Tourette's syndrome

Tourette’s syndrome is a tic disorder that is often associated with behavioural symptoms. Diagnostic criteria are based on the presence of both motor and vocal tics; because of its varied presentations, the syndrome has the potential to be misdiagnosed. Prevalence is higher than commonly assumed; coprolalia is relatively rare (10-30%) and not required for diagnosis. The syndrome can cause serious distress and compromise health related quality of life. The main management strategies include psychoeducation, behavioural techniques, and drugs. Service provision is patchy even in developed countries and patients of all ages often “fall through the net” between neurology and psychiatry

Neurophysiological investigations for the diagnosis of non-epileptic attack disorder in neuropsychiatry services: from safety standards to improved effectiveness

OBJECTIVE: The discipline of clinical neuropsychiatry currently provides specialised services for a number of conditions that cross the traditional boundaries of neurology and psychiatry, including non-epileptic attack disorder. Neurophysiological investigations have an important role within neuropsychiatry services, with video-electroencephalography (EEG) telemetry being the gold standard investigation for the differential diagnosis between epileptic seizures and non-epileptic attacks. This article reviews existing evidence on best practices for neurophysiology investigations, with focus on safety measures for video-EEG telemetry. METHODS: We conducted a systematic literature review using the PubMed database in order to identify the scientific literature on the best practices when using neurophysiological investigations in patients with suspected epileptic seizures or non-epileptic attacks. RESULTS: Specific measures need to be implemented for video-EEG telemetry to be safely and effectively carried out by neuropsychiatry services. A confirmed diagnosis of non-epileptic attack disorder following video-EEG telemetry carried out within neuropsychiatry units has the inherent advantage of allowing diagnosis communication and implementation of treatment strategies in a timely fashion, potentially improving clinical outcomes and cost-effectiveness significantly. CONCLUSION: The identified recommendations set the stage for the development of standardised guidelines to enable neuropsychiatry services to implement streamlined and evidence-based care pathways

Misophonia:current perspectives

Misophonia is characterized by a negative reaction to a sound with a specific pattern and meaning to a given individual. In this paper, we review the clinical features of this relatively common yet underinvestigated condition, with focus on co-occurring neurodevelopmental disorders. Currently available data on the putative pathophysiology of the condition can inform our understanding and guide the diagnostic process and treatment approach. Tinnitus retraining therapy and cognitive behavior therapy have been proposed as the most effective treatment strategies for reducing symptoms; however, current treatment algorithms should be validated in large population studies. At the present stage, competing paradigms see misophonia as a physiological state potentially inducible in any subject, an idiopathic condition (which can present with comorbid psychiatric disorders), or a symptomatic manifestation of an underlying psychiatric disorder. Agreement on the use of standardized diagnostic criteria would be an important step forward in terms of both clinical practice and scientific inquiry. Areas for future research include phenomenology, epidemiology, modulating factors, neurophysiological underpinnings, and treatment trials

Safety and efficacy of aripiprazole for the treatment of pediatric Tourette syndrome and other chronic tic disorders

Tourette syndrome is a childhood-onset chronic tic disorder characterized by multiple motor and vocal tics and often accompanied by specific behavioral symptoms ranging from obsessionality to impulsivity. A considerable proportion of patients report significant impairment in health-related quality of life caused by the severity of their tics and behavioral symptoms and require medical intervention. The most commonly used medications are antidopaminergic agents, which have been consistently shown to be effective for tic control, but are also associated with poor tolerability because of their adverse effects. The newer antipsychotic medication aripiprazole is characterized by a unique mechanism of action (D2 partial agonism), and over the last decade has increasingly been used for the treatment of tics. We conducted a systematic literature review to assess the available evidence on the efficacy and safety of aripiprazole in pediatric patients with Tourette syndrome and other chronic tic disorders (age range: 4–18 years). Our search identified two randomized controlled trials (involving 60 and 61 participants) and ten open-label studies (involving between six and 81 participants). The majority of these studies used two validated clinician-rated instruments (Yale Global Tic Severity Scale and Clinical Global Impression scale) as primary outcome measures. The combined results from randomized controlled trials and open-label studies showed that aripiprazole is an effective, safe, and well-tolerated medication for the treatment of tics. Aripiprazole-related adverse effects (nausea, sedation, and weight gain) were less frequent compared to other antidopaminergic medications used for tic management and, when present, were mostly transient and mild. The reviewed studies were conducted on small samples and had relatively short follow-up periods, thus highlighting a need for further trials to assess the long-term use of aripiprazole in pediatric patients with Tourette syndrome and other chronic tic disorders with measurement of its efficacy using both clinician-rated and self-report scales

Encouraging persons to visit cultural sites through mini-games

Gamification has been recently proposed as a technique to improve user engagement in different activities, including visits to cultural sites and cultural tourism in general. We present the design, development and initial validation of the NEPTIS Poleis system, which consists of a mobile application and a Web interface for curators, allowing the definition, and subsequent fruition by users, of different minigames suitable for open-air assets

Interconexiones literarias: Textos babilónicos en el Mediterráneo oriental y regiones adyacentes (ca. 1500-1200 a.C)

Las interacciones entre los grandes poderes del Cercano Oriente antiguo —incluidos Babilonia, Asiria, Mitanni, el reino Hitita y Egipto— con otros estados de Siria y el Levante durante el Bronce Tardío (ca. 1500-1200 a.C.) pueden reconstruirse gracias a la profusa variedad de restos arqueológicos y de fuentes escritas. Parte de esa evidencia da cuenta de los contactos entre diversos grupos etnolingüísticos que utilizaban la escritura cuneiforme y el acadio como lingua franca. Tanto en Turquía como en Siria, el Levante y Egipto se han encontrado ejercicios escolares que atestiguan el aprendizaje del cuneiforme, del sumerio y del acadio. Entre esos materiales figuran (fragmentos de) obras literarias tales como “Gilgameš”, la “Historia babilónica del diluvio”, el “Poema de los primeros gobernantes” y “Nergal y Ereškigal”. En este trabajo examinaré ciertos textos literarios babilónicos hallados en la periferia occidental de Babilonia que muestran las interconexiones literarias acaecidas durante el Bronce Tardío

Comprehensive Views of the Past in Ancient Mesopotamia: The Problematic Balance between the Mythical and the Historical

Documentos provenientes de tradiciones diversas muestran que en la Mesopotamia antigua el pasado se representaba de varias maneras. Entre esos textos se encuentran listas reales, narrativas con fuertes componentes míticos, composiciones con rasgos literarios evidentes, presagios que vinculan resultados positivos o nefastos con reyes icónicos, inscripciones reales que cuentan las hazañas de los gobernantes y, más tarde, aparecen los anales asirios que registran campañas reales. Surgen, también, las crónicas de contenido ecléctico. Los agentes de cambio son dioses que premian o castigan, soberanos implacables o el simple devenir. La veracidad de hechos y personajes del pasado, sean mitológicos, fantásticos o reales, no parece haber despertado demasiadas suspicacias. En este trabajo se analiza la manera en la que la Lista Real Sumeria y la Babiloniaca de Beroso entrelazan hechos y personajes ficticios y reales para ofrecer visiones abarcadoras del pasado en un juego de equilibro entre lo mítico y lo histórico.Documents originating from diverse traditions show that in ancient Mesopotamia the past was conveyed in various ways. Among those texts are royal lists, narratives with strong mythical components, stories with evident literary features, omens that link positive or disastrous results with iconic kings, royal inscriptions recounting the exploits of kings and, later, the Assyrian annals that register royal campaigns. There are also chronicles of eclectic content. The agents of change are punishing or rewarding gods, implacable sovereigns or simply change itself. The truthfulness of events and characters from the past, whether mythological, fantastic or real, does not seem to have raised too much suspicion. In this work I analyze the way in which the Sumerian King List and Berossus’s Babyloniaca intertwine fictitious and real events and characters to offer comprehensive views of the past in a game of balance between the mythical and the historical

Premonitory urges and sensorimotor processing in Tourette syndrome

Most patients with Tourette syndrome report characteristic sensory experiences (premonitory urges) associated with the expression of tic symptoms. Despite the central role of these experiences to the clinical phenomenology of Tourette syndrome, little is known about their underlying brain processes. In the present article we present the results of a systematic literature review of the published studies addressing the pathophysiological mechanisms of premonitory urges. We identified some preliminary evidence for specific alterations in sensorimotor processing at both cortical and subcortical levels. A better insight into the brain correlates of premonitory urges could lead to the identification of new targets to treat the sensory initiators of tics in patients with Tourette syndrome

Functional neuroanatomy and behavioural correlates of the basal ganglia:evidence from lesion studies

Introduction: The basal ganglia are interconnected with cortical areas involved in behavioural, cognitive and emotional processes, in addition to movement regulation. Little is known about which of these functions are associated with individual basal ganglia substructures. Methods: Pubmed was searched for literature related to behavioural, cognitive and emotional symptoms associated with focal lesions to basal ganglia structures in humans. Results: Six case-control studies and two case reports were identified as relevant. Lesion sites included the caudate nucleus, putamen and globus pallidus. These were associated with a spectrum of behavioural and cognitive symptoms, including abulia, poor working memory and deficits in emotional recognition. Discussion: It is often difficult to precisely map associations between cognitive, emotional or behavioural functions and particular basal ganglia substructures, due to the non-specific nature of the lesions. However, evidence from lesion studies shows that most symptoms correspond with established non-motor frontal-subcortical circuits

Neuropsychiatric manifestations in inflammatory neuropathies:a systematic review

We conducted a systematic literature review on psychological and behavioral comorbidities in patients with inflammatory neuropathies. In Guillain-Barré syndrome (GBS), psychotic symptoms are reported during early stages in 30% of patients. Typical associations include mechanical ventilation, autonomic dysfunction, inability to communicate, and severe weakness. Anxiety and depression are frequent comorbidities. Anxiety may increase post-hospital admissions and be a predictor of mechanical ventilation. Post-traumatic stress disorder may affect up to 20% of ventilated patients. Sleep disturbances are common in early-stage GBS, affecting up to 50% of patients. In chronic inflammatory demyelinating polyradiculoneuropathy, memory and quality of sleep may be impaired. An independent link between depression and pre-treatment upper limb disability and ascites was reported in POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, M-protein, Skin) syndrome, with an association with early death. Hematological treatment of POEMS appears effective on depression. Published literature on psychological/behavioral manifestations in inflammatory neuropathies remains scarce, and further research is needed. This article is protected by copyright. All rights reserved