CAN THE MMPI-2 DISCRIMINATE BETWEEN MILD-MODERATE TBI AND OTHER NEUROLOGIC AND PSYCHIATRIC POPULATIONS?

MMPI-2 maintains an extensive empirical base with psychiatric populations, although more recently, neurologically compromised patients have documented unique elevation patterns. This study examined mild-moderate TBI patients, Alzheimer's Dementia patients, and Psychiatric controls on MMPI-2 scales. Participants included 160 outpatients (TBI n = 26, AD n = 74, Psychiatric n = 60). Controlling for family-wise-error, five ANCOVAs were conducted on five MMPI-2 scales, correcting for age and education. TBI and Psychiatric group means were significantly higher than AD group means for scales Hypochondriasis, Depression, and Hysteria at an alpha of .01. Results support previous research with mild TBI patients, and further document a unique pattern of elevations in this population.     

Is major depression a neurologic disorder with psychiatric symptoms?

In the last decade, multiple investigator groups have identified structural changes of various neuroanatomic structures in patients with idiopathic major depression and bipolar disorders. Using high-resolution MRI of the brain and functional neuroimaging studies (i.e., PET, SPECT), researchers have described decreases in the volume of hippocampal formation, amygdala, entorhinal cortex, various frontal lobe structures, and basal ganglia, in addition to abnormal cerebral blood flow and metabolic activity in these structures as well as in thalamic nuclei. Similar structural and functional changes have been identified in patients with depression associated with a variety of neurologic disorders (i.e., stroke, Parkinson's disease, epilepsy, Alzheimer's dementia). In addition, recent data have shown that depression is a risk factor for the development of several neurologic disorders, including epilepsy, stroke, and Parkinson's disease and bears a negative impact on the course and outcome of most neurologic disorders. This article reviews these data and provides evidence that major depressive and bipolar disorders may in fact be neurologic disorders with psychiatric symptoms.     

What is the link between migraine and psychiatric disorders? From epidemiology to therapeutics

The association between migraine and psychiatric disorders is well documented through numerous population-based studies. The results of these studies are coherent and show an increased risk of suffering from depression, bipolar disorders, numerous anxiety disorders, especially post-traumatic stress disorder. This raises the question of stress as a precipitating factor for migraine illness. Psychiatric comorbidity is even more frequent in chronic migraine than in episodic migraine patients. Many prospective studies have shown that psychiatric comorbidity could be considered as a risk factor for migraine chronicization. Psychiatric comorbidity is also responsible for an increase of the frequency of anti-migraine drug intake, a worsening of quality of life and a worsening of functional impairment. It is also responsible for an increase in the direct and indirect costs of migraine. The reason why psychiatric comorbidity is so high in migraineurs is not unambiguous. Multiple causal relationships and common etiological factors are linked. Recently, genome-wide association studies gave leads to a genetic common heritability between major depressive disorder and migraine. For clinicians, an important topic remains how to treat migraineurs with psychiatric comorbidity. These patients suffer frequently from severe migraine or refractory migraine. Antidepressant and anti-convulsive drugs can be useful, as well as psychological therapies. But moreover, it is of utmost importance to propose an integrated multidisciplinary approach to these difficult patients.     

Can therapeutic education enrich psychiatric care?

There are different ways of approaching therapeutic education in psychiatry. While the behavioural approach is based on acquisition and success, psychoanalysis focuses more on the patient's self-knowledge. The systemic approach is interested in social interaction and collective potential.     

Can embolic stroke be diagnosed on the basis of neurologic clinical criteria?

Diagnosis of embolic stroke is based on identification of a source of embolus (SOE) and on neurologic symptoms acknowledged as "clinical criteria." To test the validity of these criteria, we analyzed the symptoms at onset in 193 patients hospitalized after acute cerebral infarction. Patients were grouped according to identification of a cardiac SOE (106 patients), an arterial SOE (38 patients), or no SOE (49 patients). Cross-tabulations demonstrated that only rapidity and loss of consciousness at onset were associated with the presence of a cardiac SOE to a significant degree. Although these symptoms were highly specific for cardiac SOE, they were not sensitive. A distinct clinical neurologic profile from the symptoms and mode of onset was not identified.     

Where's the logic in neurologic education?

Current practices in neurologic education, and medical education in general, are based largely on intuition and tradition rather than empiric evidence. Educational practices can and should be rigorously evaluated. The topics to be investigated fall into one or more of three broad categories: What should we teach? How should we teach it? How do we know what they have learned? This paper presents examples of research in each of these categories.     

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.     

Do the ABCS 135 short cognitive screen and its subtests discriminate between normal cognition,mild cognitive impairment and dementia?

BACKGROUND: Cognitive screening instruments are either too long for routine clinical use or not sensitive to distinguish mild cognitive impairment (MCI) from normal cognition (NC) or dementia. OBJECTIVE: To evaluate the sensitivity and specificity of the AB Cognitive Screen (ABCS) and its subtests with a view to improving its ability to differentiate between dementia, MCI and NC. The influence of age and education on sensitivity and specificity is also examined. DESIGN: Cross-sectional study. METHODS: Participants with dementia and MCI were recruited from those presenting to four specialty geriatric clinics in southern Ontario. Participants with NC were recruited from the family and friends of patients. A comprehensive geriatric assessment was done including ABCS, SMMSE and 15 point Geriatric Depression Scale. Analysis of variance and receiver operating characteristic (ROC) curves compared test scores. SMMSE scores were also analysed for comparison purposes. RESULTS: Three hundred and two participants had dementia, 166 had MCI and 174 had NC. ABCS total scores were significantly different between NC and MCI (mean difference 7.1, 1.8-12.5 CI, p = 0.000) while SMMSE scores were not (mean difference 0.5, -0.7-1.7, p < 0.628). Of individual ABCS subtests, verbal fluency and delayed recall were most sensitive to differences between NC and MCI. ROC curve analysis, which presents sensitivity and specificity, showed verbal fluency was better than delayed recall in distinguishing between NC and MCI, among participants 75 years of age or older. CONCLUSION: The AB Cognitive Screen (ABCS) can be administered in 3-5 min. The SMMSE and ABCS total and subtests significantly distinguished between dementia and MCI or NC. Verbal fluency and delayed recall were best at distinguishing between MCI and NC. The analysis illustrates how each subtest contributes to the sensitivity of the ABCS and suggests ways that sensitivity might be improved.     

Overlap between functional GI disorders and other functional syndromes: what are the underlying mechanisms?

Abstract Background Irritable bowel syndrome and other gastrointestinal (GI) and non‐GI disorders such as functional dyspepsia, fibromyalgia, temporomandibular joint disorder, interstitial cystitis/painful bladder syndrome, and chronic fatigue syndrome are known as functional pain syndromes. They commonly coexist within the same individual. The pathophysiologic mechanisms of these disorders are not well understood, but it has been hypothesized that they share a common pathogenesis. Purpose The objective of this review is to discuss the proposed pathophysiologic mechanisms, which have been similarly studied in these conditions. These mechanisms include enhanced pain perception, altered regional brain activation, infectious etiologies, dysregulations in immune and neuroendocrine function, and genetic susceptibility. Studies suggest that these functional disorders are multifactorial, but factors which increase the vulnerability of developing these conditions are shared.     

Can Doppler time domain analysis of microembolic signals discriminate between gaseous and solid microemboli in patients with left ventricular assist device?

OBJECTIVE: Microembolic signals (MES) can be detected by transcranial Doppler sonography (TCD). To identify gaseous microemboli the inhalation of oxygen is an established method in patients with prosthetic heart valves. Time domain analysis of sample volume length (SVL) and of frequency modulation showed promising results in the discrimination between solid and gaseous microemboli. We investigated whether these time domain analyses allow the discrimination of different types of microemboli in patients with the non-pulsatile DeBakey left ventricular assist device (LVAD). MATERIALS AND METHODS: Repeated unilateral detection of MES was performed by TCD in 20 patients supported with DeBakey LVAD. Each monitoring session consisted of 20 minutes without and 20 minutes with inhalation of 100% oxygen (6 l/min). A total of 500 MES, detected with (n=250) or without (n=250) the supply of oxygen, were randomly chosen for offline analysis. The SVL (in cm) was calculated by duration and velocity of the MES measured in the time domain mode. Additionally, frequency modulation of MES was classified into three main types: Without modulation (type I), with gradual changes (type II) and with rapid changes (type III). RESULTS: With oxygen supply, both prevalence (26.4% versus 36.2%, p<0.01) and mean counts of MES per hour (49+/-293 versus 108+/-550, p<0.001) significantly declined compared with the MES load while breathing room air. There was no significant difference in the SVL of MES under oxygen (0.85+/-0.38 cm) compared with those without oxygen delivery (0.92+/-0.37 cm, p=0.6). Furthermore, no significant differences were noted for the MES frequency modulation types in time domain analysis with regard to oxygen supply. CONCLUSIONS: The reduction of MES under oxygen delivery confirms the gaseous nature in a substantial number of circulating microemboli produced by the DeBakey LVAD. However, SVL and frequency modulation of MES did not appear to provide valuable information regarding the structural nature of the underlying microembolic material.     

Low self-esteem and psychiatric patients: Part I – The relationship between low self-esteem and psychiatric diagnosis

Background

The objective of the current study was to determine the prevalence and the degree of lowered self-esteem across the spectrum of psychiatric disorders.

Method

The present study was carried out on a consecutive sample of 1,190 individuals attending an open-access psychiatric outpatient clinic. There were 957 psychiatric patients, 182 cases with conditions not attributable to a mental disorder, and 51 control subjects. Patients were diagnosed according to DSM III-R diagnostic criteria following detailed assessments. At screening, individuals completed two questionnaires to measure self-esteem, the Rosenberg self-esteem scale and the Janis and Field Social Adequacy scale. Statistical analyses were performed on the scores of the two self-esteem scales.

Results

The results of the present study demonstrate that all psychiatric patients suffer some degree of lowered self-esteem. Furthermore, the degree to which self-esteem was lowered differed among various diagnostic groups. Self-esteem was lowest in patients with major depressive disorder, eating disorders, and substance abuse. Also, there is evidence of cumulative effects of psychiatric disorders on self-esteem. Patients who had comorbid diagnoses, particularly when one of the diagnoses was depressive disorders, tended to show lower self-esteem.

Conclusions

Based on both the previous literature, and the results from the current study, we propose that there is a vicious cycle between low self-esteem and onset of psychiatric disorders. Thus, low self-esteem increases the susceptibility for development of psychiatric disorders, and the presence of a psychiatric disorder, in turn, lowers self-esteem. Our findings suggest that this effect is more pronounced with certain psychiatric disorders, such as major depression and eating disorders.