Neuropsychiatric Approach Research Articles

Late-life depression: a neuropsychiatric approach

Late-life depression refers to depressive syndromes defined in the American Psychiatric Association’s Diagnostic and Statistical Manual and in the International Classification of Diseases that arise in adults older than 65 years of age. Late life depressive syndromes often arise in the context of medical and neurologic disorders. There is a high prevalence of depression in various neurodegenerative disorders such as Alzheimer’s disease, Lewy body disease, Parkinson’s disease, cerebrovascular disease and frontotemporal dementias. It has been well recognized that late life depression may itself be the presenting symptom of a latent neurodegenerative disorder. Therefore, an accurate diagnosis of late-onset depression may serve to identify a high-risk group that would benefit from initiation of therapies with the goal of delaying or possibly even preventing the onset of dementia.

A Method for Studies of Madness

In these series of articles honouring John Marshall for his contributions to psychology, linguistics, the history of ideas and many other fields we should not forget his contribution to psychiatry. This has been mostly from the point of view of a critical observer, but also someone deeply interested in the application of cognitive neuropsychology to a broader range of disorders than the traditional ones. This “cognitive neuropsychiatric approach” is discussed in relation to attempts to understand thought disorder, delusions and lack of insight.

An integrated neuropsychiatric approach to diagnosis and management of patients with epileptic seizures

In patients who present to neurology settings with history of epileptic seizures, psychiatric disorders may be the sole manifestation of apparent neurologic symptoms, or they may coexist. Current challenges for clinicians include distinguishing between two disorders and making the correct diagnoses, interpreting test results, and (co-) managing the disorder(s). Our goal is to provide the clinician with an integrated neuropsychiatric approach for the triage, assessment (history, screening tools, examination, diagnostic tests), and treatment (neurologic and/or psychiatric) of these challenging patients. In particular, use of schemata, tables, and algorithms will offer step-by-step approaches and guidelines for the clinician. Recommendations are made for the indications for psychiatric consultation, and co-management is recommended for patients with emergencies, those who fail routine psychiatric treatments, and those with complex presentations or multiple comorbid conditions.

Whither Neuropsychiatry?

Whither Neuropsychiatry?

Chronic daily headache in children and adolescents.

Characterize chronic daily headache in those less than 20 years of age. Prospective, observational, and sequential. Private practice Pediatric Neurology Clinic in a Canadian city (Winnipeg). Patients and data collection: Data on those referred with headache between September 1998 and December 2001 were entered on data sheets. Patients were followed up for one month to four years. One hundred and forty-three (31%) of 463 referred with headache had chronic daily headache with duration of one month to five years (median: eight months). The age range was 5.5 years to 20 years (median: 13 years). There were significantly more females (N=93) than males (N=50). The main groups were: (1) transformed migraine: 6 (4%), (2) transformed tension-type headache: 80 (56%) and (3) transformed comorbid migraine and tension-type headache: 39 (27%). Tension-type features dominated in 94%. Analgesia overuse occurred in two. Stressors were recognized in 60 (42%); anxiety disorder was diagnosed in 8 (6%), and depression in 13 (9%). Computed tomography scans were done in 31 (22%), and MRI/MR angiography in 8 (6%) and were normal or showed nonspecific incidental findings. Twenty-two (15%) were lost to follow-up; 115 of the remaining 121 (95%) were headache free or greatly improved, 63 (55%) without specific treatment. Chronic daily headache is a common headache disorder in children and adolescents, especially in teenage girls. A prospective neuropsychiatric approach is necessary for evidenced-based management, since the condition has mental health, social and economic ramifications.

The cognitive neuropsychiatry of auditory verbal hallucinations: An overview

Introduction. The cognitive neuropsychiatric approach to auditory verbal hallucinations (AVHs) attempts to explain the phenomena in cognitive or information-processing terms and ultimately their brain bases.Methods. A narrative review of the literature and an overview of this special issue of Cognitive Neuropsychiatry.Results. First, an operational definition of AVHs is offered. Next, clues to etiology are derived from a detailed consideration of the clinical phenomenology of “voices”, their form and content. Functional and structural neuroimaging studies suggest the importance of left-side language areas in the generation/perception of AVHs.Conclusions. Existing cognitive neuropsychiatric models provide a useful framework for the understanding of AVHs. However, data need to be applied more specifically to these models so that they may be refined.

OLD AND FORGOTTEN: ALZHEIMER’S LESSONS (Opening lecture of the ABCDE Congress of Bologna)

In Alois Alzheimer's times, an integrated approach combining neurology, psychiatry and neuropathology was natural, but those directions are growing apart from each other. Although no doubt these fields have developed into new fruitful disciplines, there is the danger of inconsistency and tunnel vision. In this lecture, a plea is made for a more integrative neuropsychiatric approach. This is demonstrated by means of new research findings from the Maastricht Behavior and Dementia Study, and the Maastricht MCI cohort study. A broad neuropsychiatric approach, in which both biological and psychosocial aspects are studied, does greater justice to patients with dementia. A too narrow view of dementia as a cognitive disorder not only frustrates research, but also is not at all helpful to patients and their carers, because the most harrowing aspects of the disease remain underexposed. Research on psychosocial aspects and care should be given a higher priority.

Neuropsychiatry: An Introductory Approach

Neuropsychiatry: An Introductory Approach

Neuropsychiatry: An Introductory Approach

Neuropsychiatry: An Introductory Approach

Neuropsychiatry: An Introductory Approach

Back to table of contents Previous article Next article Book Forum: NeuropsychiatryFull AccessNeuropsychiatry: An Introductory ApproachLAURA A. FLASHMAN, Ph.D., LAURA A. FLASHMANSearch for more papers by this author, Ph.D., Lebanon, N.H.Published Online:1 Apr 2003https://doi.org/10.1176/appi.ajp.160.4.803AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The field of neuropsychiatry, prominent in the 19th century, has once again emerged as a specialty area. This is due, at least in part, to major advances in the basic and clinical neurosciences, which have added to our knowledge base with regard to the neurobiological basis of cognition, emotion, and behavior. In the last 15–20 years, there has been an explosion of scientific information available to assist clinicians in the diagnosis and treatment of patients with neuropsychiatric disorders. Although this progress is of great value, the sheer enormity of the available information can be overwhelming to newcomers and those interested in, but not totally familiar with, the field of neuropsychiatry. To meet this need, Neuropsychiatry: An Introductory Approach was developed as a practical introductory guide to serve as a starting point for anyone interested in brain-behavior relationships and the treatment of neuropsychiatric problems.The book serves as an overview of concepts and methods rather than as an exhaustive treatise on all neuropsychiatric problems, and it is divided into three major sections. Part 1 (chapters 1–7) reviews the history and current status of neuropsychiatry. In this section, Arciniegas and Beresford introduce a neuropsychiatric approach to use for conceptualizing and understanding basic and complex cognition, emotion, personality, and psychological adaptation. Part 2, A Neuropsychiatric Approach to Evaluating the Patient, describes the fundamental tools that should be used to understand neuropsychiatric disorders, including the neuropsychiatric evaluation, mental status examination, electrophysiology, and neuroimaging techniques. Finally, part 3 (chapters 12–18) examines several neuropsychiatric disorders with the purpose of providing an explicit application of the relevant concepts and methods discussed in part 1. Selected topics relevant to clinical neuropsychiatry are highlighted, including delirium, dementia, obsessive-compulsive disorder, Parkinson’s disease, and traumatic brain injury, as well as diminished motivation, apathy, and alcoholism and other alcohol-related disorders. The ultimate goal is to permit generalizability and application of the approach to the clinical management and care of patients with other neuropsychiatric disorders.The book is well written and easy to read and provides a cohesive, interesting, and clinically applicable learning tool for medical students, residents, allied health clinicians, and others motivated to learn about the neuropsychiatric approach. The goal of this book was not trivial—“to make the material engaging but relatively simple, and therefore useful” (p. xviii) as well as “offering enough information to convey the richness of the material, while not losing the notion of a practical, introductory guide to understanding neuropsychiatry among the seemingly endless details that might be included” (p. xviii). The authors are very clear about their purpose, and about the selectivity of the topics chosen to be included. The book is not an exhaustive review of neuropsychiatric disorders, and this is deliberate so that readers would not be distracted from the book’s primary purpose—exposure to the neuropsychiatric approach itself. Throughout the book, the authors do an admirable job providing the basic and clinical scientific foundation needed to evaluate and treat neuropsychiatric patients competently, without losing sight of their goal to keep it simple and relevant.Kudos to Drs. Arciniegas and Beresford for taking on such a worthy venture, and for a job well done. I sincerely believe that Neuropsychiatry: An Introductory Approach will be an asset to anyone who uses it.By David B. Arciniegas and Thomas P. Beresford. New York, Cambridge University Press, 2002, 438 pp., $140.00; $50.00 (paper published 2001). FiguresReferencesCited byDetailsCited byNone Volume 160Issue 4 April 2003Pages 803-804 Metrics History Published online 1 April 2003 Published in print 1 April 2003

The cognitive neuropsychiatric approach to investigating the neurobiology of schizophrenia and other disorders

In this paper, we examine a cognitive neuropsychiatric approach to understanding neuropsychiatric disorders by examining recent data in schizophrenia. By understanding and applying this approach, we suggest that the processes underlying the neurobiology of a range of other psychiatric disorders can be understood. Further, an assessment of the brain–behaviour relationships through this emerging discipline provides testable models for further study, using a range of techniques including functional and other imaging techniques.

Depression and Parkinson's disease: a conceptual challenge.

To explore the relation between Parkinson's disease (PD) and depression from a conceptual point of view. Discussion of the relevant literature on the conceptual, phenomenological and therapeutical aspects of depression in Parkinson's disease. Both semantic confusion and an erroneous belief in the mind-body distinction have contributed to some common misunderstandings of the nosology and etiology of depression in Parkinson's disease. The consequences of a different, integrated, neuropsychiatric approach for both diagnosis and treatment are discussed.

The French concept of "Athymhormie" (Loss of vital force) from 1922 to the present

The psychiatric concept of athymhormie (loss of vital force "élan vital" and affectivity) was developed at the beginning of the 20th century and used exclusively in France, until it was fortunately adopted by mostly French-speaking neurologists. The authors of the concept, M Dide and P Guiraud, considered the term an independent entity, an heir to dementia praecox, for which they did not like to substitute a "schizophrenia" with blurry boundaries. This term then came to mean to them, and to most French psychiatrists to this day, the basic core of psychosis' deficient forms. The word athymhormie (or loss of psychic self-activation) is now also used in neurology for the behavioural and emotional consequences of lesions caused on basal nuclei and, more widely, of a circuit associated with the limbic loop. However, the phenomenological reality of the associated disorders and the relevance of the same name can be questioned. This review concludes that although the settings--in a psychiatric or a neurologic clinic--where athymhormie takes place are very different, the choice of the same name is justified in a renewed and symptomatic neuropsychiatric approach. The objective of this approach is to explore why some symptoms, common or similar, could represent the lack of a physiological function, presumed here to be motivation.

Neuropsychiatry and Mental Health Services

Neuropsychiatry and Mental Health Services

Neuropsychiatry and Mental Health Services

Neuropsychiatry and Mental Health Services

Cognitive neuropsychiatry: potential for progress.

Cognitive neuropsychiatry: potential for progress.

International Neuropsychiatric Association

International Neuropsychiatric Association

Evaluation of outcome after intracranial aneurysm surgery: the neuropsychiatric approach.

With the reduction of mortality and gross neurologic morbidity of patients undergoing intracranial aneurysm surgery, the interest in outcome is shifting towards more subtle aspects such as cognitive deficits and psychosocial adjustment. We discuss two different ways of measuring outcome in a sample of 20 patients who had intracranial aneurysm surgery. Patients were evaluated at discharge using the Karnofsky Scale and the Glasgow Outcome Scale. Six months after discharge we conducted a neuropsychiatric evaluation including cognitive, behavioral, and mood status assessment. Although 13 of out patients had a "good recovery, " 18 had some neuropsychiatric impairment. Comparing patients with "good recovery" with the remainder, patients with poorer outcomes tended to have a left pterional approach, a poorer "drive", and language disorders (p < 0.05). There was no correlation between out cognitive, mood, and behavioral assessment and the results of the Karnofsky and Glasgow Outcome Scales ( p > 0.05). we conclude that neuropsychiatric deficits are common after intracranial aneurysm surgery and that for our study the Karnofsky Scale and Glasgow Outcome Scale were not sensitive enough to detect residual impairment. therefore, it is important to develop brief tests and scales able to identify these problems and to complement the standard clinical neurological examination.

A cognitive neuropsychiatric approach to the study of delusions in schizophrenia using visual scan paths

Saccadic behaviour ranges from reflexive (e.g., prosaccade) to goal oriented voluntary movements (e.g., antisaccade). Behavioural asymmetries between vertical and horizontal saccades have been described both in normal individuals (greater delay of vertical prosaccades) and in disease states such as Parkinson's disease (PD) (prosaccades are short and antisaccades are delayed, especially in the vertical plane, possibly due to a frontostriatal deficit). Importantly, the cortical mechanisms for the generation of vertical saccades are largely unknown, both in health and disease, when compared with their horizontal counterpart. Moreover, studies exploring saccadic neural correlates and putative compensatory mechanisms at a functional level in PD are scarce. We investigated horizontal and vertical prosaccades and antisaccades in an eye tracking paradigm in 19 PD patients off medication and 22 healthy controls, followed by a block-design functional Magnetic Resonance Imaging (fMRI) study, consisting of two runs (prosaccade, antisaccade) of 6 blocks each (3 vertical, 3 horizontal). While saccade metrics were not significantly different between groups, PD showed left frontal underactivation during horizontal prosaccades and right parietal overactivation during horizontal and vertical prosaccades and horizontal antisaccades. Moreover, controls showed greater deactivation of the default-mode network (DMN) during antisaccades. Vertical prosaccades were associated with greater right frontal and cerebellar activity in controls, and cuneus hypoactivity in PD. Vertical antisaccades were associated with greater DMN deactivation in both groups and left frontal hypoactivity in PD. Putative functional compensatory changes in the right parietal cortex in PD patients may help to keep saccadic behaviour at the same level as the healthy controls. We provide first time evidence showing that functional cortical asymmetries between vertical and horizontal saccades occur distinctively in PD patients and healthy controls.

Facial processing in schizophrenia and delusional misidentification: cognitive neuropsychiatric approaches

The human face is of great importance as a stimulus in view of the detailed information it contains — information vital to understand in order to survive in the complex social world. There are different aspects to facial processing, including: affect analysis, recognition of individuality and recognition of familiarity, all of which have been incorporated into the cognitive model of Bruce and Young (1986). The cognitive neuropsychiatric approach has recently been employed in the study of facial processing in schizophrenia. It has become apparent that schizophrenic subjects are impaired in facial processing tasks at all levels, and this may well be related to the misinterpretation of social interactions commonly found in such subjects. This approach has also led to a greater understanding of delusional misidentification, with particular syndromes explained in terms of processing deficits at different levels of the cognitive model above. At an anatomical level, the role of the right hemisphere in facial perception is well-known, with there being some evidence of right hemisphere hypofunction in subjects with schizophrenia and also in delusional misidentification. The review therefore emphasizes the importance of the neuropsychiatric approach for further investigation of facial processing and understanding of symptomatology in schizophrenia and related psychoses.