Innovations in clinical neuroscience最新文献

Bupropion has been in use for several decades. It is widely used for major depressive disorder (MDD), seasonal affective disorder (SAD), and smoking cessation. It is also a treatment of choice for mild-to-moderate depression and is prescribed for atypical and melancholic depression. However, bupropion overdose can lead to serious neurological and cardiovascular adverse effects. We report a recent case of bupropion overdose and review published cases in the literature to present the spectrum of clinical findings and treatments used to overcome the effects of bupropion overdose. Per our findings, bupropion doses of 2.7g and upward can lead to seizures and cause encephalopathy and cardiovascular effects. Higher doses could also lead to intubation and increased hospital stay. Therefore, patients with an increased risk of cardiovascular issues and seizures should be evaluated before starting the medication or increasing the dosage.

Objective: Individuals with serious mental illness (SMI) are recognized to be among the highest risk patients to experience more severe symptoms of COVID-19, not only due to poor baseline health and associated disparity, but also due to medications prescribed to manage their illness that are known to compromise immunity even further. Clozapine, a gold standard antipsychotic used in the treatment for refractory schizophrenia, is considered to be the antipsychotic with the greatest risk of compromising immunity due to its potential to cause blood dyscrasia, including leukopenia and rarely, but potentially, agranulocytosis. The objective of this study is to determine if there is any potential hematological consequence for the use of COVID-19 messenger ribonucleic acid (mRNA) vaccines or the impact of active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients receiving clozapine therapy. Since there is controversy over the rate of vaccine hesitancy in patients with SMI, we also examined the rate of vaccine acceptance in our subject population.

Design: This study was a retrospective chart review conducted at a 160-bed state psychiatric inpatient hospital in upstate New York evaluating the impact of COVID-19 vaccination, SARS-CoV-2 infection, and vaccine acceptance in patients prescribed clozapine.

Results: Both the administration of COVID-19 mRNA vaccines and SARS-CoV-2 infection did not appear to significantly influence the hematologic values that are monitored by the United States (US) Food and Drug Administration (FDA) to ensure safe use of clozapine. When offered vaccination, most patients hospitalized for SMI were willing to accept it.

Conclusion: With the likelihood of COVID-19 mRNA vaccinations becoming a recommended routine vaccination, requiring periodic boosters, patients receiving clozapine therapy have been observed to not be at higher risk of adverse hematological consequences when the mRNA vaccine is administered. Furthermore, inpatient psychiatry settings should be considered an optimal site of vaccination to improve vaccination efforts in our communities.

This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation and other resources offered to health care providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management consulting companies or insurance carriers might provide different advice, and readers should take this into consideration. The information in this column does not constitute legal advice. For legal advice, contact your personal attorney. Note: The information and recommendations in this article are applicable to physicians and other health care professionals so "clinician" is used to indicate all treatment team members.

Depersonalization and derealization refer to an estranged state of mind that involves a profound feeling of detachment from one's sense of self and the surrounding environment, respectively. The phenomena co-occur on a continuum of severity, ranging from a transient experience as a normal reaction to a traumatic event to a highly debilitating condition with persistent symptoms, formally described as depersonalization/derealization disorder (DPDR). Lack of awareness of DPDR is partly due to a limited neurobiological framework, and there remains a significant risk of misdiagnosis in clinical practice. Earlier literature has focused on several brain regions involved in the experience of depersonalization and derealization, including adaptive responses to stress via defense cascades comprising autonomic functioning, the hypothalamic-pituitary-adrenal (HPA) axis, and various other neurocircuits. Recent evidence has also demonstrated the role of more complex mechanisms that are bolstered by dissociative features, such as emotional dysregulation and disintegration of the body schema. This review intends to abridge the prevailing knowledge regarding structural and functional brain alterations associated with DPDR with that of its heterogenic manifestations. DPDR is not merely the disruption of various sensory integrations, but also of several large-scale brain networks. Although a comprehensive antidote is not available for DPDR, a holistic route to the neurobiological context in DPDR may improve general understanding of the disorder and help afflicted individuals re-establish their sense of personal identity. Such information may also be useful in the development of novel pharmacological agents and targeted psychological interventions.

Existential issues are common in patient experiences and can present as themes in any practice setting, but particularly in psychotherapy. Existential issues are any concerns that arise from distress or questions about difficult subjects, such as death, meaning, freedom, and isolation, and can be a source of psychiatric concerns or simply a modifying factor. Because of this, clinicians should be able to recognize and understand the basic tenets of addressing existential issues in psychotherapy. This article outlines the historical context and theoretical basis of existentialism. It also discusses existential issues in relation to psychotherapy and provides practical clinical tips for addressing these issues with patients, including helpful probing questions, tips for noticing existential themes, and ideas about how to address existential issues in session.

Objective: The assessment of child cognitive health in Sub-Saharan developing countries poses significant challenges, including the paucity of valid diagnostic tools. We report the development and the initial validation of the Zambia Symbol Cancellation Test (ZSCT), a psychometric test to evaluate selective attention in a pediatric, school-aged population.

Design: ZSCT reliability and validity were assessed in a field trial. A total of 409 children, aged 5 to 17 years, were recruited at multiple Zambian clinical sites and schools. The ZSCT provides a visuomotor processing index (VMPI), a measure of effortful processing to deliver accurate task response.

Results: The VMPI reliability estimate at test-retest was found to be adequate for a clinical use (intraclass correlation coefficient [ICC]: 0.79, ICC-95% confidence interval [CI]: 0.69-0.86). Age showed a large effect on VMPI (n=323, r=-0.62, p=0.000). Impaired visuo-perceptual-motor processing, as measured by VMPI, was associated with poor health status (i.e., chronic neurologic or medical disease or prolonged exposure to psychosocial stress and deprivation). A two-way ANOVA found significant and small health status and age group effects [F (7, 408): 33.24, p=0.0000, η²=0.367]; the main effect of health status [F (1, 408): 37.79, p=0.000, η²=0.09], age group [F (3, 408): 35.06, p=0.000, η²=0.21], and their interaction was not significant (p=0.364).

Conclusion: Study findings indicate that the ZSCT has satisfactory reliability, validity, and clinical utility to evaluate cognitive development and the effect of health conditions on attention. Study results warrant further research to validate its use in healthcare and clinical research settings.

Objective: Gene-environment interactions might play a significant role in the development of bipolar disorder (BD). The objective of the current study was to investigate the association between tumor necrosis factor (TNF)-α -308 G/A polymorphism and BD and conduct a bioinformatics analysis of the protein-protein network of TNF-α. Gene-environment interactions and the relationship between stressful life events (SLEs) and substance abuse with TNF genotypes and other characteristics were analyzed.

Methods: The genomic deoxyribonucleic acid (DNA) of 400 patients with BD and 200 control subjects were extracted and genotyped for TNF-α -308 G/A polymorphism. SLEs and substance abuse were evaluated using the Life Event and Difficulty Schedule (LEDS) and a self-designed substance abuse questionnaire for the events six months prior to the onset of the disease, respectively. Gene-environment interactions were assessed by multiple statistical tools. Bioinformatics analysis of the TNF-α network and its interacting proteins was carried out using STRING and Cytoscape softwares.

Results: Genotyping analysis revealed a significant association between TNF-α -308 G/A polymorphism and BD (p<0.009). Furthermore, analysis of gene-environment interaction revealed a significant association between TNF-α -308 G/A and SLEs (p=0.001) and TNF-α -308 G/A and substance abuse (p=0.001). Three distinct proteins, RELA, RIPK1, and BIRC3, were identified through hub analysis of the protein network.

Conclusion: TNF-α -308 G/A polymorphism is positively associated with BD. SLEs and substance abuse might trigger the early onset of BD. Proteins identified through bioinformatics analysis might contribute to the TNF-α mediated pathophysiology of BD and can be the potential therapeutic targets.

Facial nerve palsy is a clinical diagnosis differentiating between central upper motor neuron lesions and peripheral lower motor neuron lesions. Rehabilitation is an important issue in peripheral facial nerve palsy management. In this article, we present the case of an adult woman affected by right peripheral facial nerve palsy due to acoustic neuroma surgical excision. She immediately started a rehabilitation plan, but it was stopped due to COVID-19 lockdown and did not resume because of the fear of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Therefore, we planned to treat her palsy with remote neurocognitive rehabilitation. After 10 months of treatment, the patient underwent a follow-up physiatric assessment, confirming right facial palsy improvement. There was a slight nasolabial groove flattening and slight left oral rime deviation while smiling (House-Brackmann classification improved from Grade IV to III). Telerehabilitation represents a valid strategy for neurocognitive rehabilitation, not only in a pandemic scenario, but also in other conditions that lead to social distancing.