Search

Objective Hybrid teleneuropsychology has emerged as a useful assessment method to manage physical distancing requirements during the COVID-19 pandemic. We describe the development of a hybrid teleneuropsychology clinic and compare results of six neuropsychological tasks across testing modalities, as well as a participant experience survey. Method Healthy middle-aged and older adults completed a face-to-face assessment two years previously. Participants either completed reassessment face-to-face or via the hybrid setup. Results were compared across time points and delivery modality. Results There were no significant differences in scores at reassessment between face-to-face and a hybrid setup on nonverbal fluid intelligence, verbal memory, visual memory, language, working memory or verbal initiation. Retest reliability was moderate to excellent for verbal and visual memory, attention and naming. Results of an anonymous survey indicated that participants felt comfortable and established good rapport with the examiner. Conclusions This hybrid method of teleneuropsychology can be used to obtain high quality and reliable results including on tasks yet to be evaluated for teleneuropsychology, including the Graded Naming Test and the Topographical Recognition Memory Test.

This scientific commentary refers to ‘Altered nucleus accumbens functional connectivity precedes apathy in Parkinson’s disease’ by Morris et al. (https://doi.org/10.1093/brain/awad113).

Executive functions comprise a suite of higher-order cognitive processes, which interact with other processes, such asStudy 1 includedAs designed, the sentence stimuli in the Emotional Hayling were rated as significantly higher in absolute emotional valence and arousal, compared to the Standard Hayling (Study 1). Overall, initiation and suppression on the Emotional Hayling were significantly poorer than on the Standard Hayling (Study 2). Finally, within the Emotional Hayling, participants made more suppression errors in response to negative sentences compared to positive sentences, and this effect was present in younger but not older adults.Reduced performance on the Emotional Hayling Test, particularly in response to negative sentences, is consistent with the emotional content placing increased demands on the executive function system. We present the Emotional Hayling Test as a promising clinical tool, with the potential to capture disruptions in emotional processing.

The overturning of Roe v Wade has resulted in the loss of reproductive rights for millions of women in the United States. It has also put these women at risk of severe mental and physical health consequences. When legal abortions are restricted, there is a rise in illegal abortion with the risk of hemorrhage, infection, infertility, and death. There are many more risks of carrying a pregnancy to term than health or psychological risks of a legal abortion. Women who have a miscarriage risk having to prove they did not abort. In cases of medical emergencies, doctors may be restricted from performing life-saving abortions for fear of penalties. Women or children who have been victims of rape or incest will have to either have an illegal abortion or carry an unwanted pregnancy to term. In states that allow an abortion in cases of severe risk to a mother's health, panels of internists and psychiatrist may, again, be charged with deciding whether her risks are valid. Women's physical and mental health will suffer.

Introduction: To document the characteristics of ALS patients in Queensland, to examine factors influencing age of onset and survival, and to study those with early onset ( 5 years) survival. Methods: We studied subjects seen at the ALS Clinic at the Royal Brisbane & Women’s Hospital. We recorded sex, age of onset, region of onset, length of survival, presence of family history, type of disease and evidence of cognitive involvement. We analysed the influence of these features on age of onset and on survival. We analysed the features of patients with early onset of disease and patients with long survival. Results: There were 855 ALS patients (505 males) in the cohort. The age of onset was lower in males than females, in patients with a family history of ALS compared to those without and in patients with spinal onset compared to bulbar onset. Early-onset disease was seen in 10% of patients, and had a greater proportion of males, spinal onset and classical ALS phenotype compared to late onset disease. Survival was shorter in females, in patients with bulbar onset, and in patients with classical ALS. Long survival was seen in 18% of patients. Patients with long survival had younger age of onset, greater proportion of males and of spinal onset and fewer patients with classical ALS. Discussion / Conclusion: Our study confirms that ALS is more prevalent in males, and that spinal onset is more common than bulbar onset. Males have earlier onset but longer survival. We found that overall, patients with classical ALS have worse survival than ALS variants, but some patients who were considered to have classical ALS had long survival. This study confirms the similarity of ALS in our region to ALS in other geographical regions.

To determine if there is an association between antenatal hypnotic benzodiazepine receptor agonist exposure and congenital malformations or other adverse pregnancy outcomes in the offspring.Databases were searched to January 31, 2021. Cohort studies published in English on congenital malformations or other adverse pregnancy outcomes in infants following exposure compared with those unexposed, were summarized and meta-analyzed where possible.Following screening, 25 studies were assessed for eligibility and seven included in the meta-analyses. Five studies were pooled for congenital malformations following first trimester exposure and not statistically significant (OR 0.87, 95% CI 0.56-1.36). The five studies that assessed for preterm birth following anytime exposure did pool to a statistically significant effect (OR 1.49, 95% CI 1.19-1.86); study quality, control for other psychotropic drugs and psychiatric diagnosis did not appear to be moderators. There were two missing studies when examining for publication bias in both of the main analyses above but the revised estimates were similar to the original. Low birth weight (LBW) was significant (three studies, any time exposure, OR 1.51, 1.27-1.78) as was small for gestational age (SGA) (three studies with anytime exposure, OR 1.34, 1.22-1.48). There were too few studies to summarize birth weight, gestational age, respiratory difficulties, APGAR score at 5 min and NICU admission.Pregnancy exposure to hypnotics was not associated with a higher risk for congenital malformations but was associated with an increased risk for preterm birth, LBW and SGA compared with those infants who were not exposed. These findings are consistent with the antidepressant and benzodiazepine literature.

Apathy is a multi-dimensional syndrome associated with reduced initiation, executive function and emotion toward goal-directed behaviour. Affecting ∼30% of stroke patients, apathy can negatively impact rehabilitation outcomes and increase caregiver burden. However, relatively little is known about the multi-dimensional nature of post-stroke apathy and whether these dimensions map onto neuropsychological and neuroanatomical correlates. The present study aimed to address this question in a case series of stroke patients with apathy. 65 patients with acute stroke were assessed on a comprehensive battery of neuropsychological tasks and 12 patients were identified as having clinically significant apathy on one or more domains on the Dimensional Apathy Scale. Individual scores were compared to a group of healthy controls and normative data where available. Lesion mapping was completed from clinical CT and MRI scans to characterise the extent and locations of each patient's lesion. All participants performed significantly poorer than controls on one or more tasks. Difficulties with inhibition were observed across all dimensions. Prospective memory deficits were also common, while speed and social cognition were only reduced in initiation and emotional apathy, respectively. Verbal fluency was not impaired in any of the patients, despite previously established relationships with apathy. Lesions were predominantly located in right subcortical regions, with some additional frontal, temporal and cerebellar/brainstem involvement. There was substantial overlap in lesion locations within and between dimensions, such that similar apathy symptoms occurred in patients with very different lesion sites. Overall, our results suggest that neuropsychological and lesion profiles of apathy in stroke patients may be more complex and heterogenous than in neurodegenerative disease, possibly due to functional changes occurring beyond the lesion site.

This prospective cohort study, “Prospective Imaging Study of Ageing: Genes, Brain and Behaviour” (PISA) seeks to characterise the phenotype and natural history of healthy adult Australians at high future risk of Alzheimer’s disease (AD). In particular, we are recruiting mid-life Australians with high and low genetic risk of dementia to discover biological markers of early neuropathology, identify modifiable risk factors, and establish the very earliest phenotypic and neuronal signs of disease onset. PISA utilises genetic prediction to recruit and enrich a prospective cohort and follow them longitudinally. Online surveys and cognitive testing are used to characterise an Australia-wide sample currently totalling nearly 3,000 participants. Participants from a defined at-risk cohort and positive controls (clinical cohort of patients with mild cognitive impairment or early AD) are invited for onsite visits for lifestyle monitoring, detailed neurocognitive testing, blood sample donation, plus functional, structural and molecular neuroimaging. This paper describes recruitment of the PISA cohort, study methodology and baseline demographics.Author ApprovalAll authors have seen and approved this manuscript.

This chapter on risk factors for postpartum disorders describes how the postpartum period is a time in women’s lives when they are at an especially high risk for developing mental health problems. The massive hormonal changes experienced after birth can interact with other risk factors to result in a postpartum disorder. Poor sleep due to infant care can exacerbate these vulnerabilities. There are many factors that may increase the risk of developing a postpartum disorder. Depression or anxiety during pregnancy, a personal or family history of a psychiatric disorder, current stressors, and lack of social supports may all increase the risk of developing a postpartum depression or anxiety disorder. Women with a history of bipolar disorder are particularly at risk for developing a depression or manic episode postpartum. Recognition of factors that may predispose women to the development of a postpartum disorder can allow preventative factors to be put in place.

This chapter on postpartum adaptation/baby blues describes the transient symptoms of sadness, tearfulness, irritability, and insomnia know as the “baby blues” experienced by 50% to 80% of new mothers. This is not a sign of depression but, rather, the consequences of the massive bio-psycho-social changes that occur after the birth of a child. No specific treatment other than education and reassurance is required. Most often these symptoms resolve spontaneously within the first 2 to 3 weeks. Occasionally, they continue and develop into a major depression so women should be reassessed within the first 6 weeks postpartum to ensure the symptoms have cleared.

This book is designed for clinicians including obstetricians, primary care physicians, nurse practitioners, social workers, or psychiatrists who may encounter postpartum women presenting with mood or behavioral symptoms. It may also be helpful for women themselves. It uses vignettes to illustrate various clinical presentations and describes the differential and most likely diagnoses. It covers all types of mental health problems that may present postpartum including Major Depressive Episodes, Generalized Anxiety Disorders, Schizophrenia, Bipolar Disorder, Obsessive Compulsive Disorder, Posttraumatic Stress Disorder, Eating Disorders, Disorders of Attachment and Personality Disorders. The epidemiology and etiology are described followed by management of these disorders. Many disorders can be managed by these clinicians once the disorder is identified. Postpartum women who read these vignettes might realize they should go for help. A bio-psycho-social approach to management is used with advice as to when to refer to someone with more expertise. Information about the safety of psychotropic medication during pregnancy and breastfeeding is reviewed. Various scales are provided to help with making a diagnosis. The information provided in a concise form should increase the skills and confidence in clinicians managing mental health problems presenting postpartum.

This chapter on psychopharmacology in pregnancy and postpartum discusses the decisions women must make about taking psychiatric medications when pregnant or breastfeeding. Although mild illness during pregnancy or postpartum may respond to psychotherapy and support, medication is often necessary for more serious psychiatric illness. Untreated illness can have deleterious effects on the baby and the mother. This chapter reviews the evidence that indicates it is generally safe to use the majority of psychotropic medications during pregnancy and while breastfeeding. Although it may be ideal to breastfeed, this may become complicated for women who have a psychiatric illness. Women with postpartum disorders should first be evaluated to assess whether the demands of breastfeeding are too onerous for them. Those women who can’t or don’t wish to breastfeed should not be made to feel guilty. Mothers who are suffering but wish to breastfeed can be reassured that many psychotropic medications are safe to use during breastfeeding. They may also benefit from supplementing with formula feeding with a bottle to allow the mother to get more sleep. Mothers who require medication but are afraid to use it while breastfeeding should be educated to understand that the negative effects on the baby of being depressed or psychotic outweigh any concerns about the dangers of taking medication.

Verbal adynamia is characterized by markedly reduced spontaneous speech that is not attributable to a core language deficit such as impaired naming, reading, repetition, or comprehension. In some cases, verbal adynamia is severe enough to be considered dynamic aphasia. We report the case of a 40-year-old, left-handed, male native English speaker who presented with partial rhombencephalosynapsis, corpus callosum dysgenesis, and a language profile that is consistent with verbal adynamia, or subclinical dynamic aphasia, possibly underpinned by difficulties selecting and generating ideas for expression. This case is only the second investigation of dynamic aphasia in an individual with a congenital brain malformation. It is also the first detailed neuropsychological report of an adult with partial rhombencephalosynapsis and corpus callosum dysgenesis, and the only known case of superior intellectual abilities in this context.

Executive functioning generally refers to the ability to organize thought and action based on intentions and goals, especially in novel, complex or difficult situations. Executive functioning is a multifaceted psychological construct that may be depicted as a set of related but separable high-level cognitive abilities, possibly supported by the prefrontal cortex and implemented by larger brain networks (Miyake et al., 2000; Shallice and Burgess, 1996 but see Duncan et al., 1997). Many models exist that emphasize commonalities or differences among various executive functions (EF). While the number and type of EF that exist remain a topic of debate, most authors would agree that EF show high intra- and inter-individual variability in terms of their cognitive and behavioral manifestations.

There is controversy about the use of antidepressant medication during pregnancy. Decisions about their use are affected by understanding the risks of these medications causing pregnancy loss, congenital malformations, neonatal adaptation syndrome, persistent pulmonary hypertension of the newborn, autism spectrum disorder, or long-term neurocognitive deficits. Although some research has raised concerns about antidepressants causing harm to the fetus and neonate, other studies have disputed these findings or noted that any risks found do not exceed the risk of congenital problems found in 1% to 3% of neonates in the general population. Untreated depression during pregnancy can also cause harm from poor diet, substance abuse, suicidal behavior, or prematurity. Decisions about the use of antidepressants during pregnancy must be based on a risk-benefit analysis based on the best evidence of the risks of treating or not treating maternal depression.

This article is the text of a multimodal keynote address given at the fifteenth annual CALICO Symposium in San Diego, California, in July 1998. The text of course cannot include the music and video excerpts and perceptual experiments in which the audience was engaged. [Comments in brackets indicate the points at which media were used.] The address at the CALICO symposium presented a multimodal paradigm for foreign language courses which draws upon interdisciplinary theories from anthropology, psychology, and language learning. The findings reported here are based on a pilot program in intensive Spanish conducted at San Diego State University in collaboration with the National Language Resource Center.

Psychiatric illness can occur during pregnancy and the postpartum period. Not only will the mother feel distressed but also these illnesses can cause direct and indirect harm to the baby as well as create long-term negative consequences

The objective of this review is to identify and illustrate methodological issues in studies used to support claims that induced abortion results in an "abortion trauma syndrome" or a psychiatric disorder. After identifying key methodological issues to consider when evaluating such research, we illustrate these issues by critically examining recent empirical studies that are widely cited in legislative and judicial testimony in support of the existence of adverse psychiatric sequelae of induced abortion. Recent studies that have been used to assert a causal connection between abortion and subsequent mental disorders are marked by methodological problems that include, but not limited to: poor sample and comparison group selection; inadequate conceptualization and control of relevant variables; poor quality and lack of clinical significance of outcome measures; inappropriateness of statistical analyses; and errors of interpretation, including misattribution of causal effects. By way of contrast, we review some recent major studies that avoid these methodological errors. The most consistent predictor of mental disorders after abortion remains preexisting disorders, which, in turn, are strongly associated with exposure to sexual abuse and intimate violence. Educating researchers, clinicians, and policymakers how to appropriately assess the methodological quality of research about abortion outcomes is crucial. Further, methodologically sound research is needed to evaluate not only psychological outcomes of abortion, but also the impact of existing legislation and the effects of social attitudes and behaviors on women who have abortions.

This study evaluated the psychological side-effects of clomiphene citrate (CC) and hMG in women undergoing fertility treatment.This study was a cross-sectional, self-report survey of 454 women at various stages of treatment for infertility. At the time of study, 139 women had not taken fertility drugs and 315 women had taken one or more cycles of CC or hMG. All subjects were asked to complete the State-Trait Anxiety Inventory (STAI). Women taking CC or hMG were also asked to complete a self-administered questionnaire on the side-effects of their medications.In the CC group (n = 162) and hMG group (n = 153), 77.8% (126 of 162) and 94.8% (145 of 153) reported at least one side-effect, respectively. Irritability, mood swings, feeling down, and bloating had high frequencies in both CC and hMG groups, with a higher mean number of side effects reported in the hMG group (4.4 +/- 3.7 for the CC group and 6.8 +/- 3.7 for the hMG group, p0.001). There was no significant difference among the CC, hMG and no medication groups for mean state and trait anxiety scores. However, there were significant differences among the three side-effect groups (those who reported 1 to 4, 5 to 7, and more than 7 side-effects) for the mean scores of state (df = 2, F = 8.7, p0.001) and trait (df = 2, F = 11.9, p0.001) anxiety in women taking fertility drugs.Women taking CC or hMG reported high frequencies of psychological side-effects, and should be advised of these before treatment.

To evaluate whether self-report measures of psychological distress and perceived risk were associated with nonadherence to recommended ovarian cancer surveillance.Eighty-three patients attending the Familial Ovarian Cancer Clinic (FOCC) at Princess Margaret Hospital were assessed psychosocially prior to and during initial familial-genetic assessment and then monitored for adherence with recommended follow-up surveillance over a period of 12-18 months. The assessment protocol included an investigator-designed clinic questionnaire, the State-Trait Anxiety Inventory (STAI), Center for Epidemiologic Studies Depression Scale (CESD), Life Orientation Test (LOT), Medical Outcomes Study Social Support Survey (MOSSS), Texas Inventory of Grief, and the COPE. Nonadherence was measured in terms of unexplained absences at one or two recommended and scheduled surveillance appointments following the familial-genetic assessment.Univariate tests revealed a significant association between higher perception of ovarian cancer risk, as assessed immediately after the familial-genetic risk assessment in the clinic and nonadherence to physician-recommended surveillance (chi2 (2, N = 83) = 9.75, P0.008). Empirically based estimates of risk, conveyed by the clinic team to subjects, were not significantly associated with nonadherence (chi2 (2, N = 83) = 0.19, P = 0.91). Logistic regression analysis revealed that subjects who perceived themselves to be at high ovarian cancer risk were five times more likely to be nonadherent than participants who perceived themselves to be at low or medium ovarian cancer risk.These results suggest that higher self-perceived risk may predict adherence difficulties to recommended surveillance in women attending a familial-genetic risk clinic.

Contrary to widely held beliefs, menopause is not associated with an increase in psychiatric illness. Although just prior to menopause there is a slight increase in minor psychological symptoms, prevalence rates of depression fall post-menopause. Hypotheses for the occurrence of depression in some perimenopausal women include: a pre-existing sensitivity to the change in the gonadal hormones leading to decreases in neural transmitters; reactions to the physiological changes associated with menopause such as night sweats; or the influence of a multitude of negative attitudes and expectations concerning menopause. The loss of the protective effects of estrogen may be related to the slight increase in the incidence of schizophrenia in women at menopause. The role of hormone replacement therapy (HRT) in treating psychiatric symptoms remains poorly understood. In nondepressed women, HRT may improve well-being either as a direct effect or as a consequence of reduced physical symptoms and fear of aging. In women with moderate to severe depressions, HRT alone does not appear to be beneficial. HRT may have some beneficial effects on short term memory. More research is needed to assess the possible role of HRT in augmenting the effects of antidepressant and antipsychotic medications.

Objective: This paper is the first of a 2-part review on the topic of stalking. It outlines the behaviours involved, epidemiology, motivation of offenders, and mental health consequences for the victim. Method: Computerized literature searches were used to identify relevant papers from psychiatric and legal journals. Publications by victims' and women's organizations provided additional information. Results: Up to 1 in 20 women will be stalked during her lifetime. The majority of victims are female, while the offenders are usually male. Stalking behaviours range from surveillance to threatening aggressive or violent acts. The majority of stalking relates to failed intimate relationships. Stalkers may also suffer from erotomania or obsessional love with a primary psychiatric diagnosis. Victims may experience anxiety, depression, guilt, helplessness, and symptoms of posttraumatic stress disorder (PTSD). Conclusion: Stalking is a serious offence perpetrated by disturbed offenders. It can cause major mental health consequences, which are often poorly understood by society.

Objective: This paper is the second of 2 parts reviewing the topic of stalking. It focuses on victims' difficulties with the legal system and the psychotherapeutic tasks for victims and therapists. Method: Computerized literature searches were used to identify relevant papers from psychiatric and legal journals. Publications by victims' and women's organizations provided additional information. Results: Victims suffer emotional consequences from being stalked. Additional stress is caused by the legal system's lack of understanding of the causes and consequences of stalking and inadequate and unenforced laws. The treatment of victims requires a comprehensive approach, including education, supportive psychotherapy, and discussion of practical measures. Therapists may over identify with the patient's powerlessness or hesitate to take on a case out of fear of the stalker. Female therapists may protect themselves against the realization of their own vulnerability by blaming the victim, while male therapists may feel defensive or overprotective. Conclusion: Stalking is a crime with major mental health consequences which is often poorly understood by society. Therapists need to be aware of the victim's emotional reactions, the types of legal and practical supports available, and the possible biases of society. Further education and research should be encouraged.

Stalking involves recurrent unwanted communication, harassment, and intrusive behaviors. The aim of this study was to examine physicians' experiences of being stalked by their patients, with particular attention to the emotional impact on the physicians and their actions taken. A questionnaire designed to study the nature and the impact of stalking experiences among physicians was sent to 3159 randomly chosen physicians in the Greater Toronto Area. Approximately 15% (14.9%) of the 1190 physicians who responded reported having been stalked. The physicians reported feeling angry, frustrated, anxious, frightened, lacking control, and helpless. The physicians coped in a number of ways including terminating the physician-patient relationship, but many just ignored the problem. Most had no previous knowledge about stalking. Physicians experience a range of emotions as a result of being a victim of stalking. In view of the prevalence and the impact, physicians may benefit from education to help prepare them for the possibility of being stalked. Language: en

Women who lose desired pregnancies by miscarriage, stillbirth, or genetic termination are at risk of suffering from grief, anxiety, guilt and self-blame that may even present in subsequent pregnancies. It is important to find effective means of helping women deal with these losses. The approach to stillbirth has shifted from immediately removing the child from the mother to encouraging the parents to view and hold the baby. This approach has been questioned as possibly causing persistent anxiety and post-traumatic stress disorder. Women who miscarry are currently encouraged to find ways to memorialise the lost fetus. Couples who decide to terminate a pregnancy after discovering a defect may deal not only with sadness but also guilt. Immediate crisis intervention and follow-up care should be available, recognising that individual women may experience different reactions and their specific post-loss needs must be assessed.

(1996). The Psychological Impact of Infertility and New Reproductive Technologies. Harvard Review of Psychiatry: Vol. 4, No. 3, pp. 168-172.

Over the last 30 years, major advances have been made in our understanding of how bio-logical factors and sociocultural influences contribute to gender differences, gender identity formation, and gendered role behavior. Sensitivity to the psychological effects of changing family structure and workforce composition, the contribution of reproductive events, and the high rates of exposure to trauma in women is essential for optimal psychiatric assessment and treatment planning. This knowledge has not been systematically integrated into residency training. The authors present an outline for a curriculum in gender and women's issues, including educational objectives, learning experiences through which residents could meet these objectives, and recommended readings. The authors also discuss potential obstacles and suggest helpful strategies for implementing the proposed curriculum.