Narcolepsy and psychopathology: is there an association?

BACKGROUND: It is widely believed that patients with narcolepsy show high rates of associated psychiatric disturbance, especially schizophrenia and depression. However, surveys have produced conflicting findings and have not addressed the potential confounding effects of stimulant drug treatment. METHOD: Forty-five patients with narcolepsy attending a sleep disorder clinic and 50 matched normal controls underwent structured psychiatric interview. Using a 'lifetime' approach, psychiatric symptoms and diagnoses were established for both groups. RESULTS: Four of the narcolepsy patients but none of the controls had experienced psychotic symptoms. All four patients were taking amphetamines, and the symptoms resolved when the dose was lowered or treatment was changed to modafinil. The lifetime frequency of various depressive syndromes did not differ significantly between the groups. CONCLUSIONS: Contrary to previous claims this study found little to suggest that narcolepsy is associated with schizophrenia. Nor, despite its serious social and occupational consequences, does narcolepsy appear to be associated with an increased frequency of diagnosable depressive disorders.     

Diabetic polyneuropathy,deep white matter lesions,and carotid atherosclerosis: is there any association?

The morphologic and functional damages of diabetes mellitus (DM) on microcirculation can play a role in the pathogenesis of both polyneuropathy and cerebral white matter lesions. The aim of this study is to investigate the relation between polyneuropathy and cerebral deep white matter lesions (DWMLs) and carotid atherosclerosis in patients with type 2 DM. Sixty-six patients with type 2 DM without any disorder that may cause polyneuropathy, and vascular risk factors except for DM and hyperlipidemia were included in the study. DWMLs and carotid atherosclerosis were investigated in patients with and without polyneuropathy. Forty patients (60.6%) had diabetic sensorimotor polyneuropathy. DWMLs were more frequent in patients with polyneuropathy compared to patients without polyneuropathy (p = 0.003). Logistic regression analysis confirmed association between polyneuropathy and DWMLs after adjusted for age (p = 0.013), duration of DM (p = 0.007), and both age and duration of DM (p = 0.016). No statistically significant difference was found between patients with and without polyneuropathy for carotid atherosclerosis. Among patients with polyneuropathy, those having DWMLs had higher mean age (p = 0.003) and longer symptom duration (p = 0.020) compared to patients without DWMLs. No association was found between DWMLs and carotid atherosclerosis. Polyneuropathy and cerebral DWMLs in type 2 DM patients may share common pathogenesis; presence and duration of polyneuropathy symptoms may predict ischemic white matter damage independent of carotid atherosclerosis.     

Evaluation of cerebral vasomotor reactivity in Parkinson's disease: is there any association with orthostatic hypotension?

Objective

Our aim was to look for a probable relationship between cerebral vasomotor reactivity (VMR) and orthostatic hypotension (OH) in Parkinson's disease (PD).

Materials and methods

This study was conducted on 44 patients with PD. Assessment of cerebral VMR was performed by means of transcranial Doppler (TCD) of middle cerebral artery (MCA) before and after a vasodilatory stimulus, carbon dioxide test. Moreover, orthostatic hypotension was evaluated.

Results

OH was presented in 12 (27.3%) Parkinson's patients. The average resting blood flow velocity (BFV) in the MCA was 30.20 (SD = 9.58) cm s⁻¹ which significantly increased to 46.25 (SD = 16.23) cm s⁻¹ after carbon dioxide test (P < 0.001). Impaired VMR was observed in 15 (34.1%) of the subjects, while it was not associated with the presence of OH (P = 0.770).

Conclusion

Evaluation of VMR in patients affected by PD, could assist in early diagnosis of cerebral autonomic dysfunction and prevent its serious consequences prior and more valid to OH.     

The problem of psychogenic symptoms: is the psychiatric community in denial?

Psychogenic symptoms are common and pose an uncomfortable challenge. Among psychogenic symptoms, psychogenic nonepileptic seizures (PNES) are common and have been extensively studied. They are unique in that, unlike most other psychogenic symptoms, they can be diagnosed with near certainty. PNES can be used as a model, as almost everything that applies to PNES applies to other psychogenic symptoms. According to DSM-IV, somatic symptoms are the main manifestation of three groups of disorders: somatoform disorders, factitious disorder, and malingering. Treatment is challenging. Unfortunately, psychogenic symptoms tend to be neglected. For example, the American Psychiatric Association has abundant written patient education material available on diverse topics, but none on somatoform disorders. Psychogenic symptoms are also not the subject of much clinical research. A search of the journal Neurology for 1994-2003 for the word psychogenic in the title found 21 articles, only 4 of which on topics other than psychogenic seizures. A similar search for original articles in the New England Journal of Medicine found no articles with psychogenic in the title and two with psychogenic in the abstract. Thus, there seems to be a severe disconnect between the frequency of the problem and the amount of attention devoted to it.     

Comorbidity patterns in routine psychiatric practice: is there evidence of underdetection and underdiagnosis?

OBJECTIVE: The purpose of this study is to present data on the rates of diagnosis and patterns of Axis I comorbidity treated by psychiatrists in routine psychiatric practice, ascertained by practicing psychiatrists, and compare them with those ascertained through structured interview in a national sample of individuals treated in the specialty mental health sector for evidence of underdetection or underdiagnosis of comorbid disorders in routine psychiatric practice. METHODS: Data on 2117 psychiatric patients gathered by 754 psychiatrists participating in the 1997 and 1999 American Psychiatric Institute for Research and Education's Practice Research Network's Study of Psychiatric Patients and Treatments (SPPT) were analyzed, assessing psychiatrist-reported rates of Axis I disorders and comorbidities. SPPT data on patients treated by psychiatrists were compared with a clinical subset of patients in the National Comorbidity Survey who had been treated in the specialty mental health sector (SMA). RESULTS: Rates of comorbidity were higher in the SMA (53.9%) than in the SPPT (31.5%). The prevalence of schizophrenia diagnoses was more than twice as prevalent in the SPPT as in the SMA sample; anxiety disorders were 2 to 22 times more prevalent in the SMA sample. In the SPPT, 4 of the 10 most prevalent comorbid pairs included schizophrenia or bipolar disorder; only one pair in the SMA sample included either diagnoses. Of the 10 most prevalent comorbidity pairings in the SMA sample, 6 included a phobia diagnosis. CONCLUSIONS: Results of these analyses suggest greater differences in the patterns and rates of comorbidities than one might expect between these 2 samples. Possible reasons for these disparities, including methodological differences in diagnostic ascertainment and underdiagnosis of anxiety disorders, are discussed.     

Schizophrenia and oestrogens — is there an association?

Summary Some early psychiatrists already believed that schizophrenic disorders were associated with a disturbed balance of sexual hormones. This belief was based on the observation of a. an insufficient functioning of the sexual glands with so-called hypoestrogenism, and b. an influence of ovarian function on schizophrenic psychoses. As this review shows, there are findings from recent research which seem to confirm that estrogens may have a protective effect in schizophrenia. There are also occasional hints at a possible hypoestrogenism in schizophrenia. In our own epidemiological, clinical and animal studies the hypothesis of a protective effect of oestrogens was for the first time systematically examined and confirmed. Oestrogens seem to modulate the sensitivity of D2-receptors in the brain, and clinically they seem to have a neuroleptic-like effect. These findings may have important implications for the prevention and therapy of schizophrenic disorders. Furthermore, our findings indicate the need to reinvestigate the question of a disturbed balance of sexual hormones in schizophrenic disorders. Further research on the role of oestrogens in schizophrenic disorders could in our opinion contribute to understanding the still unclear, possibly aetiologically heterogeneous pathogenetic mechanism of schizophrenic psychoses.     

Vascular dementia and Alzheimer's disease: is there a difference? A comparison of symptoms by disease duration

This study examined differences between vascular dementia (VaD) by the NINDS/AIRENS criteria and Alzheimer's disease (AD) on clinical grounds. A consecutive series of 517 patients with probable and possible VaD or AD were evaluated for cognitive, functional, and behavioral symptoms and separated into three subgroups by duration of dementia. These AD and VaD subgroups were then compared on a series of standardized clinical measures. The only consistent trends were for VaD patients to be more depressed, more functionally impaired, and less cognitively impaired within each disease duration subgroup. The authors conclude that there are few differences between clinically diagnosed VaD and AD. Subclassification of VaD into subgroups will improve the clinical utility of this nosologic entity.     

Ganser symptoms in a case of frontal-temporal lobe dementia: is there a common neural substrate?

Neuropsychological testing was completed in a patient who showed cognitive decline of mental functions, unusual answers to questions, and other characteristics of what has typically been described in the literature as the "Ganser Syndrome." Clear evidence of malingering on a memory test seemed to confirm that this patient was exaggerating deficits for psychiatric reasons or secondary gain, yet the patient showed evidence of mild organic impairment on MRI and continued to deteriorate in cognitive functions and basic self-care. Although an initial SPECT scan had suggested a pattern inconsistent with dementia, a second scan showed frontal-temporal perfusion deficits. Based on this scan and the clinical picture of progressive deterioration, a diagnosis of frontal-temporal lobe dementia was made. This case illustrates that the seemingly deliberate selection of incorrect responses may occur in the early stages of an organic dementia, and that a diagnosis of frontal-temporal lobe dementia should be considered in cases where symptoms appear to be psychiatric or nonorganic. The case further raises the question of whether the reported symptoms of Ganser Syndrome may be accounted for by frontal-temporal lobe dysfunction, since there appears to be some overlap between symptoms of Ganser Syndrome and frontal-temporal lobe dementia. It is also important to note that many reported cases of Ganser Syndrome had a history of head injury.     

Left- and right-handed children's drawing performance: is there any difference?

The aim of the present study was to investigate the effect of hand preference on children's drawing development. An equal number of left- and right-handed children (N = 182), aged 7 to 12 years were asked to complete four different drawing tasks. During the drawing process, directionality of horizontal, vertical, and circular strokes as well as sequencing was recorded. Each drawing was scored according to the developmental stage to which is corresponded. It was found that drawing performance improved with age, irrespectively of hand preference and sex. In other words, left- and right-handers' drawing performance across the four tasks was not found to differ significantly. The only consistent difference between the two groups involved was in the production of horizontal lines. The results are discussed in terms of implications for questions about the lack of differences in left- and right-handed children's drawing performance.     

Juvenile myoclonic epilepsy: A benign disorder? Personality traits and psychiatric symptoms

OBJECTIVE: Since the clinical observations published by Janz in 1957, the presence of personality irregularities in patients with juvenile myoclonic epilepsy (JME) has been described repeatedly, but never quantified using standardized assessments. The aim of the present study was to investigate whether juveniles with a short history of JME exhibit psychopathological symptoms and/or personality irregularities. METHOD: We used standardized assessments, the Youth Self Report (YSR) and the Weinberger Adjustment Inventory (WAI). RESULTS: Of 38 patients who fulfilled the study entry criteria, 25 agreed to participate and completed all surveys. On the YSR, our sample exhibited twice the amount of psychiatric symptoms than age-matched norms. Furthermore, psychopathological symptoms increased with duration of JME. According to WAI results, JME significantly affected self-restraint: patients with longer disease duration showed less self-control. CONCLUSION: Adolescents with JME present not only with neurological abnormalities but also with significant psychopathology and personality irregularities. Our data suggest that psychological and behavioral changes are dynamic processes dependent on the progression of the disease.     

A case of late-onset methylmalonic acidemia complicated with recurrent psychiatric symptoms and hyperhomocysteinemia北大核心CSCD

[No abstract available]