Open Access Case Study

Sylvian Fissure Lipoma Associated with Middle Cerebral Artery Aneurysm – Report of a Rare Case Highlighting Imaging Pitfalls

Nicola Schembri, Avinash Kumar Kanodia, Richard Stephen Nicholas, Kenneth Fowler, Gavin Main

International Neuropsychiatric Disease Journal, Page 16-23
DOI: 10.9734/INDJ/2013/4607

Aim: We describe a 60 year old lady who had a Sylvian fissure lipoma associated with an underlying middle cerebral artery saccular aneurysm which is a rare association and describe its imaging features.

Presentation of Case: Due to its rarity and MRI appearances simulating blood products, this case offered an initial diagnostic dilemma to the reporting radiologists, when an incidental lesion like lipoma adjoining an aneurysm was initially misinterpreted as blood products.

Discussion and Conclusion: This case highlights potential pitfalls in imaging interpretation even with a newer neuroimaging technique to accurately identify the nature of the lesion that can lead to misdiagnosis with the potential of inappropriate clinical management, at least in some cases.


Open Access Original Research Article

Preschoolers of Mothers with Affective and Anxiety Disorders Show Impairments in Cognitive Inhibition During a Chimeric Animal Stroop

Elizabeth A. Calvin, Sharon K. Hunter, Randal G. Ross

International Neuropsychiatric Disease Journal, Page 1-15
DOI: 10.9734/INDJ/2013/4193

Aims: To determine whether maternal affective and anxiety disorders are associated with cognitive inhibitory deficits in four-year-old children utilizing a chimeric animal stroop task, a childhood adaptation of the traditional stroop task. 

Study Design: Blinded Cross-Sectional Study.

Place and Duration of Study: Department of Psychiatry, University of Colorado School of Medicine, data collected from June 2009 to October 2010.

Methodology: Four-year-olds of mothers with (n=29) and without (n=31) a history of affective or anxiety disorders completed a chimeric animal version of the stroop task.  Incongruent, neutral, and congruent stimuli were presented over three trial blocks.  Mean reaction time and response accuracy were the primary dependent measures.

Results: The increase in the number of incorrect responses to incongruent versus congruent or neutral stimuli was larger for offspring of a mother with a history of an affective or anxiety disorder than without (t=2.4, P=.02); there was no significant main effect of maternal psychiatric illness (F(1, 58)=0.9, P=.34) or a stimulus type by maternal illness (F(1 , 58)=1.1, P=.30) interaction on reaction time. 

Conclusion: The association between maternal affective and anxiety disorders and cognitive inhibitory deficit is already identifiable by four years of age.


Open Access Original Research Article

Theory of Mind Development is Impaired in 4-Year-Old Children with Prenatal Exposure to Maternal Tobacco Smoking

Rosemary E. Reidy, Randal G. Ross, Sharon K. Hunter

International Neuropsychiatric Disease Journal, Page 24-34
DOI: 10.9734/INDJ/2013/3916

Aims: Theory of Mind (ToM) is an important component of social cognition. Deficits in ToM are found in various neurodevelopmental disorders and social and environmental factors have been found to influence ToM development. Little previous research has focused on effects of exposure to toxins; this report examines the impact of tobacco.

Place of Study: Department of Psychiatry, University of Colorado School of Medicine, between April 2006 – August 2012.

Methodology: 101 children, 18 with prenatal exposure to tobacco, underwent ToM testing at 40 (n=89) and 48 (n=77) months of age.  Test questions received dichotomous pass/fail scores and percentage of correct responses was utilized as the primary dependent variable.

Results: At 40 months of age children were rarely able to correctly answer false belief questions and there were no significant differences according to prenatal tobacco exposure. At 48 months of age,  there was a significant effect of prenatal tobacco exposure with non-exposed 48-month-olds correctly answering 45±40.6% of content false belief questions correctly, compared to 13.9±25.3% for 48-month-olds with prenatal tobacco exposure (F=4.79, df= 1,73, p=.032).

Conclusion: ToM abilities are rapidly developing between 40 and 48 months of age. Prenatal exposure to tobacco is associated with impairment at 48 but not 40 months of age. This finding supports consideration of nicotinic mechanisms as contributors to early development of social cognition.


Open Access Original Research Article

Effect of Different Antipsychotics on Cytokine Production After Immunologically Stimulated PBMC Culture

Md. Mamun Al-Amin

International Neuropsychiatric Disease Journal, Page 35-45
DOI: 10.9734/INDJ/2013/4752

Aims: To investigate the effect of different antipsychotics on cytokine production in immunologically challenged Peripheral Blood Mononuclear Cell (PBMC) culture.

Study Design: In vitro cell culture study to determine cytokine (IL-4, IL-10 and IFN-γ) level.

Place and Duration of Study: Department of Pharmacy, North South University, Dhaka between January 2013 and April 2013.

Methodology: Blood sample was collected from 22 healthy volunteers. Peripheral Blood Mononuclear Cells were separated and culture was prepared. The culture was stimulated with either LPS (lipopolysaccharide) or poly(I:C) (polyinosinic:polycytidylic acid). Stimulated PBMC culture was treated with typical antipsychotic (Haloperidol) and atypical antipsychotics (Clozapine, Quetiapine, Risperidone). Pro-inflammatory (IFN-γ) and anti-inflammatory (IL-4, IL-10) cytokine levels were determined from the stimulated PBMC culture and stimulated plus antipsychotic treated PBMC culture.

Results: Typical antipsychotic; Haloperidol and atypical antipsychotics; Clozapine, Quetiapine, Risperidone significantly (P = .05) enhance IL-10 production but not IL-4 in the LPS and poly(I:C) stimulated PBMC culture. IL-10 production was robust in LPS stimulated PBMC culture than the poly(I:C) stimulated culture. Typical and atypical both antipsychotics significantly (P = .05) reduce increased IFN-γ level in the LPS and poly(I:C) stimulated PBMC culture.

Conclusion: Typical and atypical antipsychotics were successfully alters immune function by the suppression of pro-inflammatory cytokine (IFN-γ) levels and elevation of anti-inflammatory cytokine (IL-10).


Open Access Original Research Article

Suicide and Other Causes of Death in the Psychiatric Patients of a Mental Health Service over a 5-year Period

Rosaria Di Lorenzo, Fiorenza Fiorini, Elena Simoni, Stefano Mimmi, Marco Rigatelli

International Neuropsychiatric Disease Journal, Page 46-63
DOI: 10.9734/INDJ/2013/4825

Aims: 1) To compare mortality rate and causes of death between psychiatric patients of a Mental Health Department (MHD) and local population of Modena.

2) To appraise the impact of selected demographic and clinical variables on suicide.

Study Design: Retrospective analysis.

Place and Duration of Study: MHD of Modena between March 2009 and September 2009.

Methodology: Our psychiatric sample was composed by all psychiatric patients followed by the MHD of Modena, who died from 1-1-2004 to 31-12-2008 (n=168). We compared the standardized mortality rate and causes of death of our sample to those of the local population (n=250,000), who died during the same period of time, according to data provided by the registry of the Clinical Epidemiology Service of Modena. From computerized registration system and medical records of MHD and death certificates, we collected: demographic data, psychiatric diagnosis, death causes, time elapsed from the first consultation in MHD to death, time elapsed from the last discharge from psychiatric ward or from the last consultation in MHD to death. Our sample of psychiatric patients was further divided into two groups: the first one was composed of those who committed suicide (n=25) and the second one   those that died from other causes (n=143), and all variables of each group were statistically compared to highlight the demographic and clinical features of the two groups.

Results: Neoplastic and cardiovascular diseases were the two most frequent causes of death in both psychiatric and local populations and suicide represented the third leading cause of death in the psychiatric sample.  Psychiatric patients who committed suicide were statistically significantly younger in comparison to others and killed themselves after 12 days (median) from the last psychiatric consultation or hospital discharge.

Conclusion: Our patients presented the same high vulnerability to organic disorders and their fatal consequences as local population with higher risk of suicide which remains a fatal outcome of psychiatric diseases.


Open Access Original Research Article

Immunohistochemical Investigation of p53, Bax and NSE; the Link between Energy Metabolism and Cell Cycle Dysregulation in Degenerating Cells of the Cerebellar Cortex

O. M. Ogundele, J. Madukwe, V. I. Anosike, I. D. Akinrinade, O. J. Olajide

International Neuropsychiatric Disease Journal, Page 64-76
DOI: 10.9734/INDJ/2013/4537

Background: The cerebellum, also called the little brain is an organ concerned with regulation of movement and other associated motor functions. It is believed to be phylogenetically one of the oldest parts of the brain. It accounts for one tenth of the brain volume and contains approximately 50% of the total brain neuron. Damage to the cerebellum is major factor involved in the progression of movement disorders.

Aim: To investigate possibility of selective neuronal vulnerability in neurotoxicity and the etiology of neurodegenerative diseases especially those involving movement disorders originating from the cerebellum.

Method: F1 Generation adult Wistar rats were treated with 20 and 10 mg/Kg BW of potassium cyanide (KCN), the cerebellar cortex was harvested and processed for immunohistochemistry of cell cycle markers (anti-p53 and anti-Bax) and the neuronal glycolytic pathway marker; Neuron Specific Enolase (anti-NSE). Antigen retrieval method was used specifically as peroxidase anti peroxidase reaction (PAP). The reaction was developed using a polymer 3’3’Diaminobenzidine tetrachloride (DAB), intensified in Methenamine Silver and counterstained in Hematoxylin.

Results: Cyanide toxicity induced apoptosis in the cerebellum via a pathway involving Bax in mitochondria dysregulation (mitochondria apoptotic signaling) and a cytoplasmic pathway involving p53 (a nucleolase). The NSE expression level also indicates associated metabolic dysregulation with alteration in expression of cell cycle proteins.

Conclusion: Cyanide toxicity induced cell death in the cerebellar cortex by metabolic alteration (NSE) and ROS formation. The expression of Bax and p53 showed that apoptosis was triggered via a mitochondria/Bax dependent, p53 related apoptotic pathway.


Open Access Original Research Article

Ambient Sulphur Dioxide and Emergency Department Visits for Migraine and Depression

Mieczyslaw Szyszkowicz, Ian Colman, Maeve Wickham, Brian H. Rowe

International Neuropsychiatric Disease Journal, Page 77-88
DOI: 10.9734/INDJ/2013/5245

Aims: Depression and migraine are linked especially among women. Little previous research has focused on the potential association between ambient sulphur dioxide (SO2) exposure and emergency department (ED) visits for migraine, headache, depression, and anxiety.

Study Design: Case-crossover design, in which case and control is the same person, was used as study design for daily recorded diagnosed ED visits. Ambient sulphur dioxide was considered as an exposure.

Place and Duration of Study: ED data from five hospitals in Edmonton, Canada. The data were considered for the period: April 1, 1992 – March 31, 2002 (10 years).

Methodology: ED visits from Edmonton for the four health conditions were analyzed separately using case-crossover methodology. A conditional logistic regression was applied to implement a time-stratified case-crossover technique. The models were constructed for a single (one) air pollutant. Weather factors (temperature and humidity) were adjusted using natural splines. Odds ratios (ORs) and their 95% confidence intervals (CI) were estimated for an increase in an interquartile range of SO2 (IQR = 2.3 ppb).

Results: For females, statistically significant positive associations were observed between SO2 exposure and ED visits for migraine and depression (OR = 1.02, 95% CI: 1.01-1.03; OR = 1.04, 95% CI: 1.01-1.07, respectively). A positive association was observed for female ED visits for headache and anxiety. For males, ED visits for migraine were associated with ambient sulphur dioxide exposure (OR = 1.04, 95% CI: 1.00-1.08, for patients of age 20 to 60 years).

Conclusion: A known link between migraine and depression has its mapping in responses to ambient air pollution. These results provide additional evidence to indicate that ED visits for depressive disorder and migraine may be associated with exposure to ambient sulphur dioxide.


Open Access Original Research Article

Prenatal Exposure to Maternal Anxiety is Associated with Less Developed Smooth Pursuit Eye Movements in Six-Month-Old Infants: An Initial Study

Laurel Pellegrino, Randal G. Ross, Sharon K. Hunter

International Neuropsychiatric Disease Journal, Page 89-103
DOI: 10.9734/INDJ/2013/5174

Aims: There are an increasing number of reports suggesting an association between maternal anxiety experienced during pregnancy and adverse outcomes of the offspring. However, exploration of the biological changes in the brain that mediate that relationship has been hampered by the lack of appropriate biomarkers. This report represents an initial step exploring whether a potential infant biomarker, smooth pursuit eye movements, may be associated with prenatal exposure to maternal anxiety.

Study Design: Blinded cross-sectional study.

Place and Duration of Study: Department of Psychiatry, University of Colorado School of Medicine. Data collected from July 2011 to May 2012.

Methodology: Forty-three infants including 34 whose prenatal maternal anxiety status were identified (12 with a known maternal prenatal anxiety diagnosis and 22 without) had eye movements recorded during a smooth pursuit eye movement task at four and/or six months of age.

Results: At 6 months of age, infants with prenatal exposure to maternal anxiety, compared to infants without such exposure, spent a higher percentage of time utilizing smooth pursuit (t=2.7, df=24, P=.013), had longer duration of smooth pursuit uninterrupted by saccades (t=2.5, df=24, P=.019), and had decreased frequency of forward saccades (t=3.8, df=24, P=.001). No differences between groups were identified at 4 months of age.

Conclusion: Smooth pursuit abnormalities may, at six months of age, be a potential biomarker for prenatal maternal anxiety exposure.


Open Access Original Research Article

Mental Health Issues in Multiple Sclerosis Patients and Healthy Controls and Their Association with Disease Related Factors

A. Poulios, A. L. Christopoulos, D. K. Kitsos, K. I. Voumvourakis

International Neuropsychiatric Disease Journal, Page 104-112
DOI: 10.9734/INDJ/2013/4936

Purpose: To investigate the mental health problems of multiple sclerosis (MS) patients, and the relationship between mental health, MS variables and disability status.

Methods: The sample consisted of 80 participants, 40 MS patients and 40 Healthy Controls matched for gender, age and socioeconomic status. There were 30 (75%) women and 10 (25%) men, 27 (67.5%) Relapsing Remitting Multiple Sclerosis (RRMS) patients, 8 (20%), Secondary Progressive (SP) patients and 5 (12.5%) Primary Progressive (PP) patients in the MS group, 26 (65%) of those were on systemic treatment. The General Health Questionnaire-28 (GHQ-28) was used to screen for mental health issues. Disability status was assessed with the Expanded Disability Status Scale (EDSS).

Mean comparisons were performed using Student’s t test while effect sizes were estimated by Cohen’s d coefficient. Percentage ratio differences were tested using chi-square tests, corrected by Fischer’s exact test for 1 df. Correlations were investigated using Pearson’s r coefficient.

Results: MS patients exhibited significantly more mental health problems than the healthy controls. The effect size of the presence of positive MS diagnosis ranged from large to very large with respect to overall psychological distress as well as with respect to the following different dimensions of psychological distress: somatic symptoms, anxiety - insomnia, social dysfunction and severe depression. There were significantly more MS patients who could be diagnosed with mental health disorders (non psychotic disorders of axis I, DSM-IV-TR). Finally, no aspects of mental health impairment were significantly correlated with disease variables or disability status.

Conclusions: Mental health problems in MS patients are evident and frequent. As they are independent of illness duration, medication or disability, special care should be taken in treating mental health problems in MS patients.