The Neuroanatomy of Somatoform Disorders: A Magnetic Resonance Imaging Study.

BACKGROUND: Somatoform disorders (SDs) are a heterogeneous group of psychiatric syndromes characterized by common symptoms, which may mimic a physical condition but they are not explained by a medical condition. Although the biologic nature of this disorder has been widely accepted, the neuroanatomical correlates characterizing SDs are still inconclusive. OBJECTIVE: This study aims to explore gray matter (GM) volume alterations in SD patients compared to healthy controls and their possible association with clinical and cognitive measures. METHOD: We used voxel-based morphometry to examine regional GM volumes in 20 inpatients with SDs and 24-matched healthy controls. Only for SD patients, we employed multiple instruments to assess psychopathology and cognitive functioning, which were then used to explore their association with GM volume deficits. RESULTS: Compared to healthy controls, SD patients showed GM volume reductions in the hypothalamus, left fusiform gyrus, right cuneus, left inferior frontal gyrus, left posterior cingulate, and right amygdala (p < 0.05, cluster Family Wise Error corrected). Additionally, in SD, Symptom Checklist-90-Phobia and Hamilton Depressive Rating Scale scores negatively correlated with specific fronto-temporoparietal regions whereas Symptom Checklist-90-Sleep scores positively correlated with anterior cingulate cortex. Lastly, the Boston Naming Test negatively correlated with fronto-temporoparietal and striatal volumes whereas Free and Cued Selective Reminding Test and Stroop scores positively correlated with superior temporal gyrus and cuneus, respectively (all p < 0.05, cluster Family Wise Error corrected). CONCLUSION: Our results suggest that SDs might be characterized by selective impairments in specific cortico-limbic regions associated to two overlapping circuits, the neuromatrix of pain and the emotion regulation system.

Evidence for Neurocognitive Improvement After Bariatric Surgery: A Systematic Review.

BACKGROUND: Bariatric surgery is an effective means of weight reduction in severely obese patients and correlates with improvements in quality of life, mental health outcomes, and neurocognition, especially in those with high psychosocial burden. OBJECTIVE: The primary purpose of this systematic review was to evaluate the impact of bariatric surgery on long-term neurocognitive functioning and neuropsychological outcomes. METHODS: OVID Medline and PsychInfo databases from January 1990 to August 2015 were searched with key terms and phrases: "bariatric surgery" and "cognition." The inclusion criteria for the studies included the following: n ≥ 10, minimum postoperative follow-up of 12 months, and use of formal neurocognitive assessment tools presurgery and postsurgery. RESULTS: Of 422 identified abstracts, a total of 10 studies met inclusion criteria and sample sizes ranged from 10-156. Postsurgical follow-up time ranged from 12-36 months. All 10 studies documented significant improvements of statistical significance (p < 0.05) in at least 1 neurocognitive domain following bariatric surgery; 9 studies showed improvements in memory, 4 studies showed improvement in executive function, and 2 studies showed improvements in language, and 1 study showed no improvement in any neurocognitive domain. CONCLUSION: Mental health care providers should consider the effect of neurocognitive performance on presurgery psychiatric assessments for bariatric surgery and implications for psychosocial functioning postsurgery. The aforementioned effect that bariatric surgical intervention has on neurocognition underscores the complex interrelationship between metabolism and brain function. Future research should validate the use of neurocognitive screening tools presurgery and evaluate the impact of neurocognitive changes on neurocognitive, bariatric, and functional outcomes.

Reversible Valproate Induced Pisa Syndrome and Parkinsonism in a Neuro-Oncology Patient with Depression and Epilepsy.

Neurological and psychiatric conditions frequently overlap in neuro-oncology. This overlapping negatively affects patients' quality of life and decreases the ability of providers to manage specific symptoms by therapy modulation, especially when psychopharmacotherapy needs to be prescribed. We describe here a patient with recurrent brain tumor, symptomatic epilepsy and depression who developed Pisa syndrome and parkinsonism after several months of valproic acid use. An accurate recognition of symptoms and treatment side effect allowed an appropriate clinical approach so as to rapidly improve both movement disorder and depression without increasing the risk of developing seizure. This has improved the autonomy and quality of life in a patient with poor prognosis.