Open Access Case Study

Bilateral Thalamic Infarct in Two Unresponsive Octogenarians

Luca Masotti, Gianni Lorenzini, Francesca Gallesi, Daniel Agustin Godoy, Mario Di Napoli

International Neuropsychiatric Disease Journal, Page 274-279
DOI: 10.9734/INDJ/2014/9897

Bilateral thalamic infarct (BTI) represents an uncommon stroke presentation. Pathophysiology recognizes the occlusion of an anatomic variant of the thalamic blood supply from perforating branches of posterior cerebral arteries. Presentation could be nonspecific and dramatic in the same time, being coma or stupor the possible clinical scenario encountered. Diagnosis is performed by neuroradiological imaging showing the typical bilateral paramedian thalamic infarcts. Literature lacks of evidence in very old patients, therefore we describe two cases of BTI occurred in octogenarians presenting unresponsive. BTI in very old patients presenting comatose should be taken in account as diagnostic possibility.


Open Access Case Study

Cotard’s Syndrome: Clinical Case Presentation and Literature Review

Alessandro Carano, Domenico De Berardis, Marilde Cavuto, Carla Ortolani, Giampaolo Perna, Alessandro Valchera, Monica Mazza, Michele Fornaro, Felice Iasevoli, Giovanni Martinotti, Massimo Di Giannantonio

International Neuropsychiatric Disease Journal, Page 348-355
DOI: 10.9734/INDJ/2014/7215

In 1880 French neurologist Jules Cotard described a condition characterized by delusion of negation (nihilistic delusion) in a melancholia context. Recently, there has been a resurgence of interest in Cotard’s syndrome. The most prominent symptoms of Cotard’s Syndrome are depressive mood, nihilistic delusions concerning one’s own body and one’s own existence, delusions of guilt, immortality and hypochondria. The aim of the present paper is to review literature evidences concerning Cotard’s syndrome and to describe a clinical case keeping in the background the recent trends on its psychopathological implications. In the clinical study, the following sequence of stages emerged: the dissociative side, expressed as a loss of body-mind cohesion; the ‘mixed’ mood disorder, with depressive-manic episodes, and a persecutory background, all coexisting in the anguish of the idea of a body falling apart, the anguish of a descent towards the abyss of melancholia and/or an ascent to unlimited euphoria, characteristic of an “uncommon alarm” for loss of Self cohesion.


Open Access Short Communication

MicroRNA Let-7f Mediates Mitochondrial Respiratory Deficit Induced by Repeated Ethanol Exposure and Withdrawal in HT22 Cells

Marianna E. Jung, Daniel B. Metzger

International Neuropsychiatric Disease Journal, Page 303-315
DOI: 10.9734/INDJ/2014/11533

Aims: The expression of gene and gene product is typically inhibited by a small non-coding RNA (microRNA) or DNA methylation. The aim of this study is to investigate mechanisms involving microRNA let-7f by which the repeated cycles of ethanol exposure and withdrawal provoke mitochondrial respiratory damage.

Study Design: The rat or cell model of repeated withdrawal from a high dose of ethanol exposure was used to mimic human alcoholics who repeat the cycles of heavy drinking and unsuccessful attempts at abstaining. 

Place and Duration of Study: Department of Pharmacology and Neuroscience University of North Texas Health Science Center at Fort Worth, between June 2011 and March 2014.

Methodology: Male adult rats received an ethanol program, consisting of two cycles of ethanol exposure (4 weeks) and withdrawal (2 weeks). At the end of the ethanol program, one hemisphere of each rat was used to measure the level of let-7f using TaqMan let-7f primers and qPCR. The other hemisphere was used to measure the methylation of cytosine in let-7f gene using bisulfite conversion and pyrosequencing.  Separately, HT22 cells (mouse hippocampal cells) were exposed to an ethanol program, consisting of two cycles of ethanol exposure (20 hours) and withdrawal (4 hours).  During the entire ethanol program, the cells were treated with let-7f antagomir (inhibitor) or a methylation-inducing methyl-donor. The role of let-7f in mitochondria was assessed by quantifying a mitochondrial enzyme, cytochrome c oxidase-IV (COX subunit IV) and real-time mitochondrial respiration using an immunoblot method and XF respirometry, respectively.

Results: The level of let-7f increased (2.4±0.5 fold increase), whereas the methylation of let-7f gene decreased in the brain of rats that underwent repeated ethanol exposure and withdrawal (called “repeated-ethanol/withdrawal”). The methyl-donor treatment completely abolished the increase in let-7f induced by repeated-ethanol/withdrawal. let-7f antagomir treatment also abolished the inhibiting effect of repeated-ethanol/withdrawal on COX-IV and mitochondrial respiration.

Conclusion: These data suggest that repeated-ethanol/withdrawal provokes the dysregulation of let-7f, thereby damaging brain mitochondria. Mitochondria-associated microRNA may be a potential research and drug target to manage alcoholism. 

Open Access Original Research Article

Effects of Sleep Deprivation on the Cardiovascular Health

Jaspinder Kaur, Mandeep Kaur

International Neuropsychiatric Disease Journal, Page 244-254
DOI: 10.9734/INDJ/2014/10848

Aim: Insomnia is subjective perception of dissatisfaction with sleep quality and/or duration. The present study aimed to determine the effects of sleep deprivation on cardiovascular risk factors and health.

Design, Place and Duration of Study: A cross-sectional study was conducted at Exservicemen Contributory Health Scheme (ECHS) Polyclinic, Sultanpur Lodhi, Kapurthala, Punjab, India from July, 2013 to Nov, 2013.

Methodology: All the retired defence personnel and their family members (N=351) were assessed to study physical activity, body mass index (BMI), dietary habits, alcohol, hypertension, hyperglycemia, hyperlipidemia, stress, age, gender, employment, and education as determinants of sleep deprivation. The results were analyzed by Chi Square test with statistically significance of P value<.05.

Results: The total prevalence of insomnia was 27.64% with higher frequency in females (52.57%) than males (47.42%). The prevalence increased with advancing age >50 years (81.43%), unemployment (75.25%), illiteracy (69.06%) and upper socioeconomic status (39.17%). A significant association of insomnia with hypertension (59.80%; P<.05) and stress (28.86%; P<.001) was found. Alcohol (24.40%) and active lifestyle (38.58%) had shown protective role in sleep adequacy. However, sleep deprivation had no significant relation with obesity, metabolic syndrome, dietary practices, blood glucose, and lipids levels.

Conclusion: Insomnia and its significant relation with hypertension and stress increases cardiovascular risk which requires appropriate interventions by identifying those at the risk of chronic insomnia and its associations with females, advancing age, physical inactivity, low education level and unemployment.


Open Access Original Research Article

Assessment of Cognitive Functions, Psychomotor Performance and Attention Deficit Hyperactivity Disorders among Students with Dyslexia

Ghaydaa A. Shehata, Huda S. Hassan

International Neuropsychiatric Disease Journal, Page 255-265
DOI: 10.9734/INDJ/2014/9868

Aim: The present study presented as a comparison of the cognitive functions, psychomotor performance and attention deficit hyperactivity disorders between dyslexic and control students.

Method: This was a randomized study. The participants were 33 dyslexic students and 34 age, gender, and IQ-matched control students. The major evaluation tools included were Stanford Binet fourth edition for cognitive function, Quick neurological screening scale for learning disabilities, Behavioral Characteristics Rating Scales for Learning Disabilities, three Arabic standardized scales for reading and comprehension and two scales for attention deficit hyperactivity disorders (ADHD).

Results: Comparisons of the 2 groups of students revealed that significantly impairment of some cognitive functions as verbal reasoning, abstract visual reasoning, short term memory and intelligent quotient. Also, impairment of psychomotor performance and higher scores of ADHD were detected among dyslexic group than control group.

Conclusion: Association between dyslexia and ADHD are accompanied with more deterioration in some cognitive functions and psychomotor performance.

Open Access Original Research Article

Accuracy of Hyperintense Cerebrospinal Fluid Signals (CSF) on Inversion Recovery (IR) Images of Brain in the Diagnosis of Meningitis-a Cost Effective Experience from Third World Country

Fatima Mubarak, Shayan Sirat Maheen Anwer

International Neuropsychiatric Disease Journal, Page 266-273
DOI: 10.9734/INDJ/2014/10365

Objective: To detect the diagnostic accuracy of inversion recovery sequence in detection of meningitis taking cerebrospinal fluid as the gold standard.

Material and Methods: This study was conducted in Aga Khan University Hospital (AKUH) Karachi. Retrospective data was reviewed from 1ST November 2010 to 31st November 2012.

All consecutive patients who came with clinical diagnosis of meningitis were included. Fifty patients were included in study on the basis of inclusion and exclusion criteria. Two independent neuroradiologists retrospectively reviewed FLAIR sequences blinded to CSF findings. Their findings were compared with cerebrospinal fluid results.  Sensitivity, specificity, PPV, NPV and diagnostic accuracy were calculated.

Results: Hyperintense CSF signals on FLAIR sequence found to have 94.7% sensitivity, 83.3% specificity and accuracy of 92% in diagnosis of meningitis while PPV and NPV were 94.7% and 83.3% respectively.

Conclusion: We found that hyper intense CSF signals on FLAIR sequence has high accuracy in diagnosis of meningitis.

Open Access Original Research Article

Personality Traits, Depression and Anxiety among Cerebro-vascular Stroke Patients: An Egyptian Study

Ghaydaa A. Shehata, Huda S. Hassan

International Neuropsychiatric Disease Journal, Page 280-288
DOI: 10.9734/INDJ/2014/9865

Background: Over the past several decades, the relationship between personality traits, depression, anxiety and stroke has interested to clinicians and researchers.

Objective: Evaluation of personality traits, depression and anxiety among patients with stroke.

Methods: Thirty patients with stroke recruited from neurology department inpatients unit in Assiut university hospital. Another 50 subjects matched with respect to age, sex, and socioeconomic status formed the control group. For each participant, a complete medical history was obtained. Clinical examination, brain CT or MRI, and psychometric evaluation was performed for patients. Eysenck Personality Questionnaire, Hamilton anxiety and Beck Depression Inventory were used in assessment the psychometric state of patients.

Results: Patients with stroke reported significant higher scores in depression and anxiety. Psychoticism, lying and crime personality traits were significant higher among stroke patients compared with controls. Depression, anxiety were significant correlated with some of the personality traits subscales.

Conclusion: In our study stroke is associated with depression, anxiety and some abnormal personality traits.

Open Access Original Research Article

Socio-Demographic and Clinical Features of Children with Intellectual Disability and Their Parents-an Indian Study

Rejani Thudalikunnil Gopalan, Rajesh Sharma, Machat Puthur Unnikrishnan

International Neuropsychiatric Disease Journal, Page 289-302
DOI: 10.9734/INDJ/2014/10610

Aim: Intellectual disability often referred to as a mental, cognitive or mental retardation is a lifelong condition that affects intellectual functioning and adaptive behaviors. Information about children with intellectual disability attending regular schools is limited in India as there are no mandatory screening procedures used to detect these children while starting their schooling. Hence the purpose of the study was to examine the demographic and clinical features of children in regular schools with intellectual disability and also to explore their parental demographic and clinical features.  

Study Design:  Cross sectional study

Sample: The sample (N=382) was collected from regular school going children within the age range of 5 to 16 years who were referred by special educators.  

Methodology: Clinical diagnosis and psychological assessments were conducted individually for 382 children and their parents.  

Results: Results of the clinical evaluation and assessment indicate that intellectual disability was associated with male gender (61.3%), poor socio-economic status (78.8%), pre-natal, peri-natal and post-natal complications (74%), family history of intellectual disability (11.2%), mental illness (22.2%) and increased maternal age. High rates of comorbidity with psychiatric disorders (48.17%), especially with externalizing disorders were noticed. 

Conclusion: Intellectual disability is associated with psychosocial adversities and psychiatric comorbidities.


Open Access Original Research Article

The Lived Experiences of Persons with Mental Health Disorders in Public Sector Employment in the Niger Delta Region of Nigeria

Izibeloko O. Jack-Ide, Beauty P. Azebri, Dumni I. Igoni

International Neuropsychiatric Disease Journal, Page 316-327
DOI: 10.9734/INDJ/2014/10791

Aims: Relative to studies of lived experiences of people with mental health disorders in developed countries, no research has focused on the lived experiences of persons living with mental health disorders in the Niger Delta region and Nigeria in general. Mental health services are not provided at the primary health care level, and only one state hospital provides these services for Rivers State and the surrounding four states. The current understanding of the phenomenology of employment and wellbeing is almost entirely based on studies carried out in developed countries. This study sought to explore the lived experiences of persons with mental health disorders in a public sector employment, to better understand their lived experiences of being employed and to acquire knowledge in an effort to develop supportive programmes for individuals to achieve positive working outcomes.

Methodology: Six people working in the public sector who attended an outpatient clinic of the only regional mental health service were interviewed using a qualitative descriptive-phenomenological design.

Results: Participants reported that work boosts their self worth, information about the disorders and educational supports received from mental health professionals contribute to an improved health and enhance job performance and the value of spiritual support but identified a range of challenges.

Conclusion: Implications for policy are discussed.


Open Access Original Research Article

Personality and Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson’s Disease

Giovanni Abbate-Daga, Enrica Marzola, Federico Amianto, Maurizio Zibetti, Aristide Merola, Michele Lanotte, Leonardo Lopiano, Secondo Fassino

International Neuropsychiatric Disease Journal, Page 356-367
DOI: 10.9734/INDJ/2014/11740

Aims: Certain personality features and psychiatric symptoms are often observed in Parkinson’s Disease (PD) but the effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on psychiatric aspects of PD remain largely unclear. We aimed to evaluate changes in personality and psychiatric symptoms before and after STN-DBS in patients affected by PD. Moreover, motor symptoms and L-dopa equivalent daily dose (LEDD) were also investigated.

Methodology: Eighteen PD patients consecutively admitted at the San Giovanni Battista Hospital of the University of Turin to undergo STN-DBS were recruited. Participants were neurologically assessed using the Unified Parkinson’s Disease Rating Scale (UPDRS), and the Hoehn and Yahr scale. They were also psychiatrically evaluated with both      self-report and clinician-rated instruments: Temperament and Character Inventory    (TCI), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory – Y form (STAI-Y), Hamilton Depression Rating Scale (HAM-D), and Hamilton Anxiety Rating Scale (HAM-A).

Results: After STN-DBS, temperament dimensions of the TCI significantly changed whilst character did not. Moreover, both HAM-D and HAM-A improved but BDI and STAI-Y resulted unmodified. We found significant improvements as regards the UPDRS part II and part III scales and L-dopa equivalent daily dose.

Conclusions: The change we found on biological dimensions of temperament after STN-DBS raises the intriguing hypothesis that surgery may entail subtle modifications of personality in PD patients. Further studies are needed to confirm these findings.


Open Access Original Research Article

Psychological Predictors of Premenstrual Syndrome

Mahbobeh Faramarzi, Farzan Kheirkhah, Sanaz Azadfrouz

International Neuropsychiatric Disease Journal, Page 368-381
DOI: 10.9734/INDJ/2014/12638

Background: Premenstrual syndrome (PMS) is one the most common gynecological conditions that can impact an individual’s interpersonal relationships, social interactions, academic performance, and emotional well-being.

Objective: The aim of this research was to determine the psychological predictors of PMS.

Methods: A cross-sectional study was planned with medical students of Babol University of Medical Sciences. Participants were 350 female students (175 with PMS, 175 without PMS). Psychological risk factors were assessed in four domains: affect, social support, personality, alexithymia with four questionnaires; Depression, Anxiety, Stress (DAS-21); Social Support questionnaire (SSQ); NEO-Five Factor Inventory of Personality (NEO-FFI); and 20-item Toronto Alexithymia Scale (TAS-20). Also, demographic, habits, and gynecological factors were evaluated as non-psychological factors. Analysis of data was performed with χ2 test and multivariate logistic regressions analysis.

Results: The strongest predictor of PMS was alexithymia (OR 4.39; %95 CI 2.62-7.36). Risk of PMS was approximately 2.7 times higher in women with low social support (OR 2.67; %95 CI 1.59-4.48), 1.3 times higher in women with a neurotic character (OR 1.34; %95 CI 1.07-2.31), and 1.2- times higher in women with an increased level of anxiety symptoms (OR 1.17; %95 CI 1.06-2.13).

Conclusion: Psychological factors such as alexithymia character, neurotic personality, high anxiety, and low social support are helpful in differentiating women with PMS from those without PMS. This study proposes that psychological factors are the main predictors of PMS and should be considered for evaluation and treatment of the illness.


Open Access Review Article

Novel and Investigational Drugs in Depression

Desiree N. Shapiro, Stephen M. Stahl

International Neuropsychiatric Disease Journal, Page 328-347
DOI: 10.9734/INDJ/2014/11590

Major depressive disorder is a serious medical illness associated with significant burden. Our current treatments for depression are limited, which has motivated researchers to explore novel targets. This article will highlight new psychopharmacological agents and investigational directions which may show promise in achieving better outcomes and symptom relief for those suffering from depression. This review will address key categories of novel therapeutic targets for depression. The newer and investigational agents involving monoaminergic transmission will be discussed, followed by those with glutamatergic, opioid, anticholinergic, and miscellaneous mechanisms. As the field continues to learn more about the pathophysiology of depression, there will be an emergence of additional innovative targets and investigational mechanisms, along with an improvement in our treatment outcomes.