Oosterman JM, de Goede M, Wester AJ, van Zandvoort MJE, Kessels RPC. Perspective taking in Korsakoff's syndrome: the role of executive functioning and task complexity.

Objective: The ability to make inferences about knowledge, thoughts and feelings of others, i.e. perspective taking, is a key element of social cognition. Clinical observations indicate that Korsakoff patients may have impairments in social cognition, but studies are scarce. Also, executive dysfunction is present in Korsakoff patients, which may hamper perspective taking directly.

Methods: Twenty-three patients with Korsakoff's syndrome and 15 healthy matched controls were examined on a story comprehension task, in which inferences had to be made that either relied on perspective taking or not. The effects of task complexity were taken into account and executive function was assessed using an extensive neuropsychological test battery.

Results: The performance of Korsakoff patients declined with increasing complexity, but the pattern of decline for perspective-taking and non-perspective-taking stories was similar compared to that of the control group. Furthermore, the performance decline with increasing task complexity was directly related to the overall decline in executive functioning.

Conclusion: Executive dysfunction, not deficits in perspective taking per se, appears to underlie difficulties in story comprehension in patients with Korsakoff's syndrome.

Yoon H-K, Kim Y-K, Han C, Ko Y-H, Lee H-J, Kwon D-Y, Kim L. Paliperidone in the treatment of delirium: results of a prospective open-label pilot trial.

Objective: Delirium is a life-threatening neuropsychiatric syndrome characterised by disturbances in consciousness, attention, cognition and perception. Antipsychotics are considered the drugs of choice in managing the symptoms of delirium. Paliperidone is a benzisoxazole derivative and the principal active metabolite of risperidone. In this study, we aimed to evaluate the efficacy of paliperidone for the treatment of delirium.

Methods: A prospective open-label study of paliperidone for delirium treatment was performed with 6-day follow-up. Fifteen patients who met Diagnostic and Statistical Manual of Mental disorders, Fourth Edition criteria for delirium and had a score of 13 on the Delirium Rating Scale were recruited. The starting dose was 3 mg once a day and the dose was adjusted depending on the status of delirium. Daily assessments of the severity of delirium were evaluated using Memorial Delirium Assessment Scale (MDAS).

Results: The mean daily maintenance dose of paliperidone was 3.75 ± 1.06. The MDAS scores before and after treatment (day 7) were 23.60 ± 6.31 and 11.33 ± 5.45 (t = 6.78, p < 0.001), respectively. The intensity of delirium showed a statistically significant reduction in MDAS scores from the first day of treatment. No serious adverse effects were observed, and none of the patients discontinued paliperidone because of adverse effects.

Conclusions: This study shows that low-dose paliperidone is effective in reducing behavioural disturbances and symptoms in delirium and is well tolerated in delirious patients. This trial is an open-label study with a small sample size, and further controlled studies will be necessary.

Zhang X, Wang X, Sha W, Zhou H, Zhang Y. Val66Met polymorphism and serum brain-derived neurotrophic factor concentration in depressed patients.

Objective: Accumulating evidence has suggested a pathophysiological role for brain-derived neurotrophic factor (BDNF) in major depressive disorder (MDD). The present study evaluated serum levels of BDNF and explored whether Val66Met BDNF gene polymorphism is correlated with changes in circulating BDNF levels in patients with MDD and control subjects.

Methods: Subjects were 76 patients with MDD and 50 controls. Diagnosis of MDD was determined by the use of a structured clinical interview according to Diagnostic and Statistical Manual of Mental Disorder-IV (DSM-IV) criteria. The concentrations of BDNF were measured by using the enzyme-linked immunosorbent assay. The Val66Met BDNF gene polymorphism was examined by the polymerase chain reaction technique.

Results: Serum BDNF was significantly lower in MDD patients than in normal control subjects (p < 0.001). There were no significant differences either in allele or genotype in the Val66Met polymorphism between the MDD and control groups. Moreover, genotype did not significantly correlate with the BDNF serum levels in the MDD or control groups.

Conclusions: Our study suggests that there is a decrease in serum BDNF levels in untreated MDD patients. However, serum BDNF levels were not associated with the Val66Met polymorphism.

Monaco F, Mula M, Cavanna AE. The neurophilosophy of epileptic experiences.

Background: Specific alterations of consciousness have a central role in the phenomenological description of epileptic seizures and in the patient's subjective reports.

Methods: This article discusses the use of philosophical methodology within a neurological framework to understand consciousness.

Results: How the alterations in consciousness are experienced by patients with epilepsy depends largely on the localization of the underlying neurophysiological dysfuntion.

Discussion: Rigorous conceptual analysis of ictal experience reports can help to illuminate the study of consciousness.

Nimmagadda SR, Agrawal N, Worrall-Davies A, Markova I, Rickards H. Determinants of irritability in Huntington's disease.

Objectives: Irritability is a common and disabling problem associated with Huntington's disease (HD). However, the underlying causes of such irritability remain unclear. This study investigates the association of irritability in HD with possible aetiological factors including dysexecutive syndrome, depression, anxiety (state and trait) and movement disorder.

Methods: Thirty patients with genetically confirmed HD and their carers were recruited from a regional HD neuropsychiatry service. Patients completed two self-reported questionnaires (Irritability, Anxiety and Depression Scale and State Trait Anxiety Inventory). Their carers filled in the Burns Irritability Scale. Patients were also administered the Behavioural Assessment of Dysexecutive Syndrome (BADS), Montgomery and Asberg Depression Rating Scale (MADRS) and the Motor component of the Unified Huntington's Disease Rating Scale (UHDRS).

Results: Both self-rated and carer-rated irritability scales showed significant positive correlation with trait anxiety. The self-rated irritability scales also showed significant positive correlation with state anxiety and depression. No association was observed between irritability and dysexecutive syndrome or motor impairment.

Conclusions: Trait anxiety might serve as a predictor for irritability in HD. Irritability is unrelated to motor or cognitive features of HD indicating that it is an independent neuropsychiatric manifestation of HD.

Yang L, Ruan L-M, Ye H-H, Cui H-B, Mu Q-T, Lou Y-R, Ji Y-X, Li W-Z, Sun D-H, Chen X-B. Depression is associated with lower circulating endothelial progenitor cells and increased inflammatory markers.

Objective: To test the hypothesis that depression status in subjects without cardiovascular diseases (CVD) or diabetes is associated with depletion of circulating endothelial progenitor cells (EPCs) and impaired endothelial function.

Method: Thirty depressive persons with the first episode of depression (case group) diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and 30 healthy people (control group) were investigated. The depression status was estimated using Hamilton Rating Scale of Depression from which the criteria of depression are determined to be >21 score. EPCs labeled with CD34-ECD, CD133-phycoerythrin and kinase insert domain receptor (KDR)-fluorescein isothiocyanate antibodies were counted by flow cytometry in the peripheral blood of patients and control subjects. Mononuclear cells that were positive for CD34/KDR, CD133/KDR and CD34/CD133/KDR within the lymphocyte population were characterised as different phenotypes of EPCs.

Results: There were no significant differences in baseline clinical characteristics between patients and healthy individuals (all p > 0.05). However, patients with depression had significantly lower levels of circulating CD34+CD133+KDR+ EPCs (132.20 ± 17.27 vs. 225.93 ± 9.88, p = 0.000) and endothelial colony-forming units (26.40 ± 3.79 vs. 36.60 ± 2.88, p = 0.000) than that of healthy subjects. Furthermore, CD34+CD133+KDR+ EPCs had a negative correlation with tumour necrosis factor-α (Spearman's ρ = 0.433, p = 0.000) and interleukin-6 (Spearman's ρ = 0.441, p = 0.032).

Conclusion: Our result shows that depression was associated with lower levels of circulating EPCs, which may contribute to the development of endothelial dysfunction and atherosclerosis.

Tomruk NB, Saatcioglu O, Yildizhan E, Alpay N. Aripiprazole-induced tardive dyskinesia treated with quetiapine: a case report.

Background: Tardive dyskinesia (TD) is a serious, potentially irreversible side effect of antipsychotics. Although the risk is smaller, atypical antipsychotics still pose a risk. Aripiprazole is an atypical antipsychotic with a unique mechanism of action. It has a partial agonistic effect on the presynaptic D2 dopamine autoreceptor and antagonistic effect at postsynaptic D2 receptors.

Method: There have been a few case reports of aripiprazole-induced TD. A case of aripiprazole-induced TD successfully treated with another atypical antipsychotic, quetiapine, is described and discussed in line with the recent literature.

Results: TD showed rapid improvement with discontinuation of aripiprazole and initiation of quetiapine.

Conclusion: Further studies are needed to ascertain the differential effects and side effects of second-generation antipsychotics in terms of TD.

Soltan W, Sitek E, Wichowicz H, Wieczorek D, Slawek J. Abnormal gait and bradykinesia in the preclinical phase of Huntington's disease – psychogenic movement disorder?

Objective: Psychiatric symptoms may occur in individuals at risk of Huntington's disease (HD) regardless of their genetic status. Psychopathological symptomatology is attributed to both genetic and environmental factors. In case of asymptomatic gene carriers, psychiatric symptoms may precede involuntary movements.

Methods: We report the first case with abnormal gait and bradykinesia in preclinical adult HD. A 33-year-old woman blind to her mother's HD diagnosis and her own genetic status developed motor slowing and gait disturbance. The symptoms withdrew due to counselling and antidepressant medications. Subsequently, she was informed her own and her mother's genetic testing results, but 2-year follow-up did not reveal the onset of choreic movements, cognitive deterioration or depressive symptoms in the patient. Personality assessment (Minnesota Multiphasic Personality Inventory) and neurological examination results are presented, accompanied by 2-year follow-up data. Follow-up examination included Unified Huntington's Disease Rating Scale (motor, behaviour and function), Beck Depression Inventory, Hamilton Depression Rating Scale and neuropsychological assessment (trail-making test, Stroop test, verbal fluency trials, symbol digit modalities test, digit span, serial seven subtraction, Hopkins verbal learning test and nine-hole peg test).

Conclusion: Motor abnormalities in individuals at risk of HD may be of psychogenic origin. It is a matter of debate if this psychogenic reaction presented as hypokinetic syndrome may be a result of choreic movements of her mother (hyperkinetic syndrome) and depression or if this psychogenic reaction represents the preclinical psychiatric abnormalities in an asymptomatic gene carrier preceding the onset of the disease.

Réus GZ, Stringari RB, Ribeiro KF, Luft T, Abelaira HM, Fries GR, Aguiar BW, Kapczinski F, Hallak JE, Zuardi AW, Crippa JA, Quevedo J. Administration of cannabidiol and imipramine induces antidepressant-like effects in the forced swimming test and increases brain-derived neurotrophic factor levels in the rat amygdala.

Objective: Cannabidiol is a chemical constituent from Cannabis sativa and it has multiple mechanisms of action, including antidepressant effects. The main objective of the present study was to evaluate behavioural and molecular effects induced by administration of cannabidiol and imipramine in rats.

Methods: In the present study, rats were acutely or chronically treated for 14 days once a day with saline, cannabidiol (15, 30 and 60 mg/kg) or imipramine (30 mg/kg) and the animals behaviour was assessed in forced swimming and open-field tests. Afterwards, the prefrontal cortex, hippocampus and amygdala brain-derived neurotrophic factor (BDNF) levels were assessed by enzyme-linked immunosorbent sandwich assay.

Results: We observed that both acute and chronic treatments with imipramine at the dose of 30 mg/kg and cannabidiol at the dose of 30 mg/kg reduced immobility time and increased swimming time; climbing time was increased only with imipramine at the dose of 30 mg/kg, without affecting locomotor activity. In addition, chronic treatment with cannabidiol at the dose of 15 mg/kg and imipramine at the dose of 30 mg/kg increased BDNF levels in the rat amygdala.

Conclusion: In conclusion, our results indicate that cannabidiol has an antidepressant-like profile and could be a new pharmacological target for the treatment of major depression.

Hsu WY, Chiu NY, Huang SS. Hydroxychloroquine-induced acute psychosis in a systemic lupus erythematosus female.

Background: Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease. Hydroxychloroquine, a kind of anti-malarial, has become an important treatment for SLE in recent years.

Method: We want to report a 49 year-old female SLE patient, who had psychosis episode with hydroxychloroquine treatment.

Result: There's still risk of psychosis with hydroxychloroquine treatment from the possible mechanism.

Conclusion: Awareness of chloroquine-induced psychosis is very important, and psychiatric intervention is needed as soon as possible after this occurs.

Karanasios P, Loukopoulou P, Zampakis P, Tiligadas T, Makridou A, Doukas V, Argyriou AA. Foreign accent syndrome caused by a left temporal–parietal ischaemic stroke.

Aim: We present the first reported case of a Greek patient with foreign accent syndrome (FAS) secondary to a left temporal-parietal ischemic stroke.

Case report: A 76 year-old right-handed, Greek in origin, male was referred because he had suddenly manifested changes in speech expression. The neurological examination revealed that his prior typical English-Australian accent resembled a mixture of Greek and English-Britain accent consistent with FAS, though he had visited only once Greece the last 15 years and never had been to United Kingdom.

Results: A brain Magnetic Resonance Imaging scan depicted an ischemic temporal lesion in the language-dominant left hemisphere, affecting the left posterior superior and middle temporal gyri, as well as the ipsilateral inferior supramarginal angular gyrus and posterior insula.

Conclusion: We might suggest that FAS in our patient was induced because of interrupted cortical-subcortical feedback pathways. The phenomenon of subcortical-cortical diaschisis might also have contributed to its clinical manifestation.

Havaki-Kontaxaki BJ, Ferentinos PP, Kontaxakis VP, Kontaxaki M-I V, Geronikola X, Armeniakos I, Papadimitriou GN. Low-dose clozapine monotherapy for recurring episodes of depression, hypersomnia and behavioural disturbances: a case report.

Case Report: We present a 27-year-old woman who manifested recurrent episodes of hypersomnia, compulsive hyperphagia, hypersexuality, impulsive behaviours, irritability and depressive mood since the age of 13 after a viral febrile infection. She had 3–4 episodes/year lasting from a few days to 2–3 weeks which were managed with various psychotropics. During her last episode, she was admitted because of persistent behavioural disturbances. Brain 99m-Tc-ethyl cysteinate dimer single-photon emission computed tomography scans showed bilateral mesiotemporal and thalamic hypoperfusion, more significant in the right hemisphere. While hospitalised, she developed neuroleptic malignant syndrome following haloperidol administration. She was discharged on clozapine 100 mg/day. Over the following 30 months, she remained symptom free on clozapine 50–100 mg/day.

Discussion: Differential diagnosis included either an atypical recurrent mood disorder with hypersomnia and behavioural disturbances or Kleine–Levin syndrome.

Conclusion: Low-dose clozapine monotherapy may worth being further investigated for the management of recurring episodes of depression, hypersomnia and behavioural disturbances.