Autism,macrocrania and epilepsy: how are they linked?

To evaluate the possible association of autistic disorder (AD), macrocrania and epilepsy, we performed a retrospective study comparing epileptic and non-epileptic AD patients with macrocrania, and AD patients with macrocrania to age- and sex-matched AD controls without macrocrania. We found macrocrania in 17.3% of 121 patients with AD. Epilepsy was not significantly more frequent in AD patients with macrocrania than in those without macrocrania. There were no significant differences in the other clinical characteristics studied except for epileptiform EEG abnormalities which were more often found in AD patients with epilepsy. AD with macrocrania and epilepsy is not a syndrome but may be a marker for a group of subjects with AD. A role for familial macrocrania needs further assessment.     

Designer drugs: how dangerous are they?

Of the designer drugs, the amphetamine analogues are the most popular and extensively studied, ecstasy (3,4-methylenedioxymethamphetamine; MDMA) in particular. They are used recreationally with increasing popularity despite animal studies showing neurotoxic effects to serotonin (5-HT) and/or dopamine (DA) neurones. However, few detailed assessments of risks of these drugs exist in humans. Previously, there were no methods available for directly evaluating the neurotoxic effects of amphetamine analogues in the living human brain. However, development of in vivo neuroimaging tools have begun to provide insights into the effects of MDMA in human brain. In this review, contributions of brain imaging studies on the potential 5-HT and/or DA neurotoxic effects of amphetamine analogues will be highlighted in order to delineate the risks these drugs engender in humans, focusing on MDMA. An overview will be given of PET, SPECT and MR Spectroscopy studies employed in human users of these drugs. Most of these studies provide suggestive evidence that MDMA is neurotoxic to 5-HT neurones, and (meth)amphetamine to DA neurones in humans. These effects seem to be dose-related, leading to functional impairments such as memory loss, and are reversible in several brain regions. However most studies have had a retrospective design, in which evidence is indirect and differs in the degree to which any causative links can be implied between drug use and neurotoxicity. Therefore, at this moment, it cannot be ascertained that humans are susceptible to MDMA-induced 5-HT injury or (meth)amphetamine-induced DA injury. Finally, although little is known about other amphetamine analogues there are important questions as to the safety of these designer drugs as well, in view of the fact that they are chemically closely related to MDMA and some have been shown to be 5-HT neurotoxins in animals.     

Self-face and emotional faces—are they alike?

The image of one’s own face is a particularly distinctive feature of the self. The self-face differs from other faces not only in respect of its familiarity but also in respect of its subjective emotional significance and saliency. The current study aimed at elucidating similarities/dissimilarities between processing of one’s own face and emotional faces: happy faces (based on the self-positive bias) and fearful faces (because of their high perceptual saliency, a feature shared with self-face). Electroencephalogram data were collected in the group of 30 participants who performed a simple detection task. Event-related potential analyses indicated significantly increased P3 and late positive potential amplitudes to the self-face in comparison to all other faces: fearful, happy and neutral. Permutation tests confirmed the differences between the self-face and all three types of other faces for numerous electrode sites and in broad time windows. Representational similarity analysis, in turn, revealed distinct processing of the self-face and did not provide any evidence in favour of similarities between the self-face and emotional (either negative or positive) faces. These findings strongly suggest that the self-face processing do not resemble those of emotional faces, thus implying that prioritized self-referential processing is driven by the subjective relevance of one’s own face.     

Are readmission rates influenced by how psychiatric services are organized?

A transition is taking place in the organization of psychiatric services. The length of stay in hospitals is reduced and partly replaced by treatment and care in the community. The readmission rate is proposed as one indicator to analyse the effectiveness of this transition. A comprehensive literature review was conducted to ascertain whether readmission rates differ with different service systems. The search yielded 77 articles, of which 28 were selected on the basis of aims and objectives of the articles. The results show that approximately 50% of all patients admitted to psychiatric hospitals are previously admitted patients. Longer length of stay, appropriate discharge planning, and follow-up visits after discharge predicted fewer readmissions, whereas the quantity and quality of community care did not seem to have any impact on readmission rates. On the basis of the analysis of the literature review it is concluded that readmission rates are not a suitable indicator of quality of care in psychiatric hospitals. Readmission rates may, however, be an important tool in the planning of mental health services.     

Basic pathophysiological mechanisms in depression: what are they and how might they affect the course of the illness?

Basic pathophysiological mechanisms in affective disorders are discussed. Studies carried out suggest that changes in neurogenesis do not underlie the behavioral changes which lead to helplessness. Since the behavioral changes leading to depressive or anxious behaviors are not correlated with changes in neurogenesis it appears unlikely that a decrease in the rate of neurogenesis is the basis for depression. A modified gene expression resulting in both functional and structural brain changes remains the most consistent hypothesis to explain how affective disorders may occur. An alternative candidate, synaptogenesis, appears as a likely candidate and requires further experimental testing.     

Transport and industrial safety,how are they affected by sleepiness and sleep restriction?

This review shows that impaired/shortened sleep is a major cause of accidents in industry and transport. The reason is either sleep pathology, voluntary (non-pathological) sleep reduction, or activity during the circadian low. Night or morning work is a prominent factor with regard to the latter two. However, the link between sleep restriction (or shift work) and safety is much better established in the transport industry than in other industrial areas. The reason is that driving a vehicle is a task with continuous demand for attention and immediate punishment for lapses, whereas industrial work in most cases does not have the same demands. Still, there are effects and the consequences may be far-reaching.     

Entrepreneurial and parental love—are they the same?

Here we tested the hypothesis that entrepreneurs' emotional experience and brain responses toward their own firm resemble those of parents toward their own children. Using fMRI, we measured the brain activity while male entrepreneurs viewed pictures of their own and of a familiar firm, and while fathers viewed pictures of their own and of a familiar child. The entrepreneurs who self‐rated as being very closely attached with their venture showed a similar suppression of activity in the posterior cingulate cortex, temporoparietal junction, and dorsomedial prefrontal cortex as fathers during viewing pictures of their own children versus familiar children. In addition, individual differences in the confidence trait influenced the neural encoding of both paternal and entrepreneurial processing. For underconfident fathers, a picture of one's own child was associated with stronger activation and for overconfident fathers with weaker activation in the amygdala and in caudate nucleus, a brain structure associated with processing of rewards. Similar association with activation, yet more widespread in the emotional processing network, was observed in entrepreneurs suggesting a similar neural basis for increased sensitivity to threats and potential risks concerning one's venture and child. In conclusion, both entrepreneurial and parental love seem to be supported by brain structures associated with reward and emotional processing as well as social understanding. Hum Brain Mapp 38:2923–2938, 2017. © 2017 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc.     

Psychopathologies in patients with nonepileptic seizures with and without comorbid epilepsy: how different are they?

The underlying psychopathology in patients with nonepileptic seizures (NES) is diverse and poorly understood. The prevalence of epilepsy in NES patients is higher than in the general population, so epilepsy can be understood as a risk factor for NES. The question emerges if psychopathology differs in NES patients with and without epilepsy. Retrospective data concerning psychopathology and personality in both groups show two differences: (1) somatoform disorders are more prevalent in NES-only patients and (2) personality disorders are more typical in NES patients with epilepsy and resemble the pattern of psychopathology found in epilepsy-only patients. If true, then NES in epilepsy patients may be associated with an epilepsy condition. Consequently, in studies of psychopathology in epilepsy patients, patients with comorbid nonepileptic seizures have to be included.     

Cultural adaptations of current psychiatric classifications: are they the solution?

Despite the limitations of modern nosological systems the development of cultural adaptations is a step backward, leading to unavoidable pitfalls in spite of the fact that cultural diversity is imposing new attitudes and demands on psychiatrists. Cultural adaptations challenge the principles of the universality of science and of ethics. ICD-10 and DSM-IV rely on the symptoms present to classify psychiatric diseases. This kind of classification has many advantages: it is a theoretical, close to clinical reality, easy to grasp and less prone to untested hypotheses. But they have some drawbacks: they do not say what diseases are, since the concept of symptom is not totally clear in psychiatry. The greatest disadvantage of this approach is the dispersion of disorders that may be related or even unique. Furthermore, when too many symptoms are present, this method requires a hierarchical structure (as in DSM-III)--unless one is willing to live with multiple diagnoses, the so-called co-morbidities (as in DSM-IV). But at other times, too few symptoms are present, leading to atypical, waste-basket and subsyndromal categories. Another problem is that symptoms may not be consistent across cultures, leading to the need of cultural adaptations. In the case of diseases diagnosed according to symptomatic criteria, cultural adaptations of internationally accepted classifications are often sought because symptoms are deemed to be inconsistent across cultures. But at a closer look, very often the symptoms are not so different and it is only the cultural halo which makes them attractive; even when they are particular to a given culture they can easily be interpreted (e.g., the penis invagination of latah). Indeed, they represent a way of experiencing common feelings such as anxiety (e.g., the susto of Latin America, which is a typical panic disorder) and depression. To put too much emphasis on local symptoms bears the risk of yielding to social and cultural pressure.     

Why are women from Venus and men from Mars when they abuse cocaine?

Both preclinical and clinical studies have shown sexually dimorphic patterns in behavioral responses to cocaine in all phases of the cocaine addiction process (induction, maintenance, and relapse). Thus, a clear picture is emerging which suggests that the biological basis of sex-specific differences in cocaine addiction resides in the disparate regulation of the CNS by male and female gonadal hormones. This review discusses the role that gonadal hormones play in these sexually dimorphic patterns of behavioral responses to cocaine.