Promoting Growth in Behavioral Neurology: A Path Forward.

Behavioral neurology & neuropsychiatry (BNNP) is a field that seeks to understand brain-behavior relationships, including fundamental brain organization principles and the many ways that brain structures and connectivity can be disrupted, leading to abnormalities of behavior, cognition, emotion, perception, and social cognition. In North America, BNNP has existed as an integrated subspecialty through the United Council for Neurologic Subspecialties since 2006. Nonetheless, the number of behavioral neurologists across academic medical centers and community settings is not keeping pace with increasing clinical and research demand. In this commentary, we provide a brief history of BNNP followed by an outline of the current challenges and opportunities for BNNP from the behavioral neurologist's perspective across clinical, research, and educational spheres. We provide a practical guide for promoting BNNP and addressing the shortage of behavioral neurologists to facilitate the continued growth and development of the subspecialty. We also urge a greater commitment to recruit trainees from diverse backgrounds so as to dismantle persistent obstacles that hinder inclusivity in BNNP-efforts that will further enhance the growth and impact of the subspecialty. With rapidly expanding diagnostic and therapeutic approaches across a range of conditions at the intersection of neurology and psychiatry, BNNP is well positioned to attract new trainees and expand its reach across clinical, research, and educational activities.

The Neuropsychiatry Of Acquired Brain Injury

The psychiatric syndromes derived from acquired brain injury are the behaviouralconsequences of the combination of cognitive,emotional and volitional sequelae. Theirimpact on the quality of life of patients andrelatives is far greater tan the impact ofmotor or sensory deficit. The descriptionof these behavioural presentations and anattempt to understand the formation of thesymptoms will be undertaken. Changes inawareness, empathy, emotional recognitionand regulation are important mediating factors.Behavioural changes mainly take theform of disinhibition or apathy. Psychoticsyndromes, major depression or bipolar disordersare rare. Some delusional ideas respondto changes in the perception of noveltyor to changes in body perception. (AU)

Los síndromes psiquiátricos y los cambios conductuales que se derivan del daño cerebralson las consecuencias de la combinaciónde las alteraciones volitivas, emocionales ycognitivas. El impacto en la calidad de vidade los pacientes y de sus familiares es significativamentemayor que el impacto de las secuelasmotoras o sensoriales. En este artículose aborda la descripción de estos trastornosneuropsiquiátricos y se propone un acercamientoa la comprensión de cómo se gestan.Los cambios en conciencia de situación, empatía,reconocimiento y regulación emocionalson factores mediadores importantes enla formación de los síntomas. Los cambiosconductuales se presentan principalmente enforma de apatía o desinhibición. Los síndromespsicóticos, los trastornos bipolares o ladepresión mayor son muy poco frecuentes.Por otro lado, las ideas delirantes respondena cambios en la percepción de la novedad/familiaridad de los estímulos o a cambios enla percepción del cuerpo que ocurren tras lesionesdel hemisferio derecho. (AU)

Neurology and neuropsychiatry of COVID-19: a systematic review and meta-analysis of the early literature reveals frequent CNS manifestations and key emerging narratives.

There is accumulating evidence of the neurological and neuropsychiatric features of infection with SARS-CoV-2. In this systematic review and meta-analysis, we aimed to describe the characteristics of the early literature and estimate point prevalences for neurological and neuropsychiatric manifestations.We searched MEDLINE, Embase, PsycINFO and CINAHL up to 18 July 2020 for randomised controlled trials, cohort studies, case-control studies, cross-sectional studies and case series. Studies reporting prevalences of neurological or neuropsychiatric symptoms were synthesised into meta-analyses to estimate pooled prevalence.13 292 records were screened by at least two authors to identify 215 included studies, of which there were 37 cohort studies, 15 case-control studies, 80 cross-sectional studies and 83 case series from 30 countries. 147 studies were included in the meta-analysis. The symptoms with the highest prevalence were anosmia (43.1% (95% CI 35.2% to 51.3%), n=15 975, 63 studies), weakness (40.0% (95% CI 27.9% to 53.5%), n=221, 3 studies), fatigue (37.8% (95% CI 31.6% to 44.4%), n=21 101, 67 studies), dysgeusia (37.2% (95% CI 29.8% to 45.3%), n=13 686, 52 studies), myalgia (25.1% (95% CI 19.8% to 31.3%), n=66 268, 76 studies), depression (23.0% (95% CI 11.8% to 40.2%), n=43 128, 10 studies), headache (20.7% (95% CI 16.1% to 26.1%), n=64 613, 84 studies), anxiety (15.9% (5.6% to 37.7%), n=42 566, 9 studies) and altered mental status (8.2% (95% CI 4.4% to 14.8%), n=49 326, 19 studies). Heterogeneity for most clinical manifestations was high.Neurological and neuropsychiatric symptoms of COVID-19 in the pandemic's early phase are varied and common. The neurological and psychiatric academic communities should develop systems to facilitate high-quality methodologies, including more rapid examination of the longitudinal course of neuropsychiatric complications of newly emerging diseases and their relationship to neuroimaging and inflammatory biomarkers.

Neuropsychiatrie symptoms as the only acute manifestation of a stroke in the left hemisphere. Case report / Alteraciones neuropsiquiátricas como única manifestación de accidente cerebrovascular en hemisferio izquierdo. Reporte de caso

ABSTRACT We report the case of a 60-year-old female patient with a history of hypertension and dyslipidemia, who suddenly presented with a clinical picture of emotional lability, disorientation, complex visual hallucinations and persecutory delusions. There were no associated neurological findings in her initial physical examination. At a local hospital she was initially diagnosed with late-onset bipolar disorder and a manic episode with psychotic features, then referred to the mental health unit, where nuclear magnetic resonance (NMR) imaging of the brain revealed an acute ischemic stroke in the territory of the left posterior cerebral artery (PCA) with haemorrhagic reperfusion to the occipital cortex. Complete and spontaneous resolution of her clinical condition was achieved after approximately 15 days.

RESUMEN Se presenta el reporte de caso de una mujer de 60 anos de edad con antecedente de hipertensión arterial y dislipidemia, quien presenta cuadro clínico de inicio súbito consistente en labilidad emocional, desorientación alopsíquica global, alucinaciones visuales complejas e ideación delirante de tipo persecutorio, sin hallazgos neurológicos asociados en el examen físico inicial. Se enfocó en hospital local como un trastorno bipolar de inicio tardío con episodio actual maníaco con características psicóticas y es remitida a unidad de salud mental. Posteriormente hallazgos de resonancia magnética nuclear (RMN) cerebral revelaron una lesión correspondiente a ataque cerebrovascular (ACV) isquémico agudo en territorio de la arteria cerebral posterior (ACP) izquierda con reperfusión hemorrágica a nivel de corteza occipital. Se alcanzó una resolución espontánea completa de su cuadro clínico en un curso aproximado de 15 días.

Minireview on the Connections between the Neuropsychiatric and Dental Disorders: Current Perspectives and the Possible Relevance of Oxidative Stress and Other Factors.

Although the connections between neuropsychiatric and dental disorders attracted the attention of some research groups for more than 50 years now, there is a general opinion in the literature that it remains a clearly understudied and underrated topic, with many unknowns and a multitude of challenges for the specialists working in both these areas of research. In this way, considering the previous experience of our groups in these individual matters which are combined here, we are summarizing in this minireport the current status of knowledge on the connections between neuropsychiatric and dental manifestations, as well as some general ideas on how oxidative stress, pain, music therapy or even irritable bowel syndrome-related manifestations could be relevant in this current context and summarize some current approaches in this matter.

Wearable devices for seizure detection: Is it time to translate into our clinical practice?

With the exponential development of mobile health technologies over the past ten years, there has been a growing interest in the potential applications in the field of epilepsy, and specifically for seizure detection. Better detection of seizures is probably one of the best ways to improve patient safety. Overall, we are observing an exponential increase in the number of non-EEG based seizure detection systems and a progressive homogenization of their evaluation procedures. Most importantly, the properties of these devices for detection of tonic-clonic seizures are now very interesting, both in terms of sensitivity and in terms of false-alarm rates. Accordingly, we might expect that these be used in clinical practice in the near future, especially in patients at high risk of seizure-related injuries or sudden unexpected death in epilepsy (SUDEP).

Deconstructing eye contact perception: Measuring perceptual precision and self-referential tendency using an online psychophysical eye contact detection task.

Eye contact perception-the ability to accurately and efficiently discriminate others' gaze directions-is critical to understanding others and functioning in a complex social world. Previous research shows that it is affected in multiple neuropsychiatric disorders accompanied by social dysfunction, and understanding the cognitive processes giving rise to eye contact perception would help advance mechanistic investigations of psychopathology. This study aims to validate an online, psychophysical eye contact detection task through which two constituent cognitive components of eye contact perception (perceptual precision and self-referential tendency) can be derived. Data collected from a large online sample showed excellent test-retest reliability for self-referential tendency and moderate reliability for perceptual precision. Convergence validity was supported by correlations with social cognitive measures tapping into different aspects of understanding others. Hierarchical regression analyses revealed that perceptual precision and self-referential tendency explained unique variance in social cognition, suggesting that they measure unique aspects of related constructs. Overall, this study provided support for the reliability and validity of the eye contact perception metrics derived using the online Eye Contact Detection Task. The value of the task for future psychopathology research was discussed.

A framework for the investigation of rare genetic disorders in neuropsychiatry.

De novo and inherited rare genetic disorders (RGDs) are a major cause of human morbidity, frequently involving neuropsychiatric symptoms. Recent advances in genomic technologies and data sharing have revolutionized the identification and diagnosis of RGDs, presenting an opportunity to elucidate the mechanisms underlying neuropsychiatric disorders by investigating the pathophysiology of high-penetrance genetic risk factors. Here we seek out the best path forward for achieving these goals. We think future research will require consistent approaches across multiple RGDs and developmental stages, involving both the characterization of shared neuropsychiatric dimensions in humans and the identification of neurobiological commonalities in model systems. A coordinated and concerted effort across patients, families, researchers, clinicians and institutions, including rapid and broad sharing of data, is now needed to translate these discoveries into urgently needed therapies.

Placental programming of neuropsychiatric disease.

The placenta is vital for fetal growth, and compromised function is associated with abnormal development, especially of the brain. Linking placental function to brain development is a new field we have dubbed neuroplacentology. Approximately 380,000 infants in the United States each year abruptly lose placental support upon premature birth, and more than 10% of pregnancies are affected by more insidious placental dysfunction such as preeclampsia or infection. Abnormal fetal brain development or injury can lead to life-long neurological impairments, including psychiatric disorders. The majority of research connecting placental compromise to fetal brain injury has focused on gas exchange or nutritional programming, neglecting the placenta's essential neuroendocrine role. We will review the current evidence that placental dysfunction, particularly endocrine dysfunction, secretion of pro-inflammatory cytokines, or barrier breakdown may place many thousands of fetuses at risk for life-long neurodevelopmental impairments each year. Understanding how specific placental factors shape brain development and increase the risk for later psychiatric disorders, including autism, attention deficit disorder, and schizophrenia, paves the way for novel treatment strategies to maintain the normal developmental milieu and protect from further injury.

Frank Beach Award Winner - The future of mental health research: Examining the interactions of the immune, endocrine and nervous systems between mother and infant and how they affect mental health.

Pregnancy and the postpartum period are periods of significant change in the immune and endocrine systems. This period of life is also associated with an increased risk of mental health disorders in the mother, and an increased risk of developmental and neuropsychiatric disorders in her infant. The collective data described here supports the idea that peripartum mood disorders in mother and developmental disorders in her infant likely reflects multiple pathogeneses, stemming from various interactions between the immune, endocrine and nervous systems, thereby resulting in various symptom constellations. In this case, testing the mechanisms underlying specific symptoms of these disorders (e.g. deficits in specific types of learning or anhedonia) may provide a better understanding of the various physiological interactions and multiple etiologies that most likely underlie the risk of mental health disorders during this unique time in life. The goal here is to summarize the current understanding of how immune and endocrine factors contribute to maternal mental health, while simultaneously understanding the impact these unique interactions have on the developing brain of her infant.

Assessment of Cognitive Training & Social Interaction in People with Mild to Moderate Dementia: A Pilot Study.

Objectives: To evaluate the cognitive, neuropsychiatric, and quality of life outcomes of computer-based cognitive training and social interaction on people with mild to moderate dementia. Methods: Ten individuals with dementia were recruited to complete a cognitive training regimen. They were randomly assigned to a high social interaction (HSI) group (n = 5) and low social interaction (LSI) group (n = 5). Eight of the original 10 participants completed the cognitive training and were evaluated on cognitive abilities, neuropsychiatric symptoms (NPS), and quality of life (QoL). Results: Mean scores for the HSI group increased on cognitive assessments, where mean scores for the LSI group saw decline, or stability. There was an overall reduction in the frequency and severity of NPS presentation in both the HSI and LSI group. Mixed results were found for mean changes in QoL. Discussion: These results support the idea of social interaction influencing cognitive outcomes, cognitive training influencing NPS, and both social interaction and cognitive training influencing QoL. The findings illustrate the feasibility and importance of incorporating social activity to computerized cognitive training for people with dementia. Clinical Implications: Cognitive training that incorporates social interaction may be a promising intervention for individuals with dementia experiencing NPS.

Orexin receptor antagonists for the treatment of insomnia and potential treatment of other neuropsychiatric indications.

In this review, we outline the role of orexin receptor antagonists in disorders of sleep/wake and other potential neuropsychiatric conditions, with a focus on suvorexant, which is currently the only approved agent in this class. The efficacy of suvorexant was established in Phase 2-3 trials with treatment durations ranging from 1 to 12 months in patients with insomnia. Suvorexant is effective at improving sleep assessed by patient self-report and by polysomnography, with generally little effect on underlying sleep architecture. The main side-effect is next day somnolence. With the growing realization of the important connections between sleep and other disorders, studies are ongoing to explore this novel mechanism in other disorders such as Alzheimer's disease and depression.

Brain-based treatment-A new approach or a well-forgotten old one?

For a relatively long period of time, mental functioning was mainly associated with personal profile while brain functioning went by the wayside. After the 90s of the 20th century, or the so called "Decade of the Brain", today, contemporary specialists work on the boundary between fundamental science and medicine. This brings neuroscience, neuropsychology, psychiatry, and psychotherapy closer to each other. Today, we definitely know that brain structures are being built and altered thanks to experience. Psychotherapy can be more effective when based on a neuropsychological approach-this implies identification of the neural foundations of various disorders and will lead to specific psychotherapeutic conclusions. The knowledge about the brain is continually enriched, which leads to periodic rethinking and updating of the therapeutic approaches to various diseases of the nervous system and brain dysfunctions. The aim of translational studies is to match and combine scientific areas, resources, experience and techniques to improve prevention, diagnosis and therapies, and "transformation" of scientific discoveries into potential treatments of various diseases done in laboratory conditions. Neuropsychological studies prove that cognition is a key element that links together brain functioning and behaviour. According to Dr. Kandel, all experimental events, including psychotherapeutic interventions, affect the structure and function of neuronal synapses. The story of why psychotherapy works is a story of understanding the brain mechanisms of psychic processes, a story of how the brain has been evolving to ensure learning, forgetting, and the mechanisms of permanent psychological change. The new evidence on brain functioning necessitates the integration of neuropsychological achievements in the psychotherapeutic process. An integrative approach is needed to take into account the dynamic interaction between brain functioning, psyche, soul, spirit, and social interaction, ie, development of a model of psychotherapeutic work based on cerebral plasticity! Brain-based psychotherapy aims at changing brain functioning not directly, but through experiences. This is neuro-psychologically informed psychotherapy.

[Motivation in all Ks: computational approach to neuro-psychiatric diseases]. / La motivation dans tous ses K - Approche computationnelle des pathologies neuropsychiatriques.

Motivation can be defined as the function that orients and activates the behavior. Motivation deficits such as apathy are pervasive in both neurological and psychiatric diseases, and are currently assessed with clinical scales that do not give any mechanistic insight. Here, we present another approach that consists in phenotyping the behaviour of patients in motivation tests, using computational models. These formal models impose a precise and operational definition of motivation that is embedded in decision theory. We then review basic and clinical studies that have investigated the neural bases of motivation processes and shown the involvement of specific cortical, subcortical and neuromodulatory systems. Finally, we emphasize the promises of computational phenotyping for clinical purposes, as it may not only give insight into motivation deficits but also help personalize treatment.

[The influence of Spanish neuropsychiatry on the improbable medicine of Ramon Gomez de la Serna]. / Influencia de la neuropsiquiatria española en la medicina inverosimil de Ramon Gomez de la Serna.

INTRODUCTION: El doctor inverosimil (The Improbable Doctor) is a novel by Ramon Gomez de la Serna (1888-1963) in which the reader follows, by means of a series of different clinical cases, the adventures of Doctor Vivar. AIMS: To present and discuss, for the first time, the influence that Spanish neuropsychiatry had on this novel, taking the following short stories as study models: 'Casos cerebrales' ('Brain Cases') and 'La risita' ('The Giggles'). DEVELOPMENT: In these two tales, the improbable doctor embodies the three defining elements of Spanish neuropsychiatry. The repetitions of Alzheimer's disease (or in the way in which progressive general paralysis is referred to) hints at its Germanic orientation. The mixed neuropsychiatric component is exemplified in both his neurological ('La risita') and psychiatric skills ('Casos cerebrales'). Doctor Vivar's affinity to things histopathological is apparent in his wide and timely usage of neurohistological terminology, mainly from Cajal. CONCLUSIONS: It can be deduced that the Spanish neuropsychiatric school had a strong influence on Gomez de la Serna's El doctor inverosimil.

TITLE: Influencia de la neuropsiquiatria española en la medicina inverosimil de Ramon Gomez de la Serna.Introduccion. El doctor inverosimil es una novela de Ramon Gomez de la Serna (1888-1963) donde seguimos, a traves de diversos casos clinicos, las andanzas del doctor Vivar. Objetivo. Presentar y discutir, por primera vez, el influjo que tuvo la neuropsiquiatria española en esta novela, tomando como modelos de estudio los siguientes relatos: 'Casos cerebrales' y 'La risita'. Desarrollo. En este par de relatos, el doctor inverosimil encarna los tres elementos definitorios de la neuropsiquiatria española. En sus repeticiones de la enfermedad de Alzheimer (o en la forma en que se refiere a la paralisis general progresiva) insinua su orientacion germanica. El componente mixto neuropsiquiatrico esta ejemplificado en su destreza tanto neurologica ('La risita') como psiquiatrica ('Casos cerebrales'). La afinidad histopatologica del doctor Vivar es evidente en su amplio y oportuno uso de la terminologia neurohistologica, principalmente la cajaliana. Conclusiones. Es valido deducir que hay una influencia notoria de la escuela neuropsiquiatrica española en El doctor inverosimil de Gomez de la Serna.