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61 Increased Apathy Post-Laser Ablation for Refractory Obsessive-Compulsive Disorder
- Hannah Hagy, Christopher Krause, Briana Hatton, Jon Grant, Peter Warnke, Maureen Lacy
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 846-847
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Objective:
Severe OCD is often nonresponsive to pharmacological and behavioral therapies and thus surgical interventions are emerging. Surgical interventions have proven to be efficacious for treating refractory OCD, however limited publications suggest 22–40% of patients experience transient apathy and disinhibition post-surgery (McLaughlin et al., 2021). Apathy is highly associated with the same brain regions, the prefrontal cortex, striatum, and thalamus, which have also been implicated in OCD symptoms (Le Heron et al., 2018). Prior research noting post-surgical changes in apathy in OCD either used physician observations or less precise surgical methods (i.e., gamma knife or radiofrequency ablation). Apathy has also been highly associated with depression and executive dysfunction (Raffard et al, 2020) and often not co-assessed in prior studies. The newest intervention, cutting-edge MR-guided laser interstitial thermal therapy (LITT), limits damage outside the region of interest by precise control of thermal application in real-time. Thus, the current case series aims to investigate objective patient-reported change in apathy, disinhibition, depression, and executive dysfunction following anterior capsulotomy via this newest surgical approach for OCD.
Participants and Methods:In this retrospective study, the responses of ten consecutive patients pre- and post-LITT on the following measures were examined: Frontal Systems Behavior Scale (FrSBe), Beck Depression Inventory-II (BDI-II), and Yale Brown Obsessive-Compulsive Scale (Y-BOCS). Reliable Change Index (RCI) was used to evaluate meaningful change in pre- and post-LITT self-reported levels of apathy, disinhibition, executive dysfunction, along with depressive symptoms. Per prior published guidelines, patient-reported Y-BOCS (range 0–40) scores were used to measure OCD symptoms with 24–34 % score reduction representing partial and 35% or greater score reduction representing full response (Pepper et al., 2019).
Results:Seven patients (70%) were male, with a sample mean age of 38.4 (SD=13.6) and a mean of 14.6 (SD =2.27) years of education. Mean Y-BOCS score decreased from 32 (SD=5.3) before surgery to 18.8 (SD=11.1) after. Over 65% had partial or full response in OCD symptoms post-surgery. Six patients endorsed increased apathy, with others endorsing no change. Half of the non-responders reported this increase in apathy. The cohort remained relatively stable in disinhibition and executive dysfunction. Over half the cohort demonstrated a significant decrease in depressive symptoms. Interestingly, two of the non-responders and one responder endorsed increased apathy despite stable or improving depressive symptoms, disinhibition, and executive dysfunction.
Conclusions:Surgical interventions for psychiatric disorders are emerging quickly and being refined daily. In this cohort, anterior capsulotomy via LITT provided full or partial OCD recovery for most patients. However, most patients reported significant increases in apathy, despite experiencing a decrease in depressive symptoms, with stable disinhibition and executive dysfunction. Despite these promising improvements in OCD symptomatology via LITT, impact of surgery on apathy levels is clearly warranted using objective, quantifiable methods. As apathy has consistently been related to functional impairment and poorer quality of life, understanding this outcome is imperative in larger trials. Better understanding of this finding and underlying circuity will allow patients to be fully informed regarding this promising surgical intervention.
An Interesting Case of Nuchal Rigidity
- Christina Boettcher, Clemens Warnke, Stephan Macht, Hans-Peter Hartung, Bernd C. Kieseier
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 38 / Issue 3 / May 2011
- Published online by Cambridge University Press:
- 02 December 2014, pp. 516-517
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A 34 year-old female without prior relevant medical history presented to our emergency room with a two-day history of neck pain, odynophagia and elevated body temperature up to 38.2° C. Her general practitioner had started the patient on antibiotic treatment with ciprofloxacin and referred her to our emergency department for further diagnostic workup and treatment of suspected meningitis. Initial neurological examination revealed neck rigidity and head pain without further focal neurological signs. Body temperature was 37.7 °C, blood analyses revealed a normal leukocyte count (8.900/μl) and normal C-reactive protein (<0.3mg/dl), blood cultures were sterile. Lumbar puncture was without pathological findings (<1 leukocytes/μl, normal levels for glucose, lactate and protein). Cervical magnetic resonance imaging could rule out osseous injury and cervical myelopathy, however a small prevertebral, retropharyngeal fluid collection was visible (Figure 1a-c). This prompted the diagnosis of acute retropharyngeal calcific tendinitis (RCT). This diagnosis was confirmed by conventional x-ray showing the presence of a characteristic amorphous calcification in the retropharyngeal space anterior to the C1-C2 segments (Figure 1d). Treatment with i.v. methylprednisolone (250mg) was started and pain was reduced shortly after the first infusion. The patient was discharged on tapered oral methylprednisolone and non-steroidal anti-inflammatory drug (NSAID) treatment. Symptoms resolved completely within a week.
Relationship of suicide rates to economic variables in Europe: 2000–2011
- Konstantinos N. Fountoulakis, Wolfram Kawohl, Pavlos N. Theodorakis, Ad J. F. M. Kerkhof, Alvydas Navickas, Cyril Höschl, Dusica Lecic-Tosevski, Eliot Sorel, Elmars Rancans, Eva Palova, Georg Juckel, Goran Isacsson, Helena Korosec Jagodic, Ileana Botezat-Antonescu, Ingeborg Warnke, Janusz Rybakowski, Jean Michel Azorin, John Cookson, John Waddington, Peter Pregelj, Koen Demyttenaere, Luchezar G. Hranov, Lidija Injac Stevovic, Lucas Pezawas, Marc Adida, Maria Luisa Figuera, Maurizio Pompili, Miro Jakovljević, Monica Vichi, Giulio Perugi, Ole Andreassen, Olivera Vukovic, Paraskevi Mavrogiorgou, Peeter Varnik, Per Bech, Peter Dome, Petr Winkler, Raimo K. R. Salokangas, Tiina From, Vita Danileviciute, Xenia Gonda, Zoltan Rihmer, Jonas Forsman Benhalima, Anne Grady, Anne Katrine Kloster Leadholm, Susan Soendergaard, Carlos Nordt, Juan Lopez-Ibor
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- Journal:
- The British Journal of Psychiatry / Volume 205 / Issue 6 / December 2014
- Published online by Cambridge University Press:
- 02 January 2018, pp. 486-496
- Print publication:
- December 2014
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Background
It is unclear whether there is a direct link between economic crises and changes in suicide rates.
AimsThe Lopez-Ibor Foundation launched an initiative to study the possible impact of the economic crisis on European suicide rates.
MethodData was gathered and analysed from 29 European countries and included the number of deaths by suicide in men and women, the unemployment rate, the gross domestic product (GDP) per capita, the annual economic growth rate and inflation.
ResultsThere was a strong correlation between suicide rates and all economic indices except GPD per capita in men but only a correlation with unemployment in women. However, the increase in suicide rates occurred several months before the economic crisis emerged.
ConclusionsOverall, this study confirms a general relationship between the economic environment and suicide rates; however, it does not support there being a clear causal relationship between the current economic crisis and an increase in the suicide rate.