Journal of Neuropsychiatry and Clinical Neurosciences最新文献

Objective: In this exploratory study, the authors used subjective participant data to investigate sleep disturbance in functional neurological disorder (FND) and its impact on FND symptoms.

Methods: An online questionnaire was designed in collaboration with FND charities and administered to 373 adult participants with a self-reported FND diagnosis.

Results: Most participants (86%) were women, and most (73%) perceived their sleep quality over the past 3 months as poor. Almost all (93%) reported nonpositive dream content, with 78% experiencing nightmares at least once per week. Self-rated bad sleep quality increased by 41 percentage points since the onset of FND, and the frequency of nightmares also significantly increased. Obesity was highly prevalent (44% with a body mass index >30 kg/m²), but formally diagnosed sleep-related breathing disorders were rare (8%). Many participants (46%) noticed symptom improvement after a good night's sleep. Most (88%) reported worsening of functional symptoms when falling asleep, during sleep, or when waking up. About one-quarter noted symptom changes after specific dreams or nightmares, with almost all (97%) reporting negative changes, which were more common among participants reporting poor sleep quality. Moderate rates of sleep paralysis and functional seizure were observed. Among those who experienced functional seizures, 74% reported that they arose during sleep.

Conclusions: These findings support the common perception of poor sleep quality, nightmares, and negative dreams among individuals with FND and suggest that self-reported sleep and dream content may also influence FND symptoms. However, the authors recognize a high risk for selection and recall bias.

The semiology of clinical phenomena is central to neurological reasoning. When clinical manifestations occur in combination (e.g., weakness plus sensory loss), they are traditionally analyzed by considering anatomical localization (e.g., right-sided weakness and aphasia implicate the left cerebral cortex) and disease pattern recognition (e.g., tremor, bradykinesia, and rigidity indicate parkinsonism). The authors introduce a third, complementary approach-phenoconsonance-that relates neurological phenomena to each other not by their anatomical localization or disease pattern recognition but by their shared phenomenology. The authors identify the main components of the description of neurological phenomena in relation to where, what, and how neurological function is affected: examples for "where" include left-arm deficits in left brachial plexopathy or left hemispace neglect in right parietal lesions; examples for "what" include motor strength, visuospatial reasoning, or abstract planning; and examples for "how" include slowness, incoordination, or difficulty with initiation, because either the same function can be disrupted in qualitatively different ways-movement can be slowed or uncoordinated-or the same qualitative abnormality can apply to different functions-slowing may characterize movement, and it may also characterize thinking. The where, what, and how of neurological phenomenology correspond in the authors' synthesis to spatial phenoconsonance, domain phenoconsonance, and qualitative phenoconsonance, respectively. The historical context and conceptual underpinning of the notion of phenoconsonance are reviewed, as is its usefulness for the study of brain-behavior relationships in the evaluation and treatment of individuals with neurological and neuropsychiatric disorders.

Functional neurological disorder (FND) is an often-disabling condition with a complex path to diagnosis, further challenged by limited availability of evidence-based treatment resources. Providers hoping to offer treatment resources face the challenge of identifying effective and sustainable implementation of interventions. The existing literature provides limited guidance on the logistics of creating specialized programs for FND outside of tertiary care centers or high-resource medical settings. Members of a multidisciplinary treatment team may find it challenging to identify program development resources that provide a unified perspective on each member's role and how they function together. The authors' FND program at the Stanford University School of Medicine has recently fielded a high number of requests by clinicians, health care staff, and administrators across the United States for collaboration to start new programs. Frequently asked questions include the criteria for patient selection, what personnel to include, how to ensure prompt staff responses to FND symptoms, when to hospitalize patients, how to obtain funding for services, and more. The intended audience for this review includes seasoned and new clinicians, allied health professionals, and nonclinicians, including administrators. The authors discuss diagnosis and evidence-based treatment strategies and provide guidance on practical issues, including work, disability, and driving. The authors' program experience is highlighted as an example, and alternative working models are discussed. The aim of this article is to improve providers' knowledge and confidence and remove frequently encountered barriers to program development. The authors seek to provide a resource that may help connect those in need of care to FND services.

Objective: Traumatic brain injury (TBI) often involves injury to limbic structures that may be linked to posttraumatic psychological health difficulties. The authors investigated whether the relationship of amygdala and hippocampal volumes with anxiety differed among children with TBI versus children without a history of TBI over time since injury.

Methods: Structural MRI scans were acquired for children ages 8-15 years at 7 weeks (time point 1) and 14 months (time point 2) after a TBI (N=51) as well as for age-matched healthy control (HC) children (N=36). The Screen for Child Anxiety Related Emotional Disorders (SCARED) was administered at both time points. Generalized linear models were used to evaluate the relationship of limbic volumes, experimental group, time of scan, and their interactions with SCARED scores. Pubertal status at time point 1, sex, and total gray matter volume were included as covariates.

Results: The group × volume × time interaction was statistically significant for both structures bilaterally. Relative to the HC group, children with TBI showed altered directionality of the relationship of amygdala and hippocampal volumes with SCARED scores that changed between the two time points. During the subacute stage of recovery, higher self-reported anxiety was associated with larger amygdala and hippocampal volumes. During the chronic stage, higher anxiety was associated with lower volumes. SCARED scores were higher among girls than among boys when limbic volumes were controlled for.

Conclusions: TBI significantly affected the typical relationship between amygdala and hippocampal volumes and anxiety scores, suggesting that limbic volumes may serve as markers of later developing psychological health.

Objective: A significant percentage of individuals diagnosed as having posttraumatic stress disorder (PTSD) show remission within the first year after traumatic exposure, with more gradual improvement over the next several years. However, a subgroup of individuals with PTSD have an unremitting course of illness that may persist for years or decades despite treatment efforts. The authors tested the hypothesis that reduced hippocampal volume is associated with chronic, unremitting PTSD rather than with PTSD that has remitted over time.

Methods: The study included 44 Vietnam War veterans whose traumatic exposure had occurred more than three decades before study participation. The authors studied the association between hippocampal volume and three PTSD diagnostic categories: veterans with unremitting PTSD (N=26), veterans with sustained remission from earlier PTSD (N=8), and veterans who never developed PTSD (N=10).

Results: Compared with trauma-exposed veterans who never developed PTSD, those with unremitting PTSD, but not those who had recovered, showed reduced hippocampal volume. The results were anatomically lateralized to the right hippocampus, consistent with previous neuroimaging studies of male combat veterans.

Conclusions: These results support an emerging literature suggesting that reduced hippocampal volume observed among individuals with PTSD may be related to failure to recover from rather than to the development of PTSD after trauma exposure. These findings may define a subpopulation of combat veterans who are at increased risk for long-term failure to recover from PTSD because of their smaller right hippocampi.

Objective: Although high-frequency brain stimulation has demonstrated efficacy in various translational models of posttraumatic stress disorder (PTSD), there is a scarcity of studies investigating deep brain stimulation (DBS) in human PTSD populations. The authors sought to investigate the current state of DBS in the setting of treatment-resistant PTSD.

Methods: A systematic search was performed in PubMed, Scopus, and Web of Science Core Collection databases by using keywords related to DBS and PTSD. A secondary search for gray literature was conducted in ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform.

Results: Five articles reporting the effect of DBS on six patients with PTSD were retrieved. Electrodes were implanted bilaterally either in the basolateral amygdala (BLa; N=2) or in contact with the subgenual cingulum and uncinate fasciculus (SGC-UF; N=4). No significant perioperative complications related to BLa or SGC-UF lead implantation were reported in all five studies. BLa patients reported mild neuropsychiatric effects during stimulation. All but one patient had a significant decrease in Clinician-Administered PTSD Scale score, with most reporting a subjective reduction in PTSD symptoms.

Conclusions: Although additional research is needed to assess the safety and efficacy of BLa and SGC-UF DBS, these preliminary findings are encouraging. However, the application of DBS in psychiatric treatment remains controversial and largely experimental. Continued studies with larger samples are essential to establish the efficacy and safety profile of DBS specifically with PTSD patients.

Objective: Given limited access and long wait times for individualized behavioral health care focused on functional neurological disorder (FND), FND-specific group psychotherapy formats may offer patients early access to tools that could help alleviate symptoms. In this pilot study, the authors investigated the utility of using a well-known, evidence-based, and FND-focused self-help cognitive-behavioral therapy (CBT) workbook in a therapist-led skills group format for patients with primary functional movement disorder (FMD).

Methods: Six patients with primary FMD received a 10-week therapist-led CBT psychotherapy skills group based on the workbook Overcoming Functional Neurological Symptoms: A Five Areas Approach. Basic metrics of feasibility, tolerability, utility, and exploratory Patient-Reported Outcomes Measurement Information System (PROMIS) measures were compared pre- and postintervention. Pregroup guidelines and postgroup summary (summary of skills, supplemental tools, and FND next steps checklist) were included.

Results: Feasibility and tolerability metrics were sound, and three of the six patients had significant improvement in at least two of the 11 PROMIS measures. The PROMIS measures with the greatest improvement included fatigue, anxiety, depression, self-efficacy in managing symptoms, social interactions, emotions, and medications and treatments. Further, the Patient Global Impression of Change (PGIC) may alternatively be used to capture group outcomes, because two of the participants whose PROMIS scores did not change (despite reported benefits) provided PGIC ratings of 1 and 2 (very much improved and much improved, respectively).

Conclusions: These findings suggest that this therapist-led FND skills group intervention format has feasibility, tolerability, and early utility. However, further research is necessary to establish its efficacy.

Objective: The authors sought to determine the relationships among cognitive impairment, psychiatric outcome, and functional status 3 months after a hemorrhagic stroke.

Methods: Patients with nontraumatic intracerebral hemorrhage (ICH) or subarachnoid hemorrhage (SAH) were assessed by telephone 3 months after discharge by using the Quality of Life in Neurological Disorders (Neuro-QoL) cognitive function, anxiety, depression, and sleep disturbance short forms, as well as the modified Rankin Scale (mRS). The relationships between poor cognition (Neuro-QoL T score≤50), functional status, and psychiatric outcome among patients with ICH or SAH and patients with ICH only were evaluated.

Results: Of 101 patients (N=62 with ICH and N=39 with SAH), 51% had poor cognition 3 months posthemorrhage, with 61% having mRS scores of 3-5, 43% having anxiety, 28% having depression, and 31% having sleep disturbance. Univariate analysis of the full cohort indicated that poor cognition was significantly associated with anxiety, depression, sleep disturbance, and mRS scores of 3-5 (p<0.05). Multivariate analysis revealed that poor cognition was significantly associated with anxiety (OR=4.38, 95% CI=1.30-14.74, p=0.017) and mRS scores of 3-5 (OR=6.15, 95% CI=1.96-19.32, p=0.002). Univariate analysis of the 62 patients with ICH indicated that poor cognition was significantly associated with anxiety, sleep disturbance, and mRS scores of 3-5 (p<0.05). Multivariate analysis revealed that poor cognition was significantly associated with anxiety (OR=10.98, 95% CI=2.32-51.99, p=0.003).

Conclusions: Poor cognition was associated with anxiety 3 months after hemorrhagic stroke. Additional research is needed to understand whether treatment for anxiety would improve cognition in this population.

Objective: Isolated ischemic stroke of the lingual gyrus is uncommon. The authors evaluated the clinical, neuro-ophthalmological, and cognitive features of lingual gyrus infarctions.

Methods: This study was carried out from January 1, 2012, to January 30, 2022, in a hospital's stroke, neuro-ophthalmology, and neuropsychology unit, in İzmir, Turkey. Various aspects of visual and cognitive functions of 10 patients with isolated lingual infarctions were analyzed. The authors used structural MRI data to contour ischemic areas by hand and used MRIcroGL software to convert these areas to binarized images.

Results: Isolated lingual infarctions accounted for 3% of posterior cerebral artery territory infarctions. Two-thirds (N=7) of the patients had macular-sparing superior quadrantanopia with visuocognitive disturbances. One patient reported mild visual snow characterized by tiny flickering dots resembling static on an analog television screen. All six patients with right-sided lingual gyrus involvement had significant difficulties in visual memory, and three of four patients with left-sided lesions had difficulties in verbal memory. Three patients had achromatopsia, and two patients had mental color imagery impairment. One patient with topographagnosia had difficulty recognizing İzmir's landmarks and finding the city on a map.

Conclusions: The lingual gyrus is a brain structure that appears to be critical for vision processing, color integration, face recognition, visual-verbal processing, mental visual imagery, dreaming, and encoding of visual memories. The most common cause of stroke in this region was arterial-to-arterial and cardiac emboli.