Innovations in clinical neuroscience最新文献

Shame can inflict deep and lasting psychological harm. However, its pervasive negative effects often go unrecognized by both patients and their providers, and thus, it may remain wholly unaddressed. Shame may be mistaken for guilt, embarrassment, or humiliation, but shame darkens patients' quality of life much more profoundly than these other emotions. For this reason, there is a greater need for providers to remain alert to cues that patients may feel shame and if they suspect this and are right, they may seek to help patients reduce their shame. This article discusses what shame is, how to detect it, and, once detected, how providers might best intervene. The experience of shame commonly results from a wide range of negative social experiences, including discrimination, social exclusion, and patients being medically ill. Recognizing and addressing shame are critical skills that providers should strive to acquire. The interventions discussed here may significantly help undo the shame that these patients self-inflict.

Sensory impairments, including visual and auditory loss, are common across the lifespan and are increasingly recognized as risk factors for psychiatric disorders, particularly psychosis. Evidence suggests that disruptions in sensory processing, multisensory integration, and self-other signal differentiation may contribute to cortical disorganization overlapping with mechanisms implicated in psychotic illness. The psychiatric consequences of sensory impairment are influenced by chronicity and timing of onset, with congenital vs acquired loss conferring differing risks and clinical presentations. Communication barriers represent a major source of morbidity and diagnostic error, often leading to misinterpretation of symptoms as psychosis, negative symptoms, or noncooperation. This article reviews current literature on the relationship between sensory impairment and psychosis and highlights critical gaps in clinical guidance. Through illustrative case vignettes, we demonstrate common diagnostic pitfalls and propose practical strategies for assessment, including ensuring adequate communication, adapting mental status examinations to patient limitations, and carefully evaluating hallucinations and mutism in the context of sensory loss. Attention to these factors is essential to avoid misdiagnosis, improve patient-clinician communication, and reduce healthcare disparities experienced by individuals with co-occurring sensory and psychiatric conditions.

Objective: We describe the development of a probiotic-infused carbamazepine dosage form. This dosage form combines carbamazepine with probiotics, proposing the potential use of both active pharmaceutical ingredients in a single dosage form.

Design: Evaluation of Bifidobacterium bifidum and Lactobacillus acidophilus susceptibility to carbamazepine using agar disk diffusion revealed the B. bifidum was resistant to carbamazepine, prompting its selection for development of the dosage form. A suspension was formulated using the precipitation method with stability testing assessing organoleptic properties, pH, and viability of the bacteria in the dosage form. Toxicity assessment was done using 20 male albino Wistar rats, measuring weight, urination, and anxiety changes postadministration of carbamazepine and probiotics, following ethical approval from the University of Zimbabwe's animal house laboratory and board.

Results: Rats receiving only B. bifidum exhibited heightened anxiety and reduced weight, while those receiving carbamazepine alone increased weight and urination but lowered anxiety. Combining carbamazepine with B. bifidum significantly decreased anxiety (P=0.0312) and increased urination, with significant weight reduction (P=0.03186). The dosage form maintained stability, preserving B. bifidum viability over a period of 28 days.

Conclusion: Integrating probiotics into carbamazepine formulations offers a promising strategy, with potential applications to other antiepileptic drugs.

Objective: Many psychiatric inpatients are prescribed complex medication regimens that include both psychiatric and medical drugs with high anticholinergic (ACH) activity. The cumulative ACH burden (ACB), arising from the pharmacodynamic additive effects of concomitant medication use, has been linked to a range of adverse effects. These include both short-term effects and long-term consequences. Our study aims to determine the degree of ACB in a psychiatric inpatient hospital using current measurement assessment tools.

Methods: This retrospective, observational study collected medication regimens and demographic data from the electronic health records of psychiatric inpatients. We included 250 adults aged 18 years or older who were institutionalized in a psychiatric hospital. The ACB was assessed using the ACH toxicity score (ATS), with data collected at two distinct time points, one in the spring and another in the winter, from different calendar years. The total ACB for both psychiatric and medical medications was compared across the patient population, analyzing the potential seasonal variation in the cumulative burden.

Results: The degree of total ACB was not statistically significantly different (P=0.526) between the seasonal cohorts and remained consistent with an average total ATS of 8. An ATS score of 5 or higher is assumed to be clinically significant, with 75% of patients (93/124) and 78.6% (99/126) having shown significant burden in the winter and spring cohorts, respectively.

Conclusion: The prescribing of ACH medication did not significantly vary seasonally, however, most patients observed showed significant and consistent levels of ACB. It is recommended that clinicians should consider monitoring ACB in their prescribed regimens and consider pharmacologic strategies to reduce ACB. Risk reduction strategies include discontinuation of nonessential ACH medications or consideration of therapeutic interchange with an alternative agent with a lesser ACH profile. The deprescribing of long-term ACH medications for individuals who are otherwise clinically stable may improve both clinical outcomes and quality of life.

Background: Early detection and outcome prediction of stroke are crucial for enhancing poststroke care. We explored the diagnostic and prognostic potential of bioactive adrenomedullin (bio-ADM) in stroke through a systematic review and meta-analysis.

Methods: Medline, Embase, Scopus, and Web of Science were searched for studies measuring bio-ADM in patients with stroke. Diagnostic outcomes were confirmed via imaging, while prognostic outcomes included mortality and modified Rankin Scale (mRS). For meta-analysis, standardized mean differences (SMDs), pooled odds ratios (ORs), and sensitivity/specificity were synthesized.

Results: Ten articles were included. Bio-ADM levels were significantly higher in patients with stroke compared to nonstroke control groups (SMD: 1.47; 95% confidence interval [CI]: 0.98-1.97). Subgroup analyses of acute ischemic stroke (SMD: 1.22; 95% CI: 0.34-2.11) and acute hemorrhagic stroke (SMD: 1.67; 95% CI: 1.07-2.26) demonstrated similar findings. Bio-ADM levels within the first 24 hours of a stroke were significantly higher in patients who died compared to those who survived (SMD: 1.35; 95% CI: 1.08-1.61). Pooled data analysis from multivariate models demonstrated no independent association between increased bio-ADM levels within the first 24 hours of admission and mortality (pooled adjusted OR: 1.11; 95% CI: 0.97-1.27; P=0.135). Sensitivity and specificity for mortality prediction were 0.617 (95% CI: 0.516-0.709) and 0.850 (95% CI: 0.772-0.905), respectively. Bio-ADM levels were also higher in patients with mRS score of 3 to 6 compared to those with mRS score of 0 to 2 (SMD: 0.48; 95% CI: 0.16-0.80).

Conclusion: Bio-ADM is significantly elevated in both hemorrhagic and ischemic strokes and associated with mortality and poor outcomes, though it is not independently predictive of death.

Chronic pain disorders of unknown etiology, including burning mouth syndrome, chronic pelvic pain, fibromyalgia, irritable bowel syndrome, myofascial pain syndrome, and temporomandibular joint disorders, have been demonstrated to result in a substantial reduction in quality of life. These diseases exhibit a discernible gender bias, manifesting with greater frequency in women. The neurobiological underpinnings of these conditions are characterized by a decline in the volume of white matter in the medial prefrontal cortex and alterations in the connectivity of the default mode network. These conditions are frequently linked to impaired function of the central dopaminergic nervous system. The potential mechanisms connecting the gut microbiota to chronic pain disorders may be the decrease in butyrate-producing bacteria in dopamine signaling and the change in estrobolome in estrogen signaling. Consequently, an approach targeting the gut microbiota using probiotics has emerged as a potential treatment for chronic pain disorders.

Objective: Recent decades have seen a surge in empirical support for the clinical application of noninvasive neuromodulation technology, such as repetitive transcranial magnetic stimulation (rTMS). The aim of this perspective is to review the emerging research exploring the literature on combined psychotherapy with rTMS.

Methods: This article provides a narrative overview of studies combining psychotherapy and rTMS from the perspective of a practicing psychologist in the context of implicated neural networks and an evidenced-based contextual behavioral model of therapy.

Results: It is advanced that the network flexibility and connectivity changes induced by rTMS may facilitate an effective neural context for psychotherapy processes to support meaningful change, providing a synergistic strengthening of psychological and brain network flexibility. More precisely, this clinical perspective considers existing studies that combine psychotherapy techniques with rTMS across diverse clinical populations, within an acceptance and commitment therapy (ACT) framework.

Conclusion: It is argued that rTMS can be applied while concurrently fostering psychological flexibility pillars of openness, awareness, and engagement and applied as a transdiagnostic, process-based intervention in a psychosocial and biophysiological context.