Psychosis Arciniegas, David B
Continuum,
2015-June, Volume:
21, Issue:
3, Behavioral Neurology and Neuropsychiatry
Journal Article
Open access
PURPOSE OF REVIEW:Psychosis is a common and functionally disruptive symptom of many psychiatric, neurodevelopmental, neurologic, and medical conditions and an important target of evaluation and ...treatment in neurologic and psychiatric practice. The purpose of this review is to define psychosis, communicate recent changes to the classification of and criteria for primary psychotic disorders described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and summarize current evidence-based approaches to the evaluation and management of primary and secondary psychoses.
RECENT FINDINGS:The DSM-5 classification of and criteria for primary psychotic disorders emphasize that these conditions occur along a spectrum, with schizoid (personality) disorder and schizophrenia defining its mild and severe ends, respectively. Psychosis is also identified as only one of several dimensions of neuropsychiatric disturbance in these disorders, with others encompassing abnormal psychomotor behaviors, negative symptoms, cognitive impairments, and emotional disturbances. This dimensional approach regards hallucinations and delusions as arising from neural systems subserving perception and information processing, thereby aligning the neurobiological framework used to describe and study such symptoms in primary psychotic disorders with those used to study psychosis associated with other neurologic conditions.
SUMMARY:This article provides practicing neurologists with updates on current approaches to the diagnosis, evaluation, and treatment of primary and secondary psychoses.
Emotional and behavioral dyscontrol are relatively common neuropsychiatric sequelae of traumatic brain injury and present substantial challenges to recovery and community participation. Among the ...most problematic and functionally disruptive of these types of behaviors are pathologic laughing and crying, affective lability, irritability, disinhibition, and aggression. Managing these problems effectively requires an understanding of their phenomenology, epidemiology, and clinical evaluation. This article reviews these issues and provides clinicians with brief and practical suggestions for the management of emotional and behavioral dyscontrol.
Traumatic brain injury (TBI) is a common occurrence with multiple possible neuropsychiatric sequelae, including problems with cognition, emotion, and behavior. While many individuals experience ...significant improvement over the first months following mild TBI, a nontrivial minority will develop persistent, functionally impairing post-TBI symptoms. Depression and cognitive impairment are among the most common such symptoms, and they may respond to a combination of rehabilitative and pharmacologic treatments. This article discusses the clinical approach to treating an individual with depression and cognitive complaints following mild TBI. Recommendations regarding the diagnosis, evaluation, and treatment of these problems are offered.
Mood disorders after TBI Jorge, Ricardo E; Arciniegas, David B
Psychiatric clinics of North America/The Psychiatric clinics of North America,
03/2014, Volume:
37, Issue:
1
Journal Article
Peer reviewed
Open access
In this article, we examine the epidemiology and risk factors for the development of the most common mood disorders observed in the aftermath of TBI: depressive disorders and bipolar spectrum ...disorders. We describe the classification approach and diagnostic criteria proposed in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders. We also examine the differential diagnosis of post-TBI mood disorders and describe the mainstay of the evaluation process. Finally, we place a special emphasis on the analysis of the different therapeutic options and provide guidelines for the appropriate management of these conditions.
Psychological distress is common in persons with traumatic brain injury (TBI) but treatments remain underdeveloped. This randomized controlled trial of Acceptance and Commitment Therapy (ACT) was ...designed to address this gap. Ninety-three persons with medically-documented complicated mild to severe TBI, normal-to-mildly impaired memory, and clinically significant psychological distress in the chronic phase of recovery were randomized to receive eight weeks of ACT (manualized with adaptations to address TBI-related cognitive impairments) or a single session of needs assessment, brief counseling/education, and referral. The ACT group showed significantly greater reduction of psychological distress (Brief Symptom Inventory 18) and demonstrated improvements in psychological flexibility and commitment to action (Acceptance and Action Questionnaire-II (AAQ-II) scores). The number of treatment responders (post-treatment BSI 18 GSI T scores <63) was larger in the ACT group than in the control group. Entry of AAQ-II scores into the model of between-group differences in BSI 18 GSI T scores indicated that core ACT processes explained the variance in treatment group outcomes. Provision of ACT reduces psychological distress in persons with TBI in the chronic phase of recovery when adaptations are made to accommodate TBI-related cognitive impairments. Additional clinical trials with a structurally equivalent control group are needed.
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BFBNIB, DOBA, FSPLJ, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Conventional and quantitative electroencephalography (EEG and qEEG, respectively) may enhance clinical diagnosis and treatment planning provided to persons with mild traumatic brain injury (mTBI) and ...postconcussive symptoms. Effective and appropriate use of EEG and qEEG in this context requires expert-level knowledge of these technologies, mTBI, and the differential diagnosis for postconcussive symptoms. A practical and brief review from the perspective of a clinician–scientist engaged principally in the care and study of persons with mTBI therefore may be of use and value to other clinicians and scientists interested in these matters. Toward that end, this article offers an overview of the current applications of conventional EEG and qEEG to the study and clinical evaluation of persons with mTBI. The clinical case definition of TBI, the differential diagnosis of post-injury neuropsychiatric disturbances, and the typical course of recovery following mTBI are reviewed. With this background and context, the strengths and limitations of the literature describing EEG and qEEG studies in this population are considered. The implications of this review on the applications of these electrophysiologic assessments to the clinical evaluation of persons with mTBI and postconcussive symptoms are then considered. Finally, suggestions are offered regarding the design of future studies using these technologies in this population. Although this review may be of interest and value to professionals engaged in clinical or research electrophysiology in their daily work, it is intended to serve more immediately the needs of clinicians less familiar with these types of clinical electrophysiologic assessments.
► EEG and qEEG are used to assess persons with mild TBI and postconcussive symptoms. ► The differential diagnoses of these problems affect EEG and qEEG interpretation. ► These issues are inadequately considered in the qEEG research literature. ► Studies therein often make
post hoc ergo propter hoc or
cum ergo propter hoc errors. ► This limits the application of qEEG to the evaluation of persons with these problems.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
•Patients with bipolar disorder have smaller hippocampal subfields than controls.•Childhood trauma is associated with larger hippocampal subfields in patients and smaller hippocampal subfields in ...controls.•Childhood trauma affects Subiculum, presubiculum and cornu ammonis 1.
Alterations in hippocampal structure and function are present in bipolar disorder (BD). Childhood trauma is associated with risk for BD, and the several subfields of the hippocampus are differentially sensitive to the effects of stressors of the sort associated with risk for BD. The current study therefore sought to test the hypothesis that childhood trauma may be differentially associated with abnormal hippocampal subfield volumes in BD.
104 participants with BD type I (BD-I, n = 56) or BD type II (BD-II, n = 48) and 81 healthy controls (HC) underwent high-resolution structural magnetic resonance neuroimaging. Hippocampal subfield volumes were determined using FreeSurfer. Childhood trauma was assessed with the Childhood Trauma Questionnaire (CTQ).
There were significant effects of diagnosis on intracranial volume corrected hippocampal subfield volumes bilaterally as well as a significant interaction between diagnosis and childhood trauma. Hippocampal volumes did not differ between the BD-I and BD-II subgroups but hippocampal volumes were smaller in both groups when compared to HC. There was a significant effect of childhood trauma on bilateral presubiculum volume as well as significant interactions between diagnosis and childhood trauma on bilateral CA1, presubiculum and subiculum volumes, the direction of which differed between individuals with BD (larger) and HC (smaller).
Recall bias may influence the reliability of the retrospective assessment of childhood trauma experiences.
Childhood trauma demonstrates differential effects on hippocampal subfield volumes of BD and HC, particularly in hippocampal subfields involved in emotion regulation.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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