Innovations in clinical neuroscience最新文献

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Department editor: Julie P. Gentile, MD, is Professor and Chair of the Department of Psychiatry at Wright State University in Dayton, Ohio.

Editor’s note: The patient scenarios presented in this article are composite cases written to illustrate certain diagnostic characteristics and to instruct on treatment techniques. The composite cases are not real patients in treatment. Any resemblance to real patients is purely coincidental.

Abstract: The prevalence of mental illness in individuals with intellectual disability (ID) is higher compared to the general population. Persons with ID typically have insufficient coping skills and fewer systems of natural support; they are often more vulnerable to stress. There is evidence that level of intelligence is not a sole indicator for appropriateness for psychotherapy, and that the full range of mental health services help improve quality of life for patients with ID. Polypharmacy is more common in patients with co-occurring ID and mental illness. It is common for patients with ID to be prescribed multiple medications for both physical and mental health conditions. In addition, when patients are discharged from state-operated institutions to the community, it is common for them to continue taking the same number of medications. This article will review the use of adapted psychotherapy in patients with ID, as well as deprescribing protocols to address polypharmacy.

Healthy lifestyle and positive psychiatry interventions can complement the treatment of mood disorders and help individuals who are not experiencing as much happiness and satisfaction in their lives as they desire. This article gives examples of an optimal psychiatric treatment plan that would potentially include psychotherapy, psychotropic medications, and/or individualized and targeted healthy lifestyle and positive psychiatry interventions to not only treat mental illness, but also enhance overall wellbeing.

This case report presents a 35-year-old male patient from Lahore, Pakistan, who experienced recurring seasonal depressive symptoms from May to September for seven years. The patient exhibited symptoms including feelings of worthlessness, low mood, loss of appetite, decreased energy, anhedonia, and psychomotor retardation during the summer months, with a return to normal functioning outside of these months. The patient remained undiagnosed throughout this time. After multiple unsuccessful treatments from various facilities, he presented to our outpatient clinic for evaluation. Subsequently, he was admitted to the inpatient unit, where regular assessments diagnosed him with summer seasonal affective disorder (SAD), a rare and less-recognized form of SAD. After further evaluation, a treatment plan was devised that included slowly tapering off previous medications and initiating bupropion (a United States Food and Drug Administration [FDA]-approved medication for SAD) along with cognitive behavioral therapy. The patient subsequently fully recovered on bupropion and returned to normal functioning. The case highlights the challenges in diagnosing and treating summer SAD, particularly in tropical climates, where it is less recognized than winter SAD due to the scarcity of literature and awareness regarding it. Additionally, the positive response to bupropion suggests its potential efficacy for summer SAD. This report emphasizes the importance of considering regional and seasonal factors in psychiatric diagnoses and calls for increased awareness of and research on summer SAD, especially in countries such as Pakistan. The authors note this as potentially the first reported case of summer SAD in Pakistan, the sixth-most populous country globally. This highlights the need for a better understanding and management of seasonal disorders in diverse geographical contexts.

Background: Acute pain (AP) is a prevalent symptom in hospital settings, affecting up to 84 percent of the patients seeking healthcare services. It significantly impacts an individual's quality of life, with inadequate management resulting in slower recovery, increased cost of care, and a greater risk of developing chronic pain. While pharmacological approaches are effective, they are associated with numerous side effects, including nausea, addiction, and the possibility of fatal overdoses. Given this, virtual reality (VR) offers an innovative avenue to manage AP effectively while minimizing the effects of drugs.

Objectives: This study aims to map the extent of literature on utilizing VR as a tool for the nonpharmacological management of AP. Specifically, this review attempts to understand the characteristics of the populations using VR for AP management, the technical specifications and mechanisms used to alleviate AP, and the overall effectiveness of VR in managing AP.

Methods: A scoping review was conducted to identify literature from the following electronic databases: PubMed, ScienceDirect, ERIC, and Google Scholar. To be included in this review, articles had to focus on AP in both adult and pediatric populations and address AP using VR in any clinical or care setting. The search was limited to peer-reviewed, English-language, quantitative research articles published between 2000 and 2024.

Results: A total of 97 studies were identified. Sixty-six percent of studies demonstrated the efficacy of VR as an analgesic, outperforming traditional nonpharmacological approaches (eg, standard of care, mobile phones). Distraction was the most effective VR mechanism for pain management, showing efficacy in 86.9 percent of studies. The most common focus was on needle-related pain (30.9%), followed by dental and perioperative pain (15.5% each). VR was most effective in wound care (87.5%), followed by labor-related (83.33%) and dental (80%) pain.

Conclusion: VR is a promising tool for managing AP, offering considerable benefits in terms of patient care, patient experience, and reduction in drug-related side effects. The high efficacy rates for wound care, labor-related pain, and dental pain highlight the potential for VR to be integrated into standard pain management protocols. However, further research, with rigorous research design, is required to standardize VR interventions and optimize their effectiveness across different patient populations and pain contexts.

The presence of patent foramen ovale (PFO) has been associated with migraine. Several retrospective, nonrandomized studies support reduction of migraine frequency and severity after PFO closure. However, three randomized, controlled trials (RCTs) have not met their primary efficacy endpoints, and their reporting quality has not been assessed. The present study aims to determine the reporting quality of RCTs focusing on the PFO closure for the treatment of migraine according to the revised Consolidated Standards of Reporting Trials (CONSORT) 2010 checklist. Systematic searches of two databases (MEDLINE/PubMed and Cochrane Library) were conducted. The primary objective was to establish the mean CONSORT adherence of RCTs of PFO closure for the migraine treatment, and secondary objectives were the calculation of adherence per CONSORT item and the effect of CONSORT statement in high-ranked medical journals. A 37-item questionnaire based on the CONSORT 2010 checklist was used to assess the reporting quality. Adequate adherence to the CONSORT statement was defined as reporting over 70 percent of the items. The search identified three eligible articles for analysis. The mean adherence was 69.66±4.49 percent. Only one of the studies achieved a good reporting quality (≥75%). Twenty-six of the 37 items of the CONSORT checklist (70.3%) were reported in more than half of the studies. Quality of reporting in RCTs focusing on the PFO closure for the treatment of migraine remains unsatisfactory. Further improvement of reporting quality is essential to assess the validity of clinical research.