Journal of Neuropsychiatry and Clinical Neurosciences最新文献

Objective: Hoarding disorder is defined as persistent difficulty discarding or parting with possessions, regardless of their actual value. Hoarding is associated with biopsychosocial distress and reduced quality of life, and although it is often associated with obsessive-compulsive spectrum disorders, hoarding is also encountered in cases of neurodegeneration. Assessments of hoarding behavior traditionally involve a comprehensive evaluation that may be challenging in clinical settings. The authors developed a simplified hoarding screen for patients with neurobehavioral disorders.

Methods: The Single-Item Hoarding Screen (SIHS) is a single-item questionnaire. In total, 135 patients from the University of Colorado Behavioral Neurology Clinic were surveyed; caregivers filled out the SIHS. Patients' diagnoses included a range of neurobehavioral disorders, including Alzheimer's disease, behavioral variant frontotemporal dementia, Lewy body dementia, primary progressive aphasia, major neurocognitive disorder not otherwise specified, and minor neurocognitive disorder not otherwise specified.

Results: The mean age of the patients was 70.9 years, and 39% were female. Among the patients surveyed, 10% and 13% of caregivers (23% total) answered yes and maybe, respectively, to the question on the SIHS. Yes responses on this screen were significantly associated with higher scores on the established Hoarding Rating Scale, compared with maybe responses. Statistical analyses revealed significant correlations between hoarding behaviors and neuropsychiatric symptom severity as well as caregiver well-being.

Conclusions: These results suggest the potential benefits of a tool containing only a single item to screen for hoarding behavior in neurobehavioral disorders. Future research may focus on refining and validating the SIHS.

Objective: Besides cognitive deficits, dementias are characterized by behavioral symptoms, hampering efforts to distinguish between different types of dementia, such as Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD). Moreover, instruments adapted to the local sociocultural context are lacking in non-English-speaking countries. The authors developed a scoring instrument (the Behavioral Evaluation Scale of Frontotemporal Dementia [BES-FTD]) for use in the Latin American context to assess behavioral changes among patients with bvFTD and to test its accuracy to differentiate bvFTD from AD.

Methods: The BES-FTD and the Cambridge Behavioral Inventory-Revised (CBI-R) were administered to three groups of participants: patients with probable bvFTD, patients with probable AD, and cognitively healthy individuals (control). The authors investigated diagnostic accuracies with receiver operating characteristic (ROC) curve analysis.

Results: The sample comprised 86 participants matched on sex, age, and education: bvFTD group, N=26; AD group, N=16; and healthy control group, N=44. The AD and bvFTD groups were also matched on the severity of disease. The individuals in the bvFTD group had significantly higher scores on the BES-FTD and on the CBI-R compared with the control and AD groups, indicating more severe behavioral disorders. ROC curve analysis indicated an area under the curve of 0.86 for the BES-FTD and 0.58 for the CBI-R. The BES-FTD had higher specificity (93.7%) than the CBI-R (81.2%).

Conclusions: The BES-FTD provided higher diagnostic accuracy than the CBI-R for distinguishing between bvFTD and AD, demonstrating the clinical usefulness of the BES-FTD. Future studies are needed to confirm these results.

Delirium occurs in a significant proportion of hospitalized and older patients, contributing to increased morbidity and mortality rates, lengthier hospitalizations, increased readmissions, higher health care costs, greater odds of persistent functional decline, and psychological distress for patients, their families, and clinicians. Given that the global population continues to age, the incidence of delirium is expected to rise. The recently updated American Psychiatric Association Practice Guideline for the Prevention and Treatment of Delirium includes 15 statements to help clinicians prevent delirium, improve its detection, and optimize treatment for delirium in adult patient populations. In this analysis and commentary, the authors review each of the guideline statements, providing context and discussion of their clinical implications.

Objective: Catatonia is a neuropsychiatric syndrome that can occur in association with psychiatric conditions, general medical disorders, or use of psychoactive substances. Roughly 20% of catatonia cases are due to general medical conditions, two-thirds of which are neurological conditions. The authors aimed to review the diagnostic and treatment challenges posed by catatonia due to neurological conditions, including neurodevelopmental disorders.

Methods: The authors considered the diagnostic and treatment challenges of catatonia in three areas: neurodevelopmental disorders, with a focus on autism spectrum disorder; acquired neurological disorders of epilepsy, anti-N-methyl-d-aspartate receptor encephalitis, and neuropsychiatric disorders due to traumatic brain injury; and the neurocognitive conditions delirium and dementia. One consideration was how clinicians might differentiate features of catatonia from common neurological findings in these conditions.

Results: Many of catatonia's features overlap with those in neurological conditions and vice versa. This overlap often leads to underdiagnosis of catatonia, misdiagnosis, or diagnostic uncertainty, which may introduce clinical conundrums and make accurate identification of catatonia clinically important, with potential diagnostic and therapeutic implications.

Conclusions: Accurate diagnosis of catatonia is necessary to ensure timely workup and clinical management. The challenges reviewed here emphasize the importance of a collaborative and multidisciplinary approach to managing catatonia in neurological and psychiatric settings. Additional research is needed to understand the complex relationship between catatonia and neurological conditions.

Objective: Dementia with Lewy bodies (DLB) is the second most common neurodegenerative dementia after Alzheimer's disease but remains underdiagnosed because of its heterogeneous symptomatology. Network analysis may capture interrelationships among symptoms, potentially improving diagnostic precision. The authors applied network analysis to a cohort of patients with DLB to map symptom connections, identify central features, and explore clustering patterns.

Methods: Clinical records of 107 patients with a confirmed DLB diagnosis from Brugmann University Hospital, Brussels, were retrospectively analyzed. Sixteen core and supportive symptoms were coded as binary variables. Pairwise Markov random fields with least absolute shrinkage and selection operator regularization were used to construct a symptom network. Centrality indices, predictability, and community detection were computed to assess the structural importance and clustering of symptoms. Stability was evaluated via nonparametric bootstrap procedures, and redundancy was addressed with unique variable analysis, prompting reestimation of a reduced network.

Results: The network was characterized by positive correlations among symptoms, with visual hallucinations and urinary incontinence showing the highest centrality. Cognitive fluctuation and tactile hallucinations were disconnected despite high predictability from low variance. Three clusters emerged: cognitive-perceptual, motor-perceptual, and autonomic-somatic. Removal of agitation, prompted by redundancy between agitation and delirious thoughts, reduced centrality for delirious thoughts and depression. Stability analyses indicated moderate robustness for the full network and slightly improved stability in the revised model.

Conclusions: Central symptoms such as visual hallucinations and urinary incontinence may serve as high-yield diagnostic targets in DLB, and clustering patterns could represent meaningful clinical dimensions. Network analysis may help refine diagnoses and guide targeted interventions in DLB.

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: 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: Attention-deficit hyperactivity disorder, obsessive-compulsive disorder, depression, and anxiety are highly comorbid in Tourette's syndrome. Cutoff points of screening instruments for these conditions have been validated in the general population. The authors assessed whether established cutoff points on the General Anxiety Disorder-7 (GAD-7) scale; Patient Health Questionnaire-9 (PHQ-9); PHQ-2; Adult ADHD Self-Report Scale, version 1.1 (ASRS v1.1); and Obsessive-Compulsive Inventory (OCI) need to be adjusted for adults with Tourette's syndrome.

Methods: Thirty-six adults with Tourette's syndrome completed these instruments and a diagnostic psychiatric interview. Measures of diagnostic accuracy were calculated (area under the receiver operating characteristic curve [AUC], sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio) for each instrument at various cutoffs. Cutoffs for the sample of adults with Tourette's syndrome were suggested by the lowest value derived from a Euclidean distance method.

Results: In this sample of adults with Tourette's syndrome, the optimal cutoff points were a GAD-7 score ≥13 (sensitivity, 67%; specificity, 91%; and AUC, 79%), a PHQ-9 score ≥15 (sensitivity, 67%; specificity, 73%; and AUC, 70%), a PHQ-2 score ≥3 (sensitivity, 67%; specificity, 67%; and AUC, 67%), an ASRS v1.1 score ≥14 (sensitivity, 83%; specificity, 77%; and AUC, 80%), and an OCI score ≥63 (sensitivity, 70%; specificity, 89%; and AUC, 79%). The best-performing instrument was the ASRS v1.1, followed by the GAD-7 and OCI; the PHQ-9 and PHQ-2 performed least well in this population.

Conclusions: Further research is needed to adapt screening instruments for the assessment of comorbid conditions among patients with Tourette's syndrome.