Orbitofrontal Syndrome Research Articles

Orbitofrontal syndrome in an offender incarcerated for aggravated kidnapping, rape and death of a minor

Orbitofrontal syndrome is characterized by disinhibition, impulsiveness, transgression of social norms and sometimes thedevelopment of criminal behavior. This is the case of an 18-year-old male offender incarcerated for kidnapping, rape andhomicide of a minor. He was evaluated through interviews and the use of the Eysenck personality questionnaire (Form B), Raven’s progressive matrices (RPM), Rey–Osterrieth complex figure (Form A), Differences perception test (FACES-R), Stroop color and word test (SCWT), Mini-Mental state examination (MMSE) and Aggression questionnaire (AGQ). The research subject showed age-appropriate speech, language and vocabulary, and had neither physical problems nor attention, language, writing, reading, praxis, calculation, perception and memory disorders. The results highlight a higher-than-average intelligencequotient, optimal cognitive skills, melancholic temperament with depressive thoughts, introverted personality with lowenvironmental sensitivity, poor social skills, self-absorption and avoidance. Additionally, perfectionist tendencies, suddenemotional changes, difficulty changing behavioral patterns, impulsiveness and disinhibition, all of which are characteristicsof orbitofrontal syndrome. Finally, the research highlights the use of psychometric tests and neuropsychological evaluationsfor the diagnosis of orbitofrontal syndrome. Said tests and evaluations are necessary for the proper management of offendersincarcerated in prisons and/or detention centers who do not have access to neuroimaging; moreover, they may be used to design strategic intervention programs.

Pimavanserin and trazodone combination in behavioral disorders in severe dementia with Lewy bodies

Dementia with Lewy bodies (DLB) is characterized by neurocognitive disorders associated with core clinical features including hallucinations. There is currently no cure but a combination of symptomatic treatments: clozapine is commonly used in DLB-related psychosis. Pimavanserin is a serotonin5HT-2A receptor inverse agonist that has recently been shown to reduce psychosis related to dementia. Trazodone is a serotonin reuptake inhibitor and a 5-HT2 receptor antagonist: it is effective in the treatment of the frontal syndrome and is commonly used in frontotemporal degeneration. We describe three patients with DLB, hospitalized in the cognitive-behavioral unit of the University Hospitals of Strasbourg, who presented with major visual hallucinations, delusion, and an orbitofrontal syndrome including disinhibition, agitation, and irritability. The 3 patients were intolerant of low-dose Clozapine (neutropenia for one, somnolence for the other and Pisa syndrome and falls for the last one). We evaluated the Neuropsychiatric Inventory (NPI) before and after the introduction of both treatments. Given their psychotic and frontal symptoms, we used Pimavanserin and Trazodone simultaneously. After 4 to 6 weeks of treatment, a marked improvement was observed in all 3 patients, with a decrease of the NPI scores from a mean of 88 to 38. To our knowledge, there is no previously described combination of these two treatments in DLB. A clinical trial combining these two molecules against pervasive behavioral disorders in DLB would be interesting in view of these preliminary results.

The State of Florida v. Kelvin Lee Coleman Jr.: the implications of neuroscience in the courtroom through a case study

ABSTRACT Neuroscience can provide evidence in some cases of legal matters, despite its tenuous nature. Among others, arguing for diminished capacity, insanity, or pleading for mitigation is the most frequent use of neurological evidence in the courtroom. While there is a plethora of studies discussing the moral and legal matters of the practice, there is a lack of studies examining specific cases and the subsequent applications of brain knowledge. This study details the capital punishment trial of Kelvin Lee Coleman Jr., charged in 2013 with double murder in Tampa, Florida, to illustrate the extent that expert opinions – based on neuroimaging, neurological, and neuropsychiatric examinations – had an impact on the court’s decisions. The defendant was sentenced to life imprisonment without the possibility of parole. According to the comments of the trial’s jury, the most influential reason for not sentencing the defendant to death is the fact that during the incident was that he was under extreme mental and emotional disturbance. Other reasons were evidence of brain abnormalities resulting from neurological insult, fetal alcohol syndrome, and orbitofrontal syndrome contributing to severely abnormal behavior and lack of impulse control.

Orbitofrontal syndrome and “goosebumps”—A new manifestation of autoimmune epilepsy in anti-LGI1 encephalitis

Anti–leucine-rich glioma-inactivated 1 (anti-LGI1) encephalitis is a rare autoimmune disorder that presents with a triad of cognitive and psychiatric disturbances, hyponatremia, and autoimmune epilepsy. Facial-brachial dystonic (FBD) seizures are considered a pathognomonic sign of this condition. However, more subtle seizure types can occur and should be recognized, allowing for timely diagnosis and treatment. We report a case of anti-LGI1 autoimmune encephalitis presenting as orbitofrontal syndrome with focal “goosebump” seizures.

A Case of Young-Adult Stroke with Hyperhomocysteinemia and Orbitofrontal Syndrome

Stroke in young can have a significant impact on survival of patients. Early diagnosis and intervention by a holistic team approach are vital in its management. Here we describe a case of stroke in a young 37 old male patient presenting with an uncommon cause of Hyperhomocysteinemia with subsequent post-stroke psychiatric manifestations. A holistic team approach model and challenges in management are discussed

A Case of Young-Adult Stroke with Hyperhomocysteinemia and Orbitofrontal Syndrome

A Case of Young-Adult Stroke with Hyperhomocysteinemia and Orbitofrontal Syndrome

Los múltiples rostros del síndrome orbitofrontal

Orbitofrontal syndrome is a neuropsychiatric syndrome composed of cognitive, affective and behavioural symptoms, disrupting some of the traits that define us as a species, like cognitive flexibility and affective regulation. In order to effectively treat the condition, the clinician needs to be familiar with both the functional neuroanatomy and the neuropsychiatric semiology of the syndrome. A review of the literature is presented, emphasising the broad spectrum of clinical manifestations of the syndrome, together with three clinical vignettes showing the many faces of the syndrome. Several factors influencing the heterogeneity of clinical presentation are discussed. Taking a hierarchical model of neural networks, two core concepts, loss of interoceptive/exteroceptive integration and loss of affective regulation, are proposed in looking for invariants in orbitofrontal syndrome.

Genetic prion disease caused by a Q160X PRNP mutation presenting with an orbitofrontal syndrome (P4.100)

Genetic prion disease caused by a Q160X PRNP mutation presenting with an orbitofrontal syndrome (P4.100)

Disinhibition Due to Disruption of the Orbitofrontal Circuit Treated Successfully With Carbamazepine: A Case Series

Disinhibition Due to Disruption of the Orbitofrontal Circuit Treated Successfully With Carbamazepine: A Case Series

A Cognitive Neuropsychological Examination of the Das-Naglieri Cognitive Assessment System Subtests: A Report of Three Stroke Cases Studied Longitudinally During Recovery

In this study three patients with unilateral focalized stroke lesions were examined longitudinally on the CAS subtests at 1 month and 6 months postinfarct such that each patient functioned as baseline. Patient 1 with a left temporal pole lesion had a severe syntactic comprehension deficit on Sentence Questions. Patient 2 had a rare right anterior cerebral artery (ACA) aneurysm culminating in a classical orbitofrontal syndrome and impairments on Expressive Attention, Word Series as well as a previously undescribed praxis-based figure ground reversal phenomenon on Figure Memory. Patient 3 suffered a right frontoparietal lesion with resulting representational as well as elements of motor neglect and impairments on Matching Numbers, Number Detection, and Receptive Attention. The three patient's lesions were all entirely consistent with the nature of cognitive neuropsychological symptoms suggesting that the CAS subtests are not only unique but also sensitive and specific to focalized cortical lesions.

Treatment of Psychiatric Symptoms Associated With a Frontal Lobe Tumor Through Surgical Resection

Treatment of Psychiatric Symptoms Associated With a Frontal Lobe Tumor Through Surgical Resection

Aggression and Quantitative MRI Measures of Caudate in Patients With Chronic Schizophrenia or Schizoaffective Disorder

Caudate dysfunction is implicated in schizophrenia. However, little is known about the relationship between aggression and caudate volumes. Forty-nine patients received magnetic resonance imaging scanning in a double-blind treatment study in which aggression was measured. Caudate volumes were computed using a semiautomated method. The authors measured aggression with the Overt Aggression Scale and the Positive and Negative Syndrome Scale. Larger caudate volumes were associated with greater levels of aggression. The relationship between aggression and caudate volumes may be related to the iatrogenic effects of long-term treatment with typical antipsychotic agents or to a direct effect of schizophrenic processes on the caudate.

Lethal Obesity Associated with Sodium Valproate in a Brain-Injured Patient

A 34-year-old man developed posttraumatic epilepsy and a disinhibited orbitofrontal syndrome following severe head trauma at age 22. After an 11-year prison term marked by repeated impulsive aggression, he was transferred to a state psychiatric hospital. Replacement of phenytoin by valproic acid resulted in a 100-lb weight gain, exacerbation of sleep apnea, and right heart failure. Despite replacement of valproate with topiramate, he died of a cardiorespiratory arrest during a seizure. This case illustrates the potential risks associated with valproate therapy in the obese brain-damaged population.

Leukoencephalopathy and Cortical Laminar Necrosis Associated with Intrathecal Methotrexate and Cranial Irradiation

Leukoencephalopathy and Cortical Laminar Necrosis Associated with Intrathecal Methotrexate and Cranial Irradiation

The Executive Brain: Frontal Lobes and the Civilized Mind

The Executive Brain: Frontal Lobes and the Civilized Mind

Personality in frontal lobe disorders.

Personality changes in frontal lobe disorders are easy to recognize, but their evolution can be hard to predict. Both focal lesions and diffuse neurodegenerative processes may produce personality change based on interruption of prefrontal cortex or subcortical structures that comprise the frontal-subcortical circuits. Observed changes in personality have been classified by behavioral neurologists into three frontal-subcortical circuit syndromes, yet a given patient may defy this classification system by manifesting only selective features of one or more syndromes simultaneously, based on the neuroanatomic distribution of pathology. The orbitofrontal syndrome is the most well known and consists of major antisocial behaviors such as disinhibition, emotional lability, and impulsivity. In some cases, changes are severe enough to lead to new onset of criminality. Apathy and amotivational state lie at the other end of the personality change spectrum. Many psychologic instruments can measure the degree of change in personality, but none of them can be used to extrapolate a patient's ability to function at home or at large in society. The psychopathy checklist by Hare may predict risk of violence but has been validated only for use in criminal populations.

Orbital and Dorsolateral Frontal Perfusion Defect Associated With Behavioral Response to Cholinesterase Inhibitor Therapy in Alzheimer's Disease

The authors retrospectively explored the behavioral and functional imaging profile of Alzheimer's disease (AD) patients who respond to cholinesterase inhibitor therapy by using the Neuropsychiatric Inventory (NPI) and baseline [99mTc]HMPAO SPECT. Thirty AD patients were divided into three groups (Responders, Nonresponders, and Unchanged) based on their behavioral response to donepezil. Responders had significantly (P≤0.01) more pretreatment irritability, disinhibition (P≤0.05), and euphoria (P=0.05) than Nonresponders and significantly lower lateral orbital frontal (P<0.00001) and dorsolateral frontal (P≤0.0005) perfusion bilaterally. A pretreatment orbitofrontal syndrome may predict behavioral response to cholinesterase inhibitor therapy in AD.

Orbital and Dorsolateral Frontal Perfusion Defect Associated With Behavioral Response to Cholinesterase Inhibitor Therapy in Alzheimer's Disease

The authors retrospectively explored the behavioral and functional imaging profile of Alzheimer's disease (AD) patients who respond to cholinesterase inhibitor therapy by using the Neuropsychiatric Inventory (NPI) and baseline [99mTc]HMPAO SPECT. Thirty AD patients were divided into three groups (Responders, Nonresponders, and Unchanged) based on their behavioral response to donepezil. Responders had significantly (P < or = 0.01) more pretreatment irritability, disinhibition (P < or = 0.05), and euphoria (P = 0.05) than Nonresponders and significantly lower lateral orbital frontal (P < 0.00001) and dorsolateral frontal (P < or = 0.0005) perfusion bilaterally. A pretreatment orbitofrontal syndrome may predict behavioral response to cholinesterase inhibitor therapy in AD.