Postictal psychosis: common, dangerous, and treatable.
\”Occasionally, after a fit, or, more frequently, after a series of fits, an attack of mental disturbance may come on which lasts for several days. It may be simply a demented state, or there may be hallucinations, with irritability and even violence (1).\”
Devinsky O.
Departments of Neurology, Psychiatry, and Neurosurgery, NYU Epilepsy Center New York, NY.
Combined antidepressants and CBT for panic disorder with agoraphobia.
Coupland NJ.
Department of Psychiatry, University of Alberta, Edmonton, Alta.
Rostral anterior cingulate volume predicts treatment response to cognitive-behavioural therapy for posttraumatic stress disorder.
OBJECTIVE: To index the extent to which treatment response in posttraumatic stress disorder (PTSD) is predicted by rostral anterior cingulate cortex (rACC) volume. METHOD: We used structural magnetic resonance imaging in a 1.5 T scanner to examine subjects with PTSD (n = 13), traumatized control subjects (n = 13) and nontraumatized control subjects (n = 13). Subjects with PTSD then participated in 8 sessions of cognitive-behavioural therapy, after which we reassessed them for PTSD. RESULTS: According to voxel-based morphometry, treatment responders had larger rACC volume than nonresponders. Further, symptom reduction was associated with larger rACC volume. CONCLUSION: Consistent with evidence for the neural bases of extinction learning, PTSD patients with larger rACC volume may be better able to regulate fear during cognitive-behavioural therapy and thus achieve greater treatment gains.
Bryant RA, Felmingham K, Whitford TJ, Kemp A, Hughes G, Peduto A, Williams LM.
Bryant, Felmingham, Whitford, Kemp, Williams - Brain Dynamics Centre, Westmead Hospital; Bryant, Felmingham - School of Psychology, University of New South Wales; Hughes, Peduto - Department of Radiology, Westmead Hospital, Sydney, Australia.
Serotonin receptor subtype and p11 mRNA expression in stress-relevant brain regions of suicide and control subjects.
OBJECTIVE: Studies comparing people suffering from depression who commited suicide with control subjects have yielded inconsistent results regarding serotonin (5-HT) involvement in pathology, possibly owing to procedural factors. Our objective was to investigate which 5-HT receptor subtypes might be associated with depression and suicide, whether receptor differences vary across brain regions and whether they are moderated by sex. METHODS: We assessed messenger ribonucleic acid (mRNA) expression of several 5-HT receptor subtypes and that of p11, a protein involved in the functional expression of 5-HT(1B), in several stress-relevant brain regions. Tissue was obtained soon after death, and RNA integrity and pH was confirmed to be appropriate. Brain tissue from suicide subjects suffering from depression and from control subjects who had died from other causes (10 men and 10 women in each condition) was obtained within 6.5 hours postmortem. Quantitative polymerase chain reaction analyses determined mRNA expression of 5-HT receptor subtypes and p11 within the frontopolar cortex, orbitofrontal cortex, hippocampus, amygdala and paraventricular nucleus. The 5-HT transporter (5-HTT) was also assessed in the raphe nucleus. RESULTS: Differences of 5-HT(1A), 5-HT(1B) and p11 mRNA expression between people who committed suicide and control subjects were relatively widespread, whereas 5-HT(2A) and 5-HT(2C) variations were restricted to the frontopolar cortex and amygdala. Within the dorsal raphe nucleus, neither 5-HT(1A) nor 5-HTT mRNA expression differed between those who committed suicide and control subjects. CONCLUSION: Several 5-HT receptor subtypes are associated with depression and suicide, but these receptor differences vary across brain regions and are moderated by sex.
Anisman H, Du L, Palkovits M, Faludi G, Kovacs GG, Szontagh-Kishazi P, Merali Z, Poulter MO.
Anisman, Poulter — Institute of Neuroscience, Carleton University; Anisman, Merali — Departments of Psychology, Psychiatry and of Cellular and Molecular Medicine, University of Ottawa; Du, Merali — University of Ottawa Institute of Mental Health Research, Ottawa, Ont.; Palkovits — Laboratory for Neuromorphology, Hungarian Academy of Sciences and Semmelweis University, Budapest; Faludi — SOTE Hospital, Budapest; Kovacs — Department of Neuropathology, National Institute of Psychiatry and Neurology, Budapest, Hungary; Szontagh-Kishazi — Department of Pathology, Saint George Hospital, Székesfehérvár, Hungary, Poulter — Robarts Research Institute, Cell Biology Research Group, London, Ont.
Serotonin transporter genotype interacts with paroxetine plasma levels to influence depression treatment response in geriatric patients.
OBJECTIVE: To investigate whether variable antidepressant response may be influenced by an interaction between the serotonin transporter promoter polymorphism (5-HTTLPR) and antidepressant concentration. METHODS: Elderly subjects with depression treated with paroxetine (n = 110) were genotyped and assessed with the Hamilton Rating Scale for Depression (HAMD). A mixed-effect analysis of repeated measures was used. RESULTS: There was an interaction between early paroxetine concentration and 5-HTTLPR genotype on symptomatic improvement over 12 weeks (F(18,59.5) = 1.8, p < 0.05), as well as main effects of both paroxetine concentration (F(68,55.3) = 2.4, p < 0.005) and genotype (F(2,74.2) = 5.7, p < 0.005). Paroxetine concentrations were correlated with change in HAMD scores after 2 weeks of treatment in subjects with the short (s) allele (r = 0.31, p < 0.05) but not in subjects homozygous for the long (l) allele. CONCLUSION: The results demonstrate a concentration-response relation for paroxetine in late-life depression and support the hypothesis for both a direct main effect and a moderating influence of 5-HTTLPR alleles on this concentration-response relation.
Lotrich FE, Pollock BG, Kirshner M, Ferrell RF, Reynolds Iii CF.
Lotrich, Pollock, Kirshner, Reynolds — NIMH Advanced Center in Interventions and Services Research for Late-Life Mood Disorders and the John A. Hartford Foundation Center of Excellence in Geriatric Psychiatry, Department of Psychiatry, Western Psychiatric Institute and Clinics, University of Pittsburgh Medical Center; Ferrell — Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pa.; Pollock — Rotman Research Institute, Baycrest Centre for Geriatric Care, University of Toronto, Toronto, Ont.
The auditory-visual integration of anger is impaired in alcoholism: an event-related potentials study.
OBJECTIVES: Chronic alcoholism leads to impaired visual and auditory processing of emotions, but the cross-modal (auditory-visual) processing of emotional stimuli has not yet been explored. Our objectives were to describe the electrophysiological correlates of unimodal (visual and auditory) impairments in emotion processing in people suffering from alcoholism, to determine whether this deficit is general or emotion-specific, and to explore potential deterioration in the specific cross-modal integration processes in alcoholism. METHODS: We used an emotion-detection task, with recording of event-related potentials (ERPs), in which 15 patients suffering from alcoholism and 15 matched healthy control subjects were asked to detect the emotion (angry, happy or neutral) displayed by auditory, visual or auditory-visual stimuli. Behavioural performance and ERP data recorded between June 2005 and April 2006 were analyzed. RESULTS: ERPs demonstrated that the deficit in alcoholism originates earlier in the cognitive stream than has previously been described (mainly P300), namely, at the level of specific face (N170) and voice (N2) perceptive processing. Moreover, while patients with alcoholism did not show impaired processing of happy and neutral audio-visual stimuli, they did have a specific impairment in the cross-modal processing of anger. A source location analysis was used to confirm and illustrate the results. CONCLUSION: These results suggest that the specific deficit that people with alcoholism demonstrate in processing anger stimuli, widely described in clinical situations but not clearly identified in earlier studies (using unimodal stimuli), is particularly obvious during cross-modal processing, which is more common than unimodal processing in everyday life.
Maurage P, Philippot P, Joassin F, Pauwels L, Pham T, Prieto EA, Palmero-Soler E, Zanow F, Campanella S.
Maurage, Philippot, Joassin, Pauwels — Cognitive Neurosciences and Clinical Psychology Units, Department of Psychology, Catholic University of Louvain, Louvain-la-Neuve, Belgium; Pham — Center of Research in Social Defense (CRDS), University of Mons-Hainaut, Mons, Belgium; Alonso Prieto, Palmero-Soler, Zanow — Eemagine Medical Imaging Solutions GmbH, Berlin, Germany; Zanow — ANT Advanced Neuro Technologies BV, Enschede, the Netherlands; Campanella — Department of Psychiatry, Brugmann Hospital, Free University of Brussels, Brussels, Belgium.
Implication of the polyamine system in mental disorders.
The polyamine pathway has an essential role in many cellular functions and has been implicated in several pathological conditions. Accumulating evidence suggests that the polyamine system also plays a role in the etiology and pathology of mental disorders. Alterations in the expression and activity of polyamine metabolic enzymes, as well as changes in the levels of the individual polyamines, have been observed in multiple conditions, including schizophrenia, mood disorders, anxiety and suicidal behaviour. Additionally, these components have been found to be altered by various psychiatric treatments. Further, the polyamines and their precursors have demonstrated both antidepressant and anxiolytic effects. Overall, findings to date suggest that the polyamine pathway represents an important frontier for the development of neuropharmacological treatments.
Fiori LM, Turecki G.
McGill Group for Suicide Studies, Douglas Mental Health University Institute, McGill University, Montréal, Que.
Reduced subgenual cingulate volumes in mood disorders: a meta-analysis.
OBJECTIVE: Converging evidence suggests that the subgenual cingulate (SGC) is implicated in regulation of mood and in the pathophysiology of mood disorders. Our objective was to carry out the first meta-analysis of SGC volumes in patients with mood disorders. METHODS: We reviewed 10 volumetric magnetic resonance imaging studies of SGC volumes in patients with unipolar depression and bipolar disorders. For meta-analysis, we used standardized differences between means (SDMs) and random effects models. In the search for sources of heterogeneity, we subdivided the studies on the basis of diagnosis and presence of family history. RESULTS: The volumes of left and right SGC in patients with mood disorders were significantly reduced relative to healthy control subjects (SDM -0.38, 95% confidence interval [CI] -0.67 to -0.1 and SDM -0.2, 95% CI -0.4 to -0.007, respectively). There were significant SGC volume reductions in patients with unipolar (left SGC SDM -0.5, 95% CI -0.92 to -0.07; right SGC SDM -0.33, 95% CI -0.64 to -0.02,), but not bipolar, disorder. Patients with a positive family history of mood disorders showed significant left SGC volume decrease (SDM -0.52, 95% CI -0.96 to -0.07), which was not present among subjects without family history of mood disorders. There was no association between age and SGC volumes. CONCLUSION: The available evidence suggests the existence of left and less robust right SGC volumetric reductions in patients with mood disorders, predominantly in those with unipolar depression. The effect size of this difference was moderate and increased in more homogeneous subgroups of patients with a positive family history. The clustering of SGC abnormalities in patients with a family history, their presence early in the illness course and their lack of progression with age make SGC a candidate for a primary vulnerability marker, although studies in unaffected high-risk subjects are missing.
Hajek T, Kozeny J, Kopecek M, Alda M, Höschl C.
Hajek, Alda — Department of Psychiatry, Dalhousie University, Halifax, NS; Hajek, Kozeny, Kopecek, Alda, Höschl — Prague Psychiatric Centre, 3rd Faculty of Medicine, Charles University, Prague, Czech Republic; Kopecek — MOOD-CNS Program, Division of Mood and Anxiety Disorders, Department of Psychiatry, The University of Texas Health Science Center at San Antonio, San Antonio, Tex.; Alda — Department of Psychiatry, McGill University, Montréal, Que.
Do antidepressants really work?
Blier P.
Canada Research Chair in Psychopharmacology and Professor, Departments of Psychiatry and Cellular and Molecular Medicine, University of Ottawa Institute of Mental Health Research, Ottawa, Ont.
Useful resources for advocacy.