Bersani G, Clemente R, Gherardelli S, Bersani FS, Manuali G. Obstetric complications and neurological soft signs in male patients with schizophrenia. Objective: The study investigated the relationship between neurological soft signs (NSS) and obstetric complications (OCs) in patients with schizophrenia. Methods: Sixty-three male patients with schizophrenia were divided into two subgroups, based on the OCs presence or absence, which were compared in relation to NSS prevalence. After that, a Person's correlation test was performed to explore the correlation between NSS and OCs severity. Results: The subgroup with OCs showed more NSS, but there were not significant correlations between NSS and OCs severity. Conclusions: It seems that any OC, without distinction in typology and severity, could unspecifically impair the neurodevelopment and inducing NSS expression. Our findings confirm the hypothesis that neurodevelopment alterations, such as those probably induced by OCs, can contribute to a premorbid brain dysfunctional state expressed by NSS.

Aim. From literature, a sub-typification of Panic Disorder (PD) has emerged in 2 different forms, based on seasonal progression: "summer" and "winter" form, respectively characterized by onset and relapse during summer and winter. Our goal is to investigate the relationship between PD and its seasonal nature, in order to detect a potential sub-typification index linked to onset and relapse seasons. We examined subtype differences regarding the symptomatic profile, and the co-diagnosis of agoraphobia and depressive symptoms. Methods. The study involved 32 PD patients, according to DSM-IV criteria, who underwent the Agoraphobia Rating Scale (ARS), and a Retrospective Interview, aimed toward the evaluation of PD onset and progression during the drug-free period. Results. PD onset is bimodal in our sample, with a peak occurring during summer and spring, as well as in winter and fall. We found a statistically significant relationship between the onset season and the season with a greater frequency of panic attacks and agoraphobic episodes concerning the winter subtype, in agreement with existent literature. In disagreement with scientific thought, there is no significant relationship between the summer subtype and daytime onset of panic attacks; between the winter subtype, the evening onset of PD and the prevalence of depressive symptoms in the winter subtype. Discussion. Although this sample is small, we needed to evaluate the factors involved in PD's seasonal nature, patients' response to different types of therapy in both subtypes, and the possibility of considering various types of prognosis, thus leading us to new ways to further understand PD aetiopathogenesis.

Introduction. Central serous retinopathy is a primary alteration of the retinal pigment epithelium that fissures causing an exudation from choroidal capillaries. The accumulation of serous liquid between epithelium and retina causes a separation of the central macular area. This pathology is associated with vision reduction, central scotoma and metamorphopsia. The case. We report a case of a patient referred by an ophthalmologist because of a central serous retinopathy of possible psychosomatic cause. The patient referred that the symptomatology appeared in relation to worries over his daughter's health. The patient's hystory was consistent with combination of psychiatric symptoms classifiable according to DSM-IV criteria as Anxiety Disorder Not Otherwise Specified. We prescribed a therapy (mirtazapine 30 mg tablets, 1 tablet at night and lorazepam 1 mg tablet, 1 tablet when required), that induced a significant remission of psychiatric and ophthalmic symptoms after just 14 days. Conclusions. Central serous retinopathy is still a disease of unknown aetiology. The latest studies tend to associate this disease with a situation of deep psychophysical stress and to anxiety and depression symptoms; in addition there is no specific therapy for the resolution of the disease. Moreover, if we consider the remission obtained with psychiatric therapy, as in this clinical case, we can hypothesize that this affection may be included in the list of psychosomatic events.

Neurophysiologic research has shown a Neurological Soft Sign (NSS) characteristic prevalence in schizophrenic patients, and correlations between NSS and the most frequently cerebral alterations. The aim of this study was to investigate, by means of MRI, the quantitative alterations of cortical and subcortical structures and their correlation with NSS in a sample of schizophrenic patients. Linear measures of lateral ventricular (Evans ratio), third ventricular (Third Ventricular Width), hippocampal (Interuncal Index) and cerebellar (Verm Cerebellar Atrophy) atrophy were made on magnified MR images of 33 patients with a DSM IV diagnoses of chronic schizophrenia. NSS were evaluated with the Buchanan and Heinrichs's Neurological Evaluation Scale (NES). Lateral ventricular enlargement showed to be correlated with right stereoagnosia item (p=0.001). Hippocampal atrophy, with right stereoagnosia item (p=0.023), with forefinger-right thumb opposition (p=0.004), forefinger-left thumb opposition (p=0.029 and face-hand extinction (0.26). Third ventricle enlargement showed to be correlated with forefinger-right thumb opposition (p=0.001), forefinger-left thumb opposition(p=0.021) and total sensorial integration (p=0.012). Cerebellar atrophy showed to be correlated with rhythmic drumming item (p=0.042), forefinger-right thumb opposition (p=0.007), forefinger-left thumb opposition (p=0.026), left specular movements (p=0.049), face-hand extinction (p=0.001), right-left confusion (p=0.005) and with left forefinger-nose index (p=0.032). Results obtained confirm the correlation between NSS and neuroanatomical alterations in schizophrenia.

SchizophreniaMRINeurological Soft SignsEvan's IndexVerm cere- bellar atrophyThird ventricle width • Interuncal distance Summary Background and aims The direct study of the cerebral structure and functions in vivo in patients with schiz- ophrenia, made possible by the development and subsequent application of neu- roimaging techniques, has suggested the existence of an anatomic substrate related to the illness. Many results have encouraged research toward a hypothesis of real alter- ations of the brain involved in the pathogenesis of schizophrenia. These alterations could be due to disgenetic events, altered migration or differentiation of nerve cells, or neuronal degeneration with premature apoptosis. Evidence of a cerebral implication in schizophrenia is also suggested by confirmation of neurological soft signs. These are non-specific neurological signs of functional, mo- tor, sensorial and integrative type that, currently, can not be ascribed to an exact area of lesion in Central Nervous System (CNS). Despite this evidence, data in the litera- ture concerning the relationship between cerebral alterations, investigated by means of Magnetic Resonance Imaging (MRI), and Neurological Soft Sign (NSS) suggest the existence of most interested brain areas. The aim of this study was to investigate, by means of MRI, the quantitative alterations of cortical (frontal area and verm cerebellar linear measurements) and subcortical structures (hippocampal and third ventricle linear measurements) and their correla- tion with NSS in a sample of schizophrenic patients.

Background and aims The direct study of the cerebral structure and functions in vivo in patients with schizophrenia, made possible by the development and subsequent application of neuroimaging techniques, has suggested the existence of an anatomic substrate related to the illness. Many results have encouraged research toward a hypothesis of real alterations of the brain involved in the pathogenesis of schizophrenia. These alterations could be due to disgenetic events, altered migration or differentiation of nerve cells, or neuronal degeneration with premature apoptosis. Evidence of a cerebral implication in schizophrenia is also suggested by confirmation of neurological soft signs. These are non-specific neurological signs of functional, motor, sensorial and integrative type that, currently, can not be ascribed to an exact area of lesion in Central Nervous System (CNS). Despite this evidence, data in the literature concerning the relationship between cerebral alterations, investigated by means of Magnetic Resonance Imaging (MRI), and Neurological Soft Sign (NSS) suggest the existence of most interested brain areas. The aim of this study was to investigate, by means of MRI, the quantitative alterations of cortical (frontal area and verm cerebellar linear measurements) and subcortical structures (hippocampal and third ventricle linear measurements) and their correlation with NSS in a sample of schizophrenic patients.

Cognitive deficits have been reported in a large number of schizophrenic patients, and they appear to play an important role as predictors of poorer social functioning and worse clinical as well as functional outcome. Conventional neuroleptics, although they significantly improve positive symptoms of schizophrenia, appear unable to induce favourable effects on cognitive impairment associated with this illness. Many evidence, instead, seems to provide encouraging results about improvement on various neuropsychological performances following treatment with atypical antipsychotics. In the present work we reviewed the literature on the effects of clozapine, risperidone, olanzapine and quetiapine on cognitive functioning in schizophrenic patients. Reported data for each drug are reviewed separately in order to explore the hypothesis that the various atypical antipsychotics, on the basis of their different profiles of receptorial action, could also show different patterns of neuropsychological effects.

Neurologic soft signs (NSS) are considered a somatic feature associated with schizophrenia (DSM-IV) that are present in neuroleptic-treated, as well as untreated or first-episode patients. The aim of this study was to determine the incidence and severity of NSS in groups of schizophrenic patients treated with either a conventional neuroleptic medication, haloperidol (n = 37), or atypical antipsychotic medications, risperidone (n = 19), clozapine (n = 34), and olanzapine (n = 18). NSS were assessed with the Neurological Evaluation Scale (NES), whereas extrapyramidal symptoms (EPS), which occur more commonly with conventional neuroleptic treatment, were evaluated using the Simpson-Angus Scale. NES scores were not significantly different between groups. Slight differences were found for 2 items only. The haloperidol group showed higher scores for the "Romberg test," whereas the clozapine group showed higher scores for "short-term memory." There were significant correlations between EPS and NES total score in the haloperidol and risperidone groups. These results demonstrate an overall overlapping of NSS among the groups, confirming their substantial independence from neurologic implications of neuroleptic treatment.

Cognitive deficits and neurological soft signs (NSS) have frequently been reported in schizophrenic patients and they both appear related to prominent negative symptoms. The aim of the present study was to examine the relationship between deficit of executive functioning, assessed by the Wisconsin Card Sorting Test (WCST), NSS and psychopathological dimensions of schizophrenia in order to address the issue of whether a typology of schizophrenic patients may be identifiable by clinical, neurological and neuropsychological features. A sample of 26 male schizophrenic patients was divided, on the basis of the performance on the WCST, into two subgroups (‘good performers’ and ‘poor performers’) that were compared for the prevalence and severity of NSS, assessed by the Neurological Evaluation Scale (NES), and for the psychopathological features, assessed using the Positive and Negative Syndrome Scale (PANSS). To test for between-group differences, ANOVA was conducted. The ‘poor performers’ group showed greater severity of NSS: significant differences emerged for the NES total score and for the ‘sequencing of complex motor acts’ score. However, no significant differences between the groups emerged for any PANSS score. These findings seem to indicate that a common neurobiological abnormality could underlie cognitive deficits, especially concerning executive functioning, and subtle neurological abnormalities often present in schizophrenia, but they appear to deny that such dysfunctional correlates of schizophrenia are related to a prominent negative symptomatology.