Mirtazapine Monotherapy for Antipsychotics-refractory Psychosis in a Patient with Very-late-onset Schizophrenia-like Psychosis: A Case Report.

Very-late-onset schizophrenia-like psychosis (VLOSLP) is a condition in which psychotic symptoms emerge after the age of 60 years. Given its heterogeneous nature, VLOSLP remains a diagnostic and therapeutic dilemma. Here, we report a case of a 68-year-old patient with psychosis refractory to antipsychotics who was successfully treated with mirtazapine monotherapy. This case suggests that mirtazapine monotherapy may be effective for the treatment of patients with antipsychotic- refractory VLOSLP.

High Phase Synchronization in Alpha Band Activity in Older Subjects With High Creativity.

Despite growing evidence that high creativity leads to mental well-being in older individuals, the neurophysiological bases of creativity remain elusive. Creativity reportedly involves multiple brain areas and their functional interconnections. In particular, functional magnetic resonance imaging (fMRI) is used to investigate the role of patterns of functional connectivity between the default network and other networks in creative activity. These interactions among networks play the role of integrating various neural processes to support creative activity and involve attention, cognitive control, and memory. The electroencephalogram (EEG) enables researchers to capture a pattern of band-specific functional connectivity, as well as moment-to-moment dynamics of brain activity; this can be accomplished even in the resting-state by exploiting the excellent temporal resolution of the EEG. Furthermore, the recent advent of functional connectivity analysis in EEG studies has focused on the phase-difference variable because of its fine spatio-temporal resolution. Therefore, we hypothesized that the combining method of EEG signals having high-temporal resolution and the phase synchronization analysis having high-spatio-temporal resolutions brings a new insight of functional connectivity regarding high creative activity of older participants. In this study, we examined the resting-state EEG signal in 20 healthy older participants and estimated functional connectivities using the phase lag index (PLI), which evaluates the phase synchronization of EEG signals. Individual creativity was assessed using the S-A creativity test in a separate session before the EEG recording. In the analysis of associations of EEG measures with the S-A test scores, the covariate effect of the intelligence quotient was evaluated. As a result, higher individual S-A scores were significantly associated with higher node degrees, defined as the average PLI of a node (electrode) across all links with the remaining nodes, across all nodes at the alpha band. A conventional power spectrum analysis revealed no significant association with S-A scores in any frequency band. Older participants with high creativity exhibited high functional connectivity even in the resting-state, irrespective of intelligence quotient, which supports the theory that creativity entails widespread brain connectivity. Thus, PLIs derived from EEG data may provide new insights into the relationship between functional connectivity and creativity in healthy older people.

Delayed posthypoxic leukoencephalopathy following alcohol and psychotropic drug overdose: a case report.

Delayed posthypoxic leukoencephalopathy (DPHL), a demyelinating syndrome, can easily be misdiagnosed as a psychiatric condition. Our case study shows that magnetic resonance imaging is highly useful for an early diagnosis of DPHL and that vascular endothelial growth factor might be a supplementary biomarker for the early detection of DPHL.

Changes in EEG complexity with electroconvulsive therapy in a patient with autism spectrum disorders: a multiscale entropy approach.

Autism spectrum disorders (ASD) are heterogeneous neurodevelopmental disorders that are reportedly characterized by aberrant neural networks. Recently developed multiscale entropy analysis (MSE) can characterize the complexity inherent in electroencephalography (EEG) dynamics over multiple temporal scales in the dynamics of neural networks. We encountered an 18-year-old man with ASD whose refractory catatonic obsessive-compulsive symptoms were improved dramatically after electroconvulsive therapy (ECT). In this clinical case study, we strove to clarify the neurophysiological mechanism of ECT in ASD by assessing EEG complexity using MSE. Along with ECT, the frontocentral region showed decreased EEG complexity at higher temporal scales, whereas the occipital region expressed an increase at lower temporal scales. Furthermore, these changes were associated with clinical improvement associated with the elevation of brain-derived neurotrophic factor, which is a molecular hypothesis of ECT, playing key roles in ASD pathogenesis. Changes in EEG complexity in a region-specific and temporal scale-specific manner that we found might reflect atypical EEG dynamics in ASD. Although MSE is not a direct approach to measuring neural connectivity and the results are from only a single case, they might reflect specific aberrant neural network activity and the therapeutic neurophysiological mechanism of ECT in ASD.

Neurophysiological basis of creativity in healthy elderly people: a multiscale entropy approach.

OBJECTIVES: Creativity, which presumably involves various connections within and across different neural networks, reportedly underpins the mental well-being of older adults. Multiscale entropy (MSE) can characterize the complexity inherent in EEG dynamics with multiple temporal scales. It can therefore provide useful insight into neural networks. Given that background, we sought to clarify the neurophysiological bases of creativity in healthy elderly subjects by assessing EEG complexity with MSE, with emphasis on assessment of neural networks. METHODS: We recorded resting state EEG of 20 healthy elderly subjects. MSE was calculated for each subject for continuous 20-s epochs. Their relevance to individual creativity was examined concurrently with intellectual function. RESULTS: Higher individual creativity was linked closely to increased EEG complexity across higher temporal scales, but no significant relation was found with intellectual function (IQ score). CONCLUSIONS: Considering the general "loss of complexity" theory of aging, our finding of increased EEG complexity in elderly people with heightened creativity supports the idea that creativity is associated with activated neural networks. SIGNIFICANCE: Results reported here underscore the potential usefulness of MSE analysis for characterizing the neurophysiological bases of elderly people with heightened creativity.

Effectiveness and tolerability of switching to aripiprazole from risperidone in subjects with autism spectrum disorders: a prospective open-label study.

BACKGROUND: Subjects with autism spectrum disorders (ASDs) often exhibit behavioral symptoms such as aggressiveness and irritability. The purpose of this study was to examine the efficacy and the tolerability of aripiprazole switched from risperidone in children and adolescents with ASD. METHODS: This prospective, 12-week, open-label study included 9 male subjects with ASD (age range, 9-22 years; mean ± SD age, 14.8 ± 4.0 years) followed up for 12 weeks after switching to aripiprazole from risperidone. The primary outcome measures were the Clinical Global Impression-Improvement scales and the irritability subscale of the Aberrant Behavior Checklist. RESULTS: The mean ± SD maintenance dosages of risperidone and aripiprazole were 0.6 ± 0.4 mg/d and 4.8 ± 4.0 mg/d, respectively. The mean ± SD scores of the irritability subscale of the Aberrant Behavior Checklist before switching to aripiprazole (baseline) and 12 weeks after switching to aripiprazole (end point) were 14.8 ± 7.6 and 13.1 ± 8.0, respectively. The mean ± SD Clinical Global Impression-Improvement score, a comparison from baseline to end point, was 2.4 ± 0.7. Mild somnolence was observed only in 1 subject. No significant changes in vital signs, weight, electrocardiogram, or laboratory measures occurred during switching to aripiprazole. Serum prolactin levels decreased significantly from 17.3 ± 9.4 ng/mL (baseline) to 2.3 ± 1.7 ng/mL (end point). CONCLUSIONS: The results show that aripiprazole might be generally well tolerated and might constitute an alternative treatment of subjects with ASD who experience poor efficacy or tolerability issues with risperidone treatment. Additional long-term controlled studies are needed to evaluate the efficacy and the safety of switching to aripiprazole from other antipsychotics in subjects with ASD.

Effects of electroconvulsive therapy on neural complexity in patients with depression: report of three cases.

BACKGROUND: The exact neurophysiological mechanism of electroconvulsive therapy (ECT) for treating patients with depression remains elusive. Results of previous neurophysiological studies support the hypothesis that aberrant functional connectivity underlies the pathophysiology of depression, which engenders abnormal electroencephalogram (EEG) complexity. METHODS: Recently developed multiscale entropy analysis, which has underpinned aberrant functional connectivity in mental disorders, was introduced to explore changes in EEG complexity occurring with ECT in three patients with depression. RESULTS: All patients demonstrated a decrease in EEG complexity, especially at higher frequencies. This decrease was associated with improvement of depressive symptoms. LIMITATIONS: The generalizability of our findings was constrained because of the small sample size and lack of a comparison with healthy controls. CONCLUSIONS: The decrease in EEG complexity with ECT might be a result of amelioration of functional connectivity in the brain of a depressed patient. Multiscale entropy analysis might be a useful analytical method to elucidate neurophysiological mechanisms and evaluate the therapeutic efficacy of ECT in depression.