R. Dennis Staton

Performance of children with ADHD on tests sensitive to frontal lobe dysfunction

The performances of 20 children with attention deficit hyperactivity disorder (ADHD) were compared with those of 20 matched normal controls on a battery of neuropsychological tests. The ADHD children exhibited impaired function in reading comprehension, verbal learning and memory, and on the Information, Arithmetic, Digit Span, Block Design, and Coding subtests of the Wechsler Intelligence Scale for Children-Revised, but they performed nearly normally on measures of verbal and design fluency and on the Wisconsin Card Sorting Test. The hypothesis that disturbances in frontal lobe function related to impulse control may be responsible for the cognitive impairments observed in ADHD was not supported. Inability to control and direct attention appears to be more central to the pathophysiology of this disorder.

Neuropsychological Study of Children during and after Remission of Endogenous Depressive Episodes

2 children experiencing endogenous depressive episodes show impaired cognitive functioning. Following tricyclic antidepressant-induced remission of depression, there was significant improvement in psychometric test performance.

Cognitive Disturbances in Parkinson's Disease

To test the hypothesis that the cognitive impairments that accompany Parkinsons disease (PD) arise from frontal lobe dys function, patients with idiopathic PD and controls were tested on a neuropsychological battery that included measures of anterograde memory, visuospatial perception, and naming, as well as several tests that are known to be sensitive to lesions of the frontal lobes. PD patients of normal mental status as measured by the Mini-Mental State Examination performed normally on the naming, line orientation, and verbal recognition memory tests but exhibited deficits on verbal recall. On tests of frontal lobe function, these patients showed mild deficits on a category fluency task and on the Wisconsin Card Sorting Test. However, their errors on the latter were not typical of patients with frontal lesions, and they performed nor mally on a letter fluency task and exhibited normal release from proactive interference. Patients of lower than normal mental status performed poorly on nearly all of the cognitive tasks including confrontational naming, line orientation, and recognition memory, suggesting that their cerebral dysfunction extended beyond subcortical-frontal circuits. The present study supports the usefulness of the Mini-Mental State Examination for cognitive screening of PD patients, but does not support the hypothesis that the cognitive impairments in PD arise principally from disruption of frontal lobe functioning. (J Geriatr Psychiatry Neurol 1989;2:22-33).

Cognitive Improvement Associated with Tricyclic Antidepressant Treatment of Childhood Major Depressive Illness.

11 children fulfilling DSM-III criteria for major depressive illness were administered detailed neuropsychological batteries prior to and 3 to 6 mo. after starting tricyclic antidepressant treatment. Remission of depressive illness in those children with melancholic major depression was associated with significant improvement in WISC-R Verbal IQ and Performance IQ, and on the Similarities, Comprehension, Block Design, and Coding subtests. In addition, there were significant improvements on the Halstead Categories test, on the Visual Reception subtest of the Illinois Test of Psycholinguistic Abilities, and in response latencies on the Matching Familiar Figures test. Two children with evidence of mild left hemiparesis showed amelioration of hemiparesis during tricyclic antidepressant treatment.

An Hypothesis regarding the Commonality of Right-Hemisphere Involvement in Learning Disability, Attentional Disorder, and Childhood Major Depressive Disorder

Learning disability, attentional disorder, and childhood major depression are frequent clinical diagnoses for children who show behavioral disturbances and impaired school performance. We suggest that all three of these conditions may be associated with dysfunction of the right cerebral hemisphere. Anatomical disturbance of right-hemisphere function is often associated with learning disability or attentional deficits. The physiological disturbance of right-hemisphere function by a major depressive episode may produce or exacerbate learning disability or attentional disorder.

Non-Specificity of Motor Hyperactivity as a Diagnostic Criterion.

The relationship between motor hyperactivity and childhood depression was investigated in a group of 178 children referred for evaluation of school problems. 60% (n = 107) of the children fulfilled the modified Feighner criteria for primary childhood depression. 44% (n = 78) of the children had motor hyperactivity and 75% (n = 59) of these also showed depression. Terminal insomnia, somatic complaints, self-deprecation, episodic loss of interest in school and usual activities, social withdrawal, and preoccupation with death and dying were the symptoms which significantly differentiated depressed from non-depressed children.

Muscle fibrosis associated with intramuscular chlorpromazine administration. A preliminary report.

depression in rats; this did not occur with nalorphine, bremazocine and cyclazocine. Furthermore, in contrast to morphine and EK, these agents had poor efficacy in the rat tail flick test and in inhibiting gastrointestinal transit (unpublished results; Green 1959). Against this background, we have recently learned that EK does not substitute for morphine in rats receiving an i.p. infusion of morphine (Teiger 1974) (Dr M. E. Feigenson, Sterling-Winthrop, personal communication). Taken together, these data show that the in vivo pharmacological profile of EK, in rats, resembles that of morphine far more than the profiles of other proposed K compounds such as nalorphine, bremazocine and cyclazocine. The major difference between morphine and EK is the lack of substitution by EK for morphine in Teigers rat model. In summary, we call attention to the separation between cross-tolerance and cross-dependence in the rat and pose the following question: what criteria should be used to classify opioids in this species? Generous samples of ethylketocyclazocine and naloxone were obtained from Sterling-Winthrop and Endo, respectively. The study was supported by Grant D A 02322 from the National Institute on Drug Abuse.

The Electroencephalographic Pattern during Electroconvulsive Therapy

Methods Eighty EEG recordings were obtained during electroconvulsive therapy-induced seizures in 14 patients. Each patient was diagnosed as experiencing a severe major depressive episode (DSM-III criteria). Consent for ECT was obtained from each patient and/or family. On the morning of ECT, patients were given meperidine 50-100 mg. and atropine 0.4-1.0 mg. intramuscularly. Patients were then taken to the EEG suite where disc EEG electrodes were attached with collodion according to the International (10-20) EEG System. These recording electrodes were connected to a Grass Mode18-18C multichannel EEG instrument. ECT impulses were delivered using 3.2 cm. diameter metal stimulating electrodes attached to a Medcraft Model 8-24 III ECT machine. Areas under the stimulating electrodes were cleansed with isopropyl alcohol and prepared with electrically conductive gel. Impedence between the stimulus electrodes ranged from 7 to 13 kilohms. Electrical stimuli of 150-170 volts and 0.75-1.0 seconds duration were used. Unilateral ECT (UND-ECT) was delivered with the stimulus electrodes placed over the nondominant (right) hemisphere in the positions described by Lancaster et al. 9 (Figure 1). Once the electrodes were in place, patients were anesthetized intravenously with either

Neuropsychological Changes in Children Associated with Tricyclic Antidepressant Therapy

We have previously reported significant neuropsychological improvements associated with the pharmacotherapy of small samples of childhood depressives (Brumback, et al, 1980; Staton, et al, 1981). Although there is a small literature describing limited but similar changes in treated adult depressives (Fromm-Auch, 1982a, 1982b; Gibson, 1981; Glass, et al., 1978; Heaton & Crowley, 1981; Henry, et al., 1973; and Savard, et al., 1980), no other studies describe the cognitive effects of antidepressant treatment of children. We now report a summary of findings derived from the study of 75 depressed children treated with tricyclic antidepressants, confirming our earlier findings that highly significant right hemisphere and frontal lobe neuropsychological test improvements are observed on retest of such patients.

The Electroencephalographic Pattern during Electroconvulsive Therapy II. Preliminary Analysis of Spectral Energy

Computer assisted energy-spectral analyses were obtained on EEG recordings of unilateral non-dominant hemisphere ECT-induced seizures using the different pre-ECT anesthetic agents methohexital (Brevital), Innovar, and ketamine (Ketalar). The previously postulated predominance of electrical energy over the stimulated (right) hemisphere early in ECT-induced seizures is confirmed. There appears to be marked reduction in total seizure energy with methohexital anesthesia, whereas ketamine anesthesia appears to be associated with increased overall seizure energy. The greatest right to left energy transfer during the seizure occurred with Innovar anesthesia.