Neuroleptic malignant syndrome: diagnostic and therapeutic dilemmas

Neuroleptic malignant syndrome (NMS) is a life threatening medical state complicating the use of antipsychotic medications and other drugs that affect the dopaminergic system on administration or withdrawal. The condition was recognised nearly half a century ago, shortly after the discovery of antipsychotic medications. However, there are still no systematic studies about NMS. There are no definitive guidelines on its treatment. Although early recognition is emphasised and usually possible, delayed diagnosis is not rare. We here report on a case of NMS complicated by renal failure, and possibly respiratory failure. The report underscores the seriousness of delayed diagnosis and puts forward a comprehensive management recommendation based on our experience and the existing literature.     

The wane of childhood amnesia for autobiographical and public event memories

We modified Bruce, Dolan, and Phillips-Grant's (2000) threshold procedure for determining the wane of childhood amnesia. In two experiments, undergraduates labelled childhood events (e.g., your first permanent tooth came in) as know or recollect memories and estimated their age at the event's occurrence. In both studies the estimated transition from mostly know memories to mostly recollect memories was roughly 4.7 years. This transition estimate was replicated in a sample of adults (ages 24-65 years) with both Bruce et al.'s event-generation task and the Experiment 1a questionnaire. By contrast, in two experiments a transition estimate of roughly 6 years was found for undergraduates' memories of public events (e.g., the Challenger explosion). The wane of childhood amnesia appears to occur around 4.7 years.     

How bad is a 10% chance of losing a toe? Judgments of probabilistic conditions by doctors and laypeople

We presented a Web questionnaire to 139 physicians and medical researchers and 109 laypeople. The subjects made judgments of badness and importance of prevention for eight medical conditions at each of seven different probability levels. By assuming that the response to each of the 56 risks was monotonically related to transformations of the probability and of the disutility of the condition, we could assess the relative effect of probability and disutility on each subject's judgments. Physicians' judgments were more sensitive than laypeople's judgments to changes in probability. Older and female laypeople were less sensitive to probability (and correspondingly, more responsive to differences in severity among medical conditions). Laypeople varied more than physicians in their responsiveness to probability. These results point to general individual differences in the effect of probability on evaluations of medical risks. They may also provide insight into causes and noncauses of physician-patient miscommunication.     

Schizophrenia and deliberate self-harm: a systematic review of risk factors

Deliberate self-harm (DSH) is a strong predictor of suicide in schizophrenia. The aim of this review was to identify risk factors for DSH in schizophrenia. This systematic review of the international literature examined cohort and case-control studies of patients with schizophrenia or related diagnoses that reported DSH as an outcome. Studies were identified by searching electronic databases and reference lists, and by consulting international experts. Fourteen studies met the eligibility criteria. Of the 29 variables examined by two or more studies, five (past or recent suicidal ideation, previous DSH, past depressive episode, drug abuse or dependence, and higher mean number of psychiatric admissions) were associated with an increased risk of DSH, and one (unemployment) was associated with a reduced risk. Schizophrenic patients with these risk factors need careful follow-up and monitoring, with treatment of any associated comorbid depression or drug abuse. Large, prospective studies of DSH in schizophrenia are needed to further define risk factors and to build on the findings of this review.     

The visual search analogue of latent inhibition: Implications for theories of irrelevant stimulus processing in normal and schizophrenic groups

Latent inhibition (LI) is a robust phenomenon that is demonstrated when a previously inconsequential stimulus is less effective in a new learning situation than a novel stimulus. Despite LI’s simplicity, there is considerable disagreement as to its theoretical basis. Attentional theories claim that unattended stimulus preexposures reduce stimulus associability. Alternatively, it has been asserted that associability is unaffected and that LI is a result of competition/retrieval processes. The present article reviews a series of visual search studies, some with normal subjects, both undifferentiated and divided into low and high schizotypals, and others with pathologies that entail dysfunctional attention, such as schizophrenia, Parkinson’s disease, and anxiety. The visual search conditions were designed to model those of traditional LI experiments, while tapping attentional processes independently of the learning scores that index LI. A variety of evidence from these and other studies is used to support the involvement of attentionaland retrieval processes in LI. A model of the mechanism of action of these processes in LI is presented, together with its application to schizophrenia.     

Emotional intensity of idiographic sad memories in depression predicts symptom levels 1 year later

When cued with generic happy and sad words, depressed individuals have been found to articulate contextually impoverished memories of autobiographical events. Although this pattern predicts a worse symptomatic course of disorder in some depressed samples, longitudinal findings with the cue-word paradigm are inconsistent. To address the etiological significance of autobiographical memories outside the cue-word paradigm, the authors used an idiographic interview in which depressed participants generated memories of their happiest and saddest lifetime events. Each memory was coded for detail and emotional intensity. At a 1-year follow-up, participants' levels of depressive symptoms were reassessed. Lower emotional intensity of saddest memories predicted higher levels of depressive symptoms at follow-up. Several implications for understanding sadness and emotional disclosure in depression are discussed.     

Are there interactions among dysfunctional beliefs in obsessive compulsive disorder?

Contemporary cognitive models of obsessive-compulsive disorder emphasize the importance of various types of dysfunctional beliefs, such as beliefs about inflated responsibility, perfectionism and the importance of controlling one's thoughts. These beliefs have been conceptualized as main effects, each influencing obsessive-compulsive symptoms independent of the contributions of other beliefs. It is not known whether beliefs interact with one another in their influence on obsessive-compulsive symptoms. To investigate this issue, data from 248 obsessive-compulsive disorder patients were analyzed. Dependent variables were the factor scores on the 4 Padua Inventory subscales. Predictor variables were the factor scores from the 3 factors (inflated responsibility, perfectionism and controlling one's thoughts) of the Obsessive Beliefs Questionnaire and their 2- and 3-way interactions. Regression analyses revealed significant main effects; in almost all analyses one or more of inflated responsibility, perfectionism, and controlling one's thoughts factors predicted scores on the Padua factors even after controlling for general distress. There was no evidence that beliefs interact in their effects on obsessive-compulsive symptoms, thereby providing a relatively unusual instance in which a simpler explanation (main effects only) is just as powerful as a more complex model.     

Comorbidity in compulsive hoarding: a case report

A 56-year-old male presented with compulsive hoarding along with attention-deficit/hyperactivity disorder and schizotypal personality disorder. Hoarding has been described as difficult to treat both pharmacologically and behaviorally, and this patient's comorbid conditions also contributed to his overall impairment. The patient's treatment regimen of fluvoxamine, amphetamine salts, and risperidone, along with behavioral therapy, has helped with hoarding behaviors, motivation, procrastination, and increased socialization. Hoarding may be a unique subtype of obsessive-compulsive disorder with poorer prognosis and distinct neuroanatomic dysfunction. Augmentation with stimulants may provide benefits in aspects of hoarding such as procrastination, especially in patients with comorbid attention-deficit hyperactivity disorder.     

The effect of manipulated sympathy and anger on left and right frontal cortical activity

The present research extended past research demonstrating that approach-motivated anger is associated with greater left than right frontal cortical activity. Because past research had examined difference scores between left and right frontal activity, it was unable to test whether approach-motivated anger increased left activity, decreased right activity, or both. In addition, the present research examined a potential moderator of the effect of insult on left frontal activity. That is, it tested whether sympathy for an insulting person would reduce the left frontal activity that occurs following being insulted. Results indicated that left frontal activity was increased and right frontal activity was decreased by the insult. Moreover, these effects were inhibited when high levels of sympathy were first aroused.