Longitudinal Changes in Brain Gyrification in Schizophrenia Spectrum Disorders

Previous magnetic resonance imaging (MRI) studies reported increased brain gyrification in schizophrenia and schizotypal disorder, a prototypic disorder within the schizophrenia spectrum. This may reflect deviations in early neurodevelopment; however, it currently remains unclear whether the gyrification pattern longitudinally changes over the course of the schizophrenia spectrum. The present MRI study using FreeSurfer compared longitudinal changes (mean inter-scan interval of 2.7 years) in the local gyrification index (LGI) in the entire cortex among 23 patients with first-episode schizophrenia, 14 with schizotypal disorder, and 39 healthy controls. Significant differences were observed in longitudinal LGI changes between these groups; the schizophrenia group exhibited a progressive decline in LGI, predominantly in the fronto-temporal regions, whereas LGI increased over time in several brain regions in the schizotypal and control groups. In the schizophrenia group, a greater reduction in LGI over time in the right precentral and post central regions correlated with smaller improvements in negative symptoms during the follow-up period. The cumulative medication dosage during follow-up negatively correlated with a longitudinal LGI increase in the right superior parietal area in the schizotypal group, but did not affect longitudinal LGI changes in the schizophrenia group. Collectively, these results suggest that gyrification patterns in the schizophrenia spectrum reflect both early neurodevelopmental abnormalities as a vulnerability factor and active brain pathology in the early stages of schizophrenia.

Influence of attachment on socio-psychological adaptation and its dynamics in the course of treatment in adolescent patients with schizotypal disorder

Summary. Purpose. Study of the influence of attachment quality (based on the analysis of its representation) on the results of treatment and socio-psychological adaptation of adolescent patients with schizotypal disorder.Materials and Methods. 41 adolescents with pseudoneurotic type of schizotypal disorder were surveyed [F 21.3]. All respondents were divided into two groups based on the type of early attachment to mother («reliable attachment» and «unreliable attachment»). A battery of 6 tests was used: a questionnaire for studying of coping-behavior ways (Lazarus R., Folkman С., WCQ, The Waysof Coping Questionnaire, 1988); test LSI, Life style index Plutchik R., Kellerman H., 1979 (in adapt.Wasserman L. I., etc., 1998), the modified questionnaire of attachment ( Yaremchuk M. V., 2005; in modific. Almazova O.V., Burmenskaya G.V., 2015), SCL-90R («Simptom Check List-90-Revised»; Derogatis, Rickels, Rock, 1976), integrative anxiety test (Bizyuk A.P, Wasserman L.I., Iovlev B.V., 2005), scale of assessment of social functioning of patients (Kotsyubinsky A.P., Sheinina N.S., etc. 2013). Studied were the features of protectively-adaptive behavior and the actual psychological symptomatic status, indicators of personal and situational anxiety, as well as features of contact with the doctor, and dynamics of indicators of social adaptation during treatment.Results. Confirmed the relationship of representation unreliable type of attachment to the mother, in patients with schizotypal disorder, and sustained violation in the sphere of relationships with parents, disorders of emotional regulation, reduce psychological adaption in general. In such patients, during the treatment process, lower compliance indicators, specific features of the protective-coping style of behavior, as well as slower rates of psychological and social recovery were revealed.Conclusion. According to the results of the study, data indicating the negative impact of unreliable attachment in adolescent patients with schizotypal disorder on psychological recovery during treatment and socio — psychological adaptation of patients in general were obtained. Psychotherapeutic recommendations are presented.

“Transition” to Schizophrenia or Fluctuations within the Same Disorder?

<b><i>Background:</i></b> To prevent or delay the onset of psychotic disorders or ameliorate their course, prodromal research has strived to identify and treat individuals at risk of developing psychosis. While this approach is laudable, it is, however, not entirely unproblematic from clinical and conceptual perspectives. For example, it remains unclear how we are to understand the development from a nonpsychotic, distressing condition such as schizotypal disorder to a psychotic disorder such as schizophrenia? The current terminology on the subject implies either a nonlinear jump (“conversion”) or a more linear progression (“transition”) from one disorder to another. To enrich our understanding of such diagnostic shifts, we examined the psychopathological pictures of patients who “transitioned” from schizotypal disorder to schizophrenia. <b><i>Methods:</i></b> From a larger study on psychopathology, we examined 40 patients who were diagnosed with schizotypal disorder at baseline. At 5-year follow-up, 30 patients maintained the diagnosis of schizotypal disorder, while 10 were re-diagnosed with schizophrenia. We examined detailed descriptions of the 10 patients who progressed to schizophrenia, comparing psychopathology and level of functioning. <b><i>Results:</i></b> The level of functioning decreased slightly from baseline to follow-up in 9 out of 10 patients. Eight patients had previously had micro-psychotic or psychotic experiences. All patients had self-disorders at baseline, and several patients had perceptual disorders. Nine patients had formal thought disorders at baseline. The progression is illustrated by 2 cases. <b><i>Conclusion:</i></b> In this small study, we did not find any striking changes in any of the patients, neither in terms of psychopathological manifestations nor in terms of their level of functioning. Thus, rather than witnessing a genuine “conversion” or “transition” from schizotypal disorder to schizophrenia, we observed dimensional fluctuations within the same condition.

Psychopathology structure of affective disturbances in patients with schizotypal disorder

The study of the structural features of the psychopathological symptomatology of schizophrenic spectrum disorders remains one of the most urgent topics in modern psychiatry; schizotypal disorder deserves special attention in this context. In order to identify the structural characteristics of affective disturbances in patients with schizotypal disorder, during 2019-2020, aprospective study of 128 patients with schizotypal disorder who were on outpatient treatment was conducted. By using clinical-anamnestic, clinical-psychopathological, psychodiagnostic and statistical methods it was revealed, that affective pathology has a significant prevalence among patients with schizotypal disorder, in the vast majority of cases it is represented by unipolar depressive symptoms, the intensity of which varies in a continuum from moderate severity of manifestations to their complete absence; in a quarter of cases affective psychopathological symptoms have a wider spectrum and reach hypomanic states; the prevalence of manic symptoms in the clinical picture lids to a partial elimination of the underlying disease symptoms; the psychopathological content of the affective sphere in one third of the examined patients with schizotypal disorder is represented by specific changes in the form of reduced affect display.

Diagnosis of schizotypal disorder: reliability of categorial approach or validity of dimensional one?

The article examines the problem of modern classifications used in psychiatry (ICD, DSM) that are devoid of the fundamental scientific base and primarily serve the goals of statistics and epidemiological research. In this context researchers are increasingly interested in the relationship between the two diagnostic approaches: categorical and dimensional. It is noted that each of these approaches has its own advantages and disadvantages. In this context it is proposed to take into consideration while making a diagnosis of schizotypal disorder not only typological (categorical) attributes but also dementia characteristics of the patients mental status, which, in the holistic approach, should be compared with the psychological, social and functional diagnosis.

Psychopatology as a cultural paradigm

In the context of models of modern society (modernism, postmodernism and post-postmodernism), psychopathological phenomena are considered that correspond to them in the form of neurosis, schizophrenia, as well as schizotypal disorder, pseudo-autism and digital dementia.

Increased Heschl’s Gyrus Duplication in Schizophrenia Spectrum Disorders: A Cross-Sectional MRI Study

Duplicated Heschl’s gyrus (HG) is prevalent in patients with schizophrenia and may reflect early neurodevelopmental anomalies. However, it currently remains unclear whether patients with schizotypal disorder, a prototypic disorder within the schizophrenia spectrum, exhibit a similar HG gyrification pattern. In this magnetic resonance imaging study, HG gyrification patterns were examined in 47 patients with schizotypal disorder, 111 with schizophrenia, and 88 age- and sex-matched healthy subjects. HG gyrification patterns were classified as single, common stem duplication (CSD), or complete posterior duplication (CPD). The prevalence of the duplicated HG patterns (CSD or CPD) bilaterally was higher in the schizophrenia and schizotypal groups than in healthy controls, whereas no significant difference was observed between the schizophrenia and schizotypal groups. Schizophrenia patients with the right CPD pattern had less severe positive symptoms, whereas the right single HG pattern was associated with higher doses of antipsychotic medication in schizotypal patients. The present study demonstrated shared HG gyrification patterns in schizophrenia spectrum disorders, which may reflect a common biological vulnerability factor. HG patterns may also be associated with susceptibility to psychopathology.