Neuropsychiatry

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.

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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

A discussion of the intellectual, social, and historical similarities and differences between sacred texts and the DSM would require a full-length book, but we will concentrate here on 5 main aspects: controversy, communication, interpretation, change, and power.

Psychotic symptoms--delusions, hallucinations, paranoia, thought disorder--are mostly attributed now to aberrations in brain structure and function.

It may come as a surprise, especially given its low repute in the popular mind since the 1980s, but electroconvulsive therapy (ECT) is making a comeback, both as a recommended treatment for depression and in public awareness.

Prevalence of depression in PD is estimated to range from 7% to 76%. The variation is largely attributed to the diversity of the populations under study, differences in the definition of depression, and the fact that some studies used point prevalence and other studies used monthly prevalence. Also, the prevalence of depression varies with fluctuations of cognitive status and other comorbidities that are an integral part of PD.

Alzheimer dementia (AD) represents a profound global health concern. By the year 2050, the prevalence of AD in the United States is expected to reach 15 million. At present, there are 4.5 million cases in the United States, which equals an estimated cost of $100 billion each year in medical and family expenses.

Many physicians, including psychiatrists, may shy away from seeing elderly patients with symptoms of dementia because they imagine that there are a large number of alternative diagnoses and that differential diagnosis is complicated. In fact, however, the number of possible diagnoses in most situations is relatively small and the diagnosis of dementia in older patients is certainly feasible in primary care psychiatry.

The setting of a fast-paced emergency department (ED) or psychiatric emergency service makes it especially difficult to sensitively elicit and address an individual patient's needs and concerns. When considering the myriad differences in culture that come into play between a patient and a psychiatrist or other mental health care clinician, optimal diagnosis and treatment can be even more challenging, as the cases described here illustrate. The important influence of culture cannot be stressed enough. Taking the time to understand "where the patient is coming from" can prevent an already stressful, highly emotionally charged situation from becoming even more convoluted.

A possible link between diabetes and cognitive dysfunction, specifically Alzheimer disease (AD), is becoming increasingly apparent. Indeed, compared with AD risk in healthy persons, the risk of AD development is 65% to 100% greater in persons with diabetes.

The editors of Pediatric Neuropsychiatry must have drawn on their experiences and the feedback they received on their first book, Textbook of Pediatric Neuropsychiatry (American Psychiatric Press, 1998), for this text.

Typically, delirium worsens at night ("sundowning"), with lucid intervals often present in the morning. It is important to realize that delirium may appear before any abnormal laboratory values are detected and may persist after the resolution of these abnormalities.

Complaints of persistent memory loss in otherwise well-functioning individuals after recovery from a psychiatric illness through electroconvulsive therapy (ECT) are best viewed as a conversion reaction or a somatoform disorder. The Camelford experience is a model for the complaints of ECT's profound personal memory losses.

Your patient has pain and numbness that extends from the shoulder to the hand. You suspect a herniated cervical disk, but the MRI scan comes back normal. What else could the culprit be?

A review of the book, "Principles and Practice of Geriatric Psychiatry."

While dementia is marked by such cognitive deficits as disorientation, memory loss and changes in intellectual functioning, these are not the symptoms that cause the most distress to caregivers.

The obvious sometimes bears repeating: Sick people have trouble thinking. They may be suffering from a delirium, a dementia or a more subtle disturbance of cognition caused by fever, drugs, infection, inflammation, trauma, hypoxemia, metabolic derangement, hypotension, tumor, intracranial pathology, pain and so forth.

Can sociodemographic and clinical variables predict outcome in cases of schizophrenia? Results from studies related to prognostic variables for schizophrenia have yielded interesting yet inconsistent results.

With an application to certify its use in depression before the FDA, transcranial magnetic stimulation (TMS) has become a hot topic in the expanding field of device-based treatment modalities.

The following 3 cases illustrate the diagnostic challenges related to differentiating brain injury and posttraumatic stress disorder (PTSD) in patients presenting to the emergency department (ED) in the acute period following a traumatic injury. Such patients pose a dilemma for ED clinicians because of the interplay between head injury and PTSD in the clinical presentation of cognitive impairments in the aftermath of trauma.

Any survivor of a traumatic event is at increased risk for the development of a stress disorder. Considering the number of persons affected by events related to the global war on terrorism and several recent large-scale natural disasters, it seems inevitable that the number of persons who will experience a stress disorder will increase. It is also probable that many of these persons will at some point seek treatment in or be brought to an emergency department (ED).