Background. Previous research has suggested that several factors may influence the presence of cognitive impairment in human immunodeficiency virus (HIV) infection. The objective of this study was to assess the impact of cognitive reserve capacity and other variables on neuropsychological performance in early HIV infection.

Methods. The neuropsychological performance of 100 HIV-seropositive subjects without AIDS (71 men and 29 women) was compared with that of 63 seronegative controls (51 men and 12 women). Measures included a neuropsychological battery, a medical examination and a psychiatric assessment. Cognitive reserve scores were based on a combination of years in school, a measure of educational achievement, and an estimate of pre-morbid intelligence.

Results. HIV-positive subjects had longer reaction time latencies than HIV-negative subjects. Those in the HIV-positive group with low cerebral reserve scores showed the poorest performance on the neuropsychological tests. The prevalence of cognitive impairment was significantly higher in the HIV-positive group (27%) than in the controls (3·2%). Multiple regression analysis and logistic regression analysis were used to identify factors associated with global neuropsychological performance and cognitive impairment. Older age, lower cerebral reserve scores and not being on zidovudine treatment were associated with lower global neuropsychological scores and with the presence of cognitive impairment.

Conclusions. Our results suggest that although cognitive impairment is not characteristic of early HIV infection, there is a subgroup of subjects who perform more poorly than expected. A lower reserve capacity, older age and not being on zidovudine treatment are factors that lower the threshold for neuropsychological abnormalities in cases of early HIV infection.

Background. Loss events are the stressors most closely associated with the onset of depressive illnesses. The acute cortisol response to loss has been little studied although it could be an important mediator of the effects of environmental stress on psychological state.

Methods. The salivary cortisol response to an established negative mood induction procedure involving music and an imagined bereavement was measured in 30 healthy volunteers.

Results. Considerable but transient mood lowering in response to the negative mood induction was associated with a small increase in cortisol output over 30 min.

Conclusions. This procedure has some potential as a tool to investigate individual differences in the neuroendocrine response to loss events, but this is limited. There remains a need for laboratory models of relevant psychosocial stressors in mood disorders research.

Background. While most studies of quality of life (QoL) in schizophrenia have investigated long-term patients, relatively little is known about QoL early in the illness and how it changes over time. This study was conducted to investigate objective and subjective quality of life in first-admitted schizophrenia patients as compared to patients with long-term schizophrenia, changes between first admission and 9-month follow-up and predictors of changes.

Method. Eighty-six patients were examined after first admission and 51 were re-interviewed at follow-up. Results were compared with samples of in-patients and out-patients with long-term schizophrenia. QoL was assessed using a German version of the Lancashire Quality of Life Profile.

Results. Although some objective QoL data were more favourable in first-admitted patients, subjective QoL was lower than in each of the other two groups, even when psychopathology and age were controlled for. On a group level, patients showed a slight improvement in subjective QoL, which was not statistically significant. Individual changes over time were not predicted by initial data, but were correlated with changes in anxiety/depression.

Conclusion. Subjective QoL appears to be lower in first-admitted schizophrenics than in groups with long-term illness and, on a group level, it changes little within 9 months. On an individual level, changes in depressive symptoms need to be considered when interpreting changes in satisfaction with life.

The 13th World Congress on Medical Law will be held at the Marina Congress Center, Helsinki, Finland, from 6 to 10 August 2000. For information and further details, please contact Pirkko Kuorehjärvi, Congress Manager: tel +358 9 3967 2073; fax +358 9 3967 2030; email [email protected]

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