Memory Functioning in Obsessive-Compulsive Disorder

A number of studies have reported neuropsychological deficits in obsessive-compulsive disorder (OCD). These have mainly implicated frontal or temporal dysfunction. In this study, we compared the performances of OCD patients and normal subjects using a factorial interpretation of the Wechsler Memory Scale. Our results do not demonstrate significant memory impairment in OCD patients but point to the possibility of frontal lobe dysfunction as a factor in the pathophysiology of OCD

Memory Functioning in Obsessive-Compulsive Disorder

A number of studies have reported neuropsychological deficits in obsessive-compulsive disorder (OCD). These have mainly implicated frontal or temporal dysfunction. In this study, we compared the performances of OCD patients and normal subjects using a factorial interpretation of the Wechsler Memory Scale. Our results do not demonstrate significant memory impairment in OCD patients but point to the possibility of frontal lobe dysfunction as a factor in the pathophysiology of OCD

Una valutazione ragionata delle principali linee guida internazionali sulla farmacoterapia della schizofrenia

This review focuses on a comparative analysis on international Guidelines for the treatment of schizophrenia and, more generally, on specific literature, starting from the 2004 APA Guidelines. The first issue taken into consideration is treatment: general purpose of drug treatment is generally distinguished from specific target as well as needs of specific therapeutic practices are distinguished from theoretical aspects of optimal treatment. Guidelines refer to a global reduction in symptoms, primarily in terms of potential clinical recovery. The complexity of schizophrenia implies the need to consider different options for treatment due to the clinical phase of the disorder and other critical factors. The choice of drug treatment is thus considered as a priority in the acute phase of schizophrenia and should be considered as continuous and possibly indefinite, if the response is inadequate or there are frequent relapses over time. The definition of clinical phases of schizophrenia is linked to the chosen reference. The analysis then focuses on the pharmacological treatment of schizophrenia in its various phases, with particular reference to similarities/differences and limitations of the Guidelines. The impression given by a comparative reading of the Guidelines taken into consideration, is that of a general separation between indications for pharmacological management of schizophrenia and clinical practice, both in the acute and chronic phase. Authors then examine the general recommendations to specific drugs focusing particularly on the relationship between first and second generation antipsychotics, with an analysis of comparative efficacy and special considerations (eg, negative symptoms, cognitive symptoms, resistance); recommendations regarding antipsychotic therapy in schizophrenia and early-onset time and duration and treatment strategies are also described and commented. Particular attention is devoted to side effects and monitoring of physical health, both in terms of neurological effects (Tables II-III) and of effects on sexual (Table IV) and hepatic function. Much space is devoted to emerging issues such as metabolic syndrome, obesity, dyslipidemia, diabetes (Tables VI) and cardiovascular risk (Table VII) with emphasis on the growing awareness that many side effects, especially metabolic ones, require particular care with a multidisciplinary approach

Insight and dissociation in lucid dreaming and psychosis

Dreams and psychosis share several important features regarding symptoms and underlying neurobiology, which is helpful in constructing a testable model of, for example, schizophrenia and delirium. The purpose of the present communication is to discuss two major concepts in dreaming and psychosis that have received much attention in the recent literature: insight and dissociation. Both phenomena are considered functions of higher order consciousness because they involve metacognition in the form of reflective thought and attempted control of negative emotional impact. Insight in dreams is a core criterion for lucid dreams. Lucid dreams are usually accompanied by attempts to control the dream plot and dissociative elements akin to depersonalization and derealization. These concepts are also relevant in psychotic illness. Whereas insightfulness can be considered innocuous in lucid dreaming and even advantageous in psychosis, the concept of dissociation is still unresolved. The present review compares correlates and functions of insight and dissociation in lucid dreaming and psychosis. This is helpful in understanding the two concepts with regard to psychological function as well as neurophysiology

Iatrogenic hypothyroidism and acute psychosis

We present the case of a 39 years old woman who was referred to our day hospital unit because of anxiety. The patient didn\u2019t endorse any past psychiatric symptoms except for an acute psychotic episode in August 2010. In June 2010 she was diagnosed with hypothyroidism (likely due to Hashimoto\u2019s thyroiditis) and was started on Methilmazole 30 mg. Shortly after that she reported persecutory ideation and hallucinations which quickly progressed, until she was hospitalized in a psychiatric facility. Upon admittance her lab work revealed severe hypothyroidism. Methilmazole was suspended, she was started on Haloperidol, and the symptoms went into remission after four days. Despite the fact that she self discontinued Haloperidol shortly after discharge, she showed no sign of psychotic symptoms. While it is widely accepted that hypothyroidism can cause depressive symptoms, to the best of our knowledge very few cases of psychotic symptoms associated with this condition have been described. Based on the patient\u2019s clinical history, on the rapid onset and remission of symptoms, on the lab values and on the doses of medication that were prescribed, we hypothesize that our patient\u2019s psychotic episode was caused by iatrogenic hypothyroidism

Psychiatric screening for migraine patients

Psychiatric disorders in migraine patients have a higher prevalence than general population. The presence of psychiatric comorbidities may influence the complexity of the migraine pictures and be related to medication overuse. Severely impaired chronic migraineurs presenting with medication overuse are a challenge for headache clinics. Psychiatric comorbities, such as dependency-like behaviors, anxiety and mood symptoms, might account for headache-related disability and recurrent relapses into medication overuse after a successful detoxification. Within a sample of 63 chronic migraineurs with medication overuse and severe disability, we investigated to which extent clinical severity, affective states and attitudes about medication impact the overall functioning at time of detoxification. To unravel whether some of these factors could predict their long-term outcome, we followed and retest them 1 year after withdrawal. We hypothesized that the detoxification would have led to a partial improvement and not modified the attitudes toward medication and dependence. Detoxification improves most of the clinical and affective measures, but does not free from significant levels of pain intensity and headache-related disability. The partial benefit from detoxification, the severity bias and the maladaptive cognitive profile led us to believe that subgroups of chronic-relapsing migraineurs deserve a multidisciplinary approach that addresses not only the reduction of clinical severity but also specific cognitive and behavioral impairments

Decision-making deficit in chronic migraine patients with medication overuse

Patients with chronic migraine developing medication-overuse headache (MOH) show dependency-like behaviors such as loss of control over analgesics despite adverse consequences on headaches, high rates of relapse after withdrawal from symptomatic medications, and compromised social functioning. Neuroimaging research suggests a common pathophysiology between substance-use disorders and MOH, which involves functional alterations in fronto-striatal networks, particularly in the orbitofrontal region of prefrontal cortex. These findings could explain the impaired decision-making observed in substance-use disorders. We hypothesize that MOH could share fronto-striatal circuit dysfunction and relative decision-making deficit with addiction. We further examine whether this deficit is a persistent cognitive trait or a reversible consequence of medication overuse. This study shows a dataset of 50 patients with MOH before the detoxification. All patients underwent a complete neurological and psychiatric examination. Psychiatric examination consisted of a clinical interview, Structured Clinical Interview for DSM-IV TR Axis II Personality Disorders, Anxiety and Depression Hamilton Scales, Severity of Dependence Scale. The neurological examination included the migraine disability assessment questionnaire. Neuropsychological assessment of fronto-striatal circuits was investigated using the Iowa gambling task (IGT). Twenty patients monitored for any relapse into medication overuse had 12 months of follow-up. Our sample, characterized by high rates of disability and dependency-like behaviors, exhibited a deficit in IGT performance, indicating an overall impairment in decision-making. All the 20 patients showed neurological and psychiatric improvement at 12-month follow-up, notwithstanding the overuse relapse, but a persistent IGT deficit was found. To our knowledge this is the first study that assesses this cognitive function in patients with MOH. Medication-overuse headache seems to share a persistent decision-making deficit with substance abuse that confirms the orbitofrontal cortex hypometabolism described in literature from a neuropsychological perspective. Looking at these shared neurocognitive features, our results suggest that MOH could belong to the addiction spectrum. Fronto-striatal dysfunction could be a premorbid psychobiological condition of vulnerability explaining the clinical onset of medication overuse and recurrent relapses. We propose that IGT could be used to identify chronic migraine patients with higher risk for medication overuse and relaps

Childhood sleep disturbance and risk of psychotic experiences at 18 : UK birth cohort

BACKGROUND: Sleep disturbances are commonly reported in the psychosis prodrome, but rarely explored in relation to psychotic experiences. AIMS: To investigate the relationship between specific parasomnias (nightmares, night terrors and sleepwalking) in childhood and later adolescent psychotic experiences. METHOD: The sample comprised 4720 individuals from a UK birth cohort. Mothers reported on children's experience of regular nightmares at several time points between 2 and 9 years. Experience of nightmares, night terrors and sleepwalking was assessed using a semi-structured interview at age 12. Psychotic experiences were assessed at ages 12 and 18 using a semi-structured clinical interview. RESULTS: There was a significant association between the presence of nightmares at 12 and psychotic experiences at 18 when adjusted for possible confounders and psychotic experiences at 12 (OR = 1.62, 95% CI 1.19-2.20). The odds ratios were larger for those who reported persistent psychotic experiences. CONCLUSIONS: The presence of nightmares might be an early risk indicator for psychosis