Levels of diagnostic certainty for nonepileptic attack disorder in the neuropsychiatry setting.

Nonepileptic attack disorder (NEAD) is a medical condition commonly seen in neuropsychiatry services, often as a differential diagnosis of other neuropsychiatric conditions. Recommendations by the International League Against Epilepsy (ILAE) Nonepileptic Seizures Task Force propose a four-level hierarchical approach to the diagnosis of NEAD, based on history, witnessed event, and electroencephalographic (EEG) investigation. We set out to provide the first description of the diagnostic levels of patients with NEAD at a specialist neuropsychiatry clinic. Comprehensive clinical data from 148 consecutive patients with NEAD attending the specialist Neuropsychiatry Clinic run by a single Consultant in Behavioral Neurology were retrospectively reviewed. Patients with NEAD were primarily referred to neuropsychiatry by Consultant Neurologists (n = 94; 63.5%). The majority of patients were female (n = 108; 73.0%), with a disease duration of 7.9 years (standard deviation: 10.4). Anxiety was the most common comorbidity (n = 43; 26.7%). Categorization of patients according to the ILAE Nonepileptic Seizures Task Force criteria was mainly based on clinical features and EEG findings, as only 7 (4.7%) patients had attacks witnessed by a specialist. The largest diagnostic categories were 'possible' (n = 54; 36.5%) and 'clinically established' (n = 40; 27.0%), followed by 'documented' (n = 12; 8.1%) and 'probable' (n = 5; 3.4%). In 125 patients (84.4%), EEGs were performed. Selective serotonin reuptake inhibitors were the most frequently prescribed psychotropic medications (n = 48; 32.4%); 89 patients (60.1%) received behavioral therapy. There were no differences in pharmacological or behavioral management strategies across the patients categorized under different diagnostic levels. Patients with NEAD seen within neuropsychiatry settings are mainly assigned 'possible' and 'clinically established' levels of diagnostic certainty. Difficulty in capturing typical clinical events witnessed by an experienced clinician while on video-EEG can limit the clinical application of the 'documented' diagnostic level. If appropriate, active interventions can be implemented irrespective of diagnostic levels to minimize delays in the neuropsychiatric care pathways.

Deep brain stimulation: new possibilities for the treatment of mental disorders. / Gleboka stymulacja mózgu (Deep Brain Stimulation) ­ nowe mozliwosci leczenia zaburzen psychicznych.

Deep brain stimulation (DBS) is a treatment method that is currently getting more and more attention from psychiatrists. It has proven to be efficacious and safe in the treatment of neurological disorders, mainly Parkinson's disease (PD), dystonia and essential tremor. DBS has very often contributed to successful treatment in cases that had proved resistant to all other methods of treatment. Nowadays treatment-resistant obsessive-compulsive disorder (OCD) is the main psychiatric indication for DBS. Many studies have focused on assessing the efficacy and safety of this method in different mental disorders, including depressive disorders, Alzheimer's disease, anorexia nervosa, Tourette syndrome, substance addiction or aggressive behaviors. Single cases of successful treatment in bipolar disorder, schizophrenia and post-traumatic stress disorder have also emerged in recent years. In this review the current state of knowledge on the applicability of DBS in psychiatry is presented, based on the available systematic reviews, clinical trials and case studies, as well as on neurophysiological and neuroimaging data.

[Interest of extrahospital multidisciplinary unit of neuro-psycho-geriatric intervened in nursing home: Analysis of 288 interventions]. / Intérêt d'une unité mobile multidisciplinaire extra-hospitalière de neuro-psychogériatrie intervenant en EHPAD : analyse de 288 interventions.

INTRODUCTION: Geriatrics Mobile Units are a new organisation operating in nursing homes. Their mission is to propose globally oriented neuro-psychiatric and geriatric care. The purpose of the study is to assess their activity and impact over a 21-month period. METHOD: A prospective single center study of UMNPG's data including intervention characteristics, patient characteristics, recommendations and reassessment after intervention. The Neuropsychiatric Inventory Nursing Home version (NPI-NH) was measured during intervention and reassessed after 30 days (Student's t-test). RESULTS: From March 2014 to December 2015, UMNPG conducted 288 interventions mainly for medical advices (81%), clinical assessments (54%) and health care team support (46%). The average age was 84.6±7.3years, 73.3% of whom were women. The patients were dependent (62% of GIR 1 or 2) with dementia (60%) and under several medications (83.7%). The symptoms were mainly agitation/aggression (76.4%), anxiety (75%), depression (66.7%), irritability (60.4%), aberrant motor behaviour (55.9%) and delusions (48.6%). The main proposals of UMNPG were a change in treatment (79.5%), a health care team support (85.4%) and hospitalization (8.4%). The rate of follow-up on recommendation was 83% on the 15th day and 80% on the 30th day. The rate of avoided hospitalizations was 16%. The average NPI-NH decreased (on day 0 NPI=50±19.2; on day 30 NPI=33.9±19.6, p<0.001). CONCLUSION: UMNPG-EHPAD intervenes for frail elderly residents with multiple disorders in crisis situations. Medical recommendations help to support people in nursing homes and decrease NPI-NH. UMNPG-EHPAD is part of geriatric network strengthening the city/hospital connection.

Editorial. / Od Redakcji.

no summary.

Relevance of Rodent Models of Depression in Clinical Practice: Can We Overcome the Obstacles in Translational Neuropsychiatry?

The diagnosis of a mental disorder generally depends on clinical observations and phenomenological symptoms reported by the patient. The definition of a given diagnosis is criteria based and relies on the ability to accurately interpret subjective symptoms and complex behavior. This type of diagnosis comprises a challenge to translate to reliable animal models, and these translational uncertainties hamper the development of new treatments. In this review, we will discuss how depressive-like behavior can be induced in rodents, and the relationship between these models and depression in humans. Specifically, we suggest similarities between triggers of depressive-like behavior in animal models and human conditions known to increase the risk of depression, for example exhaustion and bullying. Although we acknowledge the potential problems in comparing animal findings to human conditions, such comparisons are useful for understanding the complexity of depression, and we highlight the need to develop clinical diagnoses and animal models in parallel to overcome translational uncertainties.

Clinically useful brain imaging for neuropsychiatry: How can we get there?

Despite decades of research, visions of transforming neuropsychiatry through the development of brain imaging-based "growth charts" or "lab tests" have remained out of reach. In recent years, there is renewed enthusiasm about the prospect of achieving clinically useful tools capable of aiding the diagnosis and management of neuropsychiatric disorders. The present work explores the basis for this enthusiasm. We assert that there is no single advance that currently has the potential to drive the field of clinical brain imaging forward. Instead, there has been a constellation of advances that, if combined, could lead to the identification of objective brain imaging-based markers of illness. In particular, we focus on advances that are helping to (1) elucidate the research agenda for biological psychiatry (e.g., neuroscience focus, precision medicine), (2) shift research models for clinical brain imaging (e.g., big data exploration, standardization), (3) break down research silos (e.g., open science, calls for reproducibility and transparency), and (4) improve imaging technologies and methods. Although an arduous road remains ahead, these advances are repositioning the brain imaging community for long-term success.

Cambio de régimen, cambio de paradigma / Regime change, paradigm shift

No disponible

[The problem of small "n" and big "P" in neuropsycho-pharmacology, or how to keep the rate of false discoveries under control]. / A kis "n", nagy "P" probléma a neuropszichofarmakológiában, avagy hogyan kontrolláljuk a hamis felfedezések arányát.

One of the characteristics of many methods used in neuropsychopharmacology is that a large number of parameters (P) are measured in relatively few subjects (n). Functional magnetic resonance imaging, electroencephalography (EEG) and genomic studies are typical examples. For example one microarray chip can contain thousands of probes. Therefore, in studies using microarray chips, P may be several thousand-fold larger than n. Statistical analysis of such studies is a challenging task and they are refereed to in the statistical literature such as the small "n" big "P" problem. The problem has many facets including the controversies associated with multiple hypothesis testing. A typical scenario in this context is, when two or more groups are compared by the individual attributes. If the increased classification error due to the multiple testing is neglected, then several highly significant differences will be discovered. But in reality, some of these significant differences are coincidental, not reproducible findings. Several methods were proposed to solve this problem. In this review we discuss two of the proposed solutions, algorithms to compare sets and statistical hypothesis tests controlling the false discovery rate.

Leucoencefalopatía hipóxica tardía tras autointoxicación; del abordaje psiquiátrico al neurológico / Delayed hypoxic leukoencephalopathy after autointoxication, from the psychiatric approach to neurological

La Leucoencefalopatía Hipóxica Tardía es un proceso poco frecuente y de patogenia aun desconocida en el que se describe la aparición de sintomatología confusional y deterioro cognitivo agudo tras un periodo de 2 a 10 días de aparente recuperación completa de la hipoxia. En algunos casos ha sido notificada a su vez sintomatología psiquiátrica aguda entre la que destaca apatía, ansiedad e incluso el desarrollo de psicosis. Clásicamente asociada a intoxicaciones por monóxido de carbono también se han descrito episodios secundarios a autointoxicaciones con tóxicos y psicofármacos que cursan con hipotensiones prolongadas. La bibliografía y el número de casos publicados son realmente escasos. En las presentes notas clínicas se recoge la evidente excepcionalidad, en el plazo de cuatro años, de dos pacientes con un trastorno mental previo que ingresan en la Unidad de Hospitalización Psiquiátrica de Agudos tras una autointoxicación. Desde una perspectiva psiquiátrica se desarrolla el concepto de esta desconocida entidad clínica al tiempo que se describe el inevitable paso desde el abordaje psiquiátrico al neurológico (AU)

is a rare and still unknown pathogenesis process that provokes the appearance of acute confusional symptomatology and cognitive deterioration after a period of 2 to 10 days of apparent complete recovery from hypoxia. In some cases, acute psychiatric symptoms, including apathy, anxiety and even the development of psychosis, have been observed. Mainly associated with carbon monoxide poisoning, these symptoms have also been found as secondary to self-poisoning with toxic and psychotropic drugs that cause prolonged hypotensive episodes. The number of published cases and the literature on the subject is really scanty. The rare case, within four years, of two patients with a prior mental disorder who entered Psychiatric Inpatients Unit after autointoxication, is collected in these clinical notes. They develop, from a psychiatric perspective, the concepts of this unknown clinic entity and the inevitable passage from the psychiatric approach to neurological (AU)

Suboptimal decision making in borderline personality disorder: effect of potential losses

This research explored the underlying processes mediating risky decisions for individuals with Borderline Personality Disorder (BPD). We tested whether BPD patients were more apt to take risks compared to a matched comparison group. We used two controlled tasks designed to assess risky decision-making, both to achieve gains and to avoid losses. Overall, BPD patients showed increased risk-taking compared to the comparison group (p = .011, η2 = .224), and were especially likely to be risk-seeking when the decision was framed as a potential loss (p < .0001, d = 1.77). When the outcome involved pure losses, BPD patients were insensitive to the relative expected value between choice options resulting in suboptimal decision making (p = .004, d = 1.24), but did not differ from the comparison group when taking risks to achieve gains (p = .603, d = 0.21). We discuss these results in the context of behavioral and neuropsychiatric research suggesting abnormalities BPD patients’ ability to effectively regulate affect (AU)

No disponible

Movimientos de seguimiento ocular lento y esquizofrenia: revisión de la literatura / Smooth pursuit eye movements and schizophrenia: Literature review

OBJETIVO: Revisar la literatura científica sobre la relación entre las alteraciones en los movimientos oculares de seguimiento lento y la esquizofrenia. MÉTODOS: Revisión narrativa de la literatura que incluye artículos históricos, reportes sobre investigación básica y clínica, revisiones sistemáticas y meta-análisis sobre el tema. RESULTADOS: Hasta el 80% de los pacientes con esquizofrenia tienen alteraciones en los movimientos de seguimiento ocular lento. A pesar de la diversidad de protocolos de evaluación, el 65% de los pacientes y de los controles son clasificados correctamente por su rendimiento global durante dicho seguimiento. Los movimientos de seguimiento ocular lento dependen de la capacidad de anticipar la velocidad del blanco y de la retroalimentación visual, así como del aprendizaje y la atención. La neuroanatomía implicada en el seguimiento lento se superpone en alguna medida con la de ciertas zonas de la corteza frontal relacionadas con algunas características clínicas y neuropsicológicas de la esquizofrenia, de modo que algunos aspectos específicos de la alteración en el seguimiento lento podrían servir como biomarcadores de la enfermedad. Como consecuencia de su acción sedante, los antipsicóticos tienen un efecto deletéreo sobre los movimientos de seguimiento ocular lento, por lo que dichos movimientos no pueden usarse para valorar la eficacia de los fármacos disponibles en la actualidad. CONCLUSIÓN: La evaluación estandarizada de los movimientos de seguimiento ocular lento en la esquizofrenia permitirá utilizar aspectos específicos de dicho seguimiento como biomarcadores para el estudio de su genética, psicopatología o neuropsicología

OBJECTIVE: To review the scientific literature about the relationship between impairment on smooth pursuit eye movements and schizophrenia. METHODS: Narrative review that includes historical articles, reports about basic and clinical investigation, systematic reviews, and meta-analysis on the topic. RESULTS: Up to 80% of schizophrenic patients have impairment of smooth pursuit eye movements. Despite the diversity of test protocols, 65% of patients and controls are correctly classified by their overall performance during this pursuit. The smooth pursuit eye movements depend on the ability to anticipate the target's velocity and the visual feedback, as well as on learning and attention. The neuroanatomy implicated in smooth pursuit overlaps to some extent with certain frontal cortex zones associated with some clinical and neuropsychological characteristics of the schizophrenia, therefore some specific components of smooth pursuit anomalies could serve as biomarkers of the disease. Due to their sedative effect, antipsychotics have a deleterious effect on smooth pursuit eye movements, thus these movements cannot be used to evaluate the efficacy of the currently available treatments. CONCLUSION: Standardized evaluation of smooth pursuit eye movements on schizophrenia will allow to use specific aspects of that pursuit as biomarkers for the study of its genetics, psychopathology, or neuropsychology

Editorial: Illuminating the dark matter of developmental neuropsychiatric genetics - strategic focus for future research in child psychology and psychiatry.

Research on genetic factors influencing cognitive and behavioural traits or which are central to the aetiology of neuropsychiatric diseases has been complicated by a furtive discrepancy between high heritability estimates and a scarcity of replicable gene-disorder associations. This 'missing heritability' has been either euphemised as the 'dark matter' of gene-trait association or aggravated as the 'looming crisis in behavioural genetics'. Nevertheless, in recognising the importance of this topic for our understanding of child psychiatric conditions and highlighting its commitment to the field, the Journal of Child Psychology and Psychiatry (JCPP) has for the first time appointed an editor with special responsibility for molecular (epi)genetics.

Proceso creativo, arte y psicopatología / Creative process, art and psycopathology

Se presenta una reflexión sobre el proceso creativo y sus manifestaciones psicopatológicas en artistas. Se intenta responder a las siguientes preguntas: 1) ¿Existe relación entre el proceso creativo y la “locura”? 2) ¿Hasta qué punto los artistas y los genios son (están) “locos”? 3) ¿Podemos conocer la psicopatología de los artistas a través de sus producciones artísticas? 4) ¿Puede diferenciarse la angustia neurótica de la psicótica en los cuadros y creaciones artísticas? Por último se analizan textos y obras creativas que apoyan dichas reflexiones (AU)

This article presents a reflection on the creative process and its psychopathologycal manifestations in artists. It seeks to answer the following questions: 1) Is there any relationship between the creative process and “madness”?2) Up to what point are artists and geniuses “mad”? 3) Can we know the artists’ psychopathology through their artistic productions? 4) Is it possible to differentiate the psychotic’s neurotic distress in pictures and other artistic creations? Finally, creative texts and creative works are analyzed in order to support these reflections (AU)

Delirio de Clerambault: entre un deseo de amor irreductible y la atenuación de un delirio erotomaníaco. Respuesta clínica con neuroléptico de liberació prolongada. A propósito de un caso / Clerambault’s delusion: between a desire of uncompromising love and the attenuation of a erotomanic delusion. Clinical response with neuroleptic of long liberation. A case report

El delirio erotomaníaco se menciona desde la época griega. Es en el siglo XIX, con Clerambault, cuando se hace una descripción más exhaustiva de esta ideación delirante crónica de ser amado. Existen pocos estudios descriptivos y generalmente se trata de casos aislados. En este trabajo se relata de forma detallada el seguimiento prolongado de una paciente con un delirio erotomaníaco; realizando especial incidencia en la complejidad de su diagnóstico y abordaje terapéutico (AU)

The erotomania delusion is mentioned from the greek era. It was in the nineteenth century, with Clerambault, when is done a more exhaustive description of this chronic delusional ideation of being loved. There are a few descriptive studies and usually these are isolated cases. In this work is recounted in detail the long follow up of a patient with erotomania delusion; making special incidence in the complexity of its diagnostic and therapeutic approach (AU)

Análisis psicodinámico breve en un caso de dependencia del alcohol / Brief Psychodynamic analysis in a case of alcohol dependence

Se presenta el caso de un paciente masculino de 41 años de edad diagnosticado con dependencia del alcohol, con el objetivo de elaborar un juicio diagnóstico y pronóstico desde el punto de vista psicodinámico, y descubrir, en la medida de lo posible, “quién” es el paciente, qué desarrollo vital le ha llevado a ser lo que actualmente es y derivando de esta concepción, qué sentido tiene su “enfermar” (AU)

We report a case of a client diagnosed of alcohol dependence with the aim of developing a psychodynamic approach to study his diagnosis and prognosis. In addition, we pretend to address “who” is the patient, the biographic development that led him to have his current “self” and, in relation with this concept, to what extent his mental disorder is related with the whole biographical picture (AU)