bluuebunny/crossref_metadata_2025 huggingface dataset:
Considerations on the Role of Genetics in Psychiatric Research
Authors: Placidi Giovanni P. A. , Boldrini Maura
Published: August 2016

During the last 30 years, several studies in psychiatric genetics have been conducted. These include a series of clinical and family-oriented studies on genetic factors in schizophrenia, alcoholism, and manic-depressive disorder. Since these trials have taken place, great emphasis has been placed on the hypothesis that psychiatric disorders could have a genetic vulnerability. This hypothesis is supported by significant advancements in biological and mathematical analysis methods, as well as by the large number of epidemiological and diagnostic studies on the prevalence of psychiatric disorders in patients' families. This article provides on overview of this research.

Many other hypotheses have been raised by the optimism of research, but are often followed by experimental failures. There are several pitfalls in methods, ranging from sample selection to genotyping to statistical analysis methods. Finally, the interpretations of the results often have been misunderstood. Nonetheless, this body of research contributes to future genetic perspectives in psychiatry.
Personality Disorders: Myths and Neuroscience
Authors: Pallanti Stefano
Published: August 2016

In the field of personality, the application of neuroscientific techniques is faced with a clinical category that is still unsatisfactory. The adoption of a coevolutionist, perspective-associated, multidimensional construct is a suggested way to improve clinical models to match the sophisticated techniques of neuroscience.
Pathophysiology of Basal Ganglia Disorders
Authors: Lou Jau-Shin
Published: August 2016

Parkinson's disease is the most common basal ganglia disorder that is caused by the degeneration of dopaminergic neurons in the substantia nigra. This article reviews the normal physiology of the basal ganglia in the normal state, as well as the pathophysiology of Parkinson's disease (PD) and other movement disorders associated with the basal ganglia. Also discussed is the pathophysiological basis for the surgical treatment of PD.
Origins of the Panic-Agoraphobic Spectrum and Its Implications for Comorbidity
Authors: Pini Stefano , Maser Jack D. , Dell'Osso Liliana , Cassano Giovanni B.
Published: August 2016

Available data from the literature supporting the hypothesis that partial manifestations of the panic-agoraphobic spectrum may be as clinically relevant as a full-fledged syndrome were reviewed. These partial expressions of disorder may occur singly or in connection with other mental disorders. In particular, we have examined evidences indicating relationships of panic-agoraphobic spectrum with other mental disorders in childhood and adolescence and with psychotic disorders. Their importance in childhood and adolescence is significant because we believe that these symptoms influence adult behavior and are viewed, at a later time, as atypical symptoms. Panic-agoraphobic spectrum syndromes, both in their full-fledged and partial manifestations frequently co-occur with other mental disorders and are likely to be associated with significant impairment either when occurring singly, partially, or comorbidly. Several conditions typical of childhood, such as separation anxiety, school phobia, and other symptoms related to the concept of “behavioral inhibition” seem to be connected with the panic-agoraphobic spectrum and deserve attention in relation to the development of different anxiety and mood disorders in subsequent phases of the life cycle. Identification of panic-agoraphobic spectrum features is also important within the realm of psychoses where they may substantially affect phenomenology, course of illness, and treatment response.
Panic-Agoraphobic Spectrum and Cardiovascular Disease
Authors: Miniati Mario , Mauri Mauro , Dell'Osso Liliana , Pini Stefano , Mengali Francesco , Shear Katherine , Maser Jack D. , Grochocinski Victoria , Frank Ellen , Cassano Giovanni B.
Published: August 2016

Panic disorder occurs frequently with different forms of cardiovascular disease and hypertension. The 13 panic symptoms described in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) often overlap with manifestations of cardiovascular disorders, raising problems in the differential diagnosis. In order to explore in greater detail the phenomenology of panic symptoms in cardiovascular patients, the Structured Clinical Interview for Panic-Agoraphobic Spectrum (SCI-PAS) was administered to 111 patients with hypertension and 29 patients with a recent myocardial infarction.

With regard to the frequency of endorsement of many of the symptoms assessed on the SCI-PAS, more than 40% of the cardiovascular patients who failed to meet the DSM-IV criteria for panic disorder did not significantly differ from the 10% of cardiovascular patients who did fulfill the criteria for panic disorder. A third distinct subgroup comprising 48.6% of the cardiovascular patients reported a significantly smaller number of SCI-PAS symptoms than the other two groups.

These preliminary findings suggest the existence of a relatively large proportion of cardiovascular patients who present with physical and psychological symptoms that are potentially related to panic disorder and that may provoke considerable subjective distress. Further studies are needed to clarify the nature of these symptoms and their potential interference with treatment and symptomatology of cardiovascular disease.
Pharmacologic Approaches in the Treatment of Pathological Gambling
Authors: Hollander Eric , Begaz Tomer , DeCaria Concetta M.
Published: August 2016

Pathological gambling is an understudied disorder that causes significant distress to sufferers, their families, and society. Despite its prevalence among the general population, the impact of pathological gambling remains largely unrecognized by many health care providers. Although a discrete entity, pathological gambling shares salient characteristics with addiction and obsessive-compulsive disoders, and is comorbid with these and other conditions such as attention-deficit hyperactivity disorder in a large number of cases. Recognizing these similarities has significant implications for treatment, as pharmacologic therapies used for these disorders, including serotonergic and mood-stabilizing agents, have shown some degree of efficacy in pathological gambling.
Behavior Therapy and Pharmacotherapy for Trichotillomania: Choice of Treatment, Patient Acceptance, and Long-Term Outcome
Authors: Keuthen Nancy J. , O’Sullivan Richard L. , Goodchild Paige , Rodriguez Dayami , Jenike Michael A. , Baer Lee
Published: August 2016

Sixty-three trichotillomania (TTM) patients treated in a specialty clinic were retrospectively studied for treatment referral patterns, comparison of treatment outcomes, and long-term follow-up. Patients subjectively rated their individual treatments based on success, logicality, confidence in recommending the treatment to others, outcome expectations, and compliance. Subjects referred for combined behavior therapy (BT) and medication treatment (MT) were more depressed, more anxious, and reported greater psychosocial impairment and impact secondary to hair pulling than individuals referred for either treatment alone. Neither the Massachusetts General Hospital Hair Pulling Severity Scale (HPS) nor the Rosenberg Self-Esteem Scale (SES) scores differed between those referred for combined treatment vs those receiving monotherapy. The combination therapy patients showed a greater reduction in HPS scores than those receiving single-modality treatment and no longer differed significantly from monotherapy patients following treatment in terms of Beck Depression Inventory (BDI), Beck Anxiety Index (BAI), and Sickness Impact Profile (SIP) scores. Patients treated with both BT and MT rated BT as more successful and had greater confidence in recommending the intervention. Conversely, compliance was significantly higher for MT than BT. Other treatments, especially support groups, were rated positively. Comparison of patients currently receiving treatment with those no longer in active treatment revealed no statistically significant differences. Ten of 19 patients who were out of treatment for over 1 year rated themselves as treatment responders. Significant improvements in HPS, BDI, BAI, and SES scores were reported in the few hair pullers out of treatment more than 1 year for whom objective rating scale scores were available.
Trichotillomania, Obsessive-Compulsive Disorder, and Tourette Syndrome: Comorbid Relationships and Risks for Expression
Authors: O'Sullivan Richard L. , Miguel Euripedes C. , Coffey Barbara , Rauch Scott L. , Savage Cary , Keuthen Nancy J. , Baer Lee , Jenike Michael A.
Published: August 2016

Trichotillomania (TTM, repetitive hair pulling) is a complex underdiagnosed syndrome that often causes considerable psychological distress and physical disfigurement. Although many aspects of hair pulling bear similarity to compulsions of obsessive-compulsive disorder (OCD), TTM lacks obsessions associated with OCD. The phenomenology of TTM also is similar to tics in Tourette Syndrome (TS) and overlaps with TS in both limited structural neuroimaging data and in terms of treatment response to pharmacotherapy with dopamine antagonists.

In order to study potential comorbid relationships between TTM, TS, and OCD, a total of 61 patients with either TS, OCD, or OCD comorbid with TS were assessed using structured interviews as part of a phenomenological study of these groups. Post hoc analyses indicated significantly higher proportions of hair pulling in those subjects with OCD comorbid with TS compared to subjects with either OCD or TS alone.

These data, in conjunction with clinical phenomenology, neuroimaging results, and response to pharmacotherapy suggest the possibility that some forms of TTM may be more closely related to tic disorders than OCD. Futher research is needed to clarify and confirm these observations of putative relationships between TTM and TS and potential treatment implications.
Demographics, Prevalence, and Clinical Features of the Schizo-obsessive Subtype of Schizophrenia
Authors: Dominguez Roberto A. , Backman Karl E. , Lugo Susana C.
Published: August 2016

The schizo-obsessive subtype of schizophrenia has been proposed to describe the condition of patients with chronic psychotic disorders and prominent obsessive-compulsive (OC) symptoms. These patients differ from others with schizophrenia not only in their psychopathology, but perhaps also in their prognosis and pharmacotherapeutic response. Potent serotonin reuptake blockers, such as clomipramine, fluvoxamine, andfluoxetine, in conjunction with antipsychotics, can prove helpful in improving these patients' OC symptoms. The current study to access the demographics, prevalence, and clinical features of the schizo-obsessive subtype included established outpatients with a principal diagnosis of schizophrenia or schizoaffective disorder treated at a large urban public hospital. More than 50% of the hospital's psychiatric population is Hispanic. The Modified Maudsley Obsessive Compulsive Inventory (MMOCI) was used to identify prominent compulsive symptoms. Of the 52 patients who fulfilled the specific screening criteria, 17 (33%) also had prominent OC symptoms. Surprisingly, there was a statistical trend (P=0.06) for Hispanic patients to meet our threshold for the schizo-obsessive subtype. The MMOCI proved to be an adequate and efficient self-rated screening tool. The prevalence of the schizo-obsessive subtype, especially among Hispanic patients, highlights the importance for mental health professionals working with this population to identify and appropriately treat this group of patients.
The Savant Syndrome and Autistic Disorder
Authors: Treffert Darold A.
Published: August 2016

Savant syndrome, characterized by remarkable islands of mental ability in otherwise mentally handicapped persons, may occur in autistic as well as nonautislic individuals. Overall, approximately 10% of autistic persons exhibit savant abilities; roughly 50% of those with savant syndrome have autism, and the remaining 50% have other forms of developmental disability. Most commonly, savant syndrome takes the form of extraordinary musical abilities, but may also include calendar-calculation, artistic, mathematical, spatial, mechanical, and memory skills. While savant syndrome was first described more than a century ago, only recently have researchers begun to employ a more uniform nomenclature and more standardized testing in an effort to compare the abilities of savants with those of normal persons. Males show signs of savant syndrome approximately four times more often than females. Along with imaging study findings, this fact suggests the presence of a developmental disorder involving left-brain damage with right-brain compensation.
Predictors of Physical Aggression in Children With Attention-Deficit/Hyperactivity Disorder
Authors: Marks David J. , McKay Kathleen E. , Himelstein Jessica , Walter Katharine J. , Newcorn Jeffrey H. , Halperin Jeffrey M.
Published: August 2016

The present investigation examined factors that predict physical aggression in children with attention-deficit/hyperactivity disorder (ADHD). Stepwise, multiple regression-analyses were used to examine predictors of children's physical aggression as rated by parents at a 1-year follow-up point and by teachers at both 1- and 2-year follow-up points. Early parent and teacher ratings of verbal aggression (ie, cursing, teasing, and threatening) accounted for the greatest proportion of the variance in physical aggression ratings obtained at follow-up. None of the other predictor variable, including early ratings of physical aggression and ADHD behaviors, contributed significant additional variance beyond that accounted for by early verbal aggression ratings. Temporal and cross-informant analyses revealed that the relationship between verbal aggression and later physical aggression was situation-specific for teacher ratings but no parent ratings. Although physical aggression may emerge early in development, these data suggest that verbal aggre sion represents a stable, temperamental characteristic that may be of greater value than early physical aggression for predicting later physically aggressive acts.
Neuroimaging Research and Neurocircuitry Models of Obsessive-Compulsive Disorder: Proceedings of the Third IOCDC
Authors: Rauch Scott L. , Benkelfat Chawki , Dager Stephen R. , Greenberg Benjamin D. , Hendler Talma , Hollander Eric , Laruelle Marc , Rosenberg David R. , Saxena Sanjaya , Zohar Joseph , Baxter Lewis R.
Published: August 2016

A summary of the Third International Obsessive Compulsive Disorder Conference proceedings on neuroimaging research and neurocircuitry models of obsessive-compulsive disorder (OCD) is presented. This survey of recent and ongoing research indicates that a wide range of modern techniques and experimental strategies are being employed in a complementary fashion to enhance our understanding of OCD. Imaging studies in animal models of OCD are helping to elaborate relevant normal anatomy and neuro-chemistry. Functional imaging methods are being employed in conjunction with behavioral, pharmacologic, and cognitive challenge paradigms. Magnetic resonance spectroscopy as well as radiotracer methods are being utilized to measure neurochemical and neuropharmacologic indices in OCD. Transcranial magnetic stimulation has emerged as a tool for probing neurocircuitry that may also have therapeutic potential. Experimental designs and data-analytic methods are evolving to help elucidate the pathophysiology of OCD and related disorders, delineate neurobiologically meaningful subtypes of OCD, and identify potential predictors of treatment response. Collectively, these efforts promise important advances as we approach the new millennium.
Evidence for Immune Etiology in Clozapine-Induced Thrombocytopenia of 40 Months' Duration: A Case Report
Authors: Gonzales M. Francisco , Elmore James , Luebbert Charlotte
Published: August 2016

Platelet dysfunction and thrombocytopenia rarely occur during clozapine therapy, but constitute an important source of morbidity and mortality if they are not detected and therapy is discontinued. The manufacturer recommends discontinuing clozapine when the platelet count falls below 100,000/μL and resuming therapy when the count returns to within normal range (150,000–450,000/μL). If thrombocytopenia recurs, clozapine should be permanently discontinued.

The authors report a rare case of long-term thrombocy-topenia persisting 40 months postclozapine treatment. In addition, increased in vitro platelet [14C] serotonin release was observed in the presence of the drug, suggesting an immune-related cause for the thrombocytopenia.

G.W., a 43-year-old African-American man, had been treated in the South Carolina Department of Mental Health since 1974 with a diagnosis of schizophrenia of chronic undifferentiated type, along with severe paranoid, delusional, threatening, and assaulting behavior. There was no history of illicit drug use. He had received intramuscular fluphenazine deconoate and haloperidol, as well as other neuroleptics, with little benefit observed during his years of treatment.

Clozapine was initiated at 25 mg bid on July 2, 1993, and was gradually increased to 650 mg daily over the next 20 months. After 7 weeks on this dose, the patient's platelet count fell from 103,000/μL to 60,000/μL, and clozapine was discontinued. A week later, the count had improved to 109,000/μL; 3 weeks later, with the platelet count at 109,000/μL, clozapine was reintroduced and titration started. However, within 7 days, his platelet count fell to 70,000/μL and clozapine was permanently stopped.
Onset of Obsessive-Compulsive Disorder: Premorbid Conditions and Prodromal Phase
Authors: Maina Giuseppe , Albert Umberto , Bogetto Filippo , Ravizza Luigi
Published: August 2016

This article focuses on the clinical onset of obsessive-compulsive disorder (OCD), specifically addressing the of onset, gradual and acute onset, and whether there are some types of premorbid conditions or a prodromal phase that predispose individuals to the onset of OCD. Clinical and epidemiological studies have come to different conclusions regarding age at onset as well as regarding differences between the sexes. Data gleaned from research to date have demonstrated a relationship between OCD and obsessive-compulsive personality disorder (OCPD), although OCPD does not appear to be the more prevalent personality disorder among patients with OCD. Preliminary research has suggested that Axis I disorders may predispose individuals to OCD onset; however, the significance of this relationship remains to be clarified. Evidence of the association between OCD and subthreshold obsessive-compulsive syndrome suggests that these disorders lie on a continuum of severity, with some cases developing OCD while others do not.
The Effect of Smoking on Brainstem Auditory Evoked Potentials in Positive- and Negative-Symptom Schizophrenia
Authors: Mubarak Ahmed , Badawy Adel
Published: August 2016

Studying brainstem auditory evoked potentials (BAEPs) and comparing the specific waves in smokers vs nonsmokers in both positive- and negative-symptom schizophrenia may elucidate the role of smoking in information processing. BAEPs were recorded in 40 patients with schizophrenia; 20 had predominantly positive symptoms (10 smokers and 10 nonsmokers) and 20 had predominantly negative symptoms (10 smokers and 10 nonsmokers). The severity of positive and negative symptoms was assessed by scale of assessment of positive symptoms and scale of assessment of negative symptoms (SANS). The BAEP results were compared with 15 healthy control individuals matched with the patients by age, sex, and cultural background. The smokers with negative symptoms showed a significant increase in the alogia, summary, and composite scores of SANS as compared to the nonsmokers. Although, most of the BAEP abnormalities were among patients with positive symptoms. The effect of smoking on the BAEPs was only in patients with negative symptoms.

We also studied the interaction between smoking factor (smokers vs nonsmokers) and group type (group with mostly positive symptoms vs group with mostly negative symptoms) on the BAEPs and found a significant difference only for the first-wave latency mainly on the right side (P=0.012). The absence of a significant effect of smoking on most of the parameters of the BAEPs on interaction with the group factor suggests that the effect of smoking on the BAEPs is more apparent when negative symptoms prevail. However, studies are warranted to substantiate this finding.
Treatment Considerations for Anxiety in the Elderly
Authors: Lenze Eric J. , Pollock Bruce G. , Shear M. Katherine , Mulsant Benoit H. , Bharucha Ashok , Reynolds Charles F.
Published: August 2016

Anxiety is common in the elderly and can present as a primary anxiety disorder or as a symptom of another disorder. Generalized anxiety disorder, in particular, is a common syndrome in late life. Anxiety symptoms are also common features of late-life depression and dementia. Treatment of anxiety in elderly persons has typically involved the use of benzodiazepines, which are often effective but problematic because they are associated with increased risk of cognitive impairment, falls, and fractures. Based on their safety and efficacy, antidepressants, particularly serotonergic medications, are considered first-line treatment for most anxiety disorders as well as anxiety symptoms of major depressive disorder. Psychotherapy, particularly cognitive-behavioral therapy, may be effective in these disorders as well; research is underway to adapt this therapy to the needs of elderly persons. Anxiety symptoms in dementia are poorly understood but may respond to atypical antipsychotics, serotonergic antidepressants, or mood stabilizers. Overall, the research in late-life anxiety has not caught up to the literature in late-life depression and, for the most part, treatment recommendations must be extrapolated from studies in young adults.
New Developments in Autism Clinical Trials
Authors: Hollander Eric , Robinson Ricki , Compton Doug
Published: August 2016

This issue of CNS Spectrums represents a milestone for both those affected by autism and related disorders and for clinicians and researchers who provide help and support to these individuals. In order to improve the lives of a rapidly increasing number of patients with this diagnosis, it is critical for the medical and research community to apply a collaborative and consistent strategy for clinical studies in autism.

The five articles that follow are a synopsis of the five subcommittees of the Autism Clinical Trials Task Force (ACTTF), a collaborative panel of experts convened by the Cure Autism Now (CAN) foundation in the spring of 2002. These subcommittees focused on key issues in clinical trials of autism, including subject selection, outcome measures, study design, biological measures, and governmental issues. CAN brought together this panel of participants from academia, government, and industry for the ACTTF think tank. The panel was organized and chaired by Eric Hollander, MD, and Ricki Robinson, MD, MPH. The overarching goal was to clarify what was known about the state of the art of the field in this area, what key information was still unknown, and to implement specific approaches and suggestions for studies which would provide information to fill in the missing gaps in our knowledge base.
Comorbidity in Compulsive Hoarding: A Case Report
Authors: Kaplan Alicia , Hollander Eric
Published: August 2016

A 56-year-old male presented with compulsive hoarding along with attention-deficit/hyperactivity disorder and schizotypal personality disorder. Hoarding has been described as difficult to treat both pharmacologically and behaviorally, and this patient's comorbid conditions also contributed to his overall impairment. The patient's treatment regimen of fluvoxamine, amphetamine salts, and risperidone, along with behavioral therapy, has helped with hoarding behaviors, motivation, procrastination, and increased socialization. Hoarding may be a unique subtype of obsessive-compulsive disorder with poorer prognosis and distinct neuroanatomic dysfunction. Augmentation with stimulants may provide benefits in aspects of hoarding such as procrastination, especially in patients with comorbid attention-deficit hyperactivity disorder.
Effectiveness and Safety of Epilepsy Surgery: What is the Evidence?
Authors: Wiebe Samuel
Published: August 2016

Evidence from a recent randomized controlled trial of surgical versus medical therapy of temporal lobe epilepsy proves that antero'mesial resection is safe and more effective than medical therapy. The number of patients needed to treat for one patient to become free of disabling seizures is two, which is superior to most interventions in neurology. A meta-analysis of non-randomized trials gives almost identical results; about two-thirds of patients become seizure-free, compared with only 8% with medical therapy. The results are remarkably similar among studies from different parts of the world. Quality of life improves early after epilepsy surgery, the improvements are both statistically and clinically significant, and they are sustained. Surgical morbidity with clinically important permanent sequelae is 2%. Epilepsy surgery remains underutilized in developed countries and it does not exist in all but a few developing countries. Current randomized trials are underway to explore the effect of early surgery versus optimum medical therapy on the prevention of disability in patients with mesial temporal lobe epilepsy, and to examine the effectiveness of novel interventions, such as minimally invasive surgery and brain stimulation.
Cholinesterase-inhibitor Therapy for Dementia: Novel Clinical Substrates and Mechanisms for Treatment Response
Authors: Kaufer Daniel I.
Published: August 2016

Historically, drugs that increase central cholinergic transmission have primarily been investigated for relieving cognitive symptoms in mild-to-moderate Alzheimer's disease. These efforts have led to the somewhat unexpected findings that cholinergic therapy has a beneficial effect on selected neuropsychiatric symptoms in AD across disease stages. In Parkinson's disease with dementia and dementia with Lewy bodies, cholinergic deficits are more severe than in AD, and there is emerging evidence that cholinesterase inhibitors are efficacious in treating core symptoms of attentional disturbance and psychosis. Recent data also suggest a rational basis for cholinergic therapy in vascular dementia. The cognitive and neuropsychiatric effects of cholinergic therapy observed in AD and other dementias form the crux of an integrative model of cholinergic therapeutic efficacy that encompasses the diverse central nervous system actions of acetylcholine and its complementary interactions with central monoamine transmitters. This heuristic framework highlights the broader therapeutic potential of cholinergic therapy for symptom-based indications in other neuropsychiatric disorders.
Prevalence of Mood Symptoms and Depressions During Pregnancy: Implications for Clinical Practice and Research
Authors: Halbreich Uriel
Published: August 2016

A review of the literature demonstrates that the incidence of new mental disorders and their prevalence during pregnancy is similar to the 12-month incidence of mental disorders in women during other periods of their lives. The prevalence of severe mood, behavior, and cognitive symptoms during pregnancy is rather high. Severe mental symptoms during pregnancy have been reported to be associated with an increased rate of complications during pregnancy and delivery, preterm deliveries, low birth weight, a higher rate of postpartum depression, and a longer-term impact on the offspring's development. Several pre-pregnancy risk factors to develop dysphoric symptoms have been reported, but their utility for primiparous women with no previous history of mental disorders is unclear. The association of mental symptoms with general symptoms and biological changes during pregnancy is also unclear. Given the short- and long-term impact of dysphoric symptoms and stress during pregnancy on mother and child, efficacious, efficient, and safe prevention and treatment modalities are essential and achievable. Clarification of the nature and phenotyping of mental and general symptoms during pregnancy is an important step for the development of effective interventions.
Multiple Perspectives on Cognition in Schizophrenia
Authors: Harvey Philip D.
Published: August 2016

Cognition in schizophrenia is a topic of major importance and steadily increasing interest. As evidence of this fact, the Mount Sinai School of Medicine Conference on cognition in schizophrenia has had increased attendance at each of its six meetings over the last 10 years. These meetings are official satellites of the International Congress on Schizophrenia Research, a meeting that has had skyrocketing attendance figures over the last decade. The articles in this issue of CNS Spectrum are among those presented at the latest Mount Sinai meeting, in April of 2003 in Colorado Springs, Colorado.

One of the factors that has lead to the increased interest in cognition is a clearer appreciation of the functional relevance of cognitive impairments. Since functional deficits are a major source of the indirect cost of schizophrenia and a major source of the reductions in quality of life seen in schizophrenia, which are substantial, cognition has the potential to be a major point of intervention. In addition to “purely cognitive” impairments, patients with schizophrenia have deficits in what is typically referred to as “social cognition” as well. This ability area is defined as the ability to understand social cues and affective displays. It may serve as a critical intermediate function that mediates the performance of socially skilled acts.
Repetitive Transcranial Magnetic Stimulation Improves Depersonalization: A Case Report
Authors: Jiménez-Genchi Alejandro M.
Published: August 2016

Depersonalization disorder is a poorly understood and treatment-resistant condition. This report describes a patient with depersonalization disorder who underwent six sessions of repetitive transcranial magnetic stimulation on the left dorsolateral prefrontal cortex. Repetitive transcranial magnetic stimulation produced a 28% reduction on depersonalization scores.
Genetics in Eating Disorders: State of the Science
Authors: Bulik Cynthia M. , Tozzi Federica
Published: August 2016

Eating disorders have been viewed as psychiatric illnesses that are strongly influenced by societal pressures towards thinness and attractiveness. Although the environmental context of these disorders must not be neglected, recent research in the area of genetic epidemiology suggests a substantial influence of genetic factors on liability to eating disorders. This review presents a synthesis of current knowledge about genetic factors implicated in the etiology of eating disorders.
Exercise “Addiction” in Anorexia Nervosa: Model Development and Pilot Data
Authors: Klein Diane A. , Bennett Andrew S. , Schebendach Janet , Foltin Richard W. , Devlin Michael J. , Walsh B. Timothy
Published: August 2016

Background:

Excessive exercise has long been observed to be a problematic behavior of many patients with anorexia nervosa (AN). However, many questions remain as to the exact role exercise plays in this disorder. In particular, it has been suggested that exercise holds “addictive” properties in persons with AN, but that remains to be demonstrated.

Objective:

The aim of this study was to adapt and apply a scale used in addictions research to determine whether symptoms of “dependence” to exercise could be measured in a group of women with AN.

Results:

Forty-eight percent of individuals assessed endorsed symptoms consistent with exercise dependence in the previous month. The number of criteria met for exercise dependence was directly correlated with a clinical measure of anxiety.

Conclusion:

Results support further investigation into addictive properties for exercise in individuals with AN and its relationship to anxiety.
Selective Antagonism of GABAA Receptor Subtypes: An In Vivo Approach to Exploring the Therapeutic and Side Effects of Benzodiazepine–Type Drugs
Authors: Rowlett James K. , Cook James M. , Duke Angela N. , Platt Donna M.
Published: August 2016

Benzodiazepines (BZs) are clinically used as anxiolytic, hypnotic, anticonvulsant, and antispasmodic drugs. Research using transgenic mouse models has suggested that the effects of BZs involve multiple subtypes of the γ-aminobutyric acid type A (GABAA) receptor, identified by specific α subunits (α1, α2, α3, α5). This review discusses the experimental uses of β-carboline-3-carboxylate-t-butyl ester (βCCT), a drug that binds preferentially to the GABAA α1 subtype but exerts no action (ie, is a pharmacologic antagonist at the GABAA α1 subtype receptor). βCCT blocks the anxiolytic-like effects of BZs, although studies in primates suggests this antagonism may reflect multiple receptor populations. βCCT antagonized the ataxic but not muscle relaxant effects of BZs, a finding that implicates the GABAA α1 subtype receptor in ataxia but not muscle relaxation. The potential clinical utility of βCCT is discussed, both in terms of treatment (ie, hepatic encephalopathy) and as a diagnostic imaging agent. Altogether, these results indicate that subtype-selective antagonists represent a useful approach to studying receptor mechanisms underlying the behavioral effects of BZ-type drugs.
A Linkage Study Between the GABAA β2 and GABAAγ2 Subunit Genes and Major Psychoses
Authors: Ambrósio Alda M. , Kennedy James L. , Macciardi Fabio , King Nicole , Azevedo Maria H. , Oliveira Catarina R. , Pato Carlos N.
Published: August 2016

Background:

Alterations of the γ-aminobutyric acid (GABA) system have been implicated in the pathophysiology of major psychoses.

Objective:

Restriction fragment length polymorphisms associated with the human γ-aminobutyric acid type A (GABAA) β2 and GABAA γ2 subunit genes on chromosome 5q32-q35 were tested to determine whether they confer susceptibility to major psychoses.

Methods:

Thirty-two schizophrenic families and 25 bipolar families were tested for linkage.

Results:

Nonparametric linkage (NPL) analysis performed by GENEHUNTER showed no significant NPL scores for both genes in schizophrenia (GABAAβ2: NPL narrow=−0.450; NPL broad=−0.808; GABAA γ2: NPL narrow=0.177; NPL broad=−0.051) or bipolar disorder (GABAA β2: NPL narrow=0.834; NPL broad=0.783; GABAA γ2: NPL narrow=−0.159; NPL broad=0.070).

Conclusion:

Linkage analysis does not support the hypothesis that variants within the GABAA β2 and GABAA γ2 genes are significantly linked to major psychoses in a Portuguese population.
APP23 Mice as a Model of Alzheimer's Disease: An Example of a Transgenic Approach to Modeling a CNS Disorder
Authors: Van Dam Debby , Vloeberghs Ellen , Abramowski Dorothee , Staufenbiel Matthias , De Deyn Peter Paul
Published: August 2016

Animal models are considered essential in research ensuing elucidation of human disease processes and subsequently, testing of potential therapeutic strategies. This is especially true for neurodegenerative disorders, in which the first steps in pathogenesis are often not accessible in human patients. Alzheimer's disease is vastly becoming a major medical and socioeconomic problem in our aging society. Valid animal models for this uniquely human condition should exhibit histopathological, biochemical, cognitive, and behavioral alterations observed in Alzheimer's disease patients. Major progress has been made since the understanding of the genetic basis of Alzheimer's disease and the development and improvement of transgenic mouse models. All present Alzheimer's disease models developed are partial but nevertheless essential in further unraveling the nature and spatial and temporal development of the complex molecular pathology underlying this condition. One of the more recent transgenic attempts to mode Alzheimer's disease is the APP23 transgenic mouse. This article describes the development and assessment of this human amyloid precursor protein overexpression model. We summarize histopathological and biochemical, cognitive and behavioral observations made in heterozygous APP23 mice, thereby emphasizing the model's contribution to clarification of neurodegenerative disease mechanisms. In addition, the first therapeutic interventions in the APP23 model are included.
Diagnosis and Prevention of Atherosclerotic Cerebral Infarction
Authors: Weinberger Jesse
Published: August 2016

Atherosclerotic disease accounts for ~25% of ischemic strokes. Atherosclerotic stroke is caused mainly by embolic events from the carotid artery bifurcation or the aortic arch, although intracranial thrombosis can occur, more often in African Americans, Asians, and diabetes patients. Primary prevention of stroke is critical for patients with risk factors for atherosclerosis, including hypertension, diabetes, smoking and hypercholesterolemia. Stroke can be prevented in patients with established atherosclerotic disease by identification and management of patients with carotid artery stenosis by non-invasive testing. Particular attention must be paid to patients with transient symptoms of brain ischemia.
Pregnancy and Stroke
Authors: Helms Ann K. , Kittner Steven J.
Published: August 2016

The risks of ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage are not increased in the 9 months of gestation except for a high risk in the 2 days prior and 1 day postpartum. The remaining 6 weeks postpartum also have an increased risk of ischemic stroke and intracerebral hemorrhage, though less than the peripartum period. Although there are some rare causes of stroke specific to pregnancy and the postpartum period, eclampsia, cardiomyopathy, postpartum cerebral venous thrombosis, and, possibly, paradoxical embolism warrant special consideration. The diagnostic and therapeutic approaches to stroke during pregnancy and the postpartum period are similar to the approaches in the nonpregnant woman with some minor modifications based on consideration of the welfare of the fetus. There is a theoretical risk of magnetic resonance imaging exposure during the first and second trimester but the benefit to the mother of obtaining the information may outweigh the risk. Available evidence suggests that low-dose aspirin (<150 mg/day) during the second and third trimesters is safe for both mother and fetus. Postpartum use of low-dose aspirin by breast-feeding mother is also safe for infant. While proper counseling is imperative, a history of pregnancy-related stroke should not be a contraindication for subsequent pregnancy.
Factors Associated with the Prodromal Progression of Schizophrenia that Influence the Course of the Illness
Authors: Bota Robert G. , Sagduyu Kemal , Munro J. Stuart
Published: August 2016

Objective:

This study examined factors influencing the prognosis of patients with different prodromal manifestations of schizophrenia and the association of diagnosis and antipsychotic treatment with the frequency of future acute inpatient care.

Methods:

Data was collected from the medical records of 24 patients initially diagnosed with schizophrenia.

Results:

Seventy-six percent of the patients (N=18) had at least one psychiatric assessment before the debut of schizophrenia. Patients who were assessed prior to the initial diagnosis of schizophrenia presented in two distinct time frames. Patients in the first wave received a different Axis I diagnosis, depending on the phase of prodrome upon time of initial evaluation. Receiving any Axis I diagnosis during the prodromal stage in wave one correlated with an increased need for acute inpatient treatment (P<.0001) in the following 3 years. Among the patients in wave two, those who received antipsychotic treatment required less acute inpatient care than those who did not (P=.004).

Conclusion:

Obtaining a psychiatric history of assessments and interventions during the prodromal period of schizophrenia can be useful for prognosis.
Operative Approaches for Intractable Temporal Lobe Epilepsy
Authors: Smith Kris A. , Shetter Andrew G.
Published: August 2016

Over the past half century, a number of advances have been made in surgical approaches to treating refractory temporal lobe epilepsy. This article explains some of the newer approaches and provides support for selective amygdalohippocampectomy. Appropriate preoperative workup, including various invasive monitoring techniques, is also described.
The Clinical Neurology of Tourette Syndrome
Authors: Erenberg Gerald
Published: August 2016

Tic disorders may manifest in a wide variety of clinical presentations, ranging from single tics of relatively short duration to a series of complex tics that may last for years. An understanding of the etiology of various tic disorders is essential to establish a differential diagnosis of Tourette syndrome (TS). Because TS is incurable, improvement in quality of life is the primary goal of pharmacologic therapy. Although neuroleptics have been the most effective medications to date in managing the symptoms of TS, they may have significant adverse effects that limit their use. Several alternative pharmacologic options are either available or under investigation.
Clinical Experience With Transdermal Nicotine Patch in Tourette Syndrome
Authors: Silver Archie A. , Shytle R. Douglas , Sanberg Paul R.
Published: August 2016

Stemming from the finding that nicotine potentiates haloperidol-induced catalepsy in rats, nicotine in the form of nicotine gum and as transdermal nicotine patch (TNP) has been used in open-label studies to obtund motor and vocal tics of children (age≥8 years, weighi≥25 kg), adolescents, and adults. Reduction of tics was seen during chewing of nicotine gum; the improvement lasted no longer than 1 hour after chewing. With a TNP in subjects who were not responding well to a variety of dopamine blockers, with some also receiving clonidine or a variety of selective serotonin reuptake inhibitors, motor and vocal tics were obtunded 45% over baseline in 85% of 35 subjects within 30 minutes to 3 hours after TNP application. Moreover, the relief of symptoms with a single 7-mg TNP, remaining on the skin for 24 hours, persisted for a variable period of time ranging from 1 to 120 days with an average of 10±2 days. Application of a second TNP for 24 hours when symptoms began to return resulted in a similar reduction in tic severity and frequency, which persisted an average of l3±3 days. Nicotine alone, without D2 blockers, was successful in reducing premonitory urges to tic. After follow-up of 3 to 5 years, 19 of 35 patients continued to use the TNP in gradually decreasing frequency and with gradual reduction in dose of D2 blockers. However, 16 patients (45%), as they grew into middle adolescence, discontinued use of the TNP, stating that they objected to the nausea induced by the patch. There was no evidence of habituation to nicotine. Side effects were not life threatenting; the most disturbing side effect was nausea, appearing 1 to 4 hours after the application of the patch and lasting 1 to 3 hours. There was no change in blood pressure; pulse rate increased from 5 to 10% within 3 hours but returned to baseline after 24 hours. Unsolved problems using TNP are mentioned and a putative mechanism for nicotine effectiveness in Tourette syndrome is briefly discussed.
The Shyness Spectrum
Authors: Chavira Denise A. , Stein Murray B.
Published: August 2016

Debate continues regarding the relationship between shyness and social phobia. Some have proposed that this relationship is best understood by adopting a spectrum approach where increasing levels of shyness eventually merge into the clinical disorder of social phobia. This paper begins to explore the validity of this spectrum by reviewing similarities and differences between shyness and social phobia and investigating how shyness relates to social phobia subtypes. This paper will also explore precursors to social phobia, namely childhood behavioral inhibition.
Psychostimulant Treatment of Stroke and Brain Injury
Authors: Flanagan Steven R.
Published: August 2016

Psychopharmacology is rapidly becoming an adjuvant treatment to traditional rehabilitation strategies for patients with stroke or brain injury because it helps to facilitate recovery in a time-efficient manner. Norepinephrine, dopamine, acetylcholine, and serotonin appear to play important roles in recovery from stroke or brain injury. Animal models have shown that blockade of these neurotransmitters inhibits recovery, whereas recovery is promoted by drugs that promote norepinephrine, dopamine, acetylcholine, and serotonin activity. Preliminary evidence from human trials supports these finding. Further study is needed, but expanded use of pharmacologic agents for stroke and brain-injured patients appears imminent.
Psychogenic Tremor: Long-Term Outcome
Authors: Jankovic Joseph , Vuong Kevin Dat , Thomas Madhavi
Published: August 2016

Introduction: Psychogenic disorders, also referred to as somatoform, conversion, somatization, hysteria, and medically unexplained symptoms, are among the most challenging disorders to diagnose and treat. Psychogenic movement disorders are increasingly encountered in specialized clinics, and represent ~15% of all patients evaluated in the Baylor College of Medicine Movement Disorders Clinic.

Objective: To characterize psychogenic tremor and provide data on prognosis and long-term outcome in a large group of patients with psychogenic tremor followed in a movement disorders clinic.

Methods: Patients evaluated at the Baylor College of Medicine Movement Disorders Clinic in Houston, Texas, between 1990 and 2003 with the diagnosis of psychogenic movement disorder (PMD), who consented to be interviewed, were administered a structured questionnaire designed to assess current motor and psychological function.

Results: psychogenic tremor is the most common PMD, accounting for 4.1 % of all patients evaluated in our clinic. We were able to obtain clinical information on a total of 228 of 517 (44.1%) patients with PMD, followed for a mean of 3.4±2.8 years. Among the 127 patients diagnosed with psychogenic tremor, 92 (72.4%) were female, the mean age at initial evaluation was 43.7±14.1 years, and the mean duration of symptoms was 4.6±7.6 years. The following clinical features were considered to be characteristic of psychogenic tremor: abrupt onset (78.7%), distractibility (72.4%), variable amplitude and frequency (62.2%), intermittent occurrence (35.4%), inconsistent movement (29.9%), and variable direction (17.3%). Assessment of long-term outcome showed that 56.6% of patients reported improvement in their tremor. Factors predictable of a favorable outcome were elimination of stressors and patient's perception of effective treatment by the physician.

Conclusion: This largest longitudinal study of patients with psychogenic tremor provides data on the clinical characteristics and natural history of this most common PMD. The accurate diagnosis of psychogenic tremor is based not only on exclusion of other causes but is also dependent on positive clinical criteria, the presence of which should avoid unnecessary investigation. The prognosis of psychogenic tremor may be improved with appropriate behavioral and pharmacologic management.