Impaired theory of mind on second order tests is specific to schizophrenia when compared to mild learning disability and affective disorder control groups. Subjects with schizophrenia and pre-morbid mild learning disability show greater impairment than subjects with schizophrenia and a pre-morbid IQ within the normal range.

SUMMARY Temporal lobe structure has been assessed by magnetic resonance imaging in groups of patients with schizophrenia (n = 21) bipolar affective disorder (n = 20) and normal controls (n = 21). In the temporal lobe area a significant (p < 0.05) diagnosis by side interaction was present, the area being less on the left than on the right side in patients with schizophrenia in contrast to findings in the two other groups. Lateral ventricular and temporal horn area did not distinguish the groups as a whole. However, there was a significant (p < 0-05) relationship between lateral ventricular area and poor outcome, and in an analysis confined to males, patients with schizophrenia (n = 15) were found to have significantly (p < 0-05) enlarged temporal horns.Computed tomography has demonstrated that some patients with schizophrenia have enlargement of the lateral cerebral ventricles.`-3 A study of post-mortem brains collected at Runwell Hospital (the Runwell I series) in which brains from schizophrenic patients were compared with those from affectively ill patients4 confirmed the finding of reduction of brain substance in schizophrenia but found the most striking differences lay in the temporal lobe. The inferior horns of the lateral ventricle were significantly larger and the width of the parahippocampal gyrus significantly less in the schizophrenic patients. In a further study' brains of patients with schizophrenia were compared with normal controls (the Runwell II series). From an initial sample of 56 patients and 56 age-matched controls, brains were excluded if they showed evidence of previous surgery, or significant Alzheimer type or vascular change on histological examination, to give a final sample of 19 schizophrenic patients and 23 controls. The increased size of the lateral ventricles in the schizophrenic patients became increasingly prominent posteriorly and was greatest in the inferior

SYNOPSIS A range of cerebral structures was assessed in a series of 172 CT scans of groups of psychiatric patients (including 101 in-patients with chronic schizophrenia) and related to assessments of clinical state and psychological function. Ventricular indices were increased in patients with schizophrenia by comparison with patients with other psychiatric disorders: brain area, which is modestly positively correlated with ventricular indices, was significantly (P < 001) reduced in patients with schizophrenia. Among in-patients with chronic schizophrenia, measures of increased ventricular size were significantly associated with impaired social behaviour and with movement disorder. Memory for famous names in the distant past (a test of remote memory) was the only psychological test which showed significant associations with indices of ventricular size; this suggests that ventricular enlargement and its psychological sequelae occur relatively early in the disease process. Dichotomization of the sample of schizophrenic patients around the mean age of onset revealed that a range of clinical and psychological functions are significantly more abnormal in those with an early age of onset than in those in whom the onset was later. Early onset cases also perform less well academically and occupationally before illness onset. Within the early onset group some significant correlations between cognitive function and brain area were seen.The findings suggest that: (i) some at least of the structural changes in schizophrenia arise at a time when the brain is still developing; and (ii) age of onset is an important determinant of social and intellectual impairment and is relevant to the relationship between brain structure and cognitive deficits.

SynopsisUsing computed tomography, lateral ventricular size was studied in a sample of 112 institutionalized chronic schizophrenic patients (selected from 510 cases to investigate the correlates of the defect state and intellectual decline and the effects of insulin, electroconvulsive and neuroleptic treatment), and compared with matched groups of non-institutionalized schizophrenics, patients with first schizophrenic episodes, institutionalized and non-institutionalized patients with primary affective disorder, and neurotic out-patients. Age was significantly correlated (P< 0·0002) with lateral ventricular size, but the institutionalized schizophrenic patients had significantly larger (P< 0·025) lateral ventricles than the neurotics when age was taken into account. Ventricular enlargement was unrelated to past physical treatment (neuroleptics, insulin coma and electroconvulsive therapy).Within the group of institutionalized schizophrenic patients few correlates of ventricular enlargement were identified; thus in this population increased ventricular size was not clearly associated with the features of the defect state (negative symptoms and intellectual impairment). however, there was a curvilinear (inverted-U) relationship between intellectual function and ventricular size was significantly related to absence of hallucinations, impairment of social behaviour, inactivity and the presence of abnormal involuntary movements.The findings confirm that structural brain changes do occur in chronic schizophrenia, but illustrate some of the difficulties in elucidating the clinical significance of ventricular enlargement. Lateral not bimodal; the relationship to particular features of the disease is complex and likely to emerge only in studies with a large sample size.

Abstract. The metabolic clearance rate (MCR), half‐disappearance time (T½ and apparent distribution space (DS) of unlabelled human growth hormone (HGH) have been studied using the priming dose – constant infusion technique. In 11 normal subjects MCR averaged 2.99 ml/kg/min., T½ 19.0 min. and DS 79.3 ml/kg. There were no differences between males and females and MCR was constant at HGH levels ranging from 5 to 50 ng/ml. In 10 out of 17 patients with chronic liver disease of varying severity MCR/kg was reduced below the lower limit of normal. TV2 was prolonged in 15 of these patients. There was a very close correlation between MCR/kg and DS/kg in liver disease (r = 0.8219). Increased DS/kg accounted for the normal MCR/kg seen in some patients with severe hepatocellular failure. MCR/kg was markedly reduced in three patients'with chronic renal failure. T72 and DS/kg were both significantly increased in this group (48.0 min. and 117.0 ml/kg, respectively). MCR/kg and T72 were normal in one patient with the nephrotic syndrome but normal glomerular filtration rate. MCR/kg was not significantly different from normal in patients with thyrotoxicosis, myxoedema and uncontrolled diabetes mellitus, despite the fact that T½ shorter than normal in thyrotoxicosis and longer than normal in myxoedema. It is suggested that HGH does not normally diffuse freely from the vascular to extravascular extracellular fluid, and that normally a substantial concentration gradient exists between the vascular and extravascular compartments; under these circumstances, the liver and kidneys are the major sites of HGH metabolism. In hepatic and renal failure, this gradient is reduced and extravascular degradation sites may assume more importance in the metabolism of growth hormone. Acute fluctuations in the peripheral blood concentrations of growth hormone indicate alterations in secretion rate and not alterations in metabolism.