Showing papers in "Journal of Neuropsychiatry and Clinical Neurosciences in 2004"

Disorders of the cerebellum: ataxia, dysmetria of thought, and the cerebellar cognitive affective syndrome

Abstract: Many diseases involve the cerebellum and produce ataxia, which is characterized by incoordination of balance, gait, extremity and eye movements, and dysarthria. Cerebellar lesions do not always manifest with ataxic motor syndromes, however. The cerebellar cognitive affective syndrome (CCAS) includes impairments in executive, visual-spatial, and linguistic abilities, with affective disturbance ranging from emotional blunting and depression, to disinhibition and psychotic features. The cognitive and psychiatric components of the CCAS, together with the ataxic motor disability of cerebellar disorders, are conceptualized within the dysmetria of thought hypothesis. This concept holds that a universal cerebellar transform facilitates automatic modulation of behavior around a homeostatic baseline, and the behavior being modulated is determined by the specificity of anatomic subcircuits, or loops, within the cerebrocerebellar system. Damage to the cerebellar component of the distributed neural circuit subserving sensorimotor, cognitive, and emotional processing disrupts the universal cerebellar transform, leading to the universal cerebellar impairment affecting the lesioned domain. The universal cerebellar impairment manifests as ataxia when the sensorimotor cerebellum is involved and as the CCAS when pathology is in the lateral hemisphere of the posterior cerebellum (involved in cognitive processing) or in the vermis (limbic cerebellum). Cognitive and emotional disorders may accompany cerebellar diseases or be their principal clinical presentation, and this has significance for the diagnosis and management of patients with cerebellar dysfunction.

Prefrontal cortical dysfunction in abstinent cocaine abusers

Abstract: The anterior cingulate cortex (ACC) and lateral prefrontal (LPFC) cortex are brain regions important to executive cognitive functions (ECF). We determined ACC and LPFC function in 23-day abstinent cocaine abusers using positron emission tomography (PET H215O) during performance of a modified version of the Stroop Task. Cocaine abusers showed less activation than non-drug-using comparison subjects in the left ACC and the right LPFC and greater activation in the right ACC. Average amount of cocaine used per week was negatively correlated with activity in the rostral ACC and right LPFC. Disruption of ECF in substance abusers could interfere with attempts to stop drug use and undermine treatment. Since impairment in ECF may be a common feature of various neuropsychiatric disorders, these findings have applicability beyond the neurobiology of addiction.

Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report

Abstract: The response to acupuncture of 18 anxious adult subjects who complained of insomnia was assessed in an open prepost clinical trial study. Five weeks of acupuncture treatment was associated with a significant (p = 0.002) nocturnal increase in endogenous melatonin secretion (as measured in urine) and significant improvements in polysomnographic measures of sleep onset latency (p = 0.003), arousal index (p = 0.001), total sleep time (p = 0.001), and sleep efficiency (p = 0.002). Significant reductions in state (p = 0.049) and trait (p = 0.004) anxiety scores were also found. These objective findings are consistent with clinical reports of acupuncture's relaxant effects. Acupuncture treatment may be of value for some categories of anxious patients with insomnia.

Posttraumatic Stress Disorder: Acquisition, Recognition, Course, and Treatment

Abstract: Following exposure to trauma, a large number of survivors will develop acute symptoms of posttraumatic stress disorder (PTSD), which mostly dissipate within a short time. In a minority, however, these symptoms will evolve into chronic and persistent PTSD. A number of factors increase the likelihood of this occurring, including characteristic autonomic and hypothalamic-pituitary-adrenal axis responses. PTSD often presents with comorbid depression, or in the form of somatization, both of which significantly reduce the possibilities of a correct diagnosis and appropriate treatment. Mainstay treatments include exposure-based psychosocial therapy and selective serotonin reuptake inhibitors, such as paroxetine and sertraline, both of which have been found to be effective in PTSD. This paper looks at the course of PTSD, its disabling effect, its recognition and treatment, and considers possible new research directions.

Poststroke depression and lesion location revisited.

Abstract: Seventy patients with one brain infarct on magnetic resonance imaging (MRI) were studied 3 months after ischemic stroke by a standardized protocol to detail side, site, type, and extent of the brain infarct, as well as severity of white matter lesions and brain atrophy. Depression was diagnosed by DSM-III-R and DSM-IV criteria. The brain infarcts that affected structures of the frontal-subcortical circuits, (i.e., the pallidum and caudate, especially on the left side) predisposed stroke patients to depression. The size of the infarcts at these sites in the depressed patients was larger. Using a logistic regression analysis, the authors found that a brain infarct that affected pallidum was a strong independent MRI correlate for poststroke depression (odds ratio = 7.2).

A pilot study of functional magnetic resonance imaging brain correlates of deception in healthy young men

Abstract: We hypothesized that specific brain regions would activate during deception, and these areas would correlate with changes in electrodermal activity (EDA). Eight men were asked to find money hidden under various objects. While functional MRI images were acquired and EDA was recorded, the subjects gave both truthful and deceptive answers regarding the money's location. The group analysis revealed significant activation during deception in the orbitofrontal cortex (OFCx) and anterior cingulate (AC), but individual results were not consistent. Individually and as a group, EDA correlated with blood flow changes in the OFCx and AC. Specific brain regions were activated during deception, but the present technique lacks good predictive power for individuals.

Neurometabolic functioning and neuropsychological correlates in children with ADHD-H: preliminary findings.

Abstract: Proton magnetic resonance spectroscopy (MRS) and neuropsychological testing were conducted on 8 children with attention-deficit/hyperactivity disorder (ADHD-H), with no learning disabilities or comorbidities and 8 controls. Magnetic resonance spectroscopy revealed increased Glutamate/Glutamine in both frontal areas, and increased N-acetyl aspartate and Choline in the right frontal area of the ADHD-H subjects. Neuropsychological testing revealed few within- and between-group differences. Findings related to frontal lobe dysfunction in ADHD-H subjects were noted. N-acetylasparte/creatine (NAA/Creatine) in the right frontal region, and myoinositol/creatine (Myo inositol/Creatine) in the right and left frontal regions appear to be highly associated with the regulation of sensorimotor, language, and memory and learning functioning in children with ADHD-H.

The Role of Norepinephrine in the Behavioral and Psychological Symptoms of Dementia

Abstract: The behavioral and psychological symptoms of dementia (BPSD) are common serious problems that are a major contributor to caregiver burden. Despite their significance, the underlying neurobiology of these disturbances is still unclear. This review examines the role of norepinephrine (NE) on BPSD, including depression, aggression, agitation and psychosis. A number of lines of evidence suggest that NE dysfunction leading to BPSD may result from increased NE activity and/or hypersensitive adrenoreceptors compensating for loss of NE neurons with progression of Alzheimer's disease (AD). With greater appreciation of the underlying neurobiology of behavioral and psychological symptoms of dementia (BPSD) more effective, rational, targeted pharmacotherapy will hopefully emerge.

Bilaterally Reduced Frontal Activation During a Verbal Fluency Task in Depressed Patients as Measured by Near-Infrared Spectroscopy

Abstract: The present study investigated functional changes of brain oxygenation in prefrontal brain areas of nine depressed patients and nine age- and sex-matched healthy comparison subjects by using near-infrared spectroscopy. During a verbal fluency task, the healthy subjects exhibited the typical activation pattern, with a significant increase in oxyhemoglobin and a decrease in deoxyhemoglobin, as compared to a resting baseline condition. Patients had significantly lower activation bilaterally during the cognitive task, with no significant differences in behavioral performance. The results underscore the hypothesis of a functional deficit in prefrontal cortex in depression and confirm the feasibility of near-infrared spectroscopy in measuring functional brain activation.

Pathological Laughing and Crying Following Traumatic Brain Injury

Abstract: The authors examined the prevalence and clinical correlates of pathological laughing and crying (PLC) using the Pathological Laughter and Crying Scale (PLAC) in 92 consecutive patients with acute symptoms 3, 6, and 12 months after traumatic brain injury (TBI). The prevalence of PLC during the first year after TBI was 10.9%. Compared to patients without PLC, patients with PLC had significantly more depressive, anxious, and aggressive behaviors and had poorer social functioning. Additionally, PLC was associated with the presence of anxiety disorder, and focal frontal lobe lesions, especially in the lateral aspect of the left frontal lobe. Findings revealed that prefrontal regulation of limbic circuits may be involved in the pathophysiology of this disturbed emotional expression.

Volumetric Investigation of the Frontal-Subcortical Circuitry in Patients With Obsessive-Compulsive Disorder

Abstract: The pathophysiology of obsessive-compulsive disorder (OCD) is thought to involve disturbance of the frontal-subcortical circuitry. To investigate the morphological characteristics of this circuitry, we examined the volume of the orbitofrontal cortex, anterior cingulate, thalamus, caudate, and the putamen in 36 age- and sex-matched OCD patients and normal control subjects using three-dimensional magnetic resonance (MR) brain imaging. The left orbitofrontal volumes were found to be significantly smaller in the OCD patients and showed significant negative correlations with obsessive-compulsive symptom severity. These findings suggest that a structural abnormality of this brain region is implicated in the pathophysiology of OCD.

Cognitive dysfunction and depression during treatment with interferon-alpha and chemotherapy.

Abstract: Trials with interferon-alpha (IFN-α) have provided contradictory findings regarding the presence of cognitive side effects. The development of depression in some patients also raises questions about whether cognitive dysfunction might be secondary to an organic, interferon-induced mood disorder. Thirty patients with chronic myelogenous leukemia were examined before and during treatment with IFN-α alone or IFN-α and chemotherapy. Increased depressive symptoms and declines in information processing and executive functions were observed, but depression alone could not account for cognitive dysfunction. There was some evidence suggesting that exposure to chemotherapy and higher cumulative IFN-α dose may contribute to cognitive impairment.

Marijuana Use and Cognitive Function in HIV-Infected People

Abstract: The effect of marijuana use on cognitive function is controversial. Although marijuana use is common in HIV-infected individuals for recreational and medicinal purposes, there have been no studies of the impact of marijuana on cognitive function in these subjects. Marijuana also has known immunologic effects, which increases the relevance in HIV-infected patients. We examined the interaction of HIV disease-stage and marijuana use in 282 subjects, stratified by disease stage and frequency of marijuana use. After controlling for the effects of depression, anxiety, and alcohol use, a significant interaction was observed on an overall measure of cognitive impairment. The effect of marijuana use was greatest in subjects with symptomatic HIV infection. Further inspection suggested that this effect was due primarily to performance on memory tasks. These data suggest that although there is minimal impact of marijuana on uninfected individuals or those at early stages of HIV infection, there is a synergistic effect of HIV and marijuana use in patients with advanced HIV disease. This is consistent with other data suggesting that the subtle effects of some conditions may become more manifest in the setting of immunocompromise.

Limited agreement between criteria-based diagnoses of postconcussional syndrome.

Abstract: The objectives of this study were to compare diagnoses of postconcussional syndrome between the International Classification of Diseases, 10th revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV). The patient sample was comprised of 178 adults with mild-moderate traumatic brain injury (TBI). The study design was inception cohort, and the main outcome measure was a structured interview 3 months after injury. The results were that, despite concordance of DSM-IV and ICD-10 symptom criteria (kappa=0.73), agreement between overall DSM-IV and ICD-10 diagnoses was slight (kappa=0.13) because fewer patients met the DSM-IV cognitive deficit and clinical significance criteria. Agreement between DSM-IV postconcussional disorder and ICD-10 postconcussional syndrome appears limited by different prevalences and thresholds.

Traumatic Axonal Injury: Novel Insights Into Evolution and Identification

Abstract: Figure 1. Axial Diffusion Tensor Imaging. An area with vasogenic edema is visible in the left frontal lobe on the T2 weighted image (arrows). It is much less evident on the mean diffusion-weighted map of the same section, produced by averaging the diffusion-weighted images obtained in all 23 noncolinear directions of the diffusion gradients. The corresponding trace map shows increased diffusivity in the left frontal lobe (arrows). In the fractional anisotropy map of the same section decreased anisotropy is visible in the left anterior portion of the corpus callosum due to the presence of vasogenic edema (arrowhead). Diffusion anisotropy is also decreased in the anterior portion of the left internal and external capsules (arrow), although these regions are characterized by normal T2 and trace values.

Differential DSM-III psychiatric disorder prevalence profiles in dystonia and Parkinson's disease.

Abstract: The authors investigated the prevalence of DIS-ascertained DSM-III psychiatric disorders occurring in 28 patients with dystonia and 28 patients with Parkinson's Disease (PD). In patients with dystonia, lifetime prevalences of major depression (25.0%), bipolar disorder (7.1%), atypical bipolar disorder (7.1%), social phobia (17.9%), and generalized anxiety disorder (25.0%) were significantly more common than in epidemiologic catchment area (ECA) study population controls (p < 0.005). Social phobia and generalized anxiety disorder preceded dystonia (primary), while bipolar disorder developed after dystonia onset (secondary). In PD patients, the lifetime prevalence of simple phobia (35.7%, p < 0.0001) and atypical depression (21.4%) were significantly more common. Parkinson's Disease was associated with primary simple phobia and secondary atypical depression. These findings are considered in light of previous results and in terms of the differences in pallidothalamic physiologies in dystonia and PD. These data suggest distinctive profiles of psychiatric disorders in dystonia and PD.

Neuropsychiatry and Behavioral Neuroscience

Abstract: 1. Introduction 2. Neurobiological basis of behaviour 3. Neuropsychiatric assessment 4. Treatment of neuropsychiatric disorders 5. Principles of neuropsychiatry 6. Disorders of speech and language 7. Memory disorders 8. Visuospatial, visuoperceptual, and right hemisphere disturbances 9. Frontal lobe dysfunction 10. Dementia 11. Delirium 12. Psychosis, delusions, and schizophrenia 13. Hallucinations 14. Disturbances of mood and affect 15. Apathy and other personality disorders 16. Obsessive-compulsive disorder and syndromes with repetitive behaviours 17. Anxiety disorders 18. Movement disorders 19. Tics, startle syndromes, and myoclonus 20. Catatonia, motoric manifestations of psychiatric illnesses, and drug-induced motor system disturbances 21. Epilepsy and temporal-limbic syndromes 22. Dissociative states, multiple personality, and hysteria 23. Disturbances of sleep, appetite, and sexual function 24. Violence and aggression 25. Developmental neuropsychiatric syndromes 26. Focal brain disorders and related conditions

Athymhormia and disorders of motivation in Basal Ganglia disease.

Abstract: The author proposes a general model of human motivation as a separate function at the interface between emotion and action, which can be ascribed to subcortical circuits that are mainly centered on a subset of the basal ganglia and on their limbic connections. It is argued that the long-standing historical understatement of the notion of motivation in neurology is not only due to the complexity of the issue, which has proven hard to disentangle from other domains of dysfunction, but also to the persistence of some misleading conceptual orientations in the way neurologists have considered the brain mechanisms of goal-directed action, torn between a nonspecific “activation” view and an exclusively cognitive conception of motivation. How combining early clinical intuitions of some psychiatrists, careful clinical observations of neurological patients, and data derived from experimental studies in animals provide the basis for a coherent model of human motivation and its specific impairment in clinical neurolo...

Citalopram treatment of depression in Parkinson's disease: the impact on anxiety, disability, and cognition.

Abstract: Depression in Parkinson's disease (PD) is associated with faster progression of physical symptoms, greater decline in cognitive skills, and greater decline in the ability to care for oneself. The depression in these patients is also frequently comorbid with anxiety. There are no trials that provide data on the impact of depression treatment on anxiety, disability, and cognition in these patients. In this prospective, 8-week, open label trial, 10 patients with PD and major depression, without dementia, were given flexible doses of citalopram. Depression improved significantly and was associated with significant improvements in anxiety symptoms and functional impairment. The drug was well tolerated. This is the first study that provides data suggesting that treating depression in patients with PD may lead to improvements in anxiety and functional capacity. As with all nonrandomized, open-label trials at tertiary research centers, many nonspecific factors may have influenced the results.

Autism and Familial Major Mood Disorder: Are They Related?

Abstract: Family history studies of autism consistently reveal a large subgroup with a high incidence of major mood disorder in family members, suggesting the two entities are related clinically and genetically. This review examines this concept, comparing current clinical and biological knowledge of autism and major mood disorder, and advances the hypothesis that this subgroup of autism represents an early-life phenotype of major mood disorder. If confirmed, this hypothesis would suggest that the basic biological defects determining major mood disorders may have prominent neurodevelopmental and cognitive dimensions. Testing of the hypothesis will depend on genetic studies.

Construct Validity and Frequency of Euphoria Sclerotica in Multiple Sclerosis

Abstract: Using the Neuropsychiatric Inventory (NPI), we studied euphoria and other behavioral changes in 75 consecutive, unselected multiple sclerosis (MS) patients and 25 healthy controls. We also assessed disease duration, clinical course, physical disability, personality, depression, insight, cognition, and caregiver distress. Factor analysis identified a cluster of symptoms--labeled euphoria/disinhibition--similar to the euphoria sclerotica syndrome originally described by Charcot and others. The euphoria/disinhibition factor score was elevated in 9% of patients and associated with secondary-progressive course, low agreeableness, poor insight, impaired cognition, and high caregiver distress. Thus, we used the NPI to validate the euphoria syndrome in multiple sclerosis (MS) and determined its frequency, and its neurological and psychological correlates.

Case Series: Acute Mood Symptoms Associated With Posterior Fossa Lesions in Children

Abstract: Nineteen children were acutely dysphoric, inattentive, irritable, and sometimes mute following midline posterior fossa neoplasm resection and arteriovenous malformation hemorrhage. These symptoms represent an acute manifestation of the cerebellar cognitive affective syndrome. The authors aimed to describe the acute psychiatric changes in mood and behavior in children with posterior fossa lesions and to evaluate the relationship of posterior fossa syndrome to cerebellar cognitive affective syndrome.

A Distinctive Interaction Between Chronic Anxiety and Problem Solving in Asymptomatic APOE e4 Homozygotes

Abstract: We correlated measures of problem solving (Wisconsin Card Sorting Test [WCST] categories, total errors, and perseverative errors) and chronic anxiety (Personality Assessment Inventory Anxiety Scale [ANX]) in asymptomatic apolipoprotein E (APOE) e4 homozygotes (HMZs), heterozygotes, and noncarriers (NC) (n = 42 in each group) matched for age, education, and gender. Differences between HMZ and NC in the slope of the regression of WCST scores on ANX reached statistical significance on all three WCST measures. Chronic anxiety adversely affects cognitive skills in all groups, and is associated with significantly greater decline in problem solving skills in cognitively normal APOE e4 HMZ.

SPECT imaging of body dysmorphic disorder.

Abstract: [99mTc]Hexamethylpropylene amine oxime (HMPAO) single photon emission computed tomography (SPECT) brain scans were undertaken in six subjects with body dysmorphic disorder (BDD). The scans showed a broad range of discrepant findings that do not immediately support a view of BDD as resting on either an obsessive-compulsive or affective disorder spectrum. Nevertheless, involvement of parietal regions is consistent with the characteristic altered body perception of BDD. These preliminary data highlight the need for further systematic functional imaging studies of this condition.

Neuropsychiatric Sequelae of Nipah Virus Encephalitis

Abstract: The authors followed nine patients with Nipah virus encephalitis over the course of 24 months. Eight of the nine developed psychiatric features assigned to the encephalitis. Three patients developed major depressive disorder immediately after recovering from the encephalitis, and two developed depression approximately 1 year after the outbreak. Two patients developed personality changes, and two suffered chronic fatigue syndrome. Neuropsychological testing was accomplished in eight of the nine patients. Deficits in attention, verbal, and/or visual memory were substantial in seven of the eight patients tested. Verbal memory was more impaired than visual memory in these patients. Comparison between psychiatric and cognitive impairment and total number of brain lesions showed no discernible trends.

Conversion hysteria: lessons from functional imaging.

Abstract: Cover and Figure 1. Regional cerebral blood flow (rCBF) was imaged with single photon emission computed tomography (SPECT) during vibratory stimulation of both limbs in 7 patients with hysterical sensorimotor loss prior to and after recovery. Decreased rCBF was found contralateral to the affected limb in thalamus, basal ganglia, and ventrolateral prefrontal cortex (BA 11, BA 44/45) prior to recovery (used with permission).

Comparison between olanzapine and haloperidol on procedural learning and the relationship with striatal D2 receptor occupancy in schizophrenia.

Abstract: The striatum is known to play a primary role in procedural learning. In this study, the authors simultaneously assessed the effects of two antipsychotic drugs on procedural learning and on striatal dopamine (D2) receptor occupancy. Twenty-seven patients receiving either olanzapine or haloperidol as antipsychotic medication were assessed with the Computed Visual Tracking Task (CVTT) and Single Photon Emission Computed Tomography (SPECT) following the administration of Iodine 123-IBZM (123I-IBZM), a radioligand with a high affinity and specificity for the D2 receptors. The results showed poorer procedural learning in the haloperidol-treated patients than in normal control subjects, while no difference could be found between olanzapine-treated patients and normal control subjects. In the haloperidol but not the olanzapine group, significant correlations were found between procedural learning deficits and striatal D2 receptor occupancy. However, there was no significant difference in D2 receptor occupancy bet...

Cavum septum pellucidum and its increased prevalence in schizophrenia: a neuroembryological classification.

Abstract: Thirty-two female (mean age=52.9 years [SD=9.2]) patients with a diagnosis of residual schizophrenia and 19 female (mean age=51.1 years [SD=12.7]) control subjects were studied through cerebral Magnetic Resonance Imaging. Along the entire surface of the septum pellucidum, 1-mm coronal slices were performed in all subjects. The authors classified the cavum septum pellucidum into three types based on embryological development. The prevalence of a cavum was significantly higher in the patients with schizophrenia (Chi square 6.112. p < 0.05). No other significant associations with previously described morphological brain changes were found. Although this result was found in previous reports (DeGreef et al., 1992; DeLisi et al., 1993), our discussion focused on the neurodevelopmental theory of the septum pellucidum and its possible association with schizophrenia.

Cognitive impairment and psychiatric symptoms in 133 Patients with diseases associated with Cerebellar Degeneration.

Abstract: The authors performed a chart review to determine the frequency with which neurologists detect cognitive and psychiatric symptoms in patients with cerebellar degeneration. Psychopathology, including depression, personality change, cognitive impairment, anxiety, and psychosis was noted in 51% of 133 patients.