Journal of Neuropsychiatry SPECIAL ARTICLES

Evaluating the Affective Component of the Cerebellar Cognitive Affective Syndrome [SPECIAL ARTICLES]

Wolf, U., Rapoport, M. J., Schweizer, T. A. — 2009-09-23

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.

Does Cognitive Behavioral Therapy Change the Brain? A Systematic Review of Neuroimaging in Anxiety Disorders [SPECIAL ARTICLES]

Porto, P. R., Oliveira, L., Mari, J., Volchan, E., Figueira, I., Ventura, P. — 2009-07-21

This systematic review aims to investigate neurobiological changes related to cognitive-behavioral therapy (CBT) in anxiety disorders detected through neuroimaging techniques and to identify predictors of response to treatment. Cognitive-behavioral therapy modified the neural circuits involved in the regulation of negative emotions and fear extinction in judged treatment responders. The only study on predictors of response to treatment was regarding obsessive-compulsive disorder and showed higher pretreatment regional metabolic activity in the left orbitofrontal cortex associated with a better response to behavioral therapy. Despite methodological limitations, neuroimaging studies revealed that CBT was able to change dysfunctions of the nervous system.

Agrypnia Excitata: Current Concepts and Future Prospects in Management [SPECIAL ARTICLES]

Hazin, R., Abuzetun, J. Y., Giglio, P., Khan, F. — 2009-07-21

Agrypnia excitata is an extremely rare, life-threatening syndrome characterized by autonomic activation, persistent insomnia, and generalized overactivity. Agrypnia excitata describes a triad of three separate conditions: delirium tremens, Morvan’s chorea, and familial fatal insomnia (FFI). Each of the aforementioned three conditions have sleep disturbances as a unifying theme and results in distinct neurophysiological findings. The following is an overview of agrypnia excitata with a particular emphasis placed upon each of the three individual conditions that constitute the syndrome with recommendations on appropriate management.

Amygdala Volume in Adults with Posttraumatic Stress Disorder: A Meta-Analysis [SPECIAL ARTICLES]

Woon, F. L., Hedges, D. W. — 2009-04-09

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 Behavioral Spectrum of Gilles de la Tourette Syndrome [SPECIAL ARTICLES]

Cavanna, A. E., Servo, S., Monaco, F., Robertson, M. M. — 2009-04-09

Gilles de la Tourette syndrome is a neurodevelopmental disorder consisting of multiple motor and one or more vocal/phonic tics. Tourette’s syndrome is increasingly recognized as a common neuropsychiatric disorder usually diagnosed in early childhood, and comorbid neuropsychiatric disorders occur in approximately 90% of patients; the most common of these are attention deficit hyperactivity disorder and obsessive-compulsive disorder. Depression is also common, with a lifetime risk of 10% of patients. Moreover, a high prevalence of personality disorders has been reported in preliminary investigations on Tourette’s syndrome populations. This paper provides an updated review of the literature on the multifaceted phenotype of Tourette’s syndrome, with special attention to the behavioral problems and the relationship between Tourette’s syndrome and comorbid neuropsychiatric conditions. The issue of whether Tourette’s syndrome should still be considered as a unitary nosological entity is also addressed.

A Psychological and Neuroanatomical Model of Obsessive-Compulsive Disorder [SPECIAL ARTICLES]

2009-02-05

Imaging, surgical, and lesion studies suggest that the prefrontal cortex (orbitofrontal and anterior cingulate cortexes), basal ganglia, and thalamus are involved in the pathogenesis of obsessive-compulsive disorder (OCD). On the basis of these findings several models of OCD have been developed, but have had difficulty fully integrating the psychological and neuroanatomical findings of OCD. Recent research in the field of cognitive neuroscience on the normal function of these brain areas demonstrates the role of the orbitofrontal cortex in reward, the anterior cingulate cortex in error detection, the basal ganglia in affecting the threshold for activation of motor and behavioral programs, and the prefrontal cortex in storing memories of behavioral sequences (called "structured event complexes" or SECs). The authors propose that the initiation of these SECs can be accompanied by anxiety that is relieved with completion of the SEC, and that a deficit in this process could be responsible for many of the symptoms of OCD. Specifically, the anxiety can form the basis of an obsession, and a compulsion can be an attempt to receive relief from the anxiety by repeating parts of, or an entire, SEC. The authors discuss empiric support for, and specific experimental predictions of, this model. The authors believe that this model explains the specific symptoms, and integrates the psychology and neuroanatomy of OCD better than previous models.

The Differential Diagnosis of Childhood- and Young Adult-Onset Disorders That Include Psychosis [SPECIAL ARTICLES]

Lauterbach, M. D., Stanislawski-Zygaj, A. L., Benjamin, S. — 2009-02-05

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.