[Renewed interest in neuropsychiatry within child and adolescent psychiatry]

Child and adolescent psychiatry has existed as a subspecialty since the 1920s. In the early days its practitioners regarded observation as their main source of knowledge. In the period after 1970 the anti-psychiatric movement gained momentum, presenting a threat to child and adolescent psychiatrists. Later on, however, it was realised that the influence of the anti-psychiatry movement had been fairly limited and that the most important changes had occurred as a result of the introduction of the empirical method, which in turn has led to renewed interest in neuropsychiatry.

Geriatric neuropsychology: implications for front line clinicians

Consistent with the aging population, neuropsychologists are being asked with increased frequency to evaluate older adults. These assessments are often complicated by medical and psychiatric co-morbidities, polypharmacy, and complex psychosocial and legal issues that are frequently encountered in this population. The aim of this review article is to address the challenges neuropsychologists and other frontline clinicians often confront when evaluating older individuals. Specifically, we review psychiatric and medical co-morbidities, testing accommodations, diagnostic versus descriptive testing approaches, normative issues, polypharmacy, and reimbursement rates. Finally, future implications are discussed for advancing the neuropsychologist's role in evaluating and treating older individuals.

[On the reunion between neurology and psychiatry. An old neuropsychiatrist's reflections]

What appears in this article is nothing more than a series of reflections on psychiatry and neurology based on my own experience as an educator, practitioner and scholar of both disciplines. It is not, therefore, a piece of research work in the usual sense of the word. Such has been my commitment to Revista de Neurologia that I was asked to analyse the current situation of neurology and psychiatry and the possible relations between them, and the editors have accepted this way of studying the matter.

An Internet-based symptom questionnaire that is reliable, valid, and available to psychiatrists, neurologists, and psychologists

The Neuropsych Questionnaire (NPQ) addresses 2 important clinical issues: how to screen patients for a wide range of neuropsychiatric disorders quickly and efficiently, and how to acquire independent verification of a patient's complaints. The NPQ is available over the Internet in adult and pediatric versions. The adult version of the NPQ consists of 207 simple questions about common symptoms of neuropsychiatric disorders. The NPQ scores patient and/or observer responses in terms of 20 symptom clusters: inattention, hyperactivity-impulsivity, learning problems, memory, anxiety, panic, agoraphobia, obsessions and compulsions, social anxiety, depression, mood instability, mania, aggression, psychosis, somatization, fatigue, sleep, suicide, pain, and substance abuse. The NPQ is reliable (patients tested twice, patient-observer pairs, 2 observers) and discriminates patients with different diagnoses. Scores generated by the NPQ correlate reasonably well with commonly used rating scales, and the test is sensitive to the effects of treatment. The NPQ is suitable for initial patient evaluations, and a short form is appropriate for follow-up assessment. The availability of a comprehensive computerized symptom checklist can help to make the day-to-day practice of psychiatry, neurology, and neuropsychology more objective.

Neuropsychology: traditional and new methods of investigation

The neuropsychological assessment is an integral part of the clinical investigation of patients suffering from epilepsy. The aim of the evaluation is to determine disease-related and treatment-related effects on cognition and behavior in order to orient therapeutic interventions, by taking into account the compensatory mechanisms that are available to the patient. Examples of the tests best illustrating the classical neuropsychological protocol are presented. Neuropsychology also plays an important role in the assessment of language lateralization in patients slated for epilepsy surgery. Traditionally, this has been achieved by means of the rather invasive Wada procedure. However, with the advent of new neuroimaging techniques, this procedure is gradually being replaced by minimally invasive or noninvasive methods, such as functional magnetic resonance imaging, positron emission tomography, and optical imaging. In the present paper, we discuss some of the newer techniques that are available to the neuropsychologist for the study of the impact of epilepsy on cerebral functioning.

Cognitive rehabilitation in the elderly: overview and future directions

This study provides an overview of the papers emanating from the experimental trial that evaluated a new cognitive rehabilitation program in older adults who were experiencing normal cognitive decline. The main features of the design are summarized, along with evidence that the training produced long-lasting improvement in memory performance, goal management, and psychosocial status. The benefits were attributed to several factors, including the program's emphasis on techniques that promoted efficient strategic processing. Limitations of the program and directions for future research are discussed.

Glycosylated neuropeptides: a new vista for neuropsychopharmacology?

The application of endogenous neuropeptides (e.g., enkephalins) as analgesics has been retarded by their poor stability in vivo and by their inability to effectively penetrate the blood-brain barrier (BBB). Effective BBB transport of glycosylated enkephalins has been demonstrated in several labs now. Analgesia (antinociception) levels greater than morphine, and with reduced side effects have been observed for several glycopeptides related to enkephalin. Somewhat paradoxically, enhanced BBB transport across this lipophilic barrier is achieved by attaching water-soluble carbohydrate groups to the peptide moieties to produce biousian glycopeptides that can be either water-soluble or membrane bound. Transport is believed to rely on an endocytotic mechanism (transcytosis), and allows for systemic delivery and transport of the water-soluble glycopeptides. Much larger endorphin/dynorphin glycopeptide analogs bearing amphipathic helix address regions also have been shown to penetrate the BBB in mice. This holds forth the possibility of transporting much larger neuropeptides across the BBB, which may encompass a wide variety of receptors beyond the opioid receptors.

Coalescence of psychiatry, neurology, and neuropsychology: from theory to practice

In a climate of renewed interest in the synergy between neurology and psychiatry, practitioners are increasingly recognizing the importance of exchange and collaboration between these two disciplines. However, there are few working models of interdisciplinary teams that freely share expertise in real time, while providing clinical and academic training to future physicians who specialize in the central nervous system. Over the past 11 years, the McLean Hospital Neuropsychiatry and Behavioral Neurology service has provided proof-of-principle for such collaboration, demonstrating that a team comprising psychiatrists, neurologists, and neuropsychologists can function effectively as a unit while maintaining the autonomy of these three disciplines and also synthesizing their combined knowledge. In addition to delivering enhanced patient care and promoting medical research, this clinical service has provided enriched cross-specialty training for fellows, residents, and medical students. The practical functioning of the team is described, and case vignettes are presented to illustrate the team's collaborative synergism in practice.

Cortical control of motor sequences

The neural substrate of sequence learning is well known. However, we lack a clear understanding of the detailed functional properties of many of the areas involved. The reason for this discrepancy lies, in part, in the fact that two types of processes, implicit and explicit, subserve motor sequence learning, and these often interact with each other. The most significant recent advances have been the elucidation of the very complex relationships between medial motor areas and the temporal and ordinal control of sequences, and the demonstration that motor cortex is an important site for sequence storage and production. The challenge for the future will be to develop a coherent and internally consistent theory of sequence control.

The multi-component model of working memory: Explorations in experimental cognitive psychology

There are a number of ways one can hope to describe and explain cognitive abilities, each of them contributing a unique and valuable perspective. Cognitive psychology tries to develop and test functional accounts of cognitive systems that explain the capacities and properties of cognitive abilities as revealed by empirical data gathered by a range of behavioral experimental paradigms. Much of the research in the cognitive psychology of working memory has been strongly influenced by the multi-component model of working memory [Baddeley AD, Hitch GJ (1974) Working memory. In: Recent advances in learning and motivation, Vol. 8 (Bower GA, ed), pp 47-90. New York: Academic Press; Baddeley AD (1986) Working memory. Oxford, UK: Clarendon Press; Baddeley A. Working memory: Thought and action. Oxford: Oxford University Press, in press]. By expanding the notion of a passive short-term memory to an active system that provides the basis for complex cognitive abilities, the model has opened up numerous questions and new lines of research. In this paper we present the current revision of the multi-component model that encompasses a central executive, two unimodal storage systems: a phonological loop and a visuospatial sketchpad, and a further component, a multimodal store capable of integrating information into unitary episodic representations, termed episodic buffer. We review recent empirical data within experimental cognitive psychology that has shaped the development of the multicomponent model and the understanding of the capacities and properties of working memory. Research based largely on dual-task experimental designs and on neuropsychological evidence has yielded valuable information about the fractionation of working memory into independent stores and processes, the nature of representations in individual stores, the mechanisms of their maintenance and manipulation, the way the components of working memory relate to each other, and the role they play in other cognitive abilities. With many questions still open and new issues emerging, we believe that the multicomponent model will continue to stimulate research while providing a comprehensive functional description of working memory.

Uniquely human social cognition

Recent data identify distinct components of social cognition associated with five brain regions. In posterior temporal cortex, the extrastriate body area is associated with perceiving the form of other human bodies. A nearby region in the posterior superior temporal sulcus is involved in interpreting the motions of a human body in terms of goals. A distinct region at the temporo-parietal junction supports the uniquely human ability to reason about the contents of mental states. Medial prefrontal cortex is divided into at least two subregions. Ventral medial prefrontal cortex is implicated in emotional empathy, whereas dorsal medial prefrontal cortex is implicated in the uniquely human representation of triadic relations between two minds and an object, supporting shared attention and collaborative goals.

Motor Development and Neuropsychological Patterns in Persons with Down Syndrome

Neuropsychological research has permitted defining specific cognitive profiles among individuals with mental retardation (MR) of different etiology. Namely, the cognitive profile of people with Down syndrome (DS) is often reported to be characterized by a deficit in language abilities that usually exceed impairments in visual-spatial capacities. However, recent studies have demonstrated a more complex neuropsychological profile in this population, with atypical development in the cognitive and in the linguistic domain. This paper is dedicated to reviewing literature regarding motor, linguistic and cognitive abilities in DS. Our aim is to present evidences supporting the hypothesis that individuals with these syndrome exhibit a peculiar motor development and neuropsychological profile with some abilities more preserved and others more impaired. This finding may have theoretical and practical implications. In fact, a better definition of the cognitive pattern in DS may contribute to understand the nature of MR in general and, also, it may suggests individualized rehabilitation treatment protocols.

[Novel advances in neuropsychology--forward to the "deconstruction" of psychiatry]

Neuropsychology has recently become a science which deals not only with instrumental disorders (e.g., aphasia, apraxia, and agnosia), but also with impairments of interpersonal relationships (e.g., emotional cognitions, social decision making, and understanding others), and many important paradigms are already provided. We could enumerate several representative instances: (1)application of the "theory of mind" to autistic or related disorders (-->"reasoning of psychological state of others"), (2) neuropsychological studies on the "social brain" concerning emotional recognition or social recognition (-->"amygdale, orbitofrontal cortex, and medial ventral frontal cortex"), (3) identifying related cerebral areas (-->"superior temporal sulcus") to detect eye or body movements of others, (4) discovering the mirror neuron and mirror systems in monkeys and humans (-->"imitation of the behavior of others in the brain"), and (5) intracerebral processes which may occur precedent to conscious intention (-->"consciousness as post-hoc phenomena"). These novel paradigms might lead us to the "deconstruction" of psychiatry. We believe that the fundamental assignments of neuropsychology should inquire into "cognitive representation", "conscious representation", and "cerebral representation" about the inner processes of human activities. As these assignments would be almost the same for the psychiatric symptoms, we do not have any necessity to fundamentally distinguish psychiatric and neuropsychologial symptoms. These two kinds of signs will be attributed finally to the same dimension. The specificity of psychiatry resides in "conscious representation" and its cerebral foundations. We reconsidered the "Theory of Neural Group Selection" proposed by Edelman and the excellent experimental results on the relationship between intention and movements reported by Libet, et al.. All these results strongly indicate the absolute necessity to reconsider conscious causality and psychogenesis. Finally, we have presented two main neuropsychological hypotheses on the manifestation mechanism of Capgras syndrome. These are the "mirror impairment of prosopagnosia" hypothesis and the "self-other confusion resulting from right hemisphere dysfunction" hypothesis. We insisted on the importance of the right cerebral predominance hypothesis about self-other understanding processes and also the absolute necessity to shake ourselves free from language dependent consciousness theory. Common specificity in neuropsychology and psychiatry should be converged to, and symbolized by the novel concept of sociality, which is characterized for instance by emotional cognition or social decision making supported by the social brain and by shared cerebral representations for self-other understanding and consciousness processes.

Method matters: an empirical study of impact in cognitive neuroscience

A major thrust of cognitive neuroscience is the elucidation of structure-function relationships in the human brain. Over the last several years, functional neuroimaging has risen in prominence relative to the lesion studies that formed the historical core of work in this field. These two methods have different strengths and weaknesses. Among these is a crucial difference in the nature of evidence each can provide. Lesion studies can provide evidence for necessity claims, whereas functional neuroimaging studies do not. We hypothesized that lesion studies will continue to have greater scientific impact even as the relative proportion of such studies in the cognitive neuroscience literature declines. Using methods drawn from systematic literature review, we identified a set of original cognitive neuroscience articles that employed either functional imaging or lesion techniques, published at one of two time points in the 1990s, and assessed the effect of the method used on each article's impact across the decade. Functional neuroimaging studies were cited three times more often than lesion studies throughout the time span we examined. This effect was in large part due to differences in the influence of the journals publishing the two methods; functional neuroimaging studies appeared disproportionately more often in higher impact journals. There were also differences in the degree to which articles using one method cited articles using the other method. Functional neuroimaging articles were less likely to include such cross-method citations.

Pushing the frames of reference in traumatic brain injury rehabilitation

Cognitive rehabilitation is an empirically based field driven by multiple sources of activities and knowledge bases. Drawing on frames of reference provided by rehabilitation, neuropsychology, and rehabilitation psychology, cognitive rehabilitation has evolved to a point where studies have been generated to qualify for consideration in tables of evidence. At the center of cognitive rehabilitation is the effort to teach people to overcome or adapt to limitations. While rehabilitation has traditionally been focused on activity, a recent trend in the literature is to incorporate the individuals experience into a frame of reference for rehabilitation. Emphasizing the experience of the person in the situation fits into cognitive rehabilitation and raises the bar for rehabilitation not only in viewing rehabilitation as an activity to relieve burdens but also in terms of how rehabilitants come to grips with limitations. Dealing with limitations is an important indicator of mental health.