Journal of Neuropsychiatry and Clinical Neurosciences最新文献

Psychotic symptoms frequently occur in idiopathic Parkinson's disease (PD) and often require treatment with antipsychotic therapy. Most antipsychotics have the potential to worsen the motor symptoms of PD; quetiapine, clozapine, and pimavanserin are commonly used for the treatment of idiopathic PD because these medications tend to be comparatively well tolerated. Although psychotic symptoms may also occur in monogenic forms of PD, no reviews have focused on the use of antipsychotic medications in this context. The objective of the present systematic review was to characterize the effectiveness and tolerability of quetiapine, clozapine, and pimavanserin in monogenic PD-associated psychosis. A literature search was performed with PubMed, Scopus, and Embase. The search yielded 24 eligible articles describing 30 individuals, although treatment response with respect to psychotic symptoms was described in only 11 cases; of these, six individuals experienced symptomatic improvement or remission (four with clozapine and two with quetiapine), two exhibited a poor therapeutic response (one to clozapine and one to quetiapine), and the other three responded initially to antipsychotic therapy before experiencing a recurrence of symptoms. The use of quetiapine and clozapine in GBA variant-associated PD is briefly reviewed separately. Notably, no reports of pimavanserin therapy were identified. In keeping with the idiopathic PD literature, relatively low doses of medication were used in most cases. Lastly, side effects were rarely reported. Although quetiapine and particularly clozapine may be effective and well tolerated in the treatment of monogenic PD psychosis, this review highlights the paucity of available evidence to guide clinical decision making in this context.

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.

Objective: Functional neurological disorder (FND) is a core neuropsychiatric condition that includes both physical and mental symptoms. Recently, a validated clinical phenotype termed neuroconnective endophenotype (NEP), which includes several physical and psychological characteristics together with joint hypermobility (hypermobility spectrum disorders), was found at a significantly higher frequency among patients with anxiety. The purpose of the present study was to examine the presence of the NEP among patients with FND.

Methods: The authors conducted a multicenter case-control study comprising 27 FND patients and 27 healthy control participants (matched by sex and age) ages 13 to 58 years. Eight questionnaires were administered. Proportional differences were examined with Student's t tests, one-way analyses of variance, and chi-square tests.

Results: Differences between FND patients and control participants were observed. FND patients had higher sensory sensitivity, increased prevalence of hypermobility features (including relevant physical signs and symptoms), greater frequency of polarized behaviors, a greater number of both psychiatric and physical comorbidities, and an increase in the characteristics and sensations typical of anxiety. Particularly striking was the presence of the hypermobility spectrum in more than 75% of FND patients compared with 15% among control participants.

Conclusions: FND patients presented higher scores in all five dimensions included in the NEP. Thus, this phenotype, solidifying the original association between anxiety and the hypermobility spectrum, could help to identify an FND subtype when evaluating and managing FND patients, because it provides a new global view of patients' physical and mental symptoms.

Objective: Loneliness reportedly increases the risk of dementia, especially Alzheimer's disease (AD). The authors' previous study demonstrated associations between loneliness and structural abnormalities observed in early-stage AD. The present study examined associations between the brain's functional characteristics and loneliness among older adults with concerns about cognitive decline.

Methods: This single-center study included 43 participants (13 with amnestic mild cognitive impairment and 30 with normal cognition). Participants were assessed with the revised University of California Los Angeles (UCLA) Loneliness Scale and underwent resting-state functional MRI. Functional images were preprocessed with the CONN toolbox. The selected seeds were within brain regions reportedly associated with loneliness. One-sample general linear model analysis was performed to examine regressions of UCLA Loneliness Scale scores and functional connectivity between the seeds and regions of interest.

Results: The revised UCLA Loneliness Scale scores were positively correlated with functional connectivity between the right hippocampus and left lateral parietal lobe and were negatively correlated with functional connectivity between the left amygdala and left frontal operculum and between the left amygdala and right supramarginal gyrus. Analyses were adjusted for age, sex, and education and scores on the Mini-Mental State Examination and Clinical Dementia Rating scale.

Conclusions: Loneliness was associated with abnormal function of the hippocampus, parts of the parietal lobe and frontal cortex, and the amygdala. These findings may suggest a possible correlation between loneliness and neurological changes associated with dementia.

Objective: The purpose of this study was to compare functional vision loss (FVL) among adults and children, including its presentation and the biopsychosocial factors that may contribute to FVL development.

Methods: PubMed, Scopus, and PsycInfo databases were searched in April 2023 for studies reporting data on visual acuity loss (VAL), visual field defects (VFDs), psychiatric disorders, or biopsychosocial stressors of patients with FVL. Studies were excluded if they did not report information on the specific outcomes for all patients or reported on only a subset of FVL patients.

Results: Overall, 27 studies were included, comprising 1,476 patients. Twenty-six articles reported on visual symptoms, 14 on psychiatric disorders, and 11 on biopsychosocial stressors. The prevalence of VAL was similar among adults (80%) compared with children (83%), but VFDs were significantly more common among adults (86% in adults vs. 50% in children). The prevalence of a history of psychiatric disorders was similar among both adults (42%) and children (23%). Adults most commonly reported accidents or physical trauma (31%) as predisposing or precipitating factors for VAL, whereas children most frequently reported family or home stress (19%).

Conclusions: VFDs were found to be more common among adults than among children with FVL. Among adults and children with FVL, different psychiatric and biopsychosocial stressors were reported. This review was limited by the heterogeneous data among studies and unstandardized methods of data collection and reporting. Future research may seek to better understand the differences between adults and children with FVL and explore possible treatment options.

The availability of monoclonal antibodies directed against amyloid beta, for use as disease-modifying therapies for Alzheimer's disease (AD), represented a major shift in the field of AD research and treatment. U.S. Food and Drug Administration approvals for the monoclonal antibody-based medications lecanemab and, more recently, donanemab provide clinicians with two antiamyloid therapy (AAT) options for targeting early symptomatic AD. The emergence of AAT has made careful biomarker-informed diagnosis of AD paramount, which was once reserved for highly specialized centers and research settings. Patient selection is complex, and although appropriate-use recommendations have been published, clinicians caring for patients with AD across the United States face uncertainty when trying to align clinical trial criteria, appropriate-use recommendations, and real-world patients in the clinic. Practical issues in patient selection as well as health care and systemic challenges in the implementation of AAT are considered in part 1 and part 2, respectively, of this two-part Treatment in Behavioral Neurology & Neuropsychiatry commentary on these therapies from the American Neuropsychiatric Association Dementia Special Interest Group.