Acute dissociative reaction to spontaneous delivery in a case of total denial of pregnancy: Diagnostic and forensic aspects

This article presents the history of a 21-year-old female college student with total denial of pregnancy who experienced an acute dissociative reaction during the spontaneous delivery at home without medical assistance where the newborn died immediately. Psychiatric examination, self-report questionnaires, legal documents, and witness reports have been reviewed in evaluation of the case. Evidence pointed to total denial of pregnancy, that is, until delivery. The diagnoses of an acute dissociative reaction to stress (remitted) and a subsequent PTSD were established in a follow-up examination conducted 7 months after the delivery. Notwithstanding the inherently dissociative nature of total denial of pregnancy, no other evidence has been found about pre-existing psychopathology. For causing the newborn’s death, the patient faced charges for “aggravated murder,” which were later on reduced into “involuntary manslaughter.” Given the physical incapacity to perform voluntary acts due to the loss of control over her actions during the delivery, and the presence of an acute dissociative reaction to unexpected delivery, the legal case represents an intricate overlap between “insanity” and “incapacitation” defenses. The rather broad severity spectrum of acute dissociative conditions requires evaluation of the limits and conditions of appropriate legal defenses by mental health experts and lawyers. Denial of pregnancy as a source of potential stress has attracted little interest in psychiatric literature although solid research exists which documented that it is not infrequent. Arguments are presented to introduce this condition as a diagnostic category of female reproductive psychiatry with a more neutral label: “unperceived pregnancy.”     

Vitamin B12 deficiency presenting as an acute confusional state: a case report and review of literature

Background

Vitamin B12 deficiency is associated with a wide spectrum of neuro-psychiatric manifestations.

Results

We report a case of a 44 year old female patient referred to the haematology unit with vitamin B12 deficiency presenting as an acute confusional state or delirium. Total resolution of the psychiatric symptoms occurred following parenteral vitamin B12 replacement therapy.

Conclusion

This case report highlights one of the neuro-psychiatric presentations of vitamin B12 deficiency in a previously healthy individual.     

Hyperactivity as dysfunction of activity, arousal, or attention: a study of research relating to DSM III's Attention Deficit Disorder

Examined the recent shift in emphasis from overactivity to the related constructs of arousal, attention and impulsivity in the study of "hyperactive" children. Studies are reviewed that have led to a reconceptualization of the hyperkinetic disorder that focuses on underlying physiological arousal and attentional components. The adequacy of DSM III diagnostic criteria for Attention Deficit Disorder are considered in light of relevant research developments.     

Anaphylactic deaths in Auckland, New Zealand: a review of coronial autopsies from 1985 to 2005

AIMS: To determine the frequency of anaphylactic deaths amongst coronial autopsy cases performed in the greater Auckland region from 1985 to 2005, and review the circumstances of death and autopsy findings. METHODS: A computerised search for anaphylactic deaths was performed using the Forensic Pathology Department database at Auckland City Hospital. Postmortem reports and police reports were reviewed to determine the circumstances of death. Details recorded included basic demographic data, medical history, agent responsible for the allergic reaction, and pathologic findings at autopsy. RESULTS: A total of 18 cases of anaphylactic deaths were identified for the study period, including nine males and nine females, age range 33-76 years, mean 51.9 years. There were 10 reactions to drugs or contrast media (4 anaesthetic agents, 3 antibiotic, 2 IV contrast media, 1 streptokinase), four to bee/wasp venom, two to seafood, and two undetermined. Death occurred within 1 hour of onset of anaphylaxis in 12 cases. Findings at autopsy included non-specific pulmonary oedema and congestion (n = 13), laryngeal oedema (n = 5), cerebral hypoxia (n = 4) and cutaneous oedema (n = 1). Serum tryptase levels were measured in 15 cases, and were significantly elevated (>20 microg/L) in eight cases. CONCLUSION: Anaphylactic reaction is an uncommon cause of sudden death. In many cases, no specific macroscopic or microscopic findings were detected at autopsy. In the presence of a typical clinical history, postmortem measurement of serum tryptase levels can be a useful diagnostic aid.     

The neuropathology of Alzheimer's disease: a review with pathogenetic, aetiological and therapeutic considerations

The neuropathology of Alzheimer's disease is reviewed in this paper emphasizing the morphological and morphometric changes that occur in the disease and their relationship to age and ageing. From this, a new hypothesis of pathogenesis is presented which accounts for the pattern of neuronal damage in Alzheimer's disease. This is that the pathogenesis of Alzheimer's disease begins with a leakage of a neurotoxin through a defective cortical blood brain barrier. This incites development of the senile plaque and later, via a retrograde transport of the same (or different) factors, intracellular neurofibrillary tangle formation and death of neurones within areas of cortex affected by plaques and in subcortical areas such as nucleus basalis of Meynert, locus caeruleus and dorsal raphe nuclei, all of which project to these same areas of cortex. Evidence consistent with this hypothesis is presented and the aetiological and therapeutic implications are discussed.     

Intravoxel incoherent motion MRI as a means to measure in vivo perfusion: A review of the evidence

The idea that in vivo intravoxel incoherent motion magnetic resonance signal is influenced by blood motion in the microvasculature is exciting, because it suggests that local and quantitative perfusion information can be obtained in a simple and elegant way from a few diffusion‐weighted images, without contrast injection. When the method was proposed in the late 1980s some doubts appeared as to its feasibility, and, probably because the signal to noise and image quality at the time was not sufficient, no obvious experimental evidence could be produced to alleviate them. Helped by the tremendous improvements seen in the last three decades in MR hardware, pulse design, and post‐processing capabilities, an increasing number of encouraging reports on the value of intravoxel incoherent motion perfusion imaging have emerged. The aim of this article is to review the current published evidence on the feasibility of in vivo perfusion imaging with intravoxel incoherent motion MRI.     

Major ingredients of fidelity: a review and scientific guide to improving quality of intervention research implementation

Despite the critical role of fidelity and the proliferation of intervention manuals and related measures, no comprehensive, structured guide exists, resulting in definitional confusion, varying interpretations of what constitutes core components, and inconsistent application of methods to ensure fidelity. To improve integration of fidelity criteria into intervention research, this review paper focuses on three aims: 1) to identify, define, and operationalize the key ingredients and components of intervention fidelity; 2) to identify consistency and uniformity in terms of core characteristics of fidelity; and, 3) to provide a comprehensive fidelity tool that assesses the core ingredients of fidelity that can be used by researchers to measure the degree of fidelity. Twenty-four (n = 24) meta-analyses and review articles focusing on fidelity were identified in a systematic literature search over the past 30 years. A comprehensive review and fidelity guide outlining four required components of intervention research (design, training, monitoring of intervention delivery, and intervention receipt) was developed, with special consideration given to threats and measurement. Fidelity is imperative in all stages and phases of intervention research. This review and guide can be used by practitioners and researchers in their scientific process of designing and implementing community-based psychological, social, and behavioral intervention research.     

Depression and coronary heart disease: a review of the epidemiological evidence, explanatory mechanisms and management approaches

There is compelling evidence that depression is an independent risk factor for both the development of Coronary Heart Disease (CHD) and for worsening prognosis once CHD is established. Given the increasing awareness of the high prevalence of co-morbid depression in individuals with CHD, clinical psychologists are likely to become increasingly involved in the care of cardiac patients. It is imperative therefore, that they are aware of the complex relationship between depression and CHD and are familiar with the pharmacological and psychological interventions most likely to be effective in these patients. The following review explores the epidemiological evidence for the relationship between depression and CHD, examines the biological, behavioral and social mechanisms that may account for this relationship, and considers the findings of the psychological and pharmacological intervention trials seeking to improve outcomes for depressed cardiac patients. Collaboration across a range of disciplines is needed to establish a program of research and professional education and to develop clinical practice guidelines and pathways which support the implementation of best practice in the assessment and management of co-morbid depression in people with and at risk of CHD. Clinical psychologists are well-equipped to take a lead in this important endeavor.     

Unresolved states of mind,anomalous parental behavior,and disorganized attachment: A review and meta-analysis of a transmission gap

Abstract

The current meta-analysis examines the links between unresolved representations of attachment, anomalous parental behavior, and disorganized attachment relationships in 12 studies including 851 families. We found moderate effect sizes for the associations between unresolved states of mind and anomalous behavior (r = .26), unresolved states of mind and infant disorganized attachment relationships (r = .21), and anomalous behavior and disorganized attachment relationships (r = .34). Sample characteristics, observational context, and observational measure were not associated with differences in effect sizes. Only a small part of the association between unresolved states of mind and disorganized attachment relationships was explained by the mediation of anomalous parental behavior (.26? .34 = .09). Other factors yet to be uncovered must mediate the influence of unresolved states of mind on infant disorganized attachment; thus, further exploration of infant, parental, ecological, and genetic factors are warranted.     

Leaders and followers in adolescent close friendships: susceptibility to peer influence as a predictor of risky behavior, friendship instability, and depression

Adolescents' susceptibility to peer influence was examined as a marker of difficulties in the general process of autonomy development that was likely to be related to deficits across multiple domains of psychosocial functioning. A laboratory-based assessment of susceptibility to peer influence in interactions with a close friend was developed and examined in relation to corollary reports obtained from adolescents, their mothers, and close peers at ages 13 and 14. As hypothesized, observed susceptibility to peer influence with a close friend predicted future responses to negative peer pressure, but it was also related to broader markers of problems in functioning, including decreases in popularity, and increasing levels of depressive symptoms, over time. Susceptibility to peer influence was also linked to higher concurrent levels of substance use, externalizing behavior, and sexual activity. Results are interpreted as reflecting the central role of establishing autonomy with peers in psychosocial development.     

Impact of clinical information-retrieval technology on physicians: a literature review of quantitative, qualitative and mixed methods studies

PURPOSE: This paper appraises empirical studies examining the impact of clinical information-retrieval technology on physicians and medical students. METHODS: The world literature was reviewed up to February 2004. Two reviewers independently identified studies by scrutinising 3368 and 3249 references from bibliographic databases. Additional studies were retrieved by hand searches, and by searching ISI Web of Science for citations of articles. Six hundred and five paper-based articles were assessed for relevance. Of those, 40 (6.6%) were independently appraised by two reviewers for relevance and methodological quality. These articles were quantitative, qualitative or of mixed methods, and 26 (4.3%) were retained for further analysis. For each retained article, two teams used content analysis to review extracted textual material (quantitative results and qualitative findings). RESULTS: Observational studies suggest that nearly one-third of searches using information-retrieval technology may have a positive impact on physicians. Two experimental and three laboratory studies do not reach consensus in support of a greater impact of this technology compared with other sources of information, notably printed educational material. Clinical information-retrieval technology may affect physicians, and further research is needed to examine its impact in everyday practice.     

Insomnia related to postmenopausal syndrome and hormone replacement therapy: sleep laboratory studies on baseline differences between patients and controls and double-blind,placebo-controlled investigations on the effects of a novel estrogen-progestogen combination (Climodien,Lafamme) versus estrogen alone

Differences in sleep and awakening quality between 51 insomniac postmenopausal syndrome patients and normal controls were evaluated. In a subsequent double-blind, placebo-controlled, comparative, randomized, three-arm trial (Climodien 2/3 = estradiol valerate 2 mg + the progestogen dienogest 3 mg = regimen A, estradiol valerate 2 mg = regimen EV, and placebo = regimen P), the effects of 2 months of hormone replacement therapy were investigated, followed by a 2-month open-label phase in which all patients received Climodien 2/2 (EV 2 mg + dienogest 2 mg = regimen A*). Polysomnography at baseline demonstrated significantly deteriorated sleep initiation and maintenance, increased S1 and decreased S2 in patients. Subjective sleep and awakening quality, well-being, morning drive, wakefulness, memory and reaction time performance were deteriorated too. Treatment with both regimen A and regimen EV induced a moderate, although nonsignificant, improvement in the primary efficacy variable wakefulness during the total sleep period compared with baseline, while under placebo no changes occurred. Secondary efficacy variables concerning sleep initiation and maintenance, and sleep architecture showed similar findings. The apnea and apnea-hypopnea indices improved significantly under regimen A, compared with both baseline and placebo. Subjective sleep and awakening quality improved significantly after regimen A and EV compared with baseline, with the drug-induced changes being superior to those induced by placebo. In the open-label phase, subjective sleep quality improved further, significantly in the former regimen A group. Awakening quality, somatic complaints and morning thymopsyche did not yield any significant findings. Concerning morning noopsychic performance, memory improved significantly after regimen A compared with baseline, fine motor activity after regimen EV. Reaction time performance increased with all three compounds. In conclusion, Climodien significantly improved subjective sleep quality, the apnea and apnea-hypopnea indices of insomniac postmenopausal syndrome patients, while it only marginally improved variables concerning objective sleep and awakening quality.     

To know or not to know: a review of behaviour and suicidal ideation in preclinical Huntington's disease

OBJECTIVE: At present, the problems associated with suicidal ideation and suicide in Huntington's disease (HD), worldwide, are much the same as 2 decades ago. This study seeks to investigate the psychological complications of predictive testing in HD at risk populations. METHODS: The key problems of predictive testing, fear of acquiring carrier status, psychological consequences, autonomy, and rights to know are discussed. RESULTS: This review (1) describes psychological affect and problems of persons facing the decision to test for HD, (2) discusses suicidal ideation, behaviour, and catastrophic events associated with predictive testing, (3) assesses ethical questions raised in the genetic counselling, (4) questions whether counsellors should promote or advocate predictive testing, and finally (5) discusses what professionalism actually is in genetic counselling. CONCLUSION: The need for professional counselling, using a well designed protocol, and the importance of focusing on the suicide risk of participants in predictive testing programs are emphasized. PRACTICE IMPLICATIONS: The counsellor has an obligation to provide adequate information. The professionals should not promote nor advocate presymptomatic DNA-testing. Depression, hopelessness, anxiety, emotional distress, suicidal tendencies, and social dysfunction grading should be considered in predictive testing of HD.     

A startling absence of emotion effects: Active attention to the startle probe as a motor task cue appears to eliminate modulation of the startle reflex by valence and arousal

Research has shown that during emotional imagery, valence and arousal each modulate the startle reflex. Here, two imagery-startle experiments required participants to attend to the startle probe as a simple reaction time cue. In Experiment 1, four emotional conditions differing in valence and arousal were examined. Experiment 2, to accentuate potential valence effects, included two negative high arousal, a positive high arousal and a negative low arousal condition. Imagery effectively manipulated emotional valence and arousal, as indicated by heart rate and subjective ratings. Compared to baseline, imagery facilitated startle responses. However, valence and arousal failed to significantly affect startle magnitude in both experiments and startle latency in Experiment 1. Results suggest that emotional startle modulation is eclipsed when the probe is significant for task completion and/or cues a motor response. Findings suggest that an active, rather than defensive, response set may interfere with affective startle modulation, warranting further investigation.     

Cerebrovascular MRI: a review of state‐of‐the‐art approaches,methods and techniques

Cerebrovascular imaging is of great interest in the understanding of neurological disease. MRI is a non‐invasive technology that can visualize and provide information on: (i) the structure of major blood vessels; (ii) the blood flow velocity in these vessels; and (iii) the microcirculation, including the assessment of brain perfusion. Although other medical imaging modalities can also interrogate the cerebrovascular system, MR provides a comprehensive assessment, as it can acquire many different structural and functional image contrasts whilst maintaining a high level of patient comfort and acceptance. The extent of examination is limited only by the practicalities of patient tolerance or clinical scheduling limitations. Currently, MRI methods can provide a range of metrics related to the cerebral vasculature, including: (i) major vessel anatomy via time‐of‐flight and contrast‐enhanced imaging; (ii) blood flow velocity via phase contrast imaging; (iii) major vessel anatomy and tissue perfusion via arterial spin labeling and dynamic bolus passage approaches; and (iv) venography via susceptibility‐based imaging. When designing an MRI protocol for patients with suspected cerebral vascular abnormalities, it is appropriate to have a complete understanding of when to use each of the available techniques in the ‘MR angiography toolkit’. In this review article, we: (i) overview the relevant anatomy, common pathologies and alternative imaging modalities; (ii) describe the physical principles and implementations of the above listed methods; (iii) provide guidance on the selection of acquisition parameters; and (iv) describe the existing and potential applications of MRI to the cerebral vasculature and diseases. The focus of this review is on obtaining an understanding through the application of advanced MRI methodology of both normal and abnormal blood flow in the cerebrovascular arteries, capillaries and veins. Copyright © 2015 John Wiley & Sons, Ltd.     

Idiothetic input into object-place configuration as the contribution to memory of the monkey and human hippocampus: a review

Memory for object-place configurations appears to be a common function of the hippocampus in the human and monkey brain. The nature of the spatial information which enters into these object-configural memories in the primate, and the location of the memories themselves, have remained obscure, however. In the rat, much evidence indicates that the hippocampus processes idiothetic spatial information, an estimate of the animal’s current environmental location derived from path integration. I propose that in primates the hippocampus provides idiothetic information about the environmental location of body parts, and that the main function of this information in the primate brain is to become configured with object-identity information provided by temporal lobe cortex outside the hippocampus.