Showing papers in "Cns Spectrums in 1997"
184 citations
TL;DR: The study results indicate that OCD has a profound effect on psychosocial functioning and quality of life, and large direct costs for OCD, and even larger indirect costs due to lost wages and underemployment were found.
Abstract: The study presented was conducted to analyze the effects of obsessive-compulsive symptoms on patients' quality of life and the costs incurred by patients and society for the treatment of obsessive-compulsive disorder (OCD). To accomplish this, a detailed 410-item questionnaire of psychosocial function and economic cost was sent to every fourth member of the Obsessive Compulsive Foundation. Of the 2,670 members who received the survey, 701 (26.9%) returned it.Outcome measures included symptomatology, course of illness, impact of illness on psychosocial and other functioning, effects of diagnosis and treatment, and economic consequences. The demographics of this group were similar to those in smaller treatment-seeking clinical samples, but not necessarily to OCD sufferers within the US population as a whole. More than half of the patients reported moderate to severe interference in family relationships, socializing, and ability to study or work, secondary to OCD symptoms. A 10.2-year gap was observed between the onset of symptoms and the first attempt to seek professional help, and a 17.2-year gap was observed between the onset of symptoms and receipt of effective treatment. Specific treatments, such as serotonin reuptake inhibitors and behavior therapy showed greater symptom improvement, and significantly reduced the total annual fees incurred by OCD patients when compared with nonspecific treatments.Our study results indicate that OCD has a profound effect on psychosocial functioning and quality of life. Large direct costs for OCD, and even larger indirect costs due to lost wages and underemployment were found. Greater awareness of OCD among practitioners may result in earlier diagnosis and more appropriate and cost-effective treatments.
132 citations
TL;DR: This article discusses the relationship between cognitive impairment and the other symptoms of schizophrenia, the effects of typical neuroleptic therapy on cognitive impairment, and important issues to address in cognitive enhancement studies in schizophrenia.
Abstract: Cognitive impairment is considered a central feature of schizophrenia. Many aspects of cognition are impaired in schizophrenia. Careful evaluation of the relationship between cognitive impairment and the other symptoms of schizophrenia has revealed several important findings. In this article, we discuss these findings, the effects of typical neuroleptic therapy on cognitive impairment, and important issues to address in cognitive enhancement studies in schizophrenia.
81 citations
TL;DR: Findings support previous clinical constructs that OCD and schizophrenia are not always dichotomous disorders, but may be interconnected.
Abstract: Obsessive-compulsive (OC) symptoms and schizophrenia may present, as intertwined phenomena whose relationship remains poorly understood. The purpose of this paper is to provide a detailed phenomenological description of OC symptoms in schizophrenia.Fifty long-term patients with chronic schizophrenia or schizoaffective disorder from a continuing day-treatment program were assessed using the Structured Clinical Interview for DSM-IV and the Yale-Brown Obsessive-Compulsive Scale symptom checklist. Forty-six percent (n=23) reported clinically significant OC symptoms. Twenty-six percent (n=13) met criteria for OCD, from which three subgroups emerged: (1) patients whose OCD was unrelated to their psychotic symptoms, (2) patients whose OCD was related to, but not restricted to, their psychotic symptoms, and (3) patients whose OC symptoms existed on a continuum with their psychosis. The last group tended to incorporate their OC symptoms into delusional beliefs during the active phase of illness and shift to OCD during full or partial remissions. Eight percent met all inclusion criteria for OCD, but their OC symptoms were better accounted for by their psychosis.We conclude that these findings support previous clinical constructs that OCD and schizophrenia are not always dichotomous disorders, but may be interconnected.
73 citations
60 citations
TL;DR: The concept of diagnosis, ie, collecting a group of symptoms under the umbrella of a disease or disorder, serves a number of important goals and might have some prognostic value, supports communication between physicians, and could have implications regarding the pathological basis of a disorder.
Abstract: INTRODUCTION The concept of diagnosis, ie, collecting a group of symptoms under the umbrella of a disease or disorder, serves a number of important goals. It assists in treatment, might have some prognostic value, supports communication between physicians, and, finally, it could have implications regarding the pathological basis of a disorder. All four components would not be required to bring about a new diagnostic subtype. Even simply grouping symptoms, thereby promoting communication and probably providing a clearer prognosis, might justify establishing a new diagnostic subtype. Especially if a new therapy, based on the new subtype, was suggested (which could, in some cases, actually alter the prognosis).
51 citations
TL;DR: The parameters of kindling and quenching with intracerebral stimulation of the amygdala in vivo are highly similar to those achieved in vitro in hippocampai slice preparations for inducing long-term potentiation (LTP) and longterm depression (LTD), respectively.
Abstract: Kindling involves repeated administration of brief high-frequency electrophysiological stimulation of the brain at initially subthreshold intensities that eventually evoke full-blown seizures. It has thus been used not only as a model of epileptogenesis, but of long-term neuronal memory. Quenching is a phenomenon that utilizes low-frequency stimulation for much longer periods of time (eg, 1 Hz for 15 minutes), and appears to exert preventive effects on the development of kindling and inhibit the manifestation of full-blown kindled seizures by markedly increasing the amygdala afterdischarge and seizure threshold. (See also “Kindling and Quenching: Conceptual Implications for rTMS,” by Weiss and Post, page 32). The parameters of kindling and quenching with intracerebral stimulation of the amygdala in vivo are highly similar to those achieved in vitro in hippocampai slice preparations for inducing long-term potentiation (LTP) and longterm depression (LTD), respectively. These neuroplastic changes are relatively long lasting and appear reversible at the level of synaptic function with either LTD or LTP capable of countering the effects of the other.
48 citations
TL;DR: Overall, risperidone had a positive effect on Trail Making Part B performance following 4 weeks of treatment, indicating that the evaluation of antipsychotic medications in the treatment of schizophrenia should be expanded to include cognition.
Abstract: In this article, data are presented from Parts A and B of the Trail Making Test, which examined the effects of haloperidol vs risperidone on cognitive function in treatment-resistant scxhizophrenic patients. This report focuses on findings from the Trail Making Test. Overall, risperidone had a positive effect on Trail Making Part B performance following 4 weeks of treatment. These effects were due, at least in part, to the direct effects of risperidone. The possibility that an antipsychotic agent can enhance executive functioning through direct mechanisms, perhaps mediated by frontal cortex neurochemistry, indicates that the evaluation of antipsychotic medications in the treatment of schizophrenia should be expanded to include cognition.
31 citations
TL;DR: Evidence has emerged supporting a role for serotonergic dysfunction in individuals with autism and related disorders, and clinical trials of drugs influencingserotonergic systems have demonstrated promising effects in children, adolescents, and adults with PDDs.
Abstract: While the etiologies of pervasive developmental disorders (PDDs) appear complicated, multifactorial, and relatively poorly understood research over the last 30 to 40 years has implicated certain neurochemicals in the pathophysiology of these diseases. From these studies, a great deal of evidence has emerged supporting a role for serotonergic dysfunction in individuals with autism and related disorders. Recent clinical trials of drugs influencing serotonergic systems have demonstrated promising effects in children, adolescents, and adults with PDDs.
26 citations
TL;DR: The results suggest that novel neuroleptic treatment, perhaps through preferential activation of the prefrontal cortical pathways, improves SZ patients' information processing speed and efficiency.
Abstract: Past research has established that traditional neuroleptic treatment improves attentional functioning in schizophrenic (SZ) patients. The present investigation expands on this finding by examining attentional improvement in nine acute SZ patients treated with either the novel neuroleptic ziprasidone or aripiprazole over a 4-week inpatient period. Twelve SZ in patients receiving typical neuroleptic treatment over the same time period served as controls. The results revealed that while all patients showed marked attentional improvement from medication-free baseline to week 4 of treatment, the SZ patients who received novel antipsychotics showed significant improvement on immediate recall and reaction time measures. These results suggest that novel neuroleptic treatment, perhaps through preferential activation of the prefrontal cortical pathways, improves SZ patients' information processing speed and efficiency.
24 citations
TL;DR: Repetitive transcranial magnetic stimulation (rTMS) is a relatively new technique for activating the cerebral cortex through the scalp and skull as discussed by the authors, which is able to produce a variety of effects, including muscle twitching, changes in motor performance, disruption of cognitive and perceptual processes, and changes in mood.
Abstract: Repetitive transcranial magnetic stimulation (rTMS) is a relatively new technique for activating the cerebral cortex through the scalp and skull. By inducing electrical currents in the brain, rTMS is able to produce a variety of effects, including muscle twitching, changes in motor performance, disruption of cognitive and perceptual processes, and changes in mood. Although the technique is noninvasive and easily tolerated by patients and normal subjects, rTMS can produce epileptic seizures and, potentially, other undesirable effects on brain function. Further studies will be required to fully define the safe ranges of the stimulation parameters.
TL;DR: In this paper, the authors focus on an animal model of epilepsy called kindling and a procedure that they have recently developed to inhibit kindled seizures called quenching, which involves direct intracerebral electrical stimulation of the brain.
Abstract: Unlike the other articles in this series on rTMS, this paper will not include clinical research or magnetic stimulation experiments. Instead, we will focus on an animal model of epilepsy called kindling and a procedure that we have recently developed to inhibit kindled seizures called quenching. Both procedures involve direct intracerebral electrical stimulation of the brain. We demonstrate that low-frequency stimulation, which does not disrupt ongoing behavior, can have profound and long-lasting effects on both seizure development and fully kindled seizures.At this point, we do not know how well these models relate, either mechanistically or phenomenologically, to the effects of repeated transcranial magnetic stimulation (rTMS); however, we believe that at the very least, some of the principles emerging from studying these phenomena may be relevant to our thinking about rTMS and its potential treatment utility. Specifically, we discuss the possible relationship between quenching and rTMS with regards to parameters of induction, possible common mechanisms, and potential treatment implications.
TL;DR: This study presents case studies of eight patients in whom "obsession-like" symptoms played a part in their being classified as treatment refractory, and investigates potentially treatable syndromes that co-occur with schizophrenia.
TL;DR: The arguments supporting the possibility that OC symptoms are either manifestations of comorbid OCD, or are characteristics of a distinct subtype of schizophrenia are discussed.
Abstract: The association between obsessive-compulsive (OC) symptoms and schizophrenia has been discussed in the literature for many decades. Recent studies, which have been more systematic than earlier reports and benefited from more rigorous diagnostic criteria, have generated results that contradict earlier findings. The current consensus is that OC symptoms are seen in a significant number of patients with schizophrenia, and indicate a poor prognosis. These recent studies also suggest that OC symptoms are more than just expressions of persistent schizophrenic psychosis, and that they share characteristics with obsessive-compulsive disorder (OCD). This article discusses the arguments supporting the possibility that OC symptoms are either manifestations of comorbid OCD, or are characteristics of a distinct subtype of schizophrenia.
TL;DR: In the past decade, clozapine, risperidone, and olanzapine were marketed for the first time in the United States, and other new antipsychotic drugs are expected to follow soon.
Abstract: In the past decade, clozapine, risperidone, and olanzapine were marketed for the first time in the United States, and other new antipsychotic drugs are expected to follow soon. Also within the past decade, the efficacy of serotonin-reuptake inhibitors (SRIs) has been demonstrated in patients with obsessive-compulsive disorder (OCD) and the serotonin hypothesis of OCD has been articulated clearly.
TL;DR: While each study used a somewhat different patient population and provided varying and limited information concerning patient sample, study design, and results, some tentative conclusions and treatment recommendations may be drawn from their findings.
Abstract: While obsessive-compulsive (OC) symptoms in schizophrenia have been reported for many years, they have achieved only limited recognition and, perhaps for this reason, few studies their pharmacological treatment have been carried out. One suggested treatment approach is the use of different agents for different symptoms. In this article, we review the small number of published studies and case reports regarding this multi-pharmacological method of treatment for OC symptoms in schizophrenia. While each study used a somewhat different patient population and provided varying and limited information concerning patient sample, study design, and results, some tentative conclusions and treatment recommendations may be drawn from their findings.
TL;DR: Epilepsy in children and adolescents is associated with a higher rate of comorbid psychiatric disorders than other chronic childhood illnesses and their effects on brain development, neurologic and intellectual function, and psychological adaptation for children and their families.
TL;DR: Evidence from functional neuroimaging studies and other studies suggesting regional brain involvement in anxiety disorders, specifically obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) is reviewed.
Abstract: The emergence of repetitive transcranial magnetic stimulation (rTMS) as a relatively noninvasive probe of cortical function provides an opportunity to explore the relationships between regional brain activity and symptomatology across neuropsychiatric illnesses. In this article, we briefly review evidence from functional neuroimaging studies (principally those using positron emission tomography [PET] or single-photon emission computed tomography [SPECT]) and other studies suggesting regional brain involvement in anxiety disorders, specifically obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). We also review an initial controlled study conducted by our group using rTMS as a probe of prefrontal mechanisms in OCD. This discussion is not intended to be comprehensive, but rather to provide examples of disorders that, based on current knowledge, might be good candidates for the use of rTMS as a probe. In addition, we present case reports from pilot studies of rTMS in three patients with different primary anxiety disorder diagnoses, which illustrate some of the issues involved in such studies, as well as the effects observed. The possibility that rTMS may have therapeutic potential in anxiety disorders is also discussed.
TL;DR: Experimental and clinical observations regarding cellular and humoral immune dysfunction, abnormalities associated with the complement system and major histocompatibility complex gene expression, differences in soluble mediators of the immune response, and the presence of antibrain and antimyelin autoantibodies are reviewed.
Abstract: Recent studies of the pathogenesis of autism have suggested that this disorder may have an autoimmune basis in some patients. Observations have been made regarding cellular and humoral immune dysfunction, abnormalities associated with the complement system and major histocompatibility complex gene expression, differences in soluble mediators of the immune response, and the presence of antibrain and antimyelin autoantibodies. In this article, we review these experimental and clinical observations, and examine preliminary efforts using immunomodulatory therapies to treat autism.
TL;DR: Repetitive transcranial magnetic stimulation (rTMS) has the ability to stimulate or temporarily impair brain regions, which makes it a powerful tool for directly testing theories of the neurologic basis of mood regulation.
Abstract: Recent advances in functional neuroimaging (including positron emission tomography, single-photon emission tomography, and fast magnetic resonance imaging) have allowed better understanding of the brain regions involved in regulating normal and pathological moods. Repetitive transcranial magnetic stimulation (rTMS) has the ability to stimulate or temporarily impair brain regions, which makes it a powerful tool for directly testing theories of the neurologic basis of mood regulation.
TL;DR: This article explored the parallel similarities and the reciprocal nature of obsessive-compulsive disorder (OCD) and schizophrenia (SCZ) in such a manner that OCD and SCZ may progress into one another.
Abstract: Research evidence attests to the parallel similarities and the reciprocal nature of obsessive-compulsive disorder (OCD) and schizophrenia (SCZ) in such a manner that OCD and SCZ may progress into one another. We explore this evidence by presenting a theoretical and empirical phenomenological perspective to account for and elucidate the shared psychopathology of thought, perception, and motor impairment between these disorders. The purpose of this paper is to communicate that OCD and SCZ, while preserving their individuality, share related accounts of their phenomenology within a temporal and spatial frame of reference.
TL;DR: Gabapentin demonstrates promise for the treatment of panic and generalized anxiety, while both gabapentin and lamotrigine appear useful as mood stabilizers in the treatmentof bipolar disorder.
Abstract: Clinical experience and systematic inquiry demonstrate that many patients with mood and anxiety disorders remain symptomatic despite standard interventions. These observations have prompted the search for alternative pharmacotherapeutic treatment options. Anticonvulsants, including valproic acid and carbamazepine, have demonstrated benefit for a number of psychiatric conditions. Recently, clinical and research attention has focused on the use of the new anticonvulsants gabapentin and lamotrigine as alternatives to standard pharmacotherapies for the treatment of mood and anxiety disorders. This paper reviews the experience to date with these agents in the treatment of psychiatric conditions. Gabapentin demonstrates promise for the treatment of panic and generalized anxiety, while both gabapentin and lamotrigine appear useful as mood stabilizers in the treatment of bipolar disorder.
TL;DR: An integrated psychobiological model is proposed that presumes a biological etiology without assuming biological reductionism, and that OCD reflects disruption of a behavioral inhibition/harm assessment system that incorporates brain structures from different points across human phylogeny.
Abstract: In the past 10 to 15 years, advances in psychopharmacology and research on the neurobiological basis of obsessive-compulsive disorder (OCD) have led to the currently predominant biological model of OCD. Nevertheless, the centrality of complex ideation in OCD supports the usefulness of a psychological approach.In this article, we propose an integrated psychobiological model that presumes a biological etiology without assuming biological reductionism. We hypothesize that the relationship between biological and psychological organization is best explained in the context of emergent systems theory, and that the psychological meaning of OCD reflects development across phylogeny as opposed to ontogeny. Finally, we propose that OCD reflects disruption of a behavioral inhibition/harm assessment system that incorporates brain structures from different points across human phylogeny. Hence, complex psychological symptoms of a biological etiology are generated.
TL;DR: In this paper, the diagnostic method of functional psychopathology is reviewed, with a focus on how the functional psychopathological approach could contribute to the advancement of the diagnostic process in psychiatry, and the opportunities it provides for biological psychiatric research.
Abstract: Progress in biological psychiatry is contingent upon progress in neurobiology and progress in research of proper characterization and assessment of abnormal behavior. Advances in neurobiology are rapid and steady; however, advances are few and far between in psychopathology. In many ways, developments over the past two decades run counter to what I believe to be diagnostic pre-requisites for fruitful biological research in psychiatry. I presume this to be a major reason why thus far biology has made no significant contributions to the diagnoses of mental disorders.For progress to occur in biological psychiatry, the traditional diagnostic philosophies and attitudes must be reevaluated and alternative diagnostic approaches put into practice. This and the diagnostic method of functional psychopathology are reviewed in this article, with a focus on how the functional psychopathological approach could contribute to the advancement of the diagnostic process in psychiatry, and the opportunities it provides for biological psychiatric research.
TL;DR: A study conducted by Coleman et al. as discussed by the authors indicates that fluorescent lights can increase repetitive behavior in children with autism. But, as an individual with autism, I have learned that some therapists and physicians are unaware of autistics' overly acute senses.
Abstract: As an individual with autism, I have learned that, unfortunately, some therapists and physicians are unaware of autistics' overly acute senses, specifically hyperacute hearing. For example, the birthday party fun of noise-makers for a normal child was torture for me. There are many first-person reports of people with autism who, like me, find certain loud sounds intolerable. Some children and adults with autism also have visual sensitivity problems. I enjoyed visually stimulating things such as flags or automatic supermarket doors, but individuals with severe visual sensitivities cannot tolerate even fluorescent lights. In her book, Somebody Somewhere , autistic Donna Williams describes how the flicker from fluorescent lights causes her visual overload. A study conducted by Coleman et al indicates that fluorescent lights can increase repetitive behavior in children with autism. Autistic sensory problems are highly variable. When I was a child, I liked to play with running water; however, another child with autism may not be able to tolerate the same sound. I was attracted to automatic supermarket doors and I liked to watch them move. Another autistic child or adult may scream and run away from these same automatic doors because sudden movement hurts his or her eyes. Maybe a small anomaly in my visual processing caused me to be attracted to the movement of the doors. A greater anomaly may cause another individual to avoid the same stimulus. Waterhouse et al found it puzzling that I was attracted to strong visual stimuli, yet high-pitched auditory stimuli hurt my ears.
TL;DR: Findings are statistical in nature and involve structures of complex three-dimensional shapes and new technology for studying the function of these structures may be useful in exploring the relation of each structure to symptoms of specific disorders.