Isolated inability to write cursively after transient ischemic attack (TIA).

OBJECTIVE: To examine the different aspects of language and its representation in the brain. BACKGROUND: Apractic agraphia, a form of mechanical agraphia, is produced by lesions in the left superior parietal lobe. However, little is known about the dissociation between allographic level representations for cursive writing and printing. METHOD: A 78-year-old right-handed patient with a history of transient ischemic attack was evaluated by interview, neurologic and neuropsychiatric examination, neuropsychologic testing, speech and language evaluation, and functional neuroimaging (single photon emission computed tomography). RESULTS: The patient exhibited a disorder strictly limited to cursive writing resulting from ischemic damage to parietal and occipital lobes bilateral. CONCLUSIONS: These findings support the assertion that printing and cursive writing are represented differentially and an isolated deficit in any of them can be the only presentation of disorder of language organization, secondary to brain damage in left superior parietal area.

Electroconvulsive therapy as an alternative treatment for obese patients with mood disorders.

With the increased use of atypical antipsychotic medication in the treatment of mood disorders, patients are increasingly experiencing side effects, such as obesity, insulin resistance, and the metabolic syndrome, which, in turn, increases the risk of developing cardiovascular disease, type 2 diabetes, and hypertension. Maintenance electroconvulsive therapy (MECT) can be used as a prophylaxis for the recurrence of mood episodes for treatment-resistant patients. There are no reports of metabolic syndromes associated with ECT. We reviewed the charts of 10 patients who have received MECT at our institution over the last 10-year period. Five of 10 patients were obese pre-ECT, all of whom had a significant weight loss after ECT. Patients whose weights were normal pre-ECT, did not experience weight loss. Our finding suggests that ECT is a viable alternative for overweight patients with mood disorders who do not respond to mood stabilizers or cannot tolerate side effects.

Psychopathology in neuropsychiatry: DSM and beyond.

The case reports described in this article indicate that current neuropsychiatric practice is strongly limited by reliance on the Diagnostic and Statistical Manual of Mental Disorders (DSM). Knowledge of new psychopathology that will enable the neuropsychiatrists and neuroscientists identify specific areas of brain dysfunction is essential to modern practice of neuropsychiatry. Today, less than 20% of neuropsychiatry and neuroscience programs teach such psychopathology.The development of brain imaging and metabolic measurement technologies; the continuous and rapid introduction of many new pharmaceutical agents into clinical care; and the various, detailed editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) have all shaped modern psychiatric training and thus future psychiatric practice. This "shaping" is observed most often in the teaching of psychopathology and of mental status examinations, both currently focusing on how to recognize and elicit the clinical features needed to apply the criteria set by the DSM. Once DSM criteria are met, a best-choice treatment plan based on DSM diagnosis is selected from an array of pharmacotherapy algorithms. It is assumed that the known reliability of the DSM system maximizes the likelihood that these diagnostic decisions are valid and treatment choices are therefore appropriate. Descriptive psychopathology that goes beyond the DSM is primarily relegated to historical consideration and rarely pertains to issues regarding patient care.

Relationship between specialty choice and medical student temperament and character assessed with Cloninger Inventory.

BACKGROUND: Multiple variables affect medical specialty choice, including temperament, sociodemographic factors, and personal experiences. Many studies address specific variables for specific specialties, but few assess the relative impact of each factor. PURPOSE: To identify the relative influence of temperament in choosing a specialty. METHODS: A sociodemographic and personal experiences questionnaire and a 240-question temperament and character inventory was distributed to 682 medical students. Their scores for 6 medical specialties were examined using analyses of variance, multivariate analyses of variance, and discriminant analysis. RESULTS: Students choosing surgery, emergency medicine, and obstetrics and gynecology were higher on novelty seeking than other students. Future surgeons were lower in harm avoidance and reward dependence (RD) than the others. Students choosing primary care specialties, emergency medicine, and obstetrics and gynecology were all high on RD; with pediatrics being highest. Students differed from college students, the women differed from the men, and the Asian Americans differed from the other groups. CONCLUSION: The implications of these findings are discussed for career counseling and future research.

Continuation and maintenance ECT in treatment-resistant bipolar disorder.

Continuation and maintenance electroconvulsive therapy (c/mECT) is a treatment alternative for the long-term management of mood and psychotic disorders, especially in chronic, recurring, medication-resistant illnesses and in patients who are medication-intolerant, are non-compliant, and have a high risk of suicide with medications. A MEDLINE search was performed with maintenance electroconvulsive therapy (ECT), continuation ECT, and prophylactic ECT as keywords. The relevant literature was obtained and reviewed. Despite methodologic flaws, the overwhelming majority of the studies report the effectiveness of c/mECT in bipolar mood disorder. We also reviewed the charts of 13 patients with mood disorder receiving maintenance ECT in the ECT service of a Veterans Administration medical center. Despite good results, c/mECT is underused in the treatment of bipolar mood disorder. More research with better study design is needed to define the predictors of response to c/mECT and to develop c/mECT treatment protocols for treatment-resistant bipolar patients.