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The kindling phenomenon: A likely etiopathogenic mechanism of cycloid psychosis
Cycloid or atypical psychoses versus schizophrenia
BIOL. PSYCHIATRY 1997;42:15-2975
1955
Symposia
66. Cycloid or atypical psychoses versus schizophrenia: Neurobiological evidence in favor of the differentiation
166-21 Specific P30o-features In cycloid psychoses and schizophrenia Wemer Konrad Strik. Department of Psychlafry. University Hospital Wurzburp, Gennany
:ca.
Low P300 amplitudes and topographical asymmetries have been repeat• edly described and are considered to be typical for schizophrenia. In a group of DSM·III·R schizophrenics, however, no significant differences between schizophrenics and controls were found after remission of the acute psychotic episode. SubdiViding the group into cycloid psychoses and schizophrenias according to Leonhard's classification, distinct P300-features were Identified. While low amplitudes and pathological asymmetries were found In schizophrenics, no topographical abnormalities but higher than normal amplitudes were found In cycloid psychoses (Strik et al; Acta Psy• chiat Scand, 87: 179-183). In two replication studies, these results were confirmed In Leonhard's schizophrenia (Strik et al; Psychiatry Res: Neu• roimaging, 55: 153-166) and in cycloid psychoses (Strik et al; Acta Psychi• atry Scand, In press). Pathological P3OO-asymmetries with right lateralized peaks are supposed to be expression of left temporal functional defiCits. High P300-amplitudes, at present, appear to be specific for cycloid psychosis and are Interpreted as an expression of a high psycho-vegetative excitation level (Heidrich and Strik; Bioi Psychiatry, In press). The distinction of schizophrenic groups into cyloid psychoses and core schizophrenics appears to be useful and necessary to identify psychophysiologically homogenous groups.
I!)'Illcai
166-31 The kindling phenomenon: A likely etlopathogenlc mechanism of cycloid psychosis
166-11 Brain Imaging approach to atypical psychoses t Hayashi H. Suga, N. Hotta, T. Andoh, M. Ohara. Dept of ~iatry. A/chi Medical University. Nagakute. Aichl. Japan ~ order to Investigate the heterogeneity of schizophrenic psychosis, we have alreadY studied not only the sociodemographic differences, but the brain morphological and functional diffe~ences ~tw~en typical schizophrenia n atypieaI psychoses using Mltsuda s classification system. The present communiCation deals with our attempts to pursue the etiology of atypical PI)'Cho&eS bY means of brain imaging techniques. u.thod .nd Results: The subjects for our CT study were 68 patients Wllh hallucinations and/or delusions, or psychotic abnormal behavior who treated as Inpatients or outpatients in the psychiatric ward of Aichi University Hospital. Applying Mltsuda's classnication system, the were divided Into 41 schizophrenics and 27 atypical psychotics. The ~enicS had significantly enlarged ventricles and dilated cerebral INureS In terms of ventricular brain ratio, lateral ventricle and third ventricle ideeS and syIvian fissure and interhemispheric fissure Indices, while the psychotiCS had larger values for sylvian fissure indices, especially tlt I1ght side compared to controls. Moreover, the dilatation of sylvian Iisu8S In atypical psychoses correlated well with the duration of illness, whereaS there were no correlations In schizophrenia. The subjects for our SPECT study were 18 schizophrenics and 16 atypical ychotiCS The regional cerebral (rCU) and whole cerebral uptakes (wCU) : 123 I-IMP In AOls were measured in transverse and coronal sections Itld the regional cerebral uptake rates (rCUIwCU) were calculated and ~ with 16 normal controls. On early image, the schizophrenics IhOW8d significantly decreased regional cerebral uptake rate (rCUR) In the trontaJ regions, whereas atypical psychoses patients showed no bIIaterlII In frontal regions. but significantly decreased rCUR in the right IndingS region. On late Image, the schizophrenics showed a significantly rCUR In the bilateral frontal regions. On the contrary, the atypical . had no significantly decreased rCUR in any of these regions. ~ uptake rates were shown in the both basal ganglia regions of The renicS on early Image, and In the left basal ganglia region of both Id1izOPh on late image. These increased uptake rates were associated ~ ~hallucination. Gender difference, length of illness and dose of wiltI . had no influence on these SPECT findings. ~ lon' The results of our brain Imaging studies employing Mitsuda's dUIIf.c:~ Iystem suggest that schlzophreni.a might have so~ewha~ or· . c:hafIg8S. whereas atypical psychoses might inv?lve functional dls,or· ganIC the right thalamus region. However, the correlation between duration CIerI In and CT findings suggests that a recurrence of psychotic episode in ~~psych0S8S might eventually result In irreversible organic alteration. ...,.....hand. the brain lesions on schizophrenia might have been ~ before onset, These findings Indicate that each of the two peyctlOIeS might have different etiologies.
:::::c,
=
RetereneeT. Watanabe T., K1toh H., Saklne T. (1992) Multivariate analyses 01 CT f1l In(ypicaJ schizophrenia and atypical psydlosis. Jpn J Psychlatr Neurol 46:
=:'
-",709i: Suga H. (1993) 123 I-IMP studies In typical schizophrenia and atypical l:I'J H8yaIhI "Neurol psychialr Brain research 1: 136-142. ~Ha ashl To, Ohara M. (1994) Singia photon emission computed tomogra• l3l SugI H·Ecri findings ualng N-lsopropyl-p-1123 I] iodoamphelamlne (123 I·IMP) In ~renia and atypical psycho8!a. Jpn J Psychlatr Neuro/48: 833-848.
Demetrio Barcia. , Spain Based on the slmliarlty of their clinical pictures (in particular their abrupt onsets and sudden cessations), family predisposition and EEG activity, some authors (Magnan, Kleist, Mitsuda, Fukuda, Barcia, etc) have established a close relation between epilepsy and cycloid psychosis. In two previous papers (Barcia, 1982, 1990), we reported on cases whose diagnoses of epilepsy were established on the basis of epileptic seizures and EEG activity typical of epilepsy. Patients, however, could have equally well been diagnosed of cycloid psychosis on the basis of these same symptoms. Because different conditions may share the same clinical pictures, it Is our belief that differences should be made between diseases and syndromes having the same underlying etiopathogenic mechanisms. In this paper two sets of observations are presented: First, 90 patients were selected whose diagnoses-according to DSM-III• R-could equally well fit the schizophrenia, schlzoaffective psychosis, brief reactive psychosis and schizophrenia-like psychosis diagnostic categories (By the time the study was conducted·1990 through 1994·DSM-IV was un• published). Fifteen peraent of all patients showed epllepsy·speclflc EEGs, Landolt phenomenon and, generally, characteristic features similar to those of cycloid psychoses. Secondly, electrodes were chronically Implanted on the brain cortex and in the tempore-limbic structures of 10 patients diagnosed of cycloid psychosis according to the criteria set by Perris and Bronklngton. Conventional EEGs were found to be normal while electrodes recorded the presence of dis· charges with shapes similar to SIS (Spontaneous Interlctal Spikes) typical of the kindling phenomenon. No psychic symptoms were present during recordings. Based on the above findings. we believe that cycloid psychoses might well be the result of mechanisms of the type of the kindling phenomenon. References [1) H. Milsuda.- 'Genealogical and clinical study of the relation between schizophrenia and genuine epilepsy" Fo/Iea neuropsJuJatricaJap. 1950,4,12-18. [2) H. Mltsuda and T. Fukuda.- Biological mechanisms of scfllzophrenlllllnd schlzophre• nill-Hke psychoses (Eds), G. Thlme Pbl, 1975. [3) T. Fukuda.· "Clinical and neurobiological heterogeneity of schizophrenic psychosis" Biological Psychilltry, G. Racagnl et al (Eds), Elselvler Pbl, 1991.
BIOL. PSYCHIATRY 1997;42:15-2975
1955
Symposia
66. Cycloid or atypical psychoses versus schizophrenia: Neurobiological evidence in favor of the differentiation
166-21 Specific P30o-features In cycloid psychoses and schizophrenia Wemer Konrad Strik. Department of Psychlafry. University Hospital Wurzburp, Gennany
:ca.
Low P300 amplitudes and topographical asymmetries have been repeat• edly described and are considered to be typical for schizophrenia. In a group of DSM·III·R schizophrenics, however, no significant differences between schizophrenics and controls were found after remission of the acute psychotic episode. SubdiViding the group into cycloid psychoses and schizophrenias according to Leonhard's classification, distinct P300-features were Identified. While low amplitudes and pathological asymmetries were found In schizophrenics, no topographical abnormalities but higher than normal amplitudes were found In cycloid psychoses (Strik et al; Acta Psy• chiat Scand, 87: 179-183). In two replication studies, these results were confirmed In Leonhard's schizophrenia (Strik et al; Psychiatry Res: Neu• roimaging, 55: 153-166) and in cycloid psychoses (Strik et al; Acta Psychi• atry Scand, In press). Pathological P3OO-asymmetries with right lateralized peaks are supposed to be expression of left temporal functional defiCits. High P300-amplitudes, at present, appear to be specific for cycloid psychosis and are Interpreted as an expression of a high psycho-vegetative excitation level (Heidrich and Strik; Bioi Psychiatry, In press). The distinction of schizophrenic groups into cyloid psychoses and core schizophrenics appears to be useful and necessary to identify psychophysiologically homogenous groups.
I!)'Illcai
166-31 The kindling phenomenon: A likely etlopathogenlc mechanism of cycloid psychosis
166-11 Brain Imaging approach to atypical psychoses t Hayashi H. Suga, N. Hotta, T. Andoh, M. Ohara. Dept of ~iatry. A/chi Medical University. Nagakute. Aichl. Japan ~ order to Investigate the heterogeneity of schizophrenic psychosis, we have alreadY studied not only the sociodemographic differences, but the brain morphological and functional diffe~ences ~tw~en typical schizophrenia n atypieaI psychoses using Mltsuda s classification system. The present communiCation deals with our attempts to pursue the etiology of atypical PI)'Cho&eS bY means of brain imaging techniques. u.thod .nd Results: The subjects for our CT study were 68 patients Wllh hallucinations and/or delusions, or psychotic abnormal behavior who treated as Inpatients or outpatients in the psychiatric ward of Aichi University Hospital. Applying Mltsuda's classnication system, the were divided Into 41 schizophrenics and 27 atypical psychotics. The ~enicS had significantly enlarged ventricles and dilated cerebral INureS In terms of ventricular brain ratio, lateral ventricle and third ventricle ideeS and syIvian fissure and interhemispheric fissure Indices, while the psychotiCS had larger values for sylvian fissure indices, especially tlt I1ght side compared to controls. Moreover, the dilatation of sylvian Iisu8S In atypical psychoses correlated well with the duration of illness, whereaS there were no correlations In schizophrenia. The subjects for our SPECT study were 18 schizophrenics and 16 atypical ychotiCS The regional cerebral (rCU) and whole cerebral uptakes (wCU) : 123 I-IMP In AOls were measured in transverse and coronal sections Itld the regional cerebral uptake rates (rCUIwCU) were calculated and ~ with 16 normal controls. On early image, the schizophrenics IhOW8d significantly decreased regional cerebral uptake rate (rCUR) In the trontaJ regions, whereas atypical psychoses patients showed no bIIaterlII In frontal regions. but significantly decreased rCUR in the right IndingS region. On late Image, the schizophrenics showed a significantly rCUR In the bilateral frontal regions. On the contrary, the atypical . had no significantly decreased rCUR in any of these regions. ~ uptake rates were shown in the both basal ganglia regions of The renicS on early Image, and In the left basal ganglia region of both Id1izOPh on late image. These increased uptake rates were associated ~ ~hallucination. Gender difference, length of illness and dose of wiltI . had no influence on these SPECT findings. ~ lon' The results of our brain Imaging studies employing Mitsuda's dUIIf.c:~ Iystem suggest that schlzophreni.a might have so~ewha~ or· . c:hafIg8S. whereas atypical psychoses might inv?lve functional dls,or· ganIC the right thalamus region. However, the correlation between duration CIerI In and CT findings suggests that a recurrence of psychotic episode in ~~psych0S8S might eventually result In irreversible organic alteration. ...,.....hand. the brain lesions on schizophrenia might have been ~ before onset, These findings Indicate that each of the two peyctlOIeS might have different etiologies.
:::::c,
=
RetereneeT. Watanabe T., K1toh H., Saklne T. (1992) Multivariate analyses 01 CT f1l In(ypicaJ schizophrenia and atypical psydlosis. Jpn J Psychlatr Neurol 46:
=:'
-",709i: Suga H. (1993) 123 I-IMP studies In typical schizophrenia and atypical l:I'J H8yaIhI "Neurol psychialr Brain research 1: 136-142. ~Ha ashl To, Ohara M. (1994) Singia photon emission computed tomogra• l3l SugI H·Ecri findings ualng N-lsopropyl-p-1123 I] iodoamphelamlne (123 I·IMP) In ~renia and atypical psycho8!a. Jpn J Psychlatr Neuro/48: 833-848.
Demetrio Barcia. , Spain Based on the slmliarlty of their clinical pictures (in particular their abrupt onsets and sudden cessations), family predisposition and EEG activity, some authors (Magnan, Kleist, Mitsuda, Fukuda, Barcia, etc) have established a close relation between epilepsy and cycloid psychosis. In two previous papers (Barcia, 1982, 1990), we reported on cases whose diagnoses of epilepsy were established on the basis of epileptic seizures and EEG activity typical of epilepsy. Patients, however, could have equally well been diagnosed of cycloid psychosis on the basis of these same symptoms. Because different conditions may share the same clinical pictures, it Is our belief that differences should be made between diseases and syndromes having the same underlying etiopathogenic mechanisms. In this paper two sets of observations are presented: First, 90 patients were selected whose diagnoses-according to DSM-III• R-could equally well fit the schizophrenia, schlzoaffective psychosis, brief reactive psychosis and schizophrenia-like psychosis diagnostic categories (By the time the study was conducted·1990 through 1994·DSM-IV was un• published). Fifteen peraent of all patients showed epllepsy·speclflc EEGs, Landolt phenomenon and, generally, characteristic features similar to those of cycloid psychoses. Secondly, electrodes were chronically Implanted on the brain cortex and in the tempore-limbic structures of 10 patients diagnosed of cycloid psychosis according to the criteria set by Perris and Bronklngton. Conventional EEGs were found to be normal while electrodes recorded the presence of dis· charges with shapes similar to SIS (Spontaneous Interlctal Spikes) typical of the kindling phenomenon. No psychic symptoms were present during recordings. Based on the above findings. we believe that cycloid psychoses might well be the result of mechanisms of the type of the kindling phenomenon. References [1) H. Milsuda.- 'Genealogical and clinical study of the relation between schizophrenia and genuine epilepsy" Fo/Iea neuropsJuJatricaJap. 1950,4,12-18. [2) H. Mltsuda and T. Fukuda.- Biological mechanisms of scfllzophrenlllllnd schlzophre• nill-Hke psychoses (Eds), G. Thlme Pbl, 1975. [3) T. Fukuda.· "Clinical and neurobiological heterogeneity of schizophrenic psychosis" Biological Psychilltry, G. Racagnl et al (Eds), Elselvler Pbl, 1991.