Shifted inferior frontal laterality in women with major depressive disorder is related to emotion-processing deficits.

BACKGROUND: Facial emotion perception (FEP) is a critical human skill for successful social interaction, and a substantial body of literature suggests that explicit FEP is disrupted in major depressive disorder (MDD). Prior research suggests that weakness in FEP may be an important phenomenon underlying patterns of emotion-processing challenges in MDD and the disproportionate frequency of MDD in women. Method Women with (n = 24) and without (n = 22) MDD, equivalent in age and education, completed a FEP task during functional magnetic resonance imaging. RESULTS: The MDD group exhibited greater extents of frontal, parietal and subcortical activation compared with the control group during FEP. Activation in the inferior frontal gyrus (IFG) appeared shifted from a left >right pattern observed in healthy women to a bilateral pattern in MDD women. The ratio of left to right suprathreshold IFG voxels in healthy controls was nearly 3:1, whereas in the MDD group, there was a greater percentage of suprathreshold IFG voxels bilaterally, with no leftward bias. In MDD, relatively greater activation in right IFG compared with left IFG (ratio score) was present and predicted FEP accuracy (r = 0.56, p < 0.004), with an inverse relationship observed between FEP and subgenual cingulate activation (r = - 0.46, p = 0.02). CONCLUSIONS: This study links, for the first time, disrupted IFG activation laterality and increased subgenual cingulate activation with deficient FEP in women with MDD, providing an avenue for imaging-to-assessment translational applications in MDD.

Crashes and violations among drivers with Alzheimer disease.

BACKGROUND: Several small studies have found a high automobile crash rate for drivers with Alzheimer disease (AD) compared with unaffected elderly drivers, prompting the suggestion that the diagnosis of AD mandate cessation of driving. OBJECTIVES: To compare automobile crash and violation rates of a large number of patients with AD with appropriately matched elderly subjects. To determine if neuropsychological test scores predict these adverse driving events. To determine if intervention by physicians or family members influences driving cessation. DESIGN: Review of crashes and violations from 1986 to 1993 in police-filed Michigan State driving records of 143 licensed patients with AD and 715 licensed comparison subjects matched 5 to 1 in age (+/- 6 years), sex, and county of residence. We correlated crashes and violations with neuropsychological test scores. A questionnaire-based inquiry on the influence of physician, family, and state interventions on driving cessation was administered. RESULTS: The crash and violation rates of patients with AD were not significantly different from those of comparison subjects. However, patients with AD probably drove fewer kilometers than did comparison subjects. Neuropsychological test scores did not predict future crashes or violations. CONCLUSIONS: This study, the largest to our knowledge involving state driving records of patients with AD, does not confirm the previously reported excessive crash rate among drivers with AD relative to an appropriate comparison population. Reduced driving exposure of patients with AD probably kept their crash adverse equal to that of comparison subjects. Intervention by physicians and family members was major factor in reducing driving exposure. These findings affirm that the mere diagnosis of AD does not justify license revocation.

Chronic dopaminergic sensitivity after Sydenham's chorea.

We studied psychometric performance on the Minnesota Multiphasic Personality Inventory (MMPI) mini-mult and drug-induced choreic reactions in a group of patients with a history of Syndenham's chorea. Action tremor, motor signs, and residual chorea were common. One-half of the patients reported adverse choreic reactions to one or more agents. Patients with adverse reactions to central stimulants and anorectics had statistically significant elevations in the psychotic tetrad of the MMPI. Sydenham's chorea in childhood seems to confer persistent sensitivity to agents that augment central dopaminergic activity, which may be expressed as acute chorea. Central dopaminergic sensitivity may explain earlier reports of psychologic difficulties in survivors of rheumatic chorea.

PIP: 32 patients with Sydenham's chorea were studied at the La Rabida Institute for psychometric performance on the Minnesota Multiphasic Personality Inventory (MMPI). Questionnaires used included a definition of chorea and a description of choreic movements which the patients and members of their households were asked to read. Results were: 1) the only medical condition frequently reported was arthritis; 20/32 patients reported medical consultation for this complaint; 2) 19 patients including 2 with chorea gravidium, reported motor or psychiatric side effects from 1 or more agents; 3) in patients with multiple drug exposures a history of adverse motor reactions to decongestants was always associated with adverse reactions to anorectics or amphetamine in patients with exposure to all agents, and a similar pattern was noted with thyroid hormone and oral contraceptives (OCs); 4) 1 patient with chorea gravidium reported dyskinesias after administration of decongestants or amphetamine but tolerated OCs; and 5) MMPI scores from patients reporting adverse responses to amphetamines were statistically elevated in the psychotic tetrad. This study provides support for the belief that Sydenham's chorea is not a benign self-limited disease of childhood. In addition to mild residual neurologic abnormalities, the disorder appears to confer long-standing sensitivity to a variety of dopaminergically active agents.

A 39-year followup of the Genain quadruplets.

The Genains, a unique group of monozygotic female quadruplets, all developed a schizophrenic disorder by age 24. They have been studied since the 1950s, because of the rarity of this occurrence (estimated to be one in 1.5 billion) and because their illnesses varied in severity. The identical inheritance would tend to rule out genetic differences as the cause of the neuropsychological differences; however, we cannot disentangle the effects of early brain injury and harsh punitive treatment as factors accounting for the differences in the severity of their disorders. We conducted neuropsychological examinations of the Genains at age 66, compared their test profiles, and contrasted certain test scores at 66 with those at ages 27 and 51. Test results indicate generally stable (or even improved) performance over time and support the notion that cognitive decline is not a degenerative process in schizophrenia. The Genains remind us of the exquisite interaction among variables that must be understood before additional, satisfactory progress can be made in preventing the development and predicting the course of schizophrenia.

Psychological depression and cancer.

Studies are reviewed which relate to five basic content areas of research concerning depression and cancer: significant loss experience, emotional inhibition, hopelessness, psychiatric assessment of depression, and test measurement of depression. Methodological issues within each area are addressed as they relate to the potential validity and generalizability of findings. In general, there is no support for increased loss experience in cancer patients and mild support for increased emotional inhibition and hopelessness in these individuals. Traditional psychiatric assessment approaches are not seen as providing solid evidence for a depression/cancer relationship due to reliability and design issues, while psychometric assessment provides mild support for a prospective relationship between depression and later cancer. Issues relating to approaches to research, means of measurement of depression, design issues, and questions of conceptualization of depression are discussed.

Cranial nerve clock. Part II: functional MR imaging of brain activation during a declarative memory task.

RATIONALE AND OBJECTIVES: The authors performed this study to assess brain activation during encoding and successful recall with a declarative memory paradigm that has previously been demonstrated to be effective for teaching students about the cranial nerves. MATERIALS AND METHODS: Twenty-four students underwent functional magnetic resonance (MR) imaging during encoding and recall of the name, number, and function of the 12 cranial nerves. The students viewed mnemonic graphic and text slides related to individual nerves, as well as their respective control slides. For the recall paradigm, students were prompted with the numbers 1-12 (test condition) intermixed with the number 14 (control condition). Subjects were tested about their knowledge of cranial nerves outside the MR unit before and after functional MR imaging. RESULTS: Students learned about the cranial nerves while undergoing functional MR imaging (mean post- vs preparadigm score, 8.1 +/- 3.4 [of a possible 12] vs 0.75 +/- 0.94, bilateral prefrontal cortex, left greater than right; P < 2.0 x 10(-12)) and maintained this knowledge at I week. The encoding and recall paradigms elicited distributed networks of brain activation. Encoding revealed statistically significant activation in the bilateral prefrontal cortex, left greater than right [corrected]; bilateral occipital and parietal associative cortices, parahippocampus region, fusiform gyri, and cerebellum. Successful recall activated the left much more than the right prefrontal, parietal associative, and anterior cingulate cortices; bilateral precuneus and cerebellum; and right more than the left posterior cingulate. CONCLUSION: A predictable pattern of brain activation at functional MR imaging accompanies the encoding and successful recall of the cranial nerves with this declarative memory paradigm.

Distinguishing between depression and dementia in the elderly: a review of neuropsychological findings.

Distinguishing between cognitive deficits seen in depression and progressive dementing, diseases is complex and often difficult clinically. We review recent neuropsychological studies comparing normal elderly individuals, depressed patients, and patients with progressive dementias. Findings from these studies suggest that the distinction between depression and dementia is fairly straightforward and facilitated by neuropsychological evaluation. Data from neuroimaging studies of depressed elderly are reviewed and integrated with the neuropsychological findings. A descriptive scheme for categorizing elderly patients is proposed. It is suggested that the label "pseudodementia" be discarded in favor of more thorough description of cognitive deficits associated with various clinical presentations.

Psychological depression in the elderly in medical/rehabilitation/nursing care settings.

The prevalence of psychological depression in elderly patients in medical/rehabilitation/nursing care settings is reviewed, with general levels of 20% to 35% and more specific levels up to 70% being reported for these populations. Depression is seen as readily identifiable in these patients, though it is probably a different entity than that seen in modal onset of depression in younger psychiatric populations. In elderly non psychiatric patients, depression is more likely to be situationally/relationship based, being related to medical and behavioral difficulties. Depression is seen as having a negative impact on patient treatment, though it does not clearly have an impact on longevity in healthy, community-living older citizens. Aggressive treatment of depression in elderly patients is supported.

A long-term-care setting pilot study evaluating predictors of success in medication self-administration.

OBJECTIVE: To determine whether any specific patient variables or a short battery of neuropsychological tests of cognition and memory predict success in medication self-administration. DESIGN: A prospective, single-blinded design. SETTING: An extended care center of a university-affiliated VA Medical Center. PATIENTS: Thirty predominately male, older veteran patients, mean age 70 +/- 4 years with a range of 63 to 79 years. INTERVENTIONS: Neuropsychological testing [Mini-Mental Status Examination (MMSE), Delayed Word Recall Test (DWRT), Shipley Institute of Living Scale (SILS), Neurobehavioral Cognitive Status Examination (NCSE), Hopkins Verbal Learning Test (HVLT)], twice a week unannounced bedside medication counts and medication administration record inspections, and educational instruction, if needed, by nurses and pharmacists. MAIN OUTCOME MEASURES: Patient characteristics such as age, number of medications, presence of a disorder that can alter cognitive or memory function, years of education, and results from the above listed neuropsychological tests. The dependent variable was successful or not successful as defined by whether the patient required a re-education intervention. RESULTS: Fifteen patients required one or more re-education intervention(s) as a result of meeting the criteria for not being successful. The absence of major depression, stroke, or anxiety disorder did tend to predict success (P = 0.0716) in medication self-administration. The other patient specific characteristics did not predict success. Among the neuropsychological tests administered, only the Judgment Subtest of the NCSE tended to predict success (P = 0.098). The MMSE, DWRT, SILS,HVLT tests did not predict successful performance in the self-medication program. CONCLUSIONS: Although the presence of a diagnosis that could potentially alter cognitive and memory function tended to predict success, no patient characteristics were found that predicted success independently. Among the neuropsychological tests, only the Judgment subtest of the NCSE tended to predict success in medication self-administration. We conclude that the NCSE and characterization of patient-specific factors, including diseases that may affect cognitive and memory function, seem to be the best predictors of success in medication self-administration in a long-term-care setting.

Life events, 17-OHCS measures, and psychological defensiveness in relation to aid-seeking.

Professional aid-seeking for medical or psychological reasons was measured in 80 firefighters for a retrospective period of six months and a prospective period of eight weeks. The magnitude of life stress events, 24-hour urine 17-OHCS levels, and MMPI K-Scale scores were compared between those subjects who had sought professional aid and those who had not. The measured values did not differ significantly between groups and were, in fact, well within normal limits for all subjects tested. Analysis suggests that implied relationships between stress and illness are questionable in low-stress, low-maladjustment populations. These data lend support to the concept of a threshold effect for influence of life change on subsequent illness manifestation.