No abstract

Background: The early identification of schizophrenia is important in establishing an adequate therapeutic intervention, especially in emergency situations. Intuitive reasoning is often necessary because a standardized classification according to ICD-10 or DSM-IV criteria is not suitable in these complex, and often changing, settings. The process of recognizing the specific schizophrenic structure in an intuitive way by an experienced psychiatrist was named ‘praecox feeling’ by the Dutch psychiatrist Rümke in 1941. Sampling and Methods: To evaluate the diagnostic quality of this kind of intuitive clinical approach we investigated 67 previously unknown patients. All patients displayed acute psychotic symptoms like paranoid delusions and hallucinations belonging to the schizophrenic spectrum. The first interview by an experienced psychiatrist included only the present state psychopathology. Data referring to the course of the illness or medication or family history of schizophrenia were explored later by other independent staff members who were blind to the aim of the investigation. The intensity of the ‘praecox feeling’ was rated in four degrees: not present – mild – moderate – high. At the end of the inpatient period a standardized diagnostic classification according to ICD-10 and DSM-IV classification was carried out by independent raters. Results: Compared to the standardized diagnostic classification the precision of the intuitive reasoning was remarkably high with a sensitivity of about 0.85, a specificity of about 0.80, a positive predictive power of about 0.90, and a negative predictive power of about 0.65 depending on the standardized system used. Cognitive impairment, affective disturbances, disturbed self-perception, and reduced communication skills all correlated with intensity of ‘praecox feeling’. The single variable ‘affective disturbances’ had the highest impact on the intensity of ‘praecox feeling’ in an ordinal regression analysis. Furthermore a high intensity of ‘praecox feeling’ strongly correlated with a hereditary predisposition to schizophrenia. Neither the severity of the mental illness nor extrapyramidal side effects of the medication correlated with the intensity of ‘praecox feeling’. Conclusion: Our work can possibly help in contributing to reflection on our diagnostic practices and help to make the various factors involved in establishing diagnoses apparent.

Background: Gamma-band oscillations are prominently impaired in schizophrenia, but the nature of the deficit and relationship to perceptual processes is unclear.Methods: 16 patients with chronic schizophrenia (ScZ) and 16 age-matched healthy controls completed a visual paradigm while magnetoencephalographic (MEG) data was recorded.Participants had to detect randomly occurring stimulus acceleration while viewing a concentric moving grating. MEG data were analyzed for spectral power (1-100 Hz) at sensorand source-level to examine the brain activity and brain regions involved in aberrant rhythmic activity and for contribution of differences in baseline activity towards the generation of low-and high-frequency power.Results: Our data show reduced gamma-band power at sensor level in schizophrenia patients during stimulus processing while alpha-band and baseline spectrum were intact. Differences in oscillatory activity correlated with reduced behavioral detection rates in the schizophrenia group and higher scores on the "Cognitive Factor" of the Positive and Negative Syndrome Scale. Source reconstruction revealed that extra-striate (fusiform/lingual gyrus), but not striate (cuneus), visual cortices contributed towards the reduced activity observed at sensorlevel in ScZ patients. Importantly, differences in stimulus-related activity were not due to differences in baseline activity.Conclusions: Our findings highlight that MEG-measured high-frequency oscillations during visual processing can be robustly identified in ScZ. Our data further suggest impairments that involve dysfunctions in ventral stream processing and a failure to increase gamma-band activity in a task-context. Implications of these findings are discussed in the context of current theories of cortical-subcortical circuit dysfunctions and perceptual processing in ScZ.4

Postpartum psychiatric disorders are stressful events for all members of the family. The male partners contribute to the women's coping process. To evaluate the men's supportive function we investigated 31 partners of 34 women with postpartum psychiatric disorders. Three male partners were unreachable although we tried to contact them intensively. All the women examined were in-patients of a mother-child unit after delivery. The men's behaviour in the relationship, in their role as a partner, and as a father were rated in a categorical-qualitative way. We found that nearly one third of the male partners can be described as "supportive". This finding strongly correlates with the subjective experience of the corresponding wives of being supported by the male partners. However in the subgroup of women who had already suffered from prepartum psychiatric disorders with onset before index-delivery, the majority of the male partners were rated and experienced as "non-supportive". Additionally, ten of these men suffered from several DSM-IV/ICD-10 based psychiatric disorders themselves. Using the standardised questionnaire "operationalisierte psychodynamische Diagnostik" (OPD) we describe the higher ego-strength of the supportive male partners. We found that there was a reduction in the length of stay in the hospital in the families with supportive male partners.

As aggressive behavior has a negative impact in general psychiatry, its influence specifically from a gender-related point of view in an in-patient population of a psychiatric clinic was assessed at the time of admission. A group of 521 successively admitted psychiatric in-patients was investigated at admission with the help of the "Social Dysfunction and Aggression Scale". A slightly higher frequency and intensity of "verbal aggressive behavior" was observed in males. Within the other categories of aggressive behavior ("tension", "physical violence to things", and "assaults"), however, the percentages and intensities of gender-related aggressive behavior did not differ significantly. Furthermore, under the covarying impact of various psychiatric diagnoses, the gender-related differences concerning the intensity of "verbal aggressive behavior" disappeared. When comparing male and female subgroups, it was notable that male schizophrenic patients were younger than female patients when displaying comparable risks of showing at least one kind of aggressive behavior. In addition, in the female subgroup, "self-injurious behavior" was more strongly correlated to the category "tension" than in the male subgroup. Although there are some methodological shortcomings, the present results show that there are small qualitative differences in gender-related aggressive behavior in addition to minimal quantitative differences in the frequency and intensity of "verbal aggressive behavior" at admission.