Journal of Neuropsychiatry and Clinical Neurosciences最新文献

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.

Objective: Suicidal ideation has not been extensively studied in spinocerebellar ataxias (SCAs). The authors examined whether individuals with SCAs have increased suicidal ideation and related factors.

Methods: The authors studied patients with genetically confirmed SCAs enrolled in the Clinical Research Consortium for the Study of Cerebellar Ataxia cohort, examining the percentages of patients with SCA subtypes 1, 2, 3, and 6 who reported suicidal ideation and comparing findings with nationally representative data from the National Survey on Drug Use and Health (NSDUH). Clinical characteristics that may contribute to suicidal ideation in SCAs, including age, disease duration, sex, ataxia severity, depression, and SCA subtype, were also studied.

Results: Suicidal ideation was present among 12% of 769 patients with SCAs and 4.3% of individuals in the general population recorded in the NSDUH. Compared with individuals in the general population, SCA patients had higher odds of suicidal ideation (OR=2.72). Compared with patients with SCA without suicidal ideation, patients with SCA and suicidal ideation had a longer disease duration (mean±SD=13.1±8.2 years vs. 11.2±9.4 years), more severe ataxia (Scale for the Assessment and Rating of Ataxia mean score=15.9±8.6 vs. 12.9±7.6), and more severe depression. Having suicidal ideation at baseline significantly increased the odds of suicidality later in the disease course (OR=58.73, 95% CI=36.00-98.40).

Conclusions: Suicidal ideation was more prevalent among patients with SCAs than in the general population. The findings of this study underscore the importance of continuous suicidal risk screening among individuals with SCAs and the need for effective depression management.

Objective: The authors of this prospective cohort study sought to examine associations between mid- and late-life physical activities and incident clinical depression and anxiety among community-dwelling older adults.

Methods: The sample included 2,630 adults to examine the outcome of clinical depression (median follow-up length=5.4 years) and 2,444 to examine clinical anxiety (median follow-up length=5.6 years). Participants were ages ≥70 years, were enrolled in the Mayo Clinic Study of Aging, and did not have dementia or the respective neuropsychiatric symptoms at baseline. Mid- and late-life physical activities were assessed as predictors with a validated questionnaire, and physical activity composite scores were calculated. Outcomes of interest were new onset of clinical depression and anxiety, measured with the Beck Depression Inventory (score >13) and Beck Anxiety Inventory (score >7), respectively. The authors used Cox proportional hazard models, adjusted for age (timescale), sex, education, apolipoprotein E ε4 genotype status, and comorbid medical conditions.

Results: Higher overall physical activity in late life was associated with a decreased risk for incident clinical depression (hazard ratio [HR]=0.85, 95% CI=0.74-0.98, p=0.025). Higher late-life overall physical activity (HR=0.79, 95% CI=0.71-0.89, p<0.001) and moderate-to-vigorous physical activity (MVPA; HR=0.86, 95% CI=0.77-0.95, p=0.003) were associated with a decreased risk for incident clinical anxiety. Higher midlife overall physical activity (HR=1.16, 95% CI=1.05-1.28, p=0.003) and MVPA (HR=1.12, 95% CI=1.02-1.23, p=0.019) were associated with an increased risk for new-onset clinical anxiety but not depression.

Conclusions: Engagement in late-life physical activity was associated with reduced risk for new-onset depression and anxiety among community-dwelling older adults without dementia.

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: This article describes the design, methods, and participant characteristics of the second phase of the Concussion Assessment, Research, and Education (CARE) Consortium study ("CARE 2.0") of the effects of concussion and repetitive head impact exposure on neuropsychiatric health.

Methods: The authors conducted a prospective multisite observational study of male and female collegiate athletes and military service academy cadets and midshipmen participating in the CARE study. Participants were assessed at three time points: undergraduate baseline (UB), before departure from university or service academy (exit), and up to 6 years following graduation (postgrad) via an online battery of brain health assessments. Participant characteristics were compared across the three time points and four levels of head impact exposure.

Results: A total of 4,643 participants completed the exit assessment, and 3,981 completed the postgrad assessment. Relative to the UB assessment cohort, the exit and postgrad assessment cohorts differed with respect to the percentage of women, baseline Wechsler Test of Adult Reading scores, National Collegiate Athletic Association division category, sport contact level, and number of previous concussions. The median standardized difference across balancing variables, assessment time points, and degree of head impact exposure was 0.12 (with 90% of effect sizes ≤0.29).

Conclusions: Although there were some statistically significant differences between participants across assessments, the effect sizes were modest, and overall the data suggest that the exit and postgrad cohorts reflect the characteristics of the baseline cohort. The CARE study design and its large, richly characterized sample provide an opportunity to answer important questions about cumulative and persistent effects of concussion and repetitive head impact exposure on neuropsychiatric health.

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.