Neuropsychiatry

Updates Show Progress in TMS for Depression and Schizophrenia by Arline Kaplan In research presented at the 2005 APA annual meeting, transcranial magnetic stimulation is showing efficacy in treating depression and schizophrenia in the research setting. The question of how to translate those findings to a real-world setting still remains.

Individuals with schizophrenia are at greater risk for weight gain than the general population. From recent research, it appears that some of the second-generation antipsychotics may be more likely to cause weight gain than others. Recommendations for treatment strategies are provided.

Delirium,Dementia

traumaticbraininjury,behavioralneurology,generalneurology,neuropsychiatry

"Chemobrain," a term coined by patients in breast cancer support groups to describe cognitive impairment associated with chemotherapy, is becoming a subject of research.

Subspecialization within the practice of neurology is now reality with the recent approvals of subspecialty designations for neuromuscular pathology, headache medicine, and neuro-oncology. The American Academy of Neurology (AAN) Committee on Neuromuscular Pathology sponsored the neuromuscular pathology membership application. Two associations--the AAN Headache and Facial Pain Section and the American Headache Society--sponsored the headache medicine application.

Animal models enable researchers to track amyotrophic lateral sclerosis (ALS) pathogenesis. Erik Storkebaum, MSc, and colleagues at the Center for Transgene Technology and Gene Therapy at Flanders Interuniversity, Leuven, Belgium, took several approaches to increase supply of the neuroprotective protein vascular endothelial growth factor (VEGF) in an animal model. "When administered to rats at 60 days, which is 1 month before symptoms, it delayed onset and prolonged survival by 22 days. When we gave VEGF at the age of disease onset, which more closely mimics the human situation, the treatment still prolonged life by an average of 10 days," Storkebaum reported at the Society for Neuroscience annual meeting in October 2004

Until recently, physicians assumed that any recovery from spinal cord injury (SCI) was limited to the first few months to a year after the injury occurred. In children, this window of opportunity for recovery could last about 2 years. Certainly, no one expected any significant recovery in any person with a chronic SCI or other condition that causes SCIs, such as a stroke, blood clots, or arteriovenous malformation affecting the spinal cord.

Clinical trials--and how they are conducted--have been getting a lot of attention lately, as discussed in our article, "Clinical Trials Appear Headed for More Openness," beginning on page 13. We had already finished editing the article, however, when I got a notice on June 22 about a survey commissioned by the Michael J. Fox Foundation for Parkinson's Research. According to the results, of the surveyed US physicians who treat people with Parkinson disease (PD), 96% agreed that clinical trials are necessary to develop better treatments.

Plenty of data show that a greater share of physicians practice in urban than in rural areas. The Council of Graduate Medical Education called it geographic maldistribution, "one of the most enduring features on the American health landscape," and said that it is likely to continue until universal health care is enacted.

Neurodegeneration associated with glaucoma was prevented in DBA/2J mice as a result of treatment with 1000 rads of radiation plus T-cell-depleted bone marrow.

Can a common cough medicine contribute to effective treatment of symptoms in persons with neurologic disorders? The evidence is mounting in its favor. At the recent American Academy of Neurology annual meeting, research results were presented from a phase 3, double-blind, placebo-controlled, multicenter study into the safety and efficacy of a dextromethorphan/quinidine capsule in

Joseph I. Sirven, MD, and Joseph F. Drazkowski, MD, neurologists at the Mayo Clinic in Phoenix, led a recent study in partnership with the Walter Cronkite School of Journalism and Mass Communication at Arizona State University (ASU) to determine how well medical risks and treatment advances for neurologic conditions are conveyed in US newspaper articles.

Joseph I. Sirven, MD, and Joseph F. Drazkowski, MD, neurologists at the Mayo Clinic in Phoenix, led a recent study in partnership with the Walter Cronkite School of Journalism and Mass Communication at Arizona State University (ASU) to determine how well medical risks and treatment advances for neurologic conditions are conveyed in US newspaper articles.1 Their findings reveal that coverage of neurologic disorders does not always correlate with the prevalence of the disorders and that more collaboration is needed between journalists and neurologists to better educate the public.

More than 100 neurologic diseases, injuries, and intoxications are known to prominently or exclusively involve the white matter of the brain.

Since its 1999 appearance in New York, West Nile virus (WNV) has spread relentlessly westward each year, opening up new fronts in the Midwest and the mountain states until pummeling California in the summer of 2004. The flavivirus, which is spread primarily by mosquitos, affects a variety of animals, including humans, horses, and nearly 300 bird species. As of October 15, 2004, about 940,000 Americans had been infected, of whom 190,000 became ill and 6790 developed WNV's most feared complications: neuroinvasive disease, including meningitis, encephalitis, and acute flaccid paralysis.1

Attempts have been made to integrate psychiatry and medicine as far back as Benjamin Rush, a physician and signer of the Declaration of Independence. Recent advances in research, clinical practice and organizational makeup, however, now make integration seem more plausible than ever. Find out what's happening to bring these two fields closer together.

"No longer a pipe dream," is the suggestive lead-in of a widely distributed press release issued last October touting the potential benefits of cannabinoid compounds in the treatment of Parkinson disease (PD), Lou Gehrig disease-or amyotrophic lateral sclerosis (ALS)-and a number of other debilitating conditions, as reported during last fall's 2004 annual meeting of the Society for Neuroscience. According to Daniele Piomelli, PhD, an expert in cannabinoid research and professor in the Department of Pharmacology at the University of California, Irvine, certain cannabinoid compounds can be harnessed to "provide select benefits to patients while avoiding some of the unwanted effects" associated with marijuana use. Compounds of greatest interest have been WIN 55212-2, delta(9)-tetrahydrocannabinol (THC), and anandamide.

The post-stroke patient is at significant risk for various psychiatric syndromes. The most commonly reported of these in the literature are post-stroke depression (PSD) and post-stroke dementia (PSDem), which may present simultaneously with overlapping mood and cognitive symptoms. In this article, we offer a review of current literature on post-stroke psychiatric syndromes and an integrated clinical approach to screening, diagnosis, and pharmacologic intervention.

Since the 1990s there has been an increase in research on sexual harassment and its mental health consequences. These researchers discuss the use of alcohol to self-medicate harassment-engendered distress and the need for greater attention to potential alcohol-related consequences of harassment experiences.

Dr. Cummings, the originator of Psychiatric Times' "Brain and Behavior" column, looks back over his career in neurology. Looking forward, he predicts that psychiatry and neurology will become ever-more intertwined.

Educational Issues in Neuropsychiatry

In their introduction to the neuropsychiatry special report, Drs. Yudofsky and Hales recapitulate the evolution of neuropsychiatry over the past 150 years, offering up an answer to the question: "What is neuropsychiatry and how does it differ from the traditional specialties of neurology and psychiatry?"

Transcranial magnetic stimulation has been applied in a growing number of psychiatric disorders as a putative treatment. As a focal intervention that may exert lasting effects, TMS offers the hope of targeting underlying circuitry and ameliorating the effects of psychiatric disorders. The ultimate success of such an approach depends upon our knowledge of the neural circuitry involved, on how TMS exerts its effects and on how to control its application to achieve the desired effects. Current challenges in the field include determining how to enhance the efficacy of TMS in these disorders and how to identify patients for whom TMS may be efficacious.

The field of neuropsychiatry has undergone tremendous growth over the past few decades.

While the symptoms of somatoform and dissociative disorders are influenced by the patient's culture, these syndromes are heterogeneous and may have overlapping features. Although more frequently reported in non-Western cultures and thought of as exotic and culture-bound, multiple personality disorder may be a North American example of one such disorder.

Euthanasia is a word coined from Greek in the 17th century to refer to an easy, painless, happy death. In modern times, however, it has come to mean a physician's causing a patient's death by injection of a lethal dose of medication. In physician-assisted suicide, the physician prescribes the lethal dose, knowing the patient intends to end their life.

According to a survey done in 1999, 54% of Oregon's psychiatrists and 75% of the state's psychologists supported physician-assisted suicide, whereas between 20% and 33% of all health care professionals opposed it. The debate continues, as the federal government is trying to take away prescribing privileges for physicians who prescribe life-ending medications.

How does a clinician deal with those patients for whom they can ultimately do nothing but help them stay numb for the majority of their days?

The promise of natural products as possible sources of new treatments for Alzheimer's disease and other dementing illnesses is on the rise. Scientific evidence for the 13 dietary supplements most commonly used for memory impairment is analyzed and evaluated.