Is brain lactate increased in Huntington's disease?

Impaired brain energy metabolism with increased regional brain lactate may play a role in the pathogenesis of Huntington's disease (HD). Magnetic resonance spectroscopy (MRS) has provided conflicting evidence, however, regarding metabolic changes. Our objective was to evaluate the potential contribution of CSF lactate to the changes observed with MRS in HD. We performed single voxel MRS at 3 T in 23 patients with HD and 28 age-matched control subjects using a method to segment voxels into grey matter, white matter, and CSF, and to extrapolate regional lactate content to a hypothetical voxel containing 100% brain in order to control for differences in CSF lactate. Lactate/creatine and lactate/N-acetyl aspartate (Lac/NAA) ratios were significantly increased in parieto-occipital (p<0.05) and cerebellar (p<0.01) voxels in HD patients. After extrapolating group Lac/NAA results to a theoretical voxel containing 100% brain, this ratio was greater in the HD group than the control group, suggesting possibly increased lactate in this predicted voxel, although the difference between groups did not reach statistical significance. These results suggest an increase in brain lactate content in manifest HD, in a regionally non-specific fashion, although the possibility of a CSF contribution to this increase cannot be ruled out. Regardless, this supports the possibility of impaired mitochondrial function resulting in abnormal brain energy metabolism in HD.     

Pediatric referrals to psychiatry: III. Is the psychiatrist's opinion heard?

At least one psychiatric diagnosis was made for 205 of 220 children whose psychiatric evaluation had been requested by the medical service. Only 78 of 242 psychiatric diagnoses given the 205 patients were reflected correctly in the medical discharge diagnoses. In addition, seven of fifteen patients considered to be "normal" by the consulting psychiatrist had a psychiatric or mixed medical-psychiatric diagnoses included in the discharge diagnoses. Psychophysiological disorders, psychoses and special symptom diagnoses were likely to be correctly reflected in the discharge diagnoses, while depression and adjustment reaction were not. Possible reasons why the psychiatrist's diagnostic opinion is not correctly reflected in the discharge diagnosis in over one-half of the referrals are discussed. Pediatricians may be reluctant to label their patients "neurotic" for life, or may consider the problem transient-that is, only a "passing phase". But these theories are discounted by the fact that seven patients considered to be emotionally normal when assessed by the psychiatrist were discharged with a psychiatric or mixed medical-psychiatric diagnosis.     

Is mental health economics important in geriatric psychiatry in developing countries?

BACKGROUND: limited healthcare budgets and a seamless demand for resources suggests that a formula for allocating resources is needed. Economic evaluation can assist in developing this formula. METHOD: mental health economic studies (cost minimisation, cost-effectiveness, cost-utility, cost-benefit and cost of illness analysis) in geriatric psychiatry from developed and developed countries were examined along with all mental health economic studies in developed countries. RESULTS: there were no health economic studies in geriatric psychiatry from developing countries against a background of many such studies in developed countries. There were a greater number of health economic studies in other areas of psychiatry in developing countries. Several reasons for the paucity of such studies, the feasibility of undertaking these studies and their significance are discussed. CONCLUSION: mental health economic studies in geriatric psychiatry in developing countries are feasible, realistic and may well have an important part to play in the allocation of resources. Also, data sets necessary for such studies are emerging from many developing countries.     

Is inclination to mental disease within a population group a “racial” factor?

Psychiatric Quarterly -     

Is global equivalent to multifocal? The whole and its parts in psychiatry and neurology]

According to an influential trend within contemporary neurology, psychiatry should abandon terms like "organic brain syndrome" or "dementia", which are regarded as out-dated. Such terms which imply the questionable possibility of global disturbances of the psychic apparatus, should be replaced by a classification based on detailed neuropsychological analysis. The response of psychiatry to this challenge is essentially lacking. An examination of the reasons leads us to the methodological contradiction between categorical and global models. We consider that we here are not confronted by a decision between mutually exclusive alternatives but that the two models necessarily complement each other. From this it follows that only a biperspectivistic view is adequate to the matter under consideration. This is equally requisite both for psychiatry and neurology, though an accentuation of the one or the other perspective may be expedient for each individual syndrome.     

Globalization of psychiatry – A barrier to mental health development

Abstract

The concept of globalization has been applied recently to ways in which mental health may be developed in low- and middle-income countries (LMICs), sometimes referred to as the ‘Third World’ or developing countries. This paper (1) describes the roots of psychiatry in western culture and its current domination by pharmacological therapies; (2) considers the history of mental health in LMICs, focusing on many being essentially non-western in cultural background with a tradition of using a plurality of systems of care and help for mental health problems, including religious and indigenous systems of medicine; and (3) concludes that in a post-colonial world, mental health development in LMICs should not be left to market forces, which are inevitably manipulated by the interests of multinational corporations mostly located in ex-colonizing countries, especially the pharmaceutical companies.     

What factors contribute to senior psychiatry residents' interest in geriatric psychiatry? a Delphi study.

OBJECTIVE: To generate hypotheses regarding factors that influence senior psychiatric residents, to consider treating geriatric patients in their future practices. METHOD: Using the Delphi technique, designed to generate ideas and consensus, we asked psychiatry residents at the University of Toronto who had completed, or were completing, their geriatric rotation about the factors they thought might influence residents in devoting some of their practice to geriatric patients. Residents then rated the degree of influence of these factors which had been synthesized into a questionnaire. RESULTS: Twenty-six items were rated according to their degree of influence. The most influential item was positive clinical experiences with seniors. This was followed closely by supervisor characteristics such as enthusiasm, role modeling, competence, and mentoring. Interest in and comfort with the medical psychiatric and neuropsychiatric nature of the field were also felt to be influential. CONCLUSIONS: The factors that influence senior psychiatry resident interest in the practice of geriatric psychiatry are primarily educational and result from exposure to the field under optimal educational circumstances (positive clinical experiences and excellent supervisors). The medical and neuropsychiatric nature of the field also likely exerts a unique influence and should be considered in stimulating interest in this population.     

Is a computational model useful to understand the effect of deep brain stimulation in Parkinson's disease?

A growing number of computational models have been proposed over the last few years to help explain the therapeutic effect of deep brain stimulation (DBS) on motor disorders in Parkinson's disease (PD). However, none of these has been able to explain in a convincing manner the physiological mechanisms underlying DBS. Can these models really contribute to improving our understanding? The model by Rubin and Terman [31] represents one of the most comprehensive and biologically plausible models of DBS published recently. We examined the validity of the model, replicated its simulations and tested its robustness. While our simulations partially reproduced the results presented by Rubin and Terman [31], several issues were raised including the high complexity of the model in its non simplified form, the lack of robustness of the model with respect to small perturbations, the nonrealistic representation of the thalamus and the absence of time delays. Computational models are indeed necessary, but they may not be sufficient in their current forms to explain the effect of chronic electrical stimulation on the activity of the basal ganglia (BG) network in PD.