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The impact of atypical antipsychotic medications on long-term memory dysfunction in schizophrenia spectrum disorder: a quantitative review.

This meta-analytic review examines the efficacy of antipsychotic medications in ameliorating schizophrenia-related long-term memory (LTM) impairments. Twenty-three studies were reviewed that compared schizophrenia spectrum patients treated (a) with atypical versus typical antipsychotic medications, or (b) with various atypical treatments. In 17 atypical versus typical trials aggregating 939 participants, superior overall (verbal and nonverbal) LTM was detected in patients assigned to atypical trials. However, this difference was small (effect size estimate (ES) 0.17; 95% Confidence Interval (CI) 0.04 to 0.31) and specific to certain atypical treatments. Relative to typical antipsychotic trials, LTM superiority was marginally significant for risperidone trials (ES 0.20; 95% CI -0.03 to 0.44) and significant for olanzapine trials (ES 0.29; 95% CI 0.08 to 0.49). In contrast, clozapine trials did not produce a LTM advantage over typical trials (ES -0.06; 95% CI -0.35 to 0.23). Due to the lack of available studies, the effect of quetiapine was indeterminate. Direct comparison between atypical trials revealed a similar effect pattern. A marginally significant superiority in overall LTM was detected for risperidone and olanzapine compared to clozapine (ES 0.28; 95% CI -0.04 to 0.59), which reached significance for verbal LTM (ES 0.36; 95% CI 0.04 to 0.67). Finally, the beneficial impact of antipsychotic medications emerged as a function of differences in the anticholinergic properties of the treatment arms being compared.

Antipsychotic Agents↗

Cognitive impairment in depressive disorders. Neuropsychological evaluation of memory and behavioural disturbances.

The purpose of this article is to discuss the contribution that clinical neuropsychology and neuropsychological assessment can conter to neuropsychiatry, particularly in the evaluation of cognitive disturbances and pharmacological treatment of depression. Six patients (4 females, 2 males; age: 16-54 years old) suffering from depressive disorders underwent a clinical neuropsychological examination. Depending on the memory scores obtained on the Rey-Osterrieth complex figure test, the patients were classified as having mild or no memory impairment (< 20% decrease), moderate memory impairment (20-40% decrease) or severe memory alteration (> 60% deterioration). Evaluation of memory scores of two other memory tests (Wechsler memory scale and Rey visual design learning test) were also considered. Patients who were classified as having severe memory impairment were consistently reported as seriously impaired on all memory tests. The severity of cognitive dysfunction is in accordance with the serious ness of the neuropsychiatric disturbances of the patients as revealed by personality testing (MMPI, IDS and Eysenck questionnaires) or by personal details as assessed during the interview. This paper discusses the importance of the utility of a comprehensive neuropsychological evaluation of depressed patients and seriously considers the possibility of the use of this approach for pharmacological treatment evaluation.

Adolescent↗

Homocysteine and cognitive impairment; a case series in a General Practice setting.

BACKGROUND: An elevated blood level of homocysteine is a risk factor for cognitive impairment and dementia. Homocysteine can be lowered by folate and/or vitamin B12 supplementation; antioxidants might also be required for optimal reduction in neurovascular tissue. This report presents clinical and radiological findings from administering the antioxidant N-acetylcysteine together with B vitamins to cognitively impaired patients with hyperhomocysteinaemia. METHODS: A case series (n = 7) performed in a semi-rural General Practice setting. Formal cognitive assessments were performed in five patients, and radiological assessments in one patient, before and after supplementation. RESULTS AND DISCUSSION: The addition of N-acetylcysteine resulted in subjective clinical improvement in all patients, and an objective improvement in cognitive scores in five patients. One patient had radiological evidence of halted disease progression over a twelve month period. CONCLUSION: N-acetylcysteine, together with B vitamin supplements, improves cognitive status in hyperhomocysteinaemic patients. Randomized controlled clinical trials are required to formally evaluate this treatment approach.

Acetylcysteine↗

[Neurologic adverse manifestations and complications of ambulatory therapy with psychotropic drugs in the late stages].

Neurological side-effects and complications were studied in 100 patients having undergone long-term (3--14 years) out-patient treatment. In 14 cases there were slight side-effects. In patients of old age, after 6 year lithium treatment there were extrapyramidal signs, disturbances of memory and disorders of orientation in place. In 1 case following 2 year treatment with small doses of neuroleptical drugs there was an oral dyskinesia, after which an overdosage with antidepressive drugs and tranquillizers led to an akineticohypotonic syndrome. The side-effects and complications had a reversible character. Recommendations for therapy of such complications are given.

Adult↗

A test of the integrity of the components of Baddeley's model of working memory in attention-deficit/hyperactivity disorder (ADHD).

BACKGROUND: The integrity of working memory in attention-deficit/hyperactivity disorder (ADHD) was tested within the framework of Baddeley's model. METHODS-1: Buffers and rehearsal mechanisms were assessed by presenting children with or without ADHD (ages 8 to 15) with 1-7 target letters and a probe after 2-10 s. They decided if the probe was the same (verbal task) or in the same location (spatial task) as any of the targets. RESULTS-1: There was no interaction between group and delay or memory load in either task. METHODS-2: The central executive was assessed on a dual task. RESULTS-2: Although children with ADHD did not differ from controls in simple response time (RT) or in digits recalled, they showed greater decrements in RT when performing the 2 tasks concurrently. CONCLUSIONS: Findings suggest that children with ADHD (1) do not have generalized impairments in working memory, (2) rehearse verbal and spatial information in the same manner as healthy children, (3) may have an impairment in the central executive component of working memory, which controls ability to divide attention between two tasks.

Adolescent↗

Educational strategies for the autistic child.

This paper includes some of the latest discussions regarding educational programming for autistic children. Until the last decade, special educators have not been either effective or optimistic regarding the prognosis for such children. Recent educational developments with such techniques as behavior modification, the behaviorally engineered classroom, and early identification of the condition have caused increased interest in the possible contributions of educators to the puzzling syndrome. The various alternative treatment possibilities will be presented together with an evaluation of the effectiveness of such programs to date.

Association↗

Implicit memory in posttraumatic stress disorder with amnesia for the traumatic event.

This report documents a case of posttraumatic stress disorder (PTSD) following psychological trauma with cerebral insult and amnesia for the traumatic event. The case history demonstrates the role of implicit memory in PTSD and indicates that the mechanisms of psychopathology are one-trial sensitization and conditioned emotional responses.

Accidents, Occupational↗

Is there a syndrome of tuberothalamic artery infarction? A case report and critical review.

Short-term post-acute neuropsychological, neurological, and neuroradiological test results and a 16-month follow-up of a 65-year-old patient with a right hemisphere ischemic lesion in the tuberothalamic area of vascular supply are reported. During a 6-week period of examinations the originally left- but trained right-handed patient exhibited fluctuating neuropsychological disorders including aphasia, visuo-perceptive and visuoconstructive disorders, and memory and attention deficits. In the follow-up examination the patient exhibited no aphasia and significant improvements in most neuropsychological tasks. Based on three-dimensional reconstruction of MRI, lesion topography and involvement of thalamic nuclei were established. We discuss the neuropsychological and neurological symptoms of the present case against the background of the 'syndrome of unilateral tuberothalamic artery territory infarction' proposed by Bogousslavsky and coworkers (1986) and the neuropsychological literature on unilateral ischemic anterior/anterolateral thalamic infarction.

Aged↗

[Disorders of short-term memory, a necessary category in the multiaxial classification scheme?].

Problems with short-term memory have been reported in conjunction with numerous psychiatric disorders of childhood. Deficits in both visual and auditory short-term memory were found more frequently in a group of 23 children between the ages of 7 and 11 years with specific developmental speech and/or language disorders and in an unselected group of 23 children seen at the inpatient unit of a child psychiatry facility than in a control group of children of comparable age and sex without language or behavior problems. Because of the diagnostic and therapeutic relevance of visual and auditory short-term memory deficits, the authors argue for the inclusion of the disorder in the Multi-axial Classification Scheme.

Child↗

Attention and memory for threat in panic disorder.

Recently, information processing paradigms have been utilized to explore the role of attentional and memory processes in the maintenance of clinical anxiety disorders. The present study extended these data using a dual-task paradigm to assess attentional vigilance and a cued recognition task to evaluate short-term memory effects in Panic Disorder (PD). Twenty PD patients and 20 normal controls completed a computerized task wherein they read aloud one of a pair of rapidly presented words (primary task) while simultaneously attempting to detect a small probe that appeared adjacent to one of the words (secondary task). Eighty stimulus words were chosen to represent four categories: physical panic-related threat, social threat, positive-emotional, and neutral. Reaction time and accuracy in detecting the probe were assessed, as well as psychophysiological responding (heart rate, skin conductance, EMG). Following task completion, a cued recognition task was administered to examine short-term memory of task stimuli. Results indicated that PD patients exhibited slower reaction times relative to normal controls during presentation of physical panic-related threat and positive-emotional stimuli. A similar trend emerged for social threat stimuli, although the PD and control samples responded similarly to neutral stimuli. No group differences were found on the cued recognition measure or psychophysiological responding during task performance. The data are discussed in terms of possible implications for cognitive models of PD.

Adult↗

An investigation of visuospatial memory impairment in children with attention deficit hyperactivity disorder (ADHD), combined type.

BACKGROUND: Memory impairment is not considered a core cognitive feature of attention deficit hyperactivity disorder, combined type (ADHD-CT), although it is associated with impairments in attentional and executive functions. This study investigates visuospatial memory impairment, in particular encoding and retrieval aspects, in children with ADHD-CT who are stimulant-medication naive and medicated with stimulant medication. METHOD: A cross-sectional study of visuospatial memory in 6- to 12-year-old children with stimulant-medication-naive ADHD-CT (n = 62) and medicated ADHD-CT (n = 58) compared to an age- and gender-matched healthy control group (n = 39) was completed. RESULTS: Both medication-naive and medicated ADHD-CT groups demonstrated subtle yet significant impairment in visuospatial memory. The memory impairment was delay-independent, which, along with other factors, suggest dysfunction of the encoding rather than retrieval phase of visuospatial memory. CONCLUSIONS: Careful study of large ADHD-CT samples does detect deficits in a visuospatial memory task, but these reflect attentional deficits rather than being specifically due to dysfunction of the medial temporal lobe explicit memory system. Children with ADHD-CT may benefit from cognitive and behavioural strategies focused on improving encoding of relevant information rather than retrieval strategies.

Attention Deficit Disorder with Hyperactivity↗

Application of memory metallic stents to urinary tract disorders in pediatric patients.

The use of memory metallic stents for the urinary tract in pediatric patients has not been reported. The authors report on 2 patients with urinary tract disorders who were successfully treated with a memory metallic stent. A thermoexpandable, nickel-titanium alloy stent was placed at the urethroureteral junction of a 4-year-old boy with ureteral stenosis associated with cloacal exstrophy for 18 months and at the urethra of a 2-year-old girl with ischuria after a repair of cloacal anomaly for 6 months. Temporary insertion of a memory metallic stent is a safe and effective alternative for organic stricture or functional obstruction of the urinary tract in pediatric patients.

Abnormalities, Multiple↗