Innovations in clinical neuroscience最新文献

This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation and other resources offered to health care providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management consulting companies or insurance carriers might provide different advice, and readers should take this into consideration. The information in this column does not constitute legal advice. For legal advice, contact your personal attorney. Note: The information and recommendations in this article are applicable to physicians and other healthcare professionals so "clinician" is used to indicate all treatment team members.

Objective: The cognitive-enhancing effects of green tea have garnered significant attention in the field of neuroscience. This narrative review aims to provide a comprehensive overview of the neurobiological mechanisms underlying the memory-enhancing properties of green tea. Studies have reported the beneficial effects of green tea on memory function, highlighting its potential as a natural cognitive enhancer.

Methods: Through a systematic exploration of the current literature, this review elucidates the intricate interplay between green tea components and various neurobiological processes involved in memory formation and retention.

Results: The review discusses the modulation of key neurotransmitter systems by green tea polyphenols and their impact on synaptic plasticity and neuronal communication. Furthermore, the review delves into the antioxidant and anti-inflammatory properties of green tea components, which contribute to neuroprotection and mitigate neuronal damage associated with memory impairment. Additionally, the review examines the role of green tea in regulating neurotrophic factors crucial for neurogenesis and synaptic plasticity. Insights into the influence of green tea on neuroinflammation, oxidative stress, and neurotrophic factors provide a comprehensive understanding of how green tea exerts its memory-enhancing effects at the molecular and cellular levels.

Conclusion: This review consolidates existing knowledge on the neurobiological mechanisms of green tea-improved memory impairment and underscores the potential of green tea as a promising natural intervention for enhancing cognitive function and ameliorating memory deficits. Future research directions and clinical implications of green tea in the context of cognitive health are also discussed, emphasizing the importance of continued exploration of green tea's therapeutic potential for memory enhancement.

Objective: To report an adult-onset phenotype of KIF1A-associated neurological disorder (KAND) associated with a novel heterozygous missense variant (c.2494C>T; p.Pro832Ser) located outside the kinesin motor domain.

Case presentation: We describe a 50-year-old woman with a 15-year history of progressive imbalance. Neurological examination revealed cerebellar dysarthria, truncal ataxia, bilateral dysmetria, and sensorimotor polyneuropathy. Brain magnetic resonance imaging demonstrated moderate cerebellar atrophy. Whole-exome sequencing identified a heterozygous KIF1A variant (c.2494C>T; p.Pro832Ser). No other pathogenic mutations were found.

Results: The variant was classified as a variant of uncertain significance, yet the patient's clinical presentation was consistent with features of KAND. Compared with previously described early-onset KAND cases, our patient exhibited a milder, slowly progressive phenotype without seizures or cognitive impairment. The variant's location outside the motor domain may correlate with this attenuated disease course.

Conclusion: This case expands the phenotypic and genotypic spectrum of KAND and suggests that the novel KIF1A p.Pro832Ser variant may contribute to adult-onset cerebellar ataxia and axonal neuropathy. To our knowledge, this variant is not listed in ClinVar or population databases such as gnomAD or ExAC.

Cannabinoid hyperemesis syndrome (CHS) manifests in adults as severe nausea accompanied by episodic vomiting and intense abdominal pain, typically associated with prolonged, high-dose cannabis use. The clinical course of CHS is divided into 3 distinct phases: prodromal, hyperemetic, and recovery. Traditional antiemetic and antinausea medications, such as ondansetron and metoclopramide, are often used in the acute clinical setting to address these isolated symptoms. Discussions and occasional use of haloperidol have demonstrated a level of symptom relief in patients with CHS. In several instances, patients report complete resolution of symptoms previously refractory to, or only partially relieved by, traditional antiemetics and antinausea medications. This case report explores the hospital course of a 15-year-old female adolescent who presented to the emergency department with a recurrent episode of CHS. The patient reported symptoms of nausea, intense abdominal pain, compulsive bathing behavior, physical agitation, and delirium. In the setting of CHS symptoms refractory to traditional antiemetics and concurrent behavioral disturbances, the patient was started on a standing low dose of haloperidol. Within 6 days of starting haloperidol treatment, the patient reported complete resolution of her presenting symptoms and was subsequently discharged from the hospital. We conclude that patients presenting with CHS and concurrent delirium, as is often the clinical presentation, would further benefit from the off-label use of haloperidol. Although minimal literature exists on the management of CHS, there is almost no evidence examining CHS comorbid with delirium and/or agitation. This report seeks to demonstrate the underlying causality and explore the scientific mechanisms to show the clear benefits of haloperidol as an antiemetic and antinausea medication, in addition to any sequelae of delirium, and highlighting the need for a revision of pre-existing CHS treatment protocols, specifically in the emergency department setting.

Malingering, the intentional production or exaggeration of symptoms for external gain, presents a significant diagnostic challenge in forensic psychiatry. Distinguishing malingering from genuine psychiatric illness is essential, as diagnostic errors can delay appropriate treatment, consume limited psychiatric resources, and affect legal proceedings. This article presents three clinical case vignettes illustrating different manifestations of malingering, including feigned psychosis and intellectual disability. Key diagnostic strategies include identifying inconsistencies between reported symptoms and observed behavior, evaluating symptoms across different contexts, obtaining collateral information, assessing potential external incentives, and using structured assessment and symptom validity measures. Familiarity with characteristic patterns of feigned symptoms and a systematic, multidisciplinary approach can improve diagnostic accuracy while ensuring appropriate treatment for patients with genuine psychiatric illness.

Selective serotonin reuptake inhibitors (SSRIs) have become a preferred treatment option for psychiatric disorders due to their relatively safe adverse effect profiles. Despite their widespread prescription and general safety, there is a need to better understand the adverse effects and potential complications of SSRIs, particularly in overdose situations. Fluvoxamine, an SSRI approved for treating obsessive-compulsive disorder (OCD), is typically safe within therapeutic doses but can lead to severe adverse drug reaction in cases of overdose. This report presents an infrequent occurrence of a generalized tonic-clonic seizure following an overdose of fluvoxamine in a 20-year-old nonepileptic female patient with OCD. The patient did not consume alcohol or any other medications that could have contributed to the seizure activity. She had no previous history of epilepsy or any known risk factors for seizures. The seizure occurred shortly after 1,500 mg of fluvoxamine ingestion. Even though it is generally considered safe at therapeutic doses, this case highlights the potential proconvulsant effect of fluvoxamine in overdose and underscores the need for clinician vigilance, particularly at high doses, and to consider the risks when prescribing pharmacotherapy. Further research is necessary to clarify the dose-related proconvulsant properties of fluvoxamine and to develop strategies for overdose scenarios.

The study of psychology of men and masculinity received scientific attention through a more recent focus on its connection with the expression of emotions in men. There had been a long held proposition regarding the conformity to stereotypic masculine beliefs among men and its effect on their mental health. Therefore, the present study was designed to explore the impact of masculinity and normative male alexithymia (NMA) on the mental health of men from Pakistani origin. Assessment measures included a demographic form, the Masculine Behavior Scale (MBS), the Normative Male Alexithymia Scale (NMAS), and the Mental Health Inventory (MHI). The sample comprised of young (20-30 years) men (n=325), who were recruited, using purposive sampling, from different tertiary education institutions from an urban area in Pakistan (Lahore). Results suggested that masculinity was directly associated with NMA and psychological distress while being inversely associated with psychological wellbeing. Furthermore, NMA was found to be a significant positive mediator between masculinity and psychological distress and a significant negative mediator between masculinity and psychological wellbeing. The findings suggest that men with stereotypic masculine beliefs have a higher risk of developing mental health problems and that decreasing emotional expression may exacerbate the risk. These findings have direct relevance for further research on men's mental health and for clinical practice aimed at assisting men with different mental health issues, particularly from Eastern or subcontinent origin.

Background: Schizophrenia and bipolar disorder (BD) are chronic psychiatric conditions that place considerable psychological and relational burdens on caregivers, particularly spouses. However, comparative insights into their impact in non-Western sociocultural settings remain limited.

Objective: To compare perceived stress, marital adjustment, and quality of marital life among spouses of patients with schizophrenia and BD, and to explore the influence of perceived stress and sociodemographic variables on marital outcomes.

Methods: A cross-sectional study was conducted in a tertiary care psychiatry outpatient department in India. A total of 100 spouses-50 of patients with schizophrenia (Group 1) and 50 of patients with BD (Group 2)-were assessed using the Perceived Stress Scale (PSS), Quality Marriage Index (QMI), and Short Marital Adjustment Test (SMAT). Sociodemographic data were also analyzed.

Results: Spouses of patients with BD reported significantly higher perceived stress and poorer marital outcomes compared to those of patients with schizophrenia. Across both groups, perceived stress was strongly and negatively correlated with marital adjustment and marital quality. Older age and longer marital duration were associated with lower stress and better marital functioning.

Conclusion: Both schizophrenia and BD are associated with substantial caregiver burden, with greater impact observed among spouses of patients with BD. Integrating targeted stress management and culturally sensitive support into caregiver interventions is essential to enhance marital wellbeing and reduce psychological strain.