Psychiatry (Edgmont (Pa. : Township))最新文献

This article concludes the series on cranial nerves, with review of the final four (IX-XII). To summarize briefly, the most important and common syndrome caused by a disorder of the glossopharyngeal nerve (craniel nerve IX) is glossopharyngeal neuralgia. Also, swallowing function occasionally is compromised in a rare but disabling form of tardive dyskinesia called tardive dystonia, because the upper motor portion of the glossopharyngel nerve projects to the basal ganglia and can be affected by lesions in the basal ganglia. Vagus nerve funtion (craniel nerve X) can be compromised in schizophrenia, bulimia, obesity, and major depression. A cervical lesion to the nerve roots of the spinal accessory nerve (craniel nerve XI) can cause a cervical dystonia, which sometimes is misdiagnosed as a dyskinesia related to neuroleptic use. Finally, unilateral hypoglossal (craniel nerve XII) nerve palsy is one of the most common mononeuropathies caused by brain metastases. Supranuclear lesions of cranial nerve XII are involved in pseudobulbar palsy and ALS, and lower motor neuron lesions of cranial nerve XII can also be present in bulbar palsy and in ALS patients who also have lower motor neuron involvement. This article reviews these and other syndromes related to cranial nerves IX through XII that might be seen by psychiatry.

Stalking, which consists of chronic nuisance behaviors by an offender that result in deleterious emotional and/or physical effects on a victim, is experienced by a significant minority of individuals in the community. According to the United States Department of Justice, eight percent of women and two percent of men have been victimized at some time in their lives by stalkers. Stalking could be viewed as an illogical or irrational preoccupation with another individual. Because of the unusual and intense attachment dynamics in borderline personality disorder, this diagnosis is particularly suggestive among stalkers. In this edition of The Interface, we examine the possible association between stalking behavior and borderline personality disorder. Five studies report prevalence rates of borderline personality disorder among stalkers, with four reporting rates between 4 and 15 percent (i.e., a small minority). However, three of these studies represent forensic populations and one consists of patients who stalked their psychiatrists. In contrast, in the remaining sample of stalkers, where being charged with a crime was not an inclusion criterion, the prevalence of borderline personality disorder was considerably higher at 45 percent. These data suggest that in less forensically focused samples of stalkers, rates of borderline personality are likely to be substantially higher, but confirmatory data is lacking.

In this article, we investigate the range of treatments prescribed for fibromyalgia. The data suggest that the majority of those treated, 82 percent, receive only one pharmaceutical. An additional 12 percent of patients were prescribed two products and six percent received three products. Pregabalin (Lyrica(R)) monotherapy was the most commonly prescribed regimen (21% of patients) followed by duloxetine (Cymbalta(R)) monotherapy (20%). From a therapeutic class perspective, fibromyalgia patients received antidepressants (46%), antiepileptics (35%), pain therapies (25%), muscle relaxants (8%), and sleep agents (2%). An expert commentary is included.

Studies on the relationship between childhood experiences with parents and sleep disturbances in adulthood are relatively few in number. Excluding studies on posttraumatic stress disorder, available studies on this relationship in adult participants is scant. In this study, we examined three caretaking variables (i.e., the number of different caretakers in childhood, whether caretakers were the biological parents or not, and the perceived quality of caretaking) and their relationship to self-reported sleep quality over the past month. Contrary to our expectations, only one of the childhood caretaking variables demonstrated a relationship with quality of sleep in adulthood-the perceived quality of caretaking. Lower ratings of parental caretaking quality were associated with poorer overall sleep quality. We discuss the potential implications of this finding.

Self-harm behavior is exhibited by a substantial minority of the general population and may be particularly prevalent among adolescents and clinical samples, both in psychiatric and primary care settings. A number of measures are currently available for the assessment of self-harm behavior. These vary a great deal in terms of their content, response options, targeted clinical audience, time to complete, and availability. The Self-Harm Inventory, a measure that we developed for the assessment of self-harm behavior, is one-page in length, takes five or less minutes to complete, and is free-of-charge. Studies indicate that the Self-Harm Inventory does the following: 1) screens for the lifetime prevalence of 22 self-harm behaviors; 2) detects borderline personality symptomatology; and 3) predicts past mental healthcare utilization. Hopefully, more efficient assessment of self-harm behavior will lead to more rapid intervention and resolution.

Systemic lupus erythematosus is a chronic inflammatory condition caused by an autoimmune disease. Systemic lupus erythematosus has been described as inducing neuropsychiatric symptoms, including mania and psychosis, in approximately 14 to 80 percent of systemic lupus erythematosus patients. We present and discuss the differential diagnoses in a patient with mania and systemic lupus erythematosus being treated with immunosuppresants and also with a history of glucose-6-phosphate dehydrogenase deficiency. Finally, we review the potential pathogenesis of mania due to an inflammatory-mediated etiology and how this may be used to partly explain the pathogenesis of primary mood disorders.