Innovations in clinical neuroscience最新文献

Medical schools around the globe canceled in-person classes and switched to virtual classrooms shortly after the COVID-19 pandemic began. The shift to online platforms posed serious challenges to medical education. During normal conditions, medical school is viewed as a challenging time during which resilience is critically important. There is an intense workload, increasing the risk of burnout and difficulties in work/life balance. In addition to the intensity of the curriculum and clinical rotations, most students accumulate loans that further increase the pressure to succeed. All medical schools are required to offer mental health services for their students. Psychiatrists and other mental health professionals providing care to medical students must consider the unique circumstances during an unprecedented time in the patient's educational life. This article will review the treatment dynamics created by the medical student-patient and the evidence-based approaches that the psychiatrist can utilize in a psychotherapy setting.

This paper expands upon a session, entitled, "Special Challenges in Pediatric Drug Development," that was presented as part of a two-day meeting on Pediatric Drug Development at the International Society for Central Nervous System (CNS) Clinical Trials and Methodology (ISCTM) Autumn Conference in Boston, Massachusetts, in October 2020. Drug development in this age group is particularly important because many illnesses have their onset in this age group, many other illnesses that are more common in adults also occur in this time period, and many rare conditions that require special consideration (i.e., orphan conditions) are commonly detected in childhood as well. The special challenges addressed by our speakers in this session were cognitive and functional capacity assessment, challenges of recruitment and assessment of children for research and development of appropriate biomarkers for use in child populations, and the special challenges in training raters to address symptoms in pediatric populations. The speakers have written summaries of their talks. The session's lead chair was Philip D. Harvey, PhD, who wrote introductory and closing comments. This paper should serve as an expert-informed reference to those interested in and involved in addressing the special challenges facing those involved in CNS pediatric drug development.

Objective: The paucity of valid diagnostic tools is one of the challenges preventing the effective implementation of child cognitive health testing in Sub-Saharan developing countries. WAVES addresses the need for new psychometric tests to evaluate visuospatial construction ability in a school-aged population. WAVES involves the standardized administration of a copy design task that is sequentially repeated by four distinct reproduction modalities: copy design with open eyes (CDO), immediate reproduction from memory with open eyes (IRMO), immediate reproduction from memory with closed eyes (IRMC), and delayed reproduction from memory with closed eyes (DRMC).

Design: WAVES reliability and validity were assessed in a field trial using Classical Test Theory or Item Response Theory (IRT) methods. A total of 445 children, aged 5 to 17 years old, were recruited at multiple Zambian clinical sites and schools.

Results: WAVES provides a visuographomotor construction processing (VGCP) index and three subscale inaccuracy of reproduction scores: perseveration, decreased spacing, and changing direction difficulty (CDD). WAVES scores depended on age and showed an age-related increase of reproduction accuracy. Altered visuospatial construction, as indicated by higher scores, was associated with poor health status (i.e., chronic neurologic or medical disease or prolonged exposure to psychosocial stress and deprivation). Reliability estimates, expressed as an intraclass correlation coefficient (ICC; 95% confidence interval [CI]), at test-retest (n=86) were: VGCP Index: 0.94 (0.91, 0.96); perseveration: 0.76 (0.62, 0.84); decreased spacing: 0.86 (0.79, 0.91); and CDD: 0.93 (0.89, 0.95).

Conclusion: WAVES has potential for clinical utility in evaluating the effect of different health conditions on visuospatial construction ability. Study results warrant further research to validate its use in healthcare and clinical research settings.

Objective: This systematic review aims to evaluate the impact of psilocybin on patients experiencing psychiatric symptoms, with a focus on health-related quality of life (HRQoL) and safety.

Method of research: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed database and identified studies published from January 2011 to December 2021 pertaining to the impact of psilocybin on psychiatric symptoms. Two authors independently conducted a focused analysis and reached a final consensus on five studies meeting the specific selection criteria. Study bias was addressed using the Cochrane risk of bias tool.

Results: The impact of psilocybin on psychiatric symptoms was examined in five randomized controlled trials (RCTs). Four studies administered 1 to 2 doses of psilocybin, with doses ranging from 14mg/70kg to 30mg/70kg, and one study administered a fixed dose of 25mg to all participants. Administration of psilocybin resulted in significant and sustained reduction in symptoms of anxiety and depression, enhanced sense of wellbeing, life satisfaction, and positive mood immediately after psilocybin administration and up to six months after conclusion of treatment. All studies included some form of psychotherapy, and none reported serious adverse effects.

Conclusion: RCTs show the efficacy of psilocybin in the treatment of anxiety and depression symptoms, as well as improvement in HRQoL, and no serious side effects. However, additional research is necessary to characterize predictors of treatment response, patient screening requirements, effectiveness in broader clinical populations, and guidelines for psilocybin-assisted psychotherapy.

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.

Objective: The complexity inherent in the treatment of schizophrenia results in a multitude of outcome assessments being employed when conducting clinical trials. Subjective outcome assessments and minimal clinically important differences (MCIDs) to evaluate clinical meaningfulness have gained traction; however, the extent of application in evaluation of treatments for schizophrenia is unknown. A scoping review was conducted to assess the availability of published psychometric evaluations, including MCIDs, for clinical outcome assessments used to evaluate treatments for schizophrenia.

Method of research: Key databases (PubMed®, Embase®, APA PsycINFO®, International Society for Pharmacoeconomics and Outcomes Research) were searched for studies on schizophrenia published from 2010 to 2020. Secondary sources (ClinicalTrials.gov, PROLABELS™, FDA.gov) were also reviewed. Clinical outcome assessments were organized by type (patient-reported outcomes [PROs], clinician-reported outcomes [ClinROs], observer-reported outcomes [ObsROs]) and further classified by intended use (generic, mental health, schizophrenia). Reliability and internal consistency were evaluated using Cronbach's α. External validity was evaluated by intraclass correlation coefficient (ICC).

Results: Across 140 studies, 66 clinical outcome assessments were identified. MCIDs were reported for eight of the 66 studies. Of these, two were PROs (generic) and six were ClinROs/ObsROs (three mental health-specific, three schizophrenia-specific). Reliability was good across generic, mental health-specific, and schizophrenia-specific categories, whereas external validity was strong mainly for schizophrenia-specific PROs. Overall, ClinROs/ObsROs that focused on mental health had good reliability and strong external validity.

Conclusion: This review provides a comprehensive overview of the clinical outcome assessments used in schizophrenia research during the past ten years. Results highlight the heterogeneity of existing outcomes and a growing interest in PROs for schizophrenia.

The mental health of children and adolescents has been significantly affected by the COVID-19 pandemic, and recent data suggests there had been an upsurge of psychiatric morbidity in this subgroup of population. Nonpharmacological behavioral intervention in the form of play therapy has been regarded as one of the best treatment strategies in children with emotional disorders. During lockdown, we attempted a play therapy via telemedicine. In this case report, we describe the case of a four-year-old girl who had sudden-onset behavioral problems following an unplanned hair cut during the lockdown, which was managed with teleplay therapy.

Objective: Measuring olfactory dysfunction shows promise as one of a number of nonmotor biomarkers that can be used to detect clinically manifest and prodromal Parkinson's disease (PD) and dementia with Lewy bodies (DLB) and to differentiate these from nonsynucleinopathies. Using a larger sample size than in our previous study, we evaluated the relationship between olfactory dysfunction based on the University of Pennsylvania Smell Identification Test (UPSIT) to the clinicopathological findings in patients with PD (n=41), patients with incidental Lewy body disease (ILBD) (n=47), and controls with no neurodegenerative disease (n=137).

Design: This study was conducted through the Arizona Study of Aging and Neurodegenerative Disease (AZSAND). We selected individuals who had an UPSIT score completed antemortem and were clinicopathologically diagnosed with PD, ILBD, or control. Various measures included density of Lewy type synucleinopathy (aSyn) in the olfactory bulb and tract, as well as connected mesial temporal lobe structures. Cases and controls were analyzed using one-way analysis of variance (ANOVA) with pairwise contrasts.

Results: Compared to controls (mean: 27.8, standard deviation [SD]: 6.0), the mean UPSIT scores were lower for PD (15.8, SD: 6.0, p<0.001) and ILBD (24.1, SD: 8.6, p<0.001). The sensitivity for detecting ILBD from controls, based on a cutoff score of less than 23 (23/47), was 48.9 percent. The specificity for detecting a control was 79.6 percent with a cutoff greater than 23 (109/137).

Conclusion: These findings replicate, with a larger sample size, our previously published findings that individuals with autopsy-confirmed PD and ILBD have significantly lower UPSIT scores compared to controls. These data add to the growing body of evidence supporting early olfactory dysfunction as a prodromal biomarker for the risk of developing PD and ILBD as a prodromal Lewy body disorder.