Innovations in clinical neuroscience最新文献

Objective: The prevalence of autism spectrum disorder (ASD) in Lebanon is higher than what is reported by the World Health Organization (WHO), leading to the thought that the Lebanese population has some specific risk factors for ASD. Therefore, it is important to conduct more robust studies on this population. We conducted this study to identify pre-, peri-, and neonatal risk factors for ASD. Our ultimate goal was to detect and change some modifiable risk factors, thus reducing the incidence of ASD.

Design: A case-control study was conducted using a random proportional sample of Lebanese children with ASD to explore whether risk factors, such as family history, pregnancy (including all medication and substances taken during pregnancy and infection history), gestational age, delivery, birth milestones, and the neonate's condition at birth could be associated with a higher prevalence of ASD. The local ethical committee approved the study (USJ-2016-91), and all parents gave their written consent.

Results: A total of 66 children with ASD and 66 controls were included. The results of the multivariable analysis showed that a higher gestational weight gain (adjusted odds ratio [ORa]: 1.11) was significantly associated with higher odds of autism, whereas female sex (ORa: 0.13) and higher number of weeks of gestation (ORa: 0.76) were significantly associated with lower odds of autism.

Conclusion: Such results are of great relevance, since many of the identified factors herein could be avoidable or modifiable, suggesting the need for implementing timely and appropriate public health strategies for disease prevention in pregnant women that could reduce ASD.

Background: Patients diagnosed with major depressive disorder (MDD) who fail to respond to two or more antidepressants are often considered to have treatment-resistant depression (TRD). Many of the current options for TRD have significant side effect profiles, are expensive, and are difficult to access. There has been a revival of psychedelic research in recent years that shows promising results in the treatment of TRD.

Case presentation: Here, the case of a 43-year-old man with TRD is presented. TRD symptoms were greatly interfering with his life. He underwent psychological testing, lab work, adequate trials of numerous medications, transcranial magnetic stimulation (TMS), and electroconvulsive therapy, all without adequate relief of his symptoms. The patient began self-administering a microdosing regimen of psilocybin and experienced significant improvement of MDD symptoms, as characterized by Hamilton Depression Rating Scale (HDRS).

Discussion: In recent years, multiple randomized, controlled trials (RCTs) have shown the benefit of psilocybin in the treatment of varying types of depression. One trial evaluated psilocybin and escitalopram as treatments for depression, and psilocybin was found to be superior.

Conclusion: This case suggests the possible benefit of psilocybin in the setting of TRD, as outlined in recent research. Additional research is needed to confirm these observations.

We present the cases of a 60-year-old female patient and 40-year-old male patient who experienced exacerbations of previously well-controlled symptoms of bipolar I disorder (BD1) after receiving COVID-19 vaccines, despite being stable for years on the same medications. The first patient experienced worsened depression, mania, and psychosis that improved with an increase in risperidone. The second patient experienced depression, mania, psychosis, and suicidal ideation that resulted in hospitalization. Prior to hospitalization, he took lamotrigine and bupropion, the latter of which was changed to aripiprazole in hospital. We reviewed current literature on inflammation in mental disorders, vaccination-related inflammatory changes, and the type of inflammation induced by COVID-19 vaccines. Inflammation is a component of psychiatric disorders, and the inflammatory response induced by vaccines might potentiate acute mental health exacerbations, necessitating treatment changes. However, this case series should not be used to justify recommendations against vaccination without larger, well-designed studies. At this time, the known benefits of vaccination outweigh these unknown risks, especially because individuals with serious mental illness are more likely to die from COVID-19 than the general population.

Objective: We sought to assess the influence of Parkinson's disease (PD) on contingent negative variation (CNV).

Patients and methods: This prospective study included 49 patients with PD (69.7±16.5; 35 male) and 35 age- and sex-matched controls. The PD cohort was subdivided, according to the Hoehn-Yahr Scale, Unified Parkinson's Disease Rating Scale (UPDRS), and UPDRS Part III, into 30 cases of uncomplicated PD and 19 cases of advanced PD. CNV was recorded over the frontal and central vertex with a linked bimastoid reference using a dual-stimulus paradigm with interstimulus intervals (ISIs) of 1.7 and 2.0 seconds.

Results: In advanced PD, the amplitude of the late CNV over the central vertex was markedly reduced (p<0.005) at ISI of 1.7 seconds and correlated negatively with UPDRS (r=-0.32; p<0.003) and motor score (UPDRS Part III) (r=-0.45; p<0.002).

Conclusion: Late CNV amplitude was significantly abnormal in PD and correlated with the severity of the motor manifestations.

Objective: This article reviews evidence-based psychiatric uses of gabapentin, along with associated risks.

Method of research: An extensive literature review was conducted, primarily of articles searchable in PubMed, relating to psychiatric uses, safety, and adverse effects of gabapentin.

Results: Evidence supports gabapentin as a treatment for alcohol withdrawal and alcohol use disorder. There is sufficient evidence to consider gabapentin as a third-line treatment for social anxiety disorder and severe panic disorder. Evidence does not support the use of gabapentin for bipolar disorder, major depressive disorder (MDD), posttraumatic stress disorder (PTSD), obsessive compulsive disorder (OCD), stimulant use disorder, or opioid withdrawal. Risks of gabapentin use are highest among those with a history of a substance use disorder and those concurrently taking opioids.

Conclusion: While gabapentin has a place in psychiatry for a select few indications, the literature does not support its use for many studied diagnoses.

Both individuals with intellectual disability (ID) and individuals with personality disorders represent populations that require unique interactions with healthcare providers and consist of high utilizers of the healthcare system. The intersectionality of these diagnoses poses further considerations in diagnosis and management. This article describes two fictional case studies intended to illustrate, examine, and identify symptomology of individuals with these comorbid diagnoses and establish recommendations for evidence-based management of these individuals. While personality disorders should not be diagnosed in individuals with severe and profound ID, they can and should be diagnosed in patients with mild or moderate ID who have characteristic symptoms and meet diagnostic criteria. Management for these diagnoses focuses on themes of consistency, safety, staff education, and goal-based behavioral objectives. Care must be taken in ruling out confounding factors and overlapping symptomology, but appropriate comorbid diagnoses can aid in apposite treatment, reduce stigma, and improve quality of life.

Stroke is a leading cause of death and disability throughout the world. Although physical and cognitive impairments after stroke have been well studied, little is known about sexual functioning and satisfaction in these patients, despite being crucial aspects of quality of life. Post-stroke sexual dysfunctions seem to be common; in men affected by stroke, a decline in libido and poor or curtailed erection and ejaculation are frequently observed. Sexual disorders after stroke are thought to be due to multiple etiologies, including both organic (e.g., lesion localization, premorbid medical conditions, medications) and psychosocial (e.g., fear of recurrences, loss of self-esteem, role changes, anxiety and depression) etiologies. Thus, the exploration of sexual dysfunction and sexual counseling by trained professionals should be part of stroke rehabilitation.

The child patient who presents for psychiatric evaluation due to aggressive behavior poses specific challenges to the treating psychiatrist. Boundary violations, devaluation of relationships and social skills, and transference/countertransference issues are some of the challenges that may arise during the psychiatric treatment of the aggressive child patient. The child who displays aggression may have complex challenges, including major transitions, insomnia, trauma history, custody considerations, and family disruption, among others. This article reviews the treatment dynamics created by the child patient with history of aggression, as well as the approaches that the psychiatrist can utilize in a therapeutic manner.

Background: The tendency of the mind to wander, a characteristic of the brain's default mode network (DMN), correlates with increased unhappiness and self-referential processing and is a deterrent to establishing a consistent meditation practice. The objective of this study was to test the impact of a secular physiological method of meditation. We hypothesized that EcoMeditation would produce increases in neural communication in brain regions associated with compassion and prosociality and decreases in self-referencing networks, such as the DMN, and that these changes would be found in the experimental group, but not the control group.

Methods: Participants (n=38) were randomized into two groups, and the final sample consisted of 25 participants. One group listened daily to a 22-minute EcoMeditation audio track, while the other used an active control. Functional magnetic resonance imaging (fMRI) was used to assess brain function before and after four weeks of practice. Mystical experiences, as well as psychological conditions, such as anxiety and depression, were measured.

Results: Participants in the EcoMeditation group showed significantly increased connectivity between the bilateral hippocampus and the bilateral insula, compared to pre-intervention. In addition, significant decreases of connectivity between the bilateral hippocampus and the midprefrontal and left dorsolateral prefrontal cortices occurred. EcoMeditation participants also scored significantly higher for mystical experiences than the control group. The results for emotional states were mixed, with one assessment finding increased positive mood, but another finding increased negative affect.

Conclusion: After only four weeks, participants using EcoMeditation demonstrated brain states similar to meditation adepts with thousands of hours of traditional practice.