Aspects of the behavior of psychiatric inpatients with frontal lobe damage: some implications for diagnosis and treatment

Thalamic T-type Ca²+ channels mediate frontal lobe dysfunctions caused by a hypoxia-like damage in the prefrontal cortex

Hypoxic damage to the prefrontal cortex (PFC) has been implicated in the frontal lobe dysfunction found in various neuropsychiatric disorders. The underlying subcortical mechanisms, however, have not been well explored. In this study, we induced a PFC-specific hypoxia-like damage by cobalt-wire implantation to demonstrate that the role of the mediodorsal thalamus (MD) is critical for the development of frontal lobe dysfunction, including frontal lobe-specific seizures and abnormal hyperactivity. Before the onset of these abnormalities, the cross talk between the MD and PFC nuclei at theta frequencies was enhanced. During the theta frequency interactions, burst spikes, known to depend on T-type Ca(2+) channels, were increased in MD neurons. In vivo knockout or knockdown of the T-type Ca(2+) channel gene (Ca(V)3.1) in the MD substantially reduced the theta frequency MD-PFC cross talk, frontal lobe-specific seizures, and locomotor hyperactivity in this model. These results suggest a two-step model of prefrontal dysfunction in which the response to a hypoxic lesion in the PFC results in abnormal thalamocortical feedback driven by thalamic T-type Ca(2+) channels, which, in turn, leads to the onset of neurological and behavioral abnormalities. This study provides valuable insights into preventing the development of neuropsychiatric disorders arising from irreversible PFC damage.

Brain tumor location and psychiatric symptoms: is there any association? A meta-analysis of published case studies

A meta-analytic study of reports of brain tumors and psychiatric symptoms for the past 50 years was conducted to examine potential associations between tumor location and psychiatric symptoms. Results demonstrated that there is a statistically significant association between anorexia symptoms and hypothalamic tumors. For the rest of the brain regions a statistically significant association could not be definitively determined. However, several of the regions demonstrated an increased likelihood of associated symptoms when compared with other regions. The methodological limitations of this analysis are discussed.

Brain Neoplasm and the Potential Impact on Self-Identity

Cancers of the brain can cause alterations in a person's neurocognitive abilities, and in some patients can even challenge their concept of self and self-identity. Cancer treatment may offer some hope for longer survival, but residual neurocognitive alterations generally remain. Individualized care for these patients should include information related to anticipated effects of their disease or treatments affecting their perception or expression of self. At present, the concepts of self and self-identity are largely unexplored in neuro-oncology, but we will discuss this clinical population in order to highlight the need for further clinical evaluation of these phenomena among patients with brain neoplasm. Finally, we will briefly note the need for a clinical tool to assess self and self-identity changes in brain tumor patients.

Evaluation of brain injury related behavioral disturbances in community mental health centers

As a result of improved emergency trauma services, more individuals suffering a traumatic brain injury are surviving. Unfortunately, most of these survivors suffer chronic neuropsychiatric sequelae related to both the brain damage and the psychosocial impact of the injury on self-esteem, self-image, primary role, and vocational function. Current community supports are often inadequate to deal with the complex array of neurologic and psychiatric difficulties. This article outlines common features of brain injury, explores the link between these features and the common neuropsychiatric sequelae of brain injury, and suggests some principles helpful in the evaluation of the behaviorally challenged brain injured patient.

Oedipism in a patient with frontal lobe encephalomalacia

There is a growing recognition of the role of the frontal lobes in the aetiology of severe behavioural aberrations. The authors describe a case of Oedipism in a patient who had MRI evidence of frontal lobe encephalomalacia. After discussing the function of the frontal lobes in modulating behaviour the authors suggest that the structural lesion seen on the MRI was in part responsible for the patient's self-destructive act. Treatment issues and the importance of recognizing underlying structural lesions in instances of extreme self-mutilation are discussed.

The Staggered Spondaic Word Test. A ten-minute look at the central nervous system through the ears

We have described three major groupings that encompass most auditory processing difficulties. While the problems may be superimposed upon one another in any individual client, each diagnostic sign is closely associated with particular communication and learning disorders. In addition, these behaviors may be related back to the functional anatomy of the regions that are implicated by the SSW test. The auditory-decoding group is deficient in rapid analysis of speech. The vagueness of speech sound knowledge is thought to lead to auditory misunderstanding and confusion. In early life, this may be reflected in the child's articulation. Poor phonic skills that result from this deficit are thought to contribute to their limited reading and spelling abilities. The auditory tolerance-fading memory group is often thought to have severe auditory-processing problems because those in it are highly distracted by background sounds and have poor auditory memories. However, school performance is not far from grade level, and the resulting reading disabilities stem more from limited comprehension than from an inability to sound out the words. Distractibility and poor auditory memory could contribute to the apparent weakness in reading comprehension. Many of the characteristics of the auditory tolerance-fading memory group are similar to those of attention deficit disorder cases. Both groups are associated anatomically with the AC region. The auditory integration cases can be divided into two subgroups. In the first, the subjects exhibit the most severe reading and spelling problems of the three major categories. These individuals closely resemble the classical dyslexics. We presume that this disorder represents a major disruption in auditory-visual integration. The second subgroup has much less severe learning difficulties, which closely follow the pattern of dysfunction of the auditory tolerance-fading memory group. The excellent physiological procedures to which we have been exposed during this Windows on the Brain conference provide a glimpse of the exciting possibilities for studying brain function. However, in working with individuals who have cognitive impairments, the new technology should be validated by standard behavioral tests. In turn, the new techniques will provide those who use behavioral measures with new parameters and concepts to broaden our understanding. For the past quarter of a century, the SSW test has been compared with other behavioral, physiological, and anatomical procedures. Based on the information that has been assembled, we have been able to classify auditory processing disorders into three major categories.(ABSTRACT TRUNCATED AT 400 WORDS)

Neuropsychological assessment and brain imaging technologies in evaluation of the sequelae of blunt head injury

A 43 year old man with a traumatic amnesic syndrome experienced only a brief, if any, loss of consciousness following an injury to the head. Four years after this injury, his results on standard psychometric assessment were normal. Long-latency evoked response potentials results were normal, and the neurological examination and computed tomography scans were unhelpful in explaining his amnesic symptoms. He had no history of alcohol abuse, yet his neuropsychological profile was that of a Korsakoff-like amnesia with frontal lobe features. Magnetic-resonance images demonstrated evidence of extensive frontal lobe damage, while cerebral blood flow studies provided additional evidence of bilateral frontal lobe dysfunction. The case highlights the need for those giving opinions in medico-legal head trauma cases to go beyond a reliance on routine indicators, such as duration of coma, results of standard psychometric assessment and computed tomography scans, to more specialised neuropsychological evaluations and magnetic-resonance imaging scans.

Psychiatry and the frontal lobes

The frontal lobes of the brain have long been regarded as enigmatic in their function and perhaps should be considered even more so in states of dysfunction. Observed associations between structural lesions and psychiatric symptoms and the demonstration of disturbed function and morphology in the frontal lobes of individuals suffering from major psychiatric disorders have led to increased interest in this brain area. Psychiatrists have been particularly concerned with seeking the aetiogenesis of common diagnostic entities and this article attempts to synthesize the available facts. A brief overview of relevant biological data precedes a description of methods of neuropsychological testing and the clinical features arising from frontal lobe damage. A discussion of the role of the frontal lobes in some aspects of personality function follows. Neuropsychiatric features associated with known frontal lobe pathology are described, prefacing a discussion of those psychiatric conditions where an aetiological role for frontal lobe dysfunction has been proposed.