Dear Colleagues:
Welcome to the January issue of Innovations in Clinical Neuroscience, our first issue under our new title. We have a diverse issue this month, and we hope you enjoy reading the articles we have selected for this issue as much as we did.
We start the issue with one of our regular columns, “The Interface.” This month, Sansone and Sansone review the role of N-acetyl-cysteine (or NAC for short) in mental health. Research shows that NAC may play a therapeutic role in certain psychiatric disorders, such as schizophrenia, bipolar disorder, and certain types of impulsive/compulsive disorders. While research has yet to determine proper dosages, pharmacological strategies (monotherapy vs. augmentation), and long-term risks, NAC appears to be a promising, relatively low-risk intervention.
Next, Harvey and Velligan provide us with an “Update on Cognition,” by reviewing the challenges associated with international measurement of functional capacity in schizophrenia. They present their perspectives on what can be done with existing measures and what needs to be done in the future. The authors remind us that as America becomes more multicultural, these challenges in measuring functional capacity will not be limited to other countries, but will occur close to home as well.
Following this, Ginsberg et al present their study in which they evaluated the efficacy of L-methylfolate in combination with SSRI or SNRI compared to SSRI or SNRI monotherapy in a major depressive episode. The authors found that L-methylfolate plus antidepressant at treatment onset was more effective in improving depressive symptoms and function measured by CGI-S scores within 60 days than antidepressant monotherapy, led to major symptomatic improvement more rapidly than SSRI/SNRI monotherapy, and was better tolerated.
Next, Feifel et al present their study in which they conducted a naturalistic, head-to-head, pilot study comparing the efficacy and safety of rapidly titrated divalproex ER and quetiapine in acutely manic inpatients, with the primary outcome being improvement within the first seven days. The authors found that rapid-dose administration of both quetiapine and divalproex ER produced rapid improvement in acute mania within the first seven days and both seemed to be well tolerated.
Following this, Ali et al provide a review of the literature on psychogenic nonepileptic seizures (PNES) and provide information regarding PNES epidemiology, etiology and pathogenesis, diagnosis, and features as they compare to epileptic seizures. The authors make suggestions for treatment and provide a clinical diagnostic tool that can aid clinicians in identifying a PNES episode without the use of video EEG.
Next, Gillig and Sanders provide us with another excellent installment of their article series, “Psychiatry and Neurology.” This month, the authors describe and discuss the significance of attention deficits with regard to mood disorders, anxiety disorders, posttraumatic stress disorder, and borderline personality disorder.
Following this, Yanofski presents an interesting perspective on the long-term use of ADHD medications in children. In this commentary, he examines evidence for stimulants losing efficacy over time and provides multiple possible mechanisms for this loss of efficacy. The author considers the possibility of “paradoxical decompensation,” an iatrogenic worsening of symptoms over time, and discusses its relevance to the practice of prescribing ADHD medications long-term. Recommendations for detecting and responding to possible stimulant tolerance and dependence are provided.
And finally, we wrap up with the issue with an eloquently written book review by Dr. Assad Meymandi. This month, he reviews the book, Lincoln’s Melancholy, by Joshua Wolf Shenk.
Sincerely,
Amir Kalali, MD
Editor, Innovations in Clinical Neuroscience
