Journal of Neuropsychiatry and Clinical Neurosciences最新文献

Objective: Pediatric mild traumatic brain injury (mTBI) is a major public health concern. New psychiatric disorders (NPDs) can arise after mTBI, yet postinjury NPDs in nonclinical samples remain poorly understood.

Methods: NPDs were prospectively characterized for youths ages 9-11 years who experienced an mTBI in their first year of participation in the Adolescent Brain Cognitive Development study, compared with control groups of orthopedically injured and noninjured individuals; a broad set of preinjury factors was accounted for in analyses.

Results: Between baseline (ages 9-10) and year 1 (ages 10-11), 135 youths had an mTBI, with 110 incurring a first lifetime mTBI. The prevalence of NPDs at the year-1 study visit was comparable among the injury groups, and mTBI did not predict NPDs at year 1. Preinjury psychiatric diagnoses significantly predicted NPDs (NPD-current [NPD-C] group: OR=2.18, 95% CI=1.30-3.61, p=0.003; NPD-any [NPD-A] group: OR=1.70, 95% CI=1.16-2.52, p=0.006), and self-reported Hispanic ethnicity was associated with lower odds of NPDs at year 1 (NPD-C group: OR=0.19, 95% CI=0.03-0.78, p=0.018; NPD-A group: OR=0.57, 95% CI=0.31-0.98, p=0.043).

Conclusions: These results suggest that for nonclinically selected youths with mTBI, in the first year after late childhood injury, mTBI is not associated with differential odds of NPDs. Preinjury psychiatric history predicted NPDs, and self-reported Hispanic ethnicity predicted lower odds of NPDs at year 1. Future studies are needed to further characterize psychiatric sequelae after pediatric mTBI across adolescence to identify risk and protective factors for targeted prevention and intervention strategies.

Objective: Impulse control disorders (ICDs) are a complication of Parkinson's disease (PD) treatment, but whether deep brain stimulation (DBS) affects ICDs remains unknown. Studies have focused on de novo ICDs among individuals receiving subthalamic nucleus DBS (STN-DBS), but the effects of DBS of the globus pallidus pars internus (GPi-DBS) are less understood. Rates and severities of ICDs among individuals receiving GPi-DBS or STN-DBS were compared.

Methods: Twenty-seven individuals with PD receiving bilateral DBS (17 STN, 10 GPi-DBS) were prospectively enrolled. Before surgery, participants had a neurological and neuropsychological evaluation. At 12-18 months post-DBS, the participants completed an abbreviated battery and an ICD rating scale. Volume of tissue activated (VTA), the intersection of each participant's stimulation volume with atlas-defined subregions of the DBS target, was explored in a sample subset.

Results: GPi-DBS participants had significantly higher post-DBS ICD severity scores compared with STN-DBS participants (p=0.040, Cohen's d=0.73), despite lower presurgical scores. A significant interaction between DBS target and time point (p=0.015, η_p²=0.26) indicated increased ICD symptoms in the GPi group postsurgery. Post-DBS, 80% and 35% of the GPi-DBS and STN-DBS participants met ICD criteria, respectively. Differences in ICDs persisted in analyses controlled for levodopa-equivalent daily dose. ICD improvements post-DBS were linked to greater VTA overlap in STN limbic regions, with no significant VTA associations with GPi-DBS.

Conclusions: GPi-DBS may increase the risk for de novo ICDs. This observation should be interpreted with caution because of the small sample size and low statistical significance. Additional research may clarify the relationships between DBS targets and ICD outcomes.

Objective: The authors examined the associations among depression, pain, motor function, and cognitive performance in Parkinson's disease (PD) to determine whether these relationships differ between the tremor-dominant (TD) and postural instability and gait difficulty (PIGD) motor subtypes of PD.

Methods: Cognitive performance was assessed with a broad neuropsychological test battery. Pain was measured with the King's Parkinson's Disease Pain Scale, Numeric Rating Scale, Color Analog Scale, and Douleur Neuropathique 4; motor function with the Movement Disorder Society Unified Parkinson's Disease Rating Scale (Part III and selected Part II items); and mood with the Hospital Anxiety and Depression Scale. Composite scores were derived via factor analysis. Mediation analyses (hierarchical regression and Sobel test) were performed with data from the full sample and stratified by motor subtype.

Results: Motor function significantly mediated the relationship between depression and cognitive performance in the full sample and in the PIGD group, but not in the TD group. Pain was not significantly associated with cognition. Patients with the PIGD subtype had greater motor impairment, higher depression scores, and lower cognitive performance than those with the TD subtype.

Conclusions: Motor dysfunction may represent a significant pathway that links depressive symptoms and cognitive performance in PD, particularly in the PIGD subtype. Pain lacked a significant association with cognition. These findings underscore the clinical relevance of jointly assessing motor and nonmotor symptoms in PD, particularly among patients with the PIGD subtype.

Objective: Diagnostic agreement influences treatment outcomes, but studies on persistent diagnostic disagreement (PDD) in functional movement disorder (FMD) are lacking. The authors propose a definition for PDD and identified associated factors in a clinical cohort of patients with FMD.

Methods: The authors retrospectively reviewed clinical data of 158 FMD patients seen in an integrated movement disorders program from July 2019 to December 2021. Patients self-reported diagnostic agreement before an initial assessment (as disagree, unsure, or agree). PDD status was determined by a specialist assessment on the basis of observable behaviors. Exploratory logistic regression and a least absolute shrinkage and selection operator (LASSO) model were used to examine associations of demographic and clinical features with PDD. Alignment between referring clinician impressions and patient self-reports was also evaluated.

Results: Of 158 patients, 116 had complete data for both baseline self-reports and specialist PDD determination. Forty-seven patients (41%) were classified as having PDD. PDD was observed for 52% (N=15 of 29) of those who self-reported disagreement, 71% (N=17 of 24) who self-reported ambivalence, and 24% (N=15 of 63) who self-reported agreement. Variables associated with PDD included low agency, cluster B traits, lower readiness to change, inability to notice symptom variability, and lower self-reported agreement; only low agency was retained in the LASSO analysis. Among 78 patients with complete data including referring physician impressions, concordance with patient self-reported disagreement was low (weighted κ=0.21, p<0.001).

Conclusions: PDD was common in FMD, was not accurately identified by referral impressions or patients' self-reports, and may be linked to modifiable psychological processes.

Objective: Apathy, defined as diminished self-initiated purposeful behavior, is common in Parkinson's disease (PD) and affects health-related quality of life (HRQoL). Although apathy is now recognized as a multidimensional syndrome, the contributions of total apathy and its dimensions to HRQoL, when mood and cognition are accounted for, remain unclear. The authors examined these relationships for individuals with PD.

Methods: Twenty-eight adults with PD without dementia completed the Dimensional Apathy Scale (DAS), General Anxiety Disorder-7 (GAD-7), Beck Depression Inventory-II (BDI-II), Parkinson's Disease Questionnaire-39, and a neuropsychological battery. Motor severity was assessed via the Movement Disorders Society-Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III). A cognitive composite score reflected mean within-individual performance across cognitive tests. Hierarchical regression analyses were conducted to identify predictors of HRQoL.

Results: GAD-7, BDI-II, MDS-UPDRS III, and cognitive composite scores explained 61% of the variance in HRQoL (R²=0.605, p<0.001). Adding the DAS total score to the analysis accounted for an additional 9% of the variance (ΔR²=0.088, p=0.026), with greater apathy being associated with lower HRQoL (β=0.369, p=0.026). Secondary analyses revealed that this effect was driven exclusively by the DAS executive subdomain.

Conclusions: Total apathy and executive apathy have distinct negative effects on HRQoL in PD when mood and cognition are controlled for in analyses. These findings highlight the importance of assessing apathy subdomains in the setting of PD.

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.