Abstracts of oral presentations,presented at the British Neuropsychological Society (BNS) spring meeting,April 2002, National Hospital,Queen Square,London, UK

Abstract

Visuo-spatial neglect can be conceptualized as a failure of right hemisphere global attentional systems to direct the visual processor of the left hemisphere uniformly across an array. Two patients have recently been reported who show a dissociation of preserved global visual form perception in the context of left neglect for constituent elements. We present the first longitudinal study of the phenomenon which confirms that this pattern of neglect is associated with extensive right hemisphere damage, is fairly stable over time and may persist up to one year post insult. The use of modified Navon figures suggests that task demands may be significant in the manifestation of neglect. Correlation with conventional diagnostic tests for neglect is poor, but results suggest a subgroup of Navon stimuli that may be particularly sensitive to clinical change.     

Cannabis,Cannabinoids, and Sleep: a Review of the Literature

Purpose of Review

The current review aims to summarize the state of research on cannabis and sleep up to 2014 and to review in detail the literature on cannabis and specific sleep disorders from 2014 to the time of publication.

Recent Findings

Preliminary research into cannabis and insomnia suggests that cannabidiol (CBD) may have therapeutic potential for the treatment of insomnia. Delta-9 tetrahydrocannabinol (THC) may decrease sleep latency but could impair sleep quality long-term. Novel studies investigating cannabinoids and obstructive sleep apnea suggest that synthetic cannabinoids such as nabilone and dronabinol may have short-term benefit for sleep apnea due to their modulatory effects on serotonin-mediated apneas. CBD may hold promise for REM sleep behavior disorder and excessive daytime sleepiness, while nabilone may reduce nightmares associated with PTSD and may improve sleep among patients with chronic pain.

Summary

Research on cannabis and sleep is in its infancy and has yielded mixed results. Additional controlled and longitudinal research is critical to advance our understanding of research and clinical implications.

     

Embodying meaning: Insights from primates,autism, and Brentano

In this paper I offer an analysis of social meaning in terms of coding intentional relations between agents and objects. This analysis is amenable to embodied interpretations of intentionality and Theory of mind and may prove of help for the task of simulating the attribution of intentionality with neural networks. Work with non-human primates suggests that evolution first dealt with the problem domain of social meaning by selecting specific adaptations for coding behaviour as intentional in the sense of Brentano, i.e., as directed to or being about objects (for example, gaze following behaviours). Work with autism suggests that alterations in these basic mechanisms of intentional attribution may explain some of the most prevalent problems with social meaning in this condition. Brentanian mechanisms for encoding intentional relations between agents and objects are more basic and evolutionarily more primitive than representational theories of mind. However, some of the key components of representational theories of mind may be already present in the intentional abilities of primates, suggesting that the decisive evolutionary step may have consisted of a re-organization of existing abilities rather than the creation of new skills. Neural network models and models of the evolution and development of primitive mechanisms for intentional encoding may benefit from mutual cross-fertilization.     

Theory of mind,social development,and psychosis

The difficulty in interpreting other people’s mental states found in children with autism and in people affected by schizophrenia may be explained in terms of a unique mental process called Theory of Mind. The paper discusses the main operational issues of such a peculiar aspect of social cognition, the Theory of Mind, and its implication in schizophrenia, including a review of its related neural structures. Theory of Mind abilities may be a relevant aspect of social interaction involving people affected by schizophrenia, and they need to be further investigated in clinical research.     

Resources,Stress, and Immunity: An Ecological Perspective on Human Psychoneuroimmunology

Ecological immunology provides a broad theoretical perspective on phenotypic plasticity in immunity, that is, changes related to the value of immunity across different situations, including stressful situations. Costs of a maximally efficient immune response may at times outweigh benefits, and some aspects of immunity may be adaptively suppressed. This review provides a basic overview of the tenets of ecological immunology and the energetic costs of immunity and relates them to the literature on stress and immunity. Sickness behavior preserves energy for use by the immune system, acute stress mobilizes “first-line” immune defenders while suppressing more costly responses, and chronic stress may suppress costly responses in order to conserve energy to counteract the resource loss associated with stress. Unexpected relationships between stress “buffers” and immune functions demonstrate phenotypic plasticity related to resource pursuit or preservation. In conclusion, ecological models may aid in understanding the relationship between stress and immunity.     

Atypical herpes simplex encephalitis: clinical, virologic, and neuropathologic evaluation.

An atypical form of herpes simplex encephalitis produced by HSV-1 documented in the present article demonstrates that (1) prominent EEG abnormality may correlate with subtle increase in signal intensity on MRI; (2) the disease may start with prominent involvement of the cingulate gyri; and (3) viral infection of the brainstem may cause early onset of severe neurologic dysfunction and coma.     

Feminist identity,body image,and disordered eating

ABSTRACT

Using data from a community-based sample (Project EAT-III), this study (N = 1241; mean age = 25.2) examined the relationship of feminist identity with body image and disordered eating. Feminist-identified women reported significantly higher body satisfaction than non-feminist women and women who did not identify as feminists but held feminist beliefs. However, feminist-identified women did not differ from non-feminist women in disordered eating. Women holding feminist beliefs and non-feminist women did not differ in body satisfaction. Our findings suggest that self-identification as a feminist may promote positive body image in young adult women, but may be insufficient to change behaviors.     

Sexual dimorphism, brain morphology, and schizophrenia

The study of sexual dimorphism in brain morphology may help delineate subtypes of schizophrenia based, in part, on sex; yield insight into the relationship between brain structure and behavior; and provide a neurodevelopmental context for studying the ontogenesis of schizophrenia. Preliminary findings from an ongoing study of sex differences in brain morphology and neuropsychological performance in schizophrenia suggest that schizophrenic males are characterized by multiple morphological deviations; this may represent an extreme form of normal sexual dimorphism in brain morphology. The role of brain morphology deviation in the ontogenesis of schizophrenia is discussed.     

核纤层蛋白Lamin A的结构及功能和代谢特征

Lamin A是细胞核内重要的骨架蛋白,对维持细胞的形态结构具有重要作用。文章综述了LMNA基因在染色体的位置,lamin A蛋白质的形态、结构;LMNA基因不同位点的突变和缺失时机体产生的不同疾病;核纤层蛋白lamin A参与成肌细胞的分化作用功能;Caspase-6可促进核纤层蛋白lamin A的裂解以及NFAT5可能促进lamin A的表达等调节作用。     

Depressives syndromes in a primary care setting: Evaluation,classification, and outcome

Fifteen percent of the general population may experience a major disorder of mood during their lives.¹ Their care falls to the greatest degree upon the primary physician.² A general practitioner may be chosen for the first contact by an estimated 88% of individuals fearing an experiencing psychologic disturbance.³ As many as 63% of community based mentally ill (n = 490,000) may receive their psychiatric treatment from a general practitioner.⁴ This prevalence is further enhanced by the observation that psychiatric patients represents a high medical utilization group when contrasted with nonpsychiatric controls.⁵Since the depressive syndrome is of diverse etiology, and may present under the guise of a physical complaint, a comprehensive evaluation should include a personal and family history, physical and mental status examination, and appropriate laboratory tests. While family practitioners may spend from 17% to 27% of patients care time dealing with emotionally related problems,⁶ some 60% of the American Academy of Family Physicians reported “insufficient training in medical school” to deal with their patients' emotional problems. A comprehensive data base (Table 1) was contrasted with the practices of second and third year family practice residents by a prospective study of recently diagnosed “depression” at a community primary care center.     

The Maladaptive Pursuit of Consumption: the Impact of Materialism,Pain of Paying,Social Anxiety,Social Support,and Loneliness on Compulsive Buying

The current research examined the capability of materialism, pain of paying, social anxiety, social support, and loneliness to predict compulsive buying. A sample of students attending a public university located in the northeast USA were surveyed. A multiple regression indicated materialism, pain of paying, anhedonia, coping with substances, and social support received from family were predictors of compulsive buying. Pain of paying was the strongest predictor of compulsive buying. Understanding factors that affect compulsive buying aids the identification of compulsive buying and informs the treatment of compulsive buying. Treatment models may be more effective if additional attention is given to addressing and developing social support networks of compulsive buyers. Such social support may act as a buffer against the social anxiety compulsive buyers experience and may help reduce feelings of anhedonia and use of substances to control social anxiety.

     

Inherited focal, episodic neuropathies

Hereditary neuropathy with liability to pressure palsies (HNPP; also called tomaculous neuropathy) is an autosomal-dominant disorder that produces a painless episodic, recurrent, focal demyelinating neuropathy. HNPP generally develops during adolescence, and may cause attacks of numbness, muscular weakness, and atrophy. Peroneal palsies, carpal tunnel syndrome, and other entrapment neuropathies may be frequent manifestations of HNPP. Motor and sensory nerve conduction velocities may be reduced in clinically affected patients, as well as in asymptomatic gene carriers. The histopathological changes observed in peripheral nerves of HNPP patients include segmental demyelination and tomaculous or “sausage-like” formations. Mild overlap of clinical features with Charcot-Marie-Tooth (CMT) disease type 1 (CMT1) may lead patients with HNPP to be misdiagnosed as having CMT1. HNPP and CMT1 are both demyelinating neuropathies, however, their clinical, pathological, and electrophysiological features are quite distinct. HNPP is most frequently associated with a 1.4-Mb pair deletion on chromosome 17p12. A duplication of the identical region leads to CMT1A. Both HNPP and CMT1A result from a dosage effect of the PMP22 gene, which is contained within the deleted/duplicated region. This is reflected in reduced mRNA and protein levels in sural nerve biopsy samples from HNPP patients. Treatment for HNPP consists of preventative and symptom-easing measures. Hereditary neuralgic amyotrophy (HNA; also called familial brachial plexus neuropathy) is an autosomal-dominant disorder causing episodes of paralysis and muscle weakness initiated by severe pain. Individuals with HNA may suffer repeated episodes of intense pain, paralysis, and sensory disturbances in an affected limb. The onset of HNA is at birth or later in childhood with prognosis for recovery usually favorable; however, persons with HNA may have permanent residual neurological dysfunction following attack(s). Episodes are often triggered by infections, immunizations, the puerperium, and stress. Electrophysiological studies show normal or mildly prolonged motor nerve conduction velocities distal to the affected brachial plexus. Pathological studies have found axonal degeneration in nerves examined distal to the plexus abnormality. In some HNA pedigrees there are characteristic facial features, including hypotelorism. The prognosis for recovery of normal function of affected limbs in HNA is good, although recurrent episodes may cause residual deficits. HNA is genetically linked to chromosome 17q25, where mutations in the septin-9 (SEPT9) gene have been found.     

Pre-Eclampsia,Birth Weight,and Autism Spectrum Disorders

Autism spectrum disorders (ASD) are primarily inherited, but perinatal or other environmental factors may also be important. In an analysis of 87,677 births from 1996 through 2002, insured by the South Carolina Medicaid program, birth weight was significantly inversely associated with the odds of ASD (OR = 0.78, p = .001 for each additional kilogram). Maternal pre-eclampsia/eclampsia was significantly associated with greater odds of ASD (OR = 1.85, p < .0001 without controlling for birth weight; OR = 1.69, p = .0005, when controlling for birth weight). We conclude that reduced birth weight partially mediates the association between pre-eclampsia/eclampsia and ASD. Additional research is needed to investigate the potential mechanism(s) by which pre-eclampsia/eclampsia may influence ASD risk.     

MATRICS cognitive consensus battery (MCCB) performance in children,adolescents, and young adults

BackgroundNeurodevelopmental models of schizophrenia suggest that cognitive deficits may be observed during childhood and adolescence, long before the onset of psychotic symptoms. Elucidating the trajectory of normal cognitive development during childhood and adolescence may therefore provide a basis for identifying specific abnormalities related to the development of schizophrenia. The MATRICS Consensus Cognitive Battery (MCCB), which was designed for use in clinical trials targeting cognitive deficits most common in schizophrenia, may provide a mechanism to understand this trajectory. To date, however, there is no performance data for the MCCB in healthy children and adolescents. The present study sought to establish performance data for the MCCB in healthy children, adolescents, and young adults.MethodsThe MCCB was administered to a community sample of 190 healthy subjects between the ages of 8 and 23 years. All MCCB domain scores were converted to T-scores using sample means and standard deviations and were compared for significant performance differences between sex and age strata.ResultsAnalyses revealed age effects following quadratic trends in all MCCB domains, which is consistent with research showing a leveling off of childhood cognitive improvement upon approaching late adolescence. Sex effects after controlling for age only presented for one MCCB domain, with males exhibiting well-known spatial reasoning advantages.ConclusionsUtilizing this performance data may aid future research seeking to elucidate specific deficits that may be predictive of later development of SZ.     

Huge hydrocephalus: definition, management, and complications

Objective  

Lack of comprehensive knowledge and numerous socioeconomic problems may make the parents leave hydrocephalic children untreated, leading to progressive hydrocephalus and eventual unordinary big head. Management of huge hydrocephalus (HH) differs from common hydrocephalus. We present our experience in the management of these children.     

Hypothesis on the pathogenesis of vacuolar myelopathy, dementia, and peripheral neuropathy in AIDS

Certain aspects of the clinical syndrome of dementia, cerebralatrophy, predominantly sensory neuropathy, and vacuolar myelopathy inAIDS resemble those seen in vitamin B12 deficiency. Pathologically, there are similarities not only in the changes in the spinal cord, butalso in the brain and peripheral nerves. The pathogenesis of vacuolarmyelopathy may be secondary to a combination of immune mediated myelinand oligodendrocyte injury, and simultaneous impairment of repairmechanisms due to a deficiency of S-adenosylmethionine (SAM). Productsderived from macrophages may interfere directly with the methyltransfer cycle through the generation of reactive oxygen intermediatesand reactions involving nitric oxide and peroxynitrite which may limitthe supply of methionine for conversion to SAM, both by directinteraction as well as through inhibition of methionine synthase.Macrophage activation with secretion of cytokines and otherbiologically reactive substances within the nervous system is sustainedin the late stages of HIV infection by the general effects of immunedepletion, including loss of T cells (with concomitant reduction ofmacrophage regulatory molecules) and recurrent opportunisticinfections, and may be further augmented by the local presence of thevirus itself (or its surface glycoprotein gp120). This would accountfor the common, but not exclusive, occurrence of vacuolar myelopathy inAIDS. The ability of the virus and its products to stimulate macrophageand microglial activation may also explain the association betweenseverity ofvacuolar myelopathy and the presence of HIV encephalitis. Asimilar mechanism may underlie the pathogenesis of dementia, cerebralatrophy, and peripheral neuropathy. Local factors or differentialsusceptibility between the central and peripheral nervous system maydetermine whether myelinotoxic or neurotoxic processes predominate; the prominence of myelin involvement in the spinal cord, and axonal involvement peripherally may reflect both ends of this range, with thebrain manifesting a more equal balance of both processes.

     

Benzodiazepine use, abuse, and dependence

Although benzodiazepines are invaluable in the treatment of anxiety disorders, they have some potential for abuse and may cause dependence or addiction. It is important to distinguish between addiction to and normal physical dependence on benzodiazepines. Intentional abusers of benzodiazepines usually have other substance abuse problems. Benzodiazepines are usually a secondary drug of abuse-used mainly to augment the high received from another drug or to offset the adverse effects of other drugs. Few cases of addiction arise from legitimate use of benzodiazepines. Pharmacologic dependence, a predictable and natural adaptation of a body system long accustomed to the presence of a drug, may occur in patients taking therapeutic doses of benzodiazepines. However, this dependence, which generally manifests itself in withdrawal symptoms upon the abrupt discontinuation of the medication, may be controlled and ended through dose tapering, medication switching, and/or medication augmentation. Due to the chronic nature of anxiety, long-term low-dose benzodiazepine treatment may be necessary for some patients; this continuation of treatment should not be considered abuse or addiction.     

Informed consent, participation in research, and the Alzheimer's patient

Patients with Alzheimer's disease may want to participate in research on Alzheimer's disease, but their participation involves exceptional considerations. Plans should be made for determining these patients' cognitive capacity on a regular basis; for example, throughout a study, cognitive capacity may decline, making it necessary for a patient's pre-designated surrogate decision maker to become more involved. Patients with Alzheimer's disease may also choose to designate someone other than their primary caregiver to be their surrogate decision maker. This article discusses these and other core ethical issues.