Patients with seizure of frontal lobe origin can present with bizarre behavior. At times, this bizarre behavior can be unrecognized or confused with seizure of other origin with nonepileptic events or with psychiatric disorder.

I recently saw a patient who began to experience events that were characterized by terrible fear which was followed by irritability. It was as if she could not stand in place where she was at and felt like running away. She was referred to a psychiatrist who diagnosed her to have panic disorder. She was subsequently treated for panic disorder. Her symptoms did not improve; therefore, she came to see me for a second opinion. Upon asking, the patient reported that the episodes were always the same and that they lasted approximately seconds to minutes. Due to the stereotypicity of the event and a normal routine electroencephalography (EEG), we requested that she would undergo a 24-hour video-monitoring EEG. Stereotypicity can help the physician in the differential diagnosis of psychiatric disorder versus a seizure disorder. During 24-hour video-monitoring EEG, she experienced several of these events. Also, a computer tomography scan was performed, which showed a small meningioma in the orbital frontal region.

Beginning this month and appearing periodically in future columns, “Trends in Psychopharmacology” will cover a new concept and hot topic in the field, namely, that of “multifunctional drugs.” The concept is presented in overview here. Future installments will cover specific drugs in greater depth. Multifunctional drugs include those agents with more than one putative therapeutic mechanism of action.

Introduction: Excessive Internet use (EIU), also described as Internet addiction or pathological Internet use, has already become a serious social problem around the world. Some researchers consider EIU as a kind of behavioral addiction. However, there are few experimental studies on the cognitive functions of excessive Internet users (EIUers) and limited data are available to compare EIU with other addictive behaviors, such as drug abuse and pathological gambling.

Methods: In this study, we examined EIUers' functions of decision-making and prepotent response inhibition. Two groups of participants, EIUers and controls, were compared on these two functions by using a Gambling Task and a Go/no-go Task, respectively.

Results: Compared with controls, EIUers selected significantly less net decks in the Gambling Task (P =.007). Furthermore, the EIUers made progress in selecting strategy, but more slowly than did the control group (EIUers, chunk 3 > chunk 1, P<.001; controls, chunk 2 > chunk P<.001; controls, chunk 2 > chunk 1, P<.001). Interestingly, EIUers' accuracy during the no-go condition was significantly higher than that of controls (P=.018).

Conclusion: These results showed some similarities and dissimilarities between EIU and other addictive behaviors such as drug abuse and pathological gambling. The findings from the Gambling Task indicated that EIUers have deficits in decision-making function, which are characterized by a strategy learning lag rather than an inability to learn from task contingencies. EIUers' better performance in the Go/no-go Task suggested some dissociation between mechanisms of decision-making and those of prepotent response inhibition. However, EIUers could hardly suppress their excessive online behaviors in real life. Their ability of inhibition still needs to be further studied with more specific assessments.

Introduction: The characteristics of Asian American and white problem gamblers using a gambling helpline were examined to identify race-related differences.

Methods: Logistic regression analyses were conducted on data obtained from callers to a gambling helpline serving southern New England in 2000–2003, inclusive.

Results: Of the 144 phone calls used in the analyses, 72 were from Asian American callers and 72 were from white callers who were matched on gender, education, income, marital/cohabitation status, and age. Race-related differences were observed in forms of gambling problems, psychiatric problems secondary to gambling, substance use problems, and family history. Asian American gamblers were more likely to report suicide attempts related to gambling and problems with non-strategic gambling. White gamblers were more likely to report both casino and non-casino gambling problems and personal and familial alcohol use problems. High proportions of both groups reported problems with strategic gambling, gambling-related anxiety, family and financial problems secondary to gambling, financial debt, daily tobacco use, and a family history of problem gambling.

Conclusion: Race-related differences should be considered in optimizing prevention and treatment strategies related to problem gambling.

Introduction: Aripiprazole, a dopamine D2 receptor partial agonist, has also partial agonist activity at serotonin (5-HT)1A receptors and antagonist activity at 5-HT2A receptors.

Methods: In this 8-week, multicenter, randomized, parallel-group, open-label, flexible-dose study, patients diagnosed with schizophrenia or schizoaffective disorder were randomized to aripiprazole 15–30 mg/day or haloperidol 10–15 mg/day.

Results: Patients treated with both aripiprazole and haloperidol improved from baseline in Positive and Negative Syndrome Scale total, positive, and negative scores as well as in Clinical Global Impressions scores (all P<.001). At the end of the study, the percentage of patients classified as responders—according to ≥40% reduction in the Positive and Negative Syndrome Scale negative subscale score—was significantly higher in the aripiprazole group (20%) than in the haloperidol group (0%) (P<.05). Additionally, a higher number of patients receiving haloperidol required more anticholinergic medications (P<.001) than aripiprazole-treated patients, whereas more aripiprazole (45.5%) than haloperidol-treated patients (12.9%) required benzodiazepines (P=.002). At endpoint, rates of preference of medication were higher in the aripiprazole group (63.2%) than in the haloperidol group (21.7%), as expressed by patients and caregivers (P=.001).

Conclusion: Aripiprazole and haloperidol had similar efficacy in terms of reduction of overall psychopathology. Although aripiprazole has been demonstrated to be superior concerning negative symptoms and in terms of tolerability (extrapyramidal symptoms) and preferred by patients and caregivers than haloperidol, significantly more aripiprazole-treated patients required benzodiazepines.