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Barrera A. Formal Thought Disorder in Schizophrenia: A Problematic History. Schizophr Bull 2025:sbae214. [PMID: 39820377 DOI: 10.1093/schbul/sbae214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2025]
Abstract
BACKGROUND AND HYPOTHESIS Formal thought disorder (FTD), studied even before the inception of the concept of schizophrenia, remains a deeply isolating experience for patients as well as a difficult one for their interlocutors, including clinicians. STUDY DESIGN The views on language, paralinguistic, and extralinguistic features exhibited by patients with severe mental ill health are reviewed, including the contributions from 19th-century European authors to the last third of the 20th century. STUDY RESULTS Stages in the construction of FTD are described, including its merging with Dementia Praecox, and its subsequently being shaped by notions such as primitive archaic thinking, paralogical or autistic thinking, concretism, overinclusive thinking, and the return of the efforts to describing it with increased reliability. CONCLUSIONS It appears that some features of communication in schizophrenia, but not others, have been selected at different points in time for clinical and research use without realizing that by carrying out that selection, the phenomenon under study itself is changed. Remarkably, some theories of FTD remained in use, despite being empirically disproved (eg, word association disorder, concrete thinking, paralogical thinking) or despite its highly problematic and discriminatory nature. We would suggest that studies of FTD should explicitly consider which and why some of its features are included or excluded when assessing it. Furthermore, we would suggest that the study of FTD should incorporate the complexity of human communication, including the pragmatic, paralinguistic, non-verbal, and cognitive dimensions of the localized and unique situation where it takes place.
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Affiliation(s)
- Alvaro Barrera
- Department of Psychiatry, University of Oxford, and Oxford Health NHS Foundation Trust, Warneford Hospital, Warneford Lane, Oxford, OX37JX, United Kingdom
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Kao SK, Chan CT. Increased risk of depression and associated symptoms in poststroke aphasia. Sci Rep 2024; 14:21352. [PMID: 39266657 PMCID: PMC11393353 DOI: 10.1038/s41598-024-72742-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Accepted: 09/10/2024] [Indexed: 09/14/2024] Open
Abstract
Poststroke aphasia hinders patients' emotional processing and social adaptation. This study estimated the risks of depression and related symptoms in patients developing or not developing aphasia after various types of stroke. Using data from the US Collaborative Network within the TriNetX Diamond Network, we conducted a retrospective cohort study of adults experiencing their first stroke between 2013 and 2022. Diagnoses were confirmed using corresponding International Classification of Diseases, Tenth Revision, Clinical Modification codes. Patients were stratified by poststroke aphasia status and stroke type, with propensity score matching performed to control for confounders. The primary outcome was depression within one year post-stroke; secondary outcomes included anxiety, fatigue, agitation, emotional impact, and insomnia. Each matched group comprised 12,333 patients. The risk of depression was significantly higher in patients with poststroke aphasia (hazard ratio: 1.728; 95% CI 1.464-2.038; p < 0.001), especially those with post-hemorrhagic-stroke aphasia (hazard ratio: 2.321; 95% CI 1.814-2.970; p < 0.001). Patients with poststroke aphasia also had higher risks of fatigue, agitation, and emotional impact. Anxiety and insomnia risks were higher in those with post-hemorrhagic-stroke aphasia. Poststroke aphasia, particularly post-hemorrhagic-stroke aphasia, may increase the risks of depression and associated symptoms, indicating the need for comprehensive psychiatric assessments.
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Affiliation(s)
- Shih-Kai Kao
- Department of General Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chia-Ta Chan
- Department of Psychiatry, Shin Kong Wu Ho-Su Memorial Hospital, No. 95, Wenchang Rd., Shilin Dist., Taipei, 111, Taiwan.
- School of Medicine, College of Medicine, Fu Jen University, Taipei, Taiwan.
- Institute of Brain Science and Brain Research Center, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan.
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Edelkraut L, López-Barroso D, Torres-Prioris MJ, Starkstein SE, Jorge RE, Aloisi J, Berthier ML, Dávila G. Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia. World J Psychiatry 2022; 12:450-469. [PMID: 35433325 PMCID: PMC8968505 DOI: 10.5498/wjp.v12.i3.450] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/13/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) have been insufficiently examined in persons with aphasia (PWA) because most previous studies exclude participants with language and communication disorders.
AIM To report a two-part study consisting of a literature review and an observational study on NPS in post-stroke aphasia.
METHODS Study 1 reviewed articles obtained from PubMed, PsycINFO, Google Scholar and Cochrane databases after cross-referencing key words of post-stroke aphasia to NPS and disorders. Study 2 examined language deficits and activities of daily living in 20 PWA (median age: 58, range: 28-65 years; 13 men) with the Western Aphasia Battery-Revised and the Barthel Index, respectively. Informants of these 20 PWA were proxy-evaluated with the Neuropsychiatric Inventory and domain-specific scales, including the Stroke Aphasia Depression Questionnaire-10 item version and the Starkstein Apathy Scale. In addition, an adapted version of the Hospital Anxiety and Depression Scale was directly administered to the PWA themselves. This observational study is based on the baseline assessment of an intervention clinical trial (EudraCT: 2017-002858-36; ClinicalTrials.gov identifier: NCT04134416).
RESULTS The literature review revealed a broad spectrum of NPS in PWA, including depression, anxiety, apathy, agitation/aggression, eating and sleep disorders, psychosis, and hypomania/mania. These findings alert to the need for improving assessment and treatment approaches of NPS taking into consideration their frequent occurrence in PWA. Study 2 showed that the 20 participants had mild- to-moderate aphasia severity and were functionally independent. A wide range of comorbid NPS was found in the post-stroke aphasic population (median number of NPS: 5, range: 1-8). The majority of PWA (75%) had depressive symptoms, followed by agitation/aggression (70%), irritability (70%), anxiety (65%) and appetite/eating symptoms (65%). Half of them also presented symptoms of apathy, whereas euphoria and psychotic symptoms were rare (5%). Domain-specific scales revealed that 45% of participants had apathy and 30% were diagnosed with depression and anxiety.
CONCLUSION Concurrent NPS are frequent in the chronic period of post-stroke aphasia. Therefore, further research on reliable and valid assessment tools and treatment for this aphasic population is strongly warranted.
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Affiliation(s)
- Lisa Edelkraut
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Diana López-Barroso
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - María José Torres-Prioris
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Sergio E Starkstein
- School of Psychiatry and Neurosciences, The University of Western Australia, Perth 6009, Australia
| | - Ricardo E Jorge
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, United States
| | - Jessica Aloisi
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Guadalupe Dávila
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
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Lane ZP, Singer A, Roffwarg DE, Messias E. Differentiating psychosis versus fluent aphasia. ACTA ACUST UNITED AC 2011; 4:258-61. [PMID: 21177243 DOI: 10.3371/csrp.4.4.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Following a stroke, a patient may present with varying degrees of neurological impairment, depending on the area of the brain which is damaged. Specifically, damage to the left cortical hemisphere may result in aphasia. The characteristic speech in a patient with an aphasia caused by a stroke can be similar to the speech in some patients with schizophrenia or other psychotic disorders. In a new patient without a reliable history who presents with suspected aphasia, it is important to include psychotic disorders as part of the differential diagnosis. Failure to differentiate psychotic disorders from aphasia could result in either a lack of treatment that would improve the patient's thought process, thought content, or language, or in a delayed treatment for a stroke, respectively. While a number of psychotic disorders exist and must be differentiated from one another in accordance with DSM-IV guidelines, speech abnormalities in patients with schizophrenia are well described in the literature. For this reason, schizophrenia is the psychotic disorder of focus in this paper. This case report illustrates a clinical situation where a patient required both a psychiatric and neurological consultation in order to determine the etiology of his language disorder. The purpose of this paper is to emphasize the need to consider both psychiatric disorders and aphasia in patients with unknown histories who present with language abnormalities, and to help the clinician critically examine the patient's speech so that, in conjunction with other clinical data, the correct diagnosis can be made and appropriate treatment initiated.
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Affiliation(s)
- Zac Paul Lane
- Department of Psychiatry, Medical College of Georgia, Augusta, Georgia 30909, USA.
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Harciarek M, Heilman KM. The contribution of anterior and posterior regions of the right hemisphere to the recognition of emotional faces. J Clin Exp Neuropsychol 2009; 31:322-30. [DOI: 10.1080/13803390802119930] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Michal Harciarek
- a Institute of Psychology, University of Gdansk , Gdansk, Poland
| | - Kenneth M. Heilman
- b Department of Neurology , University of Florida College of Medicine and Veterans Affairs Medical Center , Gainesville, FL, USA
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Carota A, Bogousslavsky J. Stroke-related psychiatric disorders. HANDBOOK OF CLINICAL NEUROLOGY 2009; 93:623-651. [PMID: 18804672 DOI: 10.1016/s0072-9752(08)93031-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Antonio Carota
- Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland.
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8
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Kunert HJ, Norra C, Hoff P. Theories of delusional disorders. An update and review. Psychopathology 2007; 40:191-202. [PMID: 17337940 DOI: 10.1159/000100367] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2004] [Accepted: 02/23/2006] [Indexed: 11/19/2022]
Abstract
Delusional syndromes can occur in a number of psychiatric, neurological or other disorders. They can also be caused by neurotoxic agents (e.g., heavy metals) as well as substance addiction. There are several hypotheses on the underlying cognitive or emotional processes associated with organic factors of delusional disorders, depending on the patient groups examined and the methods used. The aim of this paper is to provide a comprehensive review and critical assessment of the various, rather heterogeneous theories in this field.
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Lee HB, Onyike CU. The cerebrovascular disease basis of psychiatric syndromes: a model for the power of disease reasoning in psychiatry. Int Rev Psychiatry 2006; 18:391-3. [PMID: 17085358 DOI: 10.1080/09540260600935371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Hochang B Lee
- Division of Geriatric Psychiatry and Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21205, USA.
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10
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Brumfitt S, Barton J. Evaluating wellbeing in people with aphasia using speech therapy and clinical psychology. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2006. [DOI: 10.12968/ijtr.2006.13.7.21406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shelagh Brumfitt
- Department of Human Communication Sciences, University of Sheffield, Sheffield S10 3QP, UK
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11
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Sockalingam S, Parekh N, Bogoch II, Sun J, Mahtani R, Beach C, Bollegalla N, Turzanski S, Seto E, Kim J, Dulay P, Scarrow S, Bhalerao S. Delirium in the postoperative cardiac patient: a review. J Card Surg 2006; 20:560-7. [PMID: 16309412 DOI: 10.1111/j.1540-8191.2005.00134.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED BACKGROUND AND AIM OF REVIEW: Cardiac surgery is increasingly common and relatively safe, but there are frequent reports of neuropsychiatric sequelae occurring in the postoperative period. One of the most common neuropsychiatric presentations of cardiac surgery is delirium, also called postcardiotomy delirium (PCD). Despite the vast numbers of cardiac surgeries performed today, there is a paucity of data on risk factors and management options of PCD available to the clinician. This review aims to summarize available information, increase clinicians' awareness of PCD and suggest effective management of this illness. METHODS Our literature search was completed using the databases Medline and CINAHL; it was limited to human and English language studies from 1964 to the present. Search terms included "delirium," "agitation," "postoperative," "cardiac," "neuropsychiatric," "neuroleptics," "psychosis," "surgery," "treatment," "postcardiotomy," and "pharmacotherapy." RESULTS Our review of the literature revealed several risk factors for PCD, as well as various options for its pharmacological management. CONCLUSIONS A multifactorial model should be applied when considering risk stratification for and prevention of delirium postoperatively. Pharmacologically, conventional antipsychotic agents, such as haloperidol, have long been used to manage delirium. In light of haloperidol's side effects, particularly those applicable to the cardiac patient, further research is required into the role of second generation antipsychotics. These agents are common in clinical use, and may be the preferred medications.
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Abstract
Cerebrovascular diseases constitute a leading health hazard. The association between stroke and depression has been recognized for many years. Depression is the most common psychiatric disorder associated with cerebrovascular diseases, most episodes of post-stroke depression occur in the first 2 years after a cerebrovascular accident. Studies have found an association between lesion location, physical impairment, cognitive impairment, aphasia, and post-stroke depression. The location of the lesion in terms of proximity to the left frontal pole of the brain has a profound impact on the frequency and severity of post-stroke depression. Treatment modalities include pharmacotherapy, psychotherapy, electroconvulsive therapy, and rehabilitation. Understanding the psychologic and physical morbidity of post-stroke depression, as well as its timely, comprehensive treatment, are important for effective management.
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Affiliation(s)
- Himani Ghoge
- Neuropsychiatry Clinic, Jaslok Hospital and Research Centre, 15 Dr B G Deshmukh Marg, Bombay 400 026, India.
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13
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Code C, Herrmann M. The relevance of emotional and psychosocial factors in aphasia to rehabilitation. Neuropsychol Rehabil 2003; 13:109-32. [DOI: 10.1080/09602010244000291] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Payne HC. Traumatic brain injury, depression and cannabis use--assessing their effects on a cognitive performance. Brain Inj 2000; 14:479-89. [PMID: 10834343 DOI: 10.1080/026990500120583] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Patient RB is presented as a demonstration of the need for a more thorough understanding of the interactions of patient variables. RB had a history of traumatic brain injury along with current mood disorder and cannabis use. It was unclear initially whether or not his cognitive impairment was a permanent result of the brain injury, or a temporary effect of his mood and/or drug use. The literature offers few guidelines or precedents for understanding such complex cases or suggesting at which level it may be most appropriate to intervene. The impact of cannabis use in this individual appeared to have a detrimental effect on his mood. Treating RB's mood disorder resulted in larger cognitive gains than would have been anticipated in the literature. Specific neuropsychological tests are identified as being particularly sensitive to the cognitive changes in mood disorders.
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Affiliation(s)
- H C Payne
- University Department of Geriatric Medicine, Academic Centre, Clandough Hospital, Penarth, Wales, UK
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15
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Staff RT, Shanks MF, Macintosh L, Pestell SJ, Gemmell HG, Venneri A. Delusions in Alzheimer's disease: spet evidence of right hemispheric dysfunction. Cortex 1999; 35:549-60. [PMID: 10574080 DOI: 10.1016/s0010-9452(08)70818-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Delusional thinking and related behaviours are common symptoms in Alzheimer's disease (AD). The aim of the study was to determine if any consistent cerebral image pattern can be identified using Tc99m-hexamethylpropyleneamine (HMPAO) SPET in AD patients with and without delusions. 18 AD patients with delusion and 15 AD patients without delusion underwent neuropsychological testing and regional cerebral blood flow imaging using Tc99m-HMPAO SPET. The reconstructed data was compared using regions of interest drawn over each cerebral lobe and a statistical parametric mapping (SPM) approach. The neuropsychological testing showed that there was no difference in the profiles of the deluded and non deluded AD patients. The imaging results showed a significant degree of image asymmetry. This took the form of a right hemisphere hypoperfusion mainly in the right frontal and limbic regions. The results do not indicate a specific focal site of hypoperfusion in the patients with delusion. They do, however, indicate that delusions in AD may be associated with areas of hypoperfusion in the right anterior hemisphere.
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Affiliation(s)
- R T Staff
- Department of Bio-Medical Physics and Bio-Engineering, University of Aberdeen, and Aberdeen Royal Hospitals NHS Trust, UK
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Berrios GE. Falret, Séglas, Morselli, and Masselon, and the "language of the insane": a conceptual history. BRAIN AND LANGUAGE 1999; 69:56-75. [PMID: 10452814 DOI: 10.1006/brln.1999.2042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- G E Berrios
- University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, United Kingdom.
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Michallet B, Le Dorze G, Tetreault S. Aphasie sévère et situations de handicap: implications en réadaptation. ACTA ACUST UNITED AC 1999. [DOI: 10.1016/s0168-6054(99)80064-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Lior R, Nachson I. Impairments in judgment of chimeric faces by schizophrenic and affective patients. Int J Neurosci 1999; 97:185-209. [PMID: 10372647 DOI: 10.3109/00207459909000660] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The hypothesis that schizophrenic and affective patients have differential impairments in judgment of facial emotional expressions was tested on 55 right-handed patients: 15 in each of two groups of schizophrenic patients, with positive and negative symptoms; and 10 in each of two groups of bipolar affective patients, in manic and depressive states. In addition, 37 normal control subjects were also tested. The subjects were presented with eight schematic drawings of chimeric faces (each depicting a positive emotion in a given hemiface, and a negative emotion in the other hemiface), as well as with two drawings of composite faces (each depicting either a positive or a negative emotion). Subjects judged the emotions depicted by the facial expressions, as well as their intensity. The data, analyzed by analyses of variance, showed that normals judged the chimeric expressions on the basis of the emotions depicted by the left hemifaces. This tendency was weaker among the psychiatric patients. Schizophrenics with negative symptoms judged positive expressions in the left hemifaces as depicting negative emotions, and negative expressions as depicting positive emotions. Schizophrenics with positive symptoms and manic patients judged all expressions as depicting positive emotions. Depressive patients showed a stronger tendency to judge negative expressions as depicting negative emotions than positive expressions as depicting positive emotions. No significant group differences appeared in judgment of composite faces (except for schizophrenic with negative symptoms who were more accurate in judging positive than negative expressions). Patients performances were interpreted in terms of differential dysfunctions in posterior areas of the right cerebral hemisphere which might be associated with bilateral effects of dysfunctions in anterior cerebral areas.
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Affiliation(s)
- R Lior
- Department of Criminology, Bar-Ilan University, Ramat-Gan, Israel
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Devinsky O, Perrine K, Pacia S, Vazquez B, Buchwald J, Luciano DJ. Multiple subpial transections in language cortex: Effects on language functions. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s0896-6974(97)00081-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
This article discusses the use of psychostimulants, such as dextroamphetamine, methylphenidate, and pemoline, in a variety of illnesses, including depression in the medically ill, cancer, HIV, and AIDS. The chemistry and pharmacology, side effects, drug interactions, dosing, and abuse potential also are reviewed.
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Affiliation(s)
- P S Masand
- Psychiatry Consultation Service, SUNY Health Science Center, State University of New York, Syracuse, USA
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Hütter BO, Gilsbach JM. Introspective capacities in patients with cognitive deficits after subarachnoid hemorrhage. J Clin Exp Neuropsychol 1995; 17:499-517. [PMID: 7593471 DOI: 10.1080/01688639508405141] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Examined 58 patients after subarachnoid hemorrhage by means of neuropsychological tests, a self-report questionnaire, proxy ratings, and personality forms. The degree of cognitive impairment showed only a slight association with an impairment self-rating scale (r = .32, p > .01). On the other hand, the proxy impairment ratings correlated well with the degree of cognitive disturbance (r = .68, p < .001). Self-rated impairment correlated substantially with depression (r = .63, p < .001). A 2 x 2 analysis of variance showed a significant two-way interaction (p = .014) between depression and cognitive disturbance explaining the subjective impairment rating. Depressive patients tended to maximize their actual degree of impairment. Patients with right parietal and/or frontal infarcts showed significantly less depression and illness concern than did patients with infarcts at other locations, although both groups had a comparable degree of cognitive and self-rated impairment.
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Affiliation(s)
- B O Hütter
- Department of Neurosurgery, Technical University (RWTH) Aachen, Germany
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Binetti G, Padovani A, Magni E, Bianchetti A, Scuratti A, Lenzi GL, Trabucchi M. Delusions and dementia: clinical and CT correlates. Acta Neurol Scand 1995; 91:271-5. [PMID: 7625153 DOI: 10.1111/j.1600-0404.1995.tb07003.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Delusions occur frequently during the course of Alzheimer's disease (AD) and multi-infarct dementia (MID). Their clinical significance and their relationship with progression of disease and involvement of selected cerebral areas are still unclear. The aim of the study was to determine the clinical and CT correlates of delusions in patients with dementia. MATERIAL AND METHODS A series of 67 probable AD and 32 MID patients, underwent computed tomographic scans, psychometric tests, neurologic and psychiatric examination, and blood and serum tests. RESULTS Twenty-four patients were found to have delusions during the clinical evaluation. Delusional patients showed a significantly higher age when compared with non-delusional patients. The results of a multiple logistic regression (with stepwise deletion of the redundant variables) of the CT lesions on the presence of delusions, showed that only the presence of isolated white matter lesions in the frontal lobes were significantly related to the occurrence of delusions (Exp B = 3.42; Beta = 1.2; S.E. = 0.6; Sig T = 0.04). Frontal white matter changes were significantly related to delusions when a multiple regression analysis, entering age and total number of lesions at CT scans, was carried out. CONCLUSIONS We found that focal lesions in the frontal areas were the only variable that appeared to be significantly and independently associated with delusional disorders.
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Affiliation(s)
- G Binetti
- Alzheimer's Disease Unit, S. Cuore Fatebenefratelli Hospital, Brescia, Italy
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Abstract
BACKGROUND Communication problems are a common sequela of cerebrovascular disease and other central nervous system disorders. Behavioral treatment of these disorders aims to harness uninjured parts of the brain to improve the communicative life of the individual. While pharmacotherapy has held promise for the treatment of aphasia for over 50 years, it has not fulfilled this promise. This article reviews both the promise and the disappointment of aphasia pharmacotherapy. SUMMARY OF REVIEW Diverse theories of the underlying neurological deficits in aphasia have led to different pharmacologic rationales for therapy. Animal studies have demonstrated decreased levels of brain catecholamines after cortical stroke and more rapid stroke recovery with therapy aimed at augmenting brain norepinephrine and dopamine. These studies have led to recent attempts to hasten or extend language and sensorimotor rehabilitation after human stroke by administration of catecholaminergic drugs. When used as an adjunct to behavioral therapy, such pharmacotherapy appears to have benefit. CONCLUSIONS While drug therapy is unlikely to revolutionize the treatment of aphasia, it nonetheless holds promise as an adjunct to behavioral speech and language therapy to decrease performance variability and consequently to improve mean performance in patients with mild to moderate language dysfunction. Additional studies with carefully designed methods are necessary to assess the full potential of aphasia pharmacotherapy.
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Affiliation(s)
- S L Small
- Department of Neurology, University of Pittsburgh, PA 15261-2003
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Grasso MG, Pantano P, Ricci M, Intiso DF, Pace A, Padovani A, Orzi F, Pozzilli C, Lenzi GL. Mesial temporal cortex hypoperfusion is associated with depression in subcortical stroke. Stroke 1994; 25:980-5. [PMID: 8165694 DOI: 10.1161/01.str.25.5.980] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE This study was conducted to evaluate local cerebral blood flow changes in patients with depression after a subcortical stroke. METHODS Clinical and neuropsychological assessments were performed in 15 patients with a single subcortical lesion. Depression was assessed by DSM-III-R. In addition, the Hamilton Rating Scale for depression, the Zung Self-Rating Depression Scale, and the Beck scale were administered to each patient. Single-photon emission-computed tomography study was performed with 99mTc hexamethylpropyleneamine oxime. RESULTS In all patients cortical regions ipsilateral to subcortical lesions were significantly less perfused than the contralateral cortex. Cerebral blood flow values were significantly lower in depressed patients (n = 8) than in nondepressed patients (n = 7) only in the mesial temporal cortex of the affected hemisphere. Cerebral blood flow values in the mesial temporal cortex of the affected hemisphere significantly correlated with the severity of depression. CONCLUSIONS Temporal lobe hypoperfusion may reflect a dysfunction of the limbic system, suggesting that this location may be critical for the occurrence of depressive symptoms in patients with subcortical stroke.
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Affiliation(s)
- M G Grasso
- IRCCS S. Lucia Rehabilitation Center of Rome, Italy
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25
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Rieber RW, Vetter H. The problem of language and thought in schizophrenia: a review. JOURNAL OF PSYCHOLINGUISTIC RESEARCH 1994; 23:149-195. [PMID: 8046671 DOI: 10.1007/bf02143921] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- R W Rieber
- John Jay College, City University of New York (CUNY) Graduate Center 10019
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26
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Abstract
The present state of research concerning depressive alterations following cerebrovascular infarcts is reviewed with special consideration of methodological issues, the course of depressive changes and interactions with neuropsychological and clinical parameters. The concepts of 'grief response', '(depressive)-catastrophic reactions' and 'post-stroke depression' are analysed and compared. An attempt is made at a theory of post-stroke depressive alterations that is based on neuroanatomical, pathophysiological and neurochemical models of depression and psychosocial changes and interactions. Therapeutic implications are discussed.
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Affiliation(s)
- M Herrmann
- Department of Rehabilitation Psychology, Research Program in Neuropsychology and Neurolinguistics, Freiburg, Germany
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27
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Jones NA, Fox NA. Electroencephalogram asymmetry during emotionally evocative films and its relation to positive and negative affectivity. Brain Cogn 1992; 20:280-99. [PMID: 1449758 DOI: 10.1016/0278-2626(92)90021-d] [Citation(s) in RCA: 116] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The purpose of the present study was to determine if there were differences in hemispheric lateralization during the experience of emotions and if those differences were related to personality style. College-age adult subjects selected for high positive and negative affectivity on Tellegen's Multidimensional Personality Questionnaire (MPQ; Tellegen, 1982) viewed video stimuli selected for their emotionally evocative nature and rated the intensity of the emotions they experienced. The ongoing electroencephalogram (EEG) was recorded while they watched the video clips. Analyses of the EEG data revealed that there were differences in regional activation during the emotional video clips, especially for those stimuli selected to elicit either happy or disgust emotions. These results support the hypothesis that the right hemisphere is specialized for the experience of certain negative affects, whereas the left hemisphere is specialized for the experience of certain positive affects. The findings also indicated some support for the theory that individual differences in personality style are related to differing levels of hemispheric arousal.
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Affiliation(s)
- N A Jones
- Institute for Child Study, University of Maryland, College Park 20742
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28
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29
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31
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Damecour CL, Caplan D. The relationship of depression to symptomatology and lesion site in aphasic patients. Cortex 1991; 27:385-401. [PMID: 1743034 DOI: 10.1016/s0010-9452(13)80034-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The prevalence of depression was examined in 54 patients recruited by speech pathologists and separated into four groups according to aphasia type (Broca's vs Wernicke's) and the duration of illness (less than six months vs more than six months). Evaluation of depression was made through questionnaires, completed by the spouse or speech pathologist, and patient interviews. The four groups were similar in demographical variables, in severity of aphasia and in lesion size (from CAT scan analyses). The prevalence of depression for the total sample was low (15%). Univariate analyses (ANOVA) did not show significant differences between the groups on the depression scales. The severity of depression was not correlated with lesion size or location. It was concluded that Wernicke's aphasics do not experience depression less often nor less severely than Broca's aphasics and that the incidence of depression in aphasia is not high. These results are in contrast with those obtained in earlier studies. Reasons for the discrepancies between this and other studies are discussed.
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MESH Headings
- Aged
- Aphasia, Broca/diagnosis
- Aphasia, Broca/physiopathology
- Aphasia, Broca/psychology
- Aphasia, Wernicke/diagnosis
- Aphasia, Wernicke/physiopathology
- Aphasia, Wernicke/psychology
- Brain Damage, Chronic/diagnosis
- Brain Damage, Chronic/physiopathology
- Brain Damage, Chronic/psychology
- Brain Mapping
- Cerebral Cortex/physiopathology
- Depressive Disorder/diagnosis
- Depressive Disorder/physiopathology
- Depressive Disorder/psychology
- Dominance, Cerebral/physiology
- Female
- Humans
- Male
- Middle Aged
- Neurocognitive Disorders/diagnosis
- Neurocognitive Disorders/physiopathology
- Neurocognitive Disorders/psychology
- Neuropsychological Tests/statistics & numerical data
- Personality Tests/statistics & numerical data
- Psychometrics
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Affiliation(s)
- C L Damecour
- Neurology Department, Massachusetts General Hospital, Boston
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32
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Abstract
Attention is drawn to some shortcomings of previous findings with regard to the nature, prevalence and aetiology of psychiatric disorder after stroke, and in particular post-stroke depression. Reasons for and drawbacks of the emphasis on depression in studies to date are discussed. Inconsistencies amongst previous findings are examined and it is suggested that many further studies in the area are warranted providing methodological difficulties are addressed adequately.
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Affiliation(s)
- G A Johnson
- Department of Psychiatry and Behavioural Science, University of Western Australia
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33
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McNamara ME. Psychological factors affecting neurological conditions. Depression and stroke, multiple sclerosis, Parkinson's disease, and epilepsy. PSYCHOSOMATICS 1991; 32:255-67. [PMID: 1882016 DOI: 10.1016/s0033-3182(91)72063-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
As a contribution to the proposed revision of the DSM-III-R category "Psychological Factors Affecting Physical Condition" for DSM-IV, this article reviews the history of how the relationship of psychiatric illness to neurological illness has been understood with respect to depression. Since both psychiatric and neurological illness are aspects of brain functioning, any statement of the relationship of these categories entails certain epistemological assumptions, some of which have undergone considerable change and rapid evolution in the course of the last century.
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Affiliation(s)
- M E McNamara
- Department of Psychiatry, Rhode Island Hospital, Brown University, Providence 02903
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34
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Abstract
A case of pure word mutism, often called "small Broca's aphasia," in a 44-year-old woman with a psychiatric history and a long history of unresolved, vague neurologic symptoms is presented. Although hysterical reaction was high on the list of differential diagnoses due to the patient's medical history, cranial computed tomography performed in the emergency department revealed an infarct in the distribution of the middle cerebral artery, which probably caused her condition. The patient improved slightly during hospitalization and was discharged on the sixth hospital day with a moderate expressive aphasia for which she received intensive speech therapy.
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Affiliation(s)
- L M Linett
- Department of Emergency Medicine, Albany Memorial Hospital, New York 12204
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35
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Abstract
Empirical studies have recently demonstrated that major and minor depressive disorders occur in 30-50% of stroke patients, and last more than one year without treatment, although they do respond to tricyclic antidepressants. These mood disorders are not strongly associated with severity of impairment, demographic characteristics, social supports or prior personal history, but major depression is often strongly associated with left frontal or left basal ganglia lesions and pre-existing subcortical atrophy. While the aetiology of these mood disorders remains unknown, serotonergic or noradrenergic dysfunction may play a role. Mania is a rare complication of stroke: the clinical presentation and response to treatment are usually the same as mania without brain injury. Post-stroke mania is strongly associated with both a right hemisphere lesion in a limbic-connected area and a second predisposing factor, such as genetic loading for affective disorder, pre-existing subcortical atrophy or seizure disorder. This disorder may be mediated through frontal lobe dysfunction. The lesion method represents a potentially fruitful technique for investigating the mechanisms of affective disorder.
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Affiliation(s)
- S E Starkstein
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21205
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36
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37
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Primeau F. Post-stroke depression: a critical review of the literature. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1988; 33:757-65. [PMID: 3060238 DOI: 10.1177/070674378803300816] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Because of its physical, psychological, interpersonal and financial repercussions, post-stroke depression is a sensitive issue facing patients, clinicians and society as a whole. The author highlights some difficulties with respect to research methodology, definition, etiology and treatment as reported in the recent scientific literature. Although this review challenges some notions about etiology and rates of post-stroke depression, suggestions are outlined to help prevent, recognize and treat this disorder, the incidence of which is expected to increase because of the demographic trend of our population towards aging.
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Affiliation(s)
- F Primeau
- Allan Memorial Institute, Royal Victoria Hospital, Department of Psychiatry, McGill University, Montreal, Quebec
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38
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Affiliation(s)
- H G Koenig
- Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710
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39
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Seron X, van der Linden M. Aphasia and personality. ACTA NEUROCHIRURGICA. SUPPLEMENTUM 1988; 44:113-7. [PMID: 2464905 DOI: 10.1007/978-3-7091-9005-0_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A critical review of the data in the literature and their interpretations is given. There are three main lines of interpretation: --The neuropsychological point of view interprets personality disorders as a reaction to the language deficit; --the anatomical point of view tries to relate personality disorders to the location and extent of brain lesions; --the historical point of view links personality disorders to the pre-morbid personality. All of them seem to have shortcomings and to be based at least in part on inadequate scientific methods including the principle problems of psychologically testing aphasics, of not having pre-morbid personality tests or using tests which are developed outside the field of neuropsychology. We suggest the development of multifactorial approaches which take into account biological, sociological and psycho-individual variables in an interactive way.
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Affiliation(s)
- X Seron
- Université Catholique de Louvain, Faculté de Médecine, Unité de Neuropsychologie expérimentale de l'Adulte NEXA, Bruxelles, Belgium
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40
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Robinson RG, Bolla-Wilson K, Kaplan E, Lipsey JR, Price TR. Depression influences intellectual impairment in stroke patients. Br J Psychiatry 1986; 148:541-7. [PMID: 3779224 DOI: 10.1192/bjp.148.5.541] [Citation(s) in RCA: 117] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Patients with ischaemic lesions of the left cerebral hemisphere were examined for depression and intellectual impairment: in non-depressed patients, the severity of impairment was related to both lesion volume and location, as assessed by CT scan analysis. Cognitive impairment in patients with major depression was greater than predicted by lesion volume alone, and when patients were matched for severity of impairment, depressed patients had smaller lesion volumes than the non-depressed. After six months, non-depressed patients had significantly less cognitive impairment than depressed patients who showed no improvement. Both depression and lesion volume were significantly and independently related to cognitive impairment. These findings suggest that post-stroke depression can produce a true dementia in its own right, and that treatment of post-stroke depression might benefit cognitive function.
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42
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Borod JC, Koff E, Perlman Lorch M, Nicholas M. The expression and perception of facial emotion in brain-damaged patients. Neuropsychologia 1986; 24:169-80. [PMID: 3714022 DOI: 10.1016/0028-3932(86)90050-3] [Citation(s) in RCA: 166] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This study examined the expression and perception of facial emotion in patients with unilateral cerebrovascular pathology. Subjects were 12 right brain-damaged (RBD), 15 left brain-damaged (LBD) aphasic, and 16 normal control (NC) right-handed males. Expressions were elicited during posed and spontaneous conditions. Both positive and negative emotions were studied. RBDs were significantly impaired, relative to LBDs and NCs, in expressing and perceiving facial emotion. There were no group differences as a function of condition, but there were differences as a function of emotional valence. Qualitative performance differences also were observed. There was no evidence that the ability to produce a particular emotion was related to the ability to identify the same emotion. Overall, these findings support the notion that the right cerebral hemisphere is dominant for expressing and perceiving facial emotion.
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43
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Robinson RG, Lipsey JR, Price TR. Diagnosis and clinical management of post-stroke depression. PSYCHOSOMATICS 1985; 26:769-72, 775-8. [PMID: 4059499 DOI: 10.1016/s0033-3182(85)72790-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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44
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Abstract
Organic delusions are common, but have received little systematic study. Review of the literature reveals that they occur most commonly in toxic-metabolic processes and in disorders affecting the limbic system and basal ganglia. A prospective study of 20 consecutive patients with organic delusions revealed four general types of false beliefs: simple persecutory delusions, complex persecutory delusions, grandiose delusions, and those associated with specific neurological defects (anosognosia, reduplicative paramnesia). Simple delusions responded best to treatment, and complex delusions were more resistent. Acting on delusional beliefs was not unusual, and treatment of the delusions was an important aspect of management of the patient.
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45
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Abstract
The study investigates the effect of speech therapy on the mood of aphasic stroke patients and their spouses. Patients were randomly allocated to receive speech therapy for 24 weeks starting at 10 weeks post stroke. Patient's mood was measured by means of simple rating scales and an adjective checklist. The mood of relatives was measured by The Goldberg General Health Questionnaire and The Wakefield Depression Inventory. Whereas depression and anxiety were surprisingly uncommon in aphasic patients, many spouses suffered depression and minor psychiatric disturbances. There were no significant differences between treated and untreated patients and their spouses on any measure. Speech therapy was not shown to have any psychological benefits.
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46
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Trevarthen C. Hemispheric Specialization. Compr Physiol 1984. [DOI: 10.1002/cphy.cp010325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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47
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Abstract
A case of mutism due to left hemisphere infarction is described. Recovery revealed mild motor dysphasia. Review of the literature showed that the case resembles aphemia but is unique by virtue of its duration, and the absence of associated apraxia and paresis.
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48
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Halpern H, McCartin-Clark M. Differential language characteristics in adult aphasic and schizophrenic subjects. JOURNAL OF COMMUNICATION DISORDERS 1984; 17:289-307. [PMID: 6209302 DOI: 10.1016/0021-9924(84)90032-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Sixty-one adult aphasic and 61 noncerebrally involved chronic undifferentiated schizophrenic subjects were tested for impairment in 10 language categories. Results indicated that the language categories of strongest differentiating value were writing of words to dictation, naming, syntax, where aphasic subjects were more impaired in all three, and relevance, where schizophrenic subjects were more impaired. To a lesser extent, other differentiating language features were auditory retention span, and overall language ability, where aphasic subjects were more impaired in both, and fluency, where aphasic subjects were less fluent. Both groups also were tested for apraxia of speech, oral apraxia, limb apraxia, time and place orientation, and ability to respond to questions containing general information.
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49
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Newman S. The social and emotional consequences of head injury and stroke. APPLIED PSYCHOLOGY-AN INTERNATIONAL REVIEW-PSYCHOLOGIE APPLIQUEE-REVUE INTERNATIONALE 1984. [DOI: 10.1111/j.1464-0597.1984.tb01448.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Abstract
A musically naive patient with dominant fronto-temporal and anterior parietal infarct developed transcortical mixed aphasia. From early convalescence, he exhibited elated mood with hyperprosody and repetitive, spontaneous whistling and whistling in response to questions. He often spontaneously sang without error in pitch, melody, rhythm and lyrics, and spent long periods of time listening to music. His behaviour progressively improved in parallel with very good recovery of verbal skills. Musicality and singing are rarely tested at the bedside. Preservation of these abilities in aphasics might portend eventual recovery.
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