OBJECTIVES: The purpose of this study was to investigate whether longitudinal changes in positive and negative symptoms affect cognitive functioning in chronic schizophrenia. METHODS: Sixty-eight patients diagnosed with DSM-IV schizophrenia were examined on two occasions over 6 months for symptoms and cognitive changes. Symptoms were measured by PANSS. Cognitive functions were examined for sustained attention, executive function, concentration and attention, and verbal memory and learning using Degraded Stimulus Continuous Performance Test, Wisconsin Card Sorting Test, Digit Span, and Rey Auditory Verbal Learning Test, respectively. Twenty control subjects were assessed to compare the cognitive scores of remitted schizophrenic patients. RESULTS: Patients showed significant improvement in symptoms and all cognitive tests after 6 months treatments. Significant improvements in positive and negative symptoms did not predict improvements in any aspect of cognitive functioning measured. Normal controls performed significantly better than remitted schizophrenic patients on all cognitive tests. The results show no relationship between change in symptoms and change in cognition in chronic schizophrenia. CONCLUSION: We suggest that symptomatic and cognitive impairment may be a distinct construct. These findings highlight the importance of treating cognitive impairment in addition to the clinical symptoms of schizophrenia.
Cognition ; Diagnostic and Statistical Manual of Mental Disorders ; Executive Function ; Follow-Up Studies* ; Humans ; Learning ; Memory ; Schizophrenia* ; Verbal Learning ; Wisconsin

OBJECTIVES: The purpose of this study is to examine whether the neurocognitive deficits of schizophrenia may be associated with certain features of symptomatology or a stable vulnerability of disease itself. METHOD: The 42 schizophrenic patients and 35 matched normal controls with sex, age, and education level were examined for their sustained attention, sensory register, executive function, concentration and attention, and verbal memory and learning in the acute and remitted stages of schizophrenia using Degraded Stimulus Continuous Performance Test, Span Apprehension Task, Wisconsin Card Sorting Test, Digit Span, and Rey Auditory Verbal Learning Test, respectively. RESULTS: The schizophrenic patients showed significant deficits in the sustained attention, sensory register, executive function, and verbal memory and learning compared with the normal controls in both acute and remitted stages of schizophrenia. Regarding the concentration and attention, the schizophrenic patients showed significant deficits in the backward digit span compared with the normal controls during acute stages, but there was no difference between two groups in the forward and backward digit span during remitted stages. No difference was evident in the sustained attention, sensory register, executive function, and verbal memory and learning between acute and remitted stages of schizophrenia. But the forward and backward digit span of schizophrenic patients showed significant improvement in the remitted stages compared with acute stages. CONCLUSIONS: The sustained attention and sensory register deficits in the visual information processing associated with schizophrenia, detected by high-processing-load version of the Degraded Stimulus Continuous Performance Test and Span Apprehension Task, are highly possible to be stable vulnerability indicators. Executive functioning deficit in the schizophrenic patients detected by Wisconsin Card Sorting Test is not likely to be dependent on symptoms, so it is difficult to conclude that it is a stable vulnerability indicators of schizophrenia. In the digit span task, the forward digit span is more likely to be a episodic indicator but the backward digit span is likely to be a mediating vulnerability indicator. And the forward and backward digit span tasks seem to be tap different cognitive abilities that are differentially associated with the diathesis for schizophrenia. Some forms of the verbal memory and learning deficits associated with schizophrenia appear to be a stable vulnerability indicators.
Automatic Data Processing ; Disease Susceptibility ; Education ; Executive Function ; Humans ; Learning ; Memory ; Negotiating ; Schizophrenia* ; Verbal Learning ; Wisconsin

OBJECTIVES: The purpose of this study is to examine differences of treatment responses and cognitive functions between typical antipsychotics and Olanzapine in schizophreniac inpatients. METHODS: Ninety-nine patients with schizophrenia treated by Olanzapine (n=56) or typical antipsychotics (n=43) by their attending were included in this study. Prior to entering the study, all subjects did not take any antipsychotics for at least 4 weeks. Cognitive and psychopathological evaluations were carried out on three times: prior to drug assignment immediately after admission (baseline), 3 months and 6 months after starting medications. Cognitive assessments were blinded to medication and psychopathological status. Cognitive functions were examined for sustained attention, sensory register, executive function, concentration and attention, and verbal memory and learning using Degraded Stimulus Continuous Performance Test, Span Apprehension Task, Wisconsin Card Sorting Test, Digit Span, and Rey Auditory Verbal Learning Test. RESULTS: The Olanzapine group presented a significantly greater improvement in the perseverative response, perseverative errors, number of completed categories of Wisconsin Card Sorting Test, forward Digit Span, immediate recall of Rey Auditory Verbal Learning Test, and positive and negative symptomatology than the typical antipsychotic group in the repeated-measures of ANCOVA among baseline, 3 month and 6 month assessments. These cognitive differences remained statistically significant after covarying out changes in symptomatology except forward Digit Span, which was affected by positive symptom in 3 month assessments. CONCLUSION: These data suggest that Olanzapine is associated with significantly greater symptomatic improvement and less cognitive than typical antipsychotics, and its benefits continued after 3 and 6 months of treatment in patients with schizophrenia.
Antipsychotic Agents ; Cognition* ; Executive Function ; Humans ; Inpatients ; Learning ; Memory ; Memory, Short-Term ; Schizophrenia* ; Verbal Learning ; Wisconsin

BACKGROUND: Moyamoya disease is a chronic cerebrovascular disorders in which stenosis of the major arteries of the circle of Willis at the base of the skull progresses to occlusion. We observed two kinds of collateral pathways from the extracranial to the intracranial arteries. Also we evaluated clinlcal and neuroimaging features of moyamoya disease to give on aid in diagnosis. METHODS: We analysed 17 patients with moyamoya disease through the medical record and neuroimaging (conventional angiography and/or MR angiography) review. Six out of 17 patients were children(< OR =15 years) and the other 11 patients were adults(15 years). There were 8 males and 9 females. RESULTS: In our result, moyamoya disease was more common in the adult. There was bimodal age distribution, so average age of onset in children was 8-year-old and in adult 37-year-old. Common clinical features are seizure (66%), TIA (17%), and psychotic behavior (17%) in childrens and hemorrhages (73%), infarction (18%), seizures (9%) in adults. According to angiographic staging classification of Suzuki et al. (1967), our cases showed distribution of stage I (13%), stage II (8.8%), stage III (65.3%), stage IV (4.3%), stage V (4.3%), stage VI (4.3%). In collateral vessels of moyamoya disease, there were 7 cases of ethmoidal moyamoya, 3 of vault moyamoya and 1 of mixed form. It is interesting that there were five cases of unilateral moyamoya disease and one case had pseudoaneurysm. CONCLUSION: According to our results, we may say that seizures are common in the children and hemorrhages are in the adult. Unilateral moyamoya were mainly occurred in the adult. Ethmoidal collaterals were common among collaterals and stage III had a more cases than others in our neuroimaging data. These clinical and neuroimaging data may help interpretation and diagnosis of moyamoya disease.
Adult ; Age Distribution ; Age of Onset ; Aneurysm, False ; Angiography ; Arteries ; Cerebrovascular Disorders ; Child ; Circle of Willis ; Classification ; Constriction, Pathologic ; Diagnosis ; Female ; Hemorrhage ; Humans ; Infarction ; Male ; Medical Records ; Moyamoya Disease* ; Neuroimaging* ; Seizures ; Skull

Spinal epidural lipomatosis(SEL) is characteristic by abnormal accumulation of unencapsulated fat in the epidural space, which usually occurred as a complication of longterm steroid therapy or Cushing's syndrome and occasionally in obese patients with no other known etiology. This condition, which may result in devastating neurologic complications has also been reported without exogenous steroid intake. Magnetic resonance imaging is the meet helpful diagnostic means and should be used initially. We describe a case of nonsteroid induced symptomatic SEL associated with phenytoin-induced hypothyroidism and obesity. A 27-year-old woman was hospitalized with inability to walk for 2 months ago. She has back pain in her legs associated with radiating pain. She had a history of myoclonic seizure and treated with phenytoin 300 mg for 8 years. On admission, she shows mild hypothyroidism on thyroid function test. Serum phenytoin level was elevated as to 22.1 ug/ml. On cross sectional MRI, the thecal sac has a striking stellate appearance with three rays emanating from a central core. It produces a trifid shape resembling the letter "Y". Correction of underlying endocrine abnormality with weight reduction instead of decompressive laminectomy can reverse the process. In a obese patient with radicular pain or progressive paralysis, SEL may be the etiologic factor involved.
Adult ; Back Pain ; Cushing Syndrome ; Epidural Space ; Female ; Humans ; Hypothyroidism* ; Laminectomy ; Leg ; Lipomatosis* ; Magnetic Resonance Imaging ; Obesity* ; Paralysis ; Phenytoin* ; Seizures ; Strikes, Employee ; Thyroid Function Tests ; Weight Loss

OBJECTIVE: The purpose of this research was to investigate the differences of symptoms and neurocognitive functions with good and poor social functioning schizophrenic outpatients. METHOD: 152 schizophrenic outpatients were divided to good social functioning group(n=26) and poor social functioning group(n=126) based on the instrumental role of workers or students. Neurocognitive functions of these patient groups were compared with normal control group, which was composed of 30 healthy persons without a history of psychiatric illness. Schizophrenic symptoms were assessed by the Positive and Negative Syndrome Scale(PANSS). Neurocognitive function tests include the sustained attention, sensory register, executive function, concentration and attention, and verbal memory and learning assessed with Degraded Stimulus Continuous Performance Test(DS-CPT), Span Apprehension Task(SAT), Wisconsin Card Sorting Test(WCST), Digit Span(DS), and Rey Auditory Verbal Learning Test(RAVLT). RESULTS: 1) No significant differences were noted in the symptom subtypes of PANSS between good and poor social functioning patient groups. 2) The poor social functioning patient group showed significant deficits in the sustained attention, sensory register, concentration and attention, and verbal memory and learning as manifested in the data of DS-CPT, SAT, DS, and RAVLT compared with normal control and good social functioning patient groups. But there were no differences in these neurocognitive functions between good social functioning patient group and normal control group. CONCLUSIONS: These results suggested that some neurocognitive deficits such as sustained attention, sensory register, concentration and attention, and verbal memory and learning may be more important factors than symptoms for social functioning in the stable schizophrenic outpatients.
Executive Function ; Humans ; Learning ; Memory ; Outpatients ; Schizophrenia ; Verbal Learning ; Wisconsin

Cerebral venous angomas are a rare form of intracranial vascular malformation and first reported by Wolf in 1967. The characteristic angiographic appearance of venous malformation is a local network of small veins that converged centrally into a single large drainage vein. The CT findings are linear or curvilinear enhancement after administration of contrast media. The authors present a case of venous angiomatosis of the both hemisphere combined with dural arteriovenous malformations demonstrated by the carotid angiography and bran CT, with clinical presentation of status epilepcus and following left hemiplegia due to cerebral infarction.
Angiography ; Angiomatosis* ; Arteriovenous Malformations* ; Cerebral Infarction ; Contrast Media ; Drainage ; Hemiplegia ; Vascular Malformations ; Veins ; Wolves

BACKGROUND: Although a magnetic resonance imaging (MRI) is highly sensitive for changes associated with ischemic stroke, the detection of an acute ischemic lesion is usually impossible within 6 hours of the stroke onset on a conventional MRI. The perfusion MRI is a new imaging technique for diagnosing acute ischemic stroke. We evaluate the clinical usefulness of the perfusion MRI in predicting the final infarct extent in 18 patients with acute middle cerebral artery (MCA) territory ischemic stroke. METHOD: The perfusion MRI was performed within 6 hours after the stroke onset in all patients with a single-section dynamic contrast-enhanced T2*-weighted imaging in conjunction with a conventional routine MRI and MR angiography. Time-concentration curves and cerebral blood volume (CBV) maps were calculated from the dynamic MR imaging data by using numerical integration techniques. We compared findings of CBV maps with infarction on a follow-up CT or MRI. RESULTS: In 14 of 18 patients, the CBV in the occluded MCA territory were decreased. In the remaining 4 patients with a reversible ischemic neurologic deficit (RIND) or transient ischemic attack (TIA), the CBV were increased in 3 and normal in 1. Out of 14 patients with a decreased CBV, two had focal regions of increased CBV within the affected territory, indicating reperfusion hyperemia. The regions of increased or decreased CBV were eventually converted to infarction on follow-up images in all 14 patients. Out of 4 patients with RIND or TIA, one showed focal infarction in centrum semiovale on a follow-up image. CONCLUSIONS: The perfusion MRI was useful for the assessment of hemodynamic change about cerebral perfusion and may predict the extent of final infarction in acute MCA territory ischemic stroke. These results suggest that the perfusion MRI may play an important role in the diagnosis and management of acute ischemic stroke.
Angiography ; Blood Volume ; Diagnosis ; Follow-Up Studies ; Hemodynamics ; Humans ; Hyperemia ; Infarction ; Ischemic Attack, Transient ; Magnetic Resonance Imaging* ; Middle Cerebral Artery* ; Neurologic Manifestations ; Perfusion* ; Reperfusion ; Stroke*

OBJECTIVES: The purpose of this study was to compare the social functioning between schizophrenic patients treated with olanzapine and those with typical antipsychotics. METHODS: Fifty-seven schizophrenic patients with acute exacerbation entered consecutively to olanzapine treatment (N=33) or typical antipsychotic treatment (N=24). The assessment of social functioning and symptoms were made at 3 time points:at the time of admission (baseline), 6 months and 12 months after starting medications. Social functioning and symptoms were examined using the Korean version of Social Adjustment Scale II-Revised Version (KSAS II-RV) and the Positive and Negative Syndrome Scale (PANSS). RESULTS: After 6-months and 12-months treatments, olanzapine treatment group showed significantly improved PANSS total scores (p=.02), positive scores (p=.04), negative scores (p=.01), and KSAS II-RV total score (p=.004), instrumental role (p=.002), social leisure (p=.03), personal well-being subarea scores (p=.02), compared with the scores of typical antipsychotic treatment group. CONCLUSION: Olanzapine was more effective than typical antipsychotics in reducing the severity of psychopathology and in improving some subareas of social functionings in patients with schizophrenia. The benefits of olanzapine on social functioning, although modest, may be important factor considering their accumulative effects for long-term treatment.
Antipsychotic Agents* ; Humans ; Leisure Activities ; Psychopathology ; Schizophrenia* ; Social Adjustment

OBJECTIVES: The purpose of this study was to compare the social functioning between schizophrenic patients treated with olanzapine and those with typical antipsychotics. METHODS: Fifty-seven schizophrenic patients with acute exacerbation entered consecutively to olanzapine treatment (N=33) or typical antipsychotic treatment (N=24). The assessment of social functioning and symptoms were made at 3 time points:at the time of admission (baseline), 6 months and 12 months after starting medications. Social functioning and symptoms were examined using the Korean version of Social Adjustment Scale II-Revised Version (KSAS II-RV) and the Positive and Negative Syndrome Scale (PANSS). RESULTS: After 6-months and 12-months treatments, olanzapine treatment group showed significantly improved PANSS total scores (p=.02), positive scores (p=.04), negative scores (p=.01), and KSAS II-RV total score (p=.004), instrumental role (p=.002), social leisure (p=.03), personal well-being subarea scores (p=.02), compared with the scores of typical antipsychotic treatment group. CONCLUSION: Olanzapine was more effective than typical antipsychotics in reducing the severity of psychopathology and in improving some subareas of social functionings in patients with schizophrenia. The benefits of olanzapine on social functioning, although modest, may be important factor considering their accumulative effects for long-term treatment.
Antipsychotic Agents* ; Humans ; Leisure Activities ; Psychopathology ; Schizophrenia* ; Social Adjustment