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Biomedical subjects

E C Lauterbach

Publications and source records attributed to E C Lauterbach.

At least 19 recordsLinked to original sources
PubMed2000

Posthallucinogen-like visual illusions (palinopsia) with risperidone in a patient without previous hallucinogen exposure: possible relation to serotonin 5HT2a receptor blockade.

BACKGROUND: Previous reports document visual illusions resembling hallucinogen persisting perception disorder (HPPD) after risperidone treatment in patients with histories of previous LSD exposure. METHODS: We report a case with visual disturbances resembling HPPD after each of three consecutive risperidone dose increases. RESULTS: Contrasting with previous reports, our patient lacked any history of substance abuse, particularly hallucinogen exposure. She lacked neurologic or other contributory illnesses. Illusions generally remitted within 48 hours each time. Coadministration of trazodone and clonazepam may have contributed to these phenomena, although clonazepam has been used to treat this condition. She had been unusually sensitive to the side-effects of many psychotropics. CONCLUSIONS: This case is unique due to the absence of substance abuse. This and another report note heightened sensitivity to medication side-effects. Visual phenomena resembling HPPD evidently can occur with risperidone and, possibly, other atypical antipsychotics and certain antidepressants regardless of previous hallucinogen use. Several lines of evidence implicate reduced 5HT2a serotonin receptor stimulation rather than increased 5HT2c stimulation.

Antidepressive Agents, Second-Generation↗
PubMed1999

Pharmacologic efficacy in neuropsychiatry: a review of placebo-controlled treatment trials. A report of the ANPA Committee on Research.

Psychiatric disorders frequently compound the disability and complicate the management of neurologic conditions. These disorders result in increased morbidity for the person afflicted, stress for the caregiver, and financial burden. This study reviews the randomized double-blind placebo-controlled pharmacologic treatment trials of psychosis, depression, anxiety, and agitation in neurologic conditions from 1966 to 1998. Ten studies involving psychosis, 13 involving depression, and 20 involving anxiety-agitation meeting the committee's criteria were identified. Relatively few randomized double-blind placebo-controlled pharmacologic treatment trials of psychiatric disorders complicating neurologic disease have been conducted. These trials do not strongly support one specific pharmacologic approach to treatment. Further study of newer psychotropic agents, augmentation strategies, and novel use of other agents may help improve the treatment of psychiatric disorders observed in patients with neurologic disease.

Humans↗
PubMed1998

The clinician-scientist in neuropsychiatry: a position statement from the Committee on Research of the American Neuropsychiatric Association.

Neuropsychiatric research seeks to improve the lives of patients with brain-based behavioral disturbances. There has been dramatic progress in diagnosis and treatment of neuropsychiatric disorders, and progress in neuroscience and biotechnology promises further success. Paradoxically, recent trends threaten to erode this progress. In this environment, neuropsychiatric clinician-scientists must advocate for the importance of research. This position statement defines neuropsychiatric research, describes current challenges to the neuropsychiatric clinician-scientist, summarizes research opportunities, describes how future neuropsychiatric clinician-investigators should be trained, and makes recommendations for promoting neuropsychiatric research.

Career Choice↗
PubMed1998

Neuropsychiatric correlates and treatment of lenticulostriatal diseases: a review of the literature and overview of research opportunities in Huntington's, Wilson's, and Fahr's diseases. A report of the ANPA Committee on Research. American Neuropsychiatric Association.

This report reviews clinical neuropsychiatric findings and opportunities for research in Huntington's, Wilson's, and Fahr's diseases. Consistent, systematic methodology is lacking among neuropsychiatric studies in these lenticulostriatal diseases. Systematic cross-sectional and longitudinal assessments are needed to ascertain the prevalence of psychiatric disorders as a function of disease course. Preliminary synthesis of existing data suggests the following heuristic relationships in these diseases: depression with parkinsonian states; personality changes with caudate or putamen disease; psychosis, impulsivity, and sexual disorders with caudate disease; dementia and mania with caudate and pallidal diseases; and compulsions with pallidal disease. Correlation of neuropsychiatric findings with disease stage, clinical signs, and radiologic, metabolic, physiologic, and pathologic markers of disease will add to our understanding of these conditions.

Basal Ganglia Diseases↗
PubMed1998

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Basal Ganglia Diseases↗
PubMed1998

Catatonia-like events after valproic acid with risperidone and sertraline.

A patient with schizoaffective disorder developed signs of catatonia while on a regimen of valproic acid, sertraline, and risperidone. The catatonic features evolved for the first time after a single dose of valproate and were alleviated by lorazepam. The same catatonic signs recurred after a second dose of valproate and again remitted after lorazepam. Catatonia did not recur subsequent to discontinuing valproate, and the patient had tolerated the combination of valproate and risperidone in the past without developing catatonia. Although the catatonia in this case initially appears to be paradoxical, the phenomenon is actually consistent with current models of catatonia. A unique drug interaction may account for this phenomenon. Possible pharmacokinetic and pharmacodynamic explanations are discussed, including the relation of catatonia to increased activity of the medial globus pallidus and current models of catatonia.

Adult↗
PubMed1997

Cognitive screening instruments in neuropsychiatry: a report of the Committee on Research of the American Neuropsychiatric Association.

A 1994 survey by the Research Committee of the American Neuropsychiatric Association revealed that 58% of respondents employed formal assessment of cognitive status; the Mini-Mental State Examination (MMSE) and neuropsychological testing were the commonest techniques. Literature review on common cognitive screening instruments found that the MMSE has widespread popularity, ease of use, and a large body of research demonstrating its sensitivity to common neuropsychiatric disorders. The Committee recommends that clinicians who employ the MMSE 1) use it as a minimum screening for cognitive dysfunction; 2) employ age- and education-normative corrections; and 3) supplement it with specific measures of spatial functions, delayed memory, and executive abilities. The Modified MMSE and the Neurobehavioral Cognitive Status Examination also show promise as screening tools.

Adolescent↗
PubMed1997

Clinical, motor, and biological correlates of depressive disorders after focal subcortical lesions.

The authors studied depression after focal subcortical lesions (SCLs) in 45 highly selected subjects. Secondary major depression (secondary MD) occurred in 20.0%, depressive disorder NOS (secondary DDNOS) in 4.4%, and secondary dysthymia in 0.0%. secondary MD after SCLs was associated with pallidal lesions (88.9%) and dystonia without geste antagonistique; subjects with secondary DDNOS had nigrotegmental lesions and parkinsonism. Depressive severity after SCLs correlated positively with severity of parkinsonism and dystonia. Pallidal lesions disrupting neurotransmitter systems and pallidothalamic and parietal input to the frontal lobe may lead to secondary MD, whereas nigrotegmental lesions may predispose to secondary MD forme fruste (secondary DDNOS) through disruption of mesocortical frontal or nigrostriatal dopamine tracts. Patients should be closely followed over several years for depression after such lesions, especially when accompanied by parkinsonism or dystonia without geste antagonistique.

Brain Diseases↗
PubMed1997

Major depression after left posterior globus pallidus lesions.

We studied subjects with focal subcortical lesions (SCLs) and investigated the frequency of pallidal lesions in secondary major depression (secondary MD) presenting after but not before lesion onset. Forty-five subjects were selected for focal subcortical lesions (SCLs) from 10,000 hospital magnetic resonance imaging (MRI) films. SCLs were ascertained by neuroradiologic criteria. Major depression was ascertained by DSM-III, -III-R, and -IV criteria. We compared subjects with secondary MD to SCL subjects lacking life histories of mood disorders and investigated the lesion distribution among pallidal subregions evident on MRI. We further tested an association between pallidal lesions and secondary MD. Pallidal lesions were present in eight (89%) of nine subjects with secondary MD and 13 (59%) of 22 controls. Left posterior pallidal lesions occurred in four (44%) of the nine subjects with secondary MD and two (9%) of the 22 controls (one-tailed Fisher's exact test p = 0.043). Demographic and other factors did not differ between subjects with secondary MD and controls (using Fisher's exact test or Mann-Whitney U test as statistically appropriate). These data, of small sample size and requiring confirmation, suggest the possibility that abnormal pallidal function may contribute to depressive pathophysiology, perhaps by influencing basal ganglia-thalamocortical mood circuits. Left-lateralized circuits in the posterior pallidum may be of particular relevance. The left pallidal association is compatible with previous findings in poststroke depression. Patients with left pallidal lesions may deserve close monitoring for secondary MD after subcortical lesions.

Aged↗
PubMed1996

Bipolar disorders, dystonia, and compulsion after dysfunction of the cerebellum, dentatorubrothalamic tract, and substantia nigra.

Bipolar disorders occurred in 3 of 15 (20%) subjects after focal cerebellar circuit lesions. Two presented with rapid cycling bipolar disorder and dystonia, including one with a checking compulsion. Lesions included right cerebellar hypoplasia (bipolar disorder), bilateral cerebellar atrophy (rapid cycling unipolar mania and dystonia), and left midbrain pathology (mixed bipolar disorder, dystonia, and compulsion). Bipolar disorders were associated with cerebellar circuit pathology (p = 0.032) and were more prevalent than in population controls (p = 0.004). Diminished cerebellar output (to cortical, thalamic, basal ganglia, limbic, or other circuits) or nigral pars reticulata dysfunction may result in abnormal neuronal oscillation in bipolar disorders, especially rapid-cycling types, or in dystonia. Review of the literature supports the concept of nigral and cerebellar direct and indirect connections with thalamofrontotemporal and basal ganglia circuits in bipolar disorders, dystonia, and compulsions, as well as possible clinical relationships between these disorders.

Adult↗
PubMed1995

Assessment of treatment outcomes in neuropsychiatry: a report from the Committee on Research of the American Neuropsychiatric Association.

The ANPA Committee on Research conducted a survey of its members and those of the British Neuropsychiatry Association to determine the extent to which neuropsychiatrists employ formal measures of clinical outcome. Results revealed that although respondents endorsed the practice of outcome assessment, formal diagnostic evaluations and outcome measures were rarely applied consistently to the broad range of neuropsychiatric conditions encountered clinically. These findings have implications for clinical research and managed care in neuropsychiatry and will form the basis for future work by the Committee on Research.

Cognition↗
PubMed1994

Neuropsychiatric disorders, myoclonus, and dystonia in calcification of basal ganglia pathways.

Two cases of basal ganglia calcification involving the globus pallidus are presented. Both patients had cognitive dysfunction, temporal lobe-like symptoms (including amnestic state, perceptual distortions, or complex visual hallucinations), and myoclonus. Patient 1 manifested depression, auditory hallucinations, anxiety, paranoia, and postural tremor; patient 2 manifested multifocal dystonia with dystonic tremor. These cases supplement other reports of psychotic features and dementia associated with pallidal pathology. Additionally, the phenomena encountered in these cases are considered in light of recent advances in our understanding of basal ganglia functional pathways. These cases afford a potential pathophysiological window to the possible role of the globus pallidus in these neuropsychiatric conditions. In concert with other recent findings, these cases suggest specific pathway involvement in hallucinations, paranoia, depression, myoclonus, and dystonia. Further research will indicate if these pathways play a role in schizophrenia, mood disorders, and anxiety disorders.

Adult↗
PubMed1994

Reversible intermittent rhythmic myoclonus with fluoxetine in presumed Pick's disease.

A 61-year-old man with presumed Pick's disease was successfully treated with fluoxetine for pathological affect. Severe intermittent, rhythmically repetitive trains of myoclonus developed suddenly the following year. A dystonic-like component involving the shoulder region and a decrescendo frequency pattern were observed. Myoclonus involved the face, palate, shoulder, neck, upper chest and back, diaphragm, hips, and upper extremities, especially on the right side. Movements were not influenced by postural adjustments, startle, or other stimuli. Movements proved insensitive to benztropine but abated with discontinuation of fluoxetine. Rechallenge with fluoxetine or trazodone evoked the movements, whereas clonazepam and chloral hydrate abolished the movements. The pattern of myoclonus is unlike previous reported cases and may relate to activation of serotonin 5HT1A receptors (possibly supersensitive in Pick's disease) or to hypodopaminergia. Although fluoxetine may be useful as adjunct therapy in dementing disorders, caution may be warranted in its use in Pick's disease.

Affective Disorders, Psychotic↗