# Innovations in Clinical Neuroscience

> A peer-reviewed journal providing evidence-based information
> Last updated: 2026-10-14

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## Recent Content

- [Rajesh Pahwa, MD: Nighttime Symptoms and Sleep in Parkinson’s Disease](https://innovationscns.com/rajesh-pahwa-md-nighttime-symptoms-and-sleep-in-parkinsons-disease/): Dr. Pahwa discusses the use of continuous subcutaneous Vyalev (foscarbidopa/foslevodopa) infusion to address motor fluctuations and nighttime symptoms in patients with Parkinson’s disease. Clinical trial findings showed increased good “on” time compared with oral carbidopa/levodopa, while post-hoc analyses using the Parkinson’s Disease Sleep Scale (PDSS) demonstrated improvements in motor symptoms, Parkinson’s disease symptoms, and general sleep disturbances. Dr. Pahwa explains how continuous infusion could help extend symptom control through the night and into the early morning, supporting a more comprehensive approach to 24-hour Parkinson’s disease management. The discussion also addresses individualized nighttime dosing, including dose reduction when adverse effects occur.
- [Letter to the Editor: Response to “Literary Prescriptions: Applying Bibliotherapy in a Psychotherapeutic Context”](https://innovationscns.com/letter-to-the-editor-response-to-literary-prescriptions-applying-bibliotherapy-in-a-psychotherapeutic-context/): Dear Editor: I read with great interest the article by Correll et al,1 titled, “Literary Prescriptions: Applying Bibliotherapy in a Psychotherapeutic Context,” published in Innovations in Clinical Neuroscience. The authors provide a timely and practical overview of bibliotherapy as a cost-effective adjunct to traditional psychotherapy, which is particularly relevant given the increasing demand for accessible mental healthcare. While the clinical utility and patient-centered focus of the article are commendable, I would like to offer a few observations regarding the methodological framework. First, many of the meta-analyses reporting significant effect sizes involve “guided self-help” rather than pure bibliotherapy. As these interventions often include brief clinician contact, it remains difficult to decouple the therapeutic effect of the reading material from the supportive effect of the clinician’s check-ins. Second, while the data on major depressive disorder (MDD) is robust, the extrapolation to broader psychiatric conditions requires caution due to the heterogeneity of protocols and the risk of attrition in unguided settings. Furthermore, to enhance the discoverability and visibility of this valuable work in clinical databases, I would suggest expanding the current keywords (Bibliotherapy; psychotherapy). Including more specific Medical Subject Headings (MeSH) and thematic terms such as “Depressive Disorder, Major,” “Healthy Lifestyle,” and “Prescriptions” would significantly improve the article’s search engine optimization (SEO) and ensure it reaches a wider audience of clinicians and researchers searching for lifestyle-based psychiatric interventions. In conclusion, Correll et al1 have highlighted an underutilized tool that empowers patients. However, further research should focus on isolating the literature component through rigorous trials and standardizing keywords to improve the reach of such evidence-based reviews. I thank the authors for their contribution and look forward to further discussions on this topic. With regards, Hasan Siamian, PhD Dr. Siamian is with the Department of Health Information Technology, School of Allied Medical Sciences, Mazandaran University of Medical Sciences, Sari, Iran. Funding/financial disclosures. Dr. Siamian has no relevant conflicts of interest. No funding was received for the preparation of this letter. References Correll AB, Correll TL, Correll MC. Literary prescriptions: applying bibliotherapy in a psychotherapeutic context. Innov Clin Neurosci. 2024; 21(7–9):15–21.
- [Letter to the Editor: Responding to Correspondence on “Literary Prescriptions: Applying Bibliotherapy in a Psychotherapeutic Context”](https://innovationscns.com/letter-to-the-editor-responding-to-correspondence-on-literary-prescriptions-applying-bibliotherapy-in-a-psychotherapeutic-context/): Dear Editor: We thank Dr. Siamian for the thoughtful commentary on our article, “Literary Prescriptions: Applying Bibliotherapy in a Psychotherapeutic Context.”1 The letter addresses important questions about how bibliotherapy is operationalized, how its effects are measured, how the data should be most faithfully interpreted, and how we wisely integrate such interventions in optimal treatment plans. We agree that research on bibliotherapy frequently overlaps with guided self-help. This important limitation we attempted to clarify in our original article, specifically how most meta-analyses in clinical populations include some element of clinician contact, often through 5- to 15-minute weekly telephone calls or emails, and many protocols combine bibliotherapy with exercises or other therapeutic tasks.2 Cuijpers et al2 even suggested that phone contact seems necessary to prevent patients from prematurely giving up. Our goal was not, therefore, to note all observed effect sizes as being solely from reading material in isolation, but to describe the evidence as it exists in practical application models that can translate into ways to incorporate therapeutic reading into clinical care. It would be helpful for future studies to disentangle reading alone, brief clinician contact alone, and their combination to see not only the contribution of each component but also whether clinician contact is needed for patients to engage in care. We also agree that heterogeneity across populations, reading/learning/media materials, amount of clinician guidance, and ultimate outcome measures warrant caution. We would, however, clarify that our discussion of conditions beyond major depressive disorder (MDD) was not based simply on extrapolating MDD findings. The MDD vignette served as the principal clinical example, while discussion of anxiety, sexual dysfunction, and alcohol-related problems drew from meta-analytic evidence examining those outcomes directly.3–5 At the same time, the quality and age of this evidence vary substantially, and we do not intend to suggest that bibliotherapy has similar efficacy across all psychiatric diagnoses. Indeed, our conclusion specifically called for research comparing individual reading/learning/media materials, diagnoses, and delivery formats.1 The suggestions for expanded indexing terms are also on target. While keyword selection does not alter the underlying evidence, the potential benefit of bibliotherapy for expanding psychiatric care makes it especially important to enhance discoverability for clinicians and researchers searching by diagnosis or treatment/intervention type. We defer to the journal’s editorial expertise and indexing conventions regarding final terminology. Ultimately, we believe Dr. Siamian’s commentary helps reinforce our central thesis: bibliotherapy should not be viewed as a uniform, stand-alone, and clinician-independent intervention. More useful research would ask which patients benefit from which learning materials, under what type and dose of clinician guidance, and in which therapeutic contexts. Our goal was to encourage thoughtful, well-chosen, patient-centered reading (or learning via other forms of media) as an adjunct within a comprehensive treatment plan while emphasizing the need for more rigorous research. We are very grateful for Dr. Siamian’s excellent insights and engagement that help clarify our treatment ideas and intentions. With regards, Andrew B. Correll, MD; Terry L. Correll, DO; and Matthew C. Correll, MS-2 Mr. A. Correll is a third-year psychiatry resident Wright State University Boonshoft School of Medicine, Dayton, Ohio. Dr. T. Correll is Clinical Professor, Department of Psychiatry, Wright State University Boonshoft School of Medicine, Dayton, Ohio. Mr. M. Correll is a second-year medical student at Wright State University Boonshoft School of Medicine, Dayton, Ohio. Funding/financial disclosures. No funding was received for the preparation of this letter.  References Correll AB, Correll TL, Correll MC. Literary prescriptions: applying bibliotherapy in a psychotherapeutic context. Innov Clin Neurosci. 2024;21(7–9):15–21. Cuijpers P. Bibliotherapy in unipolar depression: a meta-analysis. J Behav Ther Exp Psychiatry. 1997;28(2):139–147.  Marrs RW. A meta-analysis of bibliotherapy studies. Am J Community Psychol. 1995;23(6):843–870.  Apodaca TR, Miller WR. A meta‐analysis of the effectiveness of bibliotherapy for alcohol problems. J Clin Psychol. 2003;59(3):289–304.  van Lankveld JJDM. Bibliotherapy in the treatment of sexual dysfunctions: a meta-analysis. J Consult Clin Psychol. 1998;66(4):702–708. 
- [Understanding the Neurobiological Mechanisms of Green Tea in Modulating Cognitive Function in Neurodegenerative Disorders: A Narrative Review](https://innovationscns.com/understanding-the-neurobiological-mechanisms-of-green-tea-in-modulating-cognitive-function-in-neurodegenerative-disorders-a-narrative-review/): Innov Clin Neurosci. 2026;23(7–9):7–18. Mahdiyeh Hedayati-Moghadam, PhD; Fatemeh Seyedi, PhD; Habibeh Mashayekhi-Sardoo, PhD; Faezeh Mirzaee, MD; Mohammad Dalfardi, MSc; and Yousef Baghcheghi, PhD Dr. Hedayati-Moghadam is with the Department of Physiology, School of Medicine and the Student Research Committee, Jiroft University of Medical Sciences, Jiroft, Iran. Dr. Hedayati-Moghadam, Mashayekhi-Sardoo, and Dr. Mirzaee are with the Student Research Committee, Jiroft University of Medical Sciences, Jiroft, Iran. Dr. Seyedi is with the Department of Anatomical Sciences, School of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran. Dr. Mashayekhi-Sardoo and Dr. Baghcheghi are additionally with the Bio Environmental Health Hazards Research Center, Jiroft University of Medical Sciences, Jiroft, Iran. Mr. Dalfardi is with the Department of Immunology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. Abstract: Objective: The cognitive-enhancing effects of green tea have garnered significant attention in the field of neuroscience. This narrative review aims to provide a comprehensive overview of the neurobiological mechanisms underlying the memory-enhancing properties of green tea. Studies have reported the beneficial effects of green tea on memory function, highlighting its potential as a natural cognitive enhancer. Methods: Through a systematic exploration of the current literature, this review elucidates the intricate interplay between green tea components and various neurobiological processes involved in memory formation and retention. Results: The review discusses the modulation of key neurotransmitter systems by green tea polyphenols and their impact on synaptic plasticity and neuronal communication. Furthermore, the review delves into the antioxidant and anti-inflammatory properties of green tea components, which contribute to neuroprotection and mitigate neuronal damage associated with memory impairment. Additionally, the review examines the role of green tea in regulating neurotrophic factors crucial for neurogenesis and synaptic plasticity. Insights into the influence of green tea on neuroinflammation, oxidative stress, and neurotrophic factors provide a comprehensive understanding of how green tea exerts its memory-enhancing effects at the molecular and cellular levels. Conclusion: This review consolidates existing knowledge on the neurobiological mechanisms of green tea-improved memory impairment and underscores the potential of green tea as a promising natural intervention for enhancing cognitive function and ameliorating memory deficits. Future research directions and clinical implications of green tea in the context of cognitive health are also discussed, emphasizing the importance of continued exploration of green tea’s therapeutic potential for memory enhancement. Keywords: Green tea, memory improvement, molecular mechanisms Neuroprotective effects of green tea Green tea is a popular beverage that has been consumed for centuries, hailing from the Camellia sinensis plant. It is renowned for its numerous health benefits, making it a staple in many cultures around the world.1 Key components in green tea are catechins, a type of antioxidant that helps fight oxidative stress in the body.2 These antioxidants decrease the risk of chronic diseases such as heart disease, diabetes, and cancer.3,4 Green tea is also known to boost metabolism and aid in weight loss. The catechins in green tea increase fat burning and improve physical performance.5 Additionally, green tea, like peroxisome proliferator-activated receptor-γ (PPAR-γ) agonists, has been found to improve brain function and reduce the risk of neurodegenerative diseases such as Alzheimer’s disease (AD) and Parkinson’s disease (PD).6,7 Caffeine and the amino acid L-theanine in green tea work together to improve mood and cognitive function.8 Green tea has anti-inflammatory properties that can help reduce inflammation in the body and lower the risk of chronic diseases.9 It contains compounds that may help protect against skin aging and promote overall skin health.10 Neuroprotection refers to the preservation of neuronal structure and function and the prevention of damage to the nervous system.11 Green tea’s neuroprotective properties have been studied extensively in recent years, with promising results.12 The key compounds responsible for this effect are catechins, notably epigallocatechin gallate (EGCG), which have been shown to have anti-inflammatory, antioxidant, and anti-apoptotic effects on the brain.13,14 Research has also suggested that green tea may help to reduce oxidative stress and inflammation in the brain, which are key factors in the development of neurodegenerative diseases.15 Additionally, green tea has been found to promote the growth of new brain cells and improve overall brain function.16 Studies have also shown that green tea catechins can help to protect neurons from damage caused by toxins and reduce the buildup of amyloid-β (Aβ) plaques, which are characteristic of AD.17,18 Several studies have investigated the potential impact of green tea on memory improvement, shedding light on its cognitive-enhancing properties and neuroprotective effects.19 For example, it has been demonstrated that the consumption of green tea extract was associated with improvements in spatial working memory in humans.20 A meta-analysis review study has revealed that green tea catechins are linked to enhanced cognitive function, including improvements in memory, attention, and processing speed. This study synthesized data from multiple studies and highlighted the potential of green tea compounds to support cognitive performance and mitigate age-related cognitive decline.21 Another study revealed that green tea extract can enhance connectivity between different regions of the brain, potentially leading to improved memory function.22 Overall, the accumulating evidence from these studies indicates that green tea has promising potential as a natural cognitive enhancer, with the ability to positively impact memory function and other aspects of cognitive performance. Therefore, understanding the precise mechanisms by which green tea enhances memory could pave the way for developing novel cognitive-enhancing therapies. Animal studies. In animal studies, green tea has been shown to have a positive impact on memory and cognitive function.23,24 Studies on animals have demonstrated that green tea extract can enhance memory and learning abilities, as well as protect against age-related memory decline.25 In particular, research has shown that green tea can increase the levels of neurotransmitters in the brain, such as dopamine and serotonin, which play a key role in memory and cognition.6 Furthermore, green tea stimulates the growth of new neurons in the hippocampus, the region of the brain responsible for memory formation. This process, known as neurogenesis, can help improve memory retention and cognitive flexibility.16 Animal studies have also suggested that green tea might enhance memory formation and retention. For example, a study
- [How to Approach Malingering in the Forensic Setting](https://innovationscns.com/how-to-approach-malingering-in-the-forensic-setting/): Innov Clin Neurosci. 2026;23(7–9):19–23. David Klopfer, MD; William Jeffrey, PT, DPT; Lara Shoukair, MD; and Nita V. Bhatt, MD, MPH Drs. Klopfer, Jeffrey, Shoukair, and Bhatt are with the Wright State University Boonshoft School of Medicine, Department of Psychiatry. FUNDING: No funding was provided for this article. DISCLOSURES: The authors have no relevant conflicts of interest. Department Editor: Julie P. Gentile, MD, is Professor and Chair of the Department of Psychiatry at Wright State University in Dayton, Ohio. Editor’s Note: The patient scenarios presented in this article are composite cases written to illustrate certain diagnostic characteristics and to instruct on treatment techniques. The composite cases are not real patients in treatment. Any resemblance to real patients is purely coincidental. Abstract: Malingering, the intentional production or exaggeration of symptoms for external gain, presents a significant diagnostic challenge in forensic psychiatry. Distinguishing malingering from genuine psychiatric illness is essential, as diagnostic errors can delay appropriate treatment, consume limited psychiatric resources, and affect legal proceedings. This article presents three clinical case vignettes illustrating different manifestations of malingering, including feigned psychosis and intellectual disability. Key diagnostic strategies include identifying inconsistencies between reported symptoms and observed behavior, evaluating symptoms across different contexts, obtaining collateral information, assessing potential external incentives, and using structured assessment and symptom validity measures. Familiarity with characteristic patterns of feigned symptoms and a systematic, multidisciplinary approach can improve diagnostic accuracy while ensuring appropriate treatment for patients with genuine psychiatric illness. Keywords: Malingering; forensic psychiatry; psychosis; symptom validity testing; feigned symptoms; forensic assessment Introduction Malingering is defined as the intentional exaggeration or fabrication of physical or psychological symptoms for external gain, such as obtaining financial compensation, avoiding criminal responsibility, or securing shelter or medications.1 The concept is distinguished from factitious disorder, in which symptoms are deliberately produced but the motivation is internal, often to assume the sick role or gain attention.1,2 It also differs from somatic symptom disorder and related disorders, where symptoms are experienced without conscious intent to deceive.1 Although malingering can involve a wide range of presentations—including cognitive deficits, mood symptoms, or medical complaints—psychosis is the most frequently simulated condition in forensic psychiatry,3 given its potential legal implications. Thus, the critical element that sets malingering apart is the presence of conscious, purposeful deception in pursuit of external incentives. Malingering has been described in the psychiatric and legal literature for centuries, with reports dating back to soldiers and prisoners feigning illness to avoid duty or punishment.4 In modern forensic psychiatry, systematic approaches to identifying malingering have been shaped by landmark reviews, emphasizing detection through improbable symptoms, inconsistencies, and atypical presentations.3,5 Subsequent authors have reinforced that while malingering may involve a wide range of symptom domains, the feigning of psychosis remains the most clinically relevant challenge in forensic settings.2 The consequences of misdiagnosing malingering—whether in one direction or the other—are profound. If a patient with genuine psychosis is mistakenly labeled as malingering, treatment delays can carry severe risks. Schizophrenia is among the most life-threatening psychiatric conditions, with individuals facing a lifetime suicide risk 20 times higher than the general population.⁶ Even while hospitalized, risk is not eliminated; psychiatric inpatients die by suicide at rates nearly 50 times greater than those seen in the community during the same period of observation.⁷ Risk escalates again after discharge. In the first 3 months following psychiatric hospitalization, suicide rates have been reported at 178 per 100,000 person-years—nearly 15 times the general rate.⁸ These statistics emphasize that timely and accurate diagnosis is critical, as withholding appropriate treatment may not only prolong suffering in the hospital but also worsen prognosis and increase vulnerability during the high-risk post-discharge period. Beyond suicide, untreated psychosis has been associated with more frequent relapses, longer hospitalizations, and reduced long-term functioning.⁹ Mislabeling psychosis as malingering therefore endangers both short-term safety and long-term recovery. On the other hand, when a patient who is malingering is misdiagnosed as truly psychotic, the ramifications extend beyond the individual to the healthcare system and society at large. State psychiatric bed availability has dropped dramatically—now at around 11 beds per 100,000 population, far below the estimated need of 30 to 50 beds per 100,000 for individuals with serious mental illness.¹⁰ In many states, forensic patients occupy up to half of these already scarce beds.¹¹ This shortage has created long waitlists—sometimes lasting weeks to months—for patients in genuine need of secure psychiatric care.¹² As a result, patients with true psychosis may languish in jails, emergency departments, or on the streets without treatment.¹³ Untreated, they may deteriorate further, face victimization, or suffer worsening of medical and psychiatric comorbidities. Meanwhile, hospitals absorb the financial and logistical strain of caring for miscategorized patients—providing food, shelter, medications, and intensive observation—while staff face increased risks of burnout and workplace violence.14,15 Whereas violence in acute psychosis is often unintentional or self-directed, malingering occurs in populations with high rates of antisocial traits, where aggression may be used instrumentally to achieve goals. Empirical evidence supports this concern; a forensic inpatient study found that individuals identified as malingering were significantly more likely to commit assaults—and at higher rates—than matched genuinely ill patients, with younger age and co-occurring personality disorders amplifying the risk.¹⁶ Thus, misdiagnosing malingering as psychosis not only delays care for patients who truly have psychosis, but also reduces overall system capacity and introduces unique safety risks for staff and peers. Recent studies suggest that malingering is relatively common in psychiatric and forensic contexts. Prevalence estimates vary depending on setting and methodology, but rates of 8% to 20% of psychiatric presentations in forensic settings have been reported, with even higher rates among incarcerated populations seeking mental health services.17,18 Detecting malingering remains challenging, but structured instruments provide clinicians with additional support. These include the Structured Interview of Reported Symptoms (SIRS), the Miller Forensic Assessment of Symptoms Test (M-FAST), and validity scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), each designed to identify improbable symptom patterns or inconsistencies.19,20 In this article, we present 3 case vignettes illustrating the presentation and detection of malingering in forensic psychiatry. Each vignette is accompanied by


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