Psychiatry and the frontal lobes

Treatment status of psychiatric disorders and falls in the workplace among Japanese workers: a nationwide cross-sectional study

OBJECTIVES

In Japan, the most common injury requiring sick leave is a fall in the workplace; therefore, it is very important to prevent falls. Most measures to prevent falls involve aspects of the workplace environment and safety. However, few measures consider the perspective of individual health. We investigated the relationship between psychiatric disorders and falls in the workplace and whether treatment status for a psychiatric disorder is associated with workplace falls.

METHODS

We conducted a cross-sectional study among workers aged 20 years or older in Japan from February 28 to March 3, 2022. In total, the data of 27 693 participants were analyzed. We used a questionnaire to query participants' status of treatment for any psychiatric disorder and whether they had experienced a fall in the workplace. The association between treatment for a psychiatric disorder and workplace falls was examined using logistic regression analysis.

RESULTS

Compared with participants receiving appropriate treatment for a psychiatric disorder, the odds ratio (OR) of a workplace fall was significantly lower among participants who did not require treatment for a psychiatric disorder, at 0.56 (95% CI: 0.47-0.66; P < .001); the OR of a workplace fall was significantly higher among participants whose treatment for a psychiatric disorder was interrupted, at 1.47 (95% CI: 1.21-1.78; P < .001), after adjusting for age, sex, household income, number of workplace employees, sleeping hours, exercise habits, and psychological distress.

CONCLUSIONS

Our findings suggest that receiving appropriate treatment for psychiatric disorders may contribute to preventing falls in the workplace.

Iatrogenic cerebral abscess leading to resolution of severe delusional disorder

A cerebral abscess (focal infection of brain parenchyma) carries a high mortality and morbidity. Iatrogenic cerebral abscesses are less common and make up 10% of all cases. The presence of a cerebral abscess can rarely improve a patient's prognosis and quality of life, however this case illustrates an abscess and its treatment following a prolonged course of antibiotics leading to resolution of a severe psychotic disorder. This is a case report of a 32-year-old female inpatient at a psychiatric hospital with a long-standing history of congenital hydrocephalus, cerebral palsy and organic delusional disorder who developed an iatrogenic cerebral abscess after insertion of an implantable intracranial pressure monitoring device. After receiving treatment of 6 weeks of intravenous meropenem the patient's mental condition rapidly improved, she became stable and euthymic and was discharged home. The patient has since had no delusions or hallucinations and is living independently at home.

Regional cerebral blood flow and neuropsychological functioning in early and late onset alcoholism

The aim of the study was to compare late and early onset alcoholism with regard to regional cerebral blood flow (rCBF) and neuropsychological functioning. Ten late onset and 13 early onset male alcoholics were included in the study, the criterion being the age of onset for alcohol abuse. Six healthy male volunteers were included as a control group. Regional measures of cortical cerebral blood flow were assessed using Tc-99m-HMPAO single photon emission computed tomography (SPECT) after a detoxification period. When compared with the control group, the early onset group showed reduced relative perfusion in the left superior frontal region, while relative perfusion in the late onset group was deficient in both right and left superior frontal regions. Both groups of alcoholic patients also displayed impairment in frontal lobe functions and non-verbal memory. The results of this study indicate that early onset alcoholism is associated with hypoperfusion in the left superior frontal region while the late onset subtype is characterized by uniformly hypoperfused left and right superior frontal regions. Additionally, both groups of alcoholic patients exhibit an almost identical pattern of neuropsychological abnormalities mainly related to frontal lobe functions and non-verbal memory. Collectively these findings support previous evidence suggesting a key role of frontal lobe pathology in understanding the neurobiology of alcoholism.

"Anorexia saved my life": coincidental anorexia nervosa and cerebral meningioma

OBJECTIVE

We report on a 13-year-old girl with coincidental occult intracranial tumor and early-onset anorexia nervosa.

METHOD

The cerebral meningioma was discovered fortuitously as the result of a research project using SPECT imaging to locate a neurobiological substrate in patients with anorexia nervosa. Without SPECT, the meningioma would have remained undiagnosed until it had become symptomatic. The two conditions appear to have been completely unrelated.

RESULTS AND DISCUSSION

The case highlights two important points. First, intracranial pathology should also be considered however certain is the diagnosis of early-onset anorexia nervosa. Second, neuroimaging plays an important part in diagnosing early-onset anorexia nervosa, both from a clinical and a research prospective.

A comparison of neuropsychological tests for the assessment of chronic toxic encephalopathy

BACKGROUND

From the viewpoint of the clinical neuropsychologist, it is not evident if the detection of solvent induced toxic encephalopathy (TE) could be optimized by a modification of the traditional test batteries, adding tests covering new dimensions or monitoring further functional domains.

METHODS

To clarify this issue, TE patients were re-examined with (a) the tests traditionally used in screening for TE and (b) some tests hitherto less utilized within neurotoxicology, involving complex attention and frontal lobe functioning.

RESULTS

The results do not indicate that tests of the latter category would be more sensitive to TE than the tests traditionally used. Using an optimized core battery, compiled of tests from both categories, the sensitivity and specificity levels reached a maximum of around 0.7 when using as criterion the reproduction of a subnormal test profile (TE type 2B).

CONCLUSIONS

A combination of several traditional and a few newer tests is suggested to optimize the detection of TE. Repeated assessments over time are also recommended.

Single photon emission computerised tomography in chronic alcoholism. Antisocial personality disorder may be associated with decreased frontal perfusion

BACKGROUND

We examined the functional and structural cerebral changes in chronic alcoholics, analysing their association with personality features and alcohol drinking habits.

METHOD

Forty patients with alcohol dependency, including 15 with antisocial personality disorder (ASP) as defined in DSM-III-R and 10 age and sex matched healthy controls were studied after termination of withdrawal symptoms, using high resolution single photon emission tomography (SPECT), cranial computerised tomography (CT) and brainstem auditory evoked potentials (BAEP).

RESULTS

We found significant reductions in regional cerebral blood flow (rCBF) measurements of alcoholic patients. Low flow in frontal regions encountered in 67.5% of the patients was associated with the duration of alcohol consumption, while no such relation existed with the amount of daily intake. Patients with ASP exhibited more marked frontal hypoperfusion. Significant brain atrophy detected by CT was present in 40% of the patients and did not correlate with frontal hypoperfusion.

CONCLUSIONS

Patients with ASP are more sensitive to toxic effects of alcohol. Alternatively chronic alcoholism leads to frontal lobe dysfunction recognised as ASP in the clinical setting.

Frontal lobology--psychiatry's new pseudoscience

The frontal lobes are the most evolutionarily advanced organ of the body. Here lies the seat of the highest human functions of thought, intellect, creativity, self-control and social interaction (Milner & Petrides, 1984; Lishman, 1987; Russell & Roxanas, 1990; Kolb & Wishaw, 1990). As one recent reviewer notes (Reading, 1991), it is hard to avoid ‘sounding metaphysical’ when going through such a list. It seems that, in accordance with psychiatry's own late phylogenesis, the frontal lobes have only just been discovered.

The brain and higher mental function

Critical evaluation of biological theories of psychiatric disorder requires an understanding of current concepts of higher mental function and its related biology. Both the nature of the topic and the rapidity of advances in the field make it difficult to obtain an updated synthesis. Part I of this paper attempts to provide that by reviewing current concepts of the mind/body relationship, emotion, arousal, attention, consciousness and motivation. Part II considers those concepts in relation to recent work on the structure and function of the reticular, limbic and anterior cerebral systems. It is concluded that the model of the limbic system as subserving emotional life could now perhaps be set aside in favour of the model of a core set of chemically identified neurons in the reticular system being necessary but not sufficient to subserve higher mental function whilst also subserving other integrating functions for which no mental terminology is required. The problem of developing an eclectic theory of higher mental function that will embrace these concepts is discussed.