A controlled study of temporal lobe structure volumes and P300 responses in schizophrenic patients with persistent auditory hallucinations

Recent studies of cerebral pathology in patients with schizophrenia have focused on symptomatological and electrophysiological correlates of reduced temporal lobe structure volumes. Volume deficits of the left superior temporal gyrus have been correlated with auditory hallucinations as well as to left-sided P300 amplitude reduction. However, caution is needed to interpret correlational data as evidence of a specific relationship. Therefore, a controlled study was undertaken on schizophrenic patients with and without auditory hallucinations. MRI-defined volumes of the left superior temporal gyrus and other temporal lobe structures were quantified from 3-mm coronal slices in 15 schizophrenic patients with chronic auditory hallucinations (hallucinators), 15 schizophrenic patients without auditory hallucinations (nonhallucinators) and 17 healthy controls. In all subjects a simple oddball paradigm was used to elicit P300 responses at temporal and centro-parietal electrode sites. No evidence was found for volume reductions of temporal lobe structures in the combined patient group compared with controls, or in the hallucinators compared with the nonhallucinators. The patients did show left P300 amplitude reduction compared with controls, particularly in the hallucinator group. Correlations between volumes of left temporal lobe structures and left P300 amplitudes were low and not significant. The results of the present study do not indicate that auditory hallucinations and associated abnormal electrophysiological activity are the consequence of atrophy of localized temporal lobe structures. However, replication in a larger sample of subjects is needed before firm conclusions can be drawn

Central monoamine metabolism in depressions. I. Serotonin and related compounds

This article reviews research into the possible significance of disorders of the central 5-HT metabolism in the pathogenesis of recurrent depressions. The available data would seem to warrant the tentative conclusion that such metabolic disorders are indeed involved in a certain subcategory of vital depressions and play a (possible predisposing) role in the pathogenesis of these depressions. The use of 5-HT precursors in depressions is regarded as a potential asset, although the conclusion that real substitution therapy can thus be given would be premature

Tablets and talking—A spurious contrast in psychiatry

Pharmacotherapy and psychotherapy of psychiatric patients are not given equal appreciation. Particularly in syndromes with marked psychogenic or psychosocial overtones, psychotherapy is regarded as the causal therapy par excellence. In these cases (the vast majority), psychotropic drugs are believed to have at best a symptomatic importance and to entail the risk of effacing the true causes. I consider this view to be as unfelicitous as it is wrong, because: (1) Psychosocially determined behavior disorders, too, have a neurochemical substrate; (2) It is by all means sensible to make an attempt to normalize behavior by correction of this substrate; (3) Normalization of the cerebral substrate with the aid of pharmacotherapy is no less a causal type of therapy than is reduction of the pathogenic input with the aid of psychotherapy; (4) This means that pharmacotherapy and psychotherapy are complementary, and that each separately is an incomplete therapy. This argument is valid where psychotropic drugs with a relatively specific effect are available, as they are for the vital depressions and psychoses of the schizophrenic type. In these groups of patients, empirical findings confirm the theoretical expectation formulated (4) above. It is postulated that, for the treatment of neuroses which has so far been based entirely on psychotherapeutic intervention, much is yet to be expected of future developments in psychopharmacology

Central monoamine metabolism in depressions. II. Catecholamines and related compounds

CA research in depressions is reviewed. The present situation can be outlined as follows: Vital depressive patients may show central CA disorders that point in the direction of CA deficiency. In principle, this deficiency can be a primary phenomenon or a secondary development: the result of hypersensitivity of postsynaptic CA receptors. The former possibility is considered more plausible than the latter. The DA disorder seems to be related to motor retardation and loss of initiative and probably plays a role in their pathogenesis. There is no reason to assume that this disorder is a predisposing factor. The NA disorder is not related to motor symptoms. Its causative significance is still uncertain. An important byproduct of CA research in depressions is the momentum it gives to attempts to “translate” behavior disorders in terms of disturbed psychological functions. Such a functional psychopathology could be an important supplement to the traditional, more syndromal, and nosological classification of psychiatric conditions

Psychopsychiatry: Can psychosocial factors cause psychiatric disorders?

It is a widely accepted view today that psychosocial factors can cause psychiatric disorders. However, this view has, as yet, no firm foundation of verifiable facts. This paper outlines some research strategies that can provide data in favor of or against this theory: (1) systematic analysis of life events preceding psychiatric disorders, covering both stable events and interactional events; (2) vulnerability research on three levels (biologic, psychological, and sociological), aimed at factors that could explain the increased vulnerability of some individuals to the detrimental effects of life events; (3) pathogenesis research, aimed at analyzing how psychosocial stress disrupts cerebral systems, and discovering which of these disruptions is responsible for disturbed behavior, and (4) research into the efficacy of combined biologic (mainly pharmacotherapeutic) and psycho(socio)therapeutic methods. Some results obtained in these areas of research are discussed. The central idea of this study is that psychosocial and biologic factors do not operate independently but in close interaction. This seems a cliché, but is not, as clearly indicated by the scantiness of relevant research so far carried out. This gap is to be filled if psychiatry is to maintain and reinforce its status as a medical discipline

About the course of schizoaffective psychoses

This study involves a program that was developed to determine whether there is a need for the category of schizoaffective disorders. The data suggest that the term schizoaffective pychoses should be upheld as a collective name for the group of the functional “mixed psychoses” between the schizophrenic group and that of the (non-psychotic) manic-depressive syndromes, and that like the group of schizophrenic psychoses, that of the schizoaffective psychoses is a heterogeneous group in terms of symptomatology, short-term treatment response, and long-term outcome

Depression vulnerability and 5-hydroxytryptophan prophylaxis

Previous studies have indicated that (1) The group of vital (endogenous) depressions encompasses a subgroup with a central serotonin (5-hydroxytryptamine; 5-HT) deficiency. (2) Abolition of this deficiency—with the aid of 5-hydroxytryptophan (5-HTP), a 5-HT precursor, or clomipramine, a 5-HT reuptake inhibitor—leads to abatement of depressive symptoms. It therefore seems plausible that the suspected 5-HT deficiency contributes to the development of depressive symptoms instead of resulting from them. (3) In a majority of patients, the suspected 5-HT deficiency persists even when the depressive symptoms have disappeared and the medication has been discontinued. This suggested that the disturbed central 5-HT metabolism is not a direct causal, but a predisposing factor. if so, abolition of the suspected 5-HT deficiency, e.g., with the aid of 5-HTP, would be expected to have a prophylactic effect. As predicted, 5-HTP was found in the present study to reduce the relapse rate in recurrent vital depressions with both a unipolar and a bipolar course. The prophylactic effect was most pronounced in patients with persistent disorders of central 5-HT metabolism; this observation, however, requires corroboration. 5-HTP prophylaxis is the first aimed (i.e., pathological substrate-oriented) type of chemoprophylaxis known in psychiatry