Journal of Neuropsychiatry and Clinical Neurosciences最新文献

{"title":"Empirical and Authoritative Classification of Neuropsychiatric Syndromes in Neurocognitive Disorders.","authors":"Toni Tapani Saari","doi":"10.1176/appi.neuropsych.21100249","DOIUrl":"https://doi.org/10.1176/appi.neuropsych.21100249","url":null,"abstract":"<p><p>Neuropsychiatric symptoms of neurocognitive disorders have been classified into higher-order constructs, often called neuropsychiatric syndromes. As with the general psychopathology literature, these classifications have been achieved through two approaches: empirical and authoritative. The authoritative approach relies on expert panels that condense the available evidence into operational criteria, whereas the empirical approach uses statistical methods to discover symptom patterns and possible hierarchies formed by them. In this article, the author reviews the strengths and weaknesses of both approaches using general psychopathology literature as a reference point. The authoritative approach, influenced by the <i>DSM</i>, has led to several sets of criteria, which could aid clinical trials, diagnostics, and communication. However, unknown reliability and the complex relationships between empirical evidence and published criteria may limit the utility of current criteria. The empirical approach has been used to explore syndrome structures on the basis of rating scales for neuropsychiatric symptoms. The structures suggested in these studies have not been replicated easily and have been limited by either small sample sizes, restricted breadth of neuropsychiatric assessment, or both. Suggestions for further development of both approaches are offered. First, neuropsychiatric symptoms and syndromes need to be studied with measures of broad scope and in large samples. These requirements are prerequisites not only for eliciting highly informative empirical classifications but also for understanding these symptoms at a more nuanced level. Second, both approaches could benefit from more transparency. Finally, the reliability of the available authoritative criteria should be examined.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":"35 1","pages":"39-47"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10534034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Tadd et al.","authors":"","doi":"10.1176/appi.neuropsych.21110269correction","DOIUrl":"https://doi.org/10.1176/appi.neuropsych.21110269correction","url":null,"abstract":"","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":"35 3","pages":"315"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9812897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Higher Health Service Costs Associated With Delayed Diagnosis of Functional Neurological Disorder.","authors":"Sofia Cuoco,&nbsp;Sara Scannapieco,&nbsp;Imma Carotenuto,&nbsp;Marina Picillo,&nbsp;Maria Teresa Pellecchia,&nbsp;Paolo Barone,&nbsp;Roberto Erro","doi":"10.1176/appi.neuropsych.21110288","DOIUrl":"https://doi.org/10.1176/appi.neuropsych.21110288","url":null,"abstract":"<p><strong>Objective: </strong>Functional neurological disorder (FND) is frequently encountered in clinical practice but commonly misdiagnosed, which might lead to higher direct costs for the health care system. The investigators analyzed the direct costs associated with the diagnosis of FND compared with costs associated with other neurological conditions and explored possible cost trends related to the clinical and demographic features of FND.</p><p><strong>Methods: </strong>Consecutive patients attending a general neurology clinic were recruited and underwent a structured assessment aimed to collect information pertaining to their demographic and clinical characteristics, as well as data regarding their prior diagnostic processes (e.g., the number of consulted specialists, number and type of investigations, emergency department visits, etc.). The costs were hence calculated and compared between the study groups.</p><p><strong>Results: </strong>A total of 155 consecutive patients were recruited; of these, 18.6% had FND, 55.84% had one or more other neurological disorder (OND), and 27.10% presented with comorbid FND and OND. The total prediagnostic costs (in euros [€]) were higher in the FND group compared with the OND group (median=€289, interquartile range [IQR] €385 vs. median=€98, IQR €216; Mann-Whitney U=879.5, p=0.04). There was a higher diagnostic delay in the FND group compared with the OND group (median=48 months, IQR 60 months vs. median=12 months, IQR 6 months; Mann-Whitney U=162.00, p<0.01). Diagnostic delay significantly correlated with the total costs in the entire study sample (Spearman's ρ=0.25, p=0.003) but more strongly in the FND group (Spearman's ρ=0.81, p<0.001). In the FND group, higher numbers of investigations and costs were associated with the presence of a physiological or psychological trigger and multiple symptoms.</p><p><strong>Conclusions: </strong>Delayed diagnosis of FND significantly affects health care system costs, and raising awareness about FND to improve the diagnostic process and outcomes is necessary.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":"35 1","pages":"86-91"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10527423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short Physical Performance Battery and Mediation of the Effect of Mild Cognitive Impairment on Falls by Community-Dwelling Older Adults.","authors":"Reza Amini,&nbsp;Quinn Counseller,&nbsp;Rebekah Taylor,&nbsp;Deena Fayyad,&nbsp;Rachelle Naimi","doi":"10.1176/appi.neuropsych.21050145","DOIUrl":"https://doi.org/10.1176/appi.neuropsych.21050145","url":null,"abstract":"<p><strong>Objective: </strong>The authors examined the association among cognitive function, falling, and physical performance among community-dwelling older adults (ages ≥65 years).</p><p><strong>Methods: </strong>Eight waves of the National Health and Aging Trends Study (NHATS; 2011-2018) were assessed, with 1,225 respondents who participated in all waves. The outcomes were self-reported number of falls and NHATS Short Physical Performance Battery (SPPB) score. The Clock Drawing Test measured participants' executive function, and immediate and delayed word recall tests assessed memory.</p><p><strong>Results: </strong>The analyses indicated no direct correlation between executive function and fall risk when controlled for contributing factors. However, executive function and memory significantly predicted the risk for poor physical performance, defined by the NHATS SPPB score. The interaction between pain medication and memory worsened poor physical performance among participants with mild and severe memory impairment, as well as among those with mild to moderate impairment in executive function.</p><p><strong>Conclusions: </strong>Screening older adults living in the community for executive function, memory impairment, and physical performance can predict the risk for falls and the subsequent consequences of falling.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":"35 1","pages":"59-68"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10529328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Study 6: The Diagnostic Challenge of a 75-Year-Old Man Who Had, Then Didn't Have, Then Did Have Alzheimer's Disease.","authors":"Sergio A Ramírez-Salazar,&nbsp;Cassie MacRae,&nbsp;Mel B Feany,&nbsp;Michael Miller,&nbsp;Hyun-Sik Yang,&nbsp;Mary-Ellen Meadows,&nbsp;Scott M McGinnis,&nbsp;David Silbersweig,&nbsp;Seth A Gale,&nbsp;Kirk R Daffner","doi":"10.1176/appi.neuropsych.20230097","DOIUrl":"10.1176/appi.neuropsych.20230097","url":null,"abstract":"","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":"35 4","pages":"325-332"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41236150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Psychiatric Disorder 6 Months After Traumatic Brain Injury in Children and Adolescents.","authors":"Jeffrey E Max,&nbsp;Imogen Drake,&nbsp;Florin Vaida,&nbsp;John R Hesselink,&nbsp;Linda Ewing-Cobbs,&nbsp;Russell J Schachar,&nbsp;Sandra B Chapman,&nbsp;Erin D Bigler,&nbsp;Elisabeth A Wilde,&nbsp;Ann E Saunders,&nbsp;Tony T Yang,&nbsp;Olga Tymofiyeva,&nbsp;Harvey S Levin","doi":"10.1176/appi.neuropsych.21120301","DOIUrl":"10.1176/appi.neuropsych.21120301","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the factors predictive of novel psychiatric disorders in the interval 0-6 months following traumatic brain injury (TBI).</p><p><strong>Methods: </strong>Children ages 5-14 years consecutively hospitalized for mild to severe TBI at five hospitals were recruited. Participants were evaluated at baseline (soon after injury) for pre-injury characteristics including psychiatric disorders, socioeconomic status (SES), psychosocial adversity, family function, family psychiatric history, and adaptive function. In addition to the psychosocial variables, injury severity and lesion location detected with acquisition of a research MRI were measured to develop a biopsychosocial predictive model for development of novel psychiatric disorders. Psychiatric outcome, including occurrence of a novel psychiatric disorder, was assessed 6 months after the injury.</p><p><strong>Results: </strong>The recruited sample numbered 177 children, and 141 children (80%) returned for the six-month assessment. Of the 141 children, 58 (41%) developed a novel psychiatric disorder. In univariable analyses, novel psychiatric disorder was significantly associated with lower SES, higher psychosocial adversity, and lesions in frontal lobe locations, such as frontal white matter, superior frontal gyrus, inferior frontal gyrus, and orbital gyrus. Multivariable analyses found that novel psychiatric disorder was independently and significantly associated with frontal-lobe white matter, superior frontal gyrus, and orbital gyrus lesions.</p><p><strong>Conclusion: </strong>The results demonstrate that occurrence of novel psychiatric disorders following pediatric TBI requiring hospitalization is common and has identifiable psychosocial and specific biological predictors. However, only the lesion predictors were independently related to this adverse psychiatric outcome.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":"35 2","pages":"141-150"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10317586/pdf/nihms-1913464.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9745399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preexisting Depression and Ambulatory Status After Stroke: Florida-Puerto Rico Collaboration to Reduce Stroke Disparities.","authors":"Amy K Starosciak, Kefeng Wang, Hao Ying, Kaushik Ravipati, Samantha Spring, Carolina M Gutierrez, Hannah Gardener, David Z Rose, Dianne Foster, Chuanhui Dong, Angus Jameson, Ayham Alkhachroum, Jose G Romano, Ralph L Sacco, Tatjana Rundek, Negar Asdaghi","doi":"10.1176/appi.neuropsych.20220211","DOIUrl":"10.1176/appi.neuropsych.20220211","url":null,"abstract":"<p><strong>Objective: </strong>Stroke is a global public health burden, and therefore it is critical to identify modifiable risk factors to reduce stroke incidence and improve outcomes. Depression is such a risk factor; however, the association between preexisting depression and stroke outcomes, such as independent ambulation, is not well studied, especially among racial-ethnic minority groups. To address this gap in the literature, effects of preexisting depression on ambulatory status at hospital discharge after stroke were evaluated among individuals participating in the racially and ethnically diverse Florida-Puerto Rico Collaboration to Reduce Stroke Disparities project.</p><p><strong>Methods: </strong>Data were analyzed from a total of 42,031 ischemic stroke patients, who were independently ambulatory prior to their stroke, after discharge from 84 hospitals between 2014 and 2017. Preexisting depression was confirmed by medical history or antidepressant medication use. Multilevel multivariate logistic regression analyses were used to assess the association of preexisting depression with independent ambulation at hospital discharge. Effects of sex and race-ethnicity on this association were examined.</p><p><strong>Results: </strong>Of 42,031 participants (mean±SD age=70.4±14.2 years; 48% were female; race-ethnicity: 16% Black, 12% Hispanic living in Florida, and 7% Hispanic living in Puerto Rico), 6,379 (15%) had preexisting depression. Compared with participants without depression, those with preexisting depression were older, were more likely to be female and non-Hispanic White, and had a greater burden of vascular risk factors or comorbid conditions. Independent ambulation at hospital discharge was less frequent among women, Black participants, and individuals with vascular risk factors or comorbid conditions. In multivariate models, preexisting depression decreased the likelihood of independent ambulation at discharge (odds ratio=0.88, 95% CI=0.81, 0.97). No interactions were found between preexisting depression and race-ethnicity or sex.</p><p><strong>Conclusions: </strong>Preexisting depression was independently associated with dependent ambulation at hospital discharge after stroke, regardless of sex and race-ethnicity. Treating depression may contribute to primary stroke prevention and could improve ambulatory status at discharge.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"361-367"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10754056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9793740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Study 4: A 68-Year-Old Woman With Progressive Cognitive Decline and Anxiety.","authors":"Rishab Gupta,&nbsp;Vihar Patel,&nbsp;Scott M McGinnis,&nbsp;David Silbersweig,&nbsp;Michael B Miller,&nbsp;Mel B Feany,&nbsp;Kirk Daffner,&nbsp;Seth A Gale","doi":"10.1176/appi.neuropsych.20220151","DOIUrl":"https://doi.org/10.1176/appi.neuropsych.20220151","url":null,"abstract":"","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":"35 1","pages":"4-11"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10540574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus Clinical Guidance for Diagnosis and Management of Adult COVID-19 Encephalopathy Patients.","authors":"Benedict D Michael,&nbsp;Dean Walton,&nbsp;Erica Westenberg,&nbsp;David García-Azorín,&nbsp;Bhagteshwar Singh,&nbsp;Arina A Tamborska,&nbsp;M Netravathi,&nbsp;Mashina Chomba,&nbsp;Greta K Wood,&nbsp;Ava Easton,&nbsp;Omar K Siddiqi,&nbsp;Thomas A Jackson,&nbsp;Thomas A Pollak,&nbsp;Timothy R Nicholson,&nbsp;Shalini Nair,&nbsp;Gerome Breen,&nbsp;Kameshwar Prasad,&nbsp;Kiran T Thakur,&nbsp;Sherry H-Y Chou,&nbsp;Erich Schmutzhard,&nbsp;Jennifer A Frontera,&nbsp;Raimund Helbok,&nbsp;Alessandro Padovani,&nbsp;David K Menon,&nbsp;Tom Solomon,&nbsp;Andrea S Winkler","doi":"10.1176/appi.neuropsych.22010002","DOIUrl":"https://doi.org/10.1176/appi.neuropsych.22010002","url":null,"abstract":"<p><p>Encephalopathy, a common condition among patients hospitalized with COVID-19, can be a challenge to manage and negatively affect prognosis. While encephalopathy may present clinically as delirium, subsyndromal delirium, or coma and may be a result of systemic causes such as hypoxia, COVID-19 has also been associated with more prolonged encephalopathy due to less common but nevertheless severe complications, such as inflammation of the brain parenchyma (with or without cerebrovascular involvement), demyelination, or seizures, which may be disproportionate to COVID-19 severity and require specific management. Given the large number of patients hospitalized with severe acute respiratory syndrome coronavirus-2 infection, even these relatively unlikely complications are increasingly recognized and are particularly important because they require specific management. Therefore, the aim of this review is to provide pragmatic guidance on the management of COVID-19 encephalopathy through consensus agreement of the Global COVID-19 Neuro Research Coalition. A systematic literature search of MEDLINE, medRxiv, and bioRxiv was conducted between January 1, 2020, and June 21, 2021, with additional review of references cited within the identified bibliographies. A modified Delphi approach was then undertaken to develop recommendations, along with a parallel approach to score the strength of both the recommendations and the supporting evidence. This review presents analysis of contemporaneous evidence for the definition, epidemiology, and pathophysiology of COVID-19 encephalopathy and practical guidance for clinical assessment, investigation, and both acute and long-term management.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":"35 1","pages":"12-27"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9525771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Systematic Review of Fragile X-Associated Neuropsychiatric Disorders.","authors":"Joshua Flavell,&nbsp;Catherine Franklin,&nbsp;Peter J Nestor","doi":"10.1176/appi.neuropsych.21110282","DOIUrl":"https://doi.org/10.1176/appi.neuropsych.21110282","url":null,"abstract":"<p><strong>Objective: </strong>Fragile X premutation carriers are reported to have increased neuropsychiatric problems, and thus the term fragile X-associated neuropsychiatric disorders (FXAND) has been proposed. Unfortunately, published prevalence estimates of these phenomena are inconsistent. This systematic review clarified this issue by reviewing both fragile X premutation prevalence in patients with neurodevelopmental disorders and psychiatric disorder prevalence in premutation carriers without fragile X-associated tremor/ataxia syndrome (FXTAS). Average prevalence was derived from studies that used semistructured clinical interviews, diagnostic criteria, and validated rating scales.</p><p><strong>Methods: </strong>Forty-six studies were reviewed. The rate of fragile X premutation in neurodevelopmental disorders was assessed from five studies. Probands with neurodevelopmental disorders were more likely than those in the general population to be premutation carriers. The rate of psychiatric disorders in premutation carriers was assessed from five studies for neurodevelopmental, 13 studies for mood, 12 studies for anxiety, and two studies for psychotic disorders. The phenotype and sex distribution among premutation carriers were similar to those with fragile X syndrome.</p><p><strong>Results: </strong>Compared to control group and general population estimates, the most prevalent psychiatric disorders were neurodevelopmental disorders, anxiety disorders, and bipolar II disorder. Psychiatric disorders were also more common in males. Most studies relied only on past medical history to define the prevalence of psychiatric disorders, yielding variability in results.</p><p><strong>Conclusions: </strong>Future studies are needed to avoid bias by identifying cohorts from population-based sampling, to describe cohort demographic characteristics to elucidate differences in age and sex, and to prioritize the use of validated psychiatric assessment methods.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":"35 2","pages":"110-120"},"PeriodicalIF":2.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9312806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}