Safety and efficacy of psychopharmacological agents used to treat the psychiatric sequelae of common neurological disorders

Exploring polymeric biomaterials in developing neural prostheses

Neuroprosthetics, with a range of applications such as cognitive, auditory, pain relief, recording, motor, and visual prosthetics have emerged as a promising field in recent years. However, poor electrical conductivity, a high disparity between tissue and interfaces and the onset of reactive gliosis post-implantation remains major challenges in the development of neuroprostheses. The choice of biomaterials in designing the neural interfaces’ in neuroprosthetic applications is of high importance, as the overall sustained performance of neuroprosthetic devices is based on the features of materials used for the neural interfaces. Numerous biomaterials, such as metals and carbon-based materials, have been used in neuroprosthetics thus far. Nonetheless, neuroprosthetics made from polymeric biomaterials are in high demand due to their high biocompatibility, conductivity, and biostability. Furthermore, polymeric biomaterials can be used as a hybrid design to overcome the limitations of other co-biomaterials. This article makes an attempt to review the polymeric biomaterials involved in this cutting-edge technology utilized for different purposes such as substrates, coatings, and miniaturization of electrodes, that might help in enriching our understanding on neuroprosthetics.

Depressive syndromes in neurological disorders

Depressive syndromes represent a common and often characteristic feature in a number of neurological disorders. One prominent example is the development of post-stroke depression, which can be observed in more than one-third of stroke survivors in the aftermath of an ischemic stroke. Thus, post-stroke depression represents one of the most prevalent, disabling, and potentially devastating psychiatric post-stroke complications. On the other hand, depressive syndromes may also be considered as a risk factor for certain neurological disorders, as recently revealed by a meta-analysis of prospective cohort studies, which demonstrated an increased risk for ischemic events in depressed patients. Moreover, depressive syndromes represent common comorbidities in a number of other neurological disorders such as Parkinson's disease, multiple sclerosis, or epilepsy, in which depression has a strong impact on both quality of life and outcome of the primary neurological disorder.

[Depression and neurological diseases]

In many neurological diseases a depressive syndrome is a characteristic sign of the primary disease or is an important comorbidity. Post-stroke depression, for example, is a common and relevant complication following ischemic brain infarction. Approximately 4 out of every 10 stroke patients develop depressive disorders in the course of the disease which have a disadvantageous effect on the course and the prognosis. On the other hand depression is also a risk factor for certain neurological diseases as was recently demonstrated in a meta-analysis of prospective cohort studies which revealed a much higher stroke risk for depressive patients. Furthermore, depression plays an important role in other neurological diseases with respect to the course and quality of life, such as Parkinson's disease, multiple sclerosis and epilepsy. This article gives a review of the most important epidemiological, pathophysiological and therapeutic aspects of depressive disorders as a comorbidity of neurological diseases and as a risk factor for neurological diseases.

Long-term psychiatric outcomes following traumatic brain injury: a review of the literature

OBJECTIVE

To determine the relationship between traumatic brain injury (TBI) and long-term psychiatric health outcomes, occurring 6 months or more after TBI.

PARTICIPANTS

Not applicable.

DESIGN

Systematic review of the published, peer-reviewed literature.

PRIMARY MEASURES

Not applicable.

RESULTS

We identified studies that examined psychiatric disorders following TBI. There was sufficient evidence of an association between TBI and depression and similarly compelling evidence of an association between TBI and aggression. There was limited/suggestive evidence of an association between TBI and subsequent completed suicide, decreased alcohol and drug use compared to preinjury levels, and psychosis. While there was also limited/suggestive evidence for posttraumatic stress disorder (PTSD) in military populations with TBI, there was inadequate evidence to reach a conclusion about whether TBI was associated with PTSD in civilian populations.

CONCLUSION

TBI is associated with a wide range of psychiatric disorders among individuals surviving at least 6 months. The association between mild TBI and PTSD seems to differ in military and civilian populations.

A clinical pathway including psychotherapy approaches for managing emotional difficulties after acquired brain injury

Emotional difficulties, such as anxiety and depression, are common after acquired brain injury in adults and can influence long-term outcome. Diagnosis in a brain injury context can be difficult. Ideally, rehabilitation approaches should consider the specific treatment of anxiety and depression as well and may include pharmacotherapy, individual psychotherapy, and family interventions. Psychotherapy, especially in regards to longer-term adjustment to brain injury, may have an important adjunctive role in treatment approaches, but adaptations of techniques may be needed. A clinical pathway is described which can help to raise clinicians awareness, as well as increase detection rates and consideration of the specific role of individual psychotherapy in this clinical population. However, an important caveat is that clinical pathways should not serve as a substitute, but rather a facilitator, for the process of reasoning about individual patients in everyday clinical practice.