Efforts for the Correct Comprehension of Deceitful and Ironic Communicative Intentions in Schizophrenia: A Functional Magnetic Resonance Imaging Study on the Role of the Left Middle Temporal Gyrus

Deficits in social cognition and more specifically in communication have an important impact on the real-life functioning of people with schizophrenia (SZ). In particular, patients have severe problems in communicative-pragmatics, for example, in correctly inferring the speaker’s communicative intention in everyday conversational interactions. This limit is associated with morphological and functional alteration of the left middle temporal gyrus (L-MTG), a cerebral area involved in various communicative processes, in particular in the distinction of ironic communicative intention from sincere and deceitful ones. We performed an fMRI study on 20 patients with SZ and 20 matched healthy controls (HCs) while performing a pragmatic task testing the comprehension of sincere, deceitful, and ironic communicative intentions. We considered the L-MTG as the region of interest. SZ patients showed difficulties in the correct comprehension of all types of communicative intentions and, when correctly answering to the task, they exhibited a higher activation of the L-MTG, as compared to HC, under all experimental conditions. This greater involvement of the L-MTG in the group of patients could depend on different factors, such as the increasing inferential effort required in correctly understanding the speaker’s communicative intentions, and the higher integrative semantic processes involved in sentence processing. Future studies with a larger sample size and functional connectivity analysis are needed to study deeper the specific role of the L-MTG in pragmatic processes in SZ, also in relation to other brain areas

Psychophysiological an fMRI correlates to stress response: a pylot study

A pilot study C. Pruneti, N. Vanello, R. Morese, C. Gentili, F. Fontana, E. Ricciardid, C. Fante, M. Paterni, P. Pietrini, M. Guazzelli, L. Landini, E.M. Ferdeghini a Department of Psychology, University of Parma, Parma, Italy b Department of Information Engineering, University of Pisa, Pisa, Italy c Unit of Clinical Psychology, AUO Pisa, Department of Psychiatry, Neurobiology, Pharmacology, and Biotechnologies, University of Pisa, Pisa, Italy d Laboratory of Clinical Biochemistry and Molecular Biology, Department of Experimental Pathology, Medical Biotechnologies, Infectivology, and Epidemiology, University of Pisa, Pisa, Italy e Institute of Clinical Physiology, CNR, Pisa, Italy Recently, prefrontal cortex (PFC) has been identified as one of the crucial area of integration of behavioural and physiological responses to stress. Here we investigated the neural correlates of psychological stress induced by a problem-solving task through the correlation between peripheral skin conductance measures with central functional data (functional magnetic resonance imaging —fMRI). Skin conductance level (SCL) and skin conductance response (SCR) are related to the activity of the sympathetic system, and are thought to be connected to autonomic arousal, emotional and attentional processing. Six healthy subjects (3F, mean age=27±7) were enrolled in the study after consent. Each subject underwent a psychophysiological stress profile (Fuller, 1974) before fMRI acquisition sessions along with administration of standardized tests (Cognitive Behavioral Assessment, 16–Personality Factor- 5, Pisa Stress, Symptom Questionnaires). Statistical descriptive analysis of acquired data, highlighted that these subjects present heterogeneous psychological and psychophysiological characteristics. The fMRI task consisted in an adapted version of the Raven Progressive Matrices 47 test, based on two different patterns involving analogic and abstract logic thinking, and it was selected to evaluate some consequences on brain activity of attention, orientation, reflex and response to stress. Subjects had to solve each of the 36 matrices, presented at increasing difficulty level, within 20 s, and were instructed to choose among available answers by using MR-compatible buttons. During fMRI data acquisition, SCL and SCR were recorded with an fMRI compatible device and used as regressors, in a general linear model, along with task-related regressors, i.e matrices presentation and button presses. Group t-tests on task-related regressors of interest, highlighted activation (pb0.001) in bilateral dorsolateral prefrontal cortices (attentional and cognitive processes), premotor and motor cortex (button press), right precuneus and left occipital medial cortex (visuospatial processing), and subcortical structures. While no significant activation was related to SCL, SCR changes were significantly associated to bilateral precentral cortex, probably due to a correlation between button presses and SCR time course, to right inferior frontal gyrus, right medial frontal gyrus, bilateral superior frontal gyri and left anterior cyngulate, related to attentional and decision making processes. Preliminary results confirm previous findings on the neural correlates of psychological stress, and underline the usefulness of this experimental design in highlighting the interaction between cognitive function and neurovegetative arousal system during stressful tasks. doi:10.1016/j.ijpsycho.2008.05.06

Fetal alcohol spectrum disorders awareness in health professionals: Implications for psychiatry [La conoscenza della sindrome alcolica fetale negli operatori sanitari: Implicazioni per la psichiatria]

La sindrome alcolica fetale (FASD) indica una pletora di condizioni malformative che portano a ritardo mentale nei bambini e che colpisce neonati che sono stati esposti all’alcol durante la gravidanza o l’allattamento. La FASD è un argomento rilevante per la salute pubblica in Europa: infatti l’Europa è il primo continente per l’uso di alcol durante la gravidanza con una prevalenza del 25,2%. L’Italia è al terzo posto tra i Paesi europei, con una maggiore prevalenza di FASD (45,0 per 1000 abitanti). Inoltre, l’incidenza della FASD potrebbe ancora essere sottovalutata a causa di numerosi casi non diagnosticati. Lo scopo dello studio è di sintetizzare brevemente le evidenze esistenti sulla conoscenza della FASD e sui suoi aspetti psichiatrici per valutare le conoscenze, gli atteggiamenti e le pratiche nei confronti del consumo di alcolici durante la gravidanza in un campione italiano di operatori sanitari, al fine di fornire informazioni sulla prevenzione della FASD. Un questionario online anonimo, contenente i modelli AUDIT-C, T-ACE, e un questionario alimentare sono stati inviati a 400 professionisti e studenti di professioni sanitarie italiani. Il sondaggio includeva informazioni socio-demografiche, domande sulle abitudini di consumo e sulla conoscenza, l’atteggiamento e la pratica nei confronti dell’assunzione di alcol durante la gravidanza. Su 400 questionari spediti, 320 sono stati restituiti per l’analisi. Di questi 320 questionari, il 96,3% sono di donne. L’AUDIT-C ha rivelato che il 52,4% erano bevitori a basso rischio, ma il 27,6% erano bevitori a rischio. Il 90,6% dei partecipanti ha negato di aver mai frequentato un corso sul danno al feto indotto dal consumo di alcol durante la gravidanza, ma il 91,3% era disposto a partecipare a iniziative di aggiornamento professionale sull’argomento. Solo il 19,1% dei partecipanti informa regolarmente degli effetti deleteri per il feto di alcol prenatale e solo il 51,1% consiglia la politica di “alcol zero”. Circa il 41% dei partecipanti tollera l’assunzione di bevande a basso contenuto di alcol. Nessuna differenza è stata trovata tra non bevitori e bevitori a basso e ad alto rischio. Conclusioni. I dati mostrano che solo aggiornamenti specifici e continuativi per gli operatori sanitari sulle abitudini alimentari possono avere un certo impatto per prevenire l’assunzione gestazionale di alcol, al fine di prevenire la principale causa di ritardo mentale nei bambini nei Paesi occidentali.Fetal Alcohol Spectrum Disorders (FASD) are a plethora of malformative conditions leading to mental retardation that affect newborns and children who have been exposed to alcohol during pregnancy or breastfeeding. FASD is a relevant topic for public health in Europe: European area is first in ranking for alcohol use during pregnancy with a prevalence of 25.2%. Italy ranked third among European countries with higher prevalence of FASD (45.0 per 1000 population). Furthermore, FASD could still be underestimated because of numerous undiagnosed and misdiagnosed cases. Aims of the study were to briefly summarize existing evidences about FASD and its psychiatric aspects to assess knowledge, attitudes and practice towards alcohol drinking during pregnancy in an Italian sample of health care professionals in order to provide information about FASD prevention. An anonymous online questionnaire containing the AUDIT-C, T-ACE model and the Drinking Motive Questionnaire was sent to 400 Italian healthcare professionals and students. The survey included socio-demographic information, questions about drinking habits and about knowledge, attitude and practice towards alcohol assumption during pregnancy. Among 320 respondents, 96.3% were women. AUDIT-C revealed that 52.4% were low risk drinkers but 27.6% were hazardous drinkers. The 90.6% of participants denied to ever attended a course about the fetus damage induced by alcohol consumption during pregnancy but 91.3% were willing to participate to professional update initiatives on the topic. Only 19.1% of participants talk regularly about the deleterious effects for the fetus of prenatal alcohol drinking to women and only 51.1% advise the 'zero alcohol' policy. Around 41% of participants tolerates the assumption of low-alcohol beverages. No differences were found between no drinkers and low and hazardous drinkers. In conclusion, data show that only specific and continuing updating for health care professionals about drinking habits may have impactful actions to prevent gestational alcohol intake in order to prevent the main cause of mental retardation in western countries