Relationships of the Mecholyl Test, Premorbid Asocial Functioning, and Long Term Outcome in Schizophrenia

Gittelman-Klein, Rachel; Klein, Donald F.; Blumberg, A; Levenstein, Sidney

doi:10.1097/00005053-197004000-00005

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“…Premorbid history was associated with long-term prognosis in first admission cases but not methacholine response. 70 The scales used in this study did not measure affective lability and disturbances which was raised as a point of difference with another study that did show a methacholine effect. This latter study correlated reaction to mecholyl along a process-reactive dimension with higher autonomic responsiveness associated with greater reactivity.…”

Section: A Nosology Of Psychosismentioning

confidence: 82%

A new nosology of psychosis and the pharmacological basis of affective and negative symptom dimensions in schizophrenia

Vakalopoulos¹

2010

Mental Illness

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Although first rank symptoms focus on positive symptoms of psychosis they are shared by a number of psychiatric conditions. The difficulty in differentiating bipolar disorder from schizophrenia with affective features has led to a third category of patients often loosely labeled as schizoaffective. Research in schizophrenia has attempted to render the presence or absence of negative symptoms and their relation to etiology and prognosis more explicit. A dichotomous population is a recurring theme in experimental paradigms. Thus, schizophrenia is defined as process or reactive, deficit or non-deficit and by the presence or absence of affective symptoms. Laboratory tests confirm the clinical impression showing conflicting responses to dexamethasone suppression and clearly defined differences in autonomic responsiveness, but their patho-physiological significance eludes mainstream theory. Added to this is the difficulty in agreeing to what exactly constitutes useful clinical features differentiating, for example, negative symptoms of a true deficit syndrome from features of depression. Two recent papers proposed that the general and specific cognitive features of schizophrenia and major depression result from a monoamine-cholinergic imbalance, the former due to a relative muscarinic receptor hypofunction and the latter, in contrast, to a muscarinic hypersensitivity exacerbated by monoamine depletion. Further development of these ideas will provide pharmacological principles for what is currently an incomplete and largely, descriptive nosology of psychosis. It will propose a dimensional view of affective and negative symptoms based on relative muscarinic integrity and is supported by several exciting intracellular signaling and gene expression studies. Bipolar disorder manifests both muscarinic and dopaminergic hypersensitivity. The greater the imbalance between these two receptor signaling systems, the more the clinical picture will resemble schizophrenia with bizarre, incongruent delusions and increasingly disorganized thought. The capacity for affective expression, by definition a non-deficit syndrome, will remain contingent on the degree of preservation of muscarinic signaling, which itself may be unstable and vary between trait and state examinations. At the extreme end of muscarinic impairment, a deficit schizophrenia subpopulation is proposed with a primary and fixed muscarinic receptor hypofunction.The genomic profile of bipolar disorder and schizophrenia overlap and both have a common dopaminergic intracellular signaling which is hypersensitive to various stressors. It is proposed that the concomitant muscarinic receptor upregulation differentiates the syndromes, being marked in bipolar disorder and rather less so in schizophrenia. From a behavioral point of view non-deficit syndromes and bipolar disorder appear most proximate and could be reclassified as a spectrum of affective psychosis or schizoaffective disorders. Because of a profound malfunction of the muscarinic receptor, the deficit subgroup cannot ex...

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Section: A Nosology Of Psychosismentioning

confidence: 82%

A new nosology of psychosis and the pharmacological basis of affective and negative symptom dimensions in schizophrenia

Vakalopoulos¹

2010

Mental Illness

View full text Add to dashboard Cite

show abstract

Relationships of the Mecholyl Test, Premorbid Asocial Functioning, and Long Term Outcome in Schizophrenia

Cited by 1 publication

References 0 publications

A new nosology of psychosis and the pharmacological basis of affective and negative symptom dimensions in schizophrenia

A new nosology of psychosis and the pharmacological basis of affective and negative symptom dimensions in schizophrenia

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