Cognitive-behaviour therapy and skilled motor performance in adults with chronic tic disorder

The first aim of the present study was to compare performance of people with tic disorders (TD) and controls on executive function and a range of skilled motor tests requiring complex performance, guided movements, hand co-ordination, and fine control of steadiness. The second aim was to investigate the effect of cognitive behaviour therapy (CBT) on motor performance. A total of 55 patients with TD were recruited at baseline from participants in a behavioural management programme. A comparison group of 55 patients suffering from a variety of habit disorders (HD) involving complex manual movements, were matched on age and level of education to 34 non-psychiatric controls. Participants were evaluated pre- and post-treatment and post-waitlist with a neuropsychological evaluation focusing on executive function (Wisconsin Card Sorting Test, WCST) and skilled motor performance (Purdue Pegboard, Hole Steadiness Test, and the Groove Test). Results revealed WCST scores in the normal range, while motor performance differed significantly on the Purdue Pegboard Tests in both TD and HD as compared to the control group. Cognitive-behavioural treatment selectively improved motor performance in both clinical groups compared to waitlist control, and this improvement related to clinical outcome measures

Sur la première ligne : sondage pour un partage. Les omnipraticiens et la schizophrénie

Contexte : Les omnipraticiens (MFs) jouent un rôle prépondérant dans le traitement des patients atteints de schizophrénie. Buts : Découvrir le nombre de patients atteints de schizophrénie qui sont traités par les MFs ; les besoins et attitudes des MFs, leurs connaissances en matière de diagnostic, et le traitement qu’ils prodiguent. Méthodologie : Un sondage postal a été conduit auprès de MFs du Québec choisis de façon aléatoire. Résultats : Un total de 1 003 MFs ont répondu au sondage. Parmi eux, un faible pourcentage a à rencontrer une schizophrénie débutante et les MFs désirent être plus informés sur l’accessibilité aux services des spécialistes. Les résultats objectivés aux questions portant sur les diagnostics et les connaissances sur les traitements sont inconsistants. La majorité des MFs traite les premiers épisodes psychotiques avec des antipsychotiques. Seulement un tiers d’entre eux proposent de maintenir le traitement après un premier épisode psychotique, conformément aux recommandations internationales et au récent guide de pratique canadien qui préconisent au moins de 6 à 12 mois de traitement après la réponse clinique partielle ou complète. Le temps consacré par les MFs masculins à un premier contact s’étale entre 10 et 20 minutes, tandis que 80 % des MFs femmes y consacrent au moins 20 minutes Les effets secondaires des antipsychotiques les plus préoccupants sont les gains de poids avant les signes neurologiques. Conclusion : un certain nombre de données de ce sondage devraient être reprises par les différentes associations professionnelles et gouvernementales, afin de bonifier la place des MFs dans un plan de santé à l’égard de la schizophrénie.Context: General practitioners (GP) play a preponderant role in the treatment of patients suffering of schizophrenia. Objectives: Discovering the number of patients with schizophrenia who are treated by GPs ; the needs and attitudes of GPs, their knowledge concerning diagnosis, and the treatment they provide. Methodology: A postal survey was conducted with Quebec GPs who were randomly chosen. Results: A total of 1 003 GPs have participated in the survey. Among them, a small percentage have to treat an early onset schizophrenia and the GPs have expressed their wish to be more informed on the accessibility of specialized services. Results pertaining to questions on diagnoses and knowledge on treatments are inconsistent. The majority of GPs treat the first psychotic episodes with antipsychotic medication. Only a third of GPs surveyed propose maintaining the treatment after a first psychotic episode, in accordance with international recommendations and the recent Canadian guidelines on practices that recommends at least 6 to 12 months of treatment after a partial or complete clinical response. Time given by male GPs to a first contact varies between 10 and 20 minutes, while 80 % of female GPs spend at least 20 minutes. The adverse effects of antipsychotic medication that raise most concern is weight gain before neurological signs. Conclusion: some of this survey’s data should be considered by various professional and governmental associations, in order to improve the place of GPs in a health plan destined to treat schizophrenia.Contexto: Los médicos familiares (MFs) desempeñan un papel preponderante en el tratamiento de pacientes que sufren de esquizofrenia. Objetivos: Descubrir el número de pacientes que sufren de esquizofrenia y que son tratados por los MFs; las necesidades y actitudes de los MFs, sus conocimientos en materia de diagnóstico y el tratamiento que ofrecen. Metodología: Se realizó una encuesta por correo con los MFs de Quebec elegidos de modo aleatorio. Resultados: Un total de 1,003 MFs respondieron a la encuesta. Entre ellos, un porcentaje bajo han encontrado una esquizofrenia inicial y los MFs desean estar más informados sobre la accesibilidad a los servicios de los especialistas. Los resultados asociados a las preguntas sobre los diagnósticos y los conocimientos acerca de los tratamientos son inconsistentes. La mayoría de los MFs tratan los primeros episodios psicóticos con antipsicóticos. Solamente un tercio de ellos propone mantener el tratamiento después de un primer episodio psicótico, conforme a las recomendaciones internacionales y a la reciente guía de práctica canadiense que preconiza al menos de 6 a 12 meses de tratamiento después de la respuesta clínica parcial o completa. El tiempo consagrado por los MFs masculinos en un primer contacto se extiende de 10 a 20 minutos, mientras que el 80% de los MFs femeninas consagran al menos 20 minutos. Los efectos secundarios de los antipsicóticos más preocupantes son el aumento de peso antes que los signos neurológicos. Conclusión: un cierto número de datos de esta encuesta deberían ser retomados por las diferentes asociaciones profesionales y gubernamentales a fin de bonificar el lugar de los MFs en un plan de salud con respecto a la esquizofrenia.Contexto: os clínicos gerais (médicos de família - MFs) representam um papel preponderante no tratamento dos pacientes que sofrem de esquizofrenia. Objetivos: descobrir o número de pacientes que sofrem de esquizofrenia que são tratados por MFs, as necessidades e atitudes dos MFs, seus conhecimentos em matéria de diagnóstico, e o tratamento que prescrevem. Metodologia: uma sondagem postal foi realizada com MFs do Quebec, escolhidos de maneira aleatória. Resultados: um total de 1.003 MFs responderam à sondagem. Dentre eles, uma pequena porcentagem encontrou uma esquizofrenia inicial e os MFs desejam ser melhor informados sobre a acessibilidade aos serviços de especialistas. Os resultados obtidos com as questões sobre os diagnósticos e os conhecimentos sobre os tratamentos são inconsistentes. A maioria dos MFs trata os primeiros episódios psicóticos com antipsicóticos. Apenas um terço dentre eles propõe manter o tratamento após um primeiro episódio psicótico, conforme as recomendações internacionais e o recente guia de prática canadense, que preconiza pelo menos 6 a 12 meses de tratamento após a resposta clínica parcial ou completa. O tempo dedicado pelos MFs masculinos a um primeiro contato dura entre 10 e 20 minutos, ao passo que 80% das MFs femininas consagram, pelo menos, 20 minutos. O efeito colateral dos antipsicóticos mais inquietante é o aumento de peso antes dos sinais neurológicos. Conclusão: um certo número de dados desta sondagem deverão ser retomados por diferentes associações profissionais e governamentais, a fim de melhorar a importância dos MFs em um plano de saúde com respeito à esquizofrenia

Neural correlates of enhanced visual short-term memory for angry faces: An fMRI study

Copyright: © 2008 Jackson et al.Background: Fluid and effective social communication requires that both face identity and emotional expression information are encoded and maintained in visual short-term memory (VSTM) to enable a coherent, ongoing picture of the world and its players. This appears to be of particular evolutionary importance when confronted with potentially threatening displays of emotion - previous research has shown better VSTM for angry versus happy or neutral face identities.Methodology/Principal Findings: Using functional magnetic resonance imaging, here we investigated the neural correlates of this angry face benefit in VSTM. Participants were shown between one and four to-be-remembered angry, happy, or neutral faces, and after a short retention delay they stated whether a single probe face had been present or not in the previous display. All faces in any one display expressed the same emotion, and the task required memory for face identity. We find enhanced VSTM for angry face identities and describe the right hemisphere brain network underpinning this effect, which involves the globus pallidus, superior temporal sulcus, and frontal lobe. Increased activity in the globus pallidus was significantly correlated with the angry benefit in VSTM. Areas modulated by emotion were distinct from those modulated by memory load.Conclusions/Significance: Our results provide evidence for a key role of the basal ganglia as an interface between emotion and cognition, supported by a frontal, temporal, and occipital network.The authors were supported by a Wellcome Trust grant (grant number 077185/Z/05/Z) and by BBSRC (UK) grant BBS/B/16178

Motor Agency: A New and Highly Sensitive Measure to Reveal Agency Disturbances in Early Psychosis

Background: Early diagnosis of young adults at risk of schizophrenia is essential for preventive approaches of the illness. Nevertheless, classic screening instruments are difficult to use because of the non-specific nature of the signs at this preonset phase of illness. The objective of the present contribution was to propose an innovating test that can probe the more specific symptom of psychosis, i.e., the sense of agency, which is defined as being the immediate experience of oneself as the cause of an action. More specifically, we tested whether motor agency is abnormal in early psychosis. Methods: Thirty-two young symptomatic patients and their age-matched controls participated in the study. 15 of these patients were at ultra high-risk for developing psychosis (UHR), and 17 patients were suffering from first-episode psychosis (FEP). Patients ’ neurocognitive capacities were assessed through the use of seven neuropsychological tests. A motor agency task was also introduced to obtain an objective indicator of the degree of sense of agency, by contrasting force levels applied during other and self-produced collisions between a hand-held objet and a pendulum. Results: As reported in the literature for adult controls, healthy adolescents used more efficient force levels in self than in other-imposed collisions. For both UHR and FEP patients, abnormally high levels of grip force were used for self-produced collisions, leading to an absence of difference between self and other. The normalized results revealed that motor agency differentiated patients from controls with a higher level of sensitivity than the more classic neuropsychological test battery

Association of Typical versus Atypical Antipsychotics with Symptoms and Quality of Life in Schizophrenia

BACKGROUND: Several reports on patients with chronic schizophrenia suggest that atypical versus typical antipsychotics are expected to lead to better quality of life (QOL) and cognitive function. Our aim was to examine the association of chronic treatment with typical or atypical antipsychotics with cognitive function, psychiatric symptoms, QOL, and drug-induced extrapyramidal symptoms in long-hospitalized patients with schizophrenia. METHODOLOGY AND PRINCIPAL FINDINGS: The Hasegawa Dementia Scale-Revised (HDS-R), Brief Psychiatric Rating Scale (BPRS), the Schizophrenia Quality of Life Scale, translated into Japanese (JSQLS), and the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS) were used to evaluate cognitive function, psychiatric symptoms, QOL, and drug-induced extrapyramidal symptoms. We examined the correlation between the dose of antipsychotics and each measure derived from these psychometric tests. The student t-test was used to compare scores obtained from psychometric tests between patients receiving typical and atypical antipsychotics. Results showed significant correlations between chlorpromazine (CPZ)-equivalent doses of typical antipsychotics and atypical antipsychotics, and the total BPRS score and BPRS subscale scores for positive symptoms. CPZ-equivalent doses of typical antipsychotics were correlated with the JSQLS subscale score for dysfunction of psycho-social activity and DIEPSS score. Furthermore, the total BPRS scores, BPRS subscale score for positive symptoms, the JSQLS subscale score for dysfunction of psycho-social activity, and the DIEPSS score were significantly higher in patients receiving typical antipsychotics than atypical antipsychotics. CONCLUSION AND SIGNIFICANCE: These findings suggest that long-term administration of typical antipsychotics has an unfavorable association with feelings of difficulties mixing in social situations in patients with chronic schizophrenia

The Self-Assessment Scale of Cognitive Complaints in Schizophrenia: A validation study in Tunisian population

<p>Abstract</p> <p>Background</p> <p>Despite a huge well-documented literature on cognitive deficits in schizophrenia, little is known about the own perception of patients regarding their cognitive functioning. The purpose of our study was to create a scale to collect subjective cognitive complaints of patients suffering from schizophrenia with Tunisian Arabic dialect as mother tongue and to proceed to a validation study of this scale.</p> <p>Methods</p> <p>The authors constructed the Self-Assessment Scale of Cognitive Complaints in Schizophrenia (SASCCS) based on a questionnaire covering five cognitive domains which are the most frequently reported in the literature to be impaired in schizophrenia. The scale consisted of 21 likert-type questions dealing with memory, attention, executive functions, language and praxia. In a second time, the authors proceeded to the study of psychometric qualities of the scale among 105 patients suffering from schizophrenia spectrum disorders (based on DSM- IV criteria). Patients were evaluated using the Positive and Negative Syndrome Scale (PANSS), the Global Assessment Functioning Scale (GAF scale) and the Calgary Depression Scale (CDS).</p> <p>Results</p> <p>The scale's reliability was proven to be good through Cronbach alpha coefficient equal to 0.85 and showing its good internal consistency. The intra-class correlation coefficient at 11 weeks was equal to 0.77 suggesting a good stability over time. Principal component analysis with Oblimin rotation was performed and yielded to six factors accounting for 58.28% of the total variance of the scale.</p> <p>Conclusion</p> <p>Given the good psychometric properties that have been revealed in this study, the SASCCS seems to be reliable to measure schizophrenic patients' perception of their own cognitive impairment. This kind of evaluation can't substitute for objective measures of cognitive performances in schizophrenia. The purpose of such an evaluation is to permit to the patient to express his own well-being and satisfaction of quality of life.</p

Survey on schizophrenia treatment in Mexico: perception and antipsychotic prescription patterns

BACKGROUND: Since the introduction of antipsychotics, especially the so called atypicals, the treatment of schizophrenia has shown important improvements. At the present time, it is preferred to label clozapine and other antipsychotics sharing similar profiles as second-generation antipsychotics (SGAs). These medications have been proposed by some experts as a first line treatment for schizophrenia. It is critical to have reliable data about antipsychotic prescription in Mexico and to create management guidelines based on expert meetings and not only on studies carried out by the pharmaceutical industry. Only this approach will help to make the right decisions for the treatment of schizophrenia. METHODS: A translated version of Rabinowitz's survey was used to evaluate antipsychotic prescription preferences and patterns in Mexican psychiatrists. The survey questionnaire was sent by mail to 200 psychiatrists from public institutions and private practice in Mexico City and Guadalajara, Mexico. RESULTS: Recommendations for antipsychotics daily doses at different stages of the treatment of schizophrenia varied widely. Haloperidol was considered as the first choice for the treatment of positive symptoms. On the contrary, risperidone was the first option for negative symptoms. For a patient with a high susceptibility for developing extrapyramidal symptoms (EPS), risperidone was the first choice. It was also considered that SGAs had advantages over typical antipsychotics in the management of negative symptoms, cognitive impairment and fewer EPS. Besides, there was a clear tendency for prescribing typical antipsychotics at higher doses than recommended and inadequate doses for the atypical ones. CONCLUSIONS: Some of the obstacles for the prescription of SGAs include their high cost, deficient knowledge about their indications and dosage, the perception of their being less efficient for the treatment of positive symptoms and the resistance of some Mexican physicians to change their prescription pattern. It is necessary to reach a consensus, in order to establish and standardize the treatment of schizophrenia, based on the information reported in clinical trials and prevailing economic conditions in Mexico