196,221 research outputs found
Ethical perspectives on relations between industry and neuropsychiatric medicine
No full textConflicts of interest may influence medical research. In particular, the study on psychotropic treatment of ageing subjects suffering from neurological disorders and comorbid neuropsychiatric phenomena may be hypothetically considered economically non-advantageous, or even of negative impact on drug reputation, because of the high probability of non-response or side effects. Thus, studies on this issue may be disregarded from industry. We aimed to verify whether the global commitment of medical research reflects the actual relevance of depression in the world ageing population, associated or not with neurological conditions. Here, we: 1) have reviewed the literature on this issue, 2) have examined world published data concerning population by age, burden of disease and frequency of depressive disorders and antidepressant therapies, and 3) have reviewed the frequency of published papers on depression and its treatment associated with three neurological conditions. The overall rate of papers about depressive disorders in ageing people reflects adequately the world population and the prevalence of depression in the elderly. However, the rate of papers concerning medical experimentation for antidepressant treatment in Alzheimer's disease, Parkinson's disease and stroke is quite inadequate with respect to the rate of depressive disorders associated to these conditions. Thus, innovative medical experimentation must be encouraged, also in areas apparently of dubious economical advantage but of undoubted clinical relevance and the adoption of strategies to limit the detrimental effect of conflicts of interest in research must be enhanced
The structural neuroanatomy of metacognitive insight in schizophrenia and its psychopathological and neuropsychological correlates
No full textLack of insight into illness is a multidimensional phenomenon that has relevant implications on clinical course and therapy compliance. Here, we focused on metacognitive insight in schizophrenia, that is, the ability to monitor one's changes in state of mind and sensations, with the aim of investigating its neuroanatomical, psychopathological, and neuropsychological correlates. Fifty-seven consecutive patients with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) diagnosis of schizophrenia were administered the Insight Scale, and comprehensive psychopathological and neuropsychological batteries. They underwent a high-resolution T1-weighted magnetic resonance imaging investigation. Gray matter (GM) and white matter (WM) volumes were analyzed on a voxel-by-voxel basis using Statistical Parametric Mapping 8. Reduced metacognitive insight was related to reduced GM volumes in the left ventrolateral prefrontal cortex, right dorsolateral prefrontal cortex and insula, and bilateral premotor area and putamen. Further, it was related to reduced WM volumes of the right superior longitudinal fasciculum, left corona radiata, left forceps minor, and bilateral cingulum. Increased metacognitive insight was related to increased depression severity and attentional control impairment, while the latter was related to increased GM volumes in brain areas linked to metacognitive insight. Results of this study suggest that prefrontal GM and WM bundles, all implied in cognitive control and self-reflection, may be the neuroanatomical correlates of metacognitive insight in schizophrenia. Further, higher metacognitive insight is hypothesized to be a risk factor for depression which may subsequently impair attention. This line of research may provide the basis for the development of cognitive interventions aimed at improving self-monitoring and compliance to treatment. Hum Brain Mapp 35:4729-4740, 2014. © 2014 Wiley Periodicals, Inc
Anosognosia and neuropsychiatric symptoms and disorders in mild Alzheimer disease and mild cognitive impairment
No full textAnosognosia is a multidimensional phenomenon that negatively affects course of illness. This study aimed to explore the association between anosognosia and neuropsychiatric phenomena in mild Alzheimer's disease (AD) and in mild cognitive impairment (MCI). The Anosognosia Questionnaire for Dementia to assess anosognosia, and the Neuropsychiatric Inventory to assess neuropsychiatric symptoms were administered to 209 patients (103 mild AD, 52 amnestic-MCI, and 54 amnestic multidomain-MCI). Categorical diagnoses of apathy, depression, and psychosis were made using specific criteria for dementia. With regard to continuous scores, in mild AD, we found positive correlation between symptoms of anosognosia and apathy, agitation and aberrant motor behaviors, while in MCI, we did not find significant association. At a categorical level, the diagnosis of anosognosia in mild AD was associated with the diagnosis of apathy. In mild AD, the frequent co-occurrence of frontally mediated behavioral disorders and anosognosia, particularly apathy, supports the hypothesis of a shared neuropsychogenic process due to the disruption of frontal brain networks
The evaluation of anosognosia in stroke patients
No full textAnosognosia in stroke patients showed a relevant detrimental effect on the rehabilitation course and patients' quality of life, especially in those with brain injury. Although a number of reliable scales for the assessment of anosognosia in stroke and traumatic brain injury have been developed, at present no single measure fully explores the multifaceted nature of the phenomenon
Effects of vecuronium bromide on intracranial pressure and cerebral perfusion pressure.
No full textThe effects of vecuronium 0.1 mg kg−1 on intracranial pressure, heart rate and arterial pressure were evaluated in 20 anaesthetized patients with intracranial tumours undergoing neurosurgery. Apart from a slight decrease in intracranial pressure (−4.9%; ns) which was most probably the result of a concomitant decrease (−14.9%) in central venous pressure, vecuronium 0.1mg kg−1 was without effect on either cerebral or systemic haemodynamics
Unawareness of illness in neuropsychiatric disorders: phenomenological certainty versus etiopathogenic vagueness
No full textAwareness of illness is a form of self-knowledge concerning information about the pathological state, its functional consequence, and the way it affects the patient and his interaction with the environment. Unawareness of illness has raised much interest for its consequences on compliance with treatment, prognosis, and the patient's quality of life. This review highlights the great complexity of this phenomenon both at phenomenological and etiopathogenic levels in stroke, traumatic brain injury, psychosis, dementias, and mood disorders. In particular, the clinical expression is characterized by failure to acknowledge being ill, misattribution of symptoms, and noncompliance with treatment. Unawareness of illness may also be linked with characteristics that are peculiar to each individual disturbance, such as symptom duration and cognitive impairment. Despite a long-lasting interest in the clinical characteristics of unawareness, only recently has the focus of research investigated pathogenic mechanisms, with sometimes controversial results. The vast majority of studies have pointed out a remarkable involvement of the right hemisphere. Specifically, functional and structural changes of the dorso-lateral prefrontal cortex and some other frontal areas have often been found to be associated with awareness deficit, as well as parieto-temporal areas and the thalamus, although to a lesser extent. These data indicate the present difficulty of localizing a specific cerebral area involved in unawareness and suggest the existence of possible brain circuits responsible for awareness. In conclusion, phenomenological manifestations of poor awareness are well outlined in their complexity, whereas neuroanatomic and neuropsychological findings are still too vague and sparse and need further, greater efforts to be clarified
Clinical-radiographic features of para-articular ossification in the coma patient. A case report
No full textNeuropsychological correlates of cognitive insight in schizophrenia
No full textClinical practice has highlighted a possible discrepancy between patient's verbal assertions, called clinical insight, and the actual convictions about the illness, called emotional insight. The complementary construct of cognitive insight refers to the cognitive processes involved in self-reflection and the ability to modify erroneous beliefs and misinterpretations. The aim of this study was to determine the psychopathological and neuropsychological predictors of cognitive insight in schizophrenia. Sixty outpatients with Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) schizophrenia diagnosis were administered the Beck Cognitive Insight Scale, the Positive and Negative Symptom Scale (PANSS), and a comprehensive neuropsychological battery. Results indicate that poor global cognitive insight in schizophrenia is significantly related to lower visual working memory, while a higher self-overconfidence is significantly related to deficits in verbal and visual memory and to the failure in using external information to correct erroneous convictions. Thus, our study suggests that impaired cognitive insight depends mainly on reduced working memory and executive function performances. These findings highlight the fundamental importance of the development of specific therapeutic strategies to improve the metacognitive components of insight in order to enhance treatment adherence in schizophrenia
Assessment of pulmonary mechanics and breathing patterns during posturally induced glossoptosis in infants.
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