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Objective: In Alzheimer's disease, antipsychotic medications are often used for a period, with relief of symptoms, and then discontinued, after which relapse may occur. The authors sought to determine which neuropsychiatric symptoms predict relapse.Method: In the Antipsychotic Discontinuation in Alzheimer's Disease trial, 180 patients with Alzheimer's disease and symptoms of agitation or psychosis were treated with risperidone for 16 weeks, after which patients who responded (N=110) were randomly assigned to continue risperidone for 32 weeks, to continue risperidone for 16 weeks followed by switch to placebo for 16 weeks, or to receive placebo for 32 weeks. As reported previously, discontinuation of risperidone was associated with a two- to fourfold increased risk of relapse over 16-32 weeks. In planned post hoc analyses, the authors examined associations between the 12 symptom domains in the Neuropsychiatric Inventory (NPI) and relapse in the first 16-week phase after randomization.Results: Compared with patients with mild hallucinations or no hallucinations, patients with severe hallucinations as a presenting symptom at baseline had a higher likelihood of relapse (hazard ratio=2.96, 95% CI=1.52, 5.76). This effect was present for the subgroup with auditory hallucinations, but not the subgroup with visual hallucinations. Among patients with baseline hallucinations, 13 of 17 (76.5%) who discontinued risperidone relapsed, compared with 10 of 26 (38.5%) who continued risperidone (p<0.02). This group difference remained significant for severe (77.8%) compared with mild (36%) hallucinations. NPI domain scores after the initial open-treatment phase were not associated with relapse.Conclusions: Patients with severe baseline hallucinations were more likely to relapse after randomization, and the presence of baseline hallucinations was associated with a higher risk of relapse after discontinuation of risperidone compared with continued risperidone treatment. For patients with hallucinations, particularly auditory hallucinations, antipsychotic discontinuation should be approached cautiously because of high relapse risk. [ABSTRACT FROM AUTHOR]

Objective: The authors conducted a prospective cohort study to estimate the risk of incident mild cognitive impairment in cognitively normal elderly (aged >70 years) individuals with or without neuropsychiatric symptoms at baseline. The research was conducted in the setting of the population-based Mayo Clinic Study of Aging. Method: A classification of normal cognitive aging, mild cognitive impairment, and dementia was adjudicated by an expert consensus panel based on published criteria. Hazard ratios and 95% confidence intervals were computed using Cox proportional hazards model, with age as a time scale. Baseline Neuropsychiatric Inventory Questionnaire data were available for 1,587 cognitively normal persons who underwent at least one follow-up visit. Results: The cohort was followed to incident mild cognitive impairment (N=365) or censoring variables (N=179) for a median of 5 years. Agitation (hazard ratio=3.06, 95% CI=1.89-4.93), apathy (hazard ratio=2.26,95% CI=1.49-3.41), anxiety (hazard ratio=1.87, 95% CI=1.28-2.73), irritability (hazard ratio=1.84, 95% CI=1.31-2.58), and depression (hazard ratio=1.63, 95% CI=1.23-2.16), observed initially, increased risk for later mild cognitive impairment. Delusion and hallucination did not. A secondary analysis, limited in significance by the small number of study participants, showed that euphoria, disinhibition, and nighttime behaviors were significant predictors of nonamnestic mild cognitive impairment but not amnestic mild cognitive impairment. By contrast, depression predicted amnestic mild cognitive impairment (hazard ratio=1.74, 95% 0=1.22-2.47) but not nonamnestic mild cognitive impairment. Conclusions: An increased incidence of mild cognitive impairment was observed in community-dwelling elderly adults who had nonpsychotic psychiatric symptoms at baseline. These baseline psychiatric symptoms were of similar or greater magnitude as biomarkers (genetic and structural MRI) in increasing the risk of incident mild cognitive impairment. [ABSTRACT FROM AUTHOR]

Objective: Despite the widespread belief that neuropsychological decline is a cardinal feature of the progression from the premorbid stage to the chronic form of schizophrenia, few longitudinal studies have examined change in neuropsychological functioning from before to after illness onset. The authors examined whether neuropsychological decline is unique to schizophrenia, whether it is generalized or confined to particular mental functions, and whether individuals with schizophrenia also have cognitive problems in everyday life. Method: Participants were members of a representative cohort of 1,037 individuals born in Dunedin, New Zealand, in 1972 and 1973 and followed prospectively to age 38, with 95% retention. Assessment of IQ and specific neuropsychological functions was conducted at ages 7, 9, 11, and 13, and again at age 38. Informants also reported on any cognitive problems at age 38. Results: Individuals with schizophrenia exhibited declines in IQ and in a range of mental functions, particularly those tapping processing speed, learning, executive function, and motor function. There was little evidence of decline in verbal abilities or delayed memory, however, and the developmental progression of deficits in schizophrenia differed across mental functions. Processing speed deficits increased gradually from childhood to beyond the early teen years, whereas verbal deficits emerged early but remained static thereafter. Neuropsychological decline was specific to schizophrenia, as no evidence of decline was apparent among individuals with persistent depression, children with mild cognitive impairment, individuals matched on childhood risk factors for schizophrenia, and psychiatrically healthy individuals. Informants also noticed more cognitive problems in individuals with schizophrenia. Conclusions: There is substantial neuro-psychological decline in schizophrenia from the premorbid to the postonset period, but the extent and developmental progression of decline varies across mental functions. Findings suggest that different pathophysiological mechanisms may underlie deficits in different mental functions. [ABSTRACT FROM AUTHOR]

Objective: In 2009, the U.S. Food and Drug Administration issued a black box warning for varenicline regarding neuropsychiatric events. The authors used data from randomized controlled trials and from a large Department of Defense (DOD) observational study to assess the efficacy and safety of varenicline. Method: The authors reanalyzed data from the 17 placebo-controlled randomized controlled trials (N=8,027) of varenicline conducted by Pfizer, using complete intent-to-treat person-level longitudinal data to assess smoking abstinence and reports of suicidal thoughts and behavior, depression, aggression/agitation, and nausea and to compare effects in patients with (N=1,004) and without (N=7,023) psychiatric disorders. The authors also analyzed a large DOD data set to compare acute (30-day and 60-day) rates of neuropsychiatric adverse events in patients receiving varenicline or nicotine replacement therapy (N=35,800) and to assess reports of anxiety, mood, and psychotic symptoms and disorders, other mental disorders, and suicide attempt. Results: In the randomized controlled trials, varenicline increased the risk of nausea (odds ratio=3.69, 95% 0=3.03-4.48) but not rates of suicidal events, depression, or aggression/agitation. It significantly increased the abstinence rate, by 124% compared with placebo and 22% compared with bupropion. Having a current or past psychiatric illness increased the risk of neuropsychiatric events equally in treated and placebo patients. In the DOD study, after propensity score matching, the overall rate of neuropsychiatric disorders was significantly lower for varenicline than for nicotine replacement therapy (2.28% compared with 3.16%). Conclusions: This analysis revealed no evidence that varenicline is associated with adverse neuropsychiatric events. The evidence supports the superior efficacy of varenicline relative to both placebo and bupropion, indicating considerable benefit without evidence of risk of serious neuropsychiatric adverse events, in individuals with and without a recent history of a psychiatric disorder. [ABSTRACT FROM AUTHOR]

Objective: Obsessive-compulsive disorder (OCO) is a common, heritable neuropsychiatric disorder, hypothetically underpinned by dysconnectivity of largescale brain systems. The extent of white matter abnormalities in OCD is unknown, and the genetic basis of this disorder is poorly understood. The authors used diffusion tensor imaging, a magnetic resonance imaging technique, for examining white matter abnormalities in brain structure through quantification of water diffusion, to confirm whether white matter abnormalities exist in OCD. They also explored whether such abnormalities occur in healthy first-degree relatives of patients, indicating they may be endophenotypes representing increased genetic risk for OCD. Method: The authors used diffusion tensor imaging to measure fractional anisotropy of white matter in 30 patients with OCD, 30 unaffected first-degree relatives, and 30 matched healthy comparison subjects. Regions of significantly abnormal fractional anisotropy in patients in relation to healthy comparison subjects were identified by permutation tests. The authors assessed whether these abnormalities were also evident in the first-degree relatives. A secondary region-of-interest analysis was undertaken to assess the extent of replication between our data and previous relevant literature. Results: Patients with OCD demonstrated significantly reduced fractional anisotropy in a large region of right inferior parietal white matter and significantly increased fractional anisotropy in a right medial frontal region. Relatives also exhibited significant abnormalities of fractional anisotropy in these regions. Conclusions: These findings indicate that OCD is associated with white matter abnormalities in parietal and frontal regions. Similar abnormalities in unaffected first-degree relatives suggest these may be white matter endophenotypes for OCD. [ABSTRACT FROM AUTHOR]

The article presents a case of a 42-year-old man who was referred for immediate admission to the inpatient neuropsychiatry unit for evaluation and management of behavior problems associated with traumatic brain injury after in Baltimore, Maryland. He found to have adequate hygiene and grooming. Finally, their negative reactions and sense of pessimism may be understood by their changing life circumstances and the associated new challenges.

Objective: The authors describe personality development and disorders in relation to symptoms of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders. Method: Consecutive adults referred for neuropsychiatric investigation (N=240) were assessed for current and lifetime ADHD and autism spectrum disorders and completed the Temperament and Character Inventory. In a subgroup of subjects (N=174), presence of axis II personality disorders was also assessed with the Structured Clinical Interview for DSM-IV Personality Disorders (SCI D-l I). Results: Patients with ADHD reported high novelty seeking and high harm avoidance. Patients with autism spectrum disorders reported low novelty seeking, low reward dependence, and high harm avoidance. Character scores (self-directedness and cooperativeness) were extremely low among subjects with neuropsychiatric disorders, indicating a high overall prevalence of personality disorders, which was confirmed with the SCID-II. Cluster B personality disorders were more common in subjects with ADHD, while cluster A and C disorders were more common in those with autism spectrum disorders. The overlap between DSM-IV personality disorder categories was high, and they seem less clinically useful in this context. Conclusions: ADHD and autism spectrum disorders are associated with specific temperament configurations and an increased risk of personality disorders and deficits in character maturation. [ABSTRACT FROM AUTHOR]

The article presents a list of physicians, which have successfully completed the examination in January 2004, conducted by American Board of Psychiatry and Neurology Inc. Some of physicians are: Bayani Yalung Abordo, Elias Nassif Aboujaoude, Paul Timothy Abrinko, Harriet Sheri Ackerman, Rebecca Ellen Adams, Larry Adam Alb, Ghada A. Albeheary, Shira Amitai, Laura Christine Anderson, David Darius Aryanpur, Gayle Glynn Augenbaum, Jasdeep Singh Aulakh, Rehana Aziz, and others.

The article presents 2004 Annual Report of the American Board of Psychiatry and Neurology Inc. (ABPN). The ABPN is a nonprofit corporation founded in 1934. The mission of the ABPN is to serve the public interest by promoting excellence in the practice of psychiatry and neurology through lifelong certification including competency-testing processes. Major accomplishments of the ABPN to date include the development and dissemination of updated core competencies for psychiatry and neurology and the development of outlines for core competencies for the subspecialties of geriatric psychiatry forensic psychiatry, and clinical neurophysiology.

Objective: Reports of increased rates of psychosis in prisons could be due to sampling and ascertainment differences, The authors compared two samples of subjects 16-64 years of age: those from the general population of residents in Great Britain and prisoners in England and Wales. Method: A random sample of remanded and sentenced male and female prisoners (N=3,142) and a two-phase, cross-sectional random sample of household residents (N=10,108) were assessed with structured questionnaires and the semistructured Schedules for Clinical Assessment in Neuropsychiatry. Results: The weighted prevalence of probable functional psychosis in the past year was 4.5 per thousand (95% CI=3.1 to 5.8) in the household survey. In the prison survey, the weighted prevalence was over 10 times greater: 52 per thousand (95% CI=45 to 60). One in four prisoners with a psychotic disorder had psychotic symptoms attributed to toxic or withdrawal effects of psychoactive substances. The proportion of subjects with specific types of hallucinations or delusions did not differ between prison and household psychosis cases. Conclusions: This large study using standardized comparisons showed that the prevalence of psychosis in prisons is substantially higher than in the community and is deserving of greater attention to treatment and prevention. Apart from a minority of prisoners with symptoms attributable to psychoactive substances, the clinical symptom profile of psychosis is the same in both settings. Longitudinal research is needed to better understand these prevalence differences. [ABSTRACT FROM AUTHOR]

The article focuses on narcolepsy with cataplexy which is a serious chronic neuropsychiatric disorder that typically begins at an early age. It has the potential to greatly disrupt social, educational, and vocational development. Because of the nature of its symptoms for example, excessive daytime sleepiness, narcolepsy provides insights into the mechanisms regulating human sleep. Its universal symptom of daytime sleepiness probably contributes most substantially to the resulting impaired quality of life that has been documented. A specific and intriguing sign of narcolepsy is cataplexy a transient muscle weakness triggered by emotions. Other classic but nonspecific symptoms include sleep paralysis and hypnagogic hallucinations. Disturbed nocturnal sleep is the most recent addition to the classic symptom complex.

Objective: The mediodorsal and anteroventral/anteromedial nuclei of the thalamus are brain regions of interest in the study of mood disorders because they connect subcortical limbic system structures such as the amygdala with the prefrontal, cingulate, and temporal cortices. Anatomical abnormalities have been observed both in the amygdala and in the aforementioned cortical regions in affective disorder patients. Neuroanatomical studies of the thalamus have rarely been conducted in patients with mood disorders. Method: Postmortem tissue from the Stanley Foundation Brain Bank was obtained from subjects diagnosed with major depressive disorder, bipolar disorder, and schizophrenia as well as a nonpsychiatric comparison group (N=10-13 per group). The optical disector stereological procedure was used to count neurons in the mediodorsal and anteroventral/anteromedial nuclei of the thalamus in each brain. Results: There were significantly more neurons in the mediodorsal (37%) and anteroventral/anteromedial (26%) nuclei in subjects with major depressive disorder relative to the nonpsychiatric comparison subjects. Neuron numbers and volumes in these limbic thalamic nuclei were normal in the schizophrenia and bipolar subjects. Conclusions: The data indicate that there is an elevation in total neuron number in the limbic thalamus that is specific for major depressive disorder. This represents the first report of a neuropsychiatric disorder being associated with an increase in total regional neuron number. The present findings, along with recent data, indicate that significant anatomical and functional abnormalities are present in limbic circuits in major depressive disorder. [ABSTRACT FROM AUTHOR]

Objective: The ethics of involving decisionally incapable adults in research will continue to grow in importance as more research is conducted to address the problems of decisionally impaired persons, especially elderly persons. The authors pro- vide an updated discussion, critique, and recommendations regarding the need for clear legal and regulatory policy on this issue. Method: The authors summarize and build on discussions of a workshop on proxy and surrogate consent in geriatric neuropsychiatric research sponsored by the Aging Research Consortium of the National Institute of Mental Health. They incorporate the views of various stakeholders present at the workshop as well as review recent federal and state initiatives, recent empirical research and media reports, and various commission reports and relevant regulations. Results: Despite a wave of initiatives in the late 1990s to clarify policy, surrogate consent for research continues to be a murky legal area and incapable subjects in the United States still lack clear regulatory protection. There is evidence that conservative risk management strategies by institutional review boards and their institutions may severely restrict research with decisionally impaired subjects. A passive approach to this problem may no longer be feasible. A recent federal advisory report on human research protections and legislative initiatives in some states could begin to provide a blueprint for future policy making. Interim recommendations for various stakeholders are given. conclusions: It is imperative that the scientific community, patients and their advocates, and policy makers at all levels establish a constructive dialogue to clarify ethical and legal standards in the area of proxy and surrogate consent for research. [ABSTRACT FROM AUTHOR]

This article focuses on two patients who were admitted to acute psychiatric inpatient units for new-onset manic behavior without any physical findings. Each received a comprehensive workup that included a psychiatric assessment, brain imaging, laboratory studies, lumbar punctures and neuropsychological testing. In both cases, the final diagnosis was multiple sclerosis. Multiple sclerosis is an inflammatory demyelinating illness that can affect any aspect of the central nervous system, including the cranial nerves.

Objective: This study investigated the neural substrates of implicit sequence learning in subjects with and without small animal phobia, in a follow-up to analogous studies of obsessive-compulsive disorder (OCD). Method: Ten subjects with specific phobia and 10 healthy comparison subjects were studied by using a serial reaction time task paradigm and functional magnetic resonance imaging. Results: A main effect of condition (implicit sequence learning versus random sequence) was observed across diagnostic groups in the right striatum, as well as in other regions. In the striatum, the a priori region of interest, there were no significant effects of diagnosis or the interaction of diagnosis and condition. Conclusions: Brain activation in the striatum of subjects with specific phobia does not significantly differ from that of normal comparison subjects during implicit sequence learning. This suggests different pathophysiological mechanisms for specific phobia in contrast to OCD, in which deficient striatal recruitment has been reproducibly found with this paradigm. This approach offers promise for demonstrating diagnostic specificity across different neuropsychiatric disorders based on the presence or absence of deficient striatal activation. [ABSTRACT FROM AUTHOR]

Provides information on anatomical framework for neuropsychiatric disorders and drug abuse. Concept of the ventral striatal-pallidal system; Existence of parallel cortical-striatal-pallidal-thalamic-cortical circuits; Basal nucleus of Meynert.

Examines the relevance of acute porphyrias in neuropsychiatry. Progressive loss of memory and concentration; Enzyme deficiency; Genetic expression.

Discusses literature on cognitive neuropsychiatric models of persecutory delusions. Examination of major cognitive theories of persecutory delusion formation and maintenance; Selective attention to threatening information; Need for further studies examining cognitive processes; Functional neuroanatomical models of persecutory delusions.

Integrates insights regarding nitric oxide, carbon monoxide and D-serine, which are novel neurotransmitters or neuromodulators of neuropsychiatric significance. Major chemical classes of novel neurotransmitters; Basis of classic criteria for transmitters; Functions.

Elucidates through brain imaging the neurobiological basis of cognitive and neuropsychotic problems in velocardiofacial syndrome and considers the association between variations in neuroanatomy in patients and the associated neurobehavioral phenotype. Group differences and symmetry in tissue volumes; Group differences and symmetry in tissue composition; Ventricular volume.

Characterizes the neuropsychiatric profile of elderly patients with schizophrenia. Difficulty in establishing neuropathologic characteristics of the disease; Demographic characteristics of subjects included in the study; Patients' need for assistance in daily living; Rating of patients as severely ill on the Brief Psychiatric Rating Scale.

The authors propose using primary and enduring negative or deficit symptoms for dichotomizing schizophrenic patients into two groups, deficit and nondeficit. The validity of this approach was examined by comparing 17 deficit and 17 nondeficit patients for differences in premorbid adjustment and degree of neurological impairment. Deficit patients were characterized by poorer premorbid adjustment and greater neurological impairment. Neurological impairment was not related to premorbid adjustment in either group or in the total patient population. These findings support the utility of deficit symptoms for defining a more homogeneous subgroup of schizophrenia. [ABSTRACT FROM AUTHOR]

The authors assessed the mood and cognitive effects of sequential T4, T3, and withdrawal of thyroid hormone replacement on 25 patients who had had thyroidectomies for thyroid cancer. The patients experienced increased sadness and anxiety when they were without medication, but no significant difference in mood was noted between T4 and T3. The patients who experienced increased affective symptoms when not taking medication were more likely to have histories of affective illness or mood lability. [ABSTRACT FROM AUTHOR]

Of the 37 juveniles currently condemned to death in the United States, all of the 14 incarcerated in four states received comprehensive psychiatric, neurological, neuropsychological, and educational evaluations. Nine had major neurological impairment, seven suffered psychotic disorders antedating incarceration, seven evidenced significant organic dysfunction on neuropsychological testing, and only two had full-scale IQ scores above 90. Twelve had been brutally physically abused, and five had been sodomized by relatives. For a variety of reasons the subjects' vulnerabilities were not recognized at the time of trial or sentencing, when they could have been used for purposes of mitigation. [ABSTRACT FROM AUTHOR]

Acquired immune deficiency syndrome (AIDS) has neuropsychiatric and psychopathological complications: anxiety, depressive symptoms, and suicidal ideation are common. Patients may express anger toward ineffective medical care and perceived public discrimination, guilt about sexual practices or drug abuse, reactions to social isolation, and uncertainty about the implications of an AIDS diagnosis. CNS dysfunction and subsequent neuropsychiatric impairment are common and are initially characterized by decreased acuity, slowed mentation, and psychomotor retardation that can resemble depression. Marked global cognitive deficits, disorientation, and delusions ensue. The author discusses case management and outlines future clinical and research activities. [ABSTRACT FROM AUTHOR]

Objective: The authors' goal was to determine whether people with schizophrenia experience changes in decisional capacity when their antipsychotic regimens are discontinued for research purposes. Method: Capacity for informed consent for research, neuro- psychological performance, and psychiatric symptoms were assessed before and after discontinuation of antipsychotic medication in 10 individuals with schizophrenia. Results: Overall, participants showed minimal change on most measures during the medication-free interval, although their reasoning ability declined significantly. All participants who demonstrated adequate understanding of study procedures at enrollment retained this capacity throughout the study. Conclusions: Participants in medication-free schizophrenia research do not show a major decline in decisional capacity. However, the apparent decline in reasoning ability found in this study is of concern and underscores the need for both additional research on this topic and the development of remediational interventions aimed at enhancing this aspect of decisional capacity. [ABSTRACT FROM AUTHOR]

Evaluates cognition in children with obsessive-compulsive disorder early in their illness. Results of neuropsychological tests; Psychiatric symptoms and cognitive performance; Frontal lobe function in psychotropic-naive children.

Investigates the incidence and course of neuropsychiatric symptoms in pediatric patients with rheumatic fever. Details on the association between Sydenham's chorea and obsessive-compulsive disorder (OCD); Methods which can be used to assess the early stages of rheumatic fever; Symptoms of the condition.

Several photographs of animals that have been drawn during a neuropsychiatric recovery from Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis.

The article presents a calendar of events related to psychiatry in 2007 in the U.S. The 18th Annual Meeting of American Neuropsychiatric Association will be held on February 17-20 in Tucson, Arizona. The 20th Annual Meeting of the American Association for Geriatric Psychiatry will be held on March 1-4 in New Orleans, Louisiana. The 28th Annual Meeting and Scientific Sessions of the Society of Behavioral Medicine will be held on April 18-21 in Miami Beach, Florida.

A letter to the editor is presented in response to the article "The Evolving Subspecialization of Psychiatry: Implications for the Profession," by Joel Yager and Donald G. Langsley.

Serum digoxin concentrations can mislead psychiatric consultants. Two patients with therapeutic digoxin concentrations were seen for neuropsychiatric disorders that cleared rapidly once digoxin was discontinued. [ABSTRACT FROM AUTHOR]