Search

Two patients, with magnetic resonance imaging (MRI)-confirmed relatively selective hippocampal damage, showed distinct patterns of performance on tests of recall, item recognition, and associative recognition. Patient AC showed a mean bilateral volume reduction of the hippocampus of 28%, but displayed no memory deficit. Both recall and recognition memory were unimpaired. In contrast, patient PR, who showed a mean bilateral hippocampal volume reduction of 59%, was more consistently impaired on recall than recognition tests, although his recognition scores were highly variable. Patients AC and PR illustrate how variable the memory deficit following seemingly selective hippocampal damage can be in humans. They highlight the need for more sophisticated imaging in future studies if the human hippocampus' role in memory is to be fully identified. © 2008 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

In the long term after traumatic brain injury, the most disabling problems are generally related to neuropsychiatric sequelae, including personality change and cognitive impairment, rather than neurophysical sequelae. Cognitive impairment after severe injury is likely to include impaired speed of information processing, poor memory and executive problems. Personality change may include poor motivation, and a tendency to be self-centred and less aware of the needs of others. Patients may be described as lazy and thoughtless. Some become disinhibited and rude. Agitation and aggression can be very difficult to manage. Anxiety and depression symptoms are quite frequent and play a role in the development of persistent post-concussion syndrome after milder injury. Depression may be associated with a deterioration in disability over time after injury. Psychosis is not unusual though it has been difficult to confirm that traumatic brain injury is a cause of schizophrenia. Head injury may, many years later, increase the risk of Alzheimer's disease. Good rehabilitation probably minimizes the risk of psychiatric sequelae, but specific psychological and pharmacological treatments may be needed. [ABSTRACT FROM AUTHOR]

Survivors of acquired and traumatic brain injuries may often experience anxiety states. Psychological reactions to neurological trauma may be caused by a complex interaction of a host of factors. We explore how anxiety states may be understood in terms of a biopsychosocial formulation of such factors. We also review the current evidence for the presence of specific anxiety disorders after brain injury. We then describe how cognitive-behaviour therapy (CBT), a treatment of choice for many anxiety disorders, may be integrated with cognitive rehabilitation (CR), for the management of anxiety disorders in brain injury. We illustrate how CBT and CR may be delivered with a case of a survivor of traumatic brain injury (TBI) who had developed obsessive compulsive disorder and health anxiety. We show how CBT plus CR allows a biopsychosocial formulation to be developed of the survivor's concerns for guiding a goal-based intervention. The survivor made significant gains from intervention in terms of goals achieved and changes on clinical measures. We argue that large-scale research is needed for developing an evidence base for managing emotional disorders in brain injury. [ABSTRACT FROM AUTHOR]

This study describes the range of service provision and explores differences in treatment approaches and therapeutic aims, in the 12 countries participating in the European Union collaborative COST B6 Adolescent Project into the treatment of adolescent anorexia nervosa (AN). Following a number of group meetings, two questionnaires were administered, completed and returned by e-mail. The first questionnaire examined features of the services provided, including details of the numbers of patients seen, inpatient admission criteria and aspects of patient management. The second questionnaire contained a list of 13 therapeutic aims, asking respondents to rank in order the six they considered most important in the first weeks of treatment. There was broad agreement between services concerning the need to offer a full spectrum of services in a range of settings. Nevertheless, there were significant differences in approaches, chiefly concerning the readiness to admit to hospital, the use of (individual or family) day units and the focus on weight restoration as opposed to therapeutic engagement. Copyright © 2002 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Introduction. Theory of mind (ToM) deficits have recently been associated with executive dysfunction and frontal brain damage. This case study investigated ToM ability and its relation to executive functioning and the role of the frontal cortex, in an adult male with orbitofrontal (OF) damage and disturbance in social behaviour. It was hypothesised that both ToM ability and executive functioning would be impaired. It has also been suggested that ability to understand affective states may be mediated by OF structures. Understanding of affective state attribution was also investigated. Methods. A 59-year-old male Caucasian with social disturbance and OF damage was administered a battery of neuropsychological tests, tests of executive function, plus ToM stories and cartoons, in order to assess the ability to infer mental and affective states in others. Results. Ability to understand mental states and affective responses was found to be intact and independent of executive functioning. Conclusion. ToM ability appears to be independent of executive skills of overall strategy formation and not necessarily dependent on OF involvement. It is concluded that evidence supports the modular hypothesis of ToM and that this ability may be supported by more posterior regions. [ABSTRACT FROM AUTHOR]

Brain uptake of 123I-iomazenil was studied in seven cirrhotic patients and eight normal controls using single photon emission computerized tomography. The highest concentration of the ligand was found in the occipital cortex, which corresponds to the brain region with the highest concentration of benzodiazepine receptors. The peak uptake was delayed in patients across all brain regions. The uptake in occipital cortex was higher in low albumin cirrhotics. Patients with low albumin also presented a more delayed peak uptake in occipital cortex and a higher volume of distribution of iomazenil in plasma, compared to patients with normal albumin levels and controls. The changes in brain uptake (delayed peak uptake and increased maximal uptake in occipital cortex) appears to reflect changes in the pharmacokinetics of the ligand, particularly in cirrhotics with low levels of plasma albumin. The curve of brain uptake of the tracer was modelled into a two compartments equation, which seems to provide a practical and reliable method to calculate the slopes of acquisition and decay, time to peak and maximal acquisition. [ABSTRACT FROM AUTHOR]

We have no introspective knowledge of the effects of preconscious processing on our perceptions. We are, therefore, not aware that our expectancies may have prejudiced our perceptions. Expectancies tend to foster perceptions with which they are consonant. Therefore false expectations, driven by false beliefs, may result in misperceptions which reinforce those false beliefs. This morbid cycle is central to the delusional misidentification syndromes. This cycle, with positive feedback, is intrinsically unstable, which helps to explain brief episodes of delusional misidentification. Good sensory data, strong links between sense data and memory, and good judgement will all help to prevent misperceptions. The less these constraints are disrupted, the stronger will be the psychological forces needed to generate a delusional misidentification. It is likely that suspiciousness generates particularly assertive effects on preconscious processing of perceptions. Abnormalities of perceptual processing in patients with schizophrenia explain their proclivity to delusional misidentification. [ABSTRACT FROM AUTHOR]

QUESTION: What is the effectiveness of disulfiram for cocaine dependence in patients who are also opioid addicts treated with methadone?DesignRandomised (allocation concealed}*,**, blinded (investigator and patient)-, placebo controlled trial with 12 weeks of follow up.SettingUrban substance abuse treatment centre in the US.Patients69 outpatients (mean age 35 y, 53% women, 74% white}* with DSM-III-R criteria for cocaine dependence who were on methadone treatment and using cocaine frequently (defined as having >/=3 urine toxicology screens positive for cocaine in the 1 mo before study). Exclusion criteria were psychotic or bipolar disorders, serious psychiatric symptoms, or contraindications to disulfiram use. Follow up was 75%. 97% were included in the analysis.InterventionPatients were allocated to disulfiram, 250 mg/day (dissolved directly in the methadone) in=37)*, or placebo in=32)* for 12 weeks. Patients used a mean methadone dose of 88.6 mg/day, and were counselled about the risk of a disulfiram alcohol interaction and advised not to drink alcohol. During the study, patients adhered to a behavioural contract with a reductiori of methadone dose for violations.Main outcome measuresFrequency and quantity of cocaine, alcohol, and other substance use were self reported and verified by urine tests and breathalyser readings.Main resultsPatients who received disulfiram had a lower mean number of days of cocaine use than those who received placebo (5.0 v 6.7 d, p = 0.04). Furthermore, those who received disulfiram had a greater mean decrease in quantity (p=0.02) of cocaine use than those who received placebo; groups did not differ for alcohol or heroin use. The effectiveness of disulfiram did not differ in patients who did and did not use alcohol at baseline.ConclusionDisulfiram was effective in patients with cocaine abuse who were also methadone treated opioid addicts with or without comorbid alcohol abuse.*Information provided by author. **See glossary. [ABSTRACT FROM AUTHOR]