Functional imaging studies have shown that certain brain regions, including posterior cingulate cortex (PCC) and ventral anterior cingulate cortex (vACC), consistently show greater activity during resting states than during cognitive tasks. This finding led to the hypothesis that these regions constitute a network supporting a default mode of brain function. In this study, we investigate three questions pertaining to this hypothesis: Does such a resting-state network exist in the human brain? Is it modulated during simple sensory processing? How is it modulated during cognitive processing? To address these questions, we defined PCC and vACC regions that showed decreased activity during a cognitive (working memory) task, then examined their functional connectivity during rest. PCC was strongly coupled with vACC and several other brain regions implicated in the default mode network. Next, we examined the functional connectivity of PCC and vACC during a visual processing task and show that the resultant connectivity maps are virtually identical to those obtained during rest. Last, we defined three lateral prefrontal regions showing increased activity during the cognitive task and examined their resting-state connectivity. We report significant inverse correlations among all three lateral prefrontal regions and PCC, suggesting a mechanism for attenuation of default mode network activity during cognitive processing. This study constitutes, to our knowledge, the first resting-state connectivity analysis of the default mode and provides the most compelling evidence to date for the existence of a cohesive default mode network. Our findings also provide insight into how this network is modulated by task demands and what functions it might subserve.

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Functional connectivity in the resting brain: A network analysis of the default mode hypothesis

Meta-analyses were conducted on 14 separate risk factors for posttraumatic stress disorder (PTSD), and the moderating effects of various sample and study characteristics, including civilian/military status, were examined. Three categories of risk factor emerged: Factors such as gender, age at trauma, and race that predicted PTSD in some populations but not in others; factors such as education, previous trauma, and general childhood adversity that predicted PTSD more consistently but to a varying extent according to the populations studied and the methods used; and factors such as psychiatric history, reported childhood abuse, and family psychiatric history that had more uniform predictive effects. Individually, the effect size of all the risk factors was modest, but factors operating during or after the trauma, such as trauma severity, lack of social support, and additional life stress, had somewhat stronger effects than pretrauma factors.

Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.

Based on the recent literature and collective experience, an international consortium developed revised guidelines for the diagnosis of behavioural variant frontotemporal dementia. The validation process retrospectively reviewed clinical records and compared the sensitivity of proposed and earlier criteria in a multi-site sample of patients with pathologically verified frontotemporal lobar degeneration. According to the revised criteria, 'possible' behavioural variant frontotemporal dementia requires three of six clinically discriminating features (disinhibition, apathy/inertia, loss of sympathy/empathy, perseverative/compulsive behaviours, hyperorality and dysexecutive neuropsychological profile). 'Probable' behavioural variant frontotemporal dementia adds functional disability and characteristic neuroimaging, while behavioural variant frontotemporal dementia 'with definite frontotemporal lobar degeneration' requires histopathological confirmation or a pathogenic mutation. Sixteen brain banks contributed cases meeting histopathological criteria for frontotemporal lobar degeneration and a clinical diagnosis of behavioural variant frontotemporal dementia, Alzheimer's disease, dementia with Lewy bodies or vascular dementia at presentation. Cases with predominant primary progressive aphasia or extra-pyramidal syndromes were excluded. In these autopsy-confirmed cases, an experienced neurologist or psychiatrist ascertained clinical features necessary for making a diagnosis according to previous and proposed criteria at presentation. Of 137 cases where features were available for both proposed and previously established criteria, 118 (86%) met 'possible' criteria, and 104 (76%) met criteria for 'probable' behavioural variant frontotemporal dementia. In contrast, 72 cases (53%) met previously established criteria for the syndrome (P < 0.001 for comparison with 'possible' and 'probable' criteria). Patients who failed to meet revised criteria were significantly older and most had atypical presentations with marked memory impairment. In conclusion, the revised criteria for behavioural variant frontotemporal dementia improve diagnostic accuracy compared with previously established criteria in a sample with known frontotemporal lobar degeneration. Greater sensitivity of the proposed criteria may reflect the optimized diagnostic features, less restrictive exclusion features and a flexible structure that accommodates different initial clinical presentations. Future studies will be needed to establish the reliability and specificity of these revised diagnostic guidelines.

/pdf/sensitivity-of-revised-diagnostic-criteria-for-the-2f3gs00fp5.pdf

Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia.

Suicidal behavior is a major problem worldwide and, at the same time, has received relatively little empirical attention. This relative lack of empirical attention may be due in part to a relative absence of theory development regarding suicidal behavior. The current article presents the interpersonal theory of suicidal behavior. We propose that the most dangerous form of suicidal desire is caused by the simultaneous presence of two interpersonal constructs—thwarted belongingness and perceived burdensomeness (and hopelessness about these states)—and further that the capability to engage in suicidal behavior is separate from the desire to engage in suicidal behavior. According to the theory, the capability for suicidal behavior emerges, via habituation and opponent processes, in response to repeated exposure to physically painful and/or fear-inducing experiences. In the current article, the theory’s hypotheses are more precisely delineated than in previous presentations (Joiner, 2005), with the aim of inviting scientific inquiry and potential falsification of the theory’s hypotheses.

/pdf/the-interpersonal-theory-of-suicide-38t99pb95m.pdf

The Interpersonal Theory of Suicide

The role of childhood trauma in the neurobiology of mood and anxiety disorders: preclinical and clinical studies

J Neuropsychiatry Clin Neurosci

Most medical faculty receive little or no training about how to be effective teachers, even when they assume major educational leadership roles. To identify the competencies required of an effective teacher in medical education, the authors developed a comprehensive conceptual model. After conducting a literature search, the authors met at a two-day conference (2006) with 16 medical and nonmedical educators from 10 different U.S. and Canadian organizations and developed an initial draft of the “Teaching as a Competency” conceptual model. Conference participants used the physician competencies (from the Accreditation Council for Graduate Medical Education [ACGME]) and the roles (from the Royal College’s Canadian Medical Education Directives for Specialists [CanMEDS]) to define critical skills for medical educators. The authors then refined this initial framework through national/regional conference presentations (2007, 2008), an additional literature review, and expert input. Four core values grounded this framework: learner engagement, learnercenteredness, adaptability, and selfreflection. The authors identified six core competencies, based on the ACGME competencies framework: medical (or content) knowledge; learnercenteredness; interpersonal and communication skills; professionalism and role modeling; practice-based reflection; and systems-based practice. They also included four specialized competencies for educators with additional programmatic roles: program design/implementation, evaluation/scholarship, leadership, and mentorship. The authors then crossreferenced the competencies with educator roles, drawing from CanMEDS, to recognize role-specific skills. The authors have explored their framework’s strengths, limitations, and applications, which include targeted faculty development, evaluation, and resource allocation. The Teaching as a Competency framework promotes a culture of effective teaching and learning.

https://larrycuban.files.wordpress.com/2016/01/00001888-201110000-00017-1.pdf

"Teaching as a Competency": Competencies for Medical Educators

Objective: Using the DSM-IV diagnostic criteria for acute stress disorder, the authors examined whether the acute psychological effects of being a bystander to violence involving mass shootings in an office building predicted later posttraumatic stress symptoms. Method: The participants in this study were 36 employees working in an office building where a gunman shot 14 persons (eight fatally). The acute stress symptoms were assessed within 8 days of the event, and posttraumatic stress symptoms of 32 employees were assessed 7 to 10 months later. Results: According to the Stanford Acute Stress Reaction Questionnaire, 12 (33%) of the employees met criteria for the diagnosis of acute stress disorder. Acute stress symptoms were found to be an excellent predictor of the subjects’ posttraumatic stress symptoms 7‐10 months after the traumatic event. Conclusions: These results suggest not only that being a bystander to violence is highly stressful in the short run, but that acute stress reactions to such an event further predict later posttraumatic stress symptoms. (Am J Psychiatry 1998; 155:620‐624)

https://ajp.psychiatryonline.org/doi/pdfplus/10.1176/ajp.155.5.620

Acute Stress Disorder as a Predictor of Posttraumatic Stress Symptoms

Risperidone is rapidly and completely absorbed after oral administration; less than 1% is excreted unchanged in the feces. The principal metabolite was found to be 9-hydroxyrisperidone. Hydroxylation of risperidone is subject to the same genetic polymorphism as debrisoquine and dextromethorphan. In poor metabolizers the half-life of risperidone was about 19 hours compared with about 3 hours in extensive metabolizers. However, becuase the pharmacology of 9-hydroxyrisperidone is very similar to that of risperidone, the half-life for the "active fraction" (risperidone +9-hydroxyrisperidone) was found to be approximately 20 hours in extensive and poor metabolizers. We found that risperidone exhibited linear elimination kinetics and that steady state was reached within 1 day for risperidone and within 5 days for the active fraction.

Pharmacologic approach to management of agitation associated with dementia.

Introduction. Foreword. Section I: Bipolar Disorders. Foreword. Differential diagnosis, natural course, and epidemiology of bipolar disorders. Biological findings in bipolar disorders. Sleep and biological rhythms in bipolar illness. Treatment of bipolar disorders. Psychotherapeutic issues and suicide prevention in the treatment of bipolar disorders. Clinical approaches to treatment-resistant bipolar illness. Afterword. Section II: Neuroscience Techniques in Clinical Psychiatry. Foreword. Psychopharmacology in clinical psychiatry. Psychoendocrinology in clinical practice. Psychoimmunology in clinical psychiatry. The neurobiology of sleep: basic concepts and clinical implications. X-ray computed tomography and magnetic resonance imaging in psychiatry. Functional brain imaging techniques. Afterword. Section III: Differential Therapeutics. Foreword. The setting for psychiatric treatment. Differential therapeutics and treatment format. Strategies and techniques of prescriptive psychotherapeutic intervention. The choice of duration and frequency for outpatient psychotherapy. Differential therapeutics: psychopharmacology. Differential therapeutics: clinical, teaching, research, and administrative issues. Afterword. Section IV: Violence and the Violent Patient. Foreword. Determinants of human violence. Patterns in human violence. Evaluation of the violent patient. Emergency management of violent patients. The long-term treatment of the violent patient. Legal aspects of violence by psychiatric patients. Afterword. Section V: Psychiatric Epidemiology. Foreword. Epidemiology overview. The assessment of psychiatric diagnosis in epidemiological studies. Psychiatric disorders in the community: the epidemiologic catchment area study. Genetic epidemiology of psychiatric disorders. Parental mental disorder as a psychiatric risk factor. Toward the prevention of psychiatric risk disorders. Epidemiologic findings from disaster research. Afterword. Section VI: Psychopharmacology: Drug Side Effects and Interactions. Foreword. Antipsychotic drug side effects. Side effects of antidepressant drugs. Lithium carbonate and carbamazepine side effects. Benzodiazepine side effects. Clinically significant psychoactive drug interactions. Afterword. Index.

Robert E. Hales

Papers

J Neuropsychiatry Clin Neurosci

"Teaching as a Competency": Competencies for Medical Educators

Acute Stress Disorder as a Predictor of Posttraumatic Stress Symptoms

Pharmacologic approach to management of agitation associated with dementia.

Psychiatry update : American Psychiatric Association annual review