Altered Brain Activation in Ventral Frontal-Striatal Regions Following a 16-week Pharmacotherapy in Unmedicated Obsessive-Compulsive Disorder

Recent studies have reported that cognitive inflexibility associated with impairments in a frontal-striatal circuit and parietal region is a core cognitive deficit of obsessive-compulsive disorder (OCD). However, few studies have examined progressive changes in these regions following clinical improvement in obsessive-compulsive symptoms. To determine if treatment changes the aberrant activation pattern associated with task switching in OCD, we examined the activation patterns in brain areas after treatment. The study was conducted on 10 unmedicated OCD patients and 20 matched controls using event-related functional magnetic resonance imaging. Treatment improved the clinical symptoms measured by the Yale-Brown Obsessive Compulsive Scale and behavioral flexibility indicated by the switching cost. At baseline, OCD showed significantly less activation in the dorsal and ventral frontal-striatal circuit and parietal regions under the task-switch minus task-repeat condition compared with controls. After treatment, the neural responses in the ventral frontal-striatal circuit in OCD were partially normalized, whereas the activation deficit in dorsal frontoparietal regions that mediate shifting attention or behavioral flexibility persisted. It is suggested that altered brain activation in ventral frontal-striatal regions in OCD patients is associated with their cognitive flexibility and changes in these regions may underlie the pathophysiology of OCD.

Medical therapy in childhood psychocognitive problems

Neurodevelopmental disability is one of the most common problems of children referred to Pediatric Neurology Clinics. These children may suffer from speech delay, intellectual deficiency and behavioral disorder. Some patients with neurodevelopomental delay, especially those with intellectual disability and speech problems, have abnormal electroencephalograms, without clinical seizure. It seems that treating these patients with antiepileptic drugs normalizes the EEG, thereby preventing the electrical paroxysmal discharges that could be harmful for the developing brain. Several studies reported the use of Valproate, Lamotrigine and Corticosteroid in suppression of subclinical epileptiform discharges and improvement of developmental behavioral conditions. In our experiences, oral Na-Valproate was effective in developmental behavioral condition of children with neurodevelopmental delay and elimination of subclinical EEG discharges after 18 months of treatment. Also we used high dose intravenous methyl - prednisolone in a group of children with neurodevelopmental delay and electrical status epilepticus during slow - wave sleep without clinical seizure. In these children results of the appropriate neuro-metabolic tests and magnetic resonance imaging of the brain revealed no abnormality. Because no underlying etiology could be determined, isolated non convulsive status epilepticus was established. After treatment no significant response was observed in these group of children. In another study we used Lamotrigine in children with neurodevelopmental delay, abnormal epileptiform discharges but without clinical seizures. Our results revealed Lamotrigine provides effective control of both subclinical epileptiform discharges and behavioral disorder, without improvement in their cognition. Further studies are needed to investigate and confirm the cognitive and behavioral effects of Lamotrigine in children with psychomotor retardation

HIV mania as a marker for clinical deterioration in AIDS / La Manía en la Infección por el VIH como Marcador de Deterioro Clínico en el SIDA

HIV infection continues to be a significant health problem in the Caribbean region. With the availability of antiretroviral drug treatment, it is becoming increasingly important to identify clinical markers for deterioration from infection to disease. Psychiatric symptoms are well recognized as a complication of HIV infection. Three cases are presented to suggest that the occurrence of HIV related mania may herald the transition from HIV infection to AIDS. This is relevant in assessing the course of the disorder and could indicate that the psychiatric manifestation of neurotropic infection represents a distinguishing marker for the diagnosis of AIDS perhaps before other clinical signs are evident

La infección del VIH continúa siendo un importante problema de salud en la región del Caribe. Con la disponibilidad de tratamiento de droga de antiretroviral, está poniéndose en aumento importante para identificar los marcadores clínicos para el deterioración de la infección enfermar. Se reconocen bien los síntomas psiquiátricos como una complicación de infección por VIH. Sin embargo, se presentan tres casos para sugerir que específicamente la manifestación de manía relacionada con el VIH puede tener importancia clínica en anunciar la transición de la infección por VIH a SIDA. Esto tiene relevancia en cuanto a evaluar el curso del trastorno y podría indicar que la manifestación psiquiátrica de infección neurotrópica representa un marcador distintivo para el diagnóstico del SIDA, quizás antes de que cualquier otra señal clínica se haga evidente.