Tic disorders and obsessive compulsive disorder: where is the link?

Over the last years evidence on the overlap between tic-disorders (TD) and obsessive compulsive behavior/disorder (OCB/OCD) has increased. The main focus of research have been the phenomenological and epidemiological similarities and differences in samples of different age, primary diagnosis (TD vs. OCD) including the co-occurrence of both. Unfortunately, only a minority of studies included all three groups (TD, TD + OCD, OCD). Nevertheless, new insight concerning possible subtypes for both TD and OCD has been gained. While some authors concentrated on OCD with/without tics we will summarize the field of TD and OCB/OCD from the viewpoint of tics, since OCB plays an important role in patients with TD. Thereby we will not only sharpen the clinicans' awareness of known differences in phenomenology, epidemiology, genetics and neurobiology, aimed to improve their diagnoses and treatment but also highlight the gaps of knowledge and discuss possibilities for further research in this field.     

What is the relationship between general practitioners' community referrals,and hospital referrals to an old age psychiatric service?

There is a large variation in the referral rates of general practitioners (GPs) to specialist services. There is also evidence that GPs under-refer patients with dementia and depression to old age psychiatric services. However, little is known about individual GP referral rates to these services. Patients may be referred to psychiatric services by GPs in the community (community referrals), or by physicians or surgeons, while the patients are receiving medical or surgical care in hospital (hospital referrals). One way of controlling for GP variables, such as practice size and the age profile of patients, may be to examine the relationship between hospital and community referrals for each GP. Our hypothesis was that there would be a positive correlation between these types of referral. Six hundred and seventy-four new referrals from 62 local GPs were examined over a 6-year period. The GPs made an average of 7.1 community referrals and 3.8 of their patients were hospital referrals. There was a large variation in the number of referrals (range 1-45). However, there was a significant positive relationship between the number of hospital and community referrals for each GP ( p =0.001). These findings support the hypothesis, and suggest that it may be useful to use the ratio, hospital to community referrals, to identify GPs with abnormal referral patterns.     

Headache and major depression: is the association specific to migraine?

OBJECTIVE: To examine the relationship between migraine and major depression, by estimating the risk for first-onset major depression associated with prior migraine and the risk for first migraine associated with prior major depression. We also examined the extent to which comorbidity with major depression is specific to migraine or is observed in other severe headaches. METHODS: Representative samples of persons 25 to 55 years of age with migraine or other severe headaches (i.e., disabling headaches without migraine features) and controls with no history of severe headaches were identified by a telephone survey and later interviewed in person to ascertain history of common psychiatric disorders. RESULTS: Lifetime prevalence of major depression was approximately three times higher in persons with migraine and in persons with severe headaches compared with controls. Significant bidirectional relationships were observed between major depression and migraine, with migraine predicting first-onset depression and depression predicting first-onset migraine. In contrast, persons with severe headaches had a higher incidence of first-onset major depression (hazard ratio = 3.6), but major depression did not predict a significantly increased incidence of other severe headaches (hazard ratio = 1.6). CONCLUSIONS: The contrasting results regarding the relationship of major depression with migraine versus other severe headaches suggest that different causes may underlie the co-occurrence of major depression in persons with migraine compared with persons with other severe headaches.     

What good is EMG to the patient and practitioner?

Electromyography (EMG) and nerve conduction studies (NCS) are not only tests to be performed in isolation and reported without consideration of the clinical context, but rather form part of what has been referred to as the electrodiagnostic consultation. Using all of the pertinent information available to the electromyographer performing the test, the electrodiagnostic consultation strives toward the goal of helping the patient and the referring physician to establish a correct diagnosis. Although not without limitations, EMG as an extension of the clinical history and physical examination can be a powerful and sensitive diagnostic tool. Like any tool, however, the final result depends on the skill and expertise with which it is wielded.     

A different view on the link between tinnitus and cognition; is there a reciprocal link?

Abstract

Tinnitus is the conscious perception of sound in the absence of any corresponding acoustic stimulus and is one of common auditory symptoms. There is some evidence that tinnitus patients suffer from difficulties in cognitive function including attention and memory. However, how exactly tinnitus affects the cognitive functions is still under debate. It seems that there is a reciprocal relationship between tinnitus and cognitive functions like auditory selective attention and working memory. In other words, as tinnitus can disrupt attention and memory functions, alterations in cognitive functions would in turn play an important role in tinnitus generation and persistence. This study reviews the literature on the relationship between tinnitus and cognition from a different view (a likely reciprocal link) and discusses its possible mechanisms.     

Cannabis use and psychiatric and cogitive disorders: the chicken or the egg?

PURPOSE OF REVIEW: Cannabis is the world's most commonly used illicit drug. In this review, we consider the recent literature on the effects of cannabis on mental health and on cognition. RECENT FINDINGS: Cannabis use in adolescence increases the risk of later schizophrenia-like psychoses, especially in genetically vulnerable individuals. Not surprisingly, patients already suffering from psychosis who use cannabis have a worse outcome than those who do not. These effects of cannabis may be consequent on its impact on the dopamine system. There is less evidence of cannabis playing an aetiological role in other mental disorders including depression, but there have been far fewer studies. Heavy cannabis use has also been shown to affect memory and learning performance, both in healthy individuals and in patients suffering from psychosis. Combined cognitive-behavioural therapy and motivational interviewing seems a promising psychological intervention to achieve a cessation of cannabis use in patients suffering from schizophrenia. SUMMARY: Further research is needed to understand the biological mechanisms underlying the effects of cannabis on mental health, but intervention strategies to help patients abstain should currently be implemented in psychiatric services, and public education campaigns should be directed at increasing awareness of the health risks of cannabis.