Journal of Neuropsychiatry and Clinical Neurosciences最新文献

{"title":"Deep Brain Stimulation in Chronic Posttraumatic Stress Disorder: A Systematic Review.","authors":"Guillermo K Pons-Monnier, Mohamed M Elgohary, Kristen M Scheitler, Tyler Oesterle, Kendall H Lee, Maximiliano A Hawkes","doi":"10.1176/appi.neuropsych.20250055","DOIUrl":"10.1176/appi.neuropsych.20250055","url":null,"abstract":"<p><strong>Objective: </strong>Although high-frequency brain stimulation has demonstrated efficacy in various translational models of posttraumatic stress disorder (PTSD), there is a scarcity of studies investigating deep brain stimulation (DBS) in human PTSD populations. The authors sought to investigate the current state of DBS in the setting of treatment-resistant PTSD.</p><p><strong>Methods: </strong>A systematic search was performed in PubMed, Scopus, and Web of Science Core Collection databases by using keywords related to DBS and PTSD. A secondary search for gray literature was conducted in ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform.</p><p><strong>Results: </strong>Five articles reporting the effect of DBS on six patients with PTSD were retrieved. Electrodes were implanted bilaterally either in the basolateral amygdala (BLa; N=2) or in contact with the subgenual cingulum and uncinate fasciculus (SGC-UF; N=4). No significant perioperative complications related to BLa or SGC-UF lead implantation were reported in all five studies. BLa patients reported mild neuropsychiatric effects during stimulation. All but one patient had a significant decrease in Clinician-Administered PTSD Scale score, with most reporting a subjective reduction in PTSD symptoms.</p><p><strong>Conclusions: </strong>Although additional research is needed to assess the safety and efficacy of BLa and SGC-UF DBS, these preliminary findings are encouraging. However, the application of DBS in psychiatric treatment remains controversial and largely experimental. Continued studies with larger samples are essential to establish the efficacy and safety profile of DBS specifically with PTSD patients.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"13-22"},"PeriodicalIF":2.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145390501","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":"Predictors of Skills-Based Psychotherapy Outcomes for Functional Neurological Disorder: A Retrospective Cohort Study.","authors":"Cristina Bleier, Ellen J Godena, Daniel Millstein, Andrew Guthrie, Caitlin Adams, Margaret Tuttle, Bruce Price, Sara A Finkelstein, David L Perez","doi":"10.1176/appi.neuropsych.20250011","DOIUrl":"10.1176/appi.neuropsych.20250011","url":null,"abstract":"<p><strong>Objective: </strong>Skills-based psychotherapy is an evidence-based treatment for functional neurological disorder (FND). However, evidence supporting its real-world efficacy is limited, and no consensus exists on optimal treatment duration. The authors examined how baseline neuropsychiatric characteristics are related to outcomes among patients with FND who were receiving psychotherapy.</p><p><strong>Methods: </strong>This retrospective cohort included 97 patients with FND who received outpatient skills-based psychotherapy between 2019 and 2023. FND symptoms included motor (79%), seizure (32%), and speech (24%) presentations. Baseline characteristics and clinician-estimated outcomes were extracted from medical records. Univariate screenings were followed by multivariate regression analyses to identify predictors of improvement.</p><p><strong>Results: </strong>At the end of treatment (mean±SD number of sessions=20.0 ± 17.1), 64 patients (66%) had chart-documented evidence of improvement; 20 had complete or near-complete symptom resolution. In a logistic regression, improvement was positively associated with full-time employment and negatively associated with being in a concurrent psychotherapy. After adjustment of analyses for baseline demographic factors and FND subtypes, the number of sessions attended positively correlated with improvement. Of 43 patients who received >16 sessions, 56% showed additional improvement with more treatment. Factors associated with continued improvement in univariate screenings were longer illness duration, cognitive symptoms at baseline, and not being in concurrent psychotherapy, the latter independently predicting continued improvement in prolonged treatment.</p><p><strong>Conclusions: </strong>These findings indicate that skills-based psychotherapy is effective for some patients with FND in real-world outpatient settings. Prolonged treatment benefits a subgroup of patients with FND, highlighting the need for prospective studies to refine and individualize psychotherapy protocols.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"194-200"},"PeriodicalIF":2.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212926","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":"Bile Acids and Functional Connectivity of Executive Control and Default Mode Networks in Patients With Major Depression.","authors":"Boadie W Dunlop, Jungho Cha, Helen S Mayberg, Ki Sueng Choi, W Edward Craighead, Siamak MahmoudianDehkordi, Sudeepa Bhattacharyya, A John Rush, Rima Kaddurah-Daouk","doi":"10.1176/appi.neuropsych.20240222","DOIUrl":"10.1176/appi.neuropsych.20240222","url":null,"abstract":"<p><strong>Objective: </strong>Bile acids may contribute to pathophysiological markers of neuropsychiatric disorders, including disruptions of the executive control network (ECN) and the default mode network (DMN). Cognitive dysfunction is common in major depressive disorder; the authors examined whether bile acids affect these networks among patients with depression.</p><p><strong>Methods: </strong>Resting-state functional MRI scans and blood levels of four bile acids from 74 treatment-naïve adults with major depressive disorder were analyzed. Dorsolateral prefrontal cortex (DLPFC) seeds were used to examine connectivity of the ECN, and posterior cingulate cortex (PCC) seeds were used to examine DMN connectivity. Using a whole-brain analysis, the authors examined correlations between the functional connectivity of these seeds and serum levels of chenodeoxycholic acid (CDCA) and its bacterially derived secondary bile acid, lithocholic acid (LCA).</p><p><strong>Results: </strong>CDCA levels were strongly and inversely correlated with connectivity among DLPFC regions of the ECN (R²=0.400, p<0.001). CDCA levels were also strongly and inversely correlated with connectivity of the DLPFC and left inferior temporal cortex of the ECN (R²=0.268, p<0.001). The LCA-to-CDCA ratio was strongly and positively correlated with connectivity of the DLPFC with two ECN components: the bilateral inferior temporal cortex and the left superior and inferior parietal lobules (all R²>0.250, p<0.001). For the DMN, the LCA-to-CDCA ratio was strongly and inversely correlated with connectivity of the PCC with multiple bilateral insula regions (all R²>0.250, p<0.001).</p><p><strong>Conclusions: </strong>The relationship between LCA and CDCA levels and functional connectivity of the ECN and DMN suggests that major depressive disorder shares pathophysiological processes with other neuropsychiatric disorders.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"170-178"},"PeriodicalIF":2.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145086372","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":"Visual and Cognitive Disorders Associated With Isolated Lingual Gyrus Infarctions.","authors":"Emre Kumral, Fatma Ece Çetin, Zeynep Deniz Çetin, Asya Ekici","doi":"10.1176/appi.neuropsych.20230182","DOIUrl":"10.1176/appi.neuropsych.20230182","url":null,"abstract":"<p><strong>Objective: </strong>Isolated ischemic stroke of the lingual gyrus is uncommon. The authors evaluated the clinical, neuro-ophthalmological, and cognitive features of lingual gyrus infarctions.</p><p><strong>Methods: </strong>This study was carried out from January 1, 2012, to January 30, 2022, in a hospital's stroke, neuro-ophthalmology, and neuropsychology unit, in İzmir, Turkey. Various aspects of visual and cognitive functions of 10 patients with isolated lingual infarctions were analyzed. The authors used structural MRI data to contour ischemic areas by hand and used MRIcroGL software to convert these areas to binarized images.</p><p><strong>Results: </strong>Isolated lingual infarctions accounted for 3% of posterior cerebral artery territory infarctions. Two-thirds (N=7) of the patients had macular-sparing superior quadrantanopia with visuocognitive disturbances. One patient reported mild visual snow characterized by tiny flickering dots resembling static on an analog television screen. All six patients with right-sided lingual gyrus involvement had significant difficulties in visual memory, and three of four patients with left-sided lesions had difficulties in verbal memory. Three patients had achromatopsia, and two patients had mental color imagery impairment. One patient with topographagnosia had difficulty recognizing İzmir's landmarks and finding the city on a map.</p><p><strong>Conclusions: </strong>The lingual gyrus is a brain structure that appears to be critical for vision processing, color integration, face recognition, visual-verbal processing, mental visual imagery, dreaming, and encoding of visual memories. The most common cause of stroke in this region was arterial-to-arterial and cardiac emboli.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"128-133"},"PeriodicalIF":2.9,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145301430","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":"Use of the <i>Overcoming Functional Neurological Symptoms: A Five Areas Approach</i> Workbook in a Therapist-Led Skills Group Format.","authors":"Emma Raffman, Tali Sorets, Dominic Golding, John-Christopher A Finley, Alan Carson, Erica Cotton","doi":"10.1176/appi.neuropsych.20250097","DOIUrl":"10.1176/appi.neuropsych.20250097","url":null,"abstract":"<p><strong>Objective: </strong>Given limited access and long wait times for individualized behavioral health care focused on functional neurological disorder (FND), FND-specific group psychotherapy formats may offer patients early access to tools that could help alleviate symptoms. In this pilot study, the authors investigated the utility of using a well-known, evidence-based, and FND-focused self-help cognitive-behavioral therapy (CBT) workbook in a therapist-led skills group format for patients with primary functional movement disorder (FMD).</p><p><strong>Methods: </strong>Six patients with primary FMD received a 10-week therapist-led CBT psychotherapy skills group based on the workbook <i>Overcoming Functional Neurological Symptoms: A Five Areas Approach</i>. Basic metrics of feasibility, tolerability, utility, and exploratory Patient-Reported Outcomes Measurement Information System (PROMIS) measures were compared pre- and postintervention. Pregroup guidelines and postgroup summary (summary of skills, supplemental tools, and FND next steps checklist) were included.</p><p><strong>Results: </strong>Feasibility and tolerability metrics were sound, and three of the six patients had significant improvement in at least two of the 11 PROMIS measures. The PROMIS measures with the greatest improvement included fatigue, anxiety, depression, self-efficacy in managing symptoms, social interactions, emotions, and medications and treatments. Further, the Patient Global Impression of Change (PGIC) may alternatively be used to capture group outcomes, because two of the participants whose PROMIS scores did not change (despite reported benefits) provided PGIC ratings of 1 and 2 (very much improved and much improved, respectively).</p><p><strong>Conclusions: </strong>These findings suggest that this therapist-led FND skills group intervention format has feasibility, tolerability, and early utility. However, further research is necessary to establish its efficacy.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"289-294"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145390519","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":"In Memoriam: Robert G. Robinson, M.D., F.A.N.P.A.","authors":"Ricardo E Jorge, Sergio S Starkstein, David B Arciniegas","doi":"10.1176/appi.neuropsych.20250232","DOIUrl":"https://doi.org/10.1176/appi.neuropsych.20250232","url":null,"abstract":"","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":"38 1","pages":"100"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148471163","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":"Functional Neurological Disorder, Sleep, and Dreaming: A Large Online Questionnaire-Based Study.","authors":"Sichen Yin, Kulveer Ghatora, Tiago Teodoro, Mark Edwards, Mahinda Yogarajah, Jan Coebergh","doi":"10.1176/appi.neuropsych.20250092","DOIUrl":"10.1176/appi.neuropsych.20250092","url":null,"abstract":"<p><strong>Objective: </strong>In this exploratory study, the authors used subjective participant data to investigate sleep disturbance in functional neurological disorder (FND) and its impact on FND symptoms.</p><p><strong>Methods: </strong>An online questionnaire was designed in collaboration with FND charities and administered to 373 adult participants with a self-reported FND diagnosis.</p><p><strong>Results: </strong>Most participants (86%) were women, and most (73%) perceived their sleep quality over the past 3 months as poor. Almost all (93%) reported nonpositive dream content, with 78% experiencing nightmares at least once per week. Self-rated bad sleep quality increased by 41 percentage points since the onset of FND, and the frequency of nightmares also significantly increased. Obesity was highly prevalent (44% with a body mass index >30 kg/m²), but formally diagnosed sleep-related breathing disorders were rare (8%). Many participants (46%) noticed symptom improvement after a good night's sleep. Most (88%) reported worsening of functional symptoms when falling asleep, during sleep, or when waking up. About one-quarter noted symptom changes after specific dreams or nightmares, with almost all (97%) reporting negative changes, which were more common among participants reporting poor sleep quality. Moderate rates of sleep paralysis and functional seizure were observed. Among those who experienced functional seizures, 74% reported that they arose during sleep.</p><p><strong>Conclusions: </strong>These findings support the common perception of poor sleep quality, nightmares, and negative dreams among individuals with FND and suggest that self-reported sleep and dream content may also influence FND symptoms. However, the authors recognize a high risk for selection and recall bias.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"264-271"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145540090","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 Single-Item Screening Tool for the Assessment of Hoarding: Preliminary Observations.","authors":"Peter S Pressman, Julia Schaffer, Kelly Finch, Francesca Dino, Christopher M Filley, David B Arciniegas","doi":"10.1176/appi.neuropsych.20250152","DOIUrl":"10.1176/appi.neuropsych.20250152","url":null,"abstract":"<p><strong>Objective: </strong>Hoarding disorder is defined as persistent difficulty discarding or parting with possessions, regardless of their actual value. Hoarding is associated with biopsychosocial distress and reduced quality of life, and although it is often associated with obsessive-compulsive spectrum disorders, hoarding is also encountered in cases of neurodegeneration. Assessments of hoarding behavior traditionally involve a comprehensive evaluation that may be challenging in clinical settings. The authors developed a simplified hoarding screen for patients with neurobehavioral disorders.</p><p><strong>Methods: </strong>The Single-Item Hoarding Screen (SIHS) is a single-item questionnaire. In total, 135 patients from the University of Colorado Behavioral Neurology Clinic were surveyed; caregivers filled out the SIHS. Patients' diagnoses included a range of neurobehavioral disorders, including Alzheimer's disease, behavioral variant frontotemporal dementia, Lewy body dementia, primary progressive aphasia, major neurocognitive disorder not otherwise specified, and minor neurocognitive disorder not otherwise specified.</p><p><strong>Results: </strong>The mean age of the patients was 70.9 years, and 39% were female. Among the patients surveyed, 10% and 13% of caregivers (23% total) answered yes and maybe, respectively, to the question on the SIHS. Yes responses on this screen were significantly associated with higher scores on the established Hoarding Rating Scale, compared with maybe responses. Statistical analyses revealed significant correlations between hoarding behaviors and neuropsychiatric symptom severity as well as caregiver well-being.</p><p><strong>Conclusions: </strong>These results suggest the potential benefits of a tool containing only a single item to screen for hoarding behavior in neurobehavioral disorders. Future research may focus on refining and validating the SIHS.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"384-388"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13228794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146125071","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":"Speech and Motor Hyperrhythmia Due to Right Frontal Glioblastoma: Case Report and Connectivity Analysis.","authors":"Marinos G Sotiropoulos, Andrew Pines, Sarah Kovan, Alexis T Roy, David N Caplan, Isaiah Kletenik, Michael P H Stanley","doi":"10.1176/appi.neuropsych.20250054","DOIUrl":"10.1176/appi.neuropsych.20250054","url":null,"abstract":"","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"419-422"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146046885","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":"Therapies for Functional Neurological Disorder: From Promising Outcomes to Evidence-Based Interventions.","authors":"Glenn Nielsen, David L Perez","doi":"10.1176/appi.neuropsych.20260044","DOIUrl":"10.1176/appi.neuropsych.20260044","url":null,"abstract":"","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"316-317"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627847","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}