Innovations in clinical neuroscience最新文献

The adult patient who presents for psychiatric evaluation with symptoms of attention deficit hyperactivity disorder (ADHD) poses specific challenges to the treating psychiatrist. Symptoms include trouble focusing, hyperactivity, and impulsive behavior. Patients may experience behavioral, mood, and cognitive issues. Co-occurrence of anxiety, boredom, sleep deprivation, or mood dysregulation may be reported. In addition, patients may have associated learning disabilities, either identified or undiagnosed. Symptoms can range from mild to severe. Many adults are unaware that they have ADHD, but they are acutely aware that they have everyday challenges. This article reviews the treatment dynamics created by the adult patient with a diagnosis of ADHD, as well as the evidence-based approaches that the psychiatrist can utilize in a psychotherapy setting.

Xanomeline, a cholinergic agonist, was initially evaluated for the treatment of Alzheimer's disease and schizophrenia. However, drug development was stopped due to the severe cholinergic adverse effects. In recent years, xanomeline has been explored, along with trospium, a peripheral cholinergic antagonist, for schizophrenia. Xanomeline acts primarily as an M1/M4 agonist and might lead to improvement in all symptom types of schizophrenia. Due to its role as an antimuscarinic agent, trospium is expected to reduce the adverse effects of xanomeline. In initial studies, this combination seems to be promising in the treatment of schizophrenia. The most common side effects of this combination included constipation, dry mouth, and nausea. This article summarizes the present status of combination xanomeline and trospium in schizophrenia.

Introduction: Recent research on the COVID-19 pandemic suggests that individuals who suffer from serious mental illness (SMI) are at heightened risk of infection and have increased mortality due to their illness and/or lack of access to healthcare. Consequently, progress in developing new treatments for SMIs has been disrupted, with many interruptions to clinical trials in psychiatry due to concerns regarding the pandemic and its risks to patients with SMI.

Objective: This study aimed to examine the impact of the COVID-19 pandemic on patients with SMI, specifically relating to psychiatric morbidity, pandemic-induced stress, and ability to cope with pandemic-related precautionary measures, restrictions, and disruptions to daily life.

Design: A cross-sectional survey study of 94 clinical trial patients diagnosed with bipolar disorder, major depressive disorder (MDD), or schizophrenia was conducted in three geographically distinct clinical trial sites between June and September 2020. Prevalence rates were calculated for sample characteristics and demographics, and low versus high stress groups were compared on survey variables using Pearson's Chi-squared test of independence.

Results: The results from the surveys indicated that COVID-19 knowledge, awareness, and the use of precautionary safety measures (e.g., handwashing, personal protective equipment [PPE], and social distancing) were robust and mirrored the general population. While the majority of patients reported experiencing moderate or extreme levels of distress (61.5%, n=56), high levels of stress were correlated with positive coping skills.

Conclusion: These findings suggest that clinical trial patients with SMI can safely participate in clinical trials despite the increase safety risks posed by the COVID-19 pandemic.

Objective: To evaluate the literature on the effectiveness of virtual reality (VR)- and augmented reality (AR)-based treatments for phantom limb pain (PLP) in postamputation or brachial plexus avulsion (BPA) populations.

Methods: Multiple databases were queried in July 2021 with the keywords "virtual reality," "augmented reality," and "phantom limb pain." Included studies utilized VR or AR to treat PLP with outcome measurement. Two independent reviewers assessed methodological quality using the Physiotherapy Evidence Databsae (PEDro) Scale and the Methodological Index for Nonrandomized Studies (MINORS) scoring. Studies were separated into immersive and nonimmersive AR/VR systems, with further categorization according to the specific methodologies used.

Results: Of 110 results from the database queries, 20 publications met the inclusion criteria. There was one unblinded, randomized, control trial (RCT), one single-blinded, randomized, crossover trial (RCxT), three comparative case series, 13 noncomparative case series, and two case reports. Seven of the 20 studies were classified as nonimmersive. Six studies reported decreased PLP after AR/VR treatments, of which four reported significant reductions. One study reported a reduction in PLP with no significant difference from control conditions. Thirteen of the 20 studies were classified as immersive AR/VR. Twelve studies reported decreased PLP after AR/VR treatments, of which eight reported significant reductions. One study found no change in PLP, compared to baseline.

Conclusion: The number of studies using AR/VR in PLP treatment has expanded since a 2017 review on the topic. The majority of these studies offer support for the efficacy of treating PLP with AR/VR-based treatments. Research has expanded on the customization, outcome measurements, and statistical analysis of AR/VR treatments. While results are promising, most publications remain at the case series level, and clinical indications should be cautioned. With improvements in the quality of evidence, there remain avenues for further investigations, including increased sampling, randomization, optimization of treatment duration, and comparisons to alternative therapies.

Objective: The goal was to compare the impairment on executive functions in children and adolescents with attention deficit hyperactivity disorder (ADHD) alone and with comorbid oppositional defiant disorder (ODD), conduct disorder (CD), or both (ADHD+ODD+CD).

Design: A total of 162 patients were diagnosed with the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), and the results of their performances in Behavior Rating Inventory of Executive Function (BRIEF) and the Tower of London (ToLo) were compared.

Results: Patients with only ADHD showed less impairment in the BRIEF domains and were younger than those with ADHD+CD; the latter group showed a better performance in the time-related domains of ToLo. Patients with ADHD+ODD+CD did not present a consistently worse cognitive performance.

Conclusion: The cognitive performance of patients with ADHD and externalizing disorders seems to vary according to the types of specific comorbid diagnoses, rather than the number of externalizing comorbidities.

Objective: The goal was to promote early diagnosis and referral of patients with depressive symptomology in the primary care setting using a biopsychosocial-informed risk stratification tool to prevent suicides.

Methods: A qualitative analysis of military suicides stationed at Fort Eustis, Virginia, using demographics from Fatality Review Boards (FRBs) of 10 cases assessing shared biopsychosocial stressors was conducted. The case reviews were used to assess the failure modes and effects analyses (FMEA), prompting the development of a performance improvement (PI) plan via a risk stratification scale that recognizes opportunities for intervention in the primary care and supervisor/peer settings to improve patient outcomes.

Results: FMEA revealed the presence and interplay of multiple biopsychosocial stressors specifically impacting relationships, occupational functioning, financial status, legal issues, and undiagnosed mental health conditions across the 10 suicides reviewed. Furthermore, the severity of each stressor was best examined from a dimensional perspective to gauge the impact on or impairment of the individual in the military setting. The dimensional use of biopsychosocial stressors is congruent with our hypothesis that an increase in duration and intensity of biopsychosocial stressors increases risk of suicide.

Conclusion: This case series reveals a gap in suicide assessment and suggests the use of a dimensional approach to measure biopsychosocial stressors at the entry level, such as primary care settings, or in the case of the military, during routine counseling. Additionally, a risk stratification tool that crosses biopsychosocial domains could provide a more accurate assessment for self-harm, in turn enabling a timely referral to appropriate helping agencies, including nonclinical resources.

Background: Deep brain stimulation (DBS) is considered an alternative treatment for patients with rapidly developing Parkinson's disease (PD). DBS can cause cognitive changes, and it is necessary to perform an executive assessment before and after DBS to better define the prognosis.

Objective: The aim of this study was to analyze the use of the Stroop test for assessment of cognitive functions in patients with PD undergoing DBS.

Methods: The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Pubmed, Scopus, PsycInfo, and Web of Science were used as electronic databases. All included studies assessed the cognitive ability of patients with PD undergoing DBS through the application of the Stroop test.

Results: Thirty-five articles met the inclusion criteria. Among the studies, there were different formats of Stroop applications. Twenty-three articles presented negative results in relation to the individuals' performances in Stroop, compared to the control groups. The results suggested that there was no correlation between low performance in the test and global cognitive risk for the patients.

Conclusion: Patients with DBS declined in Stroop performance and showed impairments in response inhibition and speed. These results are not related to the lack of cognitive security of DBS. The Stroop test can be combined with other cognitive instruments to ensure greater approximation of results with reality measures.

The main objective of this preliminary review was to identify studies that investigated extreme forms of animal hoarding in an effort to define the concept of Noah syndrome, recently proposed as the animal variant of Diogenes syndrome. From the 52 scientific articles identified in our search, we included and analyzed 23 manuscripts. The main findings show that persons hoarding animals in squalor tend to be of advanced age and socially isolated, lacking perception of the consequences of their behavior on themselves, their families, and their animals. Neurological and psychiatric conditions, such as dementia, obsessive compulsive disorder (OCD), psychoses, and drug addiction were some of the most common underlying causes. We discuss psychopathological mechanisms, such as ageism and attachment disorders. Due to the limited number of manuscripts on this topic, more research is needed to develop effective intervention strategies, which should include not only psychiatric and neurologic care, but also veterinary care and familiarity with public health policies.