Recognizing the nonmotor symptoms associated with Parkinson's disease (PD) is necessary to determine effective treatment regimens and achieve patients' maximum mobility, as well as enhance their quality of life. The Unified Parkinson's Disease Rating Scale (UPDRS) is a useful tool for the clinician in evaluating the entire patient. In this article, the nonmotor disorders related to PD are reviewed, with specific attention to the first and last sections of the UPDRS, which cover mentation and complications of therapy, respectively. Various treatment regimens for these nonmotor symptoms are presented. Other autonomic nervous system symptoms associated with PD, which are not assessed in the UPDRS, are also discussed.

Trichotillomania (TTM, repetitive hair pulling) is a complex underdiagnosed syndrome that often causes considerable psychological distress and physical disfigurement. Although many aspects of hair pulling bear similarity to compulsions of obsessive-compulsive disorder (OCD), TTM lacks obsessions associated with OCD. The phenomenology of TTM also is similar to tics in Tourette Syndrome (TS) and overlaps with TS in both limited structural neuroimaging data and in terms of treatment response to pharmacotherapy with dopamine antagonists.

In order to study potential comorbid relationships between TTM, TS, and OCD, a total of 61 patients with either TS, OCD, or OCD comorbid with TS were assessed using structured interviews as part of a phenomenological study of these groups. Post hoc analyses indicated significantly higher proportions of hair pulling in those subjects with OCD comorbid with TS compared to subjects with either OCD or TS alone.

These data, in conjunction with clinical phenomenology, neuroimaging results, and response to pharmacotherapy suggest the possibility that some forms of TTM may be more closely related to tic disorders than OCD. Futher research is needed to clarify and confirm these observations of putative relationships between TTM and TS and potential treatment implications.

Of all known neurotransmitters, 5-HT is the one most frequently mentioned in the pathophysiology of migraine. This review focuses on the relationship between the efficacy of sumatriptan and other migraine agents and their effects on specific 5-HT receptors in rodent models. These agents are seen to have effects on vascular constriction and the release of vasoactive and inflammatory peptides from trigeminovascular sensory neurons. Specific subtypes of the 5-HT1 receptors appear to mediate these effects.

A definition of the objects of a science in terms of precise measuring operations M gives the objects a set-theoretical character whereby complexity, seen as a multiplicity of possible final outcomes, emerges. An adaptive strategy introduces a frequent readjustment of the M settings, which reduces that multiplicity. This way, an adaptive cognitive task can be seen as the extraction of a simple map out of a complex landscape.

Trichotillomania (TTM), or hair pulling, in children and adolescents is a heterogeneous disorder requiring a sophisticated approach to each patient. Hair pulling in a young, preschool child may have a different etiology and prognosis than hair pulling in an adolescent. Treatment providers must have a clear understanding of an individual's hair-pulling history, family interactions, and comorbid psychiatric diagnoses. Behavioral strategies are the primary treatment for most children and adolescents, although there may be indications for pharmacotherapy in some individuals. While research in adult TTM has been increasing in recent years, fewer studies have investigated childhood hair pulling. This article will discuss aspects of TTM unique to children and adolescents and will provide a clinical description of childhood hair pullers and treatment strategies.

Research on pathological gambling has begun to demonstrate the significant pathophysiologic role of several neurotransmitter systems in this disorder. Challenge studies with various pharmacologic agents have suggested the importance of potential dysregulation of the serotonergic system in pathological gambling, as this system is linked to dysfunction in behavioral initiation and inhibition. In addition, the noradrenergic system has been associated with mediation of arousal, increases of which are manifested by pathological gamblers. The interactions between these and other neurotransmitter systems, as well as the similarities between pathological gambling and other behavioral disorders, may provide important clues for pharmacologic intervention.

Obsessive-compulsive disorder (OCD) was thought to be a rather rare disorder and little attention was focused on investigations of the disorder until the first placebo-controlled studies reported efficacy. In 1980 three pivotal papers were published: Montgomery reported that clomipramine was effective in OCD without concomitant depression, and Thoren et al and Marks et al reported that clomipramine was effective in OCD with varying amounts of concomitant depression. These results opened the floodgates of psychopharmacological research and encouraged a more aggressive research program aimed at providing sufficient data for OCD to be recognized as a treatable condition.

Various schemes have been developed in attempts to define meaningful subtypes of obsessive-compulsive disorder (OCD). A factor analytic approach presumes that the symptom of the disorder can be described by several independent symptom dimensions. The purpose of this study was to explore the neural correlates of three symptom dimensions that were derived from previous factor analyses. Positron emission tomography was used to measure relative regional cerebral blood flow (rCBF) in 14 subjects with OCD while they engaged in a continuous performance task. Clinical indices, including factor scores, we ascertained via structured interviews plus administration of the Yale-Brown Obsessive-Compulsive Scale and checklist. The severity of Factor 1 (religious/aggressive/sexual obsessions and checking) was positively correlated with rCBF in striatum bilaterally. In addition, distinct trends were observed for the other two Factors. These findings provide initial support for a modular neurobiologic model of OCD, where dysfunction within separate component systems may principally mediate independent symptom factors. More important, this nove strategy may represent a powerful new approach to interpreting brain imaging studies of neuropsychiatric diseases.

Autism spectrum disorder (ASD) is a neurobiological developmental symptom complex characterized by early onset of deficits in verbal and nonverbal communication skills, socio-communicative function, and repetitive behaviors. The well-documented increased frequency of seizures and abnormal electroencephalographic (EEG) findings in ASD support the concept that the central nervous system dysfunction has a neurobiological basis. We review the prevalence of seizures and EEG abnormalities in children with ASD and explore the possible clinical significance of this correlation.

Available data from the literature supporting the hypothesis that partial manifestations of the panic-agoraphobic spectrum may be as clinically relevant as a full-fledged syndrome were reviewed. These partial expressions of disorder may occur singly or in connection with other mental disorders. In particular, we have examined evidences indicating relationships of panic-agoraphobic spectrum with other mental disorders in childhood and adolescence and with psychotic disorders. Their importance in childhood and adolescence is significant because we believe that these symptoms influence adult behavior and are viewed, at a later time, as atypical symptoms. Panic-agoraphobic spectrum syndromes, both in their full-fledged and partial manifestations frequently co-occur with other mental disorders and are likely to be associated with significant impairment either when occurring singly, partially, or comorbidly. Several conditions typical of childhood, such as separation anxiety, school phobia, and other symptoms related to the concept of “behavioral inhibition” seem to be connected with the panic-agoraphobic spectrum and deserve attention in relation to the development of different anxiety and mood disorders in subsequent phases of the life cycle. Identification of panic-agoraphobic spectrum features is also important within the realm of psychoses where they may substantially affect phenomenology, course of illness, and treatment response.

The course of bipolar disorder is marked by relapses and remissions, even when patients are maintained on appropriate pharmacotherapy. This variability in illness course may occur in part because the disorder is affected by socioenvironmental stressors, particularly significant life events and high-conflict family relationships. Considering these factors, clinicians have focused more attention on psychosocial treatments as useful adjuncts to pharmacotherapy. In this article, a psychosocial treatment program known as family-focused psychoeducational treatment (FFT) is described. Delivered in combination with pharmacotherapy during the postepisode stabilization period, FFT begins with an assessment of the family or marital environment. Then, in three consecutive, modules, participants receive education about the nature, causes, and treatment of bipolar disorder, communication enhancement training, and problem-solving skills training. The overall goals of the program are to restore family equilibrium and improve the patient's clinical functioning after the acute-illness episode. A case study illustrating the approach is presented, and the future directions of FFT are reviewed.

The purpose of this study was to evaluate the effect of risperidone on the cognitive functioning of patients with schizophrenia and how it relates to the alleviation of psychopathological symptoms usually observed in patients receiving treatment. Twelve schizophrenic patients were evaluated while being treated with a traditional neuroleptic, and again approximately 8 and 24 weeks after initiation of risperidone. Patients were compared with a group of normal controls (n=24) who underwent the same cognitive evaluation across time. The normal control group was included to evaluate the level of impairments in patients, but also to test for practice effects. The cognitive evaluation included measures of short-term and long-term memory; attention (alertness, sustained and selective); and executive functioning (verbal and category fluency). Clinical symptoms were rated on the Positive and Negative Symptoms Scale (PANSS) and the Brief Psychiatric Rating Scale (BPRS). Extrapyramidal symptoms were rated with the Extrapyramidal Symptoms Rating Scale.

During treatment with risperidone, schizophrenic patients improved their BPRS and PANSS scores, their performance level on tests of alertness, and both sustained and selective attention.

Pharmacological challenge tests provide a method of assessing the functional responsiveness of serotonin (5-HT) receptor subtypes in the human brain. A number of selective agonist ligands for the 5-HT1B/1D receptor are available for human use; however, these compounds do not distinguish between 5-HT1B and 5-HT1D receptors, which is somewhat of a disadvantage. Acute administration of sumatriptan, rizatriptan, and zolmitriptan all increase plasma growth hormone in healthy subjects, possibly via activation of postsynaptic 5-HT1D receptors. This response is blunted in major depression. Sumatriptan lowers plasma prolactin, perhaps via activation of presynaptic 5-HT1B receptors. This response is not altered during repeated treatment with selective serotonin reuptake inhibitors (SSRIs), suggesting that 5-HT1B receptors retain the ability to restrain 5-HT outflow during short-term SSRI treatment.

Impotence occurs in approximately one third of Parkinson's disease (PD) patients. It results from autonomic insufficiency, and is accompanied by other signs of autonomic insufficiency. Impotence may be aggravated by antiparkinsonian drugs and depression. Conversely, impotence may aggravate depression. In some patients, tremor, seborrhea, and drooling aggravate impotence by resulting in loss of self-esteem. The causes and treatment of impotence in PD are discussed in this article.

Psychoneuroendocrinology (PNE) has been a method used in the past to investigate brain biochemical functions in normal and pathological mentation. These studies have subsequently uncovered variations in normal biochemical functioning. It is still being debated, however, how these variations correlate with well-defined psychopathologies.

Future studies in PNE shows promise in many areas of contemporary neurospychiatry. For example, research focusing on variations in neurotransmitter, neuropeptide, and neurohormone secretory tonus might enhance our understanding of specific personality characteristics and behavior. PNE may also be essential in investigating the correlation between hormonal variations and symptoms observed across various psychiatric disorders. PNE might likewise be important for new therapeutic approaches. Finally, PNE can be used to investigate psychoneuroimmunoendocrine relationships.

New PNE methodologies must be developed to make this branch of neuroscience more appropriate for the study of localized brain functions.

The comorbidity of schizophrenia and obsessive-compulsive disorder (OCD) might be approached from two different directions. One is the OCD with psychotic features, and the other is the schizophrenic patient with OCD.

Panic disorder occurs frequently with different forms of cardiovascular disease and hypertension. The 13 panic symptoms described in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) often overlap with manifestations of cardiovascular disorders, raising problems in the differential diagnosis. In order to explore in greater detail the phenomenology of panic symptoms in cardiovascular patients, the Structured Clinical Interview for Panic-Agoraphobic Spectrum (SCI-PAS) was administered to 111 patients with hypertension and 29 patients with a recent myocardial infarction.

With regard to the frequency of endorsement of many of the symptoms assessed on the SCI-PAS, more than 40% of the cardiovascular patients who failed to meet the DSM-IV criteria for panic disorder did not significantly differ from the 10% of cardiovascular patients who did fulfill the criteria for panic disorder. A third distinct subgroup comprising 48.6% of the cardiovascular patients reported a significantly smaller number of SCI-PAS symptoms than the other two groups.

These preliminary findings suggest the existence of a relatively large proportion of cardiovascular patients who present with physical and psychological symptoms that are potentially related to panic disorder and that may provoke considerable subjective distress. Further studies are needed to clarify the nature of these symptoms and their potential interference with treatment and symptomatology of cardiovascular disease.

Catechol-O-methyltransferase (COMT) inhibitors are a new class of medication being developed for the treatment of Parkinson's disease (PD). The enzyme COMT metabolizes levodopa and dopamine, both peripherally and centrally. Coadministration of a COMT inhibitor with levodopa creates an increase in peripheral and central levodopa bioavailability, as well as higher central dopamine concentrations. Because these actions improve the duration of response to levodopa, the COMT inhibitors should prove to be useful adjunctive therapies in PD patients.