Pseudobulbar Affect Mimicking Depression: A Case Report.

Pseudobulbar affect (PBA) is a neurological condition that is associated with short periods of involuntary, sudden, and inappropriate emotions such as crying or laughing, which are mood incongruent. An accurate estimate of the prevalence of PBA is hard to obtain due to varying diagnostic criteria and variable patient populations. The cause of PBA is not known, but current evidence suggests dual etiology. A neural circuit dysfunction and an abnormality of neurotransmitters that regulate motor expression of emotions. PBA can easily be mistaken for a depressive disorder due to the overlap of symptoms. Moreover, patients with PBA may have a major depressive disorder (MDD) or other depressive disorders. Therefore, it is essential to recognize and treat PBA as well as possible psychiatric comorbidities. We present a case report of a 59-year-old man with no past psychiatric history who presents with paroxysms of episodes of crying for the past one year. He endorsed feelings of hopelessness and poor concentration. MRI of the brain revealed bilateral basal ganglia and a thalamic infarct. The patient was treated with citalopram. This case describes a unique presentation of pseudobulbar affect mimicking depression.

Use of Bupropion in the Management of Negative Symptom Schizophrenia: A Case Series.

Antipsychotic treatment has been documented as the mainstay for the management of schizophrenia. Evidence in literature has suggested that the management of negative symptoms of schizophrenia continues to be a treatment challenge. Therefore, residual negative symptoms can become more pervasive and visible after the treatment of positive symptoms, leading to an impaired marked deficit in the vital daily functions of patients. We present a case series of three patients with a past psychiatric history of schizophrenia who presented to the psychiatric emergency with acute symptoms of schizophrenia. Following antipsychotic treatment, all these patients showed improvement of positive symptoms, however, profound negative symptoms of schizophrenia became visible. The negative symptoms include anhedonia, amotivation, alogia, affective flattening, and passive social withdrawal. We added bupropion to manage the negative symptoms, and all three patients achieved a good treatment response. This case series suggests that the anti-depressive effects of bupropion might be a valuable treatment option in the treatment of negative symptoms of schizophrenia.

Opioid-Induced Psychosis in a Patient With Sickle Cell Disease.

Sickle cell disease (SCD) is a common inherited hemoglobin disorder in which people have atypical hemoglobin, known as hemoglobin S. It is highly prevalent in non-Hispanic Blacks and people of Arab descent. It causes a distortion of the shape of red blood cells, leading to occlusion of blood vessels and thus tissue hypoxia and injury. The resultant infarction/reperfusion, in turn, causes fatigue and pain. Patients with SCD require constant analgesic medications for pain management. In the general population, opioids are amongst the most prescribed medications for pain management and the trend has been gradually growing during the past two decades. Side effects commonly associated with opioids are gastrointestinal and central nervous system-related, with up to 80% of patients experiencing at least one adverse effect. We report the case of a 36-year-old male patient who has a history of cannabis use and no prior psychiatric history, who developed acute psychosis while receiving a high dose of hydromorphone for sickle cell pain crisis. This case contributes to the growing literature about opioid-induced psychosis and also explores psychosis in sickle cell disease. Understanding the pharmacology and potential side effects of opioids is critical given the increasing number of patients using prescribed and illicit opioids.

COVID-19 Pandemic and Uptake in Suicide Attempt Among Young People of Minority Population: A Case Series.

The first case of coronavirus disease 2019 (COVID-19) was reported in Wuhan China on December 31, 2019. COVID-19 was declared a global pandemic on March 11, 2020. To reduce the spread of this virus, the World Health Organization (WHO) and the Center for Disease Control (CDC) recommended self and mandatory quarantine of exposed individuals and self-isolation. However, the psychological impact of this pandemic includes new onset or worsening of existing mental illnesses which include but are not limited to anxiety, depression from social isolation, eating disorders, and uptake in suicidality either in isolation or part of mental illness symptomatology. In the USA, suicide is the second leading cause of death among people aged 10 - 34 years while globally, it is the second cause of death among people aged 15 - 29 years. The authors present a case of two young women of minority population with no prior psychiatric illnesses who presented to the psychiatry emergency room with suicidal attempts due to COVID-19 pandemic-related psychosocial stressors.

The psychometric properties of the Self-Evaluation of Negative Symptoms Scale (SNS) in treatment-resistant schizophrenia (TRS).

BACKGROUND: Clinician-administered measures of negative symptoms may not capture patients' subjective experiences. The Self-Evaluation of Negative Symptoms (SNS) has shown good psychometric properties when used in outpatients with higher-level functioning schizophrenia. We aimed to evaluate the psychometric properties of the SNS in low functioning participants with treatment-resistant schizophrenia (TRS). METHODS: Participants were assessed using the following measures at two time-points; time-point 1: SNS, Wide Range Achievement Test, 4th Edition Reading Subtest (WRAT-4), and Brief Assessment of Cognition in Schizophrenia (BACS). Time-point 2 (within a week of time-point 1): SNS, Negative Symptom Assessment 16 items (NSA-16), Scale to Assess Unawareness in Mental Disorder-Abbreviated (SUMD-A), Clinical Global Impression Severity Scale (CGI-S), Simpson Angus Scale (SAS), Calgary Depression Scale for Schizophrenia (CDSS), and the Patient Feasibility Questionnaire. RESULTS: Fifty participants with TRS were enrolled, a mean age of 43.8 years (SD = 11.19, min = 25, max = 64), a mean IQ of 80.62 (SD = 17.12, min = 65, max = 110), and a mean BACS Composite T-Score of 14.08 (SD = 17.16, min = -27, max = 49). Participants responded to SNS prompts with moderate consistency across two time-points. There were no significant correlations between the SNS and the NSA-16 Global Symptom score (Pearson r = 0.207, p = .150, Spearman r = 0.101, p = .483), NSA-16 Global Functioning score (Pearson r = 0.209, p = .145, Spearman r = 0.126, p = .384), nor the NSA-16 total score (Pearson r = 0.149, p = .302, Spearman r = 0.116, p = .421). However, when participants were stratified by BACS Composite T-score, there was a significant positive correlation between the SNS total and the NSA-16 Global Functioning score (Pearson r = 0.500, p = .048, Spearman r = 0.546, p = .029) among participants who demonstrated higher cognitive functioning. CONCLUSION: Participants with TRS and low functioning were able to respond to questions on the SNS regarding their subjective assessment of negative symptoms. However, self-reported and clinician-rated negative symptoms were not equivalent, except in a subgroup with higher cognitive functioning. This discrepant self-reporting appeared to relate to their low levels of insight and cognitive impairments.

Assessing instrumental activities of daily living (iADL) with a game-based assessment for individuals with schizophrenia.

BACKGROUND: The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is an "applied" game-based assessment that uses a multi-level functional task to assess instrumental activities of daily living (iADL). This study examines the feasibility, convergent validity, and predictive ability of the VRFCAT in a sample of inpatients with chronic schizophrenia. METHODS: Inpatients with a DSM-5 diagnosis of schizophrenia or schizoaffective disorder, completed the VRFCAT prior to discharge. The UPSA-B, SLOF, and PSP were administered, both at baseline and after four-weeks in the community. VRFCAT performance scores were compared to published data from the VRFCAT validation study. RESULTS: All 62 participants completed the VRFCAT. Compared to the performance of stable outpatients, participants performed 1.50 SDs below the VRFCAT mean adjusted total time (ATT) (Validation study: Mean T Score = 32.5, SD = 16.59) with more errors. The VRFCAT ATT T-score was significantly correlated with baseline UPSA-B total score (p = 0.005) and PSP Global score (p = 0.010). 34 participants completed the follow-up period (55%), and 28 were lost to follow-up. There were no statistically significant differences in VRFCAT scores between these two groups (all p > 0.29). The VRFCAT composite score at baseline was significantly associated with the UPSA-B total score (p = 0.010) and the PSP total score (p = 0.008) at four-weeks, as was the PSP Socially Useful Activities subscale score (p = 0.006). CONCLUSION: The VRFCAT is a valid measure of iADLs in inpatients with chronic schizophrenia. The VRFCAT predicted instrumental functioning four-weeks post-discharge. Future studies should examine other moderators of measures of functional capacity pre-discharge, predicting function later in the community.

Does social cognition training augment response to computer-assisted cognitive remediation for schizophrenia?

OBJECTIVES: Cognitive remediation therapy (CRT) has shown significant improvement in cognition in schizophrenia. However, effect sizes of CRT have been reported to be modest raising the issue how to augment the effects of CRT on neurocognition and social cognition. Our aim was to examine whether the addition of computerized social cognition training would enhance the effects on neurocognition and social cognition as compared to CRT alone. METHODS: This is a 12-week, parallel group trial of 131 in- and out-patients with schizophrenia randomized to CRT (COGPACK or Brain Fitness) with computerized social cognition training (MRIGE), or CRT alone for 36 sessions. Participants were assessed at baseline and after 12 weeks of treatment. Assessments included neurocognition, social cognition, psychopathology, and functioning. RESULTS: The combined intervention, CRT + MRIGE, showed greater improvements in the MCCB indices of Visual Learning, Working Memory, Reasoning and Problem-Solving, and the neurocognitive composite score compared to CRT alone (Bonferroni adjusted p = 0.004, p = 0.005, p = 0.01, respectively), as did social cognition measures (Bonferroni adjusted p = 0.006, p = 0.005, respectively). CONCLUSIONS: Supplementing CRT with computerized social cognition training produced greater benefits in neurocognition, including visual learning, memory, executive functions, and social cognition relative to cognitive training alone. These findings favoring the combined training may be contributed to both the greater overall amount of cognitive practice, as well as the specific cognitive functions engaged by the social cognition training.

Cabergoline can induce mania with psychotic features in bipolar I disorder: a case report.

Up to date, only a small evidence of psychosis induced by cabergoline is available in literature. Herein, the case of a 34-year-old bipolar patient treated with cabergoline has been described. Cabergoline is generally a safe and effective method of reducing prolactin levels and it may be associated with psychiatric side effects, including psychotic features.

COMT genotype and response to cognitive remediation in schizophrenia.

BACKGROUND: A functional polymorphism of the catechol-O-methyltransferase (COMT) gene (Val158Met) partially appears to influence cognitive performance in schizophrenia subjects and healthy controls by modulating prefrontal dopaminergic activity. This study evaluated the association of the COMT Val108/158 Met genotype with response to computerized neurocognitive remediation (CRT). METHOD: 145 subjects with DSM-IV-TR schizophrenia or schizoaffective disorder were genotyped via saliva sampling. Subjects were evaluated on neurocognitive assessments (MATRICS) and clinical symptoms (PANSS) at baseline and endpoint after 12weeks of CRT. "Improvement" was defined as ≥67% of cognitive domains (≥4) showing performance increases. If ≤67% (≤2) of domains improved, the change was defined as "minimal improvement." A general linear model was conducted for change of each cognitive domain. RESULTS: Of 145 subjects, data from 138 subjects were usable. Distribution of COMT genotype: Met/Met: 28 (20.29%), Val/Met: 61 (44.20%), and Val/Val: 49 (35.51%). No significant differences were seen among genotype groups at baseline or across genotype group for "Improvement" vs. "Minimal Improvement." GLM analysis showed significant differences in Verbal Learning (p=0.003), Visual Learning (p=0.014) and Attention/Vigilance (p=0.011) favoring Met/Met and Val/Met groups. CONCLUSIONS: The low activity Met allele (Met/Met; Val/Met) was associated with significantly greater improvements in the MATRICS domains of Verbal Learning, Visual Learning and Attention/Vigilance after CRT.

Improving social cognition in schizophrenia: a pilot intervention combining computerized social cognition training with cognitive remediation.

BACKGROUND: Social cognition is significantly impaired in schizophrenia and contributes to poor community functioning. This study examined whether cognitive remediation (CR; COGPACK), shown to improve neurocognition, improves an integral component of social cognition, emotion perception, compared with CR combined with a computerized Emotion Perception intervention (Mind Reading: Interactive Guide to Emotions [MRIGE]). METHODS: 59 stable schizophrenia or schizoaffective predominantly inpatients were randomized to either CR (N=27) alone or CR+MRIGE (N=32) for 12 weeks. Assessments included the Facial Emotion Identification Task (FEIT), Facial Emotion Discrimination Task (FEDT), MCCB-MATRICS, Personal and Social Performance Scale, and the Positive and Negative Syndrome Scale. RESULTS: There was a significant group-by-time effect on FEIT (F=11.509, P=.004); CR+MRIGE demonstrated significantly greater improvement than CR alone (CR+MRIGE, Z=1.89, P=.05; CR alone Z=0.57, P=.13). There was significant group-by-time effect on FEDT (F=5.663, P=.022); CR+MRIGE demonstrated significantly greater improvement than CR alone (CR+MRIGE, Z=1.90, P=.05; CR alone Z=0.67, P=.21). There was also a significant group by time effect for social cognition, measured by the Mayer-Salovey-Caruso Emotional Intelligence Test (F=5.473, P=.050): CR+MRIGE demonstrated significantly greater improvement than CR alone (CR+MRIGE, Z=1.98, P=.02; CR alone, Z=1.00, P=.05). CONCLUSIONS: Combined CR with emotion perception remediation produced greater improvements in emotion recognition, emotion discrimination, social functioning, and neurocognition compared with CR alone in chronic schizophrenia.

Relationship between metabolic syndrome and cognition in patients with schizophrenia.

BACKGROUND: The metabolic syndrome (MetS) and cognitive impairments are common in schizophrenia. Both are associated with poor outcomes, which have received increasing medical and mental health attention. Whether MetS is associated with impaired cognitive functions in schizophrenia has not been thoroughly addressed. The aim of this study was to compare the association between patients with and without MetS and its contributing components with neurocognitive performance. We hypothesized that patients with MetS would be associated with more impaired cognitive performance. METHODS: 159 patients with schizophrenia or schizoaffective disorder, with available metabolic data were included in the study. Patients were classified as either having or not having MetS as defined by the NCEP Adult Panel-III criteria. All patients completed neurocognitive and metabolic tests. RESULTS: Of the 159 patients, 43.34% had MetS. Patients without the MetS performed significantly better on tests measuring processing speed (p=0.050), attention/vigilance (p=0.040), working memory (p=0.041) and problem solving/reasoning (p=0.050) compared with those with MetS. Patients with MetS showed significantly lower cognitive domain scores. After Bonferroni correction greater waist circumference was associated with lower scores on attention/vigilance (ß=-0.551; p≤.0083), HDL was positively associated with scores on attention/vigilance (ß=0.900, p≤.0083) and higher triglycerides were associated with lower scores on attention/vigilance (ß=-1.004, p≤.0083). CONCLUSIONS: Schizophrenia patients with MetS showed significant cognitive impairments in three key cognitive domains. Aggressive medical treatment of the constituent components of MetS may provide the potential for important beneficial effects on patients' cognitive functioning.