Showing papers in "Journal of Neuropsychiatry and Clinical Neurosciences in 1992"
3,404 citations
TL;DR: Results suggest that apathy is a frequent finding in PD, is significantly associated with specific cognitive impairments, and may have a different mechanism than depression.
Abstract: The authors examined a consecutive series of 50 patients for the presence of apathy, depression, anxiety, and neuropsychological deficits using a neuropsychological battery that included a recently designed apathy scale. This scale was found to be reliable and valid in the diagnosis of apathy in patients with PD. Of patients in the study, 12% showed apathy as their primary psychiatric problem, and 30% were both apathetic and depressed. Patients with apathy (with or without depression), showed significantly more deficits in both tasks of verbal memory and time-dependent tasks. Results suggest that apathy is a frequent finding in PD, is significantly associated with specific cognitive impairments, and may have a different mechanism than depression.
1,004 citations
TL;DR: A group of software programs are described designed to provide a comprehensive solution for fundamental problems in the analysis of functional and structural imaging data, including data transport, boundary identification, and tissue segmentation.
Abstract: Fundamental problems in the analysis of functional and structural imaging data include data transport, boundary identification (including manual tracing, edge detection, and tissue segmentation), volume estimation, three-dimensional reconstruction and display, surface and volume rendering, shape analysis, and image overlay. These problems require that research investigators have access to suitable methods of image analysis, implemented on a set of software programs, in order to conduct neuroimaging research. The authors describe a group of software programs designed to provide a comprehensive solution for these problems.
264 citations
TL;DR: It is suggested that clinically significant levels of depression and anxiety may frequently coexist in Parkinson's disease and the specific neuropathology of PD may predispose to this pattern of behavioral disturbance.
Abstract: Significant anxiety in combination with depression may represent a specific depressive subtype in Parkinson's disease (PD). To ascertain the prevalence of this symptom complex, we administered a self-report survey and standardized psychological tests that measure anxiety and depression to 164 PD patients and 150 age-matched healthy spouse control subjects. The reporting of depression in combination with panic/anxiety best differentiated the two populations (38% vs. 8%). Depression and anxiety were highly correlated in relationship to clinical features of PD. Our findings suggest that clinically significant levels of depression and anxiety may frequently coexist in PD. The specific neuropathology of PD may predispose to this pattern of behavioral disturbance.
135 citations
TL;DR: In this paper, simple and choice reactions times (RT) were slow at initial evaluation and became progressively slower at 6-month re-evaluation (P less than 0.05).
Abstract: Neuropsychological functioning and cerebrospinal fluid concentrations of an endogenous neurotoxin, quinolinic acid (QUIN) were evaluated in 52 HIV-positive individuals (71% without constitutional symptoms) and 33 HIV-seronegative controls (including 15 psychiatric patients with adjustment disorders). Although the HIV-positive subjects did not differ from controls on standard neuropsychological tests, simple and choice reactions times (RT) were slow at initial evaluation (P less than 0.01) and became progressively slower at 6-month re-evaluation (P less than 0.05). Cerebrospinal fluid (CSF) QUIN was elevated at initial evaluation and increased during the 6-month interval (P less than 0.05). Moreover, during this 6-month interval, progressive slowing of RT was highly correlated with increasing levels of CSF QUIN (r = 0.85, df = 15, P less than 0.0001) but not with changes in mood, constitutional symptoms, or CD4 cell count. These findings suggest that RT may provide a sensitive behavioral measure of relatively early central nervous system involvement in HIV-infected individuals and that QUIN may play an important role in the pathogenesis of HIV-related neurological dysfunction.
98 citations
TL;DR: It is indicated that ECT is a generally well tolerated and effective treatment for depressed, medically ill post-stroke geriatric patients.
Abstract: Medical records were retrospectively reviewed for 20 medically ill geriatric patients who received electroconvulsive therapy (ECT) for post-stroke depression from January 1982 to January 1991 at Massachusetts General Hospital. Of the 19 patients (95%) who improved with ECT, 7 patients (37%) suffered relapses despite maintenance anti-depressant medications. Relapses typically developed approximately 4 months after ECT. Five patients (23%) developed ECT-related medical complications. Three patients (15%) developed transient interictal confusion or amnesia. No patient experienced an exacerbation of preexisting neurologic deficits. These findings indicate that ECT is a generally well tolerated and effective treatment for depressed, medically ill post-stroke geriatric patients.
90 citations
TL;DR: Results suggest that the basal ganglia, thalamus, and temporal lobes are differentially affected in HIV, with a significant relationship for the AIDS group between temporal lobe metabolism and severity of dementia on the AIDS Dementia Complex Rating Scale.
Abstract: Positron-emission tomography was coupled with neurological and neuropsychological evaluation to study regional cerebral activity and neurologic status in two groups. Seventeen patients with full-blown AIDS and 14 seronegative control subjects were studied using [18F]2-fluoro-2-deoxy-D-glucose in a resting state. The AIDS group had relative regional hypermetabolism in the basal ganglia and thalamus; stepwise multiple-regression analyses revealed a significant relationship for the AIDS group between temporal lobe metabolism and severity of dementia on the AIDS Dementia Complex Rating Scale. These results suggest that the basal ganglia, thalamus, and temporal lobes are differentially affected in AIDS.
85 citations
TL;DR: High-functioning adults with a history of childhood autism and normal control subjects underwent [18F]fluoro-2-deoxyglucose positron-emission tomography to assess regional cerebral glucose metabolic rate (GMR), finding autistic patients had a left > right anterior rectal gyrus asymmetry.
Abstract: Sixteen high-functioning adults with a history of childhood autism and 26 normal control subjects underwent [18F]fluoro-2-deoxyglucose positron-emission tomography to assess regional cerebral glucose metabolic rate (GMR). Autistic patients had a left > right anterior rectal gyrus asymmetry, as opposed to the normal right > left asymmetry in that region. Patients also showed low GMR in the left posterior putamen and high GMR in the right posterior calcarine cortex. Brain regions with GMR > 3 SD from the normal mean were more prevalent in patients than in control subjects. This variable pattern of abnormal activity is consistent with heterogeneous neurophysiological etiology; group differences in striatum and cortex may represent a final common pathway.
83 citations
TL;DR: Findings suggest that poststroke depression may be mediated by serotonergic mechanisms.
Abstract: Monoamine metabolites were measured in the cerebrospinal fluid (CSF) of depressed and nondepressed patients with acute stroke lesions and in nondepressed patients without stroke lesions. Depressed stroke patients had a significantly lower concentration of CSF 5-hydroxyindoleacetic acid (5-HIAA; a serotonin metabolite) than the other two groups. These findings suggest that poststroke depression may be mediated by serotonergic mechanisms.
80 citations
TL;DR: Studies of aberrations in second messenger function may help to elucidate some of the multiple complex neurobiological alterations in bipolar affective disorders.
Abstract: Studies of aberrations in second messenger function may help to elucidate some of the multiple complex neurobiological alterations in bipolar affective disorders. The phosphatidylinositol and calcium ion (Ca2+) second messengers are of particular interest because of evidence of hyperactivity of these signaling mechanisms in both mania and bipolar depression and of their normalization by lithium and other mood-stabilizing treatments. Because the intracellular Ca2+ signal has a biphasic action, a single aberration could explain diverse clinical manifestations of the same illness, and a single action on the messenger could explain the biphasic actions of many treatments for bipolar disorders.
67 citations
TL;DR: It is suggested that severe atrophy of the corpus callosum reflects global disease and provides a relatively focal morphological marker of severe cognitive impairment in MS.
Abstract: The authors examined whether specific neuropsychological abnormalities in multiple sclerosis (MS) are associated with focal lesion areas detected by MRI. Lesion area, regardless of distribution, correlated with performance on the vast majority of neuropsychological procedures. No significant difference appeared between groups with normal/mild and moderate overall cognitive impairment on any of the MRI measures. However, patients with severe cognitive impairment had greater lesion area, regardless of location, and had significant atrophy of the corpus callosum compared with the other two groups. These results suggest that severe atrophy of the corpus callosum reflects global disease and provides a relatively focal morphological marker of severe cognitive impairment in MS.
TL;DR: Critical review of the evidence supporting the efficacy of somatic treatments with anticonvulsant properties for acute bipolar manic and depressive episodes, as well as for the prevention of subsequent episodes is conducted.
Abstract: In the last decade, a proliferation of research has emerged concerning the use of somatic treatments with anticonvulsant properties, e.g., carbamazepine, valproate, clonazepam, oxcarbazepine, and electroconvulsive therapy (ECT), for patients with bipolar disorder. A sufficient number of controlled studies have been conducted to allow critical review of the evidence supporting the efficacy of these treatments for acute bipolar manic and depressive episodes, as well as for the prevention of subsequent episodes. Further research is needed to establish the prophylactic efficacy of anticonvulsants as maintenance therapies and, perhaps most importantly, to provide clinical and biological predictors of response.
TL;DR: This article shows how tests can be used to maximize the "expected utility" associated with a clinical decision.
Abstract: In our last two articles, we showed that one can quantify the reduction in uncertainty that results from diagnostic testing, an insight that allowed us to describe a method for optimizing the performance of a test by choosing a cutoff that maximizes its information yield. Although minimizing uncertainty is an important feature of diagnostic testing, there are many situations in which diagnostic tests are most appropriately used to balance risks and benefits associated with the various possible courses of action available to a clinician. This article shows how tests can be used to maximize the "expected utility" associated with a clinical decision. Language: en
TL;DR: The results suggest that patients at CDC Stage IV who do not receive antiretroviral treatment earlier in their illness may develop clinical dementia at an annual rate of about 14%.
Abstract: In a prospective study to determine the incidence of clinical dementia in patients with AIDS and ARC, 29 men and 3 women, 19 with ARC and 13 with AIDS, were examined neurologically and neuropsychologically every 6 months for 2 years during a placebo-controlled zidovudine (AZT) licensing trial. Most received two MRI brain scans. Although no patient was clinically demented at baseline, 9 (28%) developed dementia during the 2 years. Progression to dementia was associated with neuropsychological deterioration and with worsening on MRI during a preceding 6-month period, but not with baseline treatment group assignment. The results suggest that patients at CDC Stage IV who do not receive antiretroviral treatment earlier in their illness may develop clinical dementia at an annual rate of about 14%.
TL;DR: Discriminant function analyses showed that bilateral simultaneous fine motor coordination was the most potent discriminator between patient groups, independent of psychopathology, and implications for treatment and research on course and outcome in schizophrenia are discussed.
Abstract: This study investigates specific neuropsychological functions discriminating schizophrenic patients with hospitalization beyond 18 months from patients residing in the community without rehospitalization beyond 3 years. Twenty-six Research Diagnostic Criteria-diagnosed chronic schizophrenic outpatients and 26 inpatients matched for sex, ethnicity, socioeconomic status, and chronicity completed a comprehensive neuropsychological battery and responded to an inventory of psychopathology. Discriminant function analyses showed that measures of motor coordination, preservation, memory, and attention discriminated between patient groups. Bilateral simultaneous fine motor coordination was the most potent discriminator between patient groups, independent of psychopathology. Implications for treatment and research on course and outcome in schizophrenia are discussed.
TL;DR: Results suggest that IQNB SPECT data are not primarily related to general physiological activity or regional cerebral blood flow and are not explained by attenuation or volume-averaging artifacts.
Abstract: Prior studies of patients with dementia have found similar qualitative patterns of cerebral glucose utilization with [18F]2-fluoro-2-deoxyglucose (FDG) PET and of putative muscarinic receptor activity with [123I]3-quinuclidinyl-4-iodobenzilate (IQNB). This raised doubts about whether receptor binding determines IQNB distribution and whether clinical information in IQNB scans is unique. To compare the methods directly, 4 normal volunteers and 7 patients with dementia underwent FDG PET and high-resolution IQNB SPECT scans. In normal subjects, relative regional activity from the paired scans was only weakly correlated (r = 0.29). Some regions (e.g., thalamus, frontal cortex) showed a clear disassociation of activity. In demented patients, IQNB scans tended to show larger defects than FDG scans, although one focal defect appeared only with PET. Results suggest that IQNB SPECT data are not primarily related to general physiological activity or regional cerebral blood flow and are not explained by attenuation or volume-averaging artifacts. Further studies should investigate whether IQNB scanning is a more sensitive in vivo measure of the extent of Alzheimer's disease than is FDG PET.
TL;DR: The results suggest functional disruption of right-sided and frontal brain regions and hyperactivity of cerebellar-cortical connections in alcoholic chronic organic mental disorders.
Abstract: Localized cerebral utilization rates for glucose (CMRglu) were determined in 10 detoxified patients with alcoholic organic mental disorders and in 7 age-equivalent normal volunteers using [18F]2-fluoro-2-deoxyglucose positron emission tomography. Although gray and white matter CMRglu were not significantly different, normalized CMRglu was increased in the left cerebellar and parietal cortical regions and decreased in the right posterior white matter and anterior temporal regions of alcoholic patients, and the pattern of regional CMRglu differed between the two groups. The results suggest functional disruption of right-sided and frontal brain regions and hyperactivity of cerebellar-cortical connections in alcoholic chronic organic mental disorders.
TL;DR: It is suggested that hypothalamic lesions played a major role in the development of aggressive behavior in both cases of patients with craniopharyngiomas who meet the DSM-III-R criteria for intermittent explosive disorder.
Abstract: The authors present two cases of patients with craniopharyngiomas who meet the DSM-III-R criteria for intermittent explosive disorder. Episodes of rage developed before and/or after surgery for removal of the craniopharyngioma. Magnetic resonance imaging revealed hypothalamic-hypophyseal involvement. It is suggested that hypothalamic lesions played a major role in the development of aggressive behavior in both cases. Language: en
TL;DR: The authors describe the outcomes of 3 depressed patients with MS who were treated with ECT, and consistent with previous works, ECT effectively treated the psychiatric symptoms; however, 1 patient deteriorated neurologically during ECT.
Abstract: Electroconvulsive therapy (ECT) has been used effectively in treating depressed patients with multiple sclerosis (MS). However, several reports have observed that some patients with MS may suffer neurological deterioration during ECT. The authors describe the outcomes of 3 depressed patients with MS who were treated with ECT. Consistent with previous works, ECT effectively treated the psychiatric symptoms; however, 1 patient deteriorated neurologically during ECT. The brain MRI findings and clinical courses of all 3 patients are discussed, along with the possible value of gadolinium-contrast MRI scans for identifying high-risk patients.
TL;DR: A 10-year-old girl with intractable complex partial seizures developed aphasia, coprolalia, and repetitive motor behaviors involving touching, sexual touching, and aggressive acts following surgical resection of a left anterior temporal lobe ganglioglioma and control of seizures.
Abstract: A 10-year-old girl with intractable complex partial seizures developed aphasia, coprolalia, and repetitive motor behaviors involving touching, sexual touching, and aggressive acts. Her symptoms subsided following surgical resection of a left anterior temporal lobe ganglioglioma and control of seizures. Possible neurobehavioral implications of the reversibility of this patient's symptoms are discussed.
TL;DR: Pilot data suggest a differential alteration in plasma beta-endorphin response to exercise in PTSD, associated with changes in endogenous opioid peptide function.
Abstract: Post-traumatic stress disorder (PTSD) may be associated with changes in endogenous opioid peptide function. To test this hypothesis, 10 male Vietnam combat veterans with PTSD and 8 age-matched male controls underwent a standard grade-incremented exercise treadmill stress test. Plasma beta-endorphin measurements were obtained at rest and following maximal exercise. Resting plasma beta-endorphin levels were comparable between groups. Post-exercise plasma beta-endorphin levels were significantly higher than resting levels in the PTSD patients only (P less than 0.05). These pilot data suggest a differential alteration in plasma beta-endorphin response to exercise in PTSD.
TL;DR: The psychotherapy of patients with multiple sclerosis is described, based on a grasp of the vicissitudes of the illness and their meaning to patients, an understanding of the psychopathological consequences of the cerebral dysfunction, to patients’ human needs, and extensive clinical experience.
Abstract: In this issue Neuropsychiatric Practice and Opinion inaugurates an occasional series of articles exploring the psychological management of patients with brain disease. Neuropsychiatrists differ in theoretical outlook and therapeutic approach, but we all should have in common subtlety and skill in the psychological understanding and treatment of patients with cerebral dysfunction. This first article, by Sarah Minden, M.D., describes the psychotherapy of patients with multiple sclerosis. Her discussion is based on a grasp of the vicissitudes of the illness and their meaning to patients, an understanding of the psychopathological consequences of the cerebral dysfunction, sensitivity to patients’ human needs, and extensive clinical experience. Dr. Minden is a psychiatrist at the Brigham and Women’s Hospital, Boston.
TL;DR: In this paper, three patients from different racial, social, and economic backgrounds were studied because of sudden intrusive thoughts: visions or intrusions of threatening scenes -violent, aggressive, and sometimes horrifying--that lasted from seconds to minutes.
Abstract: Three patients from different racial, social, and economic backgrounds were studied because of sudden intrusive thoughts: visions or intrusions of threatening scenes--violent, aggressive, and sometimes horrifying--that lasted from seconds to minutes. Apart from the association with intense anxiety, fear, and aggression, there was no association with oculomotor, motor, sensory, or autonomic dysfunction or altered conscious state. Patients had abnormal intermittent discharges that arose from frontal areas and probably did not spread further. Carbamazepine was useful in two cases. The authors suggest that violent, brief hallucinations with no other epileptic sign may be manifestations of frontal lobe seizures.
TL;DR: Although the results are provocative in that three of five patients were much improved at the end of the protocol, conclusions about preferential efficacy for the intravenous route must await a placebo-controlled trial.
Abstract: In a preliminary trial, five oral-clomipramine-refractory patients with obsessive-compulsive disorder (OCD) were treated openly with 14 intravenous clomipramine infusions each. Using standardized assessments, three patients were rated as much improved, one as unchanged, and one as minimally improved. Statistically significant improvements were noted on both the Yale-Brown Obsessive Compulsive Scale and the NIMH Global OCD scores. No patient discontinued treatment because of side effects. Although the results are provocative in that three of five patients were much improved at the end of the protocol, conclusions about preferential efficacy for the intravenous route must await a placebo-controlled trial.
TL;DR: Cognitive slowing in HIV-1 infection may have an attentional component, with possible involvement of both automatic and controlled processes.
Abstract: In a preliminary study, 30 nondemented human immunodeficiency virus (HIV-1) seropositive subjects without acquired immunodeficiency syndrome and 14 seronegative controls performed a reaction time measure of spatial attention. Compared with controls, seropositive asymptomatic subjects showed normal facilitation of reaction time at short cue-target intervals when attention was precued, but symptomatic subjects were impaired. However, asymptomatic subjects showed no evidence of normal inhibition of attention at the cued location at longer cue-target intervals, suggesting possible subtler spatial attentional deficits in this group. Cognitive slowing in HIV-1 infection may have an attentional component, with possible involvement of both automatic and controlled processes.
TL;DR: These are the first clinical data interpreted in a contingent tolerance formulation with reresponse following a medication-free interval of carbamazepine in a patient with coexisting trigeminal neuralgia and manic-depressive illness.
Abstract: This retrospective single-case study demonstrates the development of tolerance and reresponse to carbamazepine in a patient with coexisting trigeminal neuralgia and manic-depressive illness. After an initial positive response, tolerance to the antinociceptive and psychotropic effects of carbamazepine appeared during treatment, despite increasing doses. As in preclinical studies of contingent tolerance, periods of carbamazepine discontinuation were associated with reresponse following reinstitution. These are the first clinical data interpreted in a contingent tolerance formulation with reresponse following a medication-free interval. Controlled and prospective studies are needed of the reliability and the pathophysiological and therapeutic implications of this phenomenon.
TL;DR: This study revealed significant differences between groups only for the staining intensity of iron in the caudate nucleus (P less than 0.005).
Abstract: Evidence derived from both pharmacological and postmortem studies suggests that a disturbance of brain iron metabolism is involved in the pathophysiology of schizophrenia; i.e., the distribution of iron parallels that of dopamine, and variations in its brain concentration selectively modulate the binding affinity of the dopaminergic (D2) receptor. In the present study the authors examined the staining intensity of brain iron in postmortem specimens of 9 schizophrenic (SC) patients and 17 age-matched controls. Coronal sections were stained with the Perls's technique, photographed, and then studied using a computerized image analysis system. Optical density measurements were taken from the caudate nucleus, putamen, globus pallidus, and substantia nigra. This study revealed significant differences between groups only for the staining intensity of iron in the caudate nucleus (P less than 0.005). A review of the literature suggests that this finding may be the result of neuroleptic therapy and not a primary pathological feature of schizophrenia.
TL;DR: A method of optimizing a test's information yield that allows us to determine which of several tests gives the most information is demonstrated, allowing us to compare atest's performance with that of a perfect diagnostic test.
Abstract: We continue our examination of diagnostic tests that are used to assign individuals to one of two mutually exclusive categories, those having or not having a particular disorder. Our last article showed how the information yielded by a test depends on the choice of cutoff and on the patient's pre-test probability of having the disorder. In this article, we demonstrate a method of optimizing a test's information yield that allows us to determine which of several tests gives the most information. Our technique allows us to compare a test's performance with that of a perfect diagnostic test.