Showing papers in "Innovations in clinical neuroscience in 2019"

ADULT NEUROGENESIS IN HUMANS: A Review of Basic Concepts, History, Current Research, and Clinical Implications.

Abstract: Neurogenesis in adult humans remains a controversial area of research among neuroscientists. Methodological challenges have hampered investigators from conducting high-quality, in-vivo studies that can help elucidate the presence and/or activity of neurogenesis in human brains. Additionally, the studies that have been done in humans report conflicting results, further adding to the ambiguity surrounding the concept of adult neurogenesis in humans. In this review article, the authors seek to help clarify the concept of adult neurogenesis by providing an overview of the basic concept, as we currently understand it, including its historical birth and evolution. The authors also review and discuss current key studies (pro and con) on adult neurogenesis in humans and animals, as well as research challenges with potential solutions. Finally, the authors discuss the clinical implications of adult neurogenesis in humans, based on what we know so far, including its potential use as a drug target in the development of pharmacological treatments for various neuropsychiatric disorders.

The Effect of Early Life Stress on Adult Psychiatric Disorders.

Abstract: There is a crisis of early childhood maltreatment in the United States. In 2012, the United States Department of Health and Human Services noted 3.4 million referrals to childhood protective services, of which the majority related to child abuse or neglect. Early life stress (ELS) due to childhood abuse and/or neglect can generate life-long consequences. ELS has been associated with disrupted neurodevelopment that can yield social, emotional, and cognitive impairment; adult medical and psychiatric disorders; disability; and even earlier death. Some studies have shown that adults with major depression and ELS respond less well to conventional treatments than adults who did not experience early life stress. In this article, we review some of the neurobiological and epigenetic studies that explore this association.

Synthetic Cannabinoids-"Spice" Can Induce a Psychosis: A Brief Review.

Abstract: Synthetic cannabinoids, popularly called Spice, are common drugs of abuse in the United States. They are utilized as a substitute for marijuana, primarily for their psychoactive properties. Consumption has been rapidly increasing due to recreational effects, easy accessibility, and not being detectable by urine drug screening tests. The side effect profile of synthetic cannabinoids involves many organs and is not well known to the public. Psychoses are a common adverse result from their consumption. Primary care physicians and other medical professionals should consider synthetic cannabinoid consumption in the differential diagnoses of a patient presenting with psychosis.

Psychiatric Comorbidities in Adult Attention-deficit/Hyperactivity Disorder: Prevalence and Patterns in the Routine Clinical Setting.

Abstract: Objective: While attention-deficit/hyperactivity disorder (ADHD) is associated with a high prevalence of comorbid psychiatric disorders in every age group, the etiology and epidemiology of comorbid disorders are less clear in adult patients with ADHD. In this surveillance study, investigators sought to assess the prevalence of comorbid psychiatric disorders, evaluate relationships between comorbid psychiatric disorders and demographic characteristics, and explore the patterns of these comorbid disorders and their relationships with ADHD subtypes. Methods: Data obtained from postmarketing surveillance of methylphenidate extended-release tablets for adult ADHD were used to evaluate the prevalence of psychiatric comorbidities. Age, sex, age at diagnosis, number of comorbidities, and severity of ADHD symptoms were used as external variables for exploratory analyses. Nonmetric multidimensional scaling (NMDS) was performed to explore correlations among comorbidities and ADHD subtypes and extract major dimensions underlying variations in the pattern of comorbid disorders. Results: Data were collected from 575 patients with adult ADHD, including 301 (52.35%) with at least one concurrent psychiatric disorder. Analysis by NMDS demonstrated that different patterns of psychiatric comorbidities were related to the subtypes of ADHD. Conclusions: Psychiatric comorbidities have a high prevalence in patients with adult ADHD. Understanding these patterns could provide useful information in the diagnosis of adult ADHD and future investigations of its etiology.

Postpartum Depression in Men.

Abstract: Postpartum depression (PPD) is often defined as an episode of major depressive disorder (MDD) occurring soon after the birth of a child. It is frequently reported in mothers but can also occur in fathers. There are no established criteria for PPD in men, although it could present over the course of a year, with symptoms of irritability restricted emotions, and depression. Risk factors include a history of depression in either parent, poverty, and hormonal changes. It might be associated with anxiety disorders and can adversely affect the father, family unit, and developing child. Treatment includes psychotherapy and pharmacotherapy. Clinicians are encouraged to screen for depression in men during the first year postpartum and to offer treatment or treatment referral if depression is present.

Treatment of Functional Gait Abnormality in a Rehabilitation Setting: Emphasizing the Physical Interventions for Treating the Whole Child.

Abstract: Objective: Conversion disorder has a significant impact on families and the healthcare system. A recent review suggests there is little uniformity in treating this population. This paper describes an inpatient treatment program emphasizing physical conditioning and less time uncovering the psychological underpinnings of the presentation. Design: This study included 100 pediatric patients admitted to an inpatient rehabilitation setting with lower extremity weakness/dysfunction not explained by a medical cause. Patients followed a 16-step goal hierarchy to increase physical function. Patients participated in three hours of therapy and met with a psychologist and teacher daily. Patient functioning was assessed at three time periods using the mobility items of the Functional Independence Measure for Children (WeeFIM). Results: Ninety-four patients completed the program. The average length of stay was 10 days. There were no significant differences between gender, length of stay, or insurance. Data was collected from 73 participants at a two-month follow-up. A repeated measures analysis of variance (ANOVA), using time points at admission, discharge, and follow-up, revealed significant improvements over time. Post-hoc contrasts showed differences with admission and discharge but no differences between discharge and follow-up, suggesting gains in mobility remained. Conclusion: This paper describes an inpatient program that effectively treats patients with conversion disorder in a relatively short period. The physical gains made during hospitalization persisted over time and suggest inpatient rehabilitation focusing on physical mobility could be a more financially beneficial approach than outpatient treatment. Future considerations include identifying a more robust assessment process for patients to determine other psychological characteristics that might impact successful, more short-term treatment.

Therapeutic Potential of Ponesimod Alone and in Combination with Dimethyl Fumarate in Experimental Models of Multiple Sclerosis.

Abstract: Background: Despite the recent approval of new oral therapies for the treatment of multiple sclerosis (MS), a significant percentage of patients are still not free from disease activity. In view of the complex pathogenesis and the relapsing and progressive nature of MS, combination therapy, a classical approach to treat many chronic diseases, could improve disease control over monotherapy. Ponesimod, a selective and rapidly reversible sphingosine-1-phosphate receptor Type 1 (S1P1) modulator, currently in Phase III clinical trial stage in relapsing MS (RMS), and dimethyl fumarate (DMF) would potentially be an ideal combination due to their differing mechanisms of action and oral administration. Objective: The goal of the study was to evaluate the therapeutic effect of ponesimod monotherapy and investigate the potential additive, or synergistic, activity of ponesimod-DMF combination therapy in experimental autoimmune encephalomyelitis (EAE) animal models of MS. Methods: Efficacy was evaluated in the myelin oligodendrocyte glycoprotein (MOG)-induced EAE model in C57BL/6 mice (ponesimod monotherapy) and in the myelin basic protein (MBP)-induced EAE model in Lewis rats (monotherapies and combination therapy). The principal readout was the clinical score assessing paralysis. Additional readouts, such as histopathology, survival, and disease prevalence, were generated in parallel when applicable. Results: Ponesimod monotherapy in the mouse EAE model showed significant efficacy in both preventative and therapeutic settings. In the rat EAE model, ponesimod demonstrated significant dose-dependent efficacy on clinical scores, while DMF showed only modest activity. Combination therapy synergistically reduced the severity and prevalence of disease. Only the combination treatment of ponesimod and DMF fully suppressed clinical disease activity by the end of the study. Conclusion: The results support the potential therapeutic benefits of combining ponesimod with DMF to improve disease activity control in patients with MS. Additionally, the results suggest that combining ponesimod with other oral agents that have different mechanisms of action might also be therapeutically beneficial to patients with MS.

Is High Placebo Response Really a Problem in Depression Trials? A Critical Re-analysis of Depression Studies.

Abstract: Objective: We investigated the accuracy of the often-stated assumption that placebo nonadditivity and an increasing placebo response are major problems in clinical trials and the cause of a trend for smaller treatment effects observed in clinical trials for major depressive disorder (MDD) in recent years. Method of research: We reviewed data from 122 MDD trials conducted between the years 1983 and 2010 (analyzed originally by Undurraga and Baldessarini in 2012) to determine whether the data support the assumption of placebo additivity. Statistical techniques, such as conventional least squares regression, orthogonal least squares regression and locally weighted loess smoothing, were applied to the data set. Results: Re-analysis of the data set showed the active and placebo responses to be highly correlated, to the degree that would be expected assuming placebo additivity, when random variability in both active and placebo response is considered. Despite the placebo responses in MDD trials increasing up to approximately the year 1998, we found no evidence that it has continued to increase since this date, or that it has been the cause of smaller reported treatment effects in recent years. Conclusion: Attempts to reduce the placebo response are unlikely to increase the treatment effect since they are likely to reduce drug nonspecific effects in the treatment arm by a similar amount. Thus, it should come as no surprise that trial designs set up with the sole purpose of reducing placebo response fail to discernibly benefit our ability to identify new effective treatments.

Marijuana for Parkinson's Disease?

Abstract: Children who are inadequately treated for depression often experience greater dysfunction. Problems can include conduct disorders, substance abuse, physical illness, and poor performance at school, work, or in psychosocial contexts. Depression can lead to a greater risk of suicide. Suicide is the third most common cause of death among adolescents, with more than 500,000 attempts made by children each year. Suicide is the third most frequent cause of death among young people ages 10 to 19 years old. Thus, proper treatment is important. Major depressive disorder in adolescents is often followed by frequent recurrences in adulthood. Imaging studies document underactivity in the left dorsolateral prefrontal cortex in subjects suffering from depression. Activation of the brain with high-frequency transcranial magnetic stimulation increases neuronal excitability and induces the growth of new connections. Though larger, randomized, controlled trials with more patients and longer follow-up are needed, the favorable side effect profile and efficacy of TMS seen so far in the literature support the use of TMS as a therapeutic intervention in children and adolescents with depression.

Virtual Reality Neurorehabilitation for Mobility in Spinal Cord Injury: A Structured Review.

Abstract: Objective: The goal of this review was to evaluate the evidence regarding the use of virtual reality (VR) therapy for improvement of mobility in patients with spinal cord injury (SCI). Methods: A comprehensive literature search was conducted utilizing PubMed, CINAHL, EMBASE, and PsycINFO databases in April 2018. The phrase "virtual reality" and a combination of "spinal cord injury," "tetraplegia," "quadriplegia," or "paraplegia" were used as search terms. References included selected articles were reviewed as well. Articles were filtered based on the following inclusion criteria: 1) written in English, 2) peer-reviewed, 3) VR used for patients with SCI, and 4) changes in motor function evaluated. Main outcome measurements: Common outcomes of mobility assessment used in the studies included the Functional Reach Test (FRT), Functional Independence Measure (FIM), Limit of Stability (LOS), Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Walking Index for Spinal Cord Injury II (WISCI II) scale. Results: Seven of the nine reviewed articles were case series, while two were randomized, controlled trials. Reviewed literature demonstrated significant benefit in FRT, BBS, gait speed, muscle strength, SCIM, and WISCI-II using VR therapy. Voluntary muscle control improvement was also observed. However, no significant differences were found with regard to finehand motor movement. Conclusion: This literature review demonstrated mostly positive outcomes for the use of VR for SCI rehabilitation but were limited in quality and scope. Larger, multicenter trials are still needed.

Use of Brexanolone for Postpartum Depression.

Abstract: Postpartum depression (PPD) in women is common and adversely affects the mother, infant, and family unit. Treatments include psychotherapy and pharmacotherapy, but not all women experience response or remission, and response might be delayed. A precipitous decrease in allopregnanolone levels and failure of GABAA receptors to adapt to this change might contribute to PPD. Administered intravenously, brexanolone (BRX) is a solution of allopregnanolone that modulates the GABAA receptor and restores third-trimester levels, thus allowing for receptor adaptation and symptom improvement. In clinical studies, patients receiving BRX experienced a rapid reduction or remission of depression. Due to the risk for sedation or syncope, it is only available through a national registry, and administration and monitoring must occur in a supervised medical setting. Further studies are needed to explore its long-term efficacy.

Olanzapine Plus Samidorphan in Subjects with Schizophrenia and Comorbid Alcohol Use Disorder: Rationale and Design for a Phase II, Double-blind, Randomized Study.

Abstract: Background: Alcohol use disorder (AUD) is a common comorbidity in patients with schizophrenia. Although pharmacological options for the management of each disease exist separately, there is no agent approved for both. Moreover, studies conducted in this patient population, who face practical and social challenges as a consequence of being diagnosed with schizophrenia and comorbid AUD, are limited. Methods: We describe the design of a Phase II, double-blind, randomized trial to evaluate adult outpatients with schizophrenia and comorbid AUD receiving a combination of olanzapine plus samidorphan (OLZ+SAM; ALKS 3831), a novel entity currently under development for the treatment of schizophrenia. The combination drug formulation of OLZ+SAM is intended to provide the antipsychotic efficacy of OLZ while mitigating the weight gain and concomitant metabolic abnormalities commonly associated with OLZ alone. In considering this patient population, the novel primary efficacy endpoint is the time from randomization to the first event of exacerbation of disease symptoms (EEDS) based on the occurrence of any of eight prespecified events related to worsening of disease symptoms and/or AUD, as confirmed by a blinded independent adjudication committee. The rate and number of EEDS, improvement in drinking level, and the safety and tolerability of OLZ in combination with SAM will also be assessed. Discussion: A limited number of studies have been conducted in patients with schizophrenia and AUD, and the need for further research in this difficult-to-study population is well documented. This study is, to our knowledge, the largest and longest trial with a randomized, double-blind, active-controlled design. In addition to providing evidence for the development of OLZ+SAM (ALKS 3831) as a therapeutic option, the study aims to provide insights into the clinical management of subjects with schizophrenia and comorbid AUD. Trial registration: Clinical trials NCT02161718, registered May 2014; EudraCT Number: 2014-001211-39.

Increased Levels of Protein-methionine Sulfoxide in Plasma Correlate with a Shift from a Mild Cognitive Impairment to an Alzheimer's Disease Stage.

Abstract: Objective: Sporadic Alzheimer's disease (AD) is an oxidative, stress-dependent neurodegenerative disease. We investigated whether the levels of protein-methionine sulfoxide (MetO) in plasma could be a possible marker for AD in individuals with mild cognitive impariment (MCI). Design: We evaluated blood samples from patients with AD or MCI, as well as from normal controls, testing their MetO levels and superoxide dismutase (SOD) specific activity. Results: An increase of MetO levels of a particular protein of human plasma and a decrease of SOD activity were observed only in AD plasma. Conclusion: Monitoring the patterns of these plasma markers in patients with MCI could provide a warning sign for disease progression into AD.

Severe Lamotrigine-induced Hyponatremia Associated with Takotsubo Cardiomyopathy.

Abstract: Psychotropic-induced hyponatremia is one of the most common electrolyte abnormalities observed in routine psychiatric practice. However, many features of hyponatremia mimic those seen in depression, which can lead to the condition being overlooked. Takotsubo cardiomyopathy, or apical ballooning syndrome (ABS), is a reversible cardiomyopathy that mimics acute myocardial infarction. Limited evidence has indicated that hyponatremia might have a role in the development of ABS. We present a case of female patient with bipolar disorder who developed acute hyponatremia and ABS while taking lamotrigine. After cessation of lamotrigine, a time-sequential improvement of hyponatremia and ABS was observed via repeated electrocardiogram, suggesting a relationship between hyponatremia and ABS. Due to the association between severe hyponatremia and Takotsubo cardiomyopathy, this case highlights the importance of carefully monitoring serum sodium levels and ECG changes in patients on psychotropic medications during their entire course of treatment to prevent serious or fatal complications.

The Pathophysiology of Marijuana-induced Encephalopathy and Possible Epilepsy after Ingestion in Children: A Case Series.

Abstract: Background: Ingestion of marijuana in children presents primarily with encephalopathy and potentially, in severe cases, seizures. There is a growing body of evidence supporting the benefit of medical marijuana as an anticonvulsant treatment for intractable seizures. However, there are limited data regarding its proconvulsant effects after ingestion. In this case series, we review the pathophysiology of marijuana encephalopathy and potential seizures after ingestion of marijuana in infants and young children. Case presentation: We summarized the cases of six children who were admitted to the hospital with neurological symptoms and a positive urine test for tetrahydrocannabinol (THC) between 2016 and 2018. The primary symptom was excessive drowsiness, with two children progressing to an unarousable state. Two cases presented after ingesting a marijuana confectionery, and the caregivers in four cases were unaware that marijuana exposure was responsible for the clinical presentation. All cases resolved without sequelae and were investigated by social services. In one case, a 6-year-old child with developmental delay and a previous episode of seizures presented with recurrent seizures and evidence of marijuana exposure. Marijuana was considered a probable cause due its proconvulsant effects, but a subsequent seizure episode with a negative urine THC ruled this out. Conclusion: Physicians should consider the possibility of ingestion of marijuana in infants and young children who present with symptoms of unexplained drowsiness. Marijuana products have the potential to provoke seizures and affect the developing brain of a child. Self-medication with marijuana products should be dissuaded, particularly in households with young children.

The Very Important Patient.

Abstract: Background: The incidence rates of heart failure (HF) and chronic pain increase with age. In the geriatric population, both disorders often coexist and pose a challenge to clinicians in treating them simultaneously. Methods: We conducted an online literature search for reports of the heart failure effects of pharmacological treatments for chronic pain. Results: Topical pain medications are favored agents because of their efficacy, tolerability, and favorable side-effect profile. Acetaminophen is a preferred oral medication for the treatment of pain in patients with HF. Due to deleterious effects including HF, the long-term use of oral nonsteroidal anti-inflammatory drugs and gabapentinoids are discouraged. Conclusion: Prescribers should thoroughly consider the risk-benefit ratio and individual patient-risk profile before instituting pharmacological treatment for chronic pain in patients with HF.

Panic Attacks in HYPERALDOSTERONISM.

Abstract: Objective: This paper sought to review the impact of depression in patients with comorbid medical problems, the importance of bridging the gap between inpatient and outpatient care for medical inpatients with depression (especially for organizations that treat patients in both settings), and the elements necessary to implement a pilot for an outpatient Collaborative Care Management program for patients with depression following medical admissions. Taken into account is the presence of new billing mechanisms and potential cost offsets. Methods: The literature referenced in this paper was identified through a search of online databases, including PubMed and Google Scholar. The data used to analyze cost were drawn from national, publicly available sources, such as the Kaiser Family Foundation, Bureau of Labor Statistics, and the Organisation for Economic Cooperation and Development. Results: Collaborative care is an evidence-based intervention for depression that can aid with successful transition of care as patients move from the inpatient to the outpatient setting. It can be considered cost-effective when treating a panel of patients that falls below the recommended caseload for a single case manager (i.e., 19-46 billed encounters, depending on the payer mix), particularly when considering the savings from a reduced length of stay associated with well-controlled depressive symptoms. Conclusion: Organizations should consider implementing collaborative care management for patients with depression to improve depression outcomes, reduce costs, and prepare themselves for a health financing environment that rewards value.

A Look at Genetic Linkage between Clozapine-induced Agranulocytosis, Malignant Hyperthermia, Neuroleptic Malignant Syndrome, and Statin-induced Myopathy.

Abstract: Clozapine-induced agranulocytosis, malignant hyperthermia (MH), statin-induced myopathy, and neuroleptic malignant syndrome (NMS) are all serious drug reactions with significant overlap in terms of clinical symptomatology. The use of clozapine can lead to neutropenia, as well as the development of NMS; thus, it seemed logical to explore a possible common genetic background for the development of these two adverse effects. Furthermore, due to the overwhelming clinical resemblance between NMS, MH, and statin-induced myopathy, we decided specifically to search for a common genetic background in the development of these conditions. Methods: We searched the PubMed, OMIM, WikiGenes, Medline, and Google Scholar databases to identify articles pertinent to our subject published over the last 30 years. Articles were reviewed according to our inclusion/exclusion criteria, and irrelevant articles were excluded. Results and Conclusions: In our exploration for a common genetic background between clozapine-induced agranulocytosis, MH, NMS, and statin-induced myopathy, we identified the SLCO1B1 gene, which was common to three of these four conditions (MH, statin-induced myopathy, and clozapine-induced agranulocytosis). Although we did not find a gene common among NMS and the other conditions, the overlap of clinical symptoms between NMS, MH, and statin-induced myopathy did not allow us to rule out the possibility of a common factor, in terms of genetic predisposition, between these conditions. Future studies can aid to fill in the gaps of knowledge in terms of any genetic linkage between these three conditions and the mechanism of their associations.

High-dose Clozapine Withdrawal: A Case Report and Timeline of a Single Potential Withdrawal Seizure.

Abstract: Clozapine, a second-generation antipsychotic (SGA), is known for its superior efficacy in the treatment of refractory schizophrenia. Clozapine's hallmark side effects are well-known, including, but not limited to, drug-induced seizures associated with daily goal doses greater than 600mg and rapid dose escalation, which can also contribute to significant risk of orthostatic hypotension, bradycardia, and syncope. However, less well-known is the potential withdrawal that can occur from its rapid discontinuation. Here, we describe a case of seizure-like activity that occurred 72 hours after an abrupt high-dose clozapine discontinuation in a patient with schizoaffective disorder, bipolar type. Seizures, although known to be a high-serum-concentration-dependent side effect of clozapine, could not be excluded as a possible withdrawal syndrome in this patient.

Brain Imaging in New Onset Psychiatric Presentations.

Abstract: We report two cases of patients who presented with psychiatric symptoms and were found to have brain changes on magnetic resonance imaging. In the first case, a 19-year-old man presented with erratic behavior and odd, paranoid ideas. Imaging of the brain revealed a focus of high FLAIR signal involving the left globus pallidus. The second case was a 21-year-old woman who presented with irritability, racing thoughts, and suicidal ideation. Brain imaging revealed nodules of heterotopic grey matter in the right inferior frontal white matter and foci of subcortical heterotopia with thickening of the adjacent cortex. Both patients received psychotropic medications and showed improvement of their symptoms. Integrating neuroimaging in the evaluation of new onset or atypical psychiatric presentations might be of value in specific cases. It is important to develop clear guidelines for the use of imaging modalities in clinical psychiatric practice.

The Effect of Acutely Administered Propofol on Forced Swim Test Outcomes in Mice

Abstract: Objective: Propofol (2,6-diisopropylphenol) is a gamma-aminobutyric acid type A agonist intravenous anesthetic agent used in outpatient settings. Based on anecdotal reports of improved mood in humans following propofol-induced anesthesia, the impact of acute propofol treatment alone or in combination with subchronic fluoxetine dosing was tested on forced swim test (FST) performance. Design: Seventy-two adult male mice (C57/BL6, CRL-provided) were pretreated daily with saline or fluoxetine (20 mg/kg, intraperitoneally) (21 days for cohort 1; 24 days for cohort 2). At 24 hours after the last pretreatment injection, the mice received saline or propofol (35 or 50 mg/kg, intraperitoneally). Then, 45 minutes later, the mice underwent a five-minute FST. Immobility time was quantified and evaluated with a custom video-analysis software program. Results: A one-way analysis of variance indicated statistically significant effects of propofol on immobility time in cohorts 1 and 2. A comparison performed using Dunnett's method revealed that propofol 50 mg/kg (p < 0.05) but not 35 mg/kg (p = not significant) reduced immobility time as compared with in the saline-saline control group (difference between means of 38.42 and 16.46 seconds, respectively). Conclusion: In comparison with saline, propofol significantly decreased immobility time during the FST, which models depression and resilience to stress. Our preclinical results are consistent with a small open-label study of propofol used in treatment-resistant depression recently reported by Mickey BJ, White AT, Arp AM, et al (2018). Further investigation of propofol regarding its potential antidepressant effects seems warranted.

Psychopharmacology in Pediatric Mixed Anxiety Disorder: An Evidence-based Review.

Abstract: Anxiety disorders are the most prevalent psychiatric disorders among youth, with prevalence rates ranging from 25 to 32 percent. These disorders are under-recognized and often undertreated in this population. Anxiety disorders in youth exhibit a chronic and persistent course of symptoms with a higher risk of comorbidities, functional impairment, and worsening of severity. The early recognition and treatment of anxiety disorders in children and adolescents are vital for better long-term outcomes. This article summarizes the evidence-based pharmacologic treatments for mixed anxiety disorders including generalized anxiety disorder, social anxiety disorder, and separation anxiety disorder in children and adolescents based on case reports, case series, open-label trials, and randomized, controlled trials.

Russian Stimulation/Functional Electrical Stimulation in the Treatment of Foot Drop Resulting from Lumbar Radiculopathy: A Case Series.

Abstract: Several studies have debated the rehabilitation merits of functional electrical stimulation (FES) for the treatment of spinal radiculopathies. Many of the related studies have been performed on elite athletes. We utilized the Russian stimulation in three cases to improve outcomes in foot drop secondary to lumbar radiculopathy. These stimulations had positive results, giving patients an increase in strength in the lower limbs after each session. These outcomes suggest that Russian stimulation has potential as an affordable option in the rehabilitation of foot drop from lumbar radiculopathy when used with exercise-based physical therapy.

Addiction Disorder Considerations for Patients Seeking Psychotherapy

Abstract: Substance use disorders are widespread and cause significant dysfunction. Substance use disorders often co-occur with other psychiatric disorders. Because of this overlap, clinicians commonly encounter patients at risk for substance abuse disorders. This article reviews strategies to aid the practicing clinician in the screening, assessment, intervention, and referral of their parents at risk for substance use disorders.

A CASE OF PERIPARTUM OBSESSIVE-COMPULSIVE DISORDER: The Potential Role of Corticosteroids, Gonadal Steroids, and the Neuropeptide Oxytocin in its Pathogenesis.

Abstract: The perinatal period represents a time of increased vulnerability to psychiatric disorders, including the largely understudied obsessive-compulsive disorder (OCD). In contrast to the gradual onset of typical OCD, postpartum OCD appears to be characterized by the rapid onset of obsessional symptoms after the birth, with onset as early as the second postpartum day with a mean time to onset of 2.2 to 3.7 weeks. We present a case of a patient with prepartum generalized anxiety disorder (GAD) and new-onset postpartum OCD. The patient's ego-dystonic obsessions were aggressive in nature ("harm to newborn") with pathological checking compulsions requiring reassurance that she would not engage in this activity. Neurobiologically, there has been speculation that changes in estrogen and progesterone in the puerperium might alter serotoninergic function, placing some women at risk for this subtype of OCD. Some research studies have found evidence to suggest that oxytocin is associated with OCD. We review the growing evidence that suggests oxytocin and gonadal steroids might play a role in the pathogenesis of some forms of OCD.

Dismantling Fears Associated with Intellectual Disability Psychotherapy: An Evidence-based Practice.

Abstract: Individuals with intellectual disability (ID) and traumatic brain injury experience mental health issues at a higher rate than the general population. They are typically more vulnerable to stress, have fewer coping skills, and possess a smaller system of natural supports. It is clear that level of intelligence is not the sole indicator of the appropriateness of psychotherapy and that the full range of mental health services are able to help improve the quality of life for patients with intellectual disability. Special issues related to motivational interviewing, cognitive behavioral therapy (CBT), and supportive psychotherapy are described with specific attention to special issues for the intellectual disability population and effective adaptations addressed.

Correlation Between the Movement Disorder Society's Unified Parkinson's Disease Rating Scale and Nonmotor Scales in Patients with Parkinson's Disease.

Abstract: Objective: Our study evaluates the potential psychiatric impact of the full phase of the moon on patients in a state psychiatric hospital in Buffalo, New York, between September 2013 and July 2018. Methods: This relationship is presented as the average number of restraints or seclusions (R&S) and code green psychiatric emergencies (CG) recorded 14 days before and 14 days after a full moon. Since the timeframe of the analysis included the August 21, 2017, solar eclipse, we also highlight the correlation between a partial solar eclipse and the number of CG events. We also compared full moon phase effects in 2017 to other years to benchmark whether the solar eclipse appeared to influence behavioral effects from baseline. Results: While there was a slight decrease in mean R&S on days where there was a full moon or in the month of a partial solar eclipse, the results were not considered to be significant or associated with human behavior. Conclusion: There was no real association between lunar and solar behavior and the actions of patients with psychiatric disorders.

HIPAA COMPLIANCE: A Common Sense Approach.

Abstract: Play therapy is a valuable tool in psychotherapy with children that has been shown to be effective in the treatment of mental illness and behavioral problems. In play therapy, the therapist follows the child's lead through play, and the child expresses thoughts and feelings that might be difficult to communicate otherwise. The therapist creates a space to allow children to practice play and pretend, thus allowing the therapeutic alliance to develop. The eight tenets of play therapy are discussed, and an illustrative case vignette that demonstrates the common ego defenses and developmental hurdles that can be addressed in play therapy is presented.

Use of Noninvasive Ventilation with Volume-assured Pressure Support for Treatment-refractory Myasthenia Gravis

Abstract: Background: Stepwise approach to therapy and increasing use of immunosuppressive agents have led to increasingly good prognosis and survival in myasthenia gravis (MG). However, there is a small subset of patients with treatment-refractory disease who experience a higher disease burden and increased rates of myasthenic crises and exacerbations, including respiratory failure. A 54-year-old man with treatment-refractory MG on chronic plasma exchange therapy had rapidly fluctuating weakness, poor sleep quality, and worsening respiratory symptoms in between treatments. He was started on home nocturnal noninvasive ventilation with volume-assured pressure support mode and experienced marked improvement in sleep quality, dyspnea, fatigue, and daytime sleepiness.