At Issue: Schizophrenia Spectrum Disorders in
Persons Exposed to Ionizing Radiation as a
Result of the Chernobyl Accident
by Konstantin N. Loganovsky and Tatiana K. Loganovskaja
The At Issue section of the Schizophrenia Bulletin contains viewpoints and arguments on controversial issues.
Articles published in this section may not meet the strict
editorial and scientific standards that are applied to
major articles in the Bulletin. In addition, the viewpoints
expressed in the following article do not necessarily represent those of the staff or the Editorial Advisory Board
of the Bulletin.—The Editors.
spectrum disorders. An integration of international
efforts to discuss and organize collaborative studies in
this field is of great importance for both clinical medicine and neuroscience.
Keywords: Schizophrenia spectrum disorders,
ionizing radiation, Chernobyl accident, laterality, psychophysiology, brain mapping of EEG, evoked potentials, limbic system.
Schizophrenia Bulletin, 26(4):751-773, 2000.
Abstract
Evidence is increasing in support of the etiologic heterogeneity of schizophrenia (Coleman and Gillberg 1997;
Garver 1997). Schizophrenia results from the interaction
of multiple factors, including the person's genetic endowment and various environmental influences (Kirch 1993).
The exact role of environmental hazards in the development of the illness, however, remains unclear (Shore
1986; Buszewicz and Phelan 1994; McGuffin et al. 1994;
Syvalahti 1994; Fuller Torrey [1995] 1996).
Evidence is dramatically increasing in support of the
neuropathology of schizophrenia (Flor-Henry 1969a,
19696, 1976, 1983, 1987, 1989; Gur and Pearlson 1993;
Gruzelier and Raine 1994; Arnold 1997; Egan and
Weinberger 1997; Willner 1997; Bullmore et al. 1998;
O'Donnell and Grace 1998; Sachdev 1998). Left frontotemporal abnormalities have been outlined as a cerebral
basis of schizophrenia (Flor-Henry 1969a, 19696, 1976,
1983, 1987, 1989; Gruzelier and Hammond 1976; Deakin
et al. 1989; Gruzelier 1997; Bullmore et al. 1998).
Neurobiological studies suggest that abnormalities of both
anatomy and function occur in the limbic-cortical structures of schizophrenia patients. An anatomical circuit that
links functioning of the ventral striatum with the hippocampus and other limbic-cortical structures lies at the
site of these neurobiological abnormalities (Csernansky
and Bardgett 1998).
We studied schizophrenia spectrum disorders in
Chernobyl accident survivors by analyzing Chernobyl
exclusion zone (EZ) archives (1986-1997) and by conducting a psychophysiological examination of 100
patients with acute radiation sickness (ARS) and 100
workers of the Chernobyl EZ who had worked as "liquidators-volunteers" for S or more years since
1986-1987. Beginning in 1990, there has been a significant increase in the incidence of schizophrenia in EZ
personnel in comparison to the general population (5.4
per 10,000 in the EZ versus 1.1 per 10,000 in the
Ukraine in 1990). Those irradiated by moderate to
high doses (more than 0.30 Sv or 30 rem), including
ARS patients, had significantly more left frontotemporal limbic and schizophreniform syndromes. 1 We
hypothesized that ionizing radiation may be an environmental trigger that can actualize a predisposition
to schizophrenia or indeed cause schizophrenia-like
disorders. The development of schizophrenia spectrum
disorders in overirradiated Chernobyl survivors may
be due to radiation-induced left frontotemporal limbic
dysfunction, which may be the neurophysiological
basis of schizophrenia-like symptoms. Persons exposed
to 0.30 Sv or more are at higher risk of schizophrenia
'l Gy (gray) = one unit of absorbed dose of ionizing radiation = 100
rad (radiation absorbed dose). 1 Sv (sievert) = one unit of effective dose
of ionizing radiation = 100 rem (roentgen equivalent man). Regarding
the Chernobyl accident, 1 Sv = 1 Gy.
Send reprint requests to Dr. K.N. Loganovsky, 16D Heroes of
Stalingrad St., Apt. 173, Kyiv, 04210, Ukraine; e-mail:
[email protected].
751
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
K.N. Loganovsky and T.K. Loganovskaja
Exposure to ionizing radiation causes brain damage
with limbic system dysfunction (Grigoriev 1958;
Lebedinsky and Nakhilnitzkaja 1960; Gangloff 1962;
Haley 1962; Lebedinsky 1962; Livanov 1962; Kimeldorf
and Hunt [1965] 1969; Hunt 1987). Moreover, the hippocampus is a very radiosensitive structure (Kimeldorf
and Hunt [1965] 1969; Davydov and Ushakov 1987). Xray irradiation of the hippocampus by low doses of 6-8
mGy (0.6-0.8 rad) produces the endogenous (pacemaker)
generation of nervous impulses (Peimer et al. 1985;
Dudkin 1988). Thus, the hypothesis arises that exposure
to ionizing radiation can trigger schizophrenia in predisposed individuals or cause schizophrenia-like disorders as
a consequence of radiation-induced limbic dysfunction.
Studies on the relationship between schizophrenia
and radiation exposure are practically absent in the available literature. One study describes an atypical clinical
pattern of schizophrenia secondary to chronic irradiation
with prominent asthenia, autonomic instability, and
hypochondriac and psychosensory symptoms but does not
link schizophrenia onset to the ionizing radiation exposure (Golodetz 1962).
Nakane and Ohta (1986) reported a significant
increase in the prevalence of schizophrenia in the A-bomb
survivors in Nagasaki. The Life Span Study (LSS), started
by the Radiation Effect Research Foundation in Japan, did
not include data on severe mental disorders. The Japanese
authors combined the schizophrenia register of the
Department of Neuropsychiatry, University School of
Medicine, Nagasaki, with the LSS register to fill in this
information. They revealed that, in 1978, there were 1,589
patients with schizophrenia in the LSS register (n 26,678). The schizophrenia register had been in operation
only since 1960, and it was not possible to calculate
annual inception rates back to the bombing in 1945.
Moreover, migration out of Nagasaki cannot be estimated.
In spite of these methodological limitations, the prevalence of schizophrenia in the A-bomb survivors was still
very high (6 percent), while the prevalence of schizophrenia is no more than 1 percent in the general population
(Shore 1986; Fuller Torrey [1995] 1996).
The first information about an increase in schizophrenia incidence among the Chernobyl EZ personnel was
presented by Loganovsky and Nyagu (1997) at the
International Conference on Low Doses of Ionizing
Radiation: Biological Effects and Regulatory Control.
The purpose of this study is to investigate the schizophrenia spectrum disorders (schizophrenia, schizotypal,
schizoaffective, organic schizophrenia-like, and schizoid
personality disorders) among the irradiated Chernobyl
accident survivors. The study includes two parts: (1) an
epidemiological study of severe mental disorders in the
Chernobyl EZ personnel and (2) a psychophysiological
assessment of the irradiated persons—patients who had
ARS as well as the workers who cleaned up the Chernobyl
accident consequences (so-called "liquidators").
Design
Background. At 1:23 AM, April 26, 1986, the fourth unit
of the Chernobyl Nuclear Power Plant (ChNPP) was
destroyed and about 300 MCi (11 X 1018 Bq) of radioactive materials exploded into the environment. At the present time in the Ukraine, there are about 3 million
Chernobyl accident survivors. About 100,000 people have
been evacuated from the 30-km zone surrounding the
ChNPP (the Chernobyl EZ). More than 600,000 people
from the former USSR took part in cleaning up the
Chernobyl accident consequences from 1986 to 1989;
these workers are called "liquidators." The most critical
group from the radiological point of view is the 126,000
liquidators who worked from April 26, 1986, to the beginning of 1987. Their average dose of irradiation was
120-180 mSv (12-18 rem), but 6-15 percent
(7,560-18,900 workers) were irradiated by more than 250
mSv (25 rem). The effective doses of irradiation for other
Chernobyl accident survivor contingents were significantly lower. The average dose per year of irradiation of
"non-Chernobyl" origin for the Ukrainian population is
5.3 mSv/year (0.53 rem/year; Likhtarev et al. 1994; Los'
and Likhtarev 1994; Likhtarev 1996; Ministry of Ukraine
1996).
ARS has been diagnosed in 237 persons, 29 of whom
died as a result of the exposure 7-96 days after the accident (Kindselsky et al. 1995; Romanenko et al. 1995).
Only 134 patients had verified ARS (absorbed doses
0.7-13 Gy or 70-1300 rad) (Wagemaker and Bebeshko
1996). The remaining 103 patients in whom ARS was
diagnosed are considered to have a subclinical form of
ARS. At the present time, 180 persons who had been
diagnosed with ARS in 1986 are living in the Ukraine and
are in a followup study at the Scientific Center for
Radiation Medicine, Kiev (Bebeshko et al. 1996).
The ARS patients and the liquidators of 1986-1987
clearly have the highest radiation risk. However, until
now, epidemiological data concerning severe mental disorders among the liquidators have been practically absent,
possibly due to (1) lack of radioepidemiologic interest in
this problem in comparison with traditional topics such as
radiation-induced malignancies and hereditary disorders;
(2) a deficiency of psychiatric information in the radiological registers, and vice versa; and (3) high rates of migration among the liquidators.
The particular group of Chernobyl accident survivors
focused on in this study is the Chernobyl EZ personnel,
primarily composed of liquidators, who are volunteers
752
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
At Issue
(100 rem), 0.82 percent (Vokhmekov et al..l994). All
records in the psychiatric archives of the Medical and
Sanitary Department of Chernobyl were studied. Control
data for the epidemiological part of the study came from
the official statistical data of the Ministry of Public Health
of Ukraine (1970-1997).
In the Ukraine, the incidence of psychiatric illness,
particularly of severe mental disorders, is calculated on
the basis of hospital admissions. The diagnosis of psychotic disorder is verified during hospitalization and is
included in the calculation of base rate statistics. Until
April 1999 in the Ukraine, ICD-9 diagnostic criteria were
used. This same methodology is used in the Chernobyl EZ
to diagnose disorders in current personnel, and a nonstandardized interview and medical documentation are used to
review prospective EZ personnel. If a mental disorder is
revealed during the interview or the candidate has been
registered with national mental health care, the candidate
is not accepted for employment in the EZ. A screening for
severe mental disorders is carried out if abnormal behavior or acute symptoms are present. Individuals are transferred by colleagues, ambulance, or the police to the psychiatrist of the Medical and Sanitary Department of
Chernobyl, who decides whether to transfer the patient to
the mental hospital. If a severe mental disorder is verified
in the hospital, data about the disorder are included in the
register. This common diagnostic procedure leads to a
general underestimation of mental disorders but makes
possible a comparison of data in the EZ with data from
the general population. It should be noted that the epidemiological data on the basis of the psychiatric archives
of Chernobyl are accurate only for severe mental disorders. Borderline mental disorders irf'EZ personnel are
classified as a comorbidity of physical diseases and, consequently, are excluded from the psychiatric archives and
registration.
and work according to a watch regime (i.e., 2 weeks
within the EZ and 2 weeks at home). They were medically
monitored and available for epidemiological assessment.
Consequently, the 12-year followup study of the
Chernobyl EZ personnel is a unique opportunity to investigate the epidemiology of severe mental disorders in this
population.
Epidemiological Study. The data for the epidemiological
part of the study was obtained from the psychiatric
archives (1986-1997) of the Medical and Sanitary
Department in Chernobyl. Since 1986, this department
has undertaken the somatic and mental health monitoring
of EZ personnel. The number surveyed each year is presented in table 1.
The number of EZ personnel decreased since
1988-1990, when the emergency cleanup was complete.
It was intended that all ill workers or those who were at a
high risk for any disease (especially mental disorders)
would not be employed in the EZ or would be eliminated
from the EZ personnel if disease developed after they had
begun work. Further, it should be noted that the EZ personnel are volunteers. Therefore, it is doubtful that workers would present fictitious symptoms (e.g., malingering)
in order to be transferred out of the area and, consequently, lose their jobs, which have a higher salary than
jobs outside the EZ.
Among the EZ personnel, 78.9 percent were men,
with 32.9 percent ranging in age from 40 to 49 years, 30.2
percent from 30 to 39 years, and 24.7 percent from 50 to
59 years. The majority were engineers and technicians.
The percentage working in the EZ for 5 or more years was
60.6 percent. The distribution of EZ personnel according
to the effective doses of irradiation was as follows: < 0.05
Sv (5 rem), 81.8 percent; 0.05-0.24 Sv (5-24 rem), 13.6
percent; 0.25-0.99 Sv (25-99 rem), 3.7 percent; > 1 Sv
Table 1. Schizophrenia onset during 1986-1997 in Chernobyl exclusion zone personnel
Year
Cases of schizophrenia
onset
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
2
2
1
2
6
6
4
5
4
4
3
3
Population of the
Chernobyl exclusion zone
personnel
25,000
25,000
25,000
12,500
11,000
11,250
12,500
12,963
11,000
11,000
6,555
5,329
753
Incidence of schizophrenia
per 10,000 of population
0.8
0.8
0.4
1.6
5.4
5.3
3.2
3.9
3.6
3.6
4.6
5.6
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
K.N. Loganovsky and T.K. Loganovskaja
We should note the following limitations of the epidemiological part of our study: (1) the absence of standardized diagnostic methods and the impossibility of
being "blind" to radiation exposure status; (2) specific
demographic characteristics and the relatively small number of EZ personnel; (3) migration; and (4) the impossibility of calculating the prevalence of schizophrenia in the
personnel because (a) candidates had been medically
examined before employment in the EZ and all psychiatric patients rejected, and (b) individuals who were diagnosed with schizophrenia were terminated from employment. As a result, a natural "accumulation" of
schizophrenia is absent among personnel, which results in
an artificial reduction of schizophrenia prevalence.
Consequently it was only possible to assess schizophrenia
incidence in EZ personnel.
The data obtained have been analyzed with the chisquare test and vital statistics methods (measures of morbidity) (Kuzma 1984). Because of the large number of
variables tested for significance, the Bonferroni correction
(Kirk 1982) was used to reduce the probability of type I
(i.e., false-positive) errors.
ated above 0.30 Sv or 30 rem (average dose 0.69 ± 0.15
Sv or 69 ±15 rem).
Group C is the control group: normal age- and gendermatched adults (n = 20), veterans of the Afghanistan war
with post-traumatic stress disorder (PTSD; n = 50), and veterans with both PTSD and closed head injury (n = 50).
Neurological examination and typical clinical psychiatric interview (nonstandardized) were used, together with
the Brief Psychiatric Rating Scale (BPRS; Overall and
Gorham 1962), the Scale for the Assessment of Negative
Symptoms (SANS; Andreasen 1982), the General Health
Questionnaire (GHQ-28; Goldberg 1981, Goldberg and
Bridges 1987, Goldberg and Williams 1988), and the
adapted version of the Minnesota Multiphasic Personality
Inventory (MMPI; Sobchik 1990).
Computerized electroencephalogram (EEG) and sensory evoked potentials were carried out with a 19-channel
brain biopotentials analyzer ("Brain Surveyor," SAICO,
Italy). The brain spontaneous electric activity was
monopolarly registered with linked ears reference.
Nineteen scalp electrodes were placed according to the
10-20 International System. Visual and spectral analyses
of EEG were carried out. Epochs used in the analysis
were 60 seconds. The obtained frequency band was 1-32
Hz. All of the EEG records were visually edited for artifacts; artifacts due to eye or muscle movements or respiration were deleted prior to analysis. Estimation and interpretation of the brain spontaneous electrical activity were
conducted according to Zhirmunskaja's algorithm (1991)
for clinical EEG, while spectral analysis was carried out
using classical Fast Fourier Transformation methods
(Niedermeyer and Lopes da Silva 1982; Zenkov and
Ronkin 1991).
Checkerboard, reversible-pattern visual evoked
potentials (VEP) were registered binocularly on 50 chesspattern reversals with a frequency of 1 Hz. The 50 epochs
selected for analysis were 400 ms in duration with amplitudes measured from peak to trough (mkV) and latency
measured from onset of stimulation to its peak (ms).
Somatosensory evoked potentials (SSEP) were registered
with 40 pain threshold electrocutaneous stimulations of
the right median nerve on the lower forearm. The left
median nerve was not stimulated. The nerve was stimulated by bipolar skin electrode with right-angled electrical
impulses of 0.1-ms duration and 0.5-Hz frequency (1 per
2,000 ms). The cathode was situated proximally. The
epochs selected for analysis were 50 ms for the shortlatency SSEP and 1,000 ms for long-latency. Amplitudes
were measured from peak to trough (mkV), latency from
onset of stimulation to its peak (ms).
Statistical processing included descriptive statistics,
Student's t test, chi-square tests, and correlational analysis
(Kuzma 1984). The paired t test was used to analyze data
Psychophysiological Assessment of Irradiated Persons.
The psychophysiological part of the study was conducted
in the Neurology Department, Institute of Clinical
Radiology, Scientific Center for Radiation Medicine,
Academy of Medical Sciences of the Ukraine, in
1996-1998. Composition of the groups was as discussed
below.
Group A comprises 100 acutely irradiated patients
who had ARS (absorbed doses up to 6.6 Gy or 660 rad) as
a result of the Chernobyl disaster. All were right-handed
men and 35—64 years old at the time of examination.
Subclinical ARS has been diagnosed in 30 of these
patients (average absorbed dose of relatively even 7 and p
irradiation was 0.2 ± 0.05 Gy [20 ± 5 rad]); first degree
ARS was diagnosed in 38 (1.07 ± 0.12 Gy or 107 ± 12
rad); and second or third degree ARS in 32 (2.69 ± 0.2 Gy
or 269 ± 20 rad). All were treated in the Department of
Radiation Pathology in the Institute of Clinical Radiology,
Scientific Center for Radiation Medicine of the Academy
of Medical Sciences of Ukraine. The psychophysiological
investigations were carried out in the Neurology
Department, 10-12 years after ARS.
Group B is composed of 100 chronically irradiated
staff members of the Chernobyl EZ who have been working as liquidators-volunteers in the EZ since 1986-1987
for 5 or more years. All were right-handed men and 25-48
years old at the time of examination. Fifty-four from this
group (group Bl) were chronically irradiated at doses
below 0.30 Sv or 30 rem (average dose 0.16 ± 0.05 Sv or
16 ± 5 rem), and 46 (group B2) were chronically irradi-
754
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
At Issue
Table 2. Severe mental disorders in the
Chernobyl exclusion zone personnel (according to psychiatric archives data 1986-1997)
when a pair of measurements was obtained on each individual (Montgomery 1976). The Bonferroni correction
was used when multiple statistical tests were performed
(Kirk 1982).
Mental disorder (ICD-9 code)
Results
Number of cases,
1986-1997
Alcoholic psychoses (291)
Alcoholic delirium (291.0)
Alcoholic hallucinosis (291.3)
Alcoholic paranoid (291.5)
Organic nonalcoholic psychoses (294.8)
Epileptiform syndrome (345)
Alcoholic epileptiform syndrome (303,345)
Schizophrenia (295)
Epidemiological Study of Severe Mental Disorders in
Chernobyl EZ Personnel. Data on Chernobyl EZ personnel from the psychiatric archives on severe mental disorders are presented in table 2. The schizophrenia spectrum disorders register (1986-1997) includes 72 workers
of the EZ suffering from schizophrenia, schizoaffective
disorder, organic (nonalcoholic) schizophrenia-like psychoses, and schizoid personality disorder. There were 53
schizophrenia subjects according to the ICD-9 criteria of
schizophrenia (code 295, excluding "slow progressive
schizophrenia") who also met the criteria of ICD-10 code
F20 (schizophrenia). A statistically significant increase in
schizophrenia (among all psychoses) was found in EZ
personnel relative to the general Ukrainian population
(73% vs. 43%; x 2 = 18.5; df= \\p< 0.001). The relative
risk was 1.7, indicating that working and living in the EZ
are associated with a nearly twofold (85%) increase in the
risk of schizophrenia within all psychoses.
Affective psychoses (296)
Reactive psychoses (298)
Mental retardation (317)
22
12
1
9
10
31
15
53
5
5
4
Among those 53 cases of schizophrenia, 42 (79.2%)
onsets of schizophrenia occurred in the Chernobyl EZ,
after the Chernobyl accident (April 26, 1986).
Schizophrenia onset during 1986-1997 in the personnel is
shown in table 1. The incidence of schizophrenia in EZ
workers, in comparison with the Ukrainian population, is
presented in figure 1.
Figure 1. Incidence of schizophrenia in Chernobyl exclusion zone personnel in comparison with the
general Ukrainian population
—•—Ukraine
|
a.
—O— Exclusion zone
I
4 —
-•—•
755
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
K.N. Loganovsky and T.K. Loganovskaja
at significantly higher rates in the irradiated subjects than
in the veterans with PTSD control group, including odd
skin sensations, vertigo, mild neurological signs, autonomic nervous system dysfunction, paroxysmal attacks
(sometimes epileptiform), cognitive dysfunction, and, particularly, negative psychopathological symptoms. Some
symptoms, such as emotional lability, anxiety, "flashbacks," and nightmares, were observed at a significantly
higher rate in the controls. The typical PTSD symptoms
(flashbacks, nightmares, etc.) presented only in ARS
patients who had been involved in the accident (technicians, construction workers, etc.).
The number of neuropsychiatric symptoms was correlated with the dose of irradiation (table 4). The rate of
paroxysmal attacks and negative symptoms was significantly higher in overirradiated persons (irradiated by
more than 0.30 Sv or 30 rem, including the ARS patients).
Pathopsychological investigations also demonstrated significant differences in irradiated persons compared with
controls. The averaged MMPI profile of the irradiated persons showed peaks on the hypochondria, schizophrenia,
and paranoia scales (figure 2). Some psychopathological
Since 1990, there has been a significant increase in
schizophrenia in the EZ personnel in comparison with the
general population (5.4 per 10,000 in the EZ vs. 1.1 per
10,000 in the Ukraine in 1990). The relative risks are 2.4
for 1986-1997 and 3.4 for 1990-1997, which indicate that
working and living in the EZ are associated with more
than a twofold and even a threefold increase in the risk of
schizophrenia developing. Among the 42 patients who fell
ill after the accident, 34 (80.9%) paranoid and 8 (19.1%)
simple forms of schizophrenia were diagnosed. Of the 42
patients, there were 33 (78.6%) males and 40 (95.2%) in
the 15-54 years age group; 16 (38%) of these patients had
been evacuated between April 28 and May 5, 1986, and
later came back to work at the Chernobyl EZ before they
fell ill with schizophrenia; 31 (73.8%) of them had been
taking part in the cleanup of the Chernobyl accident and
its aftermath since 1986-1987 before they became ill with
schizophrenia.
Psychophysiological Assessment of Irradiated Persons.
Neuropsychiatric symptoms in the irradiated persons are
presented in table 3. Characteristic symptoms were seen
Table 3. Neuropsychiatric symptoms in irradiated persons and controls
Symptom
Chronic pain
Odd skin sensations
Paresthesias
Fatigue
Vertigo
Mild neurological signs
Autonomic nervous
system dysfunction
Paroxysmal attacks
Nightmares
"Flashbacks"
Emotional lability
Anxiety
Depression
Hypochondriac ideation
Paranoiac ideas
Cognitive dysfunction
Negative
psychopathological
symptoms
ARS patients
(n = 100), %
Liquidatorsvolunteers
(n=100), %
Veterans with
PTSD
(n = 50), %
Veterans with
PTSD and closed
head injury (n =
50), %
86
98
60
54
78
44
98
92
95
58
46
73
52
95
78
32*
42
38
36*
6*
72*
84
54*
52
36
48*
30
86
68
20
18
52
29
42
74
21
85
81
54
14
2*
78*
46
48
88
15
68
62
24*
68*
52*
84*
90*
44
48
6
24*
18*
38
72*
48*
90*
84*
42
58
10
44*
32*
Note.—ARS = acute radiation sickness; PTSD = post-traumatic stress disorder.
* p < 0.001 relative to ARS patients, according to the chi-square test
756
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
At Issue
Table 4. Neuropsychiatric symptoms in persons irradiated by small doses (< 0.3 Sv or 30 rem) and
by moderate or large doses (> 0.3 Sv or 30 rem, including ARS patients)
Symptom
Small (<0.3Sv)
doses, rate (%)
(n = 54)
x2
df
P
Moderate and large (>
0.3 Sv) doses, rate (%)
(n = 146)
51 (94)
52 (96)
28 (52)
24 (44)
39 (72)
18(33)
51 (94)
2.24
0.01
1.56
0.25
0.43
6.82
0.93
1
1
1
1
1
1
1
ns
ns
ns
ns
ns
ns
ns
127(87)
141 (97)
90 (62)
76 (52)
112(77)
78 (53)
142(97)
22(41)
40 (74)
28 (52)
26 (48)
45 (83)
7(13)
34 (63)
26 (48)
12.76
5.48
6.50
0.06
0.26
1.27
7.54
19.80
1
1
1
1
1
1
1
1
< 0.001
ns
ns
ns
ns
ns
. ns
< 0.001
100(68)
90 (62)
47 (32)
68 (47)
117(80)
29 (20)
119(81)
117(80)
Chronic pain
Odd skin sensations
Paresthesias
Fatigue
Vertigo
Mild neurological signs
Autonomic nervous
system dysfunction
Paroxysmal attacks
Emotional lability
Anxiety
Depression
Hypochondriac ideation
Paranoiac ideas
Cognitive dysfunction
Negative symptoms
Note.—ARS = acute radiationsickness; ns = not significant.
Figure 2. MMPI profiles in irradiated persons and controls
T scores
-•-Irradiated patients, n=200
—©— Afghanistan war veterans with PTSD
(n=100)
- 6 - N o r m a l controls (n=20)
IHJ
2D
3Hy
4Pd
5Mf
6Pa
7Pt
8Sch
9Ma
OS!
Note.—MMPI (Minnesota Multiphasic Personality Inventory) Scales: L = lie, F = trustworthiness, K = correction, 1 Hs = hypochondria, 2D
= depression, 3Hy = hysteria, 4Pd = psychopathy, 5Mf = manliness-femininity, 6Pa = paranoia, 7Pt = psychasthenia, 8Sch = schizophrenia, 9Ma = mania, OSi = social introversion. PTSD = post-traumatic stress disorder.
757
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
K.N. Loganovsky and T.K. Loganovskaja
most characteristic. The abnormal EEG activity (spikes,
acute waves, spike-waves, slow waves) was significantly
lateralized, especially to the left frontotemporal area, in
the overirradiated patients.
Computerized EEG spectral analysis (table 7)
revealed a significant increase of 8 and 3 power together
with decrease of 9 and a power in irradiated persons.
Moreover, 8 and 3 power were significantly lateralized
toward the left frontotemporal region in all examined irradiated persons. In the ARS patients, 8 power was significantly lateralized toward the left temporal area, and a
power was depressed in the left parieto-occipital region.
SSEP were characterized by topographic abnormalities
in the left temporoparietal area in irradiated persons (table
7). Their SSEP were characterized by increased contralateral
latencies and decreased contralateral amplitudes of N^, at
the C3 on right median nerve stimulation. Moreover, an
increased latency and a decreased amplitude of the late
(P300) component were found in irradiated patients.
indexes were proportional to the dose of irradiation (table
5). The social introversion scale of MMPI, emotional
withdrawal and blunted or inappropriate affect evaluated
according to the BPRS, as well as the summarized BPRS
score were significantly higher in the overirradiated persons (including the ARS patients).
Correlation analysis showed no relationship between
the dose of irradiation and neurotic symptoms (anxiety,
depression, somatic concern, tension, aggressivity, health
self-estimation, PTSD). On the other hand, negative
symptoms (blunted or inappropriate affect, emotional and
social withdrawal, alogia, avolition-apathy, anhedonia),
suspiciousness, unusual thought content, as well as the
summarized score of the BPRS were associated with the
dose of irradiation (r = 0.3-0.5, p < 0.001).
Neurophysiological patterns of irradiated persons
were dramatically distinguished (table 6). All ARS
patients and 72 percent of the liquidators demonstrated
EEG abnormalities. The flat, low-voltage EEG was the
Table 5. Pathopsychological indexes in persons irradiated by small doses (< 0.3 Sv or 30 rem) and
by moderate or large doses (> 0.3 Sv or 30 rem, including ARS patients)
Scale
Small (< 0.3 Sv)
doses, mean ± SD
(n = 54)
df
f
P
Moderate and large (>
0.3 Sv) doses, mean ±
SD(n = 146)
MMPI
1.21
ns
198
69.5 ±9.5
Trustworthiness
67.4 ±11.3
89.7 ±18.2
ns
198
1.02
92.4 ±10.5
Hypochondria
Depression
ns
198
2.98
85.0 ±12.6
78.9 + 13.3
ns
198
-2.36
76.3 ±12.6
Paranoia
82.4 ±17.3
84.1 ±17.4
91.2 + 21.1
ns
198
-2.20
Schizophrenia
< 0.001
198
-4.74
72.3 ± 8.4
Social introversion
80.1 ±10.9
BPRS
4.1 ±1.7
ns
198
Somatic concern
4.2 ±1.6
-0.38
2.11
3.0 ±1.7
ns
198
2.4 ±1.8
Anxiety
2.2 ±1.7
3.5 ±2.1
< 0.001
198
-3.97
Emotional withdrawal
2.5 ±2.2
ns
198
3.20
3.6 ±2.0
Depressive mood
-2.71
3.0 ±2.1
ns
198
2.1 ±2.0
Suspiciousness
ns
198
2.2 ±1.8
Unusual thought content
2.9 ±1.9
-2.33
< 0.001
198
2.1 ±1.9
Blunted or
3.6 ±1.9
-4.93
inappropriate affect
29.6 ±8.2
< 0.001
198
38.2 ± 9.5
-5.86
Summarized BPRS
score (scales 1-16)
SANS
ns
198
2.6 ±1.8
Affective flattening
3.2 ±1.5
-2.36
or blunting
ns
-2.34
2.9 ±1.6
198
2.3 ±1.6
Alogia
2.7 ±1.4
ns
Avolition-apathy
198
-2.36
2.1 ±1.5
ns
0.37
Anhedonia-asociality
3.1 ±1.7
198
3.2 ±1.6
ns
-1.67
2.4 ± 1.8
Attention
198
2.9 ± 1.9
GHQ-28
ns
198
36.8 ±13.4
1.40
39.7 ±11.6
General score
Note.—ARS = acute radiation sickness; BPRS = Brief Psychiatric Rating Scale; GHQ = General Health Questionnaire; MMPI
Minnesota Multiphasic Personality Inventory; ns = not significant; SANS = Scale for the Assessment of Negative Symptoms; SD
standard deviation.
758
At Issue
Schizophrenia Bulletin, Vol. 26, No. 4,2000
Table 6. EEG patterns in irradiated persons and controls
Rate (%)
EEG pattern
Normal
Organized with
predominance of
a activity
Abnormal
Hypersynchronic
Flat polymorphic
Disorganized with
predominance of
a activity
Disorganized with
predominance of
8 activity
Laterality of abnormal
activity
Bilateral
Left hemisphere
Right hemisphere
ARS patients
(n=100)
Liquidatorsvolunteers
(n=100)
Veterans
with PTSD
(n = 50)
Veterans with
PTSD and
closed head
injury (n = 50)
0
28 (28)*
37 (74)*
30 (60)*
16(80)*
10(10)
58 (58)
16(16)
8(8)
45 (45)
10(10)
9(18)
3(6)*
1(2)
8(16)
6(12)*
4(8)
4(20)
0*
0
16(16)
9(9)
0
2(4)
0
20 (20)
57 (57)
23 (23)
7(7)
31 (31)*
34 (34)
9(18)
1(2)*
3(6)
10 (20)
4(8)*
6(12)
3(15)
1(5)*
0
Normals
(n = 20)
Note.—ARS = acute radiation sickness; EEG = electroencephalogram; PTSD = post-traumatic stress disorder.
* p < 0.001 relative to ARS patients, according to the chi-square test
Table 7. Neurophysiological indexes in irradiated persons and controls
Mean ± SD
Index
ARS patients
(n=100)
Liquidatorsvolunteers
(n = 100)
Veterans with
PTSD (n = 50)
Veterans with
PTSD and
closed head
injury (n = 50)
Normals
(n = 20)
30.4 ± 9.3*
31.0 ±9.5*
-0.21 ± 2.87
t = -0.52, ns
35.7 ±10.2*
37.1 ±12.2*
-0.31 ± 3.87
t = -0.57, ns
28.6 ± 7.5*
28.0 ± 8.9*
0.12 ±2.27
f=0.24, ns
28.5 ± 8.8*
29.1 ±8.7*
-0.31 ± 3.05
t = -0.72, ns
34.1 ±10.8*
35.9 ± 8.9*
-0.19 ±2.45
t = 0.55, ns
23.4+9.7*
23.1 ±8.1*
0.1 ±1.78
t = 0.25, ns
28.3 ± 9.5*
31.1 ±10.1*
-0.28 ± 4.03
t = -0A9,ns
32.1 ±10.5*
33.4 ±10.9*
-0.18 ±3.75
f=-0.34, ns
23.9 ± 9.9*
25.1 ±10.3*
-0.11 ±2.01
t =-0.24, ns
16.1 ±4.3*
16.0 ±3.5*
0.1 ±1.98
18.7 ±5.2*
18.9 ±5.4*
-0.1 ±2.12
15.5 ±5.7*
16.1 ±4.1*
-0.12 ±2.69
Delta (1-4 Hz) power (%) of EEG in:
Laterality (F3-F4)
Paired ftest
c3
c4
Laterality (C3-C4)
Paired Mest
T3
T4
Laterality (T3-T4)
Paired Hest
49.4 ±10.3
46.0 ±9.5
2.38 ± 3.67
f=6.48, p <
0.001
48.5 ± 7.8
46.1 ±8.9
1.98+3.4
f = 5.82, p <
0.001
48.3 ± 9.3
44.1 ±10.1
3.21 ±4.67
f=6.87, p <
0.001
59.6 + 11.3*
56.0 ±12.1*
2.31 ± 3.98
f=5.8, p <
0.001
52.1 ±11.3
50.1 ±9.8
1.77 + 3.86
/ = 4.59, p <
0.001
56.3 ±9.6*
52.9 ±10.5*
2.96 ± 4.95
f=5.98, p <
0.001
Theta (4-7 Hz) power (%) of EEG in:
c3
c4
Laterality (C3-C4)
9.5 ±3.8
8.1 ±2.9
1.1 ±2.2
12.1 ±4.3*
12.0 ±3.8*
0.3 ±2.1
759
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
K.N. Loganovsky and T.K. Loganovskaja
Table 7. Neurophysiological indexes in irradiated persons and controls—Continued
Mean ± SD
Index
Veterans with
PTSD (n = 50)
Veterans with
PTSD and
closed head
injury (n = 50)
Normals
(n = 20)
f= 1.43, ns
f=0.36, ns
f = -0.33, ns
f = -0.20, ns
11.3 ±3.6*
10.9 ±3.5*
0.76 ± 2.05
f=3.71,p<
0.001
16.5 ±3.8*
16.9 ±3.5*
-0.27 ±2.13
f =-0.9, ns
19.1 ±6.8*
19.9 ±5.9*
-0.58 + 2.45
f = -1.67, ns
17.9 ±4.9*
15.1 ±6.3*
1.95 ±3.7
f = 2.36, ns
45.1 ± 8.3*
47.0 ± 7.8
-1.78 ±5.12
f=-3.48, p<
0.001
56.1 ±14.3*
55.0 ±13.5*
1.1 ±6.9
f= 1.13, ns
48.7 ±15.2*
48.9 ±15.4*
-0.1 ±6.8
f=-0.1,/7S
54.5 ±12.7*
60.4 ±14.1*
-4.3 ± 6.75
f = -2.85, ns
25.5 ± 4.8
25.1 ±3.9
0.35 ±1.85
f= 1.89, ns
24.4 ± 4.3
23.0 ±4.1
1.3 ± 1.92
f=6.77, p <
0.001
19.1 ±4.8*
17.9 ±3.9*
0.95 ± 1.92
f = 4.95, p < 0.001
18.9±5.1*
17.4 ±5.2*
1.2±2.15
f=5.58, p <
0.001
12.6 ±5.3*
12.8 ±4.8*
-0.1 ±2.11
f = -0.34, ns
12.3 ±3.4*
12.9 + 3.5*
-0.4 ±1.91
f =-1.48, ns
14.1 ±4.3*
14.0 ±4.8*
0.05 ±2.4
f = 0.15, ns
14.3 ±4.6*
14.9 ±4.5*
-0.42 + 2.07
f =-1.43, ns
12.5 ±3.7*
13.1 ±4.2*
-0.6 ± 2.75
f = -0.98, ns
11.9 ±4.9*
12.1 ±4.3*
-0.15 ±2.25
f = -0.3, ns
21.2 ±3.2
19.4 ±3.1
1.54 ± 2.25
f=6.84, p <
0.001
20.5 ± 3.8
19.6 ±3.9
0.75 ± 2.05
f=3.66, p <
0.001
19.2 ±3.0*
19.5 ±3.4
-0.17 ±1.95
f=-0.62, ns
19.7 ±4.5*
19.8 ±4.1
-0.05 ±2.2
f = -0.16, ns
18.8 ±1.3
19.2 ±1.4
-0.3 ± 0.95
f = -1.41, ns
272.3 ± 27.9
271.2 ±31.0
1.13± 12.8
f = 0.88, ns
276.3 ± 37.7
275.2 ±33.1
0.89 ±15.7
f=0.57, ns
239.3 ±19.0*
242.2 ±23.1*
-2.15 ±11.4
f =-1.33, ns
245.3 ± 33.7*
252.2 ±31.1*
-5.2 ±17.45
f = -2.11,ns
242.1 ±16.3*
245.2 ±16.4*
-2.95 ± 9.76
f = —1.35, ns
1.0 ±0.7
1.9± 1.2
-0.75 ±1.05
f = -7.14,p<
0.001
1.3 ±0.8
1.9+0.9
-0.54 ± 0.92
f=-5.87, p <
0.001
3.2 ± 0.3*
2.9 ± 0.3*
0.27 ± 0.52
f=3.67,p<
0.001
2.9 ± 0.4*
2.7 ± 0.4*
0.19 ±0.45
f = 2.99, ns
3.3 ± 0.4*
3.0 + 0.4*
0.28 ± 0.42
f = 2.98, ns
15.3 ±4.5
17.2 ±4.3
-1.36 ± 2.74
17.6 ±3.7*
17.5 ±3.3
0.05 ± 2.55
19.3 ±3.9*
19.2 ±3.1
0.07 ± 2.86
22.3 ± 9.7*
22.2 ±11.1*
0.06 ± 4.75
22.3 ± 6.3*
20.9 ± 6.4
1.52 ±3.72
ARS patients
(n=100)
Paired ftest
f=5.0, p <
0.001
9.4 ±2.3
8.0 ±4.1
1.26 ±1.97
f=6.4, p <
0.001
T3
T4
Laterality (T 3 -T 4 )
Paired ftest
Liquidatorsvolunteers
(n = 100)
Alpha (7-12 Hz) power (%) of EEG in:
°1
O
2
Laterality (O-,-O2)
Paired ftest
41.2 ±10.8
45.4 ±12.9
-3.46 ± 5.42
f=-6.38, p <
0.001
Beta (12-32 Hz) power (%) of EEG in:
c3
Laterality (C 3 -C 4 )
Paired ftest
T3
T4
Laterality (T 3 -T 4 )
Paired ftest
SSEP, latencies, ms
N2o
C3
c4
Laterality (C 3 -C 4 )
Paired f test
p
3 oo
C3
c4
Laterality (C 3 -C 4 )
Paired f test
SSEP, amplitudes, 1vkV
N 20
C3
c4
Laterality (C 3 -C 4 )
Paired ftest
P
300
c4
Laterality (C 3 -C 4 )
760
At Issue
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
Paired ftest
f=-4.96, p <
0.001
f= 0.20, ns
t= 0.17, ns
f = 0.00, ns
f= 1.83, ns
82.0 ±14.1
128.1 ±14.5
237.3 ±14.7
89.2 ±11.1*
138.2 ±13.5*
221.4 ±12.7*
88.8 + 15.0
140.0 ±13.6*
187.0 ±13.6*
102.6 ±16.0
158.0 ±14.4*
221.0 ±14.6*
96.8 + 12.0*
147.0 ±11.6*
208.0 ±12.6*
4.2 ±3.6
7.6 ±4.8
5.9 ±3.8
3.2 ±2.7
5.6 ±3.9
4.9 ±3.6
3.6 ±2.2
4.2 ±1.8*
5.5 ±3.4
3.6 ±1.3
5.2 ±2.6
4.6 ±3.3
2.6 ±1.2
4.2 ±1.6
5.6 ±3.3
VEP, latencies, ms
^100
Ni45
^200
O2
O2
02
VEP, amplitudes, mkV
^100
Ni45
P
200
O2
O2
02
Note.—ARS = acute radiation sickness; EEG = electroencephalogram; ns = not significant; PTSD = post-traumatic stress disorder;
SD = standard deviation; SSEP = somatosensory evoked potentials; VEP = visual evoked potentials.
* p < 0.001 relative to ARS patients, according to the Student's f test
VEP were characterized by a decreased latency of
P100 and N145 components and an increased latency of P200
in irradiated persons as compared to controls, as well as
an increased amplitude of N145 component in ARS patients
(table 7).
According to the correlation data analysis, we found
that the negative (affective flattening, alogia, apathy, and
social withdrawal) and paranoid symptoms as well as
dysmnesia were closely associated with 8 and p power
increase (r = 0.49-0.72, p < 0.001) in the left hemisphere
in overirradiated persons (including ARS patients).
Hypochondria was connected with left 8 power increase
(r = 0.66, p < 0.001) as well as left a power decrease (r =
-0.35, p < 0.001) and right 6 power decrease (r = -0.34, p
< 0.001). The affective symptoms (depression and anxiety) were closely correlated with both right 8 and p power
increase (r = 0.35-0.62, p < 0.001) and right a power
decrease (;• = -0.45-[-0.58], p < 0.001) (figure 3).
In light of these data, we have compressed the EEG
and evoked potential findings into two neurophysiological
syndromes: left frontotemporal limbic (88 persons [44%])
and right-hemispheric (70 [35%]). We have also integrated the psychopathological data into two syndromes:
schizophreniform (68 patients [34%]) and affective (73
(36.5%]). The schizophreniform syndrome includes negative symptoms, paranoid ideation, and sometimes elementary verbal hallucinations. The affective syndrome
includes depression and anxiety. In both syndromes, cognitive dysfunction, such as deterioration of planning skills
(including the formation of long-range goals, the ability to
marshal one's resources to achieve those goals, the capacity to consider and anticipate the future, and the ability to
develop alternative problem-solving strategies and consider a range of ideas simultaneously) and short-term
memory disorders were observed.
The distribution of the neurophysiological and psychopathological syndromes in proportion to dose of irradiation is shown in table 8. Persons irradiated by moder-
761
ate or large doses (more than 0.30 Sv or 30 rem, including
ARS patients) had significantly more left frontotemporal
limbic and schizophreniform syndromes. Persons irradiated by small doses (less than 0.30 Sv or 30 rem) had significantly more right-hemispheric and affective and neurotic syndromes.
However, among the persons irradiated by small
doses, correlation analysis showed no relationship
between the dose of irradiation and neurotic symptoms
(anxiety, depression, somatic concern, tension, aggressivity, health self-estimation, PTSD) or neurophysiological
parameters. This lack of correlation led us to conclude
that neuropsychiatric and neurophysiological changes in
Chernobyl accident survivors irradiated by small doses
were likely a result of psychogenic trauma or other reasons rather than irradiation itself. At the same time, the
schizoform symptoms together with the electrophysiological signs of the left frontotemporal dysfunction did
correlate with the large effective dose of ionizing radiation (r = 0.23-0.45; p < 0.001).Thus, we suppose that
overirradiation by doses more than 0.30 Sv or 30 rem can
induce left frontotemporal limbic dysfunction, which
may be the neurophysiological basis of schizophreniform
symptoms in these patients.
Discussion
An increase in psychopathology among Chernobyl disaster
survivors is not surprising. Etiological factors in the genesis
of mental disorders in the survivors may be due to (1) psychological trauma and stress related to the disaster itself, (2)
psychological trauma and stress related to the post-Soviet
changes in the society, or (3) radiation effects (Napreyenko
and Loganovsky, 1992, 1995, 1997; Nyagu et al. 1992;
Loganovsky and Nyagu 1995; Loganovsky 1996a, 1996b;
Nyagu and Loganovsky 1996,1997a, 1998a).
Kamenchenko (1993), in a review of PTSD, related
the prevalence of PTSD in American veterans of the
K.N. Loganovsky and T.K. Loganovskaja
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
Figure 3. EEG correlates of some psychiatric symptoms in 146 overirradiated patients
(dose more 0.30 Sv)
LEFT HEMISPHERE
RIGHT HEMISPHERE
Delta (1-4 Hz) power (%)
Delta (1-4 Hz) power (%)
Theta (4-7 Hz) power (%)
Theta (4-7 Hz) power (%)
Alpha (7-12 Hz) power (%)
Alpha (7-12 Hz) power (%)
Beta (12-32 Hz) power (%)
Beta (12-32 Hz) power (%)
Table 8. Brain laterality and psychopathological syndromes in persons irradiated by small doses
(< 0.3 Sv or 30 rem) and by moderate or large doses (> 0.3 Sv or 30 rem, including ARS patients)1
Syndrome
Left frontotemporal
limbic
Schizophreniform
Right hemispheric
Affective
Small (< 0.3 Sv)
doses, rate (%)
(n = 54)
X2
df
12(22)
14.24
1
< 0.001
76 (52)
7(13)
29 (54)
34 (63)
14.59
11.37
22.35
1
1
1
< 0.001
< 0.001
< 0.001
61 (42)
41 (28)
39 (27)
i
Note.—ARS = acute radiation sickness.
1
The x
2
Moderate or large (>
0.3 Sv) doses, rate (%)
(n = 146)
P
,
tests were performed on 2 x 2 tables of small and higher doses by syndrome presence and absence.
Vokhmekov et al. (1994) discussed the increasing
prevalence of all mental disorders (ICD-9: 290-310)
from 156.6 per 1,000 EZ workers in 1986 to 225.2 per
1,000 in 1992. Moreover, in 1992 those workers exposed
to ionizing radiation in doses more than 0.25 Sv had a
prevalence of borderline mental disorders 3.76 times
higher than other EZ personnel: 805.1 and 214.0 per
1,000 workers, respectively. This is very similar to other
data in the literature. The prevalence of autonomic nervous system dysfunction in chemical factory personnel is
86 percent and increases with the length of work (Vein et
Vietnam War as 9-15 percent and reported that about
10-20 percent of patients developed PTSD following a
natural disaster. Moreover, in the Report of the Scientific
Center of Mental Health of the Russian Academy of
Medical Sciences (1994), the prevalence of all mental disorders in the general population (including borderline
cases) has been estimated as 20-27 percent. So, at least
one-third of all Chernobyl accident survivors would be
expected to have mental disorders theoretically. However,
the real prevalence of mental disorders among the
Chernobyl population is significantly higher.
762
Schizophrenia Bulletin, Vol. 26, No. 4,2000
At Issue
tions. Moreover, the neuropsychiatric symptoms in ARS
patients were classified as postradiation encephalopathy
and the symptoms in overirradiated persons as mixed
exogenous-somatogenous encephalopathy (Nyagu et al.
1997; Nyagu and Loganovsky 1998).
According to the data obtained, overirradiation by
doses more than 0.30 Sv or 30 rem (including the development of radiation sickness) can induce left frontotemporal limbic dysfunction, which may be the neurophysiological basis of schizophreniform symptoms in these
patients. A majority of the Chernobyl accident survivors
had been exposed to low-dose irradiation (less than 0.30
Sv or 30 rem), which together with other factors of the
accident (predominantly psychogenic trauma) may have
led to the right-hemispheric dysfunction and consequent
affective symptoms. We cannot conclude that the righthemispheric dysfunction and associated affective and neurotic symptoms are radiation induced. Our psychophysiological findings are consistent with much of the literature
data (Izumi and Hayakawa 1955; Nishikawa and Tsuiki
1962; Sosnovskaja 1971; Yaar et al. 1980; Chayanov and
Monosova 1992; Zhavoronkova and Kholodova 1994;
Zhavoronkova et al. 1995; Viatleva et al. 1996) and reflect
an overlap of pathophysiological patterns of schizophrenia and postradiation brain injury (table 9).
Currently, dysfunction of the limbic system is considered to be the key neuropathological event underlying
schizophrenia (Csernansky and Bardgett 1998). The hippocampal hypothesis of psychoses was proposed by Port
and Seybold (1995). Left frontotemporal limbic dysfunction is the determining pattern of cerebral disorganization
leading to schizophrenia (Flor-Henry 1976, 1983, 1989;
Gruzelier and Hammond 1976; Gur 1978, 1997; Gruzelier
1997). The limbic system, particularly the hippocampus,
is extremely radiosensitive (Lebedinsky and
Nakhilnitzkaja 1960; Ganglof 1962; Haley 1962; Livanov
1962; Kimeldorf and Hunt [1965] 1969; Peimer et al.
1985; Hunt 1987; Dudkin 1988).
The data obtained in our laboratory demonstrated the
left frontotemporal lateralization of EEG abnormalities in
the Chernobyl accident survivors (Noshchenko and
Loganovsky 1990, 1994; Nyagu et al. 1992, 1996). Other
authors have obtained identical (Chayanov and Monosova
1992) or similar results (Zhavoronkova et al. 1995,1998).
A dysfunction of the diencephalo-limbic-reticular complex and left frontotemporal cortex was recognized as the
neurophysiological basis of ionizing radiation effects
(Nyagu and Loganovsky 19976, 1998).
We propose that the left hemisphere is more vulnerable, in right-handed men, to whole-body irradiation
than the right. Our data are consistent with other types of
evidence also indicating a specific vulnerability of the
left hemisphere: After unilateral nondominant or bilat-
al. 1991). At the same time, there are psychiatric symptoms in 89 percent of patients suffering from autonomic
nervous system dysfunction (Zharikov et al. 1996). In
other words, it is scientifically reasonable to suppose that
at least 76 percent of the Chernobyl EZ personnel probably suffer from mental disorders, predominantly of the
borderline category.
However, it is not clear what factor or factors could
produce an increase in schizophrenia incidence in the
Chernobyl EZ personnel. Schizophrenia diagnostic criteria were the same in and out of the Chernobyl EZ. It is
unlikely that workers faked mental disorders in order to
be rejected from the personnel, because the workers are
volunteers with relatively high salary. There was not a relative increase in the number of younger individuals in the
personnel of the Chernobyl EZ, which would have
resulted in a concomitant increase in risk for new cases of
schizophrenia. A self-selection of some individuals who
are marginally adapted to society to go or remain in the
accident region could be a possible explanation. However,
this does not explain why the increase in schizophrenia
only began 3 years after the disaster. Moreover, all candidates were medically examined before employment in the
EZ. Therefore, it seems reasonable to associate the
increase in schizophrenia incidence with exposure to radiation (Loganovsky and Nyagu 1997; Loganovsky 1998;
Loganovsky and Loganovskaja 1998). We suppose that
ionizing radiation is an environmental trigger that can
actualize schizophrenia in predisposed individuals.
There is another important question: If exposure to
ionizing radiation is associated with risk for schizophrenia, one might expect a decline in risk over the past
decade with an eventual return to baseline levels. Instead,
we have found an increase in incidence 3 years after the
accident, which remained relatively stable over the next 8
years. There were no changes in diagnostic practice,
screening procedures, or population composition. Also, 31
(73.8%) of the cases of schizophrenia onset that occurred
at the Chernobyl EZ were among the cleanup workers of
the Chernobyl accident (the liquidators) of 1986-1987,
those with the greatest risk for irradiation. We propose the
hypothesis that some cases of schizophrenia onset may be
a delayed stochastic aftereffect of irradiation, similar to
thyroid cancer, which has been increasing in the
Chernobyl survivors since 1990-1991.
The clinical and psychophysiological patterns in
overirradiated persons are of the greatest interest.
Previously published data (Loganovsky and Nyagu 1995;
Napreyenko and Loganovsky 1995, 1997; Nyagu and
Loganovsky 1996, 1997a) testify to a significant overlapping of diagnoses, according to the ICD-10 criteria, in
survivors who meet the criteria of different disorders
simultaneously, which produces difficulties and contradic-
763
Lateralization of EEG abnormal activity to the left frontotemporal area
(Nyagu et al. 1992,1996,1997,1998; Noschenko and Loganovsky 1994;
Zhavoronkova and Kholodova 1994; Zhavoronkova et al. 1995;
Loganovsky, 1995,1996a, 19966,1998; Loganovsky and Nyagu, 1995;
Loganovskaja and Loganovsky 1997,1998; Loganovsky and
Loganovskaja 1997,1998; Nyagu and Loganovsky 1997a, 1997b, 1998)
Increase of p activity (Sosnovskaja 1971) or p power, particularly in the left
hemisphere (frontotemporal area) (Izumi and Hayakawa 1955; Yaar et al.
1980; Nyagu et al. 1992,1996,1997,1998; Noschenko and Loganovsky
1994; Loganovsky 1995,1996a, 1996b, 1998; Loganovsky and Nyagu
1995; Zhavoronkova et al. 1995; Viatleva et al. 1996; Loganovskaja and
Loganovsky 1997,1998; Loganovsky and Loganovskaja 1997, 1998;
Nyagu and Loganovsky 1997b, 1998)
Increase of a activity (Sosnovskaja 1971) or a power (Nishikawa and Tsuiki
1962; Court 1979) shifted to the left frontotemporal area (Nyagu et al.
1992,1996,1997,1998; Chayanov and Monosova 1992; Khomskaja et al.
1993; Noschenko and Loganovsky 1994; Zhavoronkova and Kholodova
1994; Loganovsky 1995,1996a, 1996b, 1998; Loganovsky and Nyagu 1995;
Viatleva et al. 1996; Loganovskaja and Loganovsky 1997,1998; Loganovsky
and Loganovskaja 1997,1998; Nyagu and Loganovsky 1997b, 1998)
Redistribution of a power to the frontal areas (Nyagu et al. 1992,1996,
1997, 1998; Noschenko and Loganovsky 1994; Loganovsky 1995,1996a,
1996b, 1998; Loganovsky and Nyagu 1995; Loganovskaja and
Loganovsky 1997,1998; Loganovsky and Loganovskaja 1997, 1998;
Nyagu and Loganovsky 1997b, 1998; Zhavoronkova and Kholodova 1994;
Viatleva et al. 1996); dysrhythmic (low-voltage) EEG (Nyagu et al. 1996,
1997,1998; Loganovsky and Loganovskaja 1997, 1998; Nyagu and
Loganovsky 1996,1997b, 1998; Zhavoronkova et al. 1998)
Reduced left frontal and left frontotemporal coherence on EEG
(Zhavoronkova and Kholodova 1994; Zhavoronkova et al. 1995,1998)
Topographic abnormalities of SSEP and VEP at left temporoparietal areas
(C3); abnormal cortical-subcortical interactions during analysis of afferent
information; disorders of brain information processing (Loganovsky 1995,
1996a, 1996b; Loganovsky and Nyagu 1995; Loganovskaja and
Loganovsky 1997,1998; Loganovsky and Loganovskaja 1997,1998;
Nyagu and Loganovsky 1997b, 1998)
Increase in temporal p 2 power (Kessler and Kling 1991); increase in the
higher p (16-25.5 Hz) range (Michel et al. 1993); dysrhythmic EEG with an
increase of p activity (Herrmann and Winterer 1996)
Lateralization for temporal <r and frontal p1 activity (Kessler and Kling
1991); increase of a, 6^ and p 3 amplitude (Galderisi et al. 1991); increased
a, fast a, and p power in particular at left frontal sites (Gattaz et al. 1992)
Relative abundance of a 2 power value shifts from the occipital to the frontal
regions, supporting the hypofrontal hypothesis of schizophrenia (Nakagawa
etal. 1991)
Reduced bilateral alpha interhemispheric coherence on EEG during the
activation task (Morrison-Stewart et al. 1996), more on the left side
(Michelogiannis et al. 1991)
Topographic differences of SSEP and VEP at left temporoparietal areas
(Shagass and Roemer 1991); abnormal cortical-subcortical interactions
during analysis of visual information (Jutai et al. 1984); impaired auditory
sensory gating (Adler and Waldo 1991) and sensorimotor gating, sensory
flooding, and cognitive fragmentation (Swerdlow and Geyer 1998)
Psychophysiological Symptomatology
Postradiation brain injury
Left-sided EEG abnormalities, especially on the left temporal area (FlorHenry 1969a, 1969/?, 1976, 1983, 1987, 1989; Hughes 1996)
Schizophrenia
Table 9. Psychophysiological and neuropathological patterns in schizophrenia and postradiation brain injury
o
o
o
o
I
Co
S'
i
3-
•§
5?
KJ
Memory and learning disorders (Nyagu et al. 1992,1996,1997, 1998;
Nyagu and Loganovsky 1997b; Noschenko and Loganovsky 1994;
Loganovsky 1995,1996a, 1996b, 1998; Khomskaja 1995; Loganovsky and
Nyagu 1995; Loganovskaja and Loganovsky 1997,1998; Loganovsky and
Loganovskaja 1997,1998; Nyagu and Loganovsky 1997a, 1998) and verbal
memory impairment associated with medial temporal lobe dysfunction
(Meshkov et al. 1998)
Autonomic nervous system dysfunction (Nyagu et al. 1992,1996,1997,1998;
Nyagu and Loganovsky 1997b; Noschenko and Loganovsky 1994;
Loganovsky 1995,1996a, 1996b, 1998; Nyagu and Loganovsky 1997a, 1998)
Negative symptoms—blunted affect, avolition-apathy, inattention, difficulty
with problem solving, impoverished thinking—related to frontal lobe dysfunction, particularly on the left (Loganovsky 1995,1996a, 1996b, 1998;
Loganovsky and Nyagu 1995; Loganovsky and Loganovskaja 1997,1998)
Significant positive correlations between the total negative symptoms and
8 power, predominantly over the left frontotemporal region (Loganovsky
1995,1996a, 1996b, 1998; Loganovsky and Loganovskaja 1997,1998)
Working memory dysfunction (Goldman-Rakic 1994), verbal memory
dysfunction (Heinrichs 1994), selective impairments in learning and
memory consistent with medial temporal lobe dysfunction (Arnold 1997)
Autonomic nervous system dysfunction (Hollister et al. 1994)
Negative symptoms are related to left frontal lobe dysfunction (Suzuki
et al. 1992); frontal lobe dysfunction—blunted affect, difficulty with problem
solving, impoverished thinking (Weinberger et al. 1994)
Significant positive correlations between the total negative symptoms and
the 8 power, predominantly over the temporal region (Gattaz et al. 1992)
Limbic system dysfunction (Gruzelier and Raine 1994); limbic structure
abnormalities (Bogerts 1993); limbic-cortical (temporal and frontal)
neuronal damage (Arnold and Trojanowski 1996; Bachus and Kleinman
1996; Csernansky and Bardgett 1998)
Left frontotemporal cortex and diencephalo-limbic-reticular complex dysfunction (Nyagu et al. 1996,1997,1998; Loganovsky 1995,1996a, 1996b,
1998; Loganovsky and Nyagu 1995; Loganovskaja and Loganovsky
1997,1998; Loganovsky and Loganovskaja 1997,1998; Nyagu and
Loganovsky 1997b, 1998)
Temporal-limbic seizure system involvement (Flor-Henry 1976,1987);
medial temporal lobe abnormalities (Roberts 1991; Arnold 1997);
schizophrenia-like psychosis—mediobasal temporal (left) lobe epilepsy
(Flor-Henry 1969a, 1969b, 1983; Jibiki et al. 1993; Sachdev 1998)
Limbic system dysfunction (Gangloff 1962; Haley 1962; Livanov 1962);
very high radiosensitivity of hippocampus (Peimer et al. 1985; Davydov
and Ushakov 1987; Dudkin 1988)
Frontal-subcortical-limbic-reticular complex dysfunction with the prominent
impairment of brain stem and mediobasal structures (Zhavoronkova et al.
1995,1998)
Left frontotemporal-limbic dysfunction (Loganovsky 1995,1996a, 1996b,
1998; Loganovskaja and Loganovsky 1997, 1998; Loganovsky and
Loganovskaja 1997,1998)
Left frontotemporal abnormalities (Flor-Henry 1969a, 1969b, 1976,1983,
1987,1989; Deakin et al. 1989; Bullmore et al. 1998); left temporal lobe
abnormalities (Shenton et al. 1992; Rossi et al. 1994)
Neuroanatomical Syndromology
P300 SSEP and P2Oo VEP abnormalities; lower amplitude of P300 SSEP
and P200 VEP; prolonged latency of P300 and N 400 SSEP and P200 VEP
(Loganovsky 1995,1996a, 1996b; Loganovsky and Nyagu 1995;
Loganovsky and Loganovskaja 1997,1998; Nyagu and Loganovsky
1997a, 1997b, 1998)
P300 ERP abnormalities (Blackwood et al. 1991); lower P300 amplitude
(Kidogami et al. 1991) and prolonged N 400 latency of ERP (Koyama et al.
1991)
c
to
5'
K.N. Loganovsky and T.K. Loganovskaja
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
CO
C "O
I
eral electroconvulsive therapy (ECT) the post-ECT EEG
slow activity is lateralized to the left hemisphere (Green
1957; Abrams et al. 1970; Abrams 1988; Deglin 1996).
Thus, the left hemisphere seems to be generally more vulnerable to exogenous factors in right-handed men compared with the right hemisphere. A possible explanation of
such specific left-hemisphere vulnerability is the increasing number of reports showing a relative reduction of cerebral blood flow in the left hemisphere (Amsterdam and
Mozley 1992; Seitz and Roland 1992; Klingelhofer et al.
1997; Hugdahl 1998). Some authors (Risberg et al. 1975;
Kawahata et al. 1997) found no hemispheric differences.
Thus, the radiation-induced left frontotemporal limbic dysfunction may be the neurophysiological basis of
schizophrenia-like symptoms in overirradiated persons.
x> .5 - ^ r-"
o
I
5 i | « S
5*.i = "? o
1
g
figil-i
. a o > .a _ en
a> ^ re g re
o> >
5 s'Sti
C\f JO X> 3
co re CD to
ffl
C
1 in 1
CO
(TJ CC
fi> -Q
i\
*-•
o
£
So SE
£».?
15
03 —
— —S UJ
O "^ Jrt* ro CO X I
c
5 to •£•£ &
a.
s
m - i nS Q_ Q- W
I
c
I
si !
ce >
CO
%2
1
o
CO
CO
In N
re
^
In
CO
CD
I?
w.
X ) CO C CD
Q.
•o
c\T
to
E oo
in co
2
CO
•a
ll
T3
CO
O
.CO
1 8-
Conclusions
i
>n
The problem of schizophrenia spectrum disorders in individuals exposed to ionizing radiation is under discussion.
The data obtained relating an increase of schizophrenia
incidence in the Chernobyl EZ personnel support our
hypothesis that ionizing radiation is an environmental
trigger that can actualize a predisposition to schizophrenia
or indeed cause symptomatic schizophrenia. The development of schizophrenia spectrum disorders in overirradiated Chernobyl survivors may be the consequence of the
radiation-induced left frontotemporal limbic dysfunction,
which may be the neurophysiological basis of schizophrenia-like symptoms in individuals exposed to ionizing radiation in doses more than 0.30 Sv or 30 rem, including
ARS patients. Thus, those exposed to 0.30 Sv (30 rem) or
more are at higher risk of schizophrenia spectrum disorders. Prenatally irradiated children in the Chernobyl accident, especially those exposed at the second trimester of
gestation, are at higher risk for schizophrenia too
(Loganovskaja and Loganovsky 1997, 1998; Nyagu et al.
19986). An integration of international efforts to discuss
and organize collaborative studies in this field is of great
importance for both clinical medicine and neuroscience.
Q_
>
as
E Q-
E o
2 en
o "i
•s
O *D
T-
oS "co
DC
O
re
it
o
CO
CO
1
Q.
"(0
_O
O)
w
co
co
l
o . - 0)
i
fl
itsii
_o
o
II
CO
CD
re
!§
s.
^ « c ? co
" .§ •§ CD -^
11
ro E
#8
" 8 "TO
•o
CO
15
u
"5>
.o
o
'to
c
Q.
O
C- X)
° co XI
g . s re
CD
0
UJ
.§
if III
? s 1 -I i
Q.
O
S I -2 g o
ll
a
sO
O C
Q.a>
Q-
O Q.
£•0 H
r-ro
ro
91
l-sS i
0
r?
I
References
re s
Abrams, R. Electroconvulsive Therapy. New York, NY:
Oxford University Press, 1988.
Abrams, R.; Volavka, J.; Dornbush, R.; Roubicek, J.; and
Fink, M. Lateralized EEG changes after unilateral and
bilateral electroconvulsive therapy. Diseases of the
Nervous System GWAN Supplement, 31:28-33, 1970.
is
re o>
c is
0
CO
Q.
an
a
"O
o
11If
1
_:
Q.
to
1^
**- S
E
SE
O "O 05 C X)
ut re T- re re
•2 -2 "g §
egs1
r fl
Adler, L.E., and Waldo, M.C. Counterpoint: A sensory gating—hippocampal model of schizophrenia. Schizophrenia
Bulletin, 17(l):19-24,1991.
2 s
3
</>
u- w > E tra3 to
o
766
Schizophrenia Bulletin, Vol. 26, No. 4,2000
At Issue
David, A.S. Schizophrenia and the corpus callosum:
Developmental, structural, and functional relationships.
Behavioral Brain Research, 64:203-211, 1994.
Amsterdam, J.D., and Mozley, D. Temporal lobe asymmetry with iofetamine (IMP) SPECT imaging in patients
with major depression. Journal of Affective Disorders,
24:43-53, 1992.
David, A.S.; Wacharasindhu, A.; and Lishman, W.A.
Severe psychiatric disturbance and abnormalities of the
corpus callosum: Review and case series. Journal of
Neurology, Neurosurgery and Psychiatry, 56:85-93, 1993.
Andreasen, N.C. Negative symptoms in schizophrenia:
Definition and reliability. Archives of General Psychiatry,
3:784-788, 1982.
Davydov, B.I., and Ushakov, I.B. Ionizing Radiation and
Brain: Behavioral and Structural-Functional Patterns.
Ponomarenko, V.A., and Grigoriev, Yu.G., eds. Results of
Science and Technics, Series "Radiation Biology," Vol. 8,
Moscow: Academy of Sciences of the USSR, State
Committee of the USSR on Science and Technics, AllUnion Institute for Scientific and Technical Information,
1987.
Arnold, S.E. The medial temporal lobe in schizophrenia.
Journal of Neuropsychiatry and Clinical Neurosciences,
9:460-470,1997.
Arnold, S.E., and Trojanowski, J.Q. Recent advances in
defining the neuropathology of schizophrenia. Acta
Neuropathologica (Berlin), 92:217-231,1996.
Bachus, S.E., and Kleinman, J.E. The neuropathology of
schizophrenia. Journal of Clinical Psychiatry, 57(Suppl
ll):72-83,1996.
Deakin, J.F.; Slater, P.; Simpson, M.D.; Gilchrist, A.C.;
Skan, W.J.; Royston, M.C.; Reynolds, G.P.; and Cross,
A.J. Frontal cortical and left temporal glutamatergic dysfunction in schizophrenia. Journal of Neurochemistry,
52:1781-1786, 1989.
Bebeshko, V.G.; Kovalenko, A.N.; and Belyi, D.A.
Results of 10-years follow up health study of patients who
had acute radiation sickness as a result of the Chernobyl
accident. In: One Decade after Chernobyl: Book of
Extended Synopses. Austria: IAEA, 1996. pp. 556-557.
Deglin, V.L. Lectures About Functional Asymmetry of the
Human Brain. Kiev, Ukraine: Geneva Initiative in
Psychiatry, Association of Psychiatrists of Ukraine, 1996.
Blackwood, D.St.; Clair, D.; and Muir, W. DNA-markers
and biological vulnerability markers in families multiply
affected with schizophrenia. European Archives of
Psychiatry and Clinical Neuroscience, 240:191-196,
1991.
Dudkin, A.O. Some peculiarities of mammals' neuron
reactions due to small doses of radiation. Radiobiology
(Moscow), 28:663-667, 1988.
Egan, M.F., and Weinberger, D.R. Neurobiology of schizophrenia. Current Opinions in Neurobiology, 7:701-707,1997.
Bogerts, B. Recent advanced in the neuropathology of
schizophrenia. Schizophrenia Bulletin, 19(2):431-445,
1993.
Bullmore, E.T.; Woodruff, P.W.; Wright, I.C.; RabeHesketh, S.; Howard, R.J.; Shuriquie, N.; and Murray,
R.M. Does dysplasia cause anatomical dysconnectivity in
schizophrenia? Schizophrenia Research, 30:127-135,
1998.
Flor-Henry, P. Psychosis and temporal lobe epilepsy: A
controlled investigation. Epilepsia, 10:363-395, 1969a.
Flor-Henry, P. Schizophrenic-like reactions and affective
psychoses associated with temporal lobe epilepsy:
Etiological factors. American Journal of Psychiatry,
126:40(M03, 19696.
Flor-Henry, P. Lateralized temporal-limbic dysfunction
and psychopathology. Annals of the New York Academy of
Sciences, 280:777-795,1976.
Flor-Henry, P. Cerebral Basis of
Psychopathology.
Boston, MA: John Wright, 1983.
Buszewicz, M., and Phelan, M. Schizophrenia and the
environment. British Journal of Hospital Medicine,
52:149-154, 1994.
Chayanov, N.V., and Monosova, A.G. EEG mapping in
Chernobyl disaster suffered persons. In: Abstracts, Third
International Congress on Brain
Electromagnetic
Topography. Amsterdam, The Netherlands, June 9-12,1992.
Flor-Henry, P. Cerebral mechanisms of the efficacy of
electroshock therapy. Encephale, 13:329-333, 1987.
Coleman, M., and Gillberg, C. A biological approach to the
schizophrenia spectrum disorders. Journal of Neuropsychiatry and Clinical Neurosciences, 9:601-605,1997.
Court, L. Alterations Electroencephalographiques Sous
Irradiation-Relation Dose-Effect. Bruxelles, Belgium:
BMS, North Atlantic Treaty Organization, 1979.
Flor-Henry, P. Psychopathology and hemispheric specialization: Left hemisphere dysfunction in schizophrenia,
psychopathology, hysteria and the obsessional syndrome.
In: Boiler, F., and Grafman, J., eds. Handbook of
Neuropsychology. Vol. 3. Amsterdam, The Netherlands:
Elsevier, 1989. pp. 477-493.
Csemansky, J.G., and Bardgett, M.E. Limbic-cortical neuronal damage and the pathophysiology of schizophrenia.
Schizophrenia Bulletin, 24(2):231-248, 1998.
Fuller Torrey, E. Surviving Schizophrenia.
(1995)
Translated by Rapoport, D. St. Petersburg, Russia: Peter
Press, 1996.
767
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
K.N. Loganovsky and T.K. Loganovskaja
Gur, R.E. Left hemisphere dysfunction and left hemisphere overactivation in schizophrenia. Journal of
Abnormal Psychology, 87:226-238, 1978.
Galderisi, S.; Mucci, A.; Mignone, M.L.; Maj, M.; and
Kemali, D. CEEG mapping in drug-free schizophrenics:
Differences from healthy subjects and changes induced by
haloperidol treatment. Schizophrenia Research, 6:15-23,
1991.
Gangloff, H. Acute effects of X-irradiation on brain electrical
activity in cats and rabbits. In: Effects of Ionizing Radiation
on the Nervous System: Proceedings of the International
Symposium. Austria: IAEA, 1962. pp. 123-135.
Garver, D.L. The etiologic heterogeneity of schizophrenia. Harvard Reviews of Psychiatry, 4:317-327, 1997.
Gur, R.E. Disturbances in the normal asymmetry of brain
structure and function are a hallmark of schizophrenia and
may relate to sex differences and age effects on disease
course. In: Abstracts of the 4th Laterality
and
Psychopathology Conference, London, U.K., June 19-21,
1997. p. 25.
Gur, R.E., and Pearlson, G.D. Neuroimaging in schizophrenia research. Schizophrenia Bulletin, 19(2):337-353,
1993.
Gattaz, W.F.; Mayer, S.; Ziegler, P.; Platz, M ; and Gasser,
T. Hypofrontality on topographic EEG in schizophrenia:
Correlations with neuropsychological and psychopathological parameters. European Archives of Psychiatry and
Clinical Neuroscience, 241:328-332, 1992.
Haley, T. Changes induced in brain activity by low doses
of X-irradiation. In: Effects of Ionizing Radiation on the
Nervous System: Proceedings of the International
Symposium. Austria: Internation Atomic Energy Agency,
1962. pp. 171-185.
Goldberg, D. The General Health Questionnaire: GHQ28. London, U.K.: NFER-Nelson, 1981.
Heinrichs, R.W. Performance on test of diencephalic-hippocampal verbal memory function in schizophrenia,
Korsakoff's syndrome and personality disorder.
Schizophrenia Research, 13:127-132, 1994.
Goldberg, D., and Bridges, K. Screening for psychiatric
illness in general practice: the general practitioner versus
the screening questionnaire. Journal of the Royal College
of General Practitioners, 2:15-18, 1987.
Herrmann, W.M., and Winterer, G. Electroencephalography in psychiatry: Current status and outlook. Nervenarzt,
67:348-359, 1996.
Goldberg, D., and Williams, P. A User's Guide to the General Health Questionnaire. London: NFER-Nelson, 1988.
Hollister, J.M.; Mednick, S.A.; Brennan, P.; and Cannon,
T.D. Impaired autonomic nervous system: Habituation in
those at genetic risk for schizophrenia. Archives of
General Psychiatry, 51:552-558, 1994.
Goldman-Rakic, P.S. Working memory dysfunction in
schizophrenia. Journal of Neuropsychiatry and Clinical
Neurosciences, 6:348-357, 1994.
Golodetz, R.G. To the problem of schizophrenia clinical
peculiarities following influence of some occupational
factors. In: Rokhlin, L.L., ed. Problems of Schizophrenia.
Vol. 2. Moscow, Russia: Ministry of Public Health of
Russian Soviet Federative Socialistic Republic, State
Research Institute of Psychiatry, 1962. pp. 134-144.
Hugdahl, K. Cortical control of human classical conditioning: Autonomic and positron emission tomography
data. Psychophysiology, 35:170-178, 1998.
Hughes, J.R. A review of the usefulness of the standard
EEG in psychiatry. Clinical
Electroencephalography,
27:35-39, 1996.
Green, M. Significance of individual variability in EEG
response to electroshock. Journal of Hillside Hospital,
6:229-240, 1957.
Hunt, W.A. Effects of ionizing radiation on behaviour. In:
Conklin, J.J., and Walker, E.I., eds. Military Radiobiology.
San Diego, CA: Academic Press, 1987. pp. 321-330.
Grigoriev, Yu.G. Materials to Study Central Nervous
System Reaction on Ionizing Radiation. Moscow, Russia:
Medgiz, 1958.
Izumi, C , and Hayakawa, T. Electroencephalographic
researches of Hiroshima Atomic Bomb casualty on aftereffects 9 years later (preliminary report). Folio of
Psychiatry and Neurology in Japan, 9:229-242, 1955.
Gruzelier, J.H. Syndrome related asymmetry patterns in
schizophrenia and schizotypy: A review of evidence. In:
Abstracts of the 4th Laterality and Psychopathology
Conference. London, U.K., June 19-21, 1997. p. 25.
Jibiki, I.; Maeda, T.; Kubota, T; and Yamaguchi, N. l23 IIMP SPECT brain imaging in epileptic psychosis: A study
of two cases of temporal lobe epilepsy with schizophrenia-like syndrome. Neuropsychobiology, 28:207—211,
1993.
Gruzelier, J.H., and Hammond, N. Schizophrenia: A dominant hemisphere temporal-limbic disorder? Res. Comm.
Psychol. Psychiatr. Behav., 1:33-72, 1976.
Gruzelier, J., and Raine, A. Bilateral electrodermal activity and cerebral mechanisms in syndromes of schizophrenia and the schizotypal personality. International Journal
ofPsychophysiology, 16:1-16, 1994.
Jutai, J.W.; Gruzelier, J.H.; Connolly, J.F.; Manchanda,
R.; and Hirsch, S.R. Schizophrenia and spectral analysis
of the visual evoked potential. British Journal of
Psychiatry, 145:496-501, 1984.
768
At Issue
Schizophrenia Bulletin, Vol. 26, No. 4,2000
Konuma, M.; Furutani, M.; and Kubo, S. On the diencephalosis as aftereffects in Atomic Bomb casualties.
Japanese Medical Journal, 1544:5-12,1954.
Kamenchenko, P.V. Posttraumatic stress disorder. Zhurnal
Nevropatologii
i Psykhiatrii
imeni
Korsakova
(Korsakoff's Journal of Neuropathology and Psychiatry,
Moscow), 93:95-99, 1993.
Karson, C.N.; Garcia-Rill, E.; Biedermann, J.; Mrak,
R.E.; Husain, M.M.; and Skinner, R.D. The brain stem
reticular formation in schizophrenia. Psychiatry Research,
40:31-48, 1991.
Koyama, S.; Nageishi, Y.; Shimokochi, M.; Hokama, H.;
Miyazato, Y; Miyatani, M.; and Ogura, C. The N ^ component of event-related potentials in schizophrenic
patients: A preliminary study. Electroencephalography
and Clinical Neurophysiology, 78:124-132,1991.
Kuzma, J.W. Basic Statistics for the Health Sciences. Palo
Alto, CA: Mayfield, 1984.
Kawahata, N.; Daiton, N.; Shirai, F.; and Hara, S.
Reduction in mean cerebral blood flow measurements
using 99mTc-ECD-SPECT during normal aging. Kaku
Igaku, 34:909-916,1997.
Lebedinsky, A.V. Effects of ionizing radiation on the autonomic nervous system. In: Effects of Ionizing Radiation
on the Nervous System: Proceedings of the International
Symposium. Austria: International Atomic Energy Agency,
1962. pp. 375-395.
Kessler, C , and Kling, A. EEG power variation in schizophrenic subgroup: Effects of emotionally salient stimuli.
Biological Psychiatry, 30:335-348, 1991.
Khomskaja, E.D. Some results of neuropsychological
studies of persons who took a part in the Chernobyl accident consequences cleaning up. Social and Clinical
Psychiatry (Moscow), 5:6-10, 1995.
Lebedinsky, A.V., and Nakhilnitzkaja, Z.N. Ionizing
Radiation Influence on the Nervous System. Moscow,
Russia: Atomizdat, 1960.
Levy, A.V.; Laska, E.; Brodie, J.D.; Volkow, N.D.; and
Wolf, A.P. The spectral signature method for the analysis
of PET brain images. Journal of Cerebral Blood Flow and
Metabolism, ll:A103-A113,1991.
Khomskaja, E.D.; Manelis, N.G.; Yenikolopova, E.V.;
Gorina, I.S.; Budyga, E.V.; Malova, Yu. V.; Monosova, A.
Zh.; and Chayanov, N.V. Experience of EEG-studies in
persons took part in clean-up of the Cjernobyl accident
consequences. In: Nyagu, A.I., ed. Proceedings of the
International Conference "Social, Psychological, and
Pscyhoneurological Aspects of Chernobyl NPP Accident
Consequences,"
Kiev: Physicians of Chernobyl
Association, Ukrainian Scientific Center for Radiation
Medicine, 1993. pp. 273-274.
Likhtarev, I. Exposure of different population group of
Ukraine after the Chernobyl accident and main health-risk
assessment. Report for BfS/SKK Seminar "Ten Years
After Chernobyl, a Summation," Munich, Germany,
March 6-7,1996.
Likhtarev, I.; Chumak, V.; and Repin, V. Retrospective
reconstruction of individual and collective external
gamma doses of population evacuated after the Chernobyl
accident. Health Physics, 66:643-652, 1994.
Kidogami, Y.; Yoneda, H.; Asaba, H.; and Sakai, T. P 300 in
first degree relatives of schizophrenics. Schizophrenia
Research, 6:9-13, 1991.
Kimeldorf, D.J., and Hunt, E.L. Ionizing Radiation:
Neural Function and Behavior (1965) Translated by
Kvasnikova, L.N., and Pravdina, G.M. Edited by Tsypin,
A.B. Moscow, Russia: Atomizdat, 1969.
Livanov, M.N. Some Problems of Ionizing Radiation
Effects on the Nervous System. Moscow, Russia: Medgiz,
1962.
Loganovskaja, T., and Loganovsky, K. Brain laterality and
psychopathology in children irradiated in utero. In:
Abstracts of the 4th Laterality and Psychopathology
Conference, London, U.K., 1997. p. 34.
Kindselsky, L.P.; Kovalenko, A.N.; and Khaliavka, I.G.
Acute radiation sickness. In: Barjakhtar, V.G., ed.
Chernobyl Catastrophe. Kiev, Ukraine: Naukova dumka,
1995. pp. 447-449.
Loganovskaja, T., and Loganovsky, K. Left hemisphere
vulnerability of prenatally irradiated children. In:
Abstracts of the 9th World Congress of the International
Organization of Psychophysiology, Taormina, 1998.
International Journal of Psychophysiology 30:156,
1998.
Kirch, D.G. Infection and autoimmunity as etiological
factors in schizophrenia: A review and reappraisal.
Schizophrenia Bulletin, 19(2):355-370, 1993.
Kirk, R.E. Experimental Design: Procedures for the
Behavioral Sciences. Monterey, CA: Brooks/Cole, 1982.
Loganovsky, K.N. Ionizing radiation effects on human
brain information processes. In: Nyagu, A.I., ed.
Proceedings of the 1st International Conference on the
Mental Health Consequences of the Chernobyl Disaster:
Current State and Future Prospects. Kiev, Ukraine:
Chreschchatyk, 1995. p. 53.
Klingelhofer, J.; Matzander, G.; Sander, D.; Schwarze, J.;
Boecker, H.; and Bischoff, C. Assessment of functional
hemispheric asymmetry by bilateral simultaneous cerebral
blood flow velocity monitoring. Journal of Cerebral
Blood Flow and Metabolism, 17:577-585, 1997.
769
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
K.N. Loganovsky and T.K. Loganovskaja
"liquidators" of the Chernobyl accident. In: Nyagu, A.I.,
and Souchkevitch, G.N., eds. Proceedings of the 2nd
International
Conference
"Long-Term
Health
Consequences of the Chernobyl Disaster," Kiev, Ukraine:
Chernobylinterinform, 1998. p. 299.
Loganovsky, K.N. Mental disorders in the Chernobyl
accident survivors. In: Arkhipov, N.P., ed. Chernobyl-94:
Proceedings of the Fourth International Conference on
the Results of 8-years Cleaning Up Works of the
Chernobyl Accident Consequences. Vol. 2. Kiev, Ukraine:
Double, 1996a. pp. 166-174.
Michel, CM.; Koukkou, M.; and Lehmann, D. EEG reactivity in high and low symptomatic schizophrenics, using
source modeling in the frequency domain. Brain
Topography, 5:389-394, 1993.
Loganovsky, K.N. Psychophysiological basis of mental disorders in the Chernobyl exclusion zone workers. In:
Arkhipov, N.P., ed. Chernobyl-96: Proceedings of the Fifth
International Conference on the Results of 10-years
Cleaning Up Works of the Chernobyl
Accident
Consequences. Kiev: Silver Polygraph, 19966. pp. 372-373.
Loganovsky, K.N. Schizophrenia spectrum disorders in persons exposed to ionizing radiation as a result of the
Chernobyl accident. In: Nyagu, A.I., and Souchkevtich, G.N.
Proceedings of the 2nd International Conference "Longterm Health Consequences of the Chernobyl Disaster," Kiev,
Ukraine: Chernobylinterinform, 1998. p. 79.
Loganovsky, K.N., and Loganovskaja, T.K. Brain laterality and psychopathology in the remote period of acute
radiation sickness. In: Abstracts of the 4th Laterality and
Psychopathology Conference, London, U.K., 1997. p. 34.
Loganovsky, K.N., and Loganovskaja, T.K. Schizophrenia
and left frontotemporal EEG abnormalities in the aftermath of the Chernobyl disaster. In: Abstracts of the 9th
World Congress of the International Organization of
Psychophysiology, Taormina, 1998. International Journal
ofPsychophysiology, 30:170, 1998.
Loganovsky, K., and Nyagu, A. Mental disorders in
Chernobyl accident survivors according to ICD-10.
Social and Clinical Psychiatry (Moscow), 2:15-23, 1995.
Loganovsky, K.N., and Nyagu, A.I. Epidemiological
study of schizophrenia in the Chernobyl exclusion zone
personnel. In: Low Doses of Ionizing
Radiation:
Biological Effects and Regulatory Control, IAEA-TECDOC-976, Contributed papers of International
Conference, Seville, Spain, November 17-21, 1997,
International Atomic Energy Agency (IAEA), World
Health Organization, United Nations Scientific
Committee on the Effects of Atomic Radiation. Austria:
IAEA, 1997. pp. 265-268.
Michelogiannis, S.; Paritsis, N.; and Trikas, P. EEG coherence during hemispheric activation in schizophrenics.
European Archives of Psychiatry
and
Clinical
Neuroscience, 241:31-34,1991.
Ministry of Public Health of Ukraine. Psychiatric Care
for Population of Ukrainian SSR in 1970-1975. Kharkov,
Ukraine: Ministry of Public Health of Ukrainian SSR,
Kharkov Research Institute of Neurology and Psychiatry,
1976.
Ministry of Public Health of Ukraine. Psychiatric Care
for Population of Ukrainian SSR in 1975-1980. Kharkov,
Ukraine: Ministry of Public Health of Ukrainian SSR,
Republic Office of Medical Statistic of Ministry of Public
Health of Ukrainian SSR, Kharkov Research Institute of
Neurology and Psychiatry, 1982.
Ministry of Public Health of Ukraine. Main Indices of
Psychiatric Care for Population of Ukrainian SSR in
1980-1985. Kiev, Ukraine: Ministry of Public Health of
Ukrainian SSR, Republic Centre of Medical Statistic of
Ministry of Public Health of Ukrainian SSR, Kharkov
Research Institute of Neurology and Psychiatry, 1986.
Ministry of Public Health of Ukraine. Psychiatric Care
for Population of Ukraine. Kyiv, Ukraine: Ministry of
Public Health of Ukraine, Republic Medical and
Ecological Centre, Republic Informative and Computer
Centre of Medical Statistic of Ministry of Public Health
of Ukraine, 1991.
Ministry of Public Health of Ukraine. Psychiatric Care
for Population of Ukraine. Kyiv, Ukraine: Ministry of
Public Health of Ukraine, Republic Informative and
Computer Centre of Medical Statistic of Ministry of
Public Health of Ukraine, 1998.
Los', I.P., and Likhtarev, I.A. Irradiation doses as a result
of the Chernobyl NPP accident and from others sources.
In: Proceedings of the International Workshop at Chiba,
Japan, January 18-20, 1994. pp. 91-103.
Ministry of Ukraine for Problems of Population Defense
from Chernobyl Disaster. Ministry of Ukraine. Ten Years
After the Chernobyl Disaster (Kiev, Mincher-nobyl). Vienna,
Austria: International Atomic Energy Agency, 1996.
McGuffin, P.; Asherson, P.; Owen, M.; and Farmer, D.
The strength of the genetic effect: Is there room for an
environmental influence in the aetiology of schizophrenia? British Journal of Psychiatry, 164:593-599,1994.
Montgomery, D.C. Design and Analysis of Experiments.
New York, NY: John Wiley and Sons, 1976.
Morrison-Stewart, S.L.; Velikohja, D.; Corning, W.C.; and
Williamson, P. Aberrant interhemispheric alpha coherence on
electroencephalography in schizophrenic patients during
activation tasks. Psychological Medicine, 26:605-612,1996.
Meshkov, N.A.; Kholodova, N.B.; and Ryzhov, B.N.
Long-term neuro-psychological consequences among the
770
At Issue
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
Nakagawa, M.; Takede, K.; and Kakimoto, Y.
Characteristic distribution of alpha-2 wave in electroencephalograms of schizophrenic patients during discriminative tasks: Support for the hypofrontality hypothesis of
schizophrenia. Ada Psychiatrica
Scandinavica,
83:105-114,1991.
Nakane, Y., and Ohta, Y. An example from the Japanese
Register: Some long-term consequences of the A-bomb
for its survivors in Nagasaki. In: Ten Horn, G.H.M.M.;
Giel, R.; Gulbinat, W.H.; and Henderson, J.H., eds.
Psychiatric Case Registers in Public Health. Amsterdam,
The Netherlands: Elsevier Science, 1986. pp. 26-27.
Nyagu, A.I., and Loganovsky, K.N. Neurophysiological
appropriateness of ionizing radiation effects. In: Low
Doses of Ionizing Radiation: Biological Effects and
Regulatory Control, IAEA-TECDOC-976, Contributed
papers of International Conference, Seville, Spain,
November 17-21, 1997, International Atomic Energy
Agency (IAEA), World Health Organization, United
Nations Scientific Committee on the Effects of Atomic
Radiation. Austria: IAEA, 1997ft. pp. 261-264.
Nyagu, A.I., and Loganovsky, K.N. Neuropsychiatric
Effects of Ionizing Radiation. Kiev, Ukraine: Chernobylinterinform, 1998.
Napreyenko, A.K., and Loganovsky, K.N. Borderline
neuro-psychic disorders in persons exposed to ionizing
radiation. Vrachebnoye Dielo (Physicians' Affair, Kiev),
6:48-52,1992.
Napreyenko, A.K., and Loganovsky, K.N. Systematic of
mental disorders caused by the Chernobyl accident after-
math. Likarska Sprava (Physicians' Affair, Kiev),
5-6:25-29,1995.
Napreyenko, A.K., and Loganovsky, K.N. Ecological
Psychiatry. Kiev, Ukraine: Poligraphkniga, 1997.
Nyagu, A.I.; Loganovsky, K.N.; Chuprovskaja, N.Yu.;
Vashchenko, E.A.; Kostyuchenko, V.G.; Plachinda, Yu.L;
Yuriev, K.L.; Loganovskaja, T.K.; and Zdorenko, L.L.
Postradiation encephalopathy at the remote period of
acute radiation sickness. Ukrainian Medical Journal,
2-33-AA, 1997.
Nyagu, A.I.; Loganovsky, K.N.; and Loganovskaja, T.K.
Psychophysiological aftereffects of prenatal irradiation.
International Journal of Psychophysiology, 30:303-311,
1998.
Nyagu, A.; Loganovsky, K.; Vashchenko, E.; and Yuriev,
K. Psychophysiological effects of chronical irradiation as
a result of the Chernobyl disaster. In: One Decade After
Chernobyl: Book of Extended Synopses. European
Commission, International Atomic Energy Agency
(IAEA), World Health Organization. Austria: IAEA,
1996. pp. 347-348.
Niedermeyer, E., and Lopes da Silva, F. Electroencephalography: Basic Principles, Clinical Application
and Related Fields, Baltimore, MD: Urban, 1982.
Nishikawa, T., and Tsuiki, S. Psychiatric research on
Atomic Bomb survivors. Nagasaki Medical Journal,
31:111-122, 1962.
Noschenko, A.G., and Loganovsky, K.N. Bioelectrical
brain activity and peculiarities of mental disorders in the
Chernobyl accident survivors. In: Riabov, I.N., and
Riabtsev, I.A., eds. Abstracts of the 1st International
Conference
"Biological
and
Radioecological
Consequences of the Chernobyl Accident," Moscow:
Academy of Sciences of the USSR, 1990. p. 218.
Nyagu, A.I.; Noschenko, A.G.; and Loganovsky, K.N.
Delayed consequences of psychogenic and radiation factors of the Chernobyl accident on the human brain functional status. Zhurnal Nevropatologii I Psykhiatrii imeni
Korsakova (Korsakoff's Journal of Neuropathology and
Psychiatry, Moscow), 4:72-77, 1992.
O'Donnell, P., and Grace, A.A. Dysfunctions in multiple
interrelated systems as the neurobiological bases of schizophrenic symptom clusters. Schizophrenia
Bulletin,
24(2):267-283, 1998.
Noschenko, A.G., and Loganovsky, K.N. Peculiarities of
the brain functional state in the Chernobyl 30-km zone
workers from the point of view of aging changes.
Likarska Sprava (Physicians' Affair, Kiev), 2:16-19,1994.
Overall, J.E., and Gorham, D.R. The Brief Psychiatric
Rating Scale. Psychological Reports, 10:799-812, 1962.
Nyagu, A.I., and Loganovsky, K.N. Mental disorders in
the Chernobyl accident survivors. In: Abstracts of the X
World Congress of Psychiatry. Madrid, Spain, 1996,
S-136-l.p. 119.
Peimer, S.I.; Dudkin, A.O.; and Sverdlov, A.G. Direct
effects of small doses of ionizing radiation on the neurons. Reports of the Academy of Sciences of the Union of
Soviet Socialist Republics, 284:1481-1484, 1985.
Nyagu, A.I., and Loganovsky, K.N. Mental health in
Chernobyl survivors: Remote period medical and social
risks. In: Drotss-Sjoberg, B.-M., ed. New Risk Frontiers:
10th Anniversary of the Society for Risk Analysis—
Europe; Proceedings of the International Meeting of the
Society for Risk Analysis—Europe. Series Rhizikon:
Studies of Risk and Hazard. Stockholm, Sweden: The
Center for Risk Research, 1997a. pp. 769-777.
Port, R.L., and Seybold, K.S. Hippocampal synaptic plasticity as a biological substrate underlying episodic psychosis. Biological Psychiatry, 37:318-324, 1995.
Report of the Scientific Center of Mental Health of the
Russian Academy of Medical Sciences (AMS) for the
President, Russian AMS, and Ministry of Public Health of
771
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
K.N. Loganovsky and T.K. Loganovskaja
Sosnovskaja, F.M. Study of bioelectrical brain activity in
persons exposed to chronic influence of ionizing radiation. Zhurnal Nevropatologii
i Psykhiatrii
imeni
Korsakova (Korsakoff's Journal of Neuropathology and
Psychiatry, Moscow), 71:205-209, 1971.
Russian Federation. State of mental health of Russian federation population. Zhurnal Nevropatologii I Psykhiatrii
imeni Korsakova (Korsakoff's Journal of Neuropathology
and Psychiatry, Moscow), 4:79-90, 1994.
Risberg, J.; Halsey, J.H.; Wills, E.L.; and Wilson, E.M.
Hemispheric specialization in normal man studied by
bilateral measurements of the regional cerebral blood
flow. Brain, 98:511-524, 1975.
Suzuki, M.; Kurachi, M.; Kawasaki, Y.; Kiba, K.; and
Yamaguchi, N. Left hypofrontality correlates with blunted
affect in schizophrenia. Japanese Journal of Psychiatry
and Neurology, 46:653-657, 1992.
Roberts, G.W. Schizophrenia: A neuropathological perspective. British Journal of Psychiatry, 158:8-17,1991.
Romanenko, A.Ye.; Piatak, O.A.; and Kovalenko, A.N.
Health of the participants of the accident cleaning up. In:
Barjakhtar, V.G., ed., Chernobyl Catastrophe. Kiev,
Ukraine: Naukova dumka, 1995. pp. 447-449.
Swerdlow, N.R., and Geyer, M.A. Using an animal model
of deficient sensorimotor gating to study the pathophysiology and new treatments of schizophrenia. Schizophrenia
Bulletin, 24(2):285-301, 1998.
Syvalahti, E.K. Biological factors in schizophrenia:
Structural and functional aspects. British Journal of
Psychiatry, 23(Suppl):9-14, 1994.
Rossi, A.; Stratta, P.; Mancini, R; Gallucci, M.; Mattei, P.;
Core, L.; Di Michele, V.; and Casacchia, M. Magnetic resonance imaging findings of amygdala-anterior hippocampus shrinkage in male patients with schizophrenia.
Psychiatry Research, 52:43-53, 1994.
Vashchenko, E.A. Mechanisms of realization of nervous
system functional state disturbances in persons exposed to
ionizing radiation as a result of the Chernobyl accident. In:
Nyagu, A.I., and Souchkevitch, G.N., eds. Proceedings of
the 2nd International Conference "Long-term Health
Consequences of the Chernobyl Disaster." Kiev, Ukraine:
Chernobylinterinform, 1998. p. 195.
Sachdev, P. Schizophrenia-like psychosis and epilepsy:
The status of the association. American Journal of
Psychiatry, 155:325-336, 1998.
Seidman, L.J.; Talbot, N.L.; Kalinowski, A.G.; McCarley,
R.W.; Faraone, S.V.; Kremen, W.S.; Pepple, J.R.; and
Tsaung, M.T. Neuropsychological probes of fronto-limbic
system dysfunction in schizophrenia: Olfactory identification and Wisconsin Card Sorting performance.
Schizophrenia Research, 6:55-65, 1991.
Vashchenko, E.A.; Nyagu, A.I.; Brous, B.A.; and
Vasilenko, D.A. Status of somatic segmental reflectoral
mechanisms in people exposed to ionizing radiation as a
result of the nuclear disaster in Chernobyl.
Neurophysiology, 29:105-116, 1997.
Seitz, R.J., and Roland, P.E. Variability of the regional
cerebral blood flow pattern studied with n C - f l u o romethane and positron emission tomography (PET).
Computerized
Medical Imaging and
Vein, A.M.; Kolosova, O.A.; Varakin, Yu.Ya.; and
Tabeyeva, G.R. Epidemiology of vegetative disorders—
syndrome of vegetative dystonia—and its peculiarities in
cerebrovascular pathology. Zhurnal Nevropatologii i
Psykhiatrii imeni Korsakova (Korsakoff's Journal of
Neuropathology and Psychiatry, Moscow), 11:11-14,
1991.
Graphics,
16:311-322, 1992.
Shagass, C , and Roemer, R. Evoked potential topography
in unmedicated and medicated schizophrenics.
International Journal of Psychophysiology, 10:213-224,
1991.
Viatleva, O.A.; Katargina, T.A.; Puchinskaja, L.M.; and
Yurkin, M.M. Electrophysiological character of brain
functional status in the participants of the Chernobyl accident consequences cleaning up workers suffering from
mental disorders. Zhurnal Nevropatologii i Psykhiatrii
imeni Korsakova (Korsakoff's Journal of Neuropathology
and Psychiatry, Moscow), 3:41-46, 1996.
Shenton, M.E.; Kikinis, R.; Jolesz, F.A.; Pollak, S.D.;
LeMay, M.; Wible, C.G.; Hokama, H.; Martin, J.;
Metcalf, D.; Coleman, M.; et al. Abnormalities of the left
temporal lobe and thought disorder in schizophrenia: A
quantitative magnetic resonance imaging study. New
England Journal of Medicine, 327:604-612, 1992.
Vokhmekov, V.D.; Maralina, G.P.; Volkova, L.V.; and
Ganzha, Ye.G. Incidence of diseases within the personnel
of the exclusion zone. Problems of Chernobyl Exclusion
Zone (Kiev), 1:27-37, 1994.
Shore, D., ed. Schizophrenia: Questions and Answers.
Bethesda, MD: National Institute of Mental Health, 1986.
Sobchik, L.N. Standardized Methods of Personality
Multifactorial Investigation (MMPI). Moscow, Russia:
Moscow Personnel Center at Main Department for Labor
and Social Problems of Moscow City Executive
Committee, 1990.
Wagemaker, G., and Bebeshko, V.G. Diagnosis and
Treatment of Patients with Acute Radiation Syndrome:
Joint Study Project 3. Final Report. Brussels, Belgium:
European Commission, 1996.
772
At Issue
Schizophrenia Bulletin, Vol. 26, No. 4, 2000
Weinberger, D.R.; Aloia, M.S.; Goldberg, T.E.; and
Berman, K.F. The frontal lobes and schizophrenia.
Journal of Neuropsychiatry and Clinical Neurosciences,
6:419-427,1994. '
the 2nd International Conference "Long-term Health
Consequences of the Chernobyl Disaster." Kiev, Ukraine:
Chernobylinterinform, 1998. p. 233.
Zhavoronkova, L.A.; Kholodova, N.B.; Zubovsky, G.A.;
Gogitidze, N.V.; and Koptelov, Y.M. EEG power mapping, dipole source and coherence analysis in Chernobyl
patients. Brain Topography, 8:161-168, 1995.
Willner, P. The dopamine hypothesis of schizophrenia:
Current status, future prospects. International Clinical
Psychopharmacology, 12:297-308, 1997.
Yaar, I.; Ron, E.; Modan, M.; Perets, H.; and Modan, B.
Long-term cerebral effects of small doses of X-irradiation
in childhood as manifested in adult visual evoked
responses. Annals of Neurology, 8:261-268,1980.
Zhirmunskaya, E.A. Clinical Electroencephalography.
Moscow, Russia: Maybe, 1991.
Acknowledgments
Zenkov, L.R., and Ronkin, M.A. Nervous Diseases
Functional Diagnostics. Moscow, Russia: Medicine,
1991.
We express our cordial gratitude to Prof. Pierre FlorHenry (Edmonton, Canada) for his creative advice, kind
support, and encouragement during this study. We are
indebted to Dr. John Lind (Edmonton, Canada) for constructive suggestions, criticism, and help in the statistical
analysis. We thank all our anonymous referees, who have
spent a great deal of time evaluating our manuscript, for
their criticism, helpful comments, and patience.
Zharikov, N.M.; Ivanova, A.E.; and Yurikov, A.S. Factors
influencing the state and dynamics of mental health of
population. Zhurnal Nevropatologii i Psykhiatrii imeni
Korsakova (Korsakojf's Journal of Neuropathology and
Psychiatry, Moscow), 3:78-87, 1996.
Zhavoronkova, L.A., and Kholodova, N.B. Estimation of
brain functional state with EEG coherence at the remote
period after exposure to ionizing radiation (consequences
of the Chernobyl accident). Zhurnal Vyshei Nervnoi
Deyatelnosty imeni Pavlova (Pavlov's Journal of Highest
Nervous Activity, Moscow), 44:159-162, 1994.
The Authors
Konstantin N. Loganovsky, M.D., Ph.D., is Leading
Scientist and Psychiatrist, and Tatiana K. Loganovskaja,
M.D., is Scientist and Psychiatrist, Department of
Neurology, Institute of Clinical Radiology, Scientific
Center for Radiation Medicine, Academy of Medical
Sciences of the Ukraine, Kiev, Ukraine.
Zhavoronkova, L.A.; Kholodova, N.B.; and Gogitidze,
N.V. Dynamic assessment of the remote consequences of
irradiation: Clinical-electrophysiological investigation. In:
Nyagu, A.I., and Souchkevitch, G.N., eds. Proceedings of
773