophrenics with a history of suicidal behavior. Schizophrenic patients without CNS deficits may be at higher risk tor bai¢ide: ~ssibly as a result of preserved motivation, range of emotion, volition, and behavioral activity, particularly if they are !ess responsive to neuroleptic medications.
18! SUICIDAL BEHAVIOR IN SCHIZOPHRENIA J. Sidney Jones, M.D., Barbara Stanley, Ph.D., Jeannine Guido, M.A., Ronald Winchel, M.D., Michael Stanley, Ph.D., New York State Psychiatric :nstitute, New Fork, NY 10032. The rate of suicide in schizophrenic patients is several times higher than in the general population. Identification of those at highest risk remains a problem for the clinician. This study examines the importance of depressive and negative symptoms as well as the value of the dexamethasone suppression test (DST) in differentiating schizophrenics with and without a history of suicide attempts. We evaluated 59 schizophrenic patients, 25 of whom had a history of at least one suicide attempt. The majority of the sample were chronic paranoid schizophrenics. Demographic variables, including age, gender, and education, did not differentiate suicide attempters from those without a history of attempts. The Hamilton Depression Scale (HAM-D) was used to assess depression. The severity of negative symptoms was evaluated by summing Brief Psychiatric
122A
Alzheimer's Disease
BIOL PSYCHIATRY 1990;27:41A-179A
Rating Scale (BPRS) items, emotional withdrawal, motor retardation, and blunted affect. These items have been shown to be highly correlated with the Scale for the Assessment of Negative Symptoms (SANS) (Thiemann et al., 1986). Dexamethasone (1 mg) was given at the end of a 2 week neuroleptic ii'ee evaluation period at 11 pM. Serum cortisol levels were drawn at 9 AM and 4 PM the following day. Total HAM-D scores differentiated schizophrenics with a history of suicide attempts from those without a history of attempts, with attempters displaying more depressive symptoms than nonattempters (t = 3.4, df = 56, p < 0.002). BPRS negative symptom scores did not distinguish between the groups. Both AM and PM cortisol levels correlated with the total HAM-D score (r = 0.063, n = 17, p < 0.01; r = 0.65, n = 17, p < 0.01; respectively), whereas they did not correlate with the BPRS negative symptom scores. This study suggests that depressive and negative symptoms should be evaluated separately because depressive symptoms are important in the identification of schizophrenics at higher risk for suicidal behavior. Whereas HAM-D and negative symptom scores are correlated (r = 0.31, n = 57, p < 0.02), DST results were correlated with HAM-D scores but not with negative scores. These findings reinforce that depressive and negative symptoms are separate constructs.
ALZHEIMER'S DISEASE F r i d a y , M a y 11, 1 : 0 0 - 6 : 0 0 PM
Versailles'; B a l l r o o m
182 PHOSPHOINOSITIDE TURNOVER AND CALCIUM SIGNALING IN ALZHEIMER'S FIBROBLASTS Alan M. Mellow, M.D., Ph.D., Stephen K. Fisher, Ph.D., Bernard W. Agranoff, M.D. Department of Psychiatry, Mental Health Research Institute, University of Michigan Medical Center, Ann Arbor, M! 48104.1687. Abnormalities in intracellular calcium ion (Ca2+) homeostasis have been reported in both normal aging and in Alzheimer's disease (AD). Since the phosphoinositide (PPl) second messenger system is intimately linked to calcium signalL~g, we chose to examine its activity in AD fibroblasts. Skin fibroblast cultures (Coriell Institute) from both AD patients (n = 5) and age-matched controls (n = 6) were assayed for bradykinin (BK)-stimulated PPl turnover by measurement of the accumulation of 3H-labeled inositol phosphates in the presence of lithium. Resting and BK-stimulated intracellular Ca2+ levels were measured using the fluorescent calcium dye indicator fum-2. BK-stimulated PPI turnover did not differ between the two groups (AD 3.6 -*- 0.6-fold stimulation; Ctrls 4.1 .4- 1.9-fold stimulation). In addition, resting (AD 123 .4- 25 nM; Ctrls 139 - 22 nM) and stimulated (AD 8.9 - 4.l-fold stimulation; Ctrls 7.8 .4- 4.0-fold stimulation) Ca2+ levels did not significantlydistinguish AD patients from controls. PPl turnover thus appears to be preserved in AD fibroblasts. Furthermore, in our hands, calcium homeostasis is also unchanged. Although alterations in these processes may still be important in AD, they are not expressed in this cultured fibroblast system.
183 RELATIONSHIP BETWEEN SOMATOSTATIN AND 5-HIAA IN
ALZHEIMER'S DISEASE AND GERIATRIC DEPRESSION S.E. Molchan, M.D., B.A. Lawlor, M.D., R.A. Martinez, M.D., D.R. Rubinow, M.D., B. Vitiello, M.D., and T. Sunderland, M.D. Laboratory of Clinical Science, National Institute of Mental Health, Bethesda, MD 20892. Previous studies have shown multiple monoamine and neuropeptidergic system deficits in patients with Alzheimer's disease (AD). Somatostatin has been the neuropeptide most consistently shown to be decreased. Neuropathological studies have shown that decreased somatostatin-like immunoreactivity (SLI) correlates with the decreased number of serotonin (specifically S2)-receptors in frontal and temporal cortices in AD.
BIOL PSYCHIATRY
199o~27:41A- 179A
121 A
179 SEX DIFFERENCES IN NEUROCOGNITION OF
SCHIZOPHRENIA Gretchen L. Haas, Ph.D. (by invitation), John A. Sweeney, Ph.D. (by invita"~)n), John G. Keilp, Ph.D. (by invitation), Denise A. Hien, M.A. (by invitation), Alien J. Frances, M.D. Payne Whitney Clinic, CorneU University Medical College, New York, NF 10021. Gender differences in the onset and course of schizophrenia suggest a more benign form of disorder among females. Little is known about determinants of such gender-related heterogeneity of the disorder. One hundred five male and 81 female inpatients with DSM-III-R (SCID) schizophrenia, schizoaffective, and schizophreniform disorders were compared on clinical, neuroanatomic, and neurocognitive measurements. Males had an earlier age of onset of psychotic symptoms (p < 0.03), earlier age of first medication (p < 0.05), and more severe negative symptoms (p < 0.05). r~emales presented with more severe formal thought disorder on admission (p < 0.05) and I~etter global functioning at both admission and discharge (p < 0.05). Males showed a trend for greater ventricular enlargement (p < 0.09) and greater impahnlent on specific dimensions of neuropsycbological functioning, tapping verbal memory (p < 0.05). Results indicate gender differences in clinical symptomatology and neurocognitive and neuroanatomic abnormalities of schizophrenia. These findings suggest that the clinical and neurocognitive correlates of schizophrenia may differ for the two genders.
180 PSYCHOBIOLOGY OF SUICIDE iN SCHIZOPHRENIA John A. Sweeney, Ph.D., Gretchen L. Haas, Ph.D., Peter J. Weiden, M.D., J. John Mann, M.D. Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA 15213. Epidemiological studies indicate that 10% of schizophrenics die by suicide. Limited understanding of the causes of this phenomenon hampers clinical efforts to identify high-risk patients. Patients (n - 10) who had made a suicide attempt within 3 years (intent to die with serious medical injury) demonstrated fewer negative symptoms, better performance on a range of neuropsychological tests, fewer eye movement impairments, and smaller third ventricles on CT scan. Greater severity of hallucinations despite higher levels of neuroleptic medication suggests greater treatment resistance in s~.hizophrenics with a history of suicidal behavior. Schizophrenic patients without CNS deficits may be at higher risk tor bai¢ide: ~ssibly as a result of preserved motivation, range of emotion, volition, and behavioral activity, particularly if they are !ess responsive to neuroleptic medications.
18! SUICIDAL BEHAVIOR IN SCHIZOPHRENIA J. Sidney Jones, M.D., Barbara Stanley, Ph.D., Jeannine Guido, M.A., Ronald Winchel, M.D., Michael Stanley, Ph.D., New York State Psychiatric :nstitute, New Fork, NY 10032. The rate of suicide in schizophrenic patients is several times higher than in the general population. Identification of those at highest risk remains a problem for the clinician. This study examines the importance of depressive and negative symptoms as well as the value of the dexamethasone suppression test (DST) in differentiating schizophrenics with and without a history of suicide attempts. We evaluated 59 schizophrenic patients, 25 of whom had a history of at least one suicide attempt. The majority of the sample were chronic paranoid schizophrenics. Demographic variables, including age, gender, and education, did not differentiate suicide attempters from those without a history of attempts. The Hamilton Depression Scale (HAM-D) was used to assess depression. The severity of negative symptoms was evaluated by summing Brief Psychiatric
122A
Alzheimer's Disease
BIOL PSYCHIATRY 1990;27:41A-179A
Rating Scale (BPRS) items, emotional withdrawal, motor retardation, and blunted affect. These items have been shown to be highly correlated with the Scale for the Assessment of Negative Symptoms (SANS) (Thiemann et al., 1986). Dexamethasone (1 mg) was given at the end of a 2 week neuroleptic ii'ee evaluation period at 11 pM. Serum cortisol levels were drawn at 9 AM and 4 PM the following day. Total HAM-D scores differentiated schizophrenics with a history of suicide attempts from those without a history of attempts, with attempters displaying more depressive symptoms than nonattempters (t = 3.4, df = 56, p < 0.002). BPRS negative symptom scores did not distinguish between the groups. Both AM and PM cortisol levels correlated with the total HAM-D score (r = 0.063, n = 17, p < 0.01; r = 0.65, n = 17, p < 0.01; respectively), whereas they did not correlate with the BPRS negative symptom scores. This study suggests that depressive and negative symptoms should be evaluated separately because depressive symptoms are important in the identification of schizophrenics at higher risk for suicidal behavior. Whereas HAM-D and negative symptom scores are correlated (r = 0.31, n = 57, p < 0.02), DST results were correlated with HAM-D scores but not with negative scores. These findings reinforce that depressive and negative symptoms are separate constructs.
ALZHEIMER'S DISEASE F r i d a y , M a y 11, 1 : 0 0 - 6 : 0 0 PM
Versailles'; B a l l r o o m
182 PHOSPHOINOSITIDE TURNOVER AND CALCIUM SIGNALING IN ALZHEIMER'S FIBROBLASTS Alan M. Mellow, M.D., Ph.D., Stephen K. Fisher, Ph.D., Bernard W. Agranoff, M.D. Department of Psychiatry, Mental Health Research Institute, University of Michigan Medical Center, Ann Arbor, M! 48104.1687. Abnormalities in intracellular calcium ion (Ca2+) homeostasis have been reported in both normal aging and in Alzheimer's disease (AD). Since the phosphoinositide (PPl) second messenger system is intimately linked to calcium signalL~g, we chose to examine its activity in AD fibroblasts. Skin fibroblast cultures (Coriell Institute) from both AD patients (n = 5) and age-matched controls (n = 6) were assayed for bradykinin (BK)-stimulated PPl turnover by measurement of the accumulation of 3H-labeled inositol phosphates in the presence of lithium. Resting and BK-stimulated intracellular Ca2+ levels were measured using the fluorescent calcium dye indicator fum-2. BK-stimulated PPI turnover did not differ between the two groups (AD 3.6 -*- 0.6-fold stimulation; Ctrls 4.1 .4- 1.9-fold stimulation). In addition, resting (AD 123 .4- 25 nM; Ctrls 139 - 22 nM) and stimulated (AD 8.9 - 4.l-fold stimulation; Ctrls 7.8 .4- 4.0-fold stimulation) Ca2+ levels did not significantlydistinguish AD patients from controls. PPl turnover thus appears to be preserved in AD fibroblasts. Furthermore, in our hands, calcium homeostasis is also unchanged. Although alterations in these processes may still be important in AD, they are not expressed in this cultured fibroblast system.
183 RELATIONSHIP BETWEEN SOMATOSTATIN AND 5-HIAA IN
ALZHEIMER'S DISEASE AND GERIATRIC DEPRESSION S.E. Molchan, M.D., B.A. Lawlor, M.D., R.A. Martinez, M.D., D.R. Rubinow, M.D., B. Vitiello, M.D., and T. Sunderland, M.D. Laboratory of Clinical Science, National Institute of Mental Health, Bethesda, MD 20892. Previous studies have shown multiple monoamine and neuropeptidergic system deficits in patients with Alzheimer's disease (AD). Somatostatin has been the neuropeptide most consistently shown to be decreased. Neuropathological studies have shown that decreased somatostatin-like immunoreactivity (SLI) correlates with the decreased number of serotonin (specifically S2)-receptors in frontal and temporal cortices in AD.