Potential clinical applications of Ashwagandha (Withania somnifera) in medicine and neuropsychiatry.

INTRODUCTION: Ashwagandha (ASW) is the extract of the plant Withania somnifera. It is widely used in complementary, alternative, and integrative medicine (CAIM) but is little discussed in mainstream modern medical literature. AREAS COVERED: We performed a review of potential pharmacotherapeutic properties of ASW. Studies were sourced from relevant online and offline databases. In animal models, ASW displays antioxidant activity. It has GABAergic and other neurotransmitter modulatory effects. It reduces apoptosis and promotes synaptic plasticity. It improves cognition and reverses induced cognitive deficits. It attenuates indices of stress. In human subjects, ASW enhances adaptogenesis in healthy adults. It modestly benefits generalized anxiety disorder and obsessive-compulsive disorder, and symptom severity in schizophrenia, substance use disorders, and attention deficit hyperactivity disorder. It improves sleep quality. EXPERT OPINION: ASW may confer modest benefit in certain neuropsychiatric conditions. Its benefits may arise from induction of neuroplasticity, antioxidant and anti-inflammatory effects, and modulation of GABA and glutamate, as well as other neurotransmitters. The antioxidant and anti-inflammatory actions may also benefit neurodegenerative states. Reports of clinical benefit with ASW must be interpreted with caution, given the paucity of randomized clinical trials (RCTs). Greater methodological rigor is necessary before clinical recommendations on ASW can be confidently made.

ASW is an extract of the Indian winter review and meta-analysis of four RCTs reported scientific studies on the use of ASW in animal and human subjects in order to identify potential clinical uses in modern medicine.Our review finds that ASW has antioxidant and anti-inflammatory action. It also modulates the effects of several neurotransmitters in the brain. It attenuates laboratory and clinical indices of stress. These mechanisms may benefit mental illnesses such as anxiety, depression, obsessive-compulsive disorder, schizophrenia, attention deficit hyperactivity disorder, and addictive disorders. ASW improves exercise capacity in healthy adults. It also appears to improve sleep quality. In addition, ASW may also improve cognitive functioning post-brain injury and in those at risk of dementia. There is evidence from animal models that ASW may also be of benefit in cancer, stroke, and induced organ damage.These studies, while suggesting a wide range of potential clinical applications for ASW, must be viewed with caution because the clinical data are based on small numbers of patients treated for a relatively short period of time. Many clinical trials that found benefits with ASW were one-off studies that have not been replicated. Larger and more methodologically stringent clinical trials are required before ASW can be confidently recommended for clinical use. Because ASW is a herbal extract and because the efficacy of its many constituents is not known, it is not possible to generalize conclusions to all extracts, whether standardized or not.

Neuropsiquiatría del síndrome de Susac: a propósito de un caso / Neuropsychiatry of Susac Syndrome: a Case Report

RESUMEN El síndrome de Susac es una entidad clínica poco frecuente, posiblemente mediada por un proceso autoinmune; la tríada clásica se compone de retinopatía, disminución en la agudeza auditiva y síntomas neuropsiquiátricos (encefalopatía). Hay pocos casos descritos con sintomatología neuropsiquiátrica como la sintomatología principal. Presentamos un caso de síndrome de Susac, que corresponde a una mujer de 34 arios, con predominio de sintomatologia neuropsiquiátrica, caracterizada por un síndrome de Klüver-Bucy parcial, un síndrome apático, risa y llanto patológico y alteraciones cognitivas de predominio atencional; dichos síntomas mejoraron cualitativamente con el uso de terapia inmunológica. Este caso revela la importancia de las manifestaciones neuropsiquiátricas como presentación clínica en pacientes con entidades neurológicas.

ABSTRACT Susac syndrome is a rare clinical condition, possibly mediated by an autoimmune process; the classic triad is composed of retinopathy, decreased hearing acuity and neuropsychiatric symptoms (encephalopathy). There are few cases reported with neuropsychiatric symptoms as the main manifestation. We present a case of Susac syndrome in a 34-year-old female with a predominance of neuropsychiatric symptoms, characterised by partial Klüver-Bucy syndrome, apathy syndrome, pathological laughter and crying, and cognitive dysfunction predominantly affecting attention, which showed a qualitative improvement with the use of immunological therapy. This case report highlights the importance of neuropsychiatric manifestations as clinical presentation in patients with neurological conditions.

Photography's Underappreciated Contributions to Neuropsychiatry: The Photographs of W. Eugene Smith in Minamata, Japan.

Photographers and filmmakers have made important contributions to the international mental health community through documentation and social commentary, leveraging the power of visual imagery. To illustrate, this article uses the example of W. Eugene Smith who photographed the catastrophic effects of methylmercury poisoning from industrial pollution in the region around Minamata Bay, Japan. Although many art forms have been comfortably integrated into mainstream psychiatry and neuropsychiatry, photography has been underappreciated and underutilized.

Comorbilidad neuropsiquiátrica en pacientes con fibromialgia / Neuropsychiatric comorbidity in patients with fibromyalgia

RESUMEN Introducción: La fibromialgia es una causa común de dolor crónico en el mundo, con una prevalencia en la población general del 0,2% al 6,4%. Estos pacientes tienen una mayor probabilidad de presentar trastornos neuropsiquiátricos. El objetivo fue describir el perfil sociodemográfico y clínico de pacientes con fibromialgia y comorbilidad neuropsiquiátrica. Métodos: Estudio transversal, descriptivo. Se recolectó información de las historias clínicas de pacientes con fibromialgia y comorbilidad neuropsiquiátrica, de una institución especializada en Antioquia, durante los años 2010 al 2016. Se aplicaron herramientas de estadística descriptiva. Resultados: De 1.106 registros médicos con diagnóstico confirmado de fibromialgia, 497 presentaban comorbilidad neuropsiquiátrica. La mediana de edad fue de 54 años (RIC 15), la mayoría eran mujeres, residían en zona urbana y estaban casados o convivían con su pareja. Estatus socioeconómico bajo-medio y nivel educativo básico-medio, fueron los más reportados. Los síntomas más frecuentes fueron alteraciones del sueño (70,6%), mialgias (66,4%) y fatiga crónica (55,9%). Los trastornos neuropsiquiátricos más frecuentes fueron depresión (85,7%), migraña (35%) y ansiedad (14,7%). Los fármacos más utilizados fueron los inhibidores de la recaptación de serotonina y duales, acetaminofén y gabaérgicos. Manejo con terapias complementarias e intervención psicológica se observaron en baja proporción. Conclusiones: La fibromialgia y las enfermedades neuropsiquiátricas son patologías que coexisten con frecuencia; la presentación sociodemográfica y clínica es similar a lo descrito en la literatura, sin embargo, la presencia de depresión en esta población fue mayor. Un enfoque terapéutico transdisciplinario, favorecería la calidad de vida de los pacientes y el curso de la enfermedad.

ABSTRACT Introduction: Fibromyalgia is a common cause of chronic pain in the world, with a prevalence of 0.2% to 6.4% in the general population. These patients are more likely to have neuropsychiatric disorders. The objective of this study was to describe the sociodemographic and clinical profile of patients with fibromyalgia and neuropsychiatric comorbidity. Methods: A cross-sectional, descriptive study was conducted in which Information was collected from the medical records of patients with fibromyalgia and neuropsychiatric comorbidity, from specialist institution in Antioquia, during the years 2010 to 2016. Descriptive statistics tools were applied. Results: Of the 1,106 medical records with a confirmed diagnosis of fibromyalgia, 497 had neuropsychiatric comorbidity. The median age was 54 years (IQR 15), and the majority were women, residing in an urban area, and were married or living with their partner. Low-medium socioeconomic status and basic-medium educational level were the most reported. The most frequent symptoms were sleep disturbances (70.6%), myalgia (66.4%), and chronic fatigue (55.9%). The most frequent neuropsychiatric disorders were depression (85.7%), migraine (35%), and anxiety (14.7%). The most commonly used drugs were serotonin and dual reuptake inhibitors, acetaminophen, and GABAergic drugs. A low percentage was managed with complementary therapies and psychological intervention. Conclusions: Fibromyalgia and neuropsychiatric diseases are diseases that frequently coexist. Although the sociodemographic and clinical presentation is as described in the literature, the presence of depression was greater in this population. A multidisciplinary therapeutic approach would favour the quality of life of the patients and the course of the disease.

Turning Oral Presentations at the Academy of Consultation-Liaison Psychiatry's Annual Meeting Into Published Articles: A Review and Analysis.

BACKGROUND: Oral presentations at academic conferences typically describe recent or ongoing research projects or provide literature reviews. However, conversion of these presentations into full-length journal articles is not routine. OBJECTIVE: We sought to assess the frequency with which oral presentations at the Academy of Consultation-Liaison Psychiatry's annual meetings from 2012 to 2018 were turned into peer-reviewed publications and review the factors that affected publication of them. METHODS: Conference presentation titles and authors from the 2012-2018 Academy of Consultation-Liaison Psychiatry Annual Meetings were searched using PubMed to find corresponding published reports by the presenters. Data were organized in an Excel spreadsheet, and the time to publication, the journals in which they were published, and general content areas were recorded and analyzed. RESULTS: Of the 287 oral presentations delivered during the study period, 47% were published in a peer-reviewed journal. Articles were published in 72 different journals; the journals that published the most articles were Psychosomatics, General Hospital Psychiatry, Psycho-oncology, Academic Psychiatry, and the Journal of General Internal Medicine. The most common subspecialty topics of the published articles were neuropsychiatry, psycho-oncology, surgery and transplantation, and delirium. The mean time to publication after presentation was 1 year. CONCLUSION: Knowledge of the rate at which presentations are converted into peer-reviewed publications can be used to enhance the academic success of presenters, and strategies to enhance the rate of publication (e.g., by coaching on scientific writing or by selecting oral presentations with the highest publication potential) can be established.

Evolving a new neuropsychiatry.

Clinical neuroscience struggles with poor scientific validity of neuropsychiatric diagnosis and its negative impact on management. Sydenham's ancient conformity of type approach to nosology with its assumption that the symptom cluster and course of a disorder are due to a common etiology, has proven no match for the complicated comorbidities faced in neuropsychiatry. In the absence of accurate pathological biomarkers there is a challenge in finding a solid foundation for modern neuropsychiatry. We find standard psychiatric nosology to be of limited benefit at the general hospital bedside in evaluating and treating neuropsychiatric disorders. Consequently, we have developed over the years a neuro-circuitry-based training for our psychosomatic medicine fellows. In this commentary, we will introduce a strategy for understanding patients with neuropsychiatric disorders that may advance our ability to diagnose and treat them in accordance with neuroscientific evidence anchored in evolutionary neurocircuitry and attachment neurobehavior.

Las neurociencias clínicas luchan contra una pobre validación científica del diagnóstico neuropsiquiátrico y su impacto negativo sobre el manejo. La antigua conformidad de Sydenham con el tipo de aproximación a la nosología, asumiendo que el grupo de síntomas y el curso de un trastorno se deben a una etiología común, no ha demostrado ser compatible con las complicadas comorbilidades que enfrenta la neuropsiquiatría. En au-sencia de biomarcadores patológicos precisos existe un desafío para encontrar bases sólidas para la moderna neuropsiquiatría. Se cuenta con una nosología psiquiátrica estándar que es de beneficio limitado para pacientes del hospital general respecto a la evaluación y el tratamiento de los trastornos neuropsiquiátricos. En consecuencia, a través de los años se ha desarrollado un entrenamiento para los residentes de medicina psicosomática en base a circuitos neurales. En este artículo breve, se presentará una estrategia para la comprensión de pacientes con trastornos neuropsiquiátricos que puede mejorar nuestra capacidad para diagnosticarlos y tratarlos de acuerdo con evidencia neurocientífica sustentada en circuitos neurales evolutivos y en las bases neuroconductuales del apego.

Les neurosciences cliniques sont en conflit avec la médiocre validité scientifique du diagnostic neuropsychiatrique et son impact négatif sur la prise en charge. La nosologie ancienne de type Sydenham, postulant que l'étiologie des groupes de symptômes et de l'évolution de la maladie est commune, a montré qu'elle ne s'appliquait pas aux comorbidités compliquées rencontrées en neuropsychiatrie. Il est difficile de trouver une base solide pour la neuropsychiatrie moderne en l'absence de biomarqueurs pathologiques précis. Au lit du malade à l'hôpital, la nosologie psychiatrique standard est de peu d'aide pour évaluer et traiter les troubles psychiatriques. Nous avons donc développé au fil des années un enseignement basé sur les circuits neurologiques pour nos confrères de médecine psychosomatique. Nous présentons dans ce commentaire une stratégie pour comprendre les patients atteints de troubles neuropsychiatriques, qui pourrait améliorer nos capacités de diagnostic et de traitement en accord avec les preuves neuroscientifiques enracinées dans l'évolution des circuits neurologiques et les comportements neurologiques de l'attachement.

Integrated Behavioral Health Care in Pediatric Subspecialty Clinics.

Comorbid behavioral and physical health conditions are accompanied by troubling symptom burden, functional impairment, and treatment complexity. Pediatric subspecialty care clinics offer an opportunity for the implementation of integrated behavioral health (BH) care models that promote resiliency. This article reviews integrated BH care in oncology, palliative care, pain, neuropsychiatry, cystic fibrosis, and transplantation. Examples include integrated care mandates, standards of care, research, and quality improvement by child and adolescent psychiatrists (CAPs) and allied BH clinicians. The role of CAPs in integrated BH care in subspecialty care is explored, focusing on cost, resource use, financial support, and patient and provider satisfaction.

Anosognosia en la enfermedad de Alzheimer: prevalencia, factores asociados e influencia en la evolución de la enfermedad / Anosognosia in Alzheimer disease: Prevalence, associated factors, and influence on disease progression

Introducción: La anosognosia es frecuente en la enfermedad de Alzheimer (EA). El objetivo fue describir su prevalencia en el momento del diagnóstico y analizar los factores predisponentes y su influencia en la evolución posterior de la EA. Métodos: Estudio observacional, multicéntrico, prospectivo, analítico, realizado en consultas de neurología general. Se incluyó a pacientes recién diagnosticados de EA (criterios NINCDS-ADRDA). Se realizaron 2 evaluaciones -cognitivas, funcionales y neuropsiquiátricas-, con un intervalo de 18 meses. Se empleó la Clinical Insight Rating scale como medida de anosognosia (CIR, rango 0-8). El criterio de progresión fue un incremento en la Clinical Dementia Rating-sum of boxes mayor a 2,5 puntos. Las variables predictoras se analizaron mediante regresión logística. Resultados: Se incluyó a 127 pacientes, 94 completaron las 2 evaluaciones. El 31,5% mostraba anosognosia grave (CIR 7-8), el 39,4% conciencia alterada (CIR 3-6) y el 29,1% conciencia normal (CIR 0-2). La mediana del CIR basal en la cohorte fue 4 (Q1-Q3: 1-7) y a los 18 meses 6 (Q1-Q3: 3-8); p < 0,001. La edad avanzada (odds ratio [OR] 2,43; IC del 95%, 1,14-5,19), menor escolaridad (OR 2,15; IC del 95%, 1,01-4,58) y mayor afectación neuropsiquiátrica (OR 2,66; IC del 95%, 1,23-5,74) fueron variables predictoras de anosognosia. El CIR basal fue similar en los grupos con y sin progresión clínica significativa. Conclusiones: La gran mayoría de los pacientes con EA en el momento del diagnóstico muestran un grado significativo de anosognosia que se asocia a mayor edad, menor escolaridad y mayor afectación conductual. No se demostró influencia de la anosognosia sobre la evolución inicial de la EA tras el diagnóstico

Introduction: Anosognosia is a frequent symptom in Alzheimer disease (AD). The objective of this article is to describe prevalence of this condition at time of diagnosis and analyse any predisposing factors and their influence on disease progression. Methods: Observational, prospective, and analytical multi-centre study in an outpatient setting. Patients recently diagnosed with AD (NINCDS-ADRDA criteria) were included. Each patient underwent two cognitive, functional, and neuropsychiatric assessments separated by an interval of 18 months. The Clinical Insight Rating Scale was employed as a measure of anosognosia (CIR, scored 0-8). Progression was defined as an increase in the Clinical Dementia Rating Scale-sum of boxes of more than 2.5 points. The predictor variables were analysed using binary logistic regression. Results: The study included 127 patients, and 94 completed both assessments. Of the total, 31.5% displayed severe anosognosia (CIR 7-8); 39.4%, altered level of consciousness (CIR 3-6); and 29.1%, normal awareness (CIR 0-2). The median baseline CIR in this cohort was 4 (Q1-Q3: 1-7), and at 18 months, 6 (Q1-Q3: 3-8), P<.001. Advanced age (odds ratio (OR) 2.43; CI 95%:1.14-5.19), lower educational level (OR 2.15; CI 95%:1.01-4.58), and more marked neuropsychiatric symptoms (OR 2.66; CI 95%:1.23-5.74) were predictor variables of anosognosia. Baseline CIR was similar in the groups with and without significant clinical progression. Conclusions: The large majority of patients with AD at the time of diagnosis showed significant anosognosia, and this condition was associated with advanced age, lower educational level, and more marked behavioural symptoms. Our results did not show that anosognosia had an effect on the initial clinical progression of AD after diagnosis

Research on Psychiatric Treatment by Psychiatrists of Chosun-Governor Hospital and Keijo Imperial University Hospital in Korea during Japanese Colonial Rule / 신경정신의학

This review describes the types of psychiatric treatment studied during the Japanese colonial period of 1910–1945 in Korea, known at the time as Chosun. Twenty-nine research papers and abstracts on psychiatric treatment were reviewed, which were published in the Shinkeigaku-zassi (Neurologia), the Seishin-shinkei-gaku zassi (Psychiatria Et Neurologia Japonica) and the Journal of Chosun Medical Association, by faculty members of the department of neuropsychiatry, Chosun-Governor Hospital and Keijo (Seoul) Imperial University School of Medicine. The major research area was biological psychiatry and biological treatment, as Japanese pioneers in psychiatry at that time had introduced German psychiatry into Japan. Professor Kubo published the most papers, followed by Dr. Hattori, Dr. Hikari, and Professor Suits. In Chosun-Governor Hospital, research on prolonged sleep therapy was an active field. In the Imperial University Hospital, malarial fever therapy, sulphur-induced fever therapy, and insulin shock treatment were the most frequent research topics. Some were tried for the first time in the Japanese Empire, which reflected the pioneering position of the university. These achievements are attributed to Professor Kubo. Six papers on psychotherapy were published. Among them, two papers were on persuasion therapy, three papers were case reports of psychoanalytic therapy, and one paper on Freud. However, this psychoanalytic therapy research seemed to be limited trials conducted following literal guidance, and no further development was noted. Generally, research was characterized by simple design, small numbers of subjects, lack of objective evaluation method, lack of statistical treatment, and especially lack of ethical consideration comparing with today's standard.

Vagus nerve stimulation in neuropsychiatry: Targeting anatomy-based stimulation sites.

The vagus nerve (VN) is the longest cranial nerve, extending from the brain to the abdominal cavity. The VN consists of both afferent and efferent fibers (respectively 80% and 20%). Vagus nerve stimulation (VNS) is a neuromodulation strategy first developed in the 1980s for epilepsy. More recently, growing efforts in clinical research have been underscoring possible clinical benefits of VNS for different medical conditions such as epilepsy, major depression, anxiety disorders, and Tourette syndrome. Following the rational of VN anatomy and cranial innervation presented above, we hereby hypothesize that transcutaneously placing electrodes over the mastoid process could be a useful study protocol for future tVNS trials.

Research by Psychiatrists of Chosun Chongdokbu Hospital and Keijo Imperial University in Korea during Japanese Colonial Rule / 신경정신의학

Eighty-three of 114 original articles and abstracts of research published by neuropsychiatrists of Chosun Chongdokbu Hospital (the Japanese colonial government hospital in Korea) and Keijo (Seoul) Imperial University Hospital during the Japanese colonial period (1910-1945) in journals including Shinkeigaku-zassi (Neurologia), Seishin-shinkei-gaku zassi (Psychiatria Et Neurologia Japonica), and The Journal of Chosun (Korea) Medical Association were reviewed. Most articles were on clinical research based on descriptive and biological psychiatry while only 4 articles were on dynamic psychiatry, probably because Japanese pioneers in psychiatry had introduced German psychiatry into Japan during the 1880s. The first paper was written by Dr. Shim Ho-sub. Professor Kubo of Keijo (Seoul) Imperial University published most articles, followed by Dr. Hikari, Dr. Hattori, and Dr. Sugihara. There were more articles on symptomatic psychosis and morphine addiction, followed by general paralysis, schizophrenia, neurological diseases, narcolepsy, epilepsy, and neurasthenia. The meaningful articles even for today were comparative studies between Japanese and Koreans and articles on opioid use disorder in Korea. Authors reported a markedly lower rate of psychotic inpatients in the population of Koreans compared with Japanese. Japanese researchers argued that, because of simpleness in social life in Korea and less violence or excitement in symptoms, Korean mental patients could be cared for by family or members of the community, or be treated by shamanism rather than bringing them to a public mental hospital, and poverty also prohibited hospital care. Finding of higher ratio of schizophrenia to manic-depressive psychosis among Koreans than Japanese was discussed in relation to delayed cultural development of Korea compared to Japan. In addition, traditional customs prohibiting marriage between relatives in Korea was related to low prevalence of manic-depressive psychosis, local endemic malaria was related to low prevalence of general paresis, and poor general hygiene was related to high prevalence of epilepsy. Unclear (undifferentiated) form of psychotic symptoms including hallucination and delusion was reported in more Koreans than Japanese. Also Korean patients showed a more atypical form in diagnosis. Authors added that they had found no culture-specific mental illness in Korea. However, no Korean psychiatrists were included as author in such comparative studies. Comparative studies on constitution between Koreans and Japanese mental patients and prisoners were also unique. However, no Korean psychiatrists participated in such comparative studies. In studies on morphine addiction in Koreans, Japanese researchers argued that such studies were necessary to prevent introduction of morphine-related criminal phenomena to Japan. Meanwhile, Dr. Kubo had left a notion on adaptation problems of Japanese living in the foreign country, Korea. Nevertheless he reported nothing about psychosocial aspects of mental illness in relation to political, cultural, and economic difficulties Koreans were experiencing under the colonial rule of Japan. These general trends of studies based on German biological and descriptive psychiatry and policies of colonial government to isolate "dangerous" mental patients in hospital appeared to reflect colonial or ethnopsychiatry of those days. These policy and research trends seem to have worsened stigma attached to mental disorders. Japanese tradition of psychiatric research was discontinued by return home of Japanese scholars with the end of WWII and colonial rule.

Al-Akhawayni, a contributor to medieval Persian knowledge on contraception.

Modern scientific achievements in the field of contraception are clearly indebted to past studies. Al-Akhawayni Bukhari was a Persian physician in the 10th century. He lived during the 'Golden Age of Islamic Medicine' (9th to 12th century AD). This scientist recorded his knowledge on various medical matters, including contraception, in the book 'Hidayat al-Muta`allemin Fi al-Tibb' (Learner's Guide to Medicine). These 10th century views on contraception are explored in this paper through a discussion of Al-Akhawayni Bukhari's surviving book, the 'Hidayat' (Guide).

French neuropsychiatry in the Great War: between moral support and electricity.

In World War I, an unprecedented number of soldiers were suffering from nervous disturbances, known as war psychoneuroses. Mechanisms of commotion, emotion, and suggestion were defined in order to explain these disturbances. In France, emphasis was placed on the mechanism of suggestion, based on pithiatism, introduced by Joseph Babinski (1857-1932) before the war to highlight the concept of suggestion and its hazy border with simulation. As a result, many soldiers suffering from war neuroses became considered as simulators or malingerers who were merely attempting to escape the front. A medical-military collusion ensued with the aim of sending as many of these nervous cases back to the front as possible through the use of painful or experimental therapies. Aggressive therapies flourished including torpillage, a particularly painful form of electrotherapy developed by Clovis Vincent (1879-1947) and subsequently by Gustave Roussy (1874-1948). At the end of the war, some psychiatrists, such as Paul Sollier (1861-1933), Georges Dumas (1866-1946), and Paul Voivenel (1880-1975), developed a more psychological approach. In Great Britain, where Charles Myers (1873-1946) coined the term shell shock in 1915 to describe these cases, psychological theories were more successful. In Germany, aggressive therapies developed by Fritz Kaufmann (1875-1941) emerged in the second part of the war. In Austria, the future Nobel Prize winner Julius Wagner-Jauregg (1857-1940) was accused of performing violent therapies on patients with war neuroses. These methods, which now seem barbarian or inhuman, were largely accepted at the time in the medical community and today should be judged with caution given the cultural, patriotic, and medical background of the Great War.

Tibetan medicinal formulas used to treat neuropsychiatric disorders

Introduction: Men-Tsee-Khang in Dharamsala, India, formally known as the Tibetan Medical and Astrological Institute (TMAI), is dedicated to the teachings and practice of Tibetan medicine, which uses therapeutic agents in multi-ingredient formulas. Aim of the study: The aim of the present study was to identify formulas used at Men-Tsee-Khang for the treatment of neuropsychiatric disorders and to compare the Tibetan usage of particular ingredients with pharmacological data from the scientific database. Methods: Using ethnographic techniques and methods, five physicians were selected, and the interviews were conducted between July 2010 and February 2011. Results: A correlation was observed between central nervous system disorders and rLung, one of the three humors in Tibetan medicine, and 10 formulas used to treat the imbalance of this particular humor were identified. These formulas utilize 61 ingredients, including salts, animal products and plants. The 48 plant species identified in these formulas are traditionally used in Tibetan medicine and are deposited at the Men-Tsee-Khang Herbarium. Each formula treats several symptoms related to rLung imbalance, so the plants may have therapeutic uses distinct from those of the formulas in which they are included. Data from the scientific literature indicate that all of the formulas include ingredients with neuropsychiatric action and corroborate the therapeutic use of 75,6% of the plants. Conclusion: These findings indicate a level of congruence between the therapeutic uses of particular plant species in Tibetan and Western medicines.

[Dr Anto Maric (1897-1982): a journey from alcohology and dermatovenereology to psychiatry and balneology]. / Dr. Anto Maric (1897.-1982.) -od alkohologije i dermatovenerologije preko psihijatrije do balneologije.

Dr Anto Maric (1897-1982) was born in Vuksic in Bosnia. He completed medical studies in Vienna and Prague. He published his results from the Department for dermatovenerology at Sarajevo State Hospital, Bosnia. He engaged himself in the movement against alcoholism, too. Later he moved to the Neuropsychiatry ward in Belgrade and was appointed manager in a new psychiatry hospital in Kovin, Serbia. For years he had been a community physician in Stanisic in Vojvodina. During the Second World War, he worked in the psychiatric hospital Vrapce at the outskirts of Zagreb, Croatia and after the war he became the head of a thermal spa in Srebrenica, Bosnia. After specialisation in balneology, he came to Rijeka to overlook the reconstruction of a thermal spa near Buzet in Istria. He made use of his long experience in dermatovenerology, neuropsychiatry and balneology to promote the importance of the unity between physical and psychological for maintaining human health.

Aspects of psychodynamic neuropsychiatry III: magic spells, the placebo effect, and neurobiology.

Through a case study, the importance of supporting the positive transference is stressed-from both a psychological and neurobiological perspective. The article argues that the neurobiology of expectation underlies transference. This neurobiology has been investigated particularly over the past several decades in work concerning the placebo effect. By understanding the neurobiology of expectation, one gains a better understanding of the neurobiology of the transference. This enables clinical predictions-and decisions-that are informed not just by the teachings of psychology but also by the science of biology.

Manejo integral de un paciente con secuelas neuropsiquiátricas por consumo crónico de alcohol / Integral Treatment of a Patient with Neuropsychiatric Symptoms in a city in the Central-South Region of Chile

La cronicidad de los síntomas neuropsiquiátricos aun cuando tengan etiología diversa, genera una importante discapacidad para el paciente, mayor carga familiar y altos costos de atención. Objetivos. Describir la evolución clínica y el manejo integral de un paciente con deficiencias vitamínicas asociadas al consumo de alcohol. Hallazgos clínicos. Se trata de un hombre de 55 años, residente en San Carlos, Chile, sin antecedentes psiquiátricos previos excepto por dependencia al alcohol que suspendió luego del inicio de su sintomatología psiquiátrica hace cuatro años, caracterizada por ideas delirantes de tipo paranoide, místico y nihilista, además de alucinaciones complejas de tipo auditivo, olfatorio y táctil y compromiso gradual de su estado de ánimo. Posteriormente, presenta paraparesia de extremidades superiores de predominio proximal y más tarde de las inferiores, además de alteraciones cognitivas. Se descartaron otras patologías médicas y sólo se documentó anemia macrocítica, iniciándose manejo con suplencia vitamínica (B12 y folato) y un plan de intervención integral por psiquiatría y terapia ocupacional, para tratamiento sintomático y de rehabilitación. Conclusiones. A lo largo del seguimiento de las intervenciones interdisciplinarias se observa en el paciente una mejoría progresiva especialmente de las alteraciones neurológicas y de su funcionamiento global...

Chronified neuropsychiatric symptoms even when they have diverse etiology, generate an important impairment for the patient, greater family preoccupation, and high attention cost. Objectives. Describe the clinical evolution and integral management of a patient with vitamins deficit for alcohol abuse. Clinical Signs. Subject is a male patient of 55 years of age, resides in San Carlos, Chile, without psychiatric backgrounds except for alcohol dependency that he suspended after beginning psychiatric symptoms four years ago, characterized by delirious thoughts of the paranoid, mystical and nihilistic nature, also visual, olfactory and tactile complex hallucinations and gradual compromise of mood. Afterwards he presented paralysis of the superior extremities predominately proximal, and later of the inferiors, also, cognitive alterations. Other medical pathologies where discarded and only a megaloblastic anemia was documented, beginning treatment of vitamin supplements (B12 and folate) and an integral treatment plan with psychiatry and occupational therapist, for symptomatic treatment and, rehabilitation. Conclusions. Throughout the follow up of the interdisciplinary interventions it could be observed in the patient a progressive betterment of the neurological alterations, and in his global functions...

Jules Bernard Luys in Charcot's penumbra.

Jules Bernard Luys (1828-1897) is a relatively unknown figure in 19th century French neuropsychiatry. Although greatly influenced by Jean-Martin Charcot (1825-1893), Luys worked in the shadow of the 'master of La Salpêtrière' for about a quarter of a century. When he arrived at this institution in 1862, he used microscopy and photomicrography to identify pathological lesions underlying locomotor ataxia and progressive muscular atrophy. He later made substantial contributions to our knowledge of normal human brain anatomy, including the elucidation of thalamic organization and the discovery of the subthalamic nucleus. Luys's name has long been attached to the latter structure (corps de Luys), which is at the center of our current thinking about the functional organization of basal ganglia and the physiopathology of Parkinson's disease. As head of the Maison de santé d'Ivry, Luys developed a highly original view of the functional organization of the normal human brain, while improving our understanding of the neuropathological and clinical aspects of mental illnesses. In 1886, Luys left La Salpêtrière and became chief physician at La Charité hospital. Following Charcot, whom he considered as the father of scientific hypnotism, Luys devoted the last part of his career to hysteria and hypnosis. However, Luys ventured too deeply into the minefield of hysteria. He initiated experiments as unconventional as the distant action of medication, and became one of the most highly caricatured examples of the fascination that hysteria exerted upon neurologists as well as laypersons at the end of the 19th century.