Neuropsychiatry: Towards a Philosophy of Praxis / Neuropsiquiatría: hacia una filosofía de la práctica

Abstract Neuropsychiatry is a specialized clinical, academic and scientific discipline with its field located in the borderland territory between neurology and psychiatry. In this article, we approach the theoretical definition of neuropsychiatry, and in order to address the practical aspects of the discipline, we describe the profile of a neuropsychiatric liaison service in the setting of a large hospital for neurological diseases in a middle-income country. An audit of consecutive in-patients requiring neuropsychiatric assessment at the National Institute of Neurology and Neurosurgery of Mexico is reported, comprising a total of 1212 patients. The main neurological diagnoses were brain infections (21%), brain neoplasms (17%), cerebrovascular disease (14%), epilepsy (8%), white matter diseases (5%), peripheral neuropathies (5%), extrapyramidal diseases (4%), ataxia (2%), and traumatic brain injury and related phenomena (1.8%). The most frequent neuropsychiatric diagnoses were delirium (36%), depressive disorders (16.4%), dementia (14%), anxiety disorders (8%), frontal syndromes (5%), adjustment disorders (4%), psychosis (3%), somatoform disorders (3%), and catatonia (3%). The borderland between neurology and psychiatry is a large territory that requires the knowledge and clinical skills of both disciplines, but also the unique expertise acquired in a clinical and academic neuropsychiatry program.

Resumen La neuropsiquiatría es una disciplina médica cuyo campo clínico, académico y científico se localiza en el territorio fronterizo entre la neurología y la psiquiatría. En este artículo se aborda la definición teórica de la neuropsiquiatría y, con el objetivo de tratar los aspectos prácticos de la neuropsiquiatría, se describe el perfil de un servicio de interconsulta neuropsiquiátrica en el contexto de un hospital dedicado a las enfermedades del sistema nervioso, en un país de ingreso económico medio. Se incluyó a 1.212 pacientes evaluados consecutivamente en el Instituto Nacional de Neurología y Neurocirugía de México. Los diagnósticos principales fueron infecciones cerebrales (21%), neoplasias del sistema nervioso (17%), enfermedad cerebrovascular (14%), epilepsia (8%), enfermedades de la sustancia blanca (5%), neuropatías periféricas (5%), enfermedades extrapiramidales (4%), ataxias (2%) y traumatismos craneoencefálicos (1,8%). Los diagnósticos neuropsiquiátricos más frecuentes fueron síndrome confusional (36%), depresión (16,4%), demencia (14%), ansiedad (8%), síndromes frontales (5%), reacciones de ajuste (4%), psicosis (3%), trastornos somatoformes (3%) y catatonia (3%). El territorio fronterizo entre la neurología y la psiquiatría es extenso y requiere los conocimientos y fortalezas de ambas disciplinas, pero también la pericia entrenada mediante un programa clínico, científico y académico especializado.

Motor development of children with attention deficit hyperactivity disorder

Objective:To compare both global and specific domains of motor development of children with attention deficit hyperactivity disorder (ADHD) with that of typically developing children.Methods:Two hundred children (50 children with clinical diagnoses of ADHD, according to the DSM-IV-TR and 150 typically developing controls), aged 5 to 10 years, participated in this cross-sectional study. The Motor Development Scale was used to assess fine and global motricity, balance, body schema, and spatial and temporal organization.Results:Between-group testing revealed statistically significant differences between the ADHD and control groups for all domains. The results also revealed a deficit of nearly two years in the motor development of children with ADHD compared with the normative sample.Conclusion:The current study shows that ADHD is associated with a delay in motor development when compared to typically developing children. The results also suggested difficulties in certain motor areas for those with ADHD. These results may point to plausible mechanisms underlying the relationship between ADHD and motor difficulties.

Tourette and tic disorders in ICD-11: standing at the diagnostic crossroads

This article reflects discussion by the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders. After reviewing the historical classification of tic disorders, this article discusses their placement in ICD-11. Existing problems with diagnostic labels and criteria, appropriate placement of the tic disorders category within the ICD-11 system, and pragmatic factors affecting classification are reviewed. The article ends with recommendations to (a) maintain consistency with the DSM-5 diagnostic labels for tic disorders, (b) add a minimum duration guideline for a provisional tic disorder diagnosis, (c) remove the multiple motor tic guideline for the diagnosis of Tourette disorder, and (d) co-parent the tic disorder diagnoses in the disorders of the nervous system and the mental and behavioral disorders categories, with secondary co-parenting in the obsessive-compulsive and related disorders and neurodevelopmental disorders sections.

Prevalence of psychiatric comorbidities in temporal lobe epilepsy in a Southern Brazilian population / Prevalência de comorbidades psiquiátricas na epilepsia do lobo temporal em uma população do sul do Brasil

A great prevalence of psychiatric disorders in epilepsy is well demonstrated, although most studies have used unstructured psychiatric interviews for diagnosis. Here we present a study evaluating the prevalence of psychiatric comorbidities in a cohort of Southern Brazilian patients with temporal lobe epilepsy (TLE) using a structured clinical interview. We analyzed 166 patients with TLE regarding neuropsychiatric symptoms through the Structured Clinical Interview for DSM-IV. One hundred-six patients (63.9 percent) presented psychiatric comorbidities. Mood disorders were observed in 80 patients (48.2 percent), anxiety disorders in 51 patients (30.7 percent), psychotic disorders in 14 (8.4 percent), and substance abuse in 8 patients (4.8 percent) respectively. Our results agree with literature data where most authors detected mental disorders in 10 to 60 percent of epileptic patients. This wide variation is probably attributable to different patient groups investigated and to the great variety of diagnostic methods. Structured psychiatric interviews might contribute to a better evaluation of prevalence of psychiatric comorbidities in TLE.

Embora muitos estudos tenham demonstrado uma alta prevalência de transtornos psiquiátricos em pacientes com epilepsia, a maioria utilizou entrevistas psiquiátricas não-estruturadas para o diagnóstico. Este método pode levar a diferenças significativas nos resultados. Nós estudamos a prevalência de comorbidades psiquiátricas em pacientes com epilepsia do lobo temporal (ELT), utilizando uma entrevista clínica estruturada. Foram estudados 166 pacientes com ELT, aos quais foi aplicada a Entrevista Clínica Estruturada para o DSM-IV (SCID). Cento e seis pacientes (63,9 por cento) apresentaram comorbidades psiquiátricas. Transtornos de humor, observados em 80 pacientes (48,2 por cento), foram o transtorno neuropsiquiátrico mais comum. Transtornos de ansiedade, observados em 51 pacientes (30,7 por cento), foram a segunda comorbidade psiquiátrica mais frequente. Transtornos psicóticos foram encontrados em 14 (8,4 por cento), e abuso de substâncias foram observados em 8 pacientes (4,8 por cento), respectivamente. Nossos resultados estão de acordo com os dados da literatura, que demonstra problemas psiquiátricos em 10-60 por cento dos pacientes com epilepsia. A grande variação dos resultados pode ser atribuída aos diferentes grupos de pacientes estudados e à variabilidade de métodos diagnósticos empregados. Entrevistas psiquiátricas estruturadas podem contribuir para uma avaliação mais adequada da real prevalência de comorbidades psiquiátricas na ELT.

Avaliação neuropsicológica da atenção visual e do videoeletroencefalograma na condição de hiperventilação, nas epilepsias e em indivíduos normais / Neuropsychological assessment of visual attention and videoelectroencephalogram on condition of hyperventilation in epilepsy and normal individuals

Hiperventilação é um método tradicional de ativação para descargas epileptiformes generalizadas, ou crises em eletroencefalografia. Alterações comportamentais durante crises induzidas pela hiperventilação, são avaliadas por um método clinico no qual o paciente conta, em voz alta, o número de cada incursão respiratória após cada expiração. Comprometimento da consciência é detectado por omissões, repetições ou hesitação na sequência numérica. Baseados no estudo de um caso-controle de adulto com crises de ausência, nas quais as crises só puderam ser diagnosticas, com certeza, através da utilização de um teste computadorizado da atenção visual, organizamos o presente estudo com o objetivo de estudar se a hiperventilação durante 5 minutos provocava alteração na atenção visual de voluntários normais, utilizando o teste computadorizado da atenção visual com monitorização vídeoeletroencefalográfica. Em adição verificamos a contribuição do teste para o diagnóstico sindromico de um paciente com o diagnóstico presuntivo de epilepsia de lobo temporal. Nossos resultados demonstraram que a hiperventilação durante 5 minutos não altera a atenção visual de indivíduos normais, sugerindo que este possa ser útil para uso rotineiro em encefalografia ou em monitorizações videoeletroencefalográficas, com o objetivo de detectar crises, cuja identificação seja difícil apenas pela observação visual do comportamento.

Hyperventilation has been a traditional activation method for generalized epileptiform discharges or seizumes in routine electroencephalography (EEG). Behavioral alterations during hyperventilation-induced seizures are assessed by a clinical method in which patients count aloud the number of their breaths after each expiration. Impairment of consciousness is detected by omissions, repetitions of hesitation of numbers in a counting sequence. Based on an anecdotal case-control study of a patient with epilepsy with absences, in which the absences could only be diagnosed using a continuous performance test, we organized the study aiming to study the effects of hyperventilation on attention, using the CTVA during normal breathing and in the 5 minutes hyperventilation in normal adults. Our goal was to determine if hyperventilation altered the performance of normal subjects on the different parameters of the CTVA. Our data showed that hyperventilation did not significantly change any parameter of CTVA, when normal subjects performed the test in normal breathing condition compared with their performance during HV in addition, in a case with presumptive diagnosis of refractory temporal lobe epilepsy, our neuropsychological battery, which included the computadorized test of visual attention, played a critical role in elucidating the syndromic diagnosis and leading to additional tests for the correct diagnosis. Our results suggest that CTVA may be a useful tool to measure unresponsiveness in routine electroencephalography or during videoelectroencephalography monitoring.