Dear Colleagues:

Welcome to the March–April 2018 issue of Innovations in Clinical Neuroscience (ICNS). We are excited to lead this edition of ICNS with an exciting commentary by Dr. Michael Ehlers, Head of Research and Development at Biogen (Cambridge, Massachusetts). In his article, “Neuroscience is the Next Oncology,” Dr. Ehlers explores  “the signs of a coming era of neurotherapeutics” and argues that neuroscience is advancing more rapidly than any other area of biomedical science. This article is a must-read for everyone—clinicians, researchers, big pharma, and small biotechs alike.

Next, in a review article titled, “Modafinil for the Improvement of Patient Outcomes Following Traumatic Brain Injury,” Borghol et al review the evidence on the efficacy of modafinil use in patients with fatigue or excessive daytime sleepiness (EDS) following traumatic brain injury (TBI). The authors conclude that while modafinil appears to have the potential to improve wakefulness in patients with TBI, randomized, controlled research is needed before a determination on modafinil’s use in this patient population can be made confidently.

Following this, in a retrospective study titled “Effects of Statins and Cholesterol on Patient Aggression: Is There a Connection?” Leppien et al examine the potential effects that statin use and cholesterol levels have on aggression in psychiatric inpatients. While the authors did not find a statistically significant relationship between statin therapy and agitation, they did find a statistically significant relationship between total cholesterol level and aggression. The authors conclude that psychiatric inpatients with lower total cholesterol levels are at an increased risk for loss of behavioral control.

Next, in a brief review article by Khurshid titled, “Comorbid Insomnia and Psychiatric Disorders: An Update,”  the author explores the relationship between insomnia and depression, schizophrenia, and anxiety disorders. The author discusses the available evidence and provides recommendations for the management of insomnia and comorbid psychiatric illness.

Following this, in a case report by Sahoo et al titled “Psychosis in a Child with Atypical Autism: A Case Report and a Brief Review of the Association of Psychosis and Autism,” the authors present a diagnostically challenging case of a 12-year-old child with atypical autism who developed psychotic symptoms. The authors review and discuss the relationship between schizophrenia and autism spectrum disorders (ASD). They also describe the differential diagnosis relevant to the presented case, as well as their treatment plan that led to resolution of the boy’s psychotic symptoms.

Next, in a study by Targum et al titled “Audio Recording for Independent Confirmation of Clinical Assessments in Generalized Anxiety Disorder,”  the authors assess the usefulness of audio-digital recordings to obtain independent, second opinion reviews of a primary clinician’s assessment of study participants in clinical trials. The authors implemented audio-digital recordings of key site-based assessments to generate site-independent “dual” reviews of clinical presentations, symptom severity, and medication requirements of study participants as part of the screening procedures for a clinical trial on generalized anxiety disorder (GAD). The authors conclude that the audio-digital recording method provided a useful second opinion that affirmed whether a different treatment intervention was required for patients with GAD who were participating in the study.  The authors also concluded that the audio-digital recording method was less burdensome than live second opinion assessments and might have utility in both research and clinical practice settings.

Following this, our Hot Topics in Neuroscience column features an article by Srienc et al that explores the usefulness of electroconvulsive therapy (ECT) in patients following traumatic brain injury TBI. In their article, “Is Electroconvulsive Therapy a Treatment for Depression Following Traumatic Brain Injury?” the authors discuss what little published evidence there is (only 3 case reports) for the use of ECT as a treatment option for depression in patients who have suffered TBI. While the authors conclude that use of ECT for treatment of depression in patients following TBI seems promising, much more supportive evidence is needed before meaningful conclusions can be drawn.

And finally, this edition of Risk Management features a very timely article by Vanderpool titled “Prescribing Controlled Substances: Managing the Risks.” Here, the author describes proven strategies that can help clinicians reduce and manage the risk associated with prescribing controlled substances, while providing appropriate clinical care to the patients who are in need of these medications.

We hope you enjoy this very diverse issue of ICNS. As always, we welcome your feedback and submissions.


Amir Kalali, MD

Editor, Innovations in Clinical Neuroscience