Journal of Neuropsychiatry and Clinical Neurosciences最新文献

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.

In this narrative review, the authors examine the multidimensional nature and presentations of impulsivity after stroke. Impulsivity manifests as immediate or premature responses, impaired delayed gratification, perseverance despite punishment, and other displays of impaired emotional and behavioral regulation. The literature on the assessments, outcomes, and treatment of patients with these various manifestations after a cerebrovascular injury is reviewed. Findings from case reports indicate that poststroke impulsivity may manifest across neurobehavioral syndromes that are not well defined in the psychiatric nomenclature, such as alien hand syndrome and atypical impulse control disorders. Overall, impulse control disorders appear to be rare poststroke. Therapeutic approaches for poststroke impulsivity require further evidence. The field would benefit from refinement of impulsivity definitions and integration with psychiatric nomenclature.

Objective: Anxiety and depression are common among individuals with multiple sclerosis (MS) but are often undertreated. Little is known about factors that influence the odds of antidepressant treatment for MS. The authors aimed to identify predictors of antidepressant use among people with MS.

Methods: A retrospective chart review was undertaken for a consecutive sample of 315 individuals with MS attending a tertiary neuropsychiatry clinic in Toronto. Predictor variables of antidepressant use included age, sex, MS duration and subtype, disease-modifying therapy use, psychotropic medication use, Expanded Disability Status Scale (EDSS) score (for neurological disability), Hospital Anxiety and Depression Scale subscale score (for anxiety and depression), and the abbreviated five-item Modified Fatigue Impact Scale (MFIS-5) score (for fatigue). Independent predictors of antidepressant use were identified with backward stepwise regression analyses (p<0.05).

Results: Participants' mean±SD age was 45.5±11.4 years, 74% were female, the mean EDSS score was 2.8±1.9 out of 10.0, and 70% had a relapsing-remitting subtype of MS. Psychotropic medication use such as antipsychotics and anxiolytics (OR=1.77, p<0.01), increased EDSS scores (OR=1.20, p<0.01), and increased MFIS-5 scores (OR=1.11, p<0.01) independently predicted antidepressant use.

Conclusions: Polypharmacy, neurological disability, and fatigue may increase the odds of antidepressant use among people with MS. These findings clarify differences between people with MS who use or do not use antidepressants, shedding light on the factors that may influence antidepressant use among people with MS.

Objective: Using a multi-informant approach, the authors assessed the psychiatric symptoms of adolescents and young adults with or without the huntingtin gene expansion and examined the association of psychiatric symptoms with cumulative disease exposure, a measure taking into account age and genetic data.

Methods: The sample included 110 participants with (N=71) or without (N=39) the gene expansion, along with 85 family members who provided collateral reports. Saliva samples were used for genetic testing. Participants reported psychiatric symptoms with the age- and informant-appropriate Achenbach System of Empirically Based Assessment measure.

Results: Family member ratings indicated that young people (ages 10-39) with the gene expansion were more likely to exhibit depression symptoms, attention difficulties, and behavior problems compared with those without the gene expansion. Self-reports of these symptoms did not differ between the two groups and indicated elevated depression symptoms, attention difficulties, thought problems, and obsessive-compulsive symptoms in both groups. In family member reports, 25% and 15% of the individuals with the gene expansion exceeded the clinical cutoffs for internalizing and attention difficulties, respectively. Little support was found for an association between psychiatric symptoms and cumulative disease exposure.

Conclusions: These findings suggest that young people from families affected by Huntington's disease are at elevated risk for psychiatric symptoms regardless of gene status or cumulative disease exposure. However, findings differed depending on the informant type. These results emphasize a need to screen for and monitor the psychiatric symptoms of all young people from families affected by Huntington's disease regardless of gene status.

Objective: The investigators compared neuropsychiatric symptoms among COVID-19 patients at hospital admission and at discharge.

Methods: Clinical data on neuropsychiatric syndromes were prospectively collected from 103 COVID-19 patients at admission and immediately before discharge. Clinical evaluations and serum biomarkers were analyzed to assess their relationship with neuropsychiatric symptoms and patient survival.

Results: Neuropsychiatric symptoms had improved by the time of hospital discharge (N=81) compared with admission. Depression scores decreased from 5.0 to 3.8 points on the Beck Depression Inventory (t=3.04); anxiety scores decreased from 12.3 to 10.0 points on the Beck Anxiety Inventory (t=2.75); and cognitive scores increased from 21.8 to 23.6 points on the Montreal Cognitive Assessment (t=-4.07). Delirium was present among 24% of patients upon admission but only among 12% before discharge. Markers of inflammation were correlated with neuropsychiatric symptoms. Longer hospital stays significantly predicted depression (R²=0.06), and gender and procalcitonin levels were significantly associated with anxiety (R²=0.05). Cognitive impairment was linked to depression and the need for endotracheal intubation. Both cognitive impairment and endotracheal intubation were associated with lower survival rates (R²=0.10 and 0.18, respectively).

Conclusions: These findings reveal that a significant number of COVID-19 patients continued to exhibit affective symptoms, delirium, and cognitive deficits at discharge, with delirium and cognitive deficits being linked to lower survival rates and inflammation markers being significantly associated with these symptoms. Factors such as gender, hospital stay length, and mechanical ventilation predicted neuropsychiatric symptoms.

Objective: Catatonia is a neuropsychiatric disorder that is associated with a range of medical and psychiatric illnesses. Although many single-center studies have been conducted, uncertainty over the population-based incidence and prevalence of the disorder remains. This study reports on the incidence and prevalence rates of catatonia extrapolated from two large epidemiologic studies in the United Kingdom and United States.

Methods: Incidence rates (defined as the number of catatonic episodes per 100,000 person-years) and prevalence rates (defined as the proportion of individuals with catatonia in a given year) were calculated from the two studies.

Results: U.K. data showed an incidence of 4.34 (95% CI=3.98-4.72) catatonic episodes per 100,000 person-years with an average 1-year prevalence of 4.39 (95% CI=4.03-4.77) catatonic episodes per 100,000 persons. U.S. data revealed a 1-year prevalence of 5.15 (95% CI=5.08-5.23) catatonia-related hospitalizations per 100,000 persons.

Conclusions: Catatonia is a rare disorder, qualifying as an orphan disease under both European Medicines Agency and U.S. Food and Drug Administration criteria. Further research is needed to rigorously define the epidemiology of catatonia in other populations.