Neuropsychiatry

From Our Readers

In recent years, we have learned a great deal about posttraumatic stress disorder (PTSD) and its public health implications. From 9/11 to Katrina and the present Iraq war, PTSD has been in the forefront of health concerns and public policy.

It is my great honor and pleasure as a psychiatric educator to teach many excellent medical students and residents. These young and not-so-young men and women are by and large diligent, highly professional, and caring.

Evidence for Use of Neurostimulating Techniques

The adage has it that the road to hell is paved with good intentions. It is evident from this revealing portrait of neurologist Walter Freeman--the originator of the infamous "ice pick" lobotomy--that good intentions without sober analysis can indeed have hellish consequences.

Parkinson disease (PD) is a progressive neurodegenerative disorder affecting 1% of people 65 years and older. The core symptoms include the motor manifestations of tremor, bradykinesia, and rigidity.

The clinical diagnosis of Pick disease can be one of the most difficult facing the neurologist. Those patients found to have lobar atrophy usually present clinically with bouts of irrational behavior, bulimia, marked reductions in speech, abulia, and apathy.

During the past decade, a great deal of research has been undertaken to better understand the pathogenesis of neurodegenerative diseases. Data from stroke models has shown that the semisynthetic tetracycline antibiotic minocycline can mediate neuroprotection in neurodegenerative diseases by inhibiting caspase-1 and inducible nitric oxide synthase (iNOS) activity.

Book Review

Epidemiological studies report a lifetime prevalence rate of 24.9% for (any) anxiety disorder. Feelings of anxiety can also be related to normal fear of pain, loneliness, ridicule, illness, injury, grief, or death. In both these types of situations, anxiety can be difficult to deal with. Consequently, benzodiazepines, which offer almost immediate symptomatic relief for anxiety, can be quite appealing to many persons.

Civilian cases of traumatic brain injury (TBI) account for more than 50,000 deaths annually and represent about 50% of deaths attributed to physical injury. These injuries are a significant medical and socioeconomic burden and represent one of the leading public health problems in the United States. However, thanks to injury prevention and changes in hospital admission practices, a decline of almost 50% in civilian hospitalizations for TBI has been observed since 1980, with many patients now treated on an outpatient basis.

Involuntary Emotional Expression Disorder Often Misdiagnosed and Untreated

In past discussions on brain-computer interfaces (BCIs), parallels were drawn between emerging applications and the idea of the "bionic man." However, a presentation by John P. Donoghue, PhD, during a "Hot Topics" plenary session on May 2 at the 59th Annual Meeting of American Academy of Neurology in Boston suggests that current neural interface technology is much more about the marvels of the human neuron and will than about machinery.

The results of two recent studies suggest that antidepressant medication may have an expanded role in the management of stroke patients. Prophylactic use of antidepressants following stroke appeared in a meta-analysis to be effective in fending off depression, and a short course of antidepressants in a placebo-controlled study was associated with long-term restoration of executive function, independent of depressive symptoms.

The following must be one of the strangest comments I have ever heard on television. An Iraqi businessman uttered it shortly after a wave of missile strikes during the Gulf War. "The rocket flew down my street and took a left," he said in English. It had smashed into its target, a nearby building--leaving his adjacent shop completely undisturbed.

Corticospinal tract (CST) integrity may predict the potential for clinical improvement in chronic stroke patients, according to a recent study. Winston Byblow, MSc, PhD, associate professor and director of the Movement Neuroscience Laboratory in the Department of Sport & Exercise Science at the University of Auckland, Australia, and colleagues used transcranial magnetic stimulation (TMS) and MRI to determine factors that predict functional improvement in a patient's upper limbs.1 In patients with motor-evoked responses (MEPs) to TMS, researchers found that meaningful gains were still possible 3 years after stroke, although the capacity for improvement declined with time. The researchers also created an algorithm to predict functional potential for upper limb recovery in this patient population.

Physicians are often conflicted regarding prescription medications for pain, especially pain complicated by insomnia and anxiety. Concerns that patients may become addicted to medications, exacerbated by limited time available to get to know patients, can lead to underprescribing of needed medications, patient suffering, and needless surgery. At the other extreme, pressure to alleviate patients' distress can lead to overprescribing, needless side effects, and even addiction.

How is conflict of interest-or the perception of it-to be addressed when academia and industry collaborate on drug development? This was the question posed by Cheryl Bushnell, MD, assistant professor of neurology at Duke Medical Center in Durham, North Carolina, who chaired a brainstorming session on the issue at the 9th annual meeting of the American Society for Experimental Neurotherapeutics (ASENT), which took place March 8-10 in Washington, DC.

Essential tremor significantly compromises patients' professional and personal lives.

When I was young and attended church services with the family, the sermons of a certain priest, who was a historian, consisted of anecdotes about desperation and compassion that occurred in such places as Nazi concentration camps, Hell's Kitchen or the Bowery in Depression-era New York, or Dickens-like orphanages somewhere. At the end of his anecdote, the priest would dolefully lilt, Examine your own conscience. It was the point during the sermon when a person might startle awake after nodding off.

Presenting a diagnosis of amyotrophic lateral sclerosis (ALS) is one of the most difficult tasks that a neurologist may have to undertake. Despite the tragic quality of the news, experts in ALS care are exhorting fellow neurologists not to give up on patients in whom ALS is diagnosed.

Amyotrophic lateral sclerosis (ALS) is a progressive, debilitating, fatal disease that involves degeneration of upper and lower motor neurons. Patients often initially present with limb or bulbar weakness, atrophy, and spasticity, followed by progressive loss of ambulation and, ultimately, respiratory failure, which is the most common cause of death.

From Our Readers

Persons with childhood-onset schizophrenia appear to have the poorest outcome among those in whom schizophrenia is diagnosed.

New Act by Congress Gives Boost to Autism Research

PD is a common and challenging neurodegenerativemotor disorder, affecting at least a half millionpersons in the United States, according to the NationalInstitute of Neurological Disorders and Stroke. Withthe aging of the population, incidence is expected toincrease.

The connection between Parkinson disease (PD) and melanoma is becoming increasingly apparent, leading some researchers to call for increased melanoma screening in the PD population. In addition, researchers are disproving previous theories that levodopa may be implicated in the link between melanoma and PD.

Patients with PD may be at more than twice the risk for the development of malignant melanoma than the general population, according to research by John M. Bertoni, MD, PhD, professor and chair of the Department of Neurology at Creighton University, Omaha, and colleagues.1 He presented the results of this research at the American Neurological Association's 131st Annual Meeting this past October in Chicago.

On December 8, 1995, Jean-Dominique Baubyshaved, dressed, drank a cup of hot chocolate,and spent the day conducting business as theeditor-in-chief of Elle magazine. By the end ofthat day, 43-year-old Bauby was in a coma,the result of a massive brain stem stroke.

To evaluate the degree to which newer antipsychotic agents are implicated in parkinsonism and whether drug-induced parkinsonism (DIP) is being adequately recognized, Christine D. Esper, MD, clinical instructor in neurology, and Stewart A. Factor, DO, professor of neurology at Emory University in Atlanta, performed a retrospective review of 354 consecutive patients in whom parkinsonian symptoms were newly diagnosed at a movement disorders clinic in 2004-2005