Reduced automatic frontal response to auditory deviance in Huntington’s disease as indexed by magnetic mismatch negativity

Huntington’s disease (HD) is a neurodegenerative disorder accompanied by a degradation of dopaminergic receptors. It is evident that dopaminergic dysfunction leads to attention deterioration. However, little is known about the functional integrity of involuntary attention processing in patients with HD. The present study aimed to investigate whether patients with HD exhibit a deficit in automatic deviance detection that can be indexed by magnetic mismatch responses. Magnetoencephalographic responses during a passive oddball task were recorded to examine automatic neural activation to auditory deviants in patients with symptomatic HD and age and sex-matched healthy volunteers. The mean amplitude and peak latency of magnetic mismatch responses were calculated from the waveforms in each hemisphere. Furthermore, minimum current estimate (MCE) was applied to estimate the source strength of temporal and frontal mismatch responses. Compared with healthy participants, patients with HD exhibited a decreased waveform amplitude and a prolonged peak latency of magnetic mismatch responses in the left temporal lobe. The MCE analysis also revealed significantly lower activation of the bilateral frontal mismatch responses in patients. In conclusion, the frontal underactivation to occasional auditory deviance suggests a deficit of involuntary attention switching in HD.     

Botanicals as “new” drugs: US development

Botanicals are ingredients that can be marketed as foods, drugs, cosmetics, and medical devices in the United States. When a botanical is intended to diagnose, treat, prevent, mitigate, or cure a disease, it is considered to be a “drug”. This article reviews the US regulatory requirements for botanicals as “new” drugs. An overview of the regulatory principles used to determine product category and the basic elements of an Investigational New Drug application and New Drug Application with the US Food and Drug Administration are presented.This article is part of a Special Issue entitled “Botanicals for Epilepsy”.     

Human neuroimaging as a “Big Data” science

The maturation of in vivo neuroimaging has led to incredible quantities of digital information about the human brain. While much is made of the data deluge in science, neuroimaging represents the leading edge of this onslaught of “big data”. A range of neuroimaging databasing approaches has streamlined the transmission, storage, and dissemination of data from such brain imaging studies. Yet few, if any, common solutions exist to support the science of neuroimaging. In this article, we discuss how modern neuroimaging research represents a multifactorial and broad ranging data challenge, involving the growing size of the data being acquired; sociological and logistical sharing issues; infrastructural challenges for multi-site, multi-datatype archiving; and the means by which to explore and mine these data. As neuroimaging advances further, e.g. aging, genetics, and age-related disease, new vision is needed to manage and process this information while marshalling of these resources into novel results. Thus, “big data” can become “big” brain science.     

Hitler's “Table Talk” as Psychoanalytic Source Material

Treating traumatized patients famously takes its toll on the treating therapist. This process has most often been called “vicarious traumatization,” although other terms have been used. The author proposes a more interpersonal term, “countertrauma.” Although countertrauma is a common occupational hazard when working with trauma victims, it is rarely discussed in depth from a personal perspective. Drawing from the author's experiences working with sexually abused men over almost three decades, he tracks his emerging conflicts and reactions to his work. These constitute his own countertraumatic as well as counterresilient reactions to engaging intimately with patients’ trauma experiences.     

“Ego-Dystonic” Delusions as a Predictor of Dangerous Behavior

This paper aims to report a possible warning sign for dangerous behavior in delusional psychotic patients. We demonstrate an association between aggressive or auto-aggressive ideation and “ego-dystonic” grandiose delusions, where the patient believes to possess unique qualities but finds them unbearable. The study is based on the sample of seven interviews with five psychotic in-patients at the Kfar Shaul Mental Health Center, Jerusalem, Israel. All patients experienced an acute psychotic episode, and committed acts of aggression or suicidality. The research method is narrative analysis of semi-structured interviews. Patients report ideas of grandiose self-identification with deities, Biblical figures or celebrities, yet report their reluctance to be in these high positions due to feelings of unworthiness, withdrawal, and social isolation. Resulting frustration arguably leads to aggressive and suicidal ideation or actions. Contrary to the established view, grandiose delusions are not free of association with (auto-)aggression. The patient’s ego-dystonic attitude towards his/her delusional identity may serve as the warning sign for dangerous behavior and, as such, should be searched for and recognized by the mental health professionals.     

“Inoculation” as a Third Paradigm of Mental Health Promotion

Currently, two paradigms of mental health promotion are widely accepted; the ‘prevention’ and the “well-being” paradigms. This article discusses the position of the ‘Inoculation’ postulation in mental health promotion. Utilising Meichenbaum's stress inoculation training (SIT) model as an example of the paradigm, the limited reference to inoculation’ within mental health promotion literature is questioned and discussed. It is suggested that the inoculation paradigm is different from the ‘prevention’ and the “well-being” paradigms, both in its theoretical assumptions and its practical approach to mental health promotion; although various ‘prevention”’programs demonstrates that with little, and in some cases, no change such programs could be labelled as possessing an inoculation component. The paper argues for an analysis of the relevance of physical immunization assumptions for inoculation against mental health problems and after outlining a review of past and present trials in conducting physiological inoculation proposes that the inoculation paradigm requires serious and intensive consideration as a possible strategy for improved mental health promotion.     

What is “treatment as usual” for nonepileptic seizures?

ObjectiveA recent NINDS/NIMH/AES-sponsored international NES Treatment Workshop identified a lack of knowledge in the field regarding standard of care in the management of patients with psychological nonepileptic seizures (NES).MethodsWe administered a survey to AES clinicians to determine actual postdiagnostic instructions given to patients and referral practices, or NES treatment as usual.ResultsThe majority of respondents were epileptologists, followed by neurologists, neuropsychologists, and nurses, evenly dispersed across the United States. Almost all respondents reported discussing the diagnosis of NES with the patients. Sixty-nine percent of neurologists continued to follow the patient after NES diagnosis. Treatment referrals were most commonly made to psychiatrists and psychologists. Antiepileptic drugs were tapered by 83% of the respondents, and 47% prescribed psychotropic medications if comorbid diagnoses were made.ConclusionThis is the first known national survey that summarizes national practices and the range of care, or treatment as usual, offered to patients with NES.     

Do all Human Functions and Behaviors, as well as the “Self”, Have Cholinergic Correlates?

In the course of the five most recent International Symposia on Cholinergic Mechanisms (ISCMs) as well as at this XIII ISCM, the focus was mostly on matters microscopic and molecular, except for solitary excursions into memory and learning, addiction, and clinical and toxicological subjects. In fact, this is also true for many recent reviews and meetings concerned with the cholinergic transmission. Yet, macroscopic and overt phenomena that are of great importance have strong cholinergic correlates. To remedy this lacuna, macromolecular overt cholinergic brain-dependent activities will be reviewed such as reflex automatic phenomena, EEG functions, behaviors, and the sense of the “self” or “self-awareness”, particularly the difficulties associated with neuroscientific explanation of the “self,” and the many approaches to this dilemma will be discussed.     

Symmetric ganglionic hamartoma of hypothalamus appearing as four “mamillary” bodies

Summary On the basal surface of the brain of a 3-day-old newborn with left cardiac hypoplasia, there were four mamillary bodies: two spheric bodies just posterior to the infundibulum consisted of histologically well differentiated gray matter. These bodies were thought to be a ganglionic hamartoma of the tuber cinereum. A pair of mamillary bodies in its normal position was found to be histologically normal.     

A Book Review of “Consumers as Providers in Psychiatric Rehabilitation”

Abstract

edited by Carol Mowbray, David Moxley, Colleen Jasper and Lisa Howell International Association of Psychosocial Rehabilitation Services, Columbia, MD     

Dysautonomic polyneuropathy as a variant of chronic inflammatory “demyelinating” polyneuropathy?

This report describes the clinical course over almost one decade of a male patient presenting with immune-mediated pure autonomic neuropathy resembling a distinct variant of chronic dysimmune polyneuropathies. We suppose autoantibodies directed against epitopes on autonomic axons or neurons causative for the symptoms.     

“Should We Treat Vegetative and Minimally Conscious Patients as Persons?”

How should we treat patients diagnosed as being in a persistent vegetative state (PVS) or minimally conscious state (MCS)? More specifically, should we treat them as having the full moral status of persons? Yes, or so we argue. First, we introduce the medical conditions of PVS, MCS, and the related conditions of Locked-in Syndrome and covert awareness. Second, we characterize the main argument for thinking diagnosed PVS patients are not persons. Third, we contend that this argument is defeated by mounting empirical evidence for the considerable uncertainty of PVS diagnoses. Fourth, we characterize a new argument for PVS non-personhood suggested by Neil Levy and Julian Savulescu, one intended to accommodate the diagnostic uncertainty. According to this argument, even if diagnosed PVS patients are in fact MCS, it makes no difference because MCS patients are probably not persons either. Fifth, we challenge the new argument by assembling reasons for doubting the claim that MCS patients are not persons. The outcome is that it is fairly uncertain whether diagnosed PVS and MCS patients are persons or not. What should we do in light of this uncertainty (given its present intractability)? Sixth, we develop and support a guiding precautionary principle, which we call Precautionary Personhood. Finally, we apply the principle to the case of diagnosed PVS and MCS patients: we argue that given substantial uncertainty about their personhood we should go ahead and treat these patients as if they are persons.