David R. Spiegel

Validity of the Massachusetts Youth Screening Instrument–2 (MAYSI–2) Scales in Juvenile Justice Settings

High prevalence rates of psychological problems among juvenile offenders underscore the need for effective mental health screening tools in the juvenile justice system. In this study, we evaluated the validity of the Massachusetts Youth Screening Instrument–2 (MAYSI–2) developed by Grisso and Barnum (2001) to identify mental health needs of adolescents in various juvenile justice settings. The sample was 1,192 adolescents (1,082 boys and 110 girls) admitted into Virginia juvenile correction facilities between the dates of July 2004 and June 2006. Analyses revealed higher MAYSI–2 scale scores for girls than for boys and MAYSI–2 scale intercorrelations were similar to those reported in the MAYSI–2 manuals (Grisso & Barnum, 2003, 2006). We also evaluated the concurrent validity of MAYSI–2 scales by examining scale score correlations with related and unrelated extratest variables. Results showed strong convergent validity for several MAYSI–2 scales.

A presumed case of phantom limb pain treated successfully with duloxetine and pregabalin

Phantom limb pain (PLP) may occur in nearly 80% of amputation patients. Current research has highlighted several changes that occur in the nociception pathway post amputation. With this knowledge, novel therapies were found that could decrease PLP. Two such drugs are duloxetine and pregabalin, each effecting unique steps in the nociception pathway. We also review the neurobiology and efficacy of this treatment strategy.

Use of Donepezil in the Treatment of Cognitive Impairments of Moderate Traumatic Brain Injury

Case Report Our patient was a 58-year-old male who was hospitalized after a witnessed syncopal episode. He had a computed tomography (CT) scan that showed bilateral subarachnoid hemorrhages and presented with a Glasgow coma scale of 12. According to the patient’s wife, prior to admission the patient had become more irritable, complaining of headache and nausea. There was no reported history of alcohol or drug use. On the second hospital day, a repeat CT of the head visualized “small hemorrhagic contusions most prevalent in the supraorbital right frontal lobe and right lateral temporal lobe” with a preserved midline. At this point the patient was oriented times one, unable to follow simple commands, and scored a 3 on the Richard Agitation Sedation Scale (RASS). An EEG indicated intermittent generalized slowing which was maximal over the left frontal head region. The focal slowing over the left frontal region suggested an underlying structural injury. After 2 weeks of treatement with quetiapine, the patient’s RASS was 0, and he was able to complete an initial Mini-Mental State Examination (MMSE) scoring 13, indicating moderate cognitive impairment. His short term memory and working memory were impaired and he demonstrated constructional apraxia and fluent aphasia. It was then the patient was begun on donepezil, 5 mg/day p.o. Twelve days after beginning donepezil treatment, the patient demonstrated less paraphasic errors and perseveration. Cognitively, he was oriented times two. His short term memory improved; however, his working memory continued to be poor. In the ensuing 2-week period, he was no longer aphasic. He was oriented times three and his short term and working memory improved, as he could repeat four digits forward and backward. A clock drawing test was without evidence of constructional apraxia. His final MMSE score was 29/30. The patient’s discharge psychotropics were donepezil, 5 mg/day, and quetiapine, 200 mg t.i.d.

A Potential Case of Peduncular Hallucinosis Treated Successfully with Olanzapine

Visual hallucinations have a differential diagnosis, both psychiatric and nonpsychiatric in nature. Described first by Lhermitte, peduncular hallucinosis is an uncommon etiology of visual hallucinations (VH). Typically, the offending lesion is vascular in origin and occurs at the level of the midbrain, thalamus, or rostral brainstem. Interestingly, the origin of the VH in our patients case could have been either/both from an ischemic insult at the midbrain or compression of the brainstem due to aneurism. While evidence for treatment is scarce, we present a posited case of peduncular hallucinosis treated successfully with olanzapine.

Treatment of Akinetic Mutism with Intramuscular Olanzapine: A Case Series

Akinetic mutism is a wakeful state of severe apathy and paucity of volitional movement. Evidence indicates a possible dopaminergic hypofunction within the anterior cingulate cortex. The authors present three cases of acute onset akinetic mutism successfully treated with intramuscular olanzapine.

Psychosis Induced by the Interaction of Memantine and Amantadine: Lending Evidence to the Glutamatergic Theory of Schizophrenia

The dopamine hypothesis of schizophrenia is an enduring theory purporting that overactivity of the dopamine system is part of the pathogenesis of this illness. This theory is supported, in part, by the fact that amphetamines, via their enhancement of dopaminergic neurotransmission, can induce psychosis. More recently, aided by the psychoticomimetic effects of N-methyl-D-aspartate (NMDA) antagonists, it seems that glutamate, as well, has a role in the pathogenesis of schizophrenia (1). We present a case of psychosis possibly precipitated by the pharmacodynamic interaction of two NMDA antagonists.

Conceptualizing a subtype of patients with chronic pain: the necessity of obtaining a history of sexual abuse

Lifetime history of sexual abuse is estimated to range between 15% and 25% in the general female population. Cross-sectional studies have shown that sexual assault survivors frequently report chronic musculoskeletal pain and functional somatic syndromes. Treating chronic pain with opioids went from being largely discouraged to being included in standards of care and titrating doses until patients self-report adequate control has become common practice, with 8% to 30% of patients with chronic noncancer pain receiving opioids. In this clinical review, we will discuss the association between survivors of sexual assault and chronic pain/functional somatic syndromes. We will further review evidence-based treatment strategies for this “pain-prone phenotype.”

A case of mania due to cryptococcal meningitis, successfully treated with adjunctive olanzapine, in a patient with acquired immunodeficiency syndrome

We report on the case of a patient with acquired immune deficiency syndrome- and Cryptococcus neoformans meningitis-related mania in which olanzapine was successfully used adjunctively and transiently to antifungal therapy.

A case of catatonia due to posterior reversible encephalopathy syndrome treated successfully with antihypertensives and adjunctive olanzapine

Catatonia is a distinct neuropsychiatric syndrome with prominent motor manifestations. Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiologic syndrome usually precipitated by malignant hypertension. Given the overlapping neuropathology in both syndromes, we present a case of catatonia precipitated by PRES, with full resolution of the former after successful treatment of the latter.

A Case of Disulfiram-Induced Psychosis in a Previously Asymptomatic Patient Maintained on Mixed Amphetamine Salts: A Review of the Literature and Possible Pathophysiological Explanations.

Although perhaps better known as an irreversible aldehyde dehydrogenase inhibitor causing increased acetaldehyde levels after concomitant intake of ethanol, disulfiram or one of its metabolites (diethyldithiocarbamate) also inhibit dopamine β-hydroxylase, an enzyme that converts dopamine to norepinephrine. This mechanism has been advanced as a possible explanation for the development of psychosis, during disulfiram treatment, either in monotherapy or in combination therapy, when interaction-emergent psychosis could be causal. We present a young woman who was taking mixed amphetamine salts for treatment of attention-deficit/hyperactivity disorder and developed a short-lived psychosis after introduction of disulfiram. The psychotic symptoms resolved after discontinuation of both medications, without the use of antipsychotic drugs. We proceed with a review of the literature of disulfiram-induced psychosis and discuss pathophysiological theories that possibly were involved in our patients phenomenology.