Journal of Neuropsychiatry and Clinical Neurosciences最新文献

Objective: Persistent headache is the most common and debilitating chronic condition after traumatic brain injury (TBI), affecting mood and reducing quality of life. The investigators examined in a community-based setting whether repetitive transcranial magnetic stimulation (rTMS) for management of major depression among outpatients with TBI histories was associated with improvement in the functional impact of headache (FH) and whether improvements were related to treatment at a specific site in the dorsolateral prefrontal cortex (DLPFC).

Methods: In the discovery phase (posttraumatic headache 1 [PTH-1] group, N=21), the association of rTMS treatment at DLPFC targets and improvement in headache and depression and anxiety were studied. Associations between functional connectivity of the patient-specific TMS treatment sites and changes in patients' FH were used to identify a target for simultaneous treatment of behavioral and headache symptoms. Patients in the translational phase (PTH-2 group, N=7) received TMS treatment at this target.

Results: The patients in the PTH-1 group had significant improvements in depression and anxiety but not FH, and more than half had a reduction in FH and reported an improvement in headache severity and duration. Increased functional connectivity between TMS sites and a subregion in the left DLPFC and bilateral precuneus was related to improved FH. Unlike the PTH-1 group, the PTH-2 group exhibited significant reductions in FH after 4 weeks of treatment and in anxiety and depression after 1-2 weeks of treatment.

Conclusions: TMS treatment targeting the left DLPFC coordinate identified in this study may help improve treatment for both FH and anxiety and depression among PTH patients.

Objective: The authors aimed to characterize the long-term psychiatric outcomes and their predictors among survivors of autoimmune encephalitis (AE).

Methods: In this retrospective cohort study, patients diagnosed as having AE between 2008 and 2023 at two academic medical centers (in New York City and Toronto) completed the Mini International Neuropsychiatric Interview 7.0.2 (MINI) and Profile of Mood States (POMS-2) to assess long-term psychiatric outcomes. Clinical characteristics were assessed for potential predictors of psychiatric outcomes. Bivariate analyses and univariate logistic regressions were conducted to assess the relationship between the predictors and the primary outcome.

Results: Overall, 42 participants (female, N=26, 62%; median age=37.5 years, interquartile range [IQR]=32.8 years) were assessed a median of 4 years (IQR=6 years) after an AE diagnosis. AE subtypes included anti-N-methyl-d-aspartate (33%), anti-leucine-rich-glioma-inactivated 1 (24%), anti-glutamic acid decarboxylase 65 (14%), and antibody-negative encephalitis (29%). In total, 71% of participants who completed the MINI met criteria for a DSM-5 diagnosis, and 56% were diagnosed as having a mood disorder. Thirteen participants (31%) reported above-average total mood disturbance on the POMS-2. Mann-Whitney U tests revealed that participants diagnosed as having a mood disorder self-reported significantly higher levels of confusion and bewilderment (z=-2.04, p=0.04) and depression and dejection (z=-2.24, p=0.03) and lower levels of vigor and activity (z=-2.62, p=0.01).

Conclusions: AE survivors have a high prevalence of psychiatric comorbid conditions, with most being diagnosed as having a mood disorder and a significant proportion endorsing ongoing mood disturbance. Patients with a psychiatric history may benefit from closer psychiatric follow-up.

Objective: The authors examined lived experience perspectives of suicidality and nonsuicidal self-injury (NSSI) after moderate-to-severe traumatic brain injury (TBI), risk and protective factors, and methods of coping.

Methods: A record review of suicide risk assessments was completed as part of routine clinical risk management for a research study. The authors used a semistructured interview approach developed from existing clinical tools and extracted data from assessment records by using content analysis to categorize common responses.

Results: Data were extracted from records of 68 participants (mean±SD age=45.9±14.4 years; 82% male) with a history of moderate-to-severe TBI (mean=10.7±9.1 years after TBI). Most participants (86%) were currently experiencing suicidal thoughts, and 50% had experienced NSSI thoughts in their lifetime. Fifteen participants (28%) reported a lifetime suicide attempt. The most common protective factors for suicidal ideation reported by participants were support from family (59%) and the personal attributes of openness and being optimistic (49%). The most common risk factors were emotional distress or presence of a psychiatric diagnosis (62%), TBI sequelae (such as fatigue; 49%), work-related stress (43%), and lack of family support (34%). Engaging with health professionals (62%) and seeking support from family (57%) were the most common healthy coping strategies, whereas substance use (38%) and social withdrawal (32%) were the most common unhealthy coping strategies.

Conclusions: The findings of this study provide detailed insights into the lived experiences of suicidality and NSSI after moderate-to-severe TBI, how survivors conceptualize factors that may increase or attenuate risk, and common coping strategies.

Objective: Through the brain-gut-microbiome axis, myriad psychological functions that affect behavior share a dynamic, bidirectional relationship with the intestinal microbiome. Little is known about the relationship between personality-a stable construct that influences social- and health-related behaviors-and the bacterial ecosystem. The authors of this exploratory study examined the relationship between general and maladaptive personality traits and the composition of the gut microbiome.

Methods: In total, 105 psychiatric inpatients provided clinical data and fecal samples. Personality traits were measured with the five-factor model of personality, the Structured Clinical Interview for DSM-IV Axis II Personality Disorders, and the Personality Inventory for DSM-5; 16S ribosomal DNA sequencing and whole-genome shotgun sequencing methods were used on fecal samples. Machine learning (ML) was used to identify personality traits associated with bacterial variability and specific taxa.

Results: Supervised ML techniques were used to classify traits of social detachment (maximum area under the receiver operating characteristic curve [AUROC]=0.944, R²>0.20), perceptual disturbance (maximum AUROC=0.763, R²=0.301), and hoarding behaviors (maximum AUROC=0.722) by using limited sets of discriminant bacterial species or genera. Established bacterial genera associated with psychosis (e.g., Peptococcus and Coprococcus) were associated with traits of perceptual disturbance. Hoarding behaviors were associated with a defined gut microbial composition that included Streptococcus, a known contributor to the development of pediatric autoimmune neuropsychiatric disorders.

Conclusions: Observations from this study are consistent with recent findings demonstrating person-to-person interactions as a mode of gut microbiome transmission. This study adds to the emerging literature on the intricate connections between brain and gut function, expanding the interdisciplinary field of psychiatric microbiology.

Objective: Hyperorality is a core feature of behavioral variant frontotemporal dementia (bvFTD); however, the cognitive, psychiatric, and neuroanatomical correlates of hyperorality across the bvFTD stages remain unclear. The authors explored these associations in early- and advanced-stage bvFTD.

Methods: Participants with sporadic or genetic bvFTD were enrolled in the ARTFL LEFFTDS Longitudinal Frontotemporal Lobar Degeneration (ALLFTD) consortium study. Baseline cognitive and psychiatric symptoms of participants with or without hyperorality were compared after stratification by disease severity. Linear multivariable regressions adjusted for age and total intracranial volume were used to examine associations between regional gray matter volume (GMV) and hyperorality status. Five anatomical regions of interest were preselected for analysis on the basis of previously identified neuroanatomical correlates of hyperorality in bvFTD.

Results: Hyperorality was present in 50% of early-stage bvFTD participants (N=136) and was associated with higher rates of ritualistic-compulsive behavior and difficulty detecting social-emotional expressions. Hyperorality was present in 63% of advanced-stage participants (N=208) and was associated with higher rates of apathy, ritualistic-compulsive behavior, and socially aberrant behavior. Regional GMV was similar for those with or without hyperorality among early-stage participants. Among advanced-stage participants, hyperorality was associated with lower GMV in the right dorsal and ventral striatum.

Conclusions: Hyperorality emerged early in bvFTD and was accompanied by deficits in social cognition and complex-ritualistic behavior before clinically significant GMV loss. These findings suggest that early identification and management of hyperorality could improve neuropsychiatric trajectories in bvFTD.

Objective: Interpersonal conflicts are among the most prevalent stressors before the onset of functional neurological disorder (FND), possibly reflecting maladaptive anger regulation. The authors examined whether FND patients have higher scores on anger-related measures compared with healthy control individuals and how anger regulation relates to personality factors.

Methods: FND patients (N=73, mean±SD age=44.2±16.7 years, 67% women) and healthy control individuals (N=43, mean age=43.3±17.0 years, 56% women) completed the State-Trait Anger Expression Inventory-2 (STAXI-2) to measure state and trait components of anger. Personality factors were assessed with the Personality Inventory for DSM-5-Brief Form and a structured interview to explore conflict and anger-related measures.

Results: Compared with control individuals, FND patients had significantly higher levels of state anger (U=1,031.5). After adjustment of analyses for trait anger, patients with FND still had higher levels of state anger than did control individuals (Wald χ²=6.97), an association that remained statistically significant after adjustment for other personality factors (Wald χ²=7.69). Exploration of the Alternative Model of Personality Disorders factors showed that FND patients scored significantly higher on negative affectivity, disinhibition, detachment, and psychoticism but not on antagonism (U=1,244.0). Trait anger, assessed with the STAXI-2, did not differ significantly between FND patients and control individuals (U=1,317.5). Interview data analysis revealed that patients had more anger outbursts during childhood compared with control individuals (U=1,141.0).

Conclusions: FND patients reported higher levels of state anger than did healthy control individuals, even after analyses were adjusted for demographic and personality factors and trait anger. These findings emphasize the importance of anger regulation and personality factors in FND assessment and management.

Substance use disorders, including methamphetamine use disorder, are prevalent, causing extensive morbidity and death. Despite advances in evidence-based treatments for methamphetamine use disorder, many patients do not respond to these interventions, and new approaches are needed. Deep brain stimulation (DBS) involves the surgical implantation of a device to modulate nervous system function and has proven efficacy in the management of movement disorders. Recent studies of DBS for the management of substance use disorders have shown promise, and the authors of this review are currently investigating DBS for the treatment of patients with methamphetamine use disorder. However, acute and chronic intoxication with methamphetamine can result in various systemic abnormalities and medical comorbid conditions, presenting challenges for the neurosurgeon, the anesthesiologist, and other medical providers. This narrative review aims to provide a comprehensive overview of methamphetamine's systemic effects and associated medical comorbid conditions for clinicians engaged in the perioperative care of this patient population. The systemic effects and related medical comorbid conditions that may complicate the perioperative course of patients with methamphetamine use disorder are presented by organ system. With diligent preoperative planning and perioperative management, patients with methamphetamine use disorder can be successfully treated with DBS surgery. A thorough understanding of these effects and comorbid conditions is crucial for both the prevention and the rapid recognition of perioperative complications, resulting in improved outcomes in this patient population.