Neuropsychiatry

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.

In the last third of the 20th century, psychiatry boldly shook off a 120-year-long philosophical funk and rushed to catch up in the thrilling march of medicine. The biopsychosocial model that once sounded trendy now seems to be an indispensable approach. The pioneers of psychopharmacology who once labored at the margins have now been joined by thousands of bright young doctors who treat patients with depression, psychosis and impulsive aggression and realize that a troubled soul is often expressing the cries of a troubled brain. This issue of Psychiatric Times celebrates the stirring giant that is 21st-century neuropsychiatry--a discipline that derives its immense power and scope from the glad embrace of the twin Enlightenment ideals of humanism and the scientific method.

Psychotic episodes following brain injuries can often be mistaken for schizophrenia. How can the presentation of psychotic episodes reframe our understanding of this complex phenomenon?

A further look at TMS, including synopses of presentations from the 3rd Annual Meeting of the International Society of Transcranial Stimulation.

Results from the 1999 National Household Survey on Drug Abuse show significant increases in rates of prescription drug abuse. Other surveys show similar findings. An overview of the most commonly abused drugs and suggestions for preventing abuse are reviewed.

The recovered memory debate has been the most acrimonious, vicious and hurtful internal controversy in the history of modern psychiatry. From its very beginning in the late 1980s, it has been more an "ad hominem" war, appealing to feelings and prejudices, rather than a matter of reasoned professional disagreement.

The debate over the accuracy of memories of childhood sex abuse that are recovered decades later, usually during the course of therapy, has led to the polarization of psychiatrists and other mental health professionals. There are those who claim that -recovered memories are, in the main, accurate, and there are others who believe that most, if not all, recovered memories are false.

Putting Kevorkian on trial is not the same as developing a rational health care policy for those who are terminally ill. Kevorkian needs to be checked, but too much significance should not be given to his case. Our concern with the care for those who are seriously or terminally ill is too important to relegate to the trial of someone who is so narrowly fixed on being the instrument of his own death or that of others.

The department of psychiatry at Columbia-Presbyterian Medical Center (CPMC) in New York City has opened one of the first facilities in the country that brings the techniques of complementary medicine to psychiatry. The Center for Meditation and Healing, which opened this March, emphasizes traditional meditative methods used for thousands of years in Asian cultures, particularly those of India and Tibet.

Is it appropriate for physicians to accept assisted-death requests at face value, or should they be interpreted as clinical indications of suffering? Should physicians act on patient requests to die, or should they address patient needs through other measures? Such are the difficult questions facing most physicians today.

The concept of a barrier between the blood and the brain arose in the late 19th century when the German bacteriologist Paul Ehrlich observed that certain dyes administered intravenously to small animals stained all of the organs except the brain. Ehrlich interpreted this to mean that the brain had a lower affinity for the dye than the other tissues. In subsequent experiments, one of Ehrlich's students injected a blue dye directly into the cerebrospinal fluid of rabbits and dogs. The dye readily stained the entire brain, but did not enter the bloodstream to stain the other internal organs.

At stake is whether the laws defining sanity can actually distinguish between those individuals who are evil and those who are mentally ill, and what role psychiatrists should play when the legal definitions make the difference between life and death. Also under the microscope is the value of forensic psychiatric testimony itself, and whether the message about mental illness is getting through to juries, judges and appellate justices.