Dynamic Evolution of Catatonia in the Context of Cerebral Venous Sinus Thrombosis.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.Prim Care Companion CNS Disord 2023;25(4):22f03471. Author affiliations are listed at the end of this article.

Collaborative Care Model Education Opportunities for Psychiatry Trainees: A Narrative Review.

Importance: The Collaborative Care Model (CoCM) is an evidence-based methodology meant to improve access to mental health care, especially in primary care settings. While evidence about the efficacy of CoCM is abundant, literature regarding how CoCM is taught to psychiatry trainees appears to be more limited. As psychiatrists play a key role within the CoCM framework, psychiatry trainee exposure to CoCM skills and concepts is imperative for growth of these services. As psychiatry trainees may one day practice CoCM, we aimed to examine available literature about educational opportunities in CoCM for psychiatry trainees.Observations: While literature was indeed sparse, we identified that CoCM is taught to psychiatry trainees in the form of clinical rotations, didactics, and leadership experiences. Future opportunities are abundant to increase educational opportunities in CoCM for psychiatry trainees.Conclusions and Relevance: Potential future studies should make use of innovative technologies (such as telehealth), should be process-oriented, and should focus more on team dynamics and opportunities for further collaboration with primary care practices within the CoCM framework.

"Neural differences in expert guitarists during over-learned non-standard visuomotor mapping of abstract versus concrete information".

Using visual information to perform actions is a fundamental aspect of human behavior. Musicians commonly translate visual information into action using both concrete and abstract visual information. We exposed expert guitarists to four types of familiar visual depictions of action instruction including musical notation (very abstract), tablature (abstract), chord diagrams (more concrete), and actual pictures of guitars chords being formed (very concrete). These were shown during fMRI scanning as the guitarists formed the appropriate chords (as visually depicted) on a magnet safe guitar fret board with strings, or where they simply viewed the visual stimuli without an action. Whole brain contrasts revealed that the right precuneus was more active for abstract instruction while an occipito-insular circuit was more active for concrete instruction. The current findings highlight that the degree of over-learned visual abstraction is an important factor modulating visual-motor processing.

Cognitive mediated eye movements during the SDMT reveal the challenges with processing speed faced by people with MS.

BACKGROUND: The Symbol Digit Modalities Test (SDMT) is regarded as the cognitive test of choice for people with MS (pwMS). While deficits are linked to impaired processing speed, the mechanisms by which they arise are unclear. Cognitive-mediated eye movements offer one putative explanation. The objective of this study was to determine the association between eye movements and performance on the SDMT. METHODS: Thirty-three people with confirmed MS and 25 matched healthy control subjects (HC) were administered the oral SDMT while eye movements were recorded. RESULTS: Mean SDMT scores were significantly lower in pwMS (p < 0.038). Shorter mean saccade distance in the key area (p = 0.007), more visits to the key area per response (p = 0.014), and more total number of fixations in the test area (p = 0.045) differentiated pwMS from HCs. A hierarchical regression analysis revealed that the number of visits to the key area per response (p < 0.001; ΔR2 = 0.549) and total number of fixations in the test area (p < 0.001; ΔR2 = 0.782) were the most robust predictors of SDMT scores. CONCLUSION: Cognitive-mediated eye movements help elucidate the processing speed challenges confronted by people with MS. Mechanistic insights such as these can potentially help inform new cognitive rehabilitation strategies.

Journalists covering the refugee and migration crisis are affected by moral injury not PTSD.

OBJECTIVE: To explore the emotional health of journalists covering the migrations of refugees across Europe. DESIGN: Descriptive. A secure website was established and participants were given their unique identifying number and password to access the site. SETTING: Newsrooms and in the field. PARTICIPANTS: Responses were received from 80 (70.2%) of 114 journalists from nine news organisations. MAIN OUTCOME MEASURES: Symptoms of PTSD (Impact of Events Scale-revised), depression (Beck Depression Inventory-Revised) and moral injury (Moral Injury Events Scale-revised). RESULTS: Symptoms of PTSD were not prominent, but those pertaining to moral injury and guilt were. Moral injury was associated with being a parent (p = .031), working alone (p = .02), a recent increase in workload (p = .017), a belief that organisational support is lacking (p = .046) and poor control over resources needed to report the story (p = .027). A significant association was found between guilt and moral injury (p = .01) with guilt more likely to occur in journalists who reported covering the migrant story close to home (p = .011) and who divulged stepping outside their role as a journalist to assist migrants (p = .014). Effect sizes (d) ranged from .47 to .71. CONCLUSIONS: On one level, the relatively low scores on conventional psychometric measures of PTSD and depression are reassuring. However, our data confirm that moral injury is a different construct from DSM-defined trauma response syndromes, one that potentially comes with its own set of long-term maladaptive behaviours and adjustment problems.

Multiple sclerosis and suicide.

Mortality rates are elevated in people with multiple sclerosis (MS) relative to the general population. There is, however, some uncertainty whether suicide contributes to this. Epidemiological data suggest that the standardized mortality ratio (SMR) for suicide in MS is approximately twice that of the general population with younger males in the first few years following diagnosis most at risk. Rates of suicidal intent, a potential harbinger of more self-destructive behavior, are also elevated, but the frequency with which intent is followed by suicide is not known. Depression, severity of depression, social isolation, and alcohol abuse are associated with thoughts of suicide. The variables linked with suicide and suicidal intent are therefore well defined and should be readily available from routine clinical inquiry. While vigilance on the part of clinicians is required, particularly in the context of high-risk patients, it is also recognized that prevention is dependent on full disclosure of intent.

The psychological wellbeing of Iranian journalists: a descriptive study.

OBJECTIVE: Iran ranks 173 out of 180 countries on an index of press freedom. The purpose of the study was to assess the psychological wellbeing of Iranian journalists and document the stressors encountered in their work. DESIGN: A secure website was established and participants were given their unique identifying number and password to access the site. SETTING: Newsrooms in Iran and the diaspora. PARTICIPANTS: Responses were received from 114 journalists (76%) of whom 65.8% were living in the diaspora. The mean age was 37.8 years (SD = 7.30) and 57% male. MAIN OUTCOMES MEASURES: Type of stressor and behavioural data: Impact of Event Scale-revised for posttraumatic stress disorder, Beck Depression Inventory-II for depression. RESULTS: Stressors include arrest (41.2%), torture (19.3%), assault (10.5%), intimidation (51.4%) and family threatened (43.1%). Eighty nine (78.1%) journalists had stopped working on a story because of intimidation. Arrest, torture, intimidation and family threatened were associated with more intrusive and arousal PTSD symptoms (p < .01 to .001) and assault and intimidation with more depressive symptoms (p < .05). Almost a third of Iranian journalists regularly used barbiturates, with use correlating with symptoms of intrusion (p < .0001), avoidance (p < .01), arousal (p < .0001) and depression (p < .0001). 46.5% of Iranian journalists were not receiving therapy for their distress. CONCLUSIONS: The findings, the first of their kind, provide data highlighting the extraordinary degree of danger confronted by Iranian journalists, their emotional distress in response to this and their proclivity to self-medicate with barbiturates.

Attitudes to cannabis and patterns of use among Canadians with multiple sclerosis.

BACKGROUND: Canada has the highest incidence of MS worldwide. Anecdotal evidence reveals that people with MS smoke, ingest or vaporize cannabis for a multiplicity of reasons. With the legal situation in relation to use currently in flux, we undertook a study investigating patterns of use amongst people with MS and their attitudes towards the drug. METHODS: A consecutive sample of people with MS (n=246) attending a neurology (n=118) and a neuropsychiatry (n=107) clinic was enrolled and asked to complete a questionnaire containing demographic, disease and cannabis related variables. RESULTS: Of the 246 people approached, 225 (91.8%) agreed to participant. Attitude towards cannabis revealed that 122 (54.3%) participants approved of the drug while 75 (33.2%) were neutral. Legalization was endorsed by 98 (43.7%) participants, while 98 (43.7%) were in favour of legalization for medical use only. Current use was endorsed by 44 (19.5%) people with 125 (56.1%) reporting lifetime use. If cannabis were legal, 113 (50.2%) participants would use it. The most common symptoms for which cannabis was being used were: sleep (86%), pain (75%), anxiety (73%) and spasticity (68%). Participants attending the neuropsychiatry clinic were more likely to use cannabis for managing depression (χ2=4.99; p=0.03) and pain (χ2=3.85; p=0.05). CONCLUSION: There is a wide acceptance of cannabis within the MS patient community. One in five people currently use the drug for reasons that differ between neuropsychiatry and neurology clinics. Use could potentially more than double if the drug were legalized.

What to make of cannabis and cognition in MS: In search of clarity amidst the haze.

Given data showing that cannabis (herbal drug from the Cannabis sativa plant) can impair cognition in healthy subjects, the possibility that it may also do so in people with multiple sclerosis (MS) should be cause for concern. Approximately 20% of people with MS inhale or ingest cannabis for a variety of symptoms, or as a lifestyle choice. In addition, pharmaceutically manufactured cannabis (in capsules or spray) is prescribed most often for pain and spasticity; however, there is a dearth of literature on the cognitive effects of cannabis. Furthermore, methodological limitations introduce a cautionary note when interpreting the data. The evidence, which must therefore be considered preliminary, suggests that smoked cannabis may further compromise information processing speed and memory, with magnetic resonance imaging (fMRI) demonstrating more inefficient patterns of cerebral activation during task performance. The findings related to pharmaceutically manufactured cannabis are equivocal. There is a pressing need for further research to inform clinical opinion, which at present reflects a combination of uncertainty and dogma.

Multiple sclerosis, cannabis, and cognition: A structural MRI study.

OBJECTIVE: A subset of patients with multiple sclerosis (MS) smoke cannabis to relieve symptoms including spasticity and pain. Recent evidence suggests that smoking cannabis further impairs cognition in people with MS and is linked to impaired functional brain changes. No such association, however, has been reported between cannabis use and structural brain changes, hence the focus of the present study. METHODS: Twenty patients with MS who smoke cannabis for symptom relief, and 19 matched non-cannabis-smoking MS patients were given the Brief Repeatable Neuropsychological Battery and structural MRI scans. Images were segmented into gray matter and white matter, and subsequently analysed with Partial Least Squares, a data-driven multivariate technique that explores brain-behaviour associations. RESULTS: In both groups, the Partial Least Squares analysis yielded significant correlations between cognitive scores and both gray matter (33% variance, p < .0001) and white matter (17% variance, p < .05) volume. Gray matter volume in the thalamus, basal ganglia, medial temporal, and medial prefrontal regions, and white matter volume in the fornix correlated with cognitive deficits. Crucially, the analysis indicated that brain volume reductions were associated with more extensive cognitive impairment in the cannabis versus the non-cannabis MS group. INTERPRETATION: These results suggest that cannabis use in MS results in more widespread cognitive deficits, which correlate with tissue volume in subcortical, medial temporal, and prefrontal regions. These are the first findings demonstrating an association between cannabis use, cognitive impairment and structural brain changes in MS patients.

Cannabis-induced alterations in brain activation during a test of information processing speed in patients with MS.

OBJECTIVE: The objective of this article is to determine the functional brain correlates of information processing speed in multiple sclerosis (MS) patients who smoke cannabis and those who are drug naïve. METHODS: Two neurologically and demographically matched samples of MS patients were enrolled, those who smoked cannabis daily (n = 20) and those who were cannabis naïve (n = 19). All participants completed the Brief Repeatable Battery of Neuropsychological Tests and underwent fMRI testing during which they were administered a modified version of the Symbol Digit Modalities Test (mSDMT). RESULTS: The cannabis group responded slower in nine of 11 blocks of the mSDMT (p < 0.001), showing a trend toward a slower response time (p < 0.08), but did not differ in the accuracy of response (p < 0.18). Both groups displayed activation in a prefrontal cortex-parietal network associated with information processing speed. When compared to the cannabis-naïve group, cannabis users showed less activation in the right (p = 0.009) and left (p = 0.001) thalami and increased activation in the anterior cingulate (p = 0.006). CONCLUSION: Regular cannabis use in MS patients is associated with slower information processing speed and a pattern of cerebral activity that differs from cannabis-naïve individuals, most notably in a bilateral reduction of thalamic activity.

Effects of cannabis on cognition in patients with MS: a psychometric and MRI study.

OBJECTIVE: To determine functional and structural neuroimaging correlates of cognitive dysfunction associated with cannabis use in multiple sclerosis (MS). METHODS: In a cross-sectional study, 20 subjects with MS who smoked cannabis and 19 noncannabis users with MS, matched on demographic and neurologic variables, underwent fMRI while completing a test of working memory, the N-Back. Resting-state fMRI and structural MRI data (lesion and normal-appearing brain tissue volumes, diffusion tensor imaging metrics) were also collected. Neuropsychological data pertaining to verbal (Selective Reminding Test Revised) and visual (10/36 Spatial Recall Test) memory, information processing speed (Paced Auditory Serial Addition Test [2- and 3-second versions] and Symbol Digit Modalities Test), and attention (Word List Generation) were obtained. RESULTS: The cannabis group performed more poorly on the more demanding of the Paced Auditory Serial Addition Test tasks (i.e., 2-second version) (p < 0.02) and the 10/36 Spatial Recall Test (p < 0.03). Cannabis users had more diffuse cerebral activation across all N-Back trials and made more errors on the 2-Back task (p < 0.006), during which they displayed increased activation relative to nonusers in parietal (p < 0.007) and anterior cingulate (p < 0.001) regions implicated in working memory. No group differences in resting-state networks or structural MRI variables were found. CONCLUSIONS: Patients with MS who smoke cannabis are more cognitively impaired than nonusers. Cannabis further compromises cerebral compensatory mechanisms, already faulty in MS. These imaging data boost the construct validity of the neuropsychological findings and act as a cautionary note to cannabis users and prescribers.