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This chapter focuses on subtle neurological signs (SNS) in schizophrenia and illustrates the principles of their assessment and interpretation among persons with neuropsychiatric disorders more generally. Growing appreciation of the role of SNS has led to the development of multiple, structured instruments to assess neurological impairment. These instruments differ markedly in the specific neurological signs assessed and in their psychometric properties. The most commonly employed neurological scales (The Woods Scale, The Heidelberger Scale, The Modified Quantified Neurological Scale, The Cambridge Neurological Inventory, and The Neurological Evaluation Scale (NES)) and their characteristics are described. NES is among the most widely used SNS scales in schizophrenia research. Schizophrenia and other psychoses are characterized by the presence of psychotic symptoms, which are frequently divided into positive symptoms and negative symptoms. Research on neurological signs provides strong evidence supporting the conceptualization of neurological signs as a trait feature of schizophrenia.
The cognitive profile of early onset Parkinson’s disease (EOPD) has not been clearly defined. Mutations in the parkin gene are the most common genetic risk factor for EOPD and may offer information about the neuropsychological pattern of performance in both symptomatic and asymptomatic mutation carriers. EOPD probands and their first-degree relatives who did not have Parkinson’s disease (PD) were genotyped for mutations in the parkin gene and administered a comprehensive neuropsychological battery. Performance was compared between EOPD probands with (N = 43) and without (N = 52) parkin mutations. The same neuropsychological battery was administered to 217 first-degree relatives to assess neuropsychological function in individuals who carry parkin mutations but do not have PD. No significant differences in neuropsychological test performance were found between parkin carrier and noncarrier probands. Performance also did not differ between EOPD noncarriers and carrier subgroups (i.e., heterozygotes, compound heterozygotes/homozygotes). Similarly, no differences were found among unaffected family members across genotypes. Mean neuropsychological test performance was within normal range in all probands and relatives. Carriers of parkin mutations, whether or not they have PD, do not perform differently on neuropsychological measures as compared to noncarriers. The cognitive functioning of parkin carriers over time warrants further study. (JINS, 2011, 17, 1–10)
This chapter discusses opioid therapy for addicted patients based on the three cases studies. Differences in history, culture, healthcare systems, laws, and attitudes have significantly affected perspectives on the ethical management of opioid use between the US and the UK. The present state of affairs is that abuse of prescription opioids is more prevalent in the US than abuse of "street" heroin. Opioid treatment of pain has periodically come under intense scrutiny in the US, resulting in fluctuations between under- and overtreatment of pain. Fears of civil or criminal prosecution may unduly influence physicians in the US, placing self-interest ahead of the traditional prioritization of beneficence and respect for patient autonomy. Differences between the US and UK in healthcare provision additionally influence opioid prescribing. The paternalistic approach more predominant in universal healthcare systems is not appropriate in the US, thus producing ethical dilemmas for the US physicians.