Journal of Neuropsychiatry and Clinical Neurosciences最新文献

Objective: Functional neurological disorders (FNDs) are increasingly recognized in the general population and neurology clinics, and there is evidence that patients with neurological disorders are more likely to have a FND. This study was designed to identify the clinical features of FNDs among patients with movement disorders when the two disorders coexist.

Methods: The clinical histories and video recordings of 150 consecutive patients with tremors were examined: the types of tremor included essential tremor; essential tremor plus; dystonic tremor; tremor associated with dystonia; and drug-induced, myoclonic, orthostatic, task-specific, parkinsonian, Holmes, and unclassified tremor. Using criteria for "possible" and "probable" coexistent FND, clinical features that helped differentiate between functional and other neurological tremors were identified.

Results: There were 27 (18%) patients with functional manifestations, and 17 (11% of full sample) of these patients had signs suggestive of comorbid functional tremor. Patients with comorbid functional manifestations were younger at presentation, and these patients had greater severity of tremor, particularly upper limb postural tremor. Functional manifestations were not more commonly observed among patients with any particular type of tremor, except for patients with Holmes tremor, who were more likely to have comorbid functional neurological manifestations.

Conclusions: About 18% of patients with diverse types of tremors also had comorbid functional neurological manifestations. Of the coexistent FNDs, functional tremor was the most common. Patients with co-occurring functional and other neurological tremors presented for evaluation at a younger age and had greater severity of arm tremor than those without comorbid functional neurological manifestations.

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.

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: 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: Neurobehavioral dysregulation (NBD), a core clinical feature of traumatic encephalopathy syndrome, encompasses neuropsychiatric symptoms reported among individuals with a history of repetitive head impact exposure, including contact sport athletes. The objective of this study was to examine the construct and subconstructs of NBD through a series of factor and cluster analyses.

Methods: Six clinician-scientists selected self-report questionnaire items relevant to NBD from seven available neuropsychiatric scales through a blinded voting process. These items were subjected to confirmatory factor analyses in a sample of 178 former college and professional American football players and 60 asymptomatic individuals without a history of repetitive head impact exposure. All participants were enrolled in the Diagnostics, Imaging, and Genetics Network for the Objective Study and Evaluation of Chronic Traumatic Encephalopathy Research Project. Factor scores were generated on the basis of the optimal expert-informed model for NBD. Construct validity was assessed with neuropsychiatric scales not included in generation of the factor scores. Cluster analyses with NBD factor scores were used to examine symptom profiles.

Results: Factor analyses confirmed that NBD was composed of four subconstructs: explosivity, emotional dyscontrol, impulsivity, and affective lability. Cluster analyses indicated four distinct symptom profiles of NBD in this group of former football players: asymptomatic (N=80, 45%), short fuse (N=33, 19%), high affective lability (N=34, 19%), and high NBD (N=31, 17%).

Conclusions: These findings characterize NBD as a multifaceted clinical construct with a heterogeneous presentation, providing a foundation for empirical work on the diagnostic criteria for traumatic encephalopathy syndrome and research on the neurobiological underpinnings of NBD.

Alzheimer's disease (AD) is a common neurodegenerative illness affecting nearly 7 million people in the United States. Until 2023, no disease-targeting pharmacotherapeutics were widely available outside of research studies. With relatively recent regulatory approval and increasing availability of antiamyloid therapies (AATs) in the United States, management of AD is rapidly shifting from symptomatic and supportive care alone to treatments aimed at disease modification. Appropriate selection of patients for AATs can be challenging and varies among health care settings and systems despite published appropriate-use recommendations. The first of this two-part Treatment in Behavioral Neurology & Neuropsychiatry series from the American Neuropsychiatric Association Dementia Special Interest Group addresses the challenges with patient selection. In this second part, the authors offer dementia-focused health care vignettes to illustrate challenges with AAT delivery encountered in different settings and discuss emerging logistical issues associated with delivery of dementia-focused care based on AAT protocols.

Dementia is a syndrome characterized by the deterioration of cognitive function beyond what is expected. The increased risk of developing this syndrome resulting from established modifiable risk factors, such as depressive episodes, is currently a subject of interest. The aim of this study was to review the scientific evidence that addresses the relationship between depression and dementia. A bibliographic search of the PubMed and PsycInfo databases for articles published over the past 20 years was conducted with the following medical subject heading terms: depression or depressive, dementia, and incidence or cohort studies. After articles meeting the inclusion criteria were selected, relevant moderating variables were grouped as sample characteristics, methodological characteristics, extrinsic characteristics, and outcome variables. The 26 selected studies resulted in a sample comprising 1,760,262 individuals. Statistical analysis revealed a pooled relative risk for the development of dementia of 1.82 (95% CI=1.62-2.06). The primary variables evaluated were the diagnostic methods for depression and dementia and the presence of depression. Other variables, such as mean age, methodological quality of each study, follow-up time, and publication year, were also evaluated. Age was statistically but not clinically significant. No relevant publication bias or alterations in the results were found when accounting for the quality of the studies. It is recommended that new moderating variables be evaluated or that existing variables be reformulated in future studies.

Objective: Socioemotional changes, rather than cognitive impairments, are the feature that defines behavioral variant frontotemporal dementia (bvFTD). Investigators have attributed the socioemotional changes in bvFTD and other dementias to frontal lobe dysfunction; however, recent work implies a further contribution from right anterior temporal disease. The authors evaluated relationships between regional brain atrophy and socioemotional changes in both bvFTD and early-onset Alzheimer's disease (EOAD).

Methods: This study explored the neuroanatomical correlations of performance on the Socioemotional Dysfunction Scale (SDS), an instrument previously shown to document socioemotional changes in bvFTD, among 13 patients with bvFTD not preselected for anterior temporal involvement and 16 age-matched patients with early-onset Alzheimer's disease (EOAD). SDS scores were correlated with volumes of regions of interest assessed with tensor-based morphometric analysis of MRI images.

Results: As expected, the bvFTD group had significantly higher SDS scores overall and smaller frontal regions compared with the EOAD group, which in turn had smaller volumes in temporoparietal regions. SDS scores significantly correlated with lateral anterior temporal lobe (ATL) atrophy, and a regression analysis that controlled for diagnosis indicated that SDS scores predicted lateral ATL volume. Within the bvFTD group, higher SDS scores were associated with smaller lateral and right ATL regions, as well as a smaller orbitofrontal cortex. Within the EOAD group, higher SDS scores were associated with a smaller right parietal cortex.

Conclusions: This study confirms that, in addition to orbitofrontal disease, there is a prominent right and lateral ATL origin of socioemotional changes in bvFTD and further suggests that right parietal involvement contributes to socioemotional changes in EOAD.