Neuropsychiatric syndromes associated with multiple sclerosis.

Multiple sclerosis is associated with diverse behavioral changes. Rates of major depression approach 50% over the course of patients' lives, rates of bipolar disorder and psychosis are twice as common when compared to rates in the general population and pseudobulbar affect will afflict one in ten patients. However, these disorders often respond well to pharmacologic treatment and in the case of major depression, some forms of psychotherapy too.

The neuropsychiatry of multiple sclerosis: a review of recent developments.

Purpose Of Review: The aim of this review is to summarize the current literature on the neuropsychiatry of multiple sclerosis (MS).

Recent Findings: Data from community samples have supported earlier findings from tertiary referral centres of high rates of depression in MS patients. Neuroimaging offers important clues as to the pathogenesis of depression, but psychosocial factors cannot be ignored and emerge as equally important predictors.

The utility of the mini-mental status exam in older adults with traumatic brain injury.

Primary Objective: To assess the utility of the Mini-Mental Status Examination (MMSE) among the older TBI population.

Methods And Procedures: The MMSE and a number of other neuropsychological tests were administered to forty-three adults aged 50 and over one year following mild to moderate TBI. The sensitivity, specificity, and predictive value of the MMSE were evaluated in relation to these tests.

Anxiety disorders and their clinical correlates in multiple sclerosis patients.

Objective: To assess prevalence rates and clinical correlates of anxiety disorders in patients with multiple sclerosis (MS).

Methods: Demographic and neurological data were collected on 140 consecutive clinic attendees, and their lifetime and point prevalences of anxiety disorders were determined with the Structured Clinical Interview for DSM-IV disorders (SCID-IV). All subjects completed the self-report Hospital Anxiety and Depression Scale (HADS).

Unexplained neurologic symptoms: an fMRI study of sensory conversion disorder.

We investigated three subjects with unexplained sensory loss meeting criteria for conversion disorder using brain fMRI during unilateral and bilateral vibrotactile stimulation. In each subject, stimulation of the affected limb did not produce activation of the contralateral primary somatosensory (S1) region, whereas bilateral limb stimulation did. These findings implicate selective alterations in primary sensorimotor cortex activity in conversion disorder, and may also reconcile the discordant results of previous studies.

Treatment of neuropsychiatric conditions associated with multiple sclerosis.

This article reviews the treatment of behavioral disturbances associated with multiple sclerosis. Pharmacological and psychotherapeutic treatment data, when available, are presented for five discrete conditions: major depression, bipolar affective disorder, anxiety, psychosis, pseudobulbar affect and cognitive dysfunction. Despite the paucity of empirical treatment data that characterizes all of these conditions, with the exception of pseudobulbar affect, the message from open-label trials and anecdotal experience is that therapy is often successful, leading to improvements in quality of life for patients.

Simulation training for a mass casualty incident: two-year experience at the Army Trauma Training Center.

Background: Civilian and military mass casualty incidents (MCI) are an unfortunate reality in the 21st century, but there are few situational training exercises (STX) to prepare for them. To fill this gap, we developed a MCI STX for U.S.

Randomized treatment trial in mild traumatic brain injury.

Objective: To determine whether multidisciplinary treatment of mild traumatic brain injury (MTBI) improves neurobehavioral outcome at 6 months postinjury.

Methods: Subjects with MTBI were randomly assigned to treatment (n=97) or nontreatment (control, n=94) groups. Treated patients were assessed within 1 week of injury and thereafter managed by a multidisciplinary team according to clinical need for a further 6 months.

Prehospital HBOC-201 after traumatic brain injury and hemorrhagic shock in swine.

Background: Data are limited on the actions of hemoglobin based oxygen carriers (HBOCs) after traumatic brain injury (TBI). This study evaluates neurotoxicity, vasoactivity, cardiac toxicity, and inflammatory activity of HBOC-201 (Biopure, Cambridge, Mass.) resuscitation in a TBI model.

Outcome after traumatic brain injury sustained in older adulthood: a one-year longitudinal study.

Objective: The objective of this study was to explore the effects of traumatic brain injury (TBI) on cognition and functioning in older adults in a one-year longitudinal study.

Methods: Participants with mild-to-moderate TBI were compared with an age-, gender-, and education-matched healthy comparison group on aspects of cognition. Neuropsychologic tests were administered at one year.

Mood disorders in multiple sclerosis and the effects on cognition.

Background: Depression and cognitive dysfunction are common in patients with multiple sclerosis. However, it is unclear whether depression may cause or exacerbate cognitive problems as data remain equivocal. The current review attempts to clarify the relationship between these behavioral disorders.

The effect of major depression on subjective and objective cognitive deficits in mild to moderate traumatic brain injury.

The effect of major depression on subjective and objective cognitive deficits 6 months following mild to moderate traumatic brain injury (TBI) was assessed in 63 subjects. Patients with subjective cognitive complaints (n=63) were more likely to be women, with higher Glasgow Coma Scale (GCS) scores and have a diagnosis of major depression. They also performed significantly more poorly on various measures of memory, attention and executive functioning.

The impact of major depression on outcome following mild-to-moderate traumatic brain injury in older adults.

Background: Major depression is common following traumatic brain injury (TBI), yet no studies to date have explored its relationship to psychosocial outcome in older adults with TBI.

Methods: A consecutive sample of seventy-seven older patients with mild-to-moderate TBI was assessed for the presence of major depression within 2 months of injury, and followed prospectively for 1 year. Those with major depression were compared with those without on measures of psychosocial outcome, instrumental activities of daily living (IADL).

Effects of arginine vasopressin during resuscitation from hemorrhagic hypotension after traumatic brain injury.

Objective: Two series of experiments were designed to evaluate whether early arginine vasopressin improves acute outcome following resuscitation from traumatic brain injury and severe hemorrhagic hypotension.

Design: Prospective randomized, blinded animal study.

Setting: University laboratory.

Early vasopressin improves short-term survival after pulmonary contusion.

Unlabelled: Arginine vasopressin (AVP) is a promising treatment for several types of irreversible shock, but its therapeutic potential has not been examined after severe chest trauma. Two series of experiments were performed to fill this gap.

Methods: Series 1: anesthetized, mechanically-ventilated pigs (n = 20, 29 +/- 1 kg) received a blast to the chest, followed by a "controlled" arterial hemorrhage to a mean arterial pressure (MAP) <30 mm Hg.

Systemic coagulation changes caused by pulmonary artery catheters: laboratory findings and clinical correlation.

Background: A higher rate of pulmonary embolism has been associated with pulmonary artery (PA) catheters; however, no mechanism has been described. Conventional tests of coagulation reveal no changes related to PA catheterization. The purpose of this study was to determine whether PA catheterization resulted in a hypercoagulable state detectable by thrombelastography (TEG).

Embedded journalists in the Iraq war: are they at greater psychological risk?

The current war in Iraq saw an alliance between the media and the military, a process called embedded journalism. The aim of this study was to explore whether this process affected the journalists' vulnerability to psychological distress. Eighty-five of 100 journalists approached agreed to participate; 38 (44.

Resuscitation with pressors after traumatic brain injury.

Background: The purpose of the study was to compare initial resuscitation with arginine vasopressin (AVP), phenylephrine (PE), or isotonic crystalloid fluid alone after traumatic brain injury and vasodilatory shock.

Study Design: Anesthetized, ventilated swine (n = 39, 30 +/- 2 kg) underwent fluid percussion traumatic brain injury followed by hemorrhage (30 +/- 2mL/kg) to a mean arterial pressure < 30mmHg, then were randomized to 1 of 5 groups to maintain mean arterial pressure > 60mmHg for 30 to 60minutes, then cerebral perfusion pressure > 60mmHg for 60 to 300minutes, either unlimited crystalloid fluid only (n = 9), arginine vasopressin + fluid (n = 9), phenylephrine + fluid (n = 9), arginine vasopressin only (n = 5), or phenylephrine only (n = 5). Heterologous transfusions were administered if hematocrit was < 13, and mannitol was administered if intracranial pressure was > 20 mmHg.

Detecting cognitive dysfunction in multiple sclerosis with a magnetic resonance imaging rating scale: a pilot study.

Objective: In multiple sclerosis (MS), magnetic resonance imaging (MRI) predictors of cognitive impairment are based on sophisticated computer-generated analyses that are difficult to apply in clinical settings. This study investigated the clinical usefulness of a new visual rating scale, the Cholinergic Pathways Hyperintensities Scale (CHIPS), in detecting cognitive dysfunction.

Methods: Forty clinically definite MS patients underwent a brain MRI.

Cognitive impairment associated with major depression following mild and moderate traumatic brain injury.

Traumatic brain injury (TBI) and major depression are neuropsychiatric conditions that have been associated with cognitive dysfunction. The aim of this study was to explore the relationship between major depression and cognitive impairment following mild and moderate TBI. Seventy-four TBI patients were assessed for the presence of major depression using the Structured Clinical Interview for the DSM-IV and completed a neurocognitive assessment battery.

Six-month recovery from mild to moderate Traumatic Brain Injury: the role of APOE-epsilon4 allele.

The possession of at least one APOE-epsilon4 allele may be linked to poor outcome in patients with predominantly severe traumatic brain injury (TBI). In mild TBI, which accounts for approximately 85% of all cases, the role of the APOE-epsilon4 allele is less clear. Studies completed to date have relied on brief cognitive assessments or coarse measures of global functioning, thereby limiting their conclusions.

Outcome after mild to moderate traumatic brain injury: the role of dizziness.

Objective: To assess the specific effect of dizziness on psychosocial outcome after mild to moderate traumatic brain injury (TBI).

Design: Six-month cross-sectional study. Setting An outpatient TBI clinic in a tertiary care referral center.

Bilateral globus pallidus internus deep brain stimulation in tardive dyskinesia: a case report.

The clinical response of a 53-year-old woman with tardive dyskinesia treated with bilateral globus pallidus interna deep brain stimulation is described. At 18 months follow-up, her Burke-Fahn-Marsden Dystonia Rating Scale score fell from 52 (preoperative) to 21 (60% improvement).

Semiautomatic brain region extraction: a method of parcellating brain regions from structural magnetic resonance images.

Structural MR imaging has become essential to the evaluation of regional brain changes in both healthy aging and disease-related processes. Several methods have been developed to measure structure size and regional brain volumes, but many of these methods involve substantial manual tracing and/or landmark identification. We present a new technique, semiautomatic brain region extraction (SABRE), for the rapid and reliable parcellation of cortical and subcortical brain regions.