This year, more than 1311 physicians of all specialties responded to the survey . . . 287 of the respondents are psychiatrists. The charts you see show how those 287 responded to just a few of the survey questions. Read More
In this video, Senior Advisor to the NIMH Director and Professor of Psychiatry at Georgetown University School of Medicine explains how some of the latest developments in neuroscience can be used in everyday practice to treat bipolar and other mental disorders. Read More
What are the latest findings on acute and chronic effects of alcohol on the human brain? Here to discuss the latest research is psychiatrist and neuroscientist Nora D. Volkow, MD, Director of the National Institute on Drug Abuse.
Advances in basic molecular research of alcoholism await translation into important new clinical insights. Here to shed some light in this area is John Matochik, PhD, Program Director in the Division of Neuroscience and Behavior at NIAAA.
Although many symptoms of psychiatric disorders are likely due to maladaptive plasticity in mesolimbic dopamine reward pathways, there is still a shortage of data on the specific nature of this plasticity and the role it may play in influencing cognition and behavior. More in this video.
Mindfulness training is a viable treatment tool that rivals psychopharmaceutical agents for the treatment of addictions, anxiety, depression, and other psychiatric disorders. In this video, Dr Judson Brewer describes the value of MT in psychiatry.
From time to time every psychiatrist comes across patients whose problems are at least in part related to the neuropsychiatric consequences (behavioral, cognitive, and emotional) of traumatic brain injury (TBI). TBI affects approximately 2 of every 1000 persons per year. Those who are vulnerable to mental illness (eg, persons with alcohol abuse or antisocial personality disorder) are particularly at risk. Patients with TBI often have poor insight and may need hospitalization for their own safety. The neuropsychiatric and other sequelae are long-term; a head injury is for life.
Parkinson disease (PD) is the second most common neurodegenerative illness in the United States, affecting more than 1 million persons. Disease onset is usually after age 50. In persons older than 70 years, the prevalence is 1.5% to 2.5%.1 While the primary pathology involves degeneration of dopaminergic neurons in the substantia nigra, circuits important in emotion and cognition—such as the serotonergic, adrenergic, cholinergic, and frontal dopaminergic pathways—are also variably disrupted.
Cognitive impairment is underrecognized among patients with bipolar disorder and may represent not only effects of the illness but also adverse effects of its treatments. Among these, lithium is the best-studied mood stabilizer. As its cognitive effects are mixed and not well-known, we assessed reported effects of lithium on cognitive performance.|MEDLINE, PsycINFO, and EMBASE databases (1950 to December 2008) were queried with the keywords lithium, cognit*, neurocognit*, neuropsych*, psycholog*, attention, concentration, processing speed, memory, executive, and learning. Database searches were supplemented with bibliographic cross-referencing by hand. The literature search was conducted independently by 2 authors (A.P.W. and T.S.W.) during August and September 2008, and questions about appropriate inclusion or exclusion were resolved between them by consensus.|Of 586 reports initially identified as being of potential interest, 12, involving 539 subjects, met our inclusion criteria: (1
Posttraumatic stress disorder (PTSD) may be associated with structural abnormalities in the amygdala. To better characterize amygdala volume in PTSD, the authors conducted a meta-analysis comparing amygdala volumes in PTSD patients and comparison subjects. Using electronic databases, the authors found nine studies comparing amygdala volumes in adult subjects with PTSD with amygdala volumes in comparison subjects (participants unexposed to trauma and participants exposed to trauma but without PTSD). Results showed no significant differences in amygdala volumes between the groups. Within each group, the right amygdala was significantly larger than the left, indicating an asymmetrically lateralized amygdala volume that is preserved in trauma exposure and in PTSD.
The authors performed a systematic review and meta-analysis of studies evaluating the affective component of the cerebellar cognitive affective syndrome. Depressive and anxiety symptoms and personality changes were more frequent in patients with spinocerebellar ataxia. Patients with cerebellar lesions were more likely to have depression, deficits in the ability to experience emotions, and behavioral difficulties. A meta-analysis revealed modestly higher scores on the Hamilton Depression Rating Scale (HAM-D) among patients with cerebellar disease. This review highlights the need for cohort studies using noncerebellar comparison groups, more sensitive measures, and appropriate-sized populations with isolated cerebellar lesions to thoroughly assess the affective component of the cerebellar cognitive affective syndrome.
The evaluation of psychotic individuals for inherited or congenital etiologies is fraught with complexity. The authors reviewed the published literature and found 62 congenital disorders that include psychosis. Their prevalence, workup, genetics, and associated neuropsychiatric features are described. Eighteen disorders (29%) have distinct phenotypes ("doorway diagnoses"); 17 disorders (27%) are associated with mental retardation; and 45 disorders (73%) have prominent neurological signs. Thirty-four disorders (55%) can present without such distinct characteristics, and are thus more readily overlooked. We recommend a systematic and cost-effective differential diagnostic approach based on estimated prevalence and most prominent associated signs.
We compared the carriage frequencies of HLA-DRB3 and its major alleles and of HLA-DRB4 and HLA-DRB5 in an Australian sIBM cohort and a population control group who had previously been genotyped for the HLA-DRB1*03:01 risk allele. There was a strong disease association with the carriage of the DRB3*01:01 allele which was accounted for by its linkage disequilibrium with DRB1*03:01. The carriage of HLA-DRB4 was found to be strongly protective and abrogated the risk effect of HLA-DRB1*03:01. The findings indicate that haplotypic combinations of alleles at the HLA-DRB1 and secondary HLA-DRB loci have important risk modifying effects in sIBM.
Deep brain stimulation (DBS) has been firmly established as a therapy for movement disorders. Recently, evidence from case reports and small case series also suggests DBS to be effective in psychiatric disorders including addiction. Here we review the rationale of DBS in addiction and the selection of possible targets. We then consider evidence from animal models as well as human case studies. We conclude that DBS in particular of the nucleus accumbens (NAcc) represents a promising treatment option in addiction which deserves further investigation.
The brain reward system, and especially the mesolimbic dopamine pathway, plays a major role in drug reinforcement and is most likely involved in the development of drug addiction. All major drugs of abuse, including ethanol, acutely activate the mesolimbic dopamine system. Both this acute drug-induced dopamine elevation, the dopamine elevations observed after presentations of drug-associated stimuli and alterations of dopamine function induced by chronic drug administration are of importance. Whereas the mechanisms of actions for central stimulants, opioids and nicotine in their dopamine activating effects are fairly well established, the corresponding mechanisms with respect to ethanol have been elusive. Here we review the actions of ethanol in the mesolimbic dopamine system, focusing on ethanol's interaction with ligand-gated ion-channel receptors, opiate receptors, the ghrelin system and the possible involvement of acetaldehyde. Preclinical studies have provided the opportunity to
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Effective Clinical Practice January/February 2000 Volume 3 Number 1 51 An Orthopedist Questions the Utility of Surgery for Back Pain As a practicing orthopedic surgeon, I was amused by the article, Medical versus Surgical Treatment for Low