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Biomedical subjects

E Stip

Publications and source records attributed to E Stip.

At least 19 recordsLinked to original sources
PubMed2000

Leukotomy revisited: late cognitive and behavioral effects in chronic institutionalized schizophrenics.

BACKGROUND: In the 1940s and 1950s, prefrontal lobotomy was widely used to treat aggressive, disruptive and psychotic behavior in schizophrenics. Subsequent observations have confirmed its ineffectiveness in schizophrenia. Few studies have addressed its long-term consequences. METHODS: We conducted tests of frontal function, behavior (Frontal Behavioral Inventory), psychopathology (PANSS), neurological examinations and CT scans in 19 chronically institutionalized schizophrenic patients (mean age 74) who had undergone orbitofrontal leukotomy between 1948 and 1972 and 11 controls (mean age 74) matched for age, length of hospitalization, education, and diagnosis. RESULTS: There were no significant differences between leukotomized patients and controls on: Folstein Mini-Mental score (leuko 22.13+/-5.66; controls 23.55+/-5.93), utilization behavior, Luria alternating written and motor sequences, verbal fluency, imitation behavior, motor impersistence, primitive reflexes, or psychopathology. Significant differences were found on clock drawing and on the go/no-go test, which may reflect the presence of an orbitofrontal lesion in the leukotomized group. There was a tendency for the leukotomized group to have fewer indices of frontal behavioral dysfunction. Both groups showed comparable impairment on the Stroop test and cognitive rigidity on the Odd Man Out test of category shifting. CONCLUSIONS: With few exceptions, elderly leukotomized and nonleukotomized schizophrenic patients show varying degrees of distractibility, difficulty in set shifting, poor planning and organization, susceptibility to interference, primitive reflexes and signs of global cognitive impairment. Allowing for the small sample size, variability in the surgical frontal lesion, and the long interval from surgery to testing, these observations likely reflect the long-term consequences of severe schizophrenia in both groups.

Aged↗
PubMed2000

A laboratory study of sleep in Asperger's syndrome.

Asperger's syndrome (AS) is a pervasive developmental disorder that may fall along the autistic spectrum. We compared the sleep of eight patients with AS with that of participants matched for age and gender. Patients with AS showed decreased sleep time in the first two-thirds of the night, increased number of shifts into REM sleep from a waking epoch, and all but one patient showed signs of REM sleep disruption. EEG sleep spindles were significantly decreased while K complexes and REM sleep rapid eye movements were normal. Three patients with AS, but none of the comparison participants, showed a pathological index of periodic leg movements in sleep. These observations show that sleep disorders are associated with AS and suggest that defective sleep control systems may be associated with the clinical picture of AS.

Adult↗
PubMed2000

Neuropsychological change in early phase schizophrenia during 12 months of treatment with olanzapine, risperidone, or haloperidol. The Canadian Collaborative Group for research in schizophrenia.

BACKGROUND: The purpose of this investigation was to test the efficacy of novel antipsychotic medications in the treatment of cognitive impairment in early phase schizophrenia. METHODS: Sixty-five patients in this multicenter double-blind study were randomly assigned to olanzapine (5-20 mg), risperidone (4-10 mg), or haloperidol (5-20 mg). Standard measures of clinical and motor syndromes were administered, as well as a comprehensive battery of tests to assess (1) motor skills, (2) attention span, (3) verbal fluency and reasoning, (4) nonverbal fluency and construction, (5) executive skills, and (6) immediate recall at baseline and after 6, 30, and 54 weeks of treatment. RESULTS: The general cognitive index derived from the 6 domain scores revealed a significantly greater benefit from treatment with olanzapine relative to haloperidol and olanzapine relative to risperidone, but no significant difference was shown between risperidone and haloperidol. The improvement related to olanzapine was apparent after 6 weeks and enhanced after 30 and 54 weeks of treatment. Exploratory within-group analyses of the 6 cognitive domains after a conservative Bonferroni adjustment revealed a significant improvement with olanzapine only on the immediate recall domain, and similar analyses of the 17 individual tests revealed a significant improvement with olanzapine only on the Hooper Visual Organization Test. CONCLUSIONS: These data suggest that olanzapine has some superior cognitive benefits relative to haloperidol and risperidone. A larger sample replication study is necessary to confirm and generalize the observations of this study and begin evaluation of the implications of this change to cerebral function and quality of life for people with schizophrenia.

Adolescent↗
PubMed2000

Novel antipsychotics: issues and controversies. Typicality of atypical antipsychotics.

The typicality of atypical antipsychotic drugs remains debatable. Preclinical studies and findings from randomized, controlled and open trials of clozapine, olanzapine, risperidone, quetiapine, sertindole, ziprasidone and a substituted benzamide were examined. A MEDLINE search was conducted using key words, including "extrapyramidal side effects," "cognition," "schizophrenia" and the generic drug names. Over 140 articles from peer-reviewed journals were reviewed, some of which were based on a meta-analysis. New-generation neuroleptic agents were found to have greater efficacy on the negative symptoms of schizophrenia and to cause fewer unwanted extrapyramidal side effects (EPS) than the traditional antipsychotic drugs. On one hand, atypical neuroleptic agents could be strictly defined as any neuroleptic agent with antipsychotic effects at a dosage that does not cause extrapyramidal side effects. Thus, clozapine is regarded as the "standard" atypical antipsychotic drug. On the other hand, typicality is about dimension rather than category, and we suggest the use of the term "spectrum of atypicality." For example, an emphasis is placed on quetiapine to illustrate where a new compound fits in this spectrum. Although dose-related, atypicality may be more a question of prescription attitude than of a specific characteristic of a compound. The degree to which a new compound is clinically superior to another atypical antipsychotic drug, in terms of improving positive, negative or affective symptoms, cognitive function and long-term outcome, will require further a priori hypotheses based on conceptual frameworks that are clinically meaningful. In addition, the results from industry-sponsored trials should be more comparable to those obtained from investigator-leading trials. Finally, the patient characteristics that define a patient's response to a specific antipsychotic drug are unknown.

Antipsychotic Agents↗
PubMed1999

Discriminant cognitive factors in responder and non-responder patients with schizophrenia.

UNLABELLED: To identify which improvements in cognitive function are associated with symptom resolution in schizophrenic patients treated with atypical antipsychotics. DESIGN: a prospective open trial with atypical neuroleptics (risperidone, clozapine, quetiapine). SETTING: Inpatient and outpatient units, Institute of Psychiatry. PATIENTS: Thirty-nine patients with schizophrenia according to DSM-IV criteria were included. Clinical and cognitive assessment were done at baseline (T0) and again after six months of treatment (T2). Twenty-five patients completed the trial. INTERVENTIONS: New-generation antipsychotics during six months. Patients were considered as responders if their PANSS score decreased at least 20% (n = 15) and non-responders if it did not (n = 10). OUTCOME MEASURES: a computerized cognitive assessment comprised tests of short-term-memory (digit span), explicit long-term memory (word pair learning), divided attention, selective attention and verbal fluency (orthographic and semantic). Clinical assessment included PANSS and ESRS. RESULTS: A discriminant function analysis was performed to determine which changes in cognitive performance predicted symptomatic response status. Semantic fluency and orthographic fluency were significant predictors. Together they correctly predicted responder status in 88% of cases. Memory was not a significant predictor of symptomatic response. CONCLUSION: Verbal fluency discriminated the responder from the non-responder group during a pharmacological treatment.

Adult↗
PubMed1999

[Categorical refusal of treatment by psychiatric patients: balance, survey and prospects].

BACKGROUND: In his or her practice, a psychiatrist must often deal with patients who refuse treatment. In 1990, Quebec radically changed this situation by introducing a Civil Code provision imposing judicial intervention to treat an individual deemed unfit to consent, against his or her will. This paper presents an assessment and survey of patients and attending psychiatrists who have used this Code provision. METHOD: Thirty-nine subjects who explicitly refused treatment were brought to court. We asked a subgroup of these patients to be interviewed, using the Drug Attitude Inventory (DAI), the Clinical Global Impression (CGI), and 2 questionnaires specifically considering the court experience of patients and attending psychiatrists. RESULTS: The results of the survey show that patients remember their experience in court as rather uncomfortable. However, the therapeutic alliance remained unchanged, even after the legal procedure. Physicians agreed that patients would not have been clinically well enough to leave the hospital if they had not received the drug regimen resulting from the court decision. The dissociation between the perceptions of patients and physicians is compared with that found in previous studies in the United States. CONCLUSION: Even with a limited sample, this study addresses a delicate, difficult situation that professionals are increasingly likely to confront. It also proposes further research on alternatives to judicial intervention.

Adult↗
PubMed1999

[Neurologic sequelae secondary to acute lithium poisoning].

OBJECTIVE: To review the literature on the permanent neurological sequelae resulting from acute lithium poisoning. METHOD: Sixty-six articles were reviewed in English and in French. They were accessed through Medline and cover the period from 1968 to 1997. RESULTS: Fifty-nine case studies were broken down into 3 groups: lithium intoxications without a neuroleptic that has provoked a cerebellar syndrome; those in which there was a neuroleptic; and those with diverse neurological consequences, with or without a neuroleptic. CONCLUSIONS: Lithium has an intrinsic toxicity for the central nervous system and provokes a tropism specific to the cerebellum. The association with neuroleptics appears to increase toxicity as well as some associated factors, including infections and the rapid correction of the lithium level in the blood. We discuss the psychopathological mechanisms invoked to explain lithium's neurotoxicity.

Antipsychotic Agents↗
PubMed1998

The functional neuroanatomy of major depression: an fMRI study using an emotional activation paradigm.

An important issue regarding the neural basis of major depression is whether the functional brain changes associated with the affect disturbance seen in this syndrome are similar to those that accompany transient sadness in normal subjects. To address this question, we carried out an fMRI study using an emotional activation paradigm. Brain activity associated with passive viewing of an emotionally laden film clip aimed at inducing a transient state of sadness was contrasted with that associated with passive viewing of an emotionally neutral film clip in patients suffering from unipolar depression and in normal control subjects. Results showed that transient sadness produced significant activation in the medial and inferior prefrontal cortices, the middle temporal cortex, the cerebellum and the caudate in both depressed and normal subjects. They also revealed that passive viewing of the emotionally laden film clip produced a significantly greater activation in the left medial prefrontal cortex and in the right cingulate gyrus in depressed patients than in normal control subjects. These findings suggest that these two cortical regions might be part of a neural network implicated in the pathophysiology of major depression. Taken together, these results strongly support the view that activation paradigms represent an extremely useful and powerful way of delineating the functional anatomy of the various symptoms that characterize major depression.

Adult↗
PubMed1998

Atypical memory performance in an autistic savant.

This study explored the mechanisms underlying the hypermnesia of an autistic savant (NM) through three experiments. The first two served to assess whether absence of interference was responsible for NM's exceptional list memory. The third investigated the type of cues used in recall. Results indicated absence of retroactive interference but presence of slight proactive interference in list recall of proper names. Normal interference effects were found, however, in list recall of common nouns. Exceptional performance was also demonstrated in a missing-name task involving spatial and verbal recall cues. The findings suggest that the outstanding episodic memory presented by some savant persons with autism might be related to an abnormally high resistance to interference.

Adolescent↗
PubMed1998

[Cerebellar degeneration following acute lithium intoxication].

Lithium is a neurotoxin with a particular affinity for the cerebellum. The risk of permanent neurotoxic sequelae of lithium is increased by the concomitant use of certain conventional neuroleptics. We report two new cases of lithium neurotoxicity; one received lithium alone, not in combination with a neuroleptic. Both cases showed severe cerebellar atrophy on brain CT and MRI. Additional factors such as dehydration, systemic infection, other medications, or rapid correction of frequently-coexisting hyponatremia may contribute to the risk of lithium neurotoxicity. We discuss possible pathophysiologic mechanisms and preventive measures.

Antipsychotic Agents↗