Frontiers of Neurology and Neuroscience最新文献

This chapter presents an overview of different addictive and obsessive-compulsive symptoms and their constellations due to focal brain lesions. In general, such symptoms are not systematically reported in the literature, and the knowledge about the networks involved is sometimes sparse. Finally, we present an original case with an unusual combination of kleptomania and hyper-religiosity.

Violence is a significant public health problem representing one of the leading causes of death worldwide for people aged 15-44 years. Although violence and aggression are more frequent in adolescence and early adult life and decline with advancing age, these conditions can still develop for the first time in old age especially in association with organic brain disorder. Rates of violent death vary according to country income levels and are twice as higher in low- to middle-income countries than in high-income countries. Males are more affected than females. Violence is a multifactorial condition. A combination of biologic, psychodynamic, and social factors may play a role in development of violence and aggression. Since it may accompany or be result of different medical conditions it is important to determine the underlying condition or disease including mental illness for targeting the proper therapeutic strategy. In the acute setting with a behavioral emergency the primary task for the clinician is to act as soon as possible in order to stop the violence from escalating and to find the quickest way to keep the patient's agitation and violence under control with the maximum of safety for everybody using the less severe yet effective interventions. Multiple steps of talk down interventions and non-coercive behavioral and environmental treatments have been proposed. If such an approach is not effective, more coercive interventions are needed including involuntary medications and chemical restrain as well as physical restraint or seclusion in some cases.

Beliefs involving the devil and possession figured in the nosography of mental illness that alienists gradually established during the 19th century. The description of this form of cenesthetic hallucination resulted in "the possessed" being viewed as patients, which protected them from the trials and punishments they so frequently faced in earlier centuries. According to psychologists, this illusion of mental duality is linked to impairment of introspective capacities. Current brain imaging suggests inappropriate activity of the default mode network, which interferes with attentional systems during the hallucinatory episode.

Rapid eye movement sleep behavior disorder (RBD) is a brain disorder, characterized by the dream enactment during rapid eye movement (REM) sleep due to a lack of physiologic muscle atonia and increased muscle twitching. Schenk was the first to describe this disorder in 1986; however, few authors reported in the 1970-1980s loss of physiological muscle atonia combined with dream enactment in the course of brainstem disorders and as a consequence of alcoholism and antidepressant treatment. RBD affects less than 1% of the adult population, but can be found in up to 25-50% of neurodegenerative disorders including Parkinson's disease, multisystem atrophy, and dementia with Lewy body. In the last decade, many studies provided evidence that RBD precedes parkinsonian motor signs by several years, suggesting that RBD should no longer be considered a complication but a part of the prodromal phase of these diseases. Etiologically, primary (idiopathic RBD) and several secondary forms in addition to neurodegeneration (related to focal brainstem damage, narcolepsy, autoimmune disorders, and drugs) are known. Pathophysiologically, brainstem and supratentorial mechanisms involving glutamatergic, glycinergic, and GABA-ergic neurotransmission have been implicated. Recently, an animal model of RBD has been described. Clinical features consist of characteristic nocturnal behaviors, but also daytime symptoms including excessive sleepiness and cognitive alterations. The diagnosis of RBD is made according to international diagnostic criteria, based on medical history, and video-polysomnographic features. Current treatment strategies include actions which ensure a safe sleep environment, the avoidance of triggering/exacerbating factors and if necessary pharmacological (mainly clonazepam and melatonin) and non-pharmacological (e.g., behavioral measures) interventions. Future research should clarify the exact sleep-wake characteristics of RBD (also beyond REM sleep) and their evolution over time, the contribution of brainstem but also supratentorial mechanisms to its pathophysiology, and the (early?) diagnostic and (causative?) treatment consequences of RBD in the context of neurodegeneration.

Raymond Roussel (1877-1933) was an eccentric writer whose strange novelistic and theatrical work was launched by the surrealists and is still worshipped by the French intelligentia. While writing his first text at the age of 19 years, he presented a delusional episode marked by the conviction that he was shining like a sun and that he had acquired universal glory. He "fell back to earth" when the book was published and he realized that no one was stopping to gaze at him. He later led a ritualized life, continuing to write and eventually achieving success - glory even - with the champions of the surrealist revolution, who saw the genius in him. His eccentricities, permitted by his immense fortune, contributed to the legend and helped him to exist socially. He was also able to conceal his homosexuality, which appears to be closely dependent on an emotional infantilism. His pathology is recognized thanks to Pierre Janet's account (1859-1947) of his case in De l'Angoisse à l'Extase. Janet's accompanying psychotherapy, which supported him for many years, was effective in moving him towards a form of obsessive consolidation. Janet's therapeutic approach, however, is currently strongly criticized by dogmatic psychoanalysts. Roussel must have been aware of the artificial nature of his theatrical successes and he succumbed to a depressive state, taking refuge in barbiturate addiction. He died in a Palermo hotel room of a barbiturate overdose, considered to be suicidal.

Machado de Assis (1839-1908) suffered from temporal lobe epilepsy, probably with origin in the non-dominant hemisphere. The evidence for this is provided by the detailed reports of the characteristics of his seizures by his contemporaries and by his correspondence with other writers. He was treated with bromides and homeopathy. It is unclear whether his neurological disorder influenced his artistic performance. What is evident is that he was deeply ashamed of the disease - he avoided the word "epilepsy" and just wrote about it in his personal correspondence with friends in the last years of his life. Though controversial, he had no clear traces of personality disorders linked to his temporal lobe epilepsy. Despite all his adversities, including being "mulatto," having a stutter, being of humble origins, and epileptic in a period when there was no efficacious therapy and a profound stigma associated with the disease, Machado de Assis became one of the most important Brazilian writers of all times.

In this essay, we propose an association between Franz Kafka's novel, The Trial, and phenomenological and neurobiological processes in schizophrenia. We begin by presenting a summary of the plot, pointing to some of its remarkable literary aspects. We next compare the mental processes of dissociation, disorientation and delusion as represented in the novel with phenomenological processes that take place in the prodromal states of schizophrenia. We discuss how such disorders of the self and disorders of thought, both crucial aspects of the schizophrenic experience, appear in The Trial and in other literary and private writings by Franz Kafka. We relate how these disorders may arise from the false attribution of salience and false associative learning caused by hyperactivity of dopaminergic function associated with chaotic firing of dopaminergic neurons. Finally, we show how Kafka leads not just the protagonist of The Trial, but even more the reader to experience a quasi-delusional state. We discuss the relationship between the perturbation of thought and disorientation of mind evoked by the novel in the reader and the need of our brains for empathy and predictability.

Georges Moreau (1848-1901) was a painter and the son of the famous psychiatrist Jacques-Joseph Moreau de Tours. Early in his career, his paintings aspired toward figurative perfection, exalting patriotic and historical themes. His prolific production includes numerous paintings for which he drew inspiration from psychology and certain mental pathologies. At the age of 45 years he suffered right hemiplegia which forced him to set aside large-scale subjects and focus instead on intimist, almost pointillistic works, which brought him closer to the Impressionists, as his portrait of Paul Cézanne shows. Possibly his most well-known painting, Les fascinés de la Charité, service du Dr. Luys, is analysed here by comparison with La Leçon clinique à La Salpêtrière by André Brouillet, which depicts Jean-Martin Charcot and his students.

Henrik Ibsen (1828-1906) is a Norwegian playwright and poet who is known as the father of modern drama. Ibsen was in good health when he announced at his 70th birthday celebration that he intended to continue writing. His last play, When We Dead Awaken, was published in 1899. Why did Ibsen's dramatic writing come to an end? This chapter presents a medical account of Ibsen's health condition during the last 6 years of his life. It is based on a review of a document written by one of his doctors, Edvard Bull (1845-1925), letters, biographic information, and Ibsen's death certificate. The historical material suggests that he suffered from arteriosclerosis and cerebrovascular disease, and that he suffered several strokes, in 1900, 1901, and 1903. He suffered a paresis in his left foot, expressive aphasia, and a right hemiparesis, and he lost the ability to write. There is no evidence that Ibsen was hospitalised. He received medical treatment and care at his home and at a recreational spa. His health condition was unstable, and it is likely that he suffered from a series of smaller strokes in the last years of his life. Ibsen developed signs of heart failure, and he died peacefully from "paralysis cordis" at his home on May 23rd, 1906.

Cotard's syndrome is often described as the delusional belief that one is dead or non-existent. However, Jules Cotard's initial description (1880) of the "delusion of negations" was much richer and also involved delusions and claims of immortality and enormity, feelings of damnation, and illusions of bodily dissolution and transformation. Alternatively conceived as an extreme case of depression, hypochondria, or psychosis, the condition is considered rare and remains poorly understood. Cotard himself provided a taxonomy and several explanations for the condition, focusing on its distinction from classical persecutory delusions and suggesting that it could be a kind of reversed grandiosity. He proposed a psychosensory basis in the dissolution of mental imagery, which he then extended to a more general psychomotor impairment of volition. Other early authors highlighted a disorder of the bodily self, and more recent theories postulated an impairment of right hemispheric functions, leading to perceptual and somatosensory feelings of unreality, which coupled with reasoning impairments and an internalized attributional style led in turn to beliefs of non-existence. However, despite its striking presentation and its relevance to our understanding of self-awareness, Cotard's syndrome remains an elusive condition, rarely reported and poorly researched.