Neuropsychiatry, neuropsychology, and behavioral neurology最新文献

Objective: The goal of the study was to compare control participants and participants with closed-head injury (CHI) on direct and indirect memory measures of temporal order and spatial location.

Method: Twenty-seven CHI patients and 27 control participants were tested on "item" (i.e., words) and "contextual" (temporal order and spatial location) information. Contextual information was tested directly and indirectly by means of a format in which lists of words were presented repeatedly eight times in fixed or varying order for the temporal task and in a fixed or varying spatial position for the spatial task. The number of words recalled as well as their temporal and spatial judgment were the direct measure of item and contextual memory, respectively. The effect of the consistency of order or location was the indirect measure of contextual memory.

Results: As expected, the CHI group was impaired on the direct measures of item memory. Also as expected, the groups did not differ in the indirect memory measures of contextual information. Contrary to predictions, however, the groups did not differ in the direct measure of contextual information.

Conclusions: Item memory, when measured directly, is impaired in CHI patients. The finding that the groups did not differ on the direct measure of contextual information is possibly due to ceiling-level performance of the control group. Contextual information seems to be preserved in CHI patients when measured indirectly.

Objective: The authors identify a rare case of Wernicke-Korsakoff amnestic syndrome and highlight its occurrence in the absence of alcohol dependence.

Method: A longitudinal case history of a patient with schizoaffective disorder who developed Wernicke-Korsakoff syndrome secondary to malnutrition.

Results: Refusal to eat based on persecutory delusions in chronic psychotic patients can cause malnutrition and result in Wernicke-Korsakoff syndrome.

Conclusions: With increasing managed-care demands for outpatient treatment of chronic psychotic patients, physicians may see more cases of Wernicke-Korsakoff syndrome in psychiatric populations.

Objective: There is a rapidly growing body of evidence for an association between schizophrenic syndromes and the absence of a clear pattern of hemispheric dominance for language. Independent work with healthy subjects suggests that one feature of right hemispheric (RH) linguistic processing is a coarse as opposed to a focused semantic activation. We provide a comprehensive review of the literature to these hitherto unrelated fields of research and present an experiment assessing functional hemispheric asymmetries for language processing in healthy volunteers, differing in the susceptibility to schizophrenia-like experiences and thoughts.

Background: Forty right-handed men were administered a lateralized tachistoscopic lexical decision task. They also completed the Magical Ideation (MI) scale, which examines a variety of paranormal experiences and beliefs.

Results: Although the 20 subjects with MI scores below the median displayed the expected right visual field/left hemisphere (RVF/LH) superiority in lexical decision accuracy, the 20 high scorers were equally proficient in both visual fields. Compared to the low scorers, they made significantly more correct decisions in the left visual field/right hemisphere (LVF/RH).

Conclusions: These results corroborate previous findings of a reduced LH language dominance for subjects scoring high on scales measuring proneness to schizophrenic behavior and thought ("schizotypy"). We propose that this dominance failure, which is commonly observed in patients with acute signs of psychosis, facilitates the emergence of paranormal and delusional ideas by way of RH associative processing characteristics, that is, coarse rather than focused semantic activation. As unfocused semantic processing is also characteristic of creative thinking, the use of the RH semantic system may constitute a selective evolutionary advantage allowing the genes predisposing to schizophrenia to proliferate despite the obvious disadvantages of this devastating disease.

Objective: The psychogenic nonepileptic seizure (PNES) is a common problem that occurs in 10% to 20% of children and 10% to 58% of adults referred to epilepsy centers. Despite the high prevalence of this condition, the magnitude of this public health problem and its impact on quality of life are not appreciated. Moreover, there is no clear consensus regarding classification, diagnosis, or management of PNES. Therefore, this article reviews the current literature on the clinical and theoretical aspects of PNES.

Design/method: The medical literature was reviewed for all articles pertaining to pathophysiology, diagnosis, and treatment of PNES.

Results: Epidemiology, etiology, and diagnosis, and the use of diagnostic tests (including electroencephalogram and laboratory tests) are discussed. Current therapies and their efficacies are presented as well.

Conclusions: Psychogenic nonepileptic seizures are much more common than previously known. There are several clinical and laboratory tools that may aid in confirming the diagnosis of PNES. Despite the advances in the diagnosis of PNES, there is no clear agreement as to the best treatment plan for PNES patients.

Objective: The objective of this study was to correlate the densities of neurofibrillary tangles (NFTs) and senile plaques (SPs) in 10 patients with Alzheimer's disease (AD) with comprehensive neuropsychological data obtained within 1 year of death.

Background: Clinicopathologic studies in AD have been essentially limited to correlate neuropathologic data with severity of dementia. Very few studies have addressed the correlations between distribution of lesions and specific cognitive deficits. This is partly due to the limitation imposed by the interval between the last neuropsychological evaluation and death.

Methods: Ten patients with a postmortem diagnosis of AD, with a mean age at death of 80.4+/-6.6 years and a mean duration of symptoms of 5.6+/-2.9 years, were selected for the study. All of these patients were submitted to neuropsychological testing within 1 year of death, including 17 tests assessing memory, language, visuoperceptual, visuospatial, and constructional abilities as well as limb praxis. The neuropathologic study was performed using a modified Bielschowsky technique. Mean densities of SPs and NFTs were determined in the hippocampal formation (CA1, subiculum, and parasubiculum) and in six neocortical areas (midfrontal, orbitofrontal, cingulum, fusiform gyrus, superior and inferior parietal cortices). Statistical correlations were determined between cognitive scores and SP and NFT densities.

Results: For NFTs, significant correlations emerged only between tangle density in CA1 and visuoperceptual scores. For SP density values, significant correlations were found between visuoperceptual tests and lesions in the subiculum and in the fusiform gyrus, significant correlations were found between language scores and SPs in the superior parietal cortex and between visuospatial deficits and lesions in the superior parietal cortex and fusiform gyrus.

Conclusions: SPs in specific brain areas displayed a good correlation with the cognitive deficits detected in this selected group of AD patients. The association of fusiform gyrus and superior parietal lobule involvement with visuoperceptual and visuospatial deficits, respectively, is in agreement with current knowledge of the anatomic basis of visual processing.

Akathisia, "inability to remain seated", is a common condition in patients medicated with neuroleptics, and also occurs in other medication regimens. Only a few cases of akathisia resulting from focal lesions have been published. These cases suggest that differing lesion sites are sufficient for producing objective or subjective akathisia. The authors present a patient with akathisia who had no subjective complaints, suggesting that a combined basal ganglia and frontal lobe lesion may lead to objective akathisia (pseudoakathisia).

Persons with a history of exposure to organic solvents have been shown to have cognitive and personality changes, as well as abnormalities on measures of neurophysiology (e.g., delays in P300 latency). Studies assessing long-term sequelae in exposed persons have been limited, especially those using neurophysiologic measures. This study assessed cognitive event-related potentials (ERPs) in 16 persons with a history of organic solvent exposure at two testings, separated, on average, by 1.5 years. The sample was divided into persons who showed improvement on P300 latency (e.g., reduction in latency of 1.5 SD of control group) and those who did not. Sixty-three percent showed no improvement, whereas 37% showed significant improvement. Recency of exposure and the interaction of exposure duration and history of peak exposure significantly predicted group membership. That is, persons with shorter duration of exposure coupled with no peak exposures and longer time from exposure to test were more likely to fall in the improved group. Substituting age for duration of exposure in the interaction term improved classification of the two groups. The results support previous findings that most exposed persons do not show significant improvements over time. The results further suggest that there is a need to assess factors, such as aging, which may make one more vulnerable to the neurotoxic effects of solvents.

Questions of a psychological nature were presented to two split-brain patients from the California series encouraging each hemisphere to respond simultaneously and independently. The responses of both patients indicated that their hemispheres were responding independently. For the first patient, his right hemisphere appeared to be more disturbed than his left by childhood memories of being bullied. The right hemisphere of the second patient seemed to regard himself more positively, but it also seemed to feel more negative emotions such as loneliness and sadness. We discuss the possible significance of the findings.

An effect size analysis of neurocognitive function in patients with major depressive disorder using meta-analytic principles was conducted. The results from 726 patients with depression and 795 healthy normal controls revealed that depression had the largest effect on measures of encoding and retrieval from episodic memory. Intermediate effect sizes were recorded on tests of psychomotor speed and tests that require sustained attention. Minimal effect sizes were found on tests of semantic memory, primary memory, and working memory. Moreover, major depressive disorder is accompanied by dysfunction of effortful encoding of information along with an accompanying inefficiency of retrieving poorly encoded information from declarative memory.

The objective of this study was to study the relationship of poor functioning, cognition, and psychopathology in bipolar mood disorder. The authors assessed 36 patients with bipolar mood disorder (23 VA, 13 community) for the presence of psychopathology, cognitive deficits, and psychosocial impairment. The authors assessed psychopathology using screening and follow-up questions based on the schedule for affective disorder and schizophrenia, lifetime version (SADS-L), schedule for the assessment for negative symptoms (SANS), and schedule for the assessment of positive symptoms (SAPS), and psychosensory features using the "Profile of Psychomotor Symptoms." They tested cognitive functioning in the following domains: 1) general intelligence and language, 2) verbal and visual memory, and 3) visuospatial functioning. They also assessed psychosocial functioning using a structured scale to assess maladjustment and an impairment rating scale. Patients with bipolar disorder showed significant impairment compared to age equivalent normals in several cognitive domains. Anhedonia was related to memory deficits. Memory deficits were also associated with poor psychosocial functioning. This study demonstrates that nondemented, asymptomatic patients with bipolar disorder exhibit substantial cognitive deficits that are associated with poor functioning, and anhedonia and avolition best predict this outcome.