Journal of Neuropsychiatry and Clinical Neurosciences最新文献

Objective: Social cognition is defined as the ability to construct mental representations about oneself, others, and one's relationships with others to guide social behaviors, including referring to mental states (cognitive factor) and understanding emotional states (affective factor). Difficulties in social cognition may be symptoms of schizophrenia. The authors examined associations between two factors of social cognition and specific schizophrenia symptoms, as well as a potential path from low-level affective perceptual social cognition to high-level social cognition, which may be associated with schizophrenia symptoms.

Methods: The authors compared IQ, executive function, and social cognition scores of 41 patients with schizophrenia with those of a community-based group of 30 healthy individuals by using the Diagnostic Analysis of Nonverbal Accuracy 2-Taiwan version, the Movie for the Assessment of Social Cognition-Taiwan version, and the Chinese version of the theory of mind task.

Results: In analyses controlled for IQ and executive function scores, patients with schizophrenia were found to perform more poorly than individuals in the healthy comparison group on all social cognition tasks. Disorganized symptoms were associated with lower accuracy of recognizing happy and angry faces, a lower verbal theory of mind score, and altered low- and high-level social cognition scores. A potential causal link was identified between low-level affective perceptual social cognition and high-level social cognition, resulting in disorganized symptoms.

Conclusions: These results indicate distinct roles of two factors of social cognition in schizophrenia symptomatology and provide a new direction for alleviating symptoms of this disorder by enhancing social cognition.

Objective: Apathy is common in Huntington's disease (HD) and difficult to treat. Multiple recent calls have been made to increase understanding of apathy across the spectrum of HD severity. Functional status is an important outcome in HD trials; however, no consensus currently exists regarding the impact of apathy on functional status in HD. The authors aimed to identify correlates of apathy and effects on functional status in a primarily early-stage HD sample.

Methods: This study included secondary analyses of data from a study of neuropsychiatric symptoms in a clinical HD sample. Spearman correlation analyses were used to assess the relationships between apathy (with the Frontal Systems Behavior Scale-Apathy [FrSBe-Apathy] subscore), clinical variables, and patient-reported outcomes. To assess the association of apathy with functional status, two multiple regression analyses were performed, with a different functional status measure (Adult Functional Adaptive Behavior [AFAB] scale or Total Functional Capacity [TFC] scale) as the dependent variable in each analysis.

Results: Statistically significant correlates of apathy included the Quality of Life in Neurological Disorders (Neuro-QoL) Satisfaction With Social Roles and Activities and Neuro-QoL Positive Affect and Well-Being scores (N=70 patients). Univariate correlation analyses also revealed statistically significant associations of FrSBe-Apathy scores with both functional status measures. In the multiple regression analyses, apathy significantly contributed to variability in functional status as measured by both the AFAB (N=49 patients) and TFC (N=56 patients) scales.

Conclusions: These results underscore the need to address apathy as a target for improving functional status, social satisfaction, and well-being in HD, even for individuals with early-stage HD.

Neurodevelopmental disorders (NDDs) affect brain development, leading to diverse cognitive, social, behavioral, and affective impairments. Noninvasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and transcranial photobiomodulation (tPBM), have been investigated as potential treatments for NDDs. The authors of this systematic review evaluated the literature on NIBS in NDDs, including double-blind, sham-controlled, randomized controlled trials. Following PRISMA guidelines and a registered protocol, the authors conducted a comprehensive search in PubMed, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, and Scopus, identifying 23 studies. TMS showed promise for addressing hyperactivity, inattention, and working memory deficits in attention-deficit hyperactivity disorder (ADHD), with outcomes influenced by coil type (H5 vs. H6) and stimulation site (right vs. left dorsolateral prefrontal cortex). tDCS showed potential for improving inattention and executive function in ADHD, with limited effects observed on reducing symptom severity in autism spectrum disorder (ASD) and dyslexia. tPBM offered specific therapeutic benefits in reducing irritability in ASD. Although NIBS generally showed mild, transient adverse effects, isolated seizure events, such as one during TMS in ADHD, highlight the importance of rigorous safety protocols, especially in NDDs with elevated epilepsy risk. This review identified potential benefits of certain NIBS protocols in NDDs; however, high variability in methodologies, sample size limitations, and bias concerns underscore the need for further research to clarify the therapeutic efficacy and safety of NIBS among patients with NDDs.

Objective: The authors aimed to characterize the long-term psychiatric outcomes and their predictors among survivors of autoimmune encephalitis (AE).

Methods: In this retrospective cohort study, patients diagnosed as having AE between 2008 and 2023 at two academic medical centers (in New York City and Toronto) completed the Mini International Neuropsychiatric Interview 7.0.2 (MINI) and Profile of Mood States (POMS-2) to assess long-term psychiatric outcomes. Clinical characteristics were assessed for potential predictors of psychiatric outcomes. Bivariate analyses and univariate logistic regressions were conducted to assess the relationship between the predictors and the primary outcome.

Results: Overall, 42 participants (female, N=26, 62%; median age=37.5 years, interquartile range [IQR]=32.8 years) were assessed a median of 4 years (IQR=6 years) after an AE diagnosis. AE subtypes included anti-N-methyl-d-aspartate (33%), anti-leucine-rich-glioma-inactivated 1 (24%), anti-glutamic acid decarboxylase 65 (14%), and antibody-negative encephalitis (29%). In total, 71% of participants who completed the MINI met criteria for a DSM-5 diagnosis, and 56% were diagnosed as having a mood disorder. Thirteen participants (31%) reported above-average total mood disturbance on the POMS-2. Mann-Whitney U tests revealed that participants diagnosed as having a mood disorder self-reported significantly higher levels of confusion and bewilderment (z=-2.04, p=0.04) and depression and dejection (z=-2.24, p=0.03) and lower levels of vigor and activity (z=-2.62, p=0.01).

Conclusions: AE survivors have a high prevalence of psychiatric comorbid conditions, with most being diagnosed as having a mood disorder and a significant proportion endorsing ongoing mood disturbance. Patients with a psychiatric history may benefit from closer psychiatric follow-up.

Objective: The authors proposed catatonia diagnostic criteria that require the presence of three neuropsychiatric symptom clusters, rated over 24 hours; this system differs from other symptom clustering proposals and is intended to increase diagnostic rigor over Bush-Francis Catatonia Rating Scale (BFCRS) or DSM-5 criteria.

Methods: By applying new BFCRS item score thresholds, symptoms were clustered into three categories to comprise the Research Diagnostic Criteria for Catatonia (RDCC): akinesia (criterion A), unusual motor signs (criterion B), and behavioral signs (criterion C). RDCC symptom clusters were analyzed in four prospectively evaluated patient groups (delirium, medical, affective, and psychosis) (N=341).

Results: Use of the RDCC, compared with the DSM-5-TR and BFCRS, resulted in far fewer diagnoses of catatonia in the four patient groups: medical, N=1 out of 42 (2%); affective, N=1 out of 45 (2%); psychosis, N=3 out of 53 (6%); and delirium, N=0 out of 201. Permutations of the RDCC with more relaxed criteria were assessed, requiring either symptom thresholds or numbers of symptoms to meet criteria, resulting in catatonia rate gradations between those obtained with the RDCC and those obtained with current systems. The Cochrane Q test found that the DSM-5-TR was not dissimilar to the RDCC, if fulfilling numerical thresholds for criteria A-C, although any level of symptom severity was allowed. Confirmatory factor analysis with three goodness-of-fit indexes validated the RDCC.

Conclusions: The RDCC requires akinetic symptoms on the basis of literature demonstrating their high BFCRS prevalence and exploratory factor analysis co-loadings, plus symptoms from unusual motor and behavioral signs. Compared with current lenient diagnostic approaches, having the symptoms required by the RDCC produced lower catatonia rates in the psychosis, affective, and medical groups and revealed no patients with catatonia in the delirium group. Subdividing DSM-5-TR symptoms into several different criteria may improve diagnosis. RDCC symptom clusters are both research data-based and amenable to further research for validation.

Objective: Research suggests that disrupted interoception contributes to the development and maintenance of functional neurological disorder (FND); however, no functional neuroimaging studies have examined the processing of interoceptive signals in patients with FND.

Methods: The authors examined univariate and multivariate functional MRI neural responses of 38 patients with mixed FND and 38 healthy control individuals (HCs) during a task exploring goal-directed attention to cardiac interoception-versus-control (exteroception or rest) conditions. The relationships between interoception-related neural responses, heartbeat-counting accuracy, and interoceptive trait prediction error (ITPE) were also investigated for FND patients.

Results: When attention was directed to heartbeat signals versus exteroception or rest tasks, FND patients showed decreased neural activations (and reduced coactivations) in the right anterior insula and bilateral dorsal anterior cingulate cortices (among other areas), compared with HCs. For FND patients, heartbeat-counting accuracy was positively correlated with right anterior insula and ventromedial prefrontal activations during interoception versus rest. Cardiac interoceptive accuracy was also correlated with bilateral dorsal anterior cingulate activations in the interoception-versus-exteroception contrast, and neural activations were correlated with ITPE scores, showing inverse relationships to those observed for heartbeat-counting accuracy.

Conclusions: This study identified state and trait interoceptive disruptions in FND patients. Convergent between- and within-group findings contextualize the pathophysiological role of cingulo-insular (salience network) areas across the spectrum of functional seizures and functional movement disorder. These findings provide a starting point for the future development of comprehensive neurophysiological assessments of interoception for FND patients, features that also warrant research as potential prognostic and monitoring biomarkers.

Objective: Neuropsychiatric symptoms (NPSs) have been linked to cognitive decline. This study explored ethnic differences and the effects of baseline NPSs on incident mild cognitive impairment (MCI) among 386 Hispanic and non-Hispanic participants from the Texas Harris Alzheimer's Research Study.

Methods: Data on NPSs from the Neuropsychiatric Inventory Questionnaire were available for all participants. Cox proportional hazards regression models were used to estimate the effect of ≥1 NPS at baseline and Hispanic ethnicity on incident MCI over a 7-year follow-up period.

Results: NPSs at baseline were associated with incident MCI for Hispanic participants but not non-Hispanic participants. Being Hispanic with at least one NPS at baseline had an 11-times higher risk of incident MCI.

Conclusions: The Hispanic participants converted to MCI to a greater extent than the non-Hispanic participants. Only depressive symptoms increased the risk of MCI among non-Hispanics. Being of Hispanic ethnicity and having NPSs appeared to jointly increase the risk of progressing to MCI. To better understand the Alzheimer's disease continuum, further studies should explore other cultural, genetic, and medical risk factors influencing disease progression. Our findings strongly suggest the need to incorporate NPSs as outcomes of disease progression in future clinical trials involving Hispanic participants.

Objective: Responsive and human-centered neurotechnology development requires attention to public perceptions, particularly among groups underserved by existing treatments.

Methods: The authors conducted a preregistered nationally representative survey (https://osf.io/ej9h2) using the NORC at the University of Chicago AmeriSpeak panel. One vignette compared an implanted neural device with surgical resection in a scenario involving epilepsy, and another compared an implanted neural device with medications in a scenario involving mood disorders. The survey also contained questions about respondents' confidence that a device would be available if needed and confidence that enough research has been conducted among people like themselves. Responses were entered into nested survey-weighted logistic regression models, including a base demographic model (to test the overall effect of demographic factors) and an adjusted model that also included socioeconomic, religious and political, and health care access predictors.

Results: A total of 1,047 adults responded to the survey, which oversampled Black non-Hispanic (N=214), Hispanic (N=210), and rural (N=219) Americans. In the base demographic model, older Americans were more likely to prefer an implanted device in the two scenarios, and non-Hispanic Black Americans were less likely than non-Hispanic White Americans to prefer a device; rural Americans were less confident than urban or suburban Americans in having access, and non-Hispanic Black and rural Americans were less confident that enough research has been conducted among people like themselves. In adjusted models, income was a key mediator, partially explaining the effect of age and the contrast between Black and White non-Hispanic respondents on preferences for a device in the epilepsy scenario and fully explaining the effect of rurality on confidence in access.

Conclusions: Demographic differences in prospective preferences and concerns highlight the importance of including members of underserved communities in neurotechnology development.

Memory impairments are common chronic and functionally important consequences of traumatic brain injury (TBI). Among patients with persistent verbal memory impairments due to TBI-related cholinergic deficits, donepezil (an acetylcholinesterase inhibitor) may improve these and related problems. The Multicenter Evaluation of Memory Remediation in TBI with Donepezil (MEMRI-TBI-D) study, a four-site, randomized, parallel-group, double-blind, placebo-controlled, 10-week clinical trial, evaluated the efficacy of donepezil on verbal memory impairments, co-occurring cognitive and noncognitive neuropsychiatric problems, and functional status among persons with severe, persistent, and functionally limiting verbal memory problems at least 6 months after mild, moderate, or severe TBI. Efficacy, safety, and tolerability measures were assessed. Seventy-five participants were randomly assigned to donepezil (N=37) and placebo (N=38) groups. In both modified intent-to-treat and per-protocol analyses, donepezil significantly improved memory (i.e., verbal learning, as measured by the Hopkins Verbal Learning Test-Revised Total Trials 1-3, the primary outcome measure) when compared with placebo. Treatment-responder rates in the donepezil and placebo groups were 42% and 18%, respectively, yielding a number needed to treat of 3.5. Among donepezil responders, delayed recall and processing speed also improved significantly. Treatment-emergent adverse event rates for donepezil and placebo were 46% and 8%, respectively, and mild or moderate (85%); diarrhea and nausea were significantly more common in the donepezil group, yielding a number needed to harm of 6.25 and a likelihood to be helped or harmed ratio of 1.79. These results suggest that donepezil is an efficacious treatment for severe, persistent memory impairments after predominantly severe TBI, with a relatively favorable safety and tolerability profile.