Gray matter differences in patients with functional movement disorders.

Objective: To explore alterations in gray matter volume in patients with functional movement disorders.

Methods: We obtained T1-weighted MRI on 48 patients with clinically definite functional movement disorders, a subset of functional neurologic symptom disorder characterized by abnormal involuntary movements, and on 55 age- and sex-matched healthy controls. We compared between-group differences in gray matter volume using voxel-based morphometry across the whole brain.

Impaired self-agency in functional movement disorders: A resting-state fMRI study.

Objective: To investigate the neural mechanisms underlying impaired self-agency in patients with functional movement disorders using resting-state functional MRI (fMRI).

Methods: We obtained resting-state fMRI on 35 patients with clinically definite functional movement disorders and 35 age- and sex-matched healthy controls. Between-group differences in functional connectivity from the right temporo-parietal junction (TPJ), a region previously demonstrated to play a critical role in self-agency by comparing internal predictions of movement with actual external events, were assessed using t tests.

Insights into Chronic Functional Movement Disorders: The Value of Qualitative Psychiatric Interviews.

Background: Patients with functional movement disorders (FMDs) are commonly seen by neurologists and psychosomatic medicine psychiatrists. Research literature provides scant information about the subjective experiences of individuals with this often chronic problem.

Objective: To enhance our understanding of psychologic aspects of FMDs by conducting qualitative interviews of research subjects.

Impaired resting vagal tone in patients with functional movement disorders.

Introduction: The autonomic nervous system plays an integral role in the maintenance of homeostasis during times of stress. The functioning of the autonomic nervous system in patients with functional movement disorders (FMD) is of particular interest given the hypothesis that converted psychological stress plays a critical role in FMD disease pathogenesis. We sought to investigate autonomic nervous system activity in FMD patients by examining heart rate variability (HRV), a quantitative marker of autonomic function.

EEG screening for temporal lobe epilepsy in patients with acute psychosis.

Seizures may present with ictal or interictal psychosis mimicking primary psychiatric disorders. The authors reviewed EEG, brain-imaging, and clinical data of 240 patients presenting with acute psychotic episode to assess the diagnostic value of EEG in differentiating ictal psychosis from primary psychosis. Seven patients had interictal spikes, but there were no patients with ictal discharges.

Family medicine and internal medicine physicians' attitudes and beliefs about depression: implications for treatment decisions.

Studies have long shown that some patients receive less than optimal care for depression in primary care settings. However, few studies have uncovered factors that predict and explain this deficiency. The authors administered a survey to 408 primary care physicians.

An approach to the patient with anxiety.

Patients seen in primary care and in specialty medical settings often have prominent anxiety. This article presents the epidemiology, etiology, manifestations, and treatment of anxiety disorders.

Primary care physicians' evaluation and treatment of depression: Results of an experimental study using video vignettes.

Little is known about how patient and primary care physician characteristics are associated with quality of depression care. The authors conducted structured interviews of 404 randomly selected primary care physicians after their interaction with CD-ROM vignettes of actors portraying depressed patients. Vignettes varied along the dimensions of medical comorbidity, attributions regarding the cause of depression, style, race/ethnicity, and gender.

Virtual standardized patients: an interactive method to examine variation in depression care among primary care physicians.

BACKGROUND: Some primary care physicians provide less than optimal care for depression (Kessler et al., Journal of the American Medical Association 291, 2581-90, 2004). However, the literature is not unanimous on the best method to use in order to investigate this variation in care.

Mania: psychiatric manifestations of the antiphospholipid syndrome.

Background: Antiphospholipid syndrome (APS) is a prothrombotic condition characterized by recurrent vascular thrombosis and/or pregnancy morbidity in the presence of circulating antiphospholipid antibodies. Central nervous system (CNS) involvement is a prominent feature of APS, and many neurological manifestations have been described in published reports. There are limited data on psychiatric syndromes occurring in association with APS, and there have been no previous reports of mania associated with APS.

Formal training in women's issues in psychiatry: a survey of psychiatry residency training directors.

Objective: The authors describe the availability of formal residency training opportunities in women's issues in psychiatry and explore the potential relationships between the availability of training and characteristics of residency programs.

Method: The authors surveyed psychiatry residency training directors to identify program characteristics and training opportunities.

Results: Certain didactic subjects were available in greater than 80% of residencies.

Treatment patterns and outcomes of depressed medically ill and non-medically ill patients in community psychiatric practice.

The prevalence of depression among the medically ill, the recognition of depression in general medical practice, and the association between depression and medical illness have all been a focus for research in recent years. Less is known about the process and outcomes of depression care in the medically ill compared with the non-medically ill, but some studies suggest that those with concomitant physical illness have poorer outcomes. In a study of community psychiatric practice, a sample of 53 patients with no medical comorbidity (NMI) was compared with 50 patients, categorized by higher (HMI) or lower (LMI) levels of physical comorbidity, approximately 5 months after beginning treatment for a current episode of major depression.