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Antiepileptic drugs (AEDs) can have both beneficial and adverse psychotropic effects. They act on neurotransmitter systems, neuronal ion permeability and other targets, although the exact mechanisms are not generally fully elucidated. A systematic review of the literature reveals evidence for both positive and negative effects on depression, anxiety, aggression, psychosis and sleep in patients with epilepsy. Topiramate, vigabatrin, levetiracetam, tiagabine and zonisamide have been associated primarily with adverse psychotropic effects, whilst gabapentin, pregabalin, lacosamide and lamotrigine, in particular, have demonstrated a more beneficial psychotropic profile, especially with regard to affective symptoms. This review, however, identifies specific methodological issues with studies that have reported on the psychotropic effects of AEDs, suggesting that some of the findings might be inconclusive or unreliable because of confounding factors, particularly the presence of psychiatric history. More rigorous double-blind, randomized, placebo-controlled trials on larger numbers of patients with epilepsy, with clear inclusion/exclusion criteria, that are specifically designed to investigate psychotropic changes are more likely to produce results that inform clinical practice and direct future research. [ABSTRACT FROM AUTHOR]

The article aims to emphasize the importance of depressive symptoms and syndromes in the overall wellbeing of people with neurological disorders, and to equip clinicians with the practical skills to recognize and treat depression effectively. It discusses the symptom of depression in Parkinson's disease, multiple sclerosis, and stroke. Depression is a heterogeneous group of conditions and a clinical diagnosis without external validators. Diagnosis of depression in the setting of disorders that produce psychomotor retardation and changes in vegetative function can be particularly challenging.

A response form the author of the article "Time to end the distinction between mental and neurological illnesses," in 24th May 2012 issue is presented.

A principal-components factor analysis was performed on behavioural data obtained from the European Huntington's Disease Network REGISTRY study. 1690 valid assessments using the United Huntington's Disease Rating Scale Behavioural Rating Scale were included in the analysis. This large data set confirmed previous reports of distinct behavioural patterns within Huntington's disease comprising a depressive factor, a dysexecutive factor, an irritability factor and a psychosis factor. [ABSTRACT FROM AUTHOR]

Comments on the paper 'The outcome of depressive disorders in neurology patients: a prospective cohort study,' by A.J. Carson, P. Postma, J. and colleagues, which appeared in the July 2003 issue of the 'Journal of Neurology, Neurosurgery and Psychiatry.' Factors that affect the outcome in depression in the setting of neurological illness; Association of depression with the presence of neurological symptoms.

Objectives People with Huntington's disease ( HD) can exhibit interpersonal difficulties and deficits in recognizing emotional facial expressions. We investigated whether individuals with HD exhibit impairments in the understanding of other people's mental states, an aspect of Theory of Mind (ToM). Materials and methods Sixteen patients with HD and sixteen healthy controls completed two ToM tasks. One task involved recognising socially inappropriate behaviour and the other task required participants to judge complex mental states from photographs of people's eyes alone. To assess relationships between executive function and To M, participants completed measures of verbal fluency, working memory and inhibition. The Problem Behaviours Assessment-short form (Neuropsychiatry Neuropsychol Behav Neurol, 14, 2001and 219) was completed twice using information from patients and their close relatives (where possible) to identify relationships between To M impairment and behavioural problems. Results Patients with HD made significantly more errors on To M tasks than controls, exhibiting difficulties in judging the social appropriateness of story character's behaviour and problems inferring complex mental states from photographs of people's eyes. Patients with HD also exhibited executive dysfunction. However, there was little evidence that executive impairments were related to To M deficits. No correlations were apparent between problem behaviours and To M errors. Conclusions HD is associated with deficits in To M. Furthermore, some of patients' ToM difficulties appear independent of executive dysfunction. [ABSTRACT FROM AUTHOR]

Arambepola NMA, Rickards H, Cavanna AE. The evolving discipline and services of neuropsychiatry in the United Kingdom. Background: The last few decades have seen a renaissance in the development of neuropsychiatric services on a global scale. Methods: This paper reviews the existing literature on the changing role of the clinical neuropsychiatrist and discusses the evolving theory and practice of neuropsychiatry in the United Kingdom. Results: The rapidly evolving specialty of neuropsychiatry is currently facing a number of challenges. These include, but are not limited to, uncertainties about the curricular requirements for clinical neuropsychiatrists and the changing roles within the wider scenario of health-care service provision. Discussion: An informed historical perspective on this multifaceted discipline allows key insights into its future development. [ABSTRACT FROM AUTHOR]

Nimmagadda SR, Agrawal N, Worrall-Davies A, Markova I, Rickards H. Determinants of irritability in Huntington's disease. Objectives: Irritability is a common and disabling problem associated with Huntington's disease (HD). However, the underlying causes of such irritability remain unclear. This study investigates the association of irritability in HD with possible aetiological factors including dysexecutive syndrome, depression, anxiety (state and trait) and movement disorder. Methods: Thirty patients with genetically confirmed HD and their carers were recruited from a regional HD neuropsychiatry service. Patients completed two self-reported questionnaires (Irritability, Anxiety and Depression Scale and State Trait Anxiety Inventory). Their carers filled in the Burns Irritability Scale. Patients were also administered the Behavioural Assessment of Dysexecutive Syndrome (BADS), Montgomery and Asberg Depression Rating Scale (MADRS) and the Motor component of the Unified Huntington's Disease Rating Scale (UHDRS). Results: Both self-rated and carer-rated irritability scales showed significant positive correlation with trait anxiety. The self-rated irritability scales also showed significant positive correlation with state anxiety and depression. No association was observed between irritability and dysexecutive syndrome or motor impairment. Conclusions: Trait anxiety might serve as a predictor for irritability in HD. Irritability is unrelated to motor or cognitive features of HD indicating that it is an independent neuropsychiatric manifestation of HD. [ABSTRACT FROM AUTHOR]

Background: Patients on neurology wards have been shown to have high rates of psychiatric illness. Prevalence figures of 39-64% have been reported previously. However a low rate of recognition of psychiatric illness is also observed in this population.Objectives: To estimate the prevalence of psychiatric illness in neurology inpatients in a regional neuroscience centre and to assess the sensitivity and specificity of a batch of screening questionnaires.Method: Patients were assessed using the following screening questionnaires: Primary Care Evaluation of Mental Disorders, Mini Mental State Examination, Frontal Assessment Battery, Alcohol Use Disorders Identification Test and a neurologist-rating scale of organicity. All patients also had a full psychiatric assessment using the Diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV). The screening questionnaires were then compared with our "gold standard", the psychiatric assessment.Results: The prevalence of psychiatric illness (as determined by the psychiatric interview) in neurology inpatients in a tertiary referral centre was found to be 51.3% (95% confidence interval 44 to 58%). The sensitivity of this batch of screening questionnaires is 81.2% and the specificity is 77.1%.Conclusion: A high prevalence of psychiatric disorder was observed in inpatients on a dedicated neurology ward. The screening questionnaires used had a high sensitivity and specificity and could therefore be used as a simple way of identifying those with psychiatric illness. [ABSTRACT FROM AUTHOR]

The article discusses the separation of β-arrestin from the side effects of morphine, from which a strategy for the design of drugs may be provided to amplify the therapeutic effect. G-protein coupled receptors (GPCR) are described. The general features of the coupling of β-arrestins to GPCR are discussed.

Depression is the most common psychiatric disturbance in Parkinson''s disease. We conducted a Cochrane systematic review to assess the efficacy and safety of antidepressant therapies in idiopathic Parkinson''s disease. Relevant trials were identified from electronic databases, reference lists and queries to antidepressant manufacturers.Three randomised controlled trials examined oral antidepressants in 106 patients with Parkinson''s disease. No eligible trials of electroconvulsive or behavioural therapy were found. In the first arm of the crossover trial by Andersen et al. (n=22), nortriptyline treated patients showed a larger improvement than placebo in a unique depression rating scale after 16 weeks although significance levels were not provided. A parallel group trial by Wermuth et al. (n=37) did not show any significant difference between citalopram and placebo in Hamilton score after 52 weeks. Rabey et al. (n=47) performed an open-label trial comparing fluvoxamine with amitriptyline. Similar numbers in each group had a 50% reduction in Hamilton score after 16 months. Major side effects including visual hallucinations and confusion were reported with fluvoxamine and amitriptyline.Insufficient data on the effectiveness and safety of antidepressant therapies in Parkinson''s disease are available on which to make recommendations for their use. Large scale randomised controlled trials are urgently required. [Copyright &y& Elsevier]

Several letters to the editor are presented in response to the article "Hungtington's Disease Out of the Closet?," by Michael Rawlins in the October 23, 2010 issue.