Wearable devices for seizure detection: Is it time to translate into our clinical practice?

With the exponential development of mobile health technologies over the past ten years, there has been a growing interest in the potential applications in the field of epilepsy, and specifically for seizure detection. Better detection of seizures is probably one of the best ways to improve patient safety. Overall, we are observing an exponential increase in the number of non-EEG based seizure detection systems and a progressive homogenization of their evaluation procedures. Most importantly, the properties of these devices for detection of tonic-clonic seizures are now very interesting, both in terms of sensitivity and in terms of false-alarm rates. Accordingly, we might expect that these be used in clinical practice in the near future, especially in patients at high risk of seizure-related injuries or sudden unexpected death in epilepsy (SUDEP).

Selection of employee personal protective equipment based on aggressive behavior in pediatric neuropsychiatry.

PURPOSE: Hospitalized patients with a developmental or intellectual disability and a psychiatric disorder (dual-diagnosis) often pose a risk to themselves or others leading to high injury rates for their providers. Therefore, evidence-based strategies to reduce employee injuries resulting from interactions are necessary. METHODS: To reduce injuries resulting from interactions with dual-diagnosis patients, the Initial Behavioural Assessment (IBA) and Protective Equipment Decision Key (PEDK) were used in inpatient neuropsychiatry. The IBA-PEDK identify patients' aggressive behaviors to provide employees with personal protective equipment (PPE). Inter-rater reliability, validity, and adherence were examined. RESULTS: Injuries significantly decreased after implementing the IBA-PEDK. The average kappa coefficient was 0.64 with a 90.6% agreement. Ninety-three percent of respondents reported wearing PPE at the time of injury. CONCLUSIONS: A quick, user-friendly tool that provides a standardized method for determining PPE based on patient-specific behavior can significantly reduce aggression-related injuries.

Vagus nerve stimulation in neuropsychiatry: Targeting anatomy-based stimulation sites.

The vagus nerve (VN) is the longest cranial nerve, extending from the brain to the abdominal cavity. The VN consists of both afferent and efferent fibers (respectively 80% and 20%). Vagus nerve stimulation (VNS) is a neuromodulation strategy first developed in the 1980s for epilepsy. More recently, growing efforts in clinical research have been underscoring possible clinical benefits of VNS for different medical conditions such as epilepsy, major depression, anxiety disorders, and Tourette syndrome. Following the rational of VN anatomy and cranial innervation presented above, we hereby hypothesize that transcutaneously placing electrodes over the mastoid process could be a useful study protocol for future tVNS trials.

Proceso creativo, arte y psicopatología / Creative process, art and psycopathology

Se presenta una reflexión sobre el proceso creativo y sus manifestaciones psicopatológicas en artistas. Se intenta responder a las siguientes preguntas: 1) ¿Existe relación entre el proceso creativo y la “locura”? 2) ¿Hasta qué punto los artistas y los genios son (están) “locos”? 3) ¿Podemos conocer la psicopatología de los artistas a través de sus producciones artísticas? 4) ¿Puede diferenciarse la angustia neurótica de la psicótica en los cuadros y creaciones artísticas? Por último se analizan textos y obras creativas que apoyan dichas reflexiones (AU)

This article presents a reflection on the creative process and its psychopathologycal manifestations in artists. It seeks to answer the following questions: 1) Is there any relationship between the creative process and “madness”?2) Up to what point are artists and geniuses “mad”? 3) Can we know the artists’ psychopathology through their artistic productions? 4) Is it possible to differentiate the psychotic’s neurotic distress in pictures and other artistic creations? Finally, creative texts and creative works are analyzed in order to support these reflections (AU)

De la respuesta a la locura, a la locura como respuesta / From the answer to madness and madness as an answer

Se presenta el caso clínico de una mujer de cuarenta años de edad que es atendida en el Servicio de Urgencias (por recomendación de su hija) al contactar con su difunto cuñado, y sentirlo “como si estuviera dentro de ella”. La paciente comentó que el fallecido le había trasmitido que deseaba que su viuda rehiciera su vida de pareja y familiar. Durante la observación psicopatológica se aprecia, entre otros datos, verbalizaciones de ideas de perjuicio. La hija de la paciente especifica reiteradamente que existía una asociación entre la toma de tratamiento anticonceptivo con dispositivo intrauterino hormonal (levonorgestrel) y síntomas premórbidos (caracterizados por apatía, abulia y abandono parcial de sus tareas cotidianas). Se planteó el diagnóstico diferencial entre un trastorno psicótico de debut o un trastorno disociativo, a descartar una posible inducción del tratamiento hormonal. La evolución clínica y el conocimiento de la situación vital de la paciente permitirá discernir el cuadro (AU)

A case involving a 40-years old woman attended by the Emergency Service (at the request of her daughter). The woman claimed she had had contact with her late brother-in-law and felt “as if he had been inside her”. The patient also said that the deceased had expressed his desire to see his widow recover her intimate personal and family life. During the psychopathological observation, vocalizations of prejudicial ideas, among other data, were noted. The patient’s daughter repeatedly specified an association between the intake of contraceptive treatment with hormonal intrauterine device (levonorgestrel) and premorbid symptoms (characterized by apathy, abulia and partial abandonment of her routine activities). A differential diagnosis was proposed among which, a psychotic disorder, a dissociative disorder, or a possible induction by the hormonal treatment, was presented. The clinical progress and the knowledge of the patient’s vital situation will help determine the linical picture (AU)

Perfil psicopatológico de pacientes con traumatismo craneoencefálico evaluados mediante el Inventario Neuropsiquiátrico / Psychopatological evaluation of traumatic brain injury patients with the Neuropsychiatric Inventory

Introducción. El Inventario Neuropsiquiátrico (NPI) es una escala que valora la presencia de alteraciones psicopatológicas en pacientes con enfermedades neurológicas, principalmente demencias. A pesar de sus ventajas, existen pocos estudios publicado en pacientes con traumatismo craneoencefálico (TCE). Con la información derivada del NPI pretendemos describir las alteraciones psicopatológicas en un grupo de pacientes con TCE severo en fase crónica y determinar si se correlacionan con antecedentes psiquiátricos y medidas de resultado. Método. Se administró el NPI a los informantes de 53 pacientes con traumatismo craneoencefálico grave que se encontraban en fase crónica. Así mismo, se recogieron escalas de funcionalidad y de integración a la comunidad. Resultados. El 92,5% de la muestra estudiada presentaba alguna alteración psicopatológica según el NPI, siendo los síntomas más frecuentes la irritabilidad/labilidad, la apatía y la depresión/disforia. El antecedente de consumo habitual de tóxicos mostró una relación significativa con la presencia de psicopatología. Síntomas como la agitación, la apatía y la desinhibición se correlacionaron de forma significativa con el grado de discapacidad. Conclusiones. Las alteraciones psiquiátricas son frecuentes en pacientes con TCE. El nNPI es una herramienta que recoge de manera sistemática las alteraciones conductuales y emocionales más frecuentes en estos pacientes. Algunos de los síntomas influyen negativamente en el grado de discapacidad(AU)

Introduction. The Neuropsychiatric Inventory (NPI) is a scale that assesses psychiatric symptoms in patients with neurological disorders, principally dementia. Despite its advantages, there are few published studies in traumatic brain injury (TBI) patients. With the NPI information we are going to describe the psychopatologic disorders in a group of TBI chronic patients and look the possible association with psychiatric history and outcome measures. Method. The NPI was applied to caregivers of 53 patients with severe TBI in chronic phase. We also collected functional and community integration scales. Results. 92.5% of patients had some neuropsychiatric symptom, according to NPI. The most frequents were irritability/lability, apathy and depression/dysphoria. Those patients with drugs abuse history had more psychiatric symptoms. Presence of agitation/aggression, apathy and disinhibition were correlated with more disability. Conclusions. Psychiatric disorders are common between patients with TBI. The NPI is a scale that systematically assesses the behavioral and emotional disorders more common in these patients. Some of the symptoms negatively influence the degree of disability(AU)

Molecular tools and approaches for optogenetics.

The mammalian brain poses a formidable challenge to the study and treatment of neuropsychiatric diseases, owing to the complex interaction of genetic, epigenetic, and circuit-level mechanisms underlying pathogenesis. Technologies that facilitate functional dissection of distinct brain circuits are necessary for systematic identification of disease origin and therapy. Recent developments in optogenetics technology have begun to address this challenge by enabling precise perturbation of distinct cell types based on molecular signatures, functional projections, and intracellular biochemical signaling pathways. With high temporal precision and reversible neuromodulation, optogenetics promises to improve existing disease models and advance our understanding of psychiatric conditions. In this review, we describe the current state of molecular optogenetic tools and future directions of development.

Novel approaches to the study of postmortem brain in psychiatric illness: old limitations and new challenges.

Biological psychiatry has made significant advances through the development of postmortem studies, animal models, and studies with living humans. Although these approaches each have advantages and disadvantages, the postmortem field is undergoing a significant shift toward more complex and informative methodologies. In the first part of this review, we summarize the long-standing methodologic challenges facing this field. In the second part of the article, we discuss the innovative approaches being used for postmortem studies, including laser capture microdissection and subcellular fractionization. These techniques will permit scientists working in the postmortem field to ask and answer the largest possible questions, providing new targets for drug discovery and improved treatments for severe mental illness.