Ethnicity and dementia.

A large number of studies have examined both the epidemiology and neuropsychiatric manifestations of dementia among older adults. However, there is a relative dearth of studies focusing on ethnic minority elders in the United States. This article reviews the existing empiric literature in the area of ethnicity and dementia.

Antidepressant medications, mood and male fertility.

By modulating the activity of central neurotransmitters, psychotropic agents may affect reproductive functioning in men and women. Many neurotransmitters influence the hypothalamic-pituitary-gonadal (HPG) axis and can consequently affect menstrual cycling in women and spermatogenesis in men. Emotional state similarly may disrupt reproductive functioning through the effects of stress hormones on the HPG axis.

Relationship between brain electrical activity and cortical perfusion in normal subjects.

Cerebral glucose uptake and perfusion are accepted as tightly coupled measures of energy utilization in both normal and diseased brain. The coupling of brain electrical activity to perfusion has been demonstrated, however, only in the presence of chronic brain disease. Very few studies have examined the relationship between cerebral electrical activity and energy utilization in normal brain tissue.

Pharmacological and psychological treatments for depressed older patients: a meta-analysis and overview of recent findings.

A meta-analysis was carried out to evaluate data published between January 1974 and February 1998 comparing rates of treatment response and tolerability of pharmacological and psychological treatments for depression in persons over age 55. Drugs (tricyclic antidepressants, selective serotonin-reuptake inhibitors, and a mixed group of other drugs) were significantly better than placebo, with an average reduction in symptom severity of 48.0% versus 31.

Managing psychiatric medications in the breast-feeding woman.

Given the high risk of postpartum psychiatric problems, clinicians need to be prepared to appropriately manage the breast-feeding woman who needs psychotropics. These psychiatric researchers examine the issues and offer guidelines. Following childbirth, many women are at high risk for the onset or recurrence of psychiatric illness.

Complete remission of 'treatment resistant' severe melancholia in adolescents with phenelzine: two case reports.

We describe two cases of adolescents hospitalized with protracted courses of delusional melancholia who responded dramatically to treatment with phenelzine following multiple failed clinical trials with other agents and, in one case, ECT. The two cases are of interest in light of evidence linking delusional subtype of major depression in adolescents to bipolar disease, and the role of monoamine oxidase inhibitors in the management of adults with bipolar depression, as well as unipolar depressions unresponsive to other pharmacological treatments.

Bipolar depression and antidepressant-induced mania: a naturalistic study.

Background: The likelihood and character of antidepressant-induced mania remain important but poorly understood factors in the treatment of bipolar depression.

Method: We examined the response to naturalistic treatment of 29 bipolar I patients who experienced a total of 79 depressive episodes. Treatment consisted primarily of mood stabilizers used alone (N = 31) or in combination with antidepressants (N = 48).

Psychoneuroendocrinology of mood disorders. The hypothalamic-pituitary-thyroid axis.

Abnormal thyroid functioning can affect mood and influence the course of unipolar and bipolar disorder. Even mild thyroid dysfunction has been associated with changes in mood and cognitive functioning. Thyroid hormone supplementation may have role in the treatment of certain mood disorders, particularly rapid-cycling bipolar disorder.

Hormonal changes in the postpartum and implications for postpartum depression.

The months following childbirth are a time of heightened vulnerability to depressive mood changes. Because of the abrupt and dramatic changes occurring in hormone levels after delivery, many studies have examined the role of hormonal factors in postpartum depression. The authors review the literature on potential hormonal etiologies in postpartum depression, in particular for progesterone, estrogen, prolactin, cortisol, oxytocin, thyroid, and vasopressin.

Mental health and substance abuse treatment services for dually diagnosed clients: results of a statewide survey of county administrators.

Finding are presented from a survey of administrators of county departments of mental health and alcohol and drug programs in California regarding services for individuals with co-occurring mental and substance abuse disorders. A total of 47 counties responded (84% response rate). The survey findings indicate that collaboration across county mental health and alcohol and drug services primarily occurs through information sharing, coordination of services, and joint projects.

Brain structure and function and the outcomes of treatment for depression.

Background: Depressed patients have a variety of brain structural alterations, the most common being atrophy and deep white-matter lesions. Alterations in brain function also are common, particularly regional decreases in cerebral metabolism and perfusion.

Method: We review here the evidence that alterations in brain structure and function may explain some of the heterogeneity in outcomes of depression.

Course of psychiatric disorders across the menstrual cycle.

Women of reproductive age with psychiatric disorders may experience a fluctuating course of illness over the menstrual cycle. Some data suggest an exacerbation of symptoms during the premenstrual and menstrual phases. The usefulness of such reports is limited, however, by the lack of prospective assessments and the small number of patients involved.

Databases for clinical psychiatry.

Clinical information systems support patient care and research while providing data for administrative use. We assessed the informational needs of the psychiatrists at UCLA Neuropsychiatric Hospital and used the resulting criteria in evaluating commercial computer products. The systems that appear to be least expensive, most powerful, and most suitable for widespread use are assembled from various off-the-shelf packages.

The Rorschach Ego Impairment Index in heterogeneous psychiatric patients.

There is a need for test measures of ego functioning that identify treatment needs and predict treatment response. Perry and Viglione's Rorschach Ego Impairment Index (EII; Perry & Viglione, 1991) is a composite measure assessing reality testing, thought process, defensive regulation, and object relations. It has been shown to correlate with Minnesota Multiphastic Personality Inventory (MMPI; Hathaway & McKinley, 1943) scales and subscales and other measures of psychosis in a schizophrenic sample and to predict antidepressant treatment of outcome in a depressed sample.

Psychiatric sequelae in adolescent bone marrow transplantation survivors : implications for psychotherapy.

Survivors of life-threatening pediatric illness and their families present a number of psychotherapeutic challenges. The authors present pilot data evaluating the long-term psychiatric impact of pediatric bone marrow transplantation on 10 adolescent transplantation survivors compared with a matched control group. On a quantitative assessment of posttraumatic stress symptoms, the survivors reported a consistent but low level of symptoms.

Beta activity in aging and dementia.

Considerable variation remains in the reported effects of disease, age and gender on high frequency electroencephalographic activity. We examined the topographic differences in relative and absolute beta power in the 14-54 Hz range in 49 subjects with dementia of the Alzheimer's type (DAT), 25 subjects with multi-infarct dementia (MID), and 62 normal control subjects (CON). Associations of these spectral parameters with age, gender and cognitive status were assessed.

Speech and language disorders in children and adolescents with schizophrenia.

This study examines communication characteristics and specific language deficits in 47 children and adolescents diagnosed with early-onset schizophrenia using DSM-III-R criteria. All had been referred for speech and language services because of apparent communication problems. Standardized tests and formal measures were used to identify impairment in discrete areas of communication, including pragmatics, receptive and expressive vocabulary and syntax, abstract language, auditory processing, and speech production.

Relationships between EEG coherence and neuropsychological tests in dementia.

Previous research has demonstrated differences in resting state EEG coherence among groups of subjects with dementia of the Alzheimer type (DAT), multi-infarct dementia (MID), and normal elderly controls. Since reduced coherence between brain sites has been thought to reflect functional disconnection between brain areas, we hypothesized that decreased coherence would be associated with cognitive dysfunction as assessed by neuropsychological tests. We correlated several neuropsychological tests with four coherence variables and found that reduced coherence was associated with impairment on specific neuropsychological tests in ways that conform to and supplement current knowledge about the localization of brain functions.

Effect of white matter disease on functional connections in the aging brain.

Periventricular white matter hyperintensities (PVHs) seen on T2 weighted MRI studies are common in elderly people and often represent demyelination of fibres. Damage to these fibres could lead to functional disconnection between brain regions. Electroencephalographic coherence, a measure of shared electrical activity between regions, was examined to determine if there was evidence for such disconnection.

Quantitative EEG Correlates of Outcome in Older Psychiatric Patients: Part II: Two-Year Follow-Up of Patients With Depression.

The authors examined quantitative electroencephalographc (QEEG) coherence in 37 depressed elderly patients and performed 2-year follow-up evaluations. All subjects had equivocal cognitive impairment, but none had delirium or dementia. More than 40% (16/37) recovered from depression, and 38% (14/37) remained well for 2 years.

Assessment of cerebral perfusion using quantitative EEG cordance.

Brain electrical activity is related to cerebral perfusion. The nature of this relationship is unclear, however, and surface-recorded activity has not been a reliable indicator of brain perfusion. We studied 27 subjects, all of whom were examined with single photon emission tomography (SPECT) and quantitative electroencephalography (QEEG), to assess associations between QEEG cordance and relative brain perfusion.

Quantitative EEG Correlates of Outcome in Older Psychiatric Patients: Part I: Cross-Sectional and Longitudinal Assessment of Patients With Dementia.

Using quantitative electroencephalographic coherence (a measure of synchronized electrical activity between brain regions) the authors examined heterogeneity in clinical presentation and outcome inpatients with dementia. Patients (N = 114) with mild-to-moderate dementia of the Alzheimer's type (DAT) or multi-infarct dementia (MID) were examined for coherence from the left hemisphere. More than 70% diagnostic accuracy in distinguishing between DAT and MID subjects was achieved using coherence measures alone.

Cordance: a new method for assessment of cerebral perfusion and metabolism using quantitative electroencephalography.

Increased slow-wave and decreased fast-wave activity on the electroencephalogram is common in brain dysfunction and may be caused by partial cortical deafferentation. No measure that is specific or sensitive for this deafferentation, however, has yet been reported. We studied a series of subjects with white-matter lesions undercutting the cortex and developed a method for analyzing electrical activity called "cordance" that has face validity as a measure of cortical deafferentation.

Reduced EEG coherence in dementia: state or trait marker?

Recent work from our laboratory demonstrated that quantitative electroencephalographic (EEG) coherence between brain areas linked by long cortico-cortical fibers (termed "fascicle" coherence) was differentially reduced in subjects with Alzheimer's disease, whereas coherence between brain areas linked by short cortico-cortical and cortico-subcortical fibers in postcentral areas (termed "visual" coherence) was differentially reduced in subjects with multi-infarct dementia. In this study, we investigated whether these differences in coherence represent "trait" or "state" markers for dementia. Visual coherence demonstrated high stability in both demented groups as assessed by both one-year test-retest reliabilities and analysis of group mean change.

Depression in general medical settings. Implications of three health policy studies for consultation-liaison psychiatry.

Prepaid or prospective reimbursement has implications for the consultation-liaison (C-L) psychiatrist. The author reviews results from three health policy studies that indicated 1) degree of reliance on general medical providers for mental health care is not affected by generosity of fee-for-service (FFS) coverage, but is greater in some prepaid health care systems; 2) psychological sickness of depressed outpatients visiting general medical providers is similar across prepaid and FFS systems of care; 3) prepaid care is associated with lower rates of detection of depression and counseling in the general medical sector; 4) depression outcomes in the general medical sector are similar under prepaid or FFS care; 5) quality of care for depressed patients is moderate to low in the general medical sector; and 6) depressed elderly inpatients receive higher quality of psychological care in psychiatric units, but they receive higher quality of physical care in general medical wards. The discussion emphasizes the C-L psychiatrist's role in educating general medical providers, improving outcomes for the sickest patients, and improving psychosocial care in prepaid practices.