Dissociative experiences in epilepsy: effects of epilepsy-related factors on pathological dissociation.

Psychogenic nonepileptic seizures (PNESs) in patients with epilepsy can be categorized as dissociative disorders. The prevalence of PNESs in patients with epilepsy appears to be much higher than that of dissociative experiences in nonclinical subjects. In order to clarify as to whether epilepsy-related factors were associated with pathological dissociation, we conducted a controlled study with 225 patients with epilepsy and 334 nonclinically matched individuals. All participants completed the Japanese version of the Dissociative Experiences Scale (DES). There was no significant difference in the DES score (DES-S) between the group with epilepsy and the control group. The group with epilepsy showed a significantly higher DES taxon (DES-T; a subset of DES-S and an index of pathological dissociation) than the control group. Thirty-one out of the 225 patients with epilepsy (13.8%) had PNESs. Because of its strong association with the DES-S and DES-T, PNESs can be regarded as a symptom of dissociation. With multiple regression analysis, the patients with a shorter duration of epilepsy, higher seizure frequency, or shorter period in education tend to suffer from pathological dissociation. These findings demonstrate that patients with epilepsy are more prone to experiencing pathological dissociation when having certain clinical factors.

siRNA delivery into tumor cells by cationic cholesterol derivative-based nanoparticles and liposomes.

Previously, we reported that cationic nanoparticles (NP) composed of diamine-type cholesteryl-3-carboxamide (OH-Chol, N-(2-(2-hydroxyethylamino)ethyl)cholesteryl-3-carboxamide) and Tween 80 could deliver small interfering RNA (siRNA) with high transfection efficiency into tumor cells. In this study, we synthesized new diamine-type cationic cholesteryl carbamate (OH-C-Chol, cholesteryl (2-((2-hydroxyethyl)amino)ethyl)carbamate) and triamine-type carbamate (OH-NC-Chol, cholesteryl (2-((2-((2-hydroxyethyl)amino)ethyl)amino)ethyl)carbamate), and prepared cationic nanoparticles composed of OH-C-Chol or OH-NC-Chol with Tween 80 (NP-C and NP-NC, respectively), as well as cationic liposomes composed of OH-C-Chol or OH-NC-Chol with 1,2-dioleoyl-sn-glycero-3-phosphoethanolamine (DOPE) (LP-C and LP-NC, respectively) for evaluation of their possible use as siRNA delivery vectors. LP-C and LP-NC/siRNA complexes (lipoplexes) exhibited larger gene silencing effects than NP-C and NP-NC/siRNA complexes (nanoplexes), respectively, in human breast tumor MCF-7 cells, although the NP-C nanoplex showed high association with the cells. In particular, LP-NC lipoplex could induce strong gene suppression, even at a concentration of 5 nM siRNA. From these results, cationic liposomes composed of OH-NC-Chol and DOPE may have potential as gene vectors for siRNA transfection to tumor cells.

Suicide attempts in adult patients with idiopathic generalized epilepsy.

AIMS: To study clinical features of adult patients with idiopathic generalized epilepsy with special attention to suicidal behavior. METHODS: We reviewed the medical records of 145 consecutive adult patients with electro-clinically confirmed idiopathic generalized epilepsy and identified those with a history of at least one attempted suicide. Clinical variables in relation to their epilepsy and psychiatric conditions were analyzed. RESULTS: Seven patients (4.8%) had a history of suicide attempts with drug overdose, and one of these patients committed suicide after multiple attempts. All attempts were made interictally without direct relation to their epileptic seizures. All had at least one co-morbid mental disorder (two with dual diagnosis). Although their psychiatric diagnoses varied, they all appeared to have increased emotional instability and poor impulse control. Only one patient's attempt was directly associated with her co-morbid depression. CONCLUSIONS: Physicians managing people with epilepsies should be aware of psychiatric disturbances and suicidal behavior in idiopathic generalized epilepsy.

Hippocampal and amygdalar volumes in breast cancer survivors with posttraumatic stress disorder.

Although smaller hippocampi and amygdalae were found in cancer survivors with intrusions, associations between cancer-related posttraumatic stress disorder (PTSD) and these volumes are unknown. The authors performed MRI volumetric analyses of these regions in 15 cancer survivors with PTSD, 15 cancer survivors without PTSD, and 15 healthy comparison subjects. The authors also examined the correlation between PTSD symptom scores of the Impact of Event Scale and these volumes in the PTSD group. These volumes were not significantly different among the groups, but the intrusion score was inversely associated with the hippocampal volume. Results suggest intrusions, not PTSD diagnosis, might be associated with hippocampal volume.

Psychiatric comorbidity in adult patients with idiopathic generalized epilepsy.

We reviewed the medical records of 157 adult (18 years) patients with firmly diagnosed idiopathic generalized epilepsy (IGE) to investigate the extent and the type of psychiatric comorbidity and its relationship to various IGE syndromes and other epilepsy-related neurobiological factors. Forty-one patients (26.1%, 14 men and 27 women, median age: 34.0 years, range: 18-68, mean: 36.5) had comorbid mental disorders according to the 10th revision of the International Classification of Diseases (ICD-10) criteria, with four patients having a dual diagnosis. Mood disorders were the most common comorbid mental disorder (46.7%), followed by anxiety-panic disorder (26.7%). Comorbid psychiatric disorders occurred in all syndromes and in association with all seizure types, and, as in focal epilepsies, seizure control was significantly better in patients without psychiatric comorbidity (40.5% vs 19.5%, chi(2)(1)=5.873, P=0.015).

Structure of orbitofrontal cortex and its longitudinal course in cancer-related post-traumatic stress disorder.

The neurobiological basis of cancer-related post-traumatic stress disorder (PTSD) has never been studied. We investigated brain structural alterations and the longitudinal courses in patients with cancer-related PTSD. Baseline scans using magnetic resonance imaging were performed in 14 cancer survivors with PTSD, 100 without PTSD, and 70 healthy subjects. Follow-up scans were performed 2 years later in 76 cancer survivors (PTSD, n=9; non-PTSD, n=67). Using voxel-based morphometry, the gray matter volume (GMV) of the cancer survivors with PTSD was compared with the GMVs of those without PTSD and of the healthy subjects. The effects of the interactions between the diagnosis and the timing of the GMV measurements were examined. The GMV of the right orbitofrontal cortex (OFC) was significantly smaller in cancer survivors with PTSD than in those without PTSD or healthy subjects. The interaction between the diagnosis and the timing of the right OFC's GMV measurement was not significant. The OFC, which is thought to be involved in the extinction of fear conditioning and the retrieval of emotional memory, might play an important role in the pathophysiology of PTSD. Moreover, the OFC's GMV may remain constant after the development of cancer-related PTSD.

Cavum septi pellucidi and intrusive recollections in cancer survivors.

A previous study reported abnormally large cavum septi pellucidi (CSP) in posttraumatic stress disorder (PTSD). We utilized magnetic resonance imaging to examine the frequency of large CSP, as defined by Nopoulos et al. (1997), in cancer survivors with and without intrusive recollections in a sample identical to that of our previous study. The frequency of large CSP did not differ between the two groups. The results suggest that alteration in midline structures during the course of neurodevelopment may lead to severe PTSD, while subthreshold PTSD, such as intrusive recollections, appear not to be associated with such alterations.