Showing papers in "Journal of Neuropsychiatry and Clinical Neurosciences in 1993"

Cerebral Perfusion and Neuropsychological Consequences of Chronic Cocaine Use

Abstract: Research indicates that cocaine significantly constricts the cerebral vasculature and can lead to ischemic brain infarction. Long-term effects of intermittent or casual cocaine use in patients without symptoms of stroke or transient ischemic attack were investigated. Single-photon emission computed tomography with xenon-133 and [99mTc]hexamethylpropyleneamine oxime, magnetic resonance imaging, and selected neuropsychological measures were used to study cerebral perfusion, brain morphology, and cognitive functioning. Patients were drug free for at least 6 months before evaluation. All showed regions of significant cerebral hypoperfusion in the frontal, periventricular, and/or temporal-parietal areas. Deficits in attention, concentration, new learning, visual and verbal memory, word production, and visuomotor integration were observed. This study indicates that long-term cocaine use may produce sustained brain perfusion deficits and persistent neuropsychological compromise in some subgroups of cocaine-abusing patients.

Brain regions involved in recognizing facial emotion or identity: an oxygen-15 PET study.

Abstract: The functional neuroanatomy of emotion recognition is inadequately understood despite well-documented clinical situations where emotion recognition is impaired (aprosodia). Oxygen-15 water positron-emission tomography (PET) was used to study 9 healthy women volunteers during three match-to-sample conditions, each repeated twice: a study task matching facial emotions and control tasks matching spatial positions or facial identity. Results suggest that the higher order functional neural network for recognizing emotion in visual input likely involves the right anterior cingulate and the bilateral inferior frontal gyri. Language: en

A connectionist approach to the prefrontal cortex.

Abstract: Recent data from studies of the prefrontal cortex (PFC) in humans and laboratory animals are reviewed with particular reference to the anatomical substrates of prefrontal neuropsychological function in health and disease. The PFC has been shown to have a unique pattern of supramodal connectivity with intracortical and subcortical circuits that place the PFC in an anatomical position to subserve "executive" cognitive functions and modulate limbic information to relate to basal ganglia circuits in a highly specific manner and to uniquely control the neurochemical elements of attention and reward. PFC connectivity is also consistent with current hypotheses about prefrontal neuropsychology, which emphasize conscious, goal-directed behavior guided by past experience. PFC connectivity explains the frequency with which prefrontal dysfunction is seen in disease states, which, on the basis of neuroimaging and neuropathology data, can be categorized as either intrinsic or dysconnection disorders.

Early childhood abuse and limbic system ratings in adult psychiatric outpatients.

Abstract: The authors investigated the hypothesis that early abuse might affect the development of the limbic system. During initial psychiatric evaluation, 253 outpatients completed a self-report scale, the Limbic System Checklist-33 (LSCL-33), designed to measure somatic, sensory, behavioral, and memory symptoms suggestive of temporal lobe epilepsy, along with a questionnaire about physical or sexual abuse. Physical abuse was associated with a 38% increase in LSCL-33 scores (P Language: en

Voxel processing techniques for the antemortem study of neuroanatomy and neuropathology using magnetic resonance imaging.

Abstract: BRAINBLAST, a program that uses voxel processing, was developed in order to produce high-fidelity three-dimensional reconstructions of the brain. Four steps were used to produce images: washing away cerebrospinal fluid (via histogramming), dissecting away the blood vessels (via a connectivity heuristic), highlighting the sulci and gyri (via a lighting model), and resampling the interior contents of the brain. After reconstruction, the images can be resampled, rotated, written on, measured, or redissected. The technique has a variety of applications: study of individual variation in sulcal and gyral patterns, evaluation of structure/function relationships, measurement of volumes or subregions using anatomically defined landmarks, and teaching of neuroanatomy.

Human brain fluoxetine concentrations.

Abstract: Data on 22 subjects treated with fluoxetine suggest that magnetic resonance spectroscopy (MRS) of fluorine-19 can measure brain concentrations of fluoxetine/norfluoxetine in vivo. Fluoxetine accumulates in the human brain relative to plasma, with brain concentrations of fluoxetine/norfluoxetine ranging up to 10.7 micrograms/ml. Brain concentrations may reach a plateau between 6 and 8 months of treatment. The apparent concentration in brain relative to plasma is 20:1, roughly parallel to brain antidepressant concentration ratios in animal studies.

Depression and anxiety following traumatic brain injury.

Abstract: The frequency, course, and clinical correlates of generalized anxiety disorder (GAD) and its relationship to major depression were examined in 66 patients with traumatic brain injury (TBI). Of 66 TBI patients, 7 (11%) had both GAD and major depression; 10 (15%) had major depression without GAD. Median duration was 1.5 months for nonanxious depressions, 7.5 months for anxious depressions, and 1.5 months for concurrent GAD. Anxious depressions were also associated with right hemisphere lesions, whereas major depressions alone were associated with left anterior lesions. These findings suggest that anxious major depression and major depression following TBI may be two different disorders with different underlying etiological mechanisms and perhaps differential response to treatment.

Neurobiology of impulsivity and the impulse control disorders

Abstract: Clinical impulsivity has been characterized in both dimensional and categorical terms. Whereas DSM-III-R classifies personality disorders characterized by impulsivity and impulse control disorders as discrete entities, impulsive symptoms and traits can also be conceived in terms of an underlying behavioral dimension. The authors review research on impulsivity and the impulse control disorders from a biological perspective. In particular, they critically review evidence that the serotonin neurotransmitter system mediates symptoms and traits of impulsive personality disorders and the impulse control disorders.

Increased prevalence of electrophysiological abnormalities in children with psychological, physical, and sexual abuse.

Abstract: This retrospective study examined the association between abuse history and neurological abnormalities in 115 consecutive patients admitted to a child and adolescent psychiatric inpatient unit. Increased electrophysiological abnormalities were found in abused patients compared with non-abused patients (54.4% vs. 26.9%, P = 0.021), predominantly in the left side of the frontal, temporal, or anterior region (P = 0.036). This may support the hypothesis that early abuse alters brain development, particularly limbic structures. However, a large-scale prospective longitudinal assessment study is needed to interpret this association. Possible clinical consequences of relatively preserved right frontal function are discussed. Language: en

A comparison of neuropsychiatric characteristics in chronic fatigue syndrome, multiple sclerosis, and major depression.

Abstract: Chronic fatigue syndrome (CFS), a controversial clinical entity characterized by severe fatigue and constitutional symptoms, has been associated with a variety of psychiatric disorders. To further understand the psychiatric profile of CFS, the authors compared patients with CFS, multiple sclerosis (MS), and major depression by using diagnostic interviews and self-report measures of Axis I disorders and personality disorders. CFS patients differed from patients with major depression, with significantly less depression and fewer personality disorders. Compared with MS patients, CFS patients did not differ with regard to personality disorders. However, they did have significantly more frequent current depression than MS patients, particularly following onset of their illness.

Comparison between acute- and delayed-onset depression following traumatic brain injury.

Abstract: Sixty-six patients admitted for the treatment of acute closed head injury were assessed for the presence of mood disorders during the in-hospital period and at 3-, 6-, and 12-month follow-ups. Diagnosis was made using a structured psychiatric interview and DSM-III criteria. A total of 28 patients had major depression at some time during the study: 17 had acute-onset depression and 11 had delayed-onset depression. Acute-onset depressions are related to lesion location and may have their etiology in biological responses of the injured brain, whereas delayed depressions may be mediated by psychosocial factors, suggesting psychological reaction as a possible mechanism.

Neurological status of Vietnam veterans with chronic posttraumatic stress disorder.

Abstract: This study investigated neurological status in 27 medication-free outpatient Vietnam veterans meeting DSM-III-R criteria for posttraumatic stress disorder (PTSD) and 15 non-PTSD combat control subjects, all without alcohol or drug dependence or abuse during the past year. Subjects underwent neurological examination, neuropsychological testing, and sleep-deprived EEG. PTSD subjects showed significantly more neurological soft signs than non-PTSD subjects. Neither substance dependence/abuse nor the more frequent history of developmental problems in PTSD subjects accounted for this difference. There were no significant EEG or neuropsychological testing group differences; however, there were significant correlations between several neuropsychological test scores and total neurological soft signs.

SPECT Findings in Patients With Primary Mania

Abstract: Five patients with a manic episode and 7 age-comparable control subjects were studied with single-photon emission computed tomography and [99mTc]d,l-hexamethylpropyleneamine oxime. Manic patients showed significantly lower blood flow in the basal portion of the right temporal lobe compared with normal control subjects. Moreover, manic patients showed a left-right asymmetry (a significantly lower perfusion in the right versus left temporal basal cortex), as well as a dorsal-ventral asymmetry (a significantly lower perfusion in the right temporal basal versus dorsal cortex). These findings suggest that the right basotemporal cortex may play an important role in the production of primary mania.

Diagnosing dementia: a comparison between a monodisciplinary and a multidisciplinary approach.

Abstract: Discrepancies were examined in diagnostic outcome between a monodisciplinary approach and a multidisciplinary, criteria-based approach in patients referred to a university memory clinic. Of 278 patients not fulfilling dementia criteria, 19 had been previously diagnosed as demented (specificity: 0.93). In 60 of 152 demented patients, dementia had not been diagnosed before (sensitivity: 0.61). Underreporting was frequent for mildly demented patients and for patients with coexisting depressive symptoms. In patients referred by psychiatrists, sensitivity rates for dementia and Alzheimer's disease were low; in patients referred by neurologists, depression often went unreported. Results underscore the need for more frequent use of integrated multidisciplinary services for cognitively disturbed patients.

Association of anticholinergic activity of prescribed medications with postoperative delirium.

Abstract: In a prior study, delirium and plasma anticholinergic drug levels were significantly correlated in 9 of 25 surgical intensive care patients. The present study, using cumulative anticholinergic effects of parent compounds of these patients' medications, found that delirious patients' medication combinations had significantly higher cumulative anticholinergic effects than those of nondelirious patients.

A pilot study of the neuropsychology of obsessive-compulsive disorder and Parkinson's disease: basal ganglia disorders.

Abstract: This pilot study evaluated neuropsychological dysfunction in obsessive-compulsive disorder (OCD) and Parkinson's disease (PD). Both OCD and PD patients had impairment on visuoconstructional tasks but not on tasks of immediate memory and focused attention, suggesting common selective deficits in these two disorders with basal ganglia involvement.

The neuropsychiatry of brain iron.

Abstract: In the last two decades, many biological functions of iron have been identified, in particular its role in many enzymatic processes, its effect on dopamine D2 receptor function, its interaction with other neurotransmitters (gamma-aminobutyric acid, serotonin, opiate-peptides), and its catalytic role in the nonenzymatic mechanisms for oxidation, hydroxylation, and peroxidation reactions. The role of iron in Parkinson's disease, Alzheimer's disease, brain injury due to exogenous causes, neuroleptic-induced movement disorders, schizophrenia, and other neuropsychiatric disorders is currently being explored. This study summarizes current understanding of the anatomy and physiology of brain iron with special reference to these disorders.

Midline cerebral malformations and schizophrenia.

Abstract: To investigate a possible association of midline cerebral malformations with psychotic disorders, MRI and CT scans were blindly evaluated for 52 patients with schizophrenia, 9 with schizoaffective disease, and 79 consecutive nonpsychotic control subjects. Midline abnormalities were present in 10 of 61 patients (16.4%) versus 4 of 79 control subjects (5.1%; P < 0.05, chi-square). Of 52 schizophrenic patients, 8 had abnormalities of the septum pellucidum (SP): 5 had cavum vergae (CaV), 2 had cavum septum pellucidum (CaSP), and 1 had agenesis of the corpus callosum and SP. Of 9 schizoaffective patients, 2 had SP abnormalities: 1 CaV and 1 CaSP. Abnormalities of the SP, especially CaV, were significantly more frequent in women than in men (P < 0.02, chi-square).

A brief assessment of frontal and subcortical functions in dementia

Abstract: A brief assessment of cognitive and motor functions associated with the frontal/subcortical system was evaluated for discriminant validity. Patients with dementia of Huntington's disease and Parkinson's disease performed as well as normal control subjects on the Mini-Mental State Exam (MMSE) but significantly worse on the Frontal/Subcortical Assessment Battery (FSAB). Discriminant function analyses yielded significantly higher rates of accurate classification with FSAB and MMSE combined than with MMSE alone. Patients with Alzheimer's disease scored significantly lower than other groups on both measures. The authors recommend the FSAB as an adjunct to the MMSE for brief assessments of patients with suspected frontal or subcortical pathology.

Clozapine use in diffuse Lewy body disease.

Abstract: Diffuse Lewy body disease, a severely disabling neuropsychiatric disease, presents with progressive dementia, psychotic symptoms, depression, and parkinsonian symptoms. The authors report a case illustrating that clozapine, a novel neuroleptic drug, has special efficacy in treating psychotic symptoms in these patients.

EEG power modifications in panic disorder during a temporolimbic activation task: relationships with temporal lobe clinical symptomatology.

Abstract: Computerized EEG activity derived from the temporal lobes was investigated in normal subjects and panic disorder patients with and without depersonalization and/or derealization, in a resting condition and during an odor stimulation task. Panic patients without depersonalization or derealization showed an increase of fast and a decrease of slow activities independent of odor stimulation. Panic patients with depersonalization and/or derealization showed an increase of slow activity and bilateral lack of responsiveness in the fast alpha frequency band during odor stimulation. Findings suggest there are different EEG patterns in the temporal regions of the two different groups of panic patients during rest and activating conditions.

Catastrophic reaction after cerebrovascular lesions: frequency, correlates, and validation of a scale.

Abstract: The frequency and correlates of the catastrophic reaction (CR) were examined in 52 consecutive patients with an acute stroke lesion. A new scale proved reliable for measuring the severity of CR. The CR was significantly associated with depression, a personal and family history of psychiatric disorder, and subcortical lesions, which were mostly located in the basal ganglia. Patients with and without a CR, when matched for the presence and type of depression, differed only in that CR patients had significantly more anterior lesions and a significantly higher frequency of subcortical damage. Results demonstrate that the CR is significantly associated with poststroke depression and may be a specific manifestation of certain types of poststroke depression.

Neuropsychological performance, mood, and complaints of cognitive and motor difficulties in individuals infected with the human immunodeficiency virus.

Abstract: Seventy-nine military medical beneficiaries infected with human immunodeficiency virus (HIV+) and 27 HIV-seronegative control subjects (HIV-) completed a neuropsychological evaluation and a semistructured interview inquiring about difficulties in function. More HIV+ than HIV- subjects reported difficulties. HIV+ subjects reporting difficulties were significantly more likely to be deficient on attention, response speed, motor function, and memory than those not reporting difficulties. Findings for early-stage HIV+ subjects were similar. HIV+ individuals who complained of difficulties reported depression and anxiety symptoms significantly more frequently than those who did not complain, but these symptoms were not related to neuropsychological performance. Complaints of difficulties by HIV+ individuals may reflect either actual neuropsychological deficiency or mood disturbance, but the effects of each appear to be independent.

Reliability and applicability of movement disorder rating scales in the elderly

Abstract: Geriatric research clinicians were readily trained to use three scales initially developed for rating neuroleptic-induced movement disorders in mixed-age patients: the Abnormal Involuntary Movements Scale (AIMS), Simpson Extra Pyramidal Side Effect Scale (SEPSE), and Barnes Akathisia Scale (BAS). Interrater reliability, calculated by intraclass correlation coefficients, ranged from 0.79 to 0.93. Of elderly psychiatric inpatients tested, 97% were able to complete the examination, despite significant psychiatric, cognitive, and physical disabilities. AIMS, SEPSE, and BAS are reliable instruments for assessment of movement disorders in the elderly, representing an important first step in standardized evaluation of dyskinesia, parkinsonism, and akathisia in elderly psychiatric populations.

Patterns of neuropsychological deficits that discriminate schizophrenic individuals from siblings and control subjects.

Abstract: Previous research on persons with schizophrenia and their relatives suggests two independent etiologic factors may combine to produce schizophrenia, and these factors may be indexed respectively by independent neuropsychological tests. Two neurocognitive measures, the Trail Making and Wisconsin Card Sorting (WCST) tests, were administered to 28 schizophrenic subjects, 15 nonschizophrenic siblings, and 35 control subjects by investigators blind to DSM-III-R diagnoses. Results support key predictions of a two-factor model: 1) having poor scores on both tests discriminated schizophrenic individuals from both siblings and control subjects, and 2) poor Trail Making and WCST performance were inversely associated among schizophrenic individuals' non-schizophrenic siblings.

Is the Na(+)-K(+)-ATPase the link between phosphoinositide metabolism and bipolar disorder?

Abstract: Recent experimental work suggests involvement of the phosphatidyl inositol second messenger system in the biochemical mechanism of lithium action, but this work has not shed light on the pathophysiology of bipolar illness. Earlier work had established reduction in sodium-potassium-activated adenosine triphosphatase (Na(+)-K(+)-ATPase) activity as a consistent marker of mood in bipolar illness but had only partially illuminated mechanisms of the action of lithium. Now, advances from research in diabetic neuropathy suggest that inositol phosphate and diacylglycerol metabolism are indeed linked to Na(+)-K(+)-ATPase activity. The data are compatible with a model in which a primary decrease in Na(+)-K(+)-ATPase activity in bipolar patients can stimulate an increase in phosphoinositide hydrolysis, thereby generating the equivalent of a second messenger signal in the absence of a first message. Lithium appears to act by blocking this false second message.

Anticonvulsant use in the treatment of manic syndromes in patients with HIV-1 infection

Abstract: A retrospective chart review identified 11 patients with type 1 human immunodeficiency virus (HIV) who presented to an HIV/AIDS psychiatric service with an acute manic episode. Demographic data, neurodiagnostic studies, and treatment results are discussed. Abnormal brain magnetic resonance imaging significantly predicted poor tolerance of lithium and neuroleptics. Anticonvulsants were an effective alternative.

Whole-blood serotonin and cognitive functioning in autistic individuals and their first-degree relatives.

Abstract: The relationship between cognitive-intellectual abilities and whole-blood serotonin (5-hydroxytryptamine; 5-HT) in 18 autistic probands and their first-degree relatives (n = 21 parents, n = 13 siblings) was investigated. Whole-blood 5-HT was significantly negatively associated with verbal-expressive/symbolic abilities for the entire sample. The proportion of variance in cognitive-intellectual performances attributable to whole-blood 5-HT was substantial in the context of variance attributable to familial classification. The relationship between verbal-expressive abilities and whole-blood 5-HT, adjusted for race and familial classification, was noteworthy. Simple correlations between 5-HT and cognitive-intellectual performances were conducted. However, bias related to covariance attributable to race seriously limits such findings. The issue of bias and its relevance to previous research is discussed further.