Dysthymia and Apathy: Diagnosis and Treatment

Dysthymia is a depressive mood disorder characterized by chronic and persistent but mild depression. It is often difficult to be distinguished from major depression, specifically in its partially remitted state because “loss of interest” or “apathy” tends to prevail both in dysthymia, and remitted depression. Apathy may also occur in various psychiatric and neurological disorders, including schizophrenia, stroke, Parkinson's disease, progressive supranuclear palsy, Huntington's disease, and dementias such as Alzheimer's disease, vascular dementia, and frontotemporal dementia. It is symptomatologically important that apathy is related to, but different from, major depression from the viewpoint of its causes and treatment. Antidepressants, especially noradrenergic agents, are useful for depression-related apathy. However, selective serotonin reuptake inhibitors (SSRIs) may be less effective for apathy in depressed elderly patients and have even been reported to worsen apathy. Dopaminergic agonists seem to be effective for apathy. Acetylcholine esterase inhibitors, methylphenidate, atypical antipsychotics, nicergoline, and cilostazol are another choice. Medication choice should be determined according to the background and underlying etiology of the targeting disease

Dissociation of Exact and Approximate Calculation in Severe Global Aphasia

We report a 68-year-old patient with severe global aphasia secondary to a large left hemisphere infarction including the parietal lobe. In addition to language and neuroradiological evaluation, the patient was given specifically designed arithmetic and clock tasks requiring either exact calculation or approximate calculation. Despite severe language impairment, the patient showed relatively well-preserved abilities for numerical comprehension and arithmetic operations. Further analyses using specifically designed arithmetic and clock tasks demonstrated a clear dissociation of the patient’s abilities between impaired exact calculation and well-preserved approximate calculation. The results support the notion that numerical and arithmetic abilities are heterogeneous in that rote verbal arithmetic facts and quantitative numerical knowledge can be separable. Implications of the present findings for neural correlates of numerical and arithmetic processing suggest that the right hemisphere plays a crucial role in approximate calculation

失語症の回復と脳の可塑性

特集 : 脳の可塑性とリハビリテーションへの応

Integrated analysis of cell shape and movement in moving frame

形を変えながら動く3次元物体の解析手法の提唱 --動くから形が変わるのか、形を変えることで動くのか--. 京都大学プレスリリース. 2021-03-31.The cell's movement and morphological change are two interrelated cellular processes. An integrated analysis is needed to explore the relationship between them. However, it has been challenging to investigate them as a whole. The cell's trajectory can be described by its speed, curvature, and torsion. On the other hand, the three-dimensional (3D) cell shape can be studied by using a shape descriptor such as spherical harmonic (SH) descriptor, which is an extension of a Fourier transform in 3D space. We propose a novel method using parallel-transport (PT) to integrate these shape-movement data by using moving frames as the 3D-shape coordinate system. This moving frame is purely determined by the velocity vector. On this moving frame, the movement change will influence the coordinate system for shape analysis. By analyzing the change of the SH coefficients over time in the moving frame, we can observe the relationship between shape and movement. We illustrate the application of our approach using simulated and real datasets in this paper

Effects of Paroxetine and Milnacipran on Pain Disorder

The outcomes of treatment for pain disorder are generally disappointing: symptoms are poorly controlled, they are seldom managed by experts, and they are often long standing. The aim of the present study was to compare the therapeutic effectiveness of paroxetine and milnacipran for outpatients with pain disorder. The study was performed on 43 consecutive outpatients with pain disorder diagnosed according to DSM-IV-TR criteria. Patients were treated with either antidepressant for 8 weeks. Pain was self-assessed using the Short-Form McGill Pain Questionnaire (SF-MPQ), the total Pain Rating Index (t-PRI), Present Pain Intensity (PPI), and visual analogue scale (VAS). In addition, pain was evaluated objectively using Pain Vision (a machine devised by NIPRO for semiquantitative measurements). Possible depressive symptoms were rated on the Hamilton Depression Scale (HAM-D) and the Zung Self-rating Depression Scale (SDS). Although VAS scores decreased significantly over the course of the 8-week trial in both the paroxetine- and milnacipran-treated groups (from 6.6 ± 2.3 to 4.8 ± 3.0 [P = 0.01] and from 7.5 ± 2.4 to 5.4 ± 3.3 [P = 0.03], respectively), the t-PRI decreased only in the paroxetine group (from 13.9 ± 10.1 to 7.6 ± 7.5; P = 0.01). The Pain Vision indicated a tendency for decreased pain in both groups, with no significant differences between them. There were no significant changes in the SDS in either group, but the HAM-D decreased significantly in the milnacipran-treated group (from 7.8 ± 4.0 to 6.7 ± 3.9; P = 0.04). The results of the present study suggest that both paroxetine (a selective serotonin re-uptake inhibitor) and milnacipran (a selective serotonin-noradrenaline re-uptake inhibitor) may decrease pain in individuals with pain disorder

Tardive Dyskinesia in Relation to Estimated Dopamine D2 Receptor Occupancy in Patients with Schizophrenia: Analysis of the CATIE data

Objective The objective of this study was to evaluate the relationship between antipsychotic-induced tardive dyskinesia (TD) and estimated dopamine D2 receptor occupancy levels in patients with schizophrenia, using the dataset from the Clinical Antipsychotic Trials in Intervention Effectiveness (CATIE). Methods The dataset from 218 subjects (risperidone, N=78; olanzapine, N=100; ziprasidone, N=40) who presented with a score of zero on the Abnormal Involuntary Movement Scale (AIMS) at baseline in Phase 1 of the CATIE study, and remained for ≥6 months, was used. Peak and trough dopamine D2 receptor occupancy levels on the day of the AIMS assessment at the endpoint were estimated from plasma antipsychotic concentrations, using population pharmacokinetic analysis and our D2 prediction model. The estimated dopamine D2 receptor occupancy levels were compared between patients who presented an AIMS score of ≥2 at endpoint and those with a score of zero, using the Mann-Whitney U test. Results Estimated dopamine D2 receptor occupancy levels at trough were significantly higher in subjects who developed involuntary movements (N=23) than those who did not (N=195) (71.7±14.4% vs. 64.3±19.3%, p<0.05) while no significant difference was found in the estimated peak D2 receptor occupancy between them (75.4±8.7% vs. 72.1±9.9%, p=0.07). When the analyses were separately conducted for the three drugs, there were no significant differences in estimated peak or trough D2 occupancy although the values were consistently numerically higher among those developing involuntary movements. Conclusion Greater dopamine D2 receptor blockade with antipsychotics at trough might increase the risk of tardive involuntary movements although this finding needs to be replicated in larger trials