David M. Roane

Multiple Fregoli delusions after traumatic brain injury

A 61 year old man after a traumatic brain injury resulting in right frontal and left temporoparietal contusions developed florid Fregoli-type misidentifications. Extensive neuropsychological testing demonstrated significant deficits in executive and memory functions. The patients neuropsychological profile closely resembled that seen in previously reported patients with Capgras syndrome. Our findings are consistent with the hypothesis that a combination of executive and memory deficits may account for cases of delusional misidentification associated with brain lesions. However, the form which the delusion takes may be influenced by other factors including motivation.

Anosognosia, completion and confabulation: The neutral-personal dichotomy

Abstract Unawareness of defects or anosognosia has been closely associated with confabulation in neurological patients. In order to understand better the relationship between anosognosia and confabulation we have reviewed a range of phenomena from perceptual completion to elaborate confabulations such as delusional misidentifications. Using this literature and an analysis of selected cases we propose that all confabulations can be grouped into two forms, neutral and personal, both of which may contribute to the production of anosognosia. Further, we suggest personal forms can be largely equated with the delusional misidentification syndromes with which they share a common neuroanatomy and similar mechanisms. We propose that some aspects of anosognosia can best be viewed as delusional misidentification of personal illness, which is associated with paralimbic, especially caudal orbitofrontal lesions. We further suggest a new term - Delusional Missociation Syndromes - to describe the perturbation in relatedn...

Ensuring Research Competency in Psychiatric Residency Training

ObjectiveThis article discusses the importance of research training in psychiatric residency programs and makes recommendations for enhancement.MethodsThe authors examine the literature detailing the shortage of psychiatrist-researchers and the limitations of research training during residency. The authors then describe the Psychiatrists Acquiring Research Training (PART) program at Beth Israel Medical Center that attempts to address this problem. Data collected on resident scholarly activity, including publications and presentations, is presented.ResultsSince its inception, all scholarly activities have increased under the PART program. The 89 residents, followed over 5 academic years, co-authored 32 publications, gave 56 presentations, and re]prestigious honors such as NIMH fellowships and national research awards.ConclusionResidents’ participation in research has been advanced through participation in PART. Ensuring research competency among all psychiatrists is crucial to providing the best science-based care; PART represents a cost-effective way to integrate research training with psychiatric residency. The authors also discuss opportunities and obstacles to developing research programs as part of psychiatric residency training.

The effects of testosterone on cognition in elderly men: a review.

In this article, the literature examining the relationship between testosterone and various cognitive domains in elderly men is reviewed. The review focuses on the role of endogenous testosterone levels and the effects of androgen depletion and replacement. The cognitive domains most commonly linked to testosterone include memory and visuospatial function. Indeed, the literature suggests that in certain conditions (ie, hypogonadism, cognitive impairment) testosterone levels may be significantly associated with memory and visuospatial function, but not other cognitive functions. Studies with larger sample sizes and more sensitive cognitive measures are indicated, as questions remain about the potential role of testosterone as a cognitive enhancer.

Electroconvulsive Therapy for Elderly Patients With Multiple System Atrophy: A Case Series

Multiple system atrophy (MSA) is a progressive neurological illness associated with parkinsonism. Electroconvulsive therapy (ECT) improves motor function in Parkinsons disease and, thus, might be beneficial in MSA. Three cases of MSA treated with ECT are described. All patients improved neurologically, but none regained independent ambulation. A review, including previously reported cases, demonstrates that ECT can be safe and effective for depression associated with MSA. Reduced tremor and rigidity may occur, but substantial gait improvement cannot be expected.

Treatment of Memory Loss with Herbal Remedies

Opinion statementIncreased rates of dementia throughout the world are creating an emergent need for successful preventive and treatment strategies. Despite a lack of any significant scientific basis, herbal remedies and other types of “complementary and alternative medicine” (CAM) are being aggressively marketed for both prophylactic and therapeutic effects in regard to memory disorders. In the past few years, a small number of controlled studies have explored the effectiveness of some of the more popular herbal and CAM remedies, including gingko biloba, phosphatidylcholine, phosphatidylserine, and omega-3 fatty acids. To date, the bulk of evidence suggests that such approaches are not successful in preventing or delaying cognitive decline or dementia, and there is little reason to prescribe these remedies for the treatment of established cognitive impairment. Some very preliminary evidence suggests that Gingko biloba may be useful in treating behavioral problems in demented people. It is likely that the absence of regulatory controls on the sale of herbal and CAM preparations will foster continued use of these agents and perhaps even accelerated use as the dementia epidemic increases, assuming no imminent breakthroughs in pharmacotherapy.

Assessing the Benefits of a Geropsychiatric Home-Visit Program for Medical Students

ObjectiveAuthors assessed the benefit of including medical students on geropsychiatric home-visits.MethodsMedical students, during their psychiatry clerkship, were assigned to a home-visit group (N=43) or control group (N=81). Home-visit participants attended the initial visit of a home-bound geriatric patient. The Maxwell-Sullivan Attitude Scale (MSAS), measuring attitudes about geriatric patients, was administered to all students before and after the clerkship. Home-visit participants received a questionnaire to rate the experience.ResultsThere were no significant differences between the groups with regard to change from baseline to follow-up on the MSAS. On the home-visit questionnaire, participants rated positively the overall experience (mean of 3.5 on a 4-point scale). Most home-visit participants commented positively about their experience.ConclusionNo significant effect of the home visit on medical student attitudes was demonstrated. However, the student questionnaire responses suggested that the students found the experience useful.