Journal of Neuropsychiatry and Clinical Neurosciences最新文献

{"title":"Etiological Factors and Symptom Triggers in Functional Motor Symptoms and Functional Seizures: A Pilot Investigation.","authors":"L S Merritt Millman, Eleanor Short, Emily Ward, Biba Stanton, Abigail Bradley-Westguard, Laura H Goldstein, Joel S Winston, Mitul A Mehta, Timothy R Nicholson, Antje A T S Reinders, Anthony S David, Mark J Edwards, Trudie Chalder, Matthew Hotopf, Susannah Pick","doi":"10.1176/appi.neuropsych.20230103","DOIUrl":"10.1176/appi.neuropsych.20230103","url":null,"abstract":"<p><strong>Objective: </strong>This study examined etiological factors and symptom triggers of functional motor symptoms (FMS) or functional seizures (FS) and assessed potential relationships with relevant clinical features (i.e., functional symptoms, quality of life, and general functioning).</p><p><strong>Methods: </strong>Seventeen participants with FMS or FS and 17 healthy control participants underwent an in-depth clinical interview and completed questionnaires assessing adverse life events, psychological and physical symptoms, alexithymia, autistic traits, illness perceptions, health-related quality of life (HRQoL), and work and social functioning.</p><p><strong>Results: </strong>Participants with FMS or FS perceived various causes of the disorder, including physical symptoms (65%), emotional problems (53%), adverse life events (47%), and work-related factors (29%). Triggers of FMS and FS included physical activity or exertion (59%), stress and emotions (59%), sensory experiences (47%), and fatigue (41%). Compared with healthy control participants, participants with FMS or FS reported more adverse events during adolescence and higher levels of alexithymia, somatoform dissociation, psychological dissociation (disengagement, depersonalization, and derealization), anxiety, depression, and physical symptoms. Participants with FMS or FS had worse HRQoL than healthy control participants and impaired work and social functioning. There were inverse associations between HRQoL scores and somatoform dissociation, anxiety, and adverse life events.</p><p><strong>Conclusions: </strong>Participants with FMS or FS reported diverse biopsychosocial etiological factors and symptom triggers. Ongoing psychological symptoms and lifetime adverse experiences were associated with worse HRQoL. Future studies will examine these factors in larger samples of individuals with FMS or FS to better understand their shared and distinct etiological underpinnings.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"350-357"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140119770","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 Web-Based Educational Module Using Clinical Neuroscience to Deliver the Diagnosis of Functional Neurological Disorder.","authors":"Mark Fusunyan, Michel Medina, Luciana Giambarberi, Sepideh Bajestan","doi":"10.1176/appi.neuropsych.20230060","DOIUrl":"10.1176/appi.neuropsych.20230060","url":null,"abstract":"<p><p>Neuroscience-based patient education has become an evidence-based strategy for enhancing chronic pain treatment. Advances in understanding the neuroscience of functional neurological disorder (FND) may allow similar approaches to be developed and disseminated to clinicians, given the public health need for greater provider awareness and expertise around the condition. Accordingly, the authors developed an online video module for clinicians that delivers neuroscience-based psychoeducation for FND and assessed whether the intervention would be associated with changes in clinicians' perception of FND patients and knowledge about the condition. The online intervention consisted of a 20-minute video module, including an 8-minute scripted role-play that modeled neuroscience-informed diagnosis delivery. Pre- and postintervention questionnaires were embedded into the online module and included a self-assessment of FND-related perceptions and knowledge and a multiple-choice assessment of retention of the neuroscience-based content. Wilcoxon signed-rank tests and McNemar's tests were used for statistical analyses. Of the 103 individuals who submitted surveys, 40 participants provided a complete data set from before and after the intervention. Following the intervention, self-assessment items showed respondents had significantly greater comfort with diagnosis delivery and treatment options and decreased negative perception of FND patients. The percentage of correct responses on a multiple-choice assessment regarding the functional neuroanatomy of FND was significantly increased. In summary, the online neuroscience-based educational intervention was effective for increasing clinician knowledge about FND and comfort with diagnosis delivery and treatment options. Implementing web-based formats may be a viable and cost-effective approach to disseminating knowledge and basic clinical skills in the care of patients with FND.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"166-171"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139521157","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":"Generalized Periodic Discharges Associated With Catatonia and Delirium: A Case Series.","authors":"James Luccarelli, Joshua R Smith, Gregory Fricchione, M Brandon Westover","doi":"10.1176/appi.neuropsych.20230174","DOIUrl":"10.1176/appi.neuropsych.20230174","url":null,"abstract":"<p><strong>Objective: </strong>Generalized periodic discharges are a repeated and generalized electroencephalography (EEG) pattern that can be seen in the context of altered mental status. This article describes a series of five individuals with generalized periodic discharges who demonstrated signs and symptoms of catatonia, a treatable neuropsychiatric condition.</p><p><strong>Methods: </strong>Inpatients with a clinical diagnosis of catatonia, determined with the Bush-Francis Catatonia Rating Scale (BFCRS), and EEG recordings with generalized periodic discharges were analyzed in a retrospective case series.</p><p><strong>Results: </strong>Five patients with catatonia and generalized periodic discharges on EEG were evaluated from among 106 patients with catatonia and contemporaneous EEG measurements. Four of these patients showed an improvement in catatonia severity when treated with benzodiazepines, with an average reduction of 6.75 points on the BFCRS.</p><p><strong>Conclusions: </strong>Among patients with generalized periodic discharges, catatonia should be considered, in the appropriate clinical context. Patients with generalized periodic discharges and catatonia may benefit from treatment with empiric trials of benzodiazepines.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"340-343"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11479820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891960","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 Studies 7A and 7B: Two Physician-Patients With Early Alzheimer's Disease and Differing Levels of Insight.","authors":"Katelyn M Gettens Bourgea, Michael Erkkinen, Seth A Gale, Scott M McGinnis, Kirk R Daffner, David Silbersweig, Barbara Schildkrout","doi":"10.1176/appi.neuropsych.20230217","DOIUrl":"10.1176/appi.neuropsych.20230217","url":null,"abstract":"","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"220-227"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248002","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":"Practical Application of a Battery of Brief Tools to Evaluate Geriatric Medical Inpatients for the Three Ds.","authors":"Marcela Alviz Núñez, María Margarita Villa García, Maria Carolina Gonzalez, María Botero Urrea, Juan D Velásquez-Tirado, María V Ocampo, Paula T Trzepacz, José G Franco","doi":"10.1176/appi.neuropsych.20230029","DOIUrl":"10.1176/appi.neuropsych.20230029","url":null,"abstract":"<p><strong>Objective: </strong>The investigators aimed to identify the clinical characteristics of patients with or without delirium and preexisting depression, dementia, both, or neither by using validated tools easily administered in clinical practice.</p><p><strong>Methods: </strong>In this cross-sectional prospective observational study conducted in Medellín, Colombia, 200 geriatric inpatients were evaluated with the Delirium Diagnostic Tool-Provisional (DDT-Pro), Informant Questionnaire on Cognitive Decline in the Elderly, Hachinski Ischemic Scale, Cornell Scale for Depression in Dementia, and Charlson Comorbidity Index-short form. Delirium motor subtype, mortality, and length of hospital stay were assessed.</p><p><strong>Results: </strong>The study included 134 patients without delirium (67%), 14 with delirium only (7%), 16 with delirium and dementia (8%), 13 with delirium and depression (7%), and 23 with delirium, dementia, and depression (the three Ds) (12%). Prevalence rates of dementia (59%) and depression (55%) among 66 patients with delirium were higher than prevalence rates among patients without delirium (13% and 28%, respectively), suggesting that both conditions are risk factors. Main medical diagnoses, mortality, and dementia type did not differ among groups. Motor subtypes were similar among delirium groups. Patients in the delirium groups, except those in the delirium and depression group, were older than patients without delirium. Medical burden was highest among the patients with delirium and dementia and those with all three conditions. Delirium and dementia were more severe when comorbid with each other. Depression was most severe among patients with delirium and depression. Patients with all three conditions had a longer length of hospital stay than those without delirium.</p><p><strong>Conclusions: </strong>Using brief tools to detect dementia and depression in conjunction with the DDT-Pro to assess delirium diagnosis and severity is feasible and enables a more in-depth evaluation of elderly hospitalized patients. Because previous longitudinal research suggests that these comorbid conditions influence prognosis following a delirium episode, better identification of the three Ds offers proactive interventional opportunities. Depression is an underrecognized risk factor for delirium.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"63-69"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10145530","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":"Telemedicine-Based Cognitive Examinations During COVID-19 and Beyond: Perspective of the Massachusetts General Hospital Behavioral Neurology & Neuropsychiatry Group.","authors":"Kaloyan S Tanev, Joan A Camprodon, David N Caplan, Bradford C Dickerson, Zeina Chemali, Mark C Eldaief, David Dongkyung Kim, Sylvia E Josephy-Hernandez, Michael D Kritzer, Lauren R Moo, Amy Newhouse, David L Perez, Liliana A Ramirez Gomez, Mahdi Razafsha, Ana Maria Rivas-Grajales, Jeremiah M Scharf, Jeremy D Schmahmann, Janet C Sherman","doi":"10.1176/appi.neuropsych.20220154","DOIUrl":"10.1176/appi.neuropsych.20220154","url":null,"abstract":"<p><p>Telehealth and telemedicine have encountered explosive growth since the beginning of the COVID-19 pandemic, resulting in increased access to care for patients located far from medical centers and clinics. Subspecialty clinicians in behavioral neurology & neuropsychiatry (BNNP) have implemented the use of telemedicine platforms to perform cognitive examinations that were previously office based. In this perspective article, BNNP clinicians at Massachusetts General Hospital (MGH) describe their experience performing cognitive examinations via telemedicine. The article reviews the goals, prerequisites, advantages, and potential limitations of performing a video- or telephone-based telemedicine cognitive examination. The article shares the approaches used by MGH BNNP clinicians to examine cognitive and behavioral areas, such as orientation, attention and executive functions, language, verbal learning and memory, visual learning and memory, visuospatial function, praxis, and abstract abilities, as well as to survey for neuropsychiatric symptoms and assess activities of daily living. Limitations of telemedicine-based cognitive examinations include limited access to and familiarity with telecommunication technologies on the patient side, limitations of the technology itself on the clinician side, and the limited psychometric validation of virtual assessments. Therefore, an in-person examination with a BNNP clinician or a formal in-person neuropsychological examination with a neuropsychologist may be recommended. Overall, this article emphasizes the use of standardized cognitive and behavioral assessment instruments that are either in the public domain or, if copyrighted, are nonproprietary and do not require a fee to be used by the practicing BNNP clinician.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"87-100"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138803976","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":"From Software to Hardware: A Case Series of Functional Neurological Symptoms and Cerebrovascular Disease.","authors":"Jan Coebergh, Shabana Habib, Tiago Teodoro, Mark Edwards, Matt Butler","doi":"10.1176/appi.neuropsych.20220182","DOIUrl":"10.1176/appi.neuropsych.20220182","url":null,"abstract":"<p><strong>Objective: </strong>Neuroimaging studies have identified alterations in both brain structure and functional connectivity in patients with functional neurological disorder (FND). For many patients, FND emerges from physical precipitating events. Nevertheless, there are a limited number of case series in the literature that describe the clinical presentation and neuroimaging correlates of FND following cerebrovascular disease.</p><p><strong>Methods: </strong>The authors collected data from two clinics in the United Kingdom on 14 cases of acute, improving, or delayed functional neurological symptoms following cerebrovascular events.</p><p><strong>Results: </strong>Most patients had functional neurological symptoms that were localized to cerebrovascular lesions, and the lesions mapped onto regions known to be part of functional networks disrupted in FND, including the thalamus, anterior cingulate gyrus, insula, and temporoparietal junction.</p><p><strong>Conclusions: </strong>The findings demonstrate that structural lesions can lead to FND symptoms, possibly explained through changes in relevant mechanistic functional networks.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"206-213"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139723022","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":"Harnessing Placebo Effects for the Treatment of Functional Cognitive Disorder: A Feasibility Pilot Study.","authors":"Matthew J Burke, Davide Cappon, David L Perez, Alvaro Pascual-Leone, Emiliano Santarnecchi","doi":"10.1176/appi.neuropsych.20230118","DOIUrl":"10.1176/appi.neuropsych.20230118","url":null,"abstract":"<p><strong>Objective: </strong>Limited research has directly investigated whether and how placebo effects can be harnessed for the treatment of functional neurological disorder (FND), despite a long-standing and controversial history of interest in this area.</p><p><strong>Methods: </strong>A small exploratory study was conducted with adults with a cognitive subtype of FND recruited from a single cognitive neurology center in the United States. Participants were given the expectation of receiving cranial stimulation that could benefit their memory symptoms; however, the intervention was sham transcranial magnetic stimulation (placebo). Outcomes included measures of short-term memory testing, subjective memory rating, and state anxiety before and after stimulation. After the study, the true objective and rationale for investigating placebo effects were explained in a scripted debriefing session. Acceptability of the study design and qualitative feedback were collected. Institutional ethics approval and signed consent were obtained.</p><p><strong>Results: </strong>Three patients (female, N=2; male, N=1; average age=57 years) were recruited. Outcome data were analyzed descriptively at the patient level. Trends of improvement in subjective memory rating, but not objective cognitive test scores, and decreases in state anxiety were observed. After the debriefing session, all patients found the study design to be acceptable (ratings of 70%, 90%, and 100%), and two of the three patients believed that withholding mechanistic information about the intervention was needed to leverage placebo effects as treatment.</p><p><strong>Conclusions: </strong>In the first study to prospectively investigate the feasibility of harnessing placebo effects for the treatment of FND, promising preliminary findings were obtained, and methods and resources for use in larger future studies are offered.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"214-219"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139723023","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":"Resting-State Functional Connectivity of the Anterior Cingulate Cortex Among Persons With Mood Disorders and Suicidal Behaviors.","authors":"Elisa Ambrosi, Kaylah N Curtis, Puneetha Goli, Michelle A Patriquin, David B Arciniegas, Alessio Simonetti, Gianfranco Spalletta, Ramiro Salas","doi":"10.1176/appi.neuropsych.20220203","DOIUrl":"10.1176/appi.neuropsych.20220203","url":null,"abstract":"<p><strong>Objective: </strong>To assess whether anterior cingulate cortex (ACC) abnormalities contribute to suicide risk in major depressive disorder and bipolar disorder, the investigators compared resting-state functional connectivity (rsFC) of ACC subdivisions between individuals with major depressive or bipolar disorder with and without a lifetime history of suicidal behavior.</p><p><strong>Methods: </strong>Forty-two inpatients with and 26 inpatients without a history of suicidal behavior (SB+ and SB-, respectively) associated with major depressive or bipolar disorder and 40 healthy control (HC) participants underwent rsFC neuroimaging. RsFC of the subgenual, perigenual, rostral, dorsal, and caudal subdivisions of the ACC was calculated. Possible confounders, such as psychosis and severity of depression, were controlled for, seed-to-voxel and post hoc region of interest (ROI)-to-ROI analyses were performed, and the accuracy of rsFC in classifying suicidal behavior was studied.</p><p><strong>Results: </strong>Compared with individuals in the SB- and HC groups, patients in the SB+ group had higher rsFC between the left rostral and right dorsal ACC seeds and visual cortex clusters. Conversely, rsFC between the left rostral and right dorsal ACC seeds and cingulate and frontal clusters was lower in the SB+ group than in the HC group. Left rostral ACC to left Brodmann's area 18 connectivity showed up to 75% discriminative accuracy in distinguishing SB+ from SB- patients.</p><p><strong>Conclusions: </strong>A history of suicidal behavior among individuals with major depressive disorder or bipolar disorder was associated with altered rsFC of the rostral and caudal ACC, regions involved in conflict detection and error monitoring. Replication of these findings is needed to further explore the involvement of the ACC in the neurobiology of suicidal behavior and suicidal ideation.</p>","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":" ","pages":"143-150"},"PeriodicalIF":2.4,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138047158","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":"Doubling Down on Combined Neurology-Psychiatry Residency Training and Behavioral Neurology & Neuropsychiatry Fellowship Training.","authors":"David L Perez","doi":"10.1176/appi.neuropsych.20230065","DOIUrl":"10.1176/appi.neuropsych.20230065","url":null,"abstract":"","PeriodicalId":16559,"journal":{"name":"Journal of Neuropsychiatry and Clinical Neurosciences","volume":"36 1","pages":"78-79"},"PeriodicalIF":2.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139472555","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}