Richard B. Ferrell

Alpha-2 adrenergic challenge with guanfacine one month after mild traumatic brain injury: altered working memory and BOLD response.

Alterations in working memory (WM) are common after traumatic brain injury (TBI). Frontal catecholaminergic systems, including the alpha-2 adrenergic system, modulate WM function and may be affected in TBI. We hypothesized that administration of an alpha-2 adrenergic agonist might improve WM after mild TBI (MTBI). Thirteen individuals with MTBI 1month after injury and 14 healthy controls (HC) were challenged with guanfacine and placebo prior to administration of a verbal WM functional MRI task. Guanfacine was associated with improved WM performance in the MTBI but not the HC group. On guanfacine the MTBI group showed increased activation within a WM task-specific region of interest. Findings are consistent with the hypothesis that alterations in WM after MTBI may be improved with the alpha-2 agonist guanfacine.

Dopaminergic Challenge With Bromocriptine One Month After Mild Traumatic Brain Injury: Altered Working Memory and BOLD Response

Catecholamines, particularly dopamine, modulate working memory (WM). Altered sensitivity to dopamine might play a role in WM changes observed after traumatic brain injury (TBI). Thirty-one healthy controls (HC) and 26 individuals with mild TBI (MTBI) 1 month after injury were challenged with bromocriptine versus placebo before administration of a verbal WM functional MRI task. Bromocriptine was associated with improved WM performance in the HC but not the MTBI group. On bromocriptine, the MTBI group showed increased activation outside of a task-specific region of interest. Findings are consistent with the hypothesis that individuals with MTBI have altered responsivity to dopamine.

Excited delirium: Consideration of selected medical and psychiatric issues

Excited delirium, sometimes referred to as agitated or excited delirium, is the label assigned to the state of acute behavioral disinhibition manifested in a cluster of behaviors that may include bizarreness, aggressiveness, agitation, ranting, hyperactivity, paranoia, panic, violence, public disturbance, surprising physical strength, profuse sweating due to hyperthermia, respiratory arrest, and death. Excited delirium is reported to result from substance intoxication, psychiatric illness, alcohol withdrawal, head trauma, or a combination of these. This communication reviews the history of the origins of excited delirium, selected research related to its causes, symptoms, management, and the links noted between it and selected medical and psychiatric conditions. Excited delirium involves behavioral and physical symptoms that are also observed in medical and psychiatric conditions such as rhabdomyolysis, neuroleptic malignant syndrome, and catatonia. A useful contribution of this communication is that it links the state of excited delirium to conditions for which there are known and effective medical and psychiatric interventions.

Observing the preservation and decline of abilities in dementias.

The Brief Cognitive Rating Scale facilitated observation of the preservation and decline of abilities due to dementias among 73 female and 52 male residents at nursing homes in a northeastern and southwestern state. They ranged in age from 41 to 102 years (M = 78, SD=10.5). Dementia diagnoses included presenile Alzheimers, senile Alzheimers, Vascular Dementia, Dementia secondary to Huntingtons Disease, Dementia due to Picks Disease, and Korsakoff Dementia secondary to chronic alcoholism. Their ratings on tasks of the scale were submitted to an order analysis procedure to explore the order of decline and preservation of abilities. Results for these nursing home residents show an apparent order: loss singly or concurrently of the abilities of concentration and recent memory, followed by past memory and functioning and self-care that also appeared to be unpredictably lost or preserved singly or concurrently by different individuals, and, finally, by orientation that was preserved in 82% of the subjects.

Response to “Is There a Role for Physician Assistants in Community Mental Health?”

Pollack and Ford have described an instance in which on-the-job psychiatric education of a physician assistant (PA) resulted in greater efficiency and cost-effective service to patients. They recommend that PAs should receive more substantial psychiatric training than is currently the case. I agree with this argument. Several points deserve emphasis. All medical practitioners, including PAs, should have basic psychiatric knowledge. Practitioners who lack such knowledge will miss important psychiatric illnesses. They will also have difficulty in comprehending the interplay between emotion and physical illness. Comprehensive understanding of people, their illnesses and their lives is impossible without awareness of psychological and emotional factors. Of comparable importance is an understanding of contemporary psychiatric diagnosis and psychopharmacotherapy. This is especially true with regard to recent advances in the treatment of depression and schizophrenia. Pollack and Ford report that psychiatric training has been incorporated in the PA training program at the Oregon Health Sciences University. This is good news, and may it become the rule in all such training programs. Meanwhile, I join these authors in encouraging those in a position to contribute to the psychiatric knowledge of those