Neuropsychopharmacologic effects of long-term opioid therapy (LTOT) in the context of chronic pain may result in subjective anhedonia coupled with decreased attention to natural rewards. Yet, there are no known efficacious treatments for anhedonia and reward deficits associated with chronic opioid use. Mindfulness-Oriented Recovery Enhancement (MORE), a novel behavioral intervention combining training in mindfulness with savoring of natural rewards, may hold promise for treating anhedonia in LTOT.

Veterans receiving LTOT (N = 63) for chronic pain were randomized to 8 weeks of MORE or a supportive group (SG) psychotherapy control. Before and after the 8-week treatment groups, we assessed the effects of MORE on the late positive potential (LPP) of the electroencephalogram and skin conductance level (SCL) during viewing and up-regulating responses (i.e. savoring) to natural reward cues. We then examined whether these neurophysiological effects were associated with reductions in subjective anhedonia by 4-month follow-up.

Patients treated with MORE demonstrated significantly increased LPP and SCL to natural reward cues and greater decreases in subjective anhedonia relative to those in the SG. The effect of MORE on reducing anhedonia was statistically mediated by increases in LPP response during savoring.

MORE enhances motivated attention to natural reward cues among chronic pain patients on LTOT, as evidenced by increased electrocortical and sympathetic nervous system responses. Given neurophysiological evidence of clinical target engagement, MORE may be an efficacious treatment for anhedonia among chronic opioid users, people with chronic pain, and those at risk for opioid use disorder.

Treatment of medical catatonia sometimes requires management of presenting psychiatric syndrome as well as treatment of causative medical illnesses. Treatment response to these approaches may, however, differ even in the same patient suffering a relapse of a similar clinical picture, and this presents a therapeutic challenge for physicians. We therefore report a case of medical catatonia due to Graves’ disease which responded to antithyroid therapy in the first episode but required electroconvulsive therapy (ECT) when relapsed, then discuss the possible mechanism which caused different treatment response.

We describe the clinical course with the laboratory findings of recurrent catatonic episodes of a patient with Graves’ disease.

A 25-year-old woman manifested stupor, catalepsy and echolalia accompanying goiter, proptosis and tachycardia. Laboratory findings on thyroid function were consistent with Graves’ disease. Treated with thyamazole (TMZ), her psychiatric and physical symptoms gradually subsided. She had remained euthyroid and symptom free for 10 years on TMZ 5 mg every other day. However, at age 35, she exhibited stupor with mannerism and stereotypy. Laboratory findings revealed mild exercerbation of thyroid function. Though antithyroid therapy regained euthyroid, her psychiatric symptoms persisted. Further treatment with neuroleptics did not ameliorate her symptoms. She was thus administered bitemporal ECT and recovered after 7th trial.

Aggravation of thyroid function associated with catatonic symptoms when relapsed was milder compared to the first episode. This suggested that dysregulation of thyroid homeostasis in the central nervous system might have persisted despite the peripheral euthyroid and could affect the treatment response.

The authors evaluated cerebral blood flow response in schizophrenia patients during face perception to test the hypothesis of diminished limbic activation related to emotional relevance of facial stimuli.

Thirteen patients with schizophrenia and 17 comparison subjects viewed facial displays of happiness, sadness, surprise, anger, fear, and disgust as well as neutral faces using the Japanese and Caucasian Facial Expressions of Emotion and Neutral Faces (Matsumoto and Ekman, 1988). Functional magnetic resonance imaging was used to measure blood-oxygen-level-dependent signal changes as the subjects alternated between tasks of discriminating sex with an interleaved reference condition.

The groups did not differ in performance on the task. Healthy participants showed activation in the bilateral fusiform gyrus, medial temporal structures, occipital lobe, and inferior frontal cortex relative to the baseline condition. The increase was greater these regions in the right hemisphere than those in the left hemisphere. In the patients with schizophrenia, minimal focal response in the right fusiform gyrus, medial temporal structures, and occipital lobe was observed for the facial perception task relative to the baseline condition. Contrasting patients and comparison subjects revealed voxels in the left medial temporal structures, occipital lobe in which the healthy comparison subjects had significantly greater activation.

Impaired activation was seen in patients with schizophrenia for detection of facial attributes such as sex. Impairment in the medial temporal structure such as amygdale may lead to misunderstanding of social communication and may underlie difficulties in social adjustment experienced by people with schizophrenia.

Although longitudinal magnetic resonance imaging (MRI) studies have shown that various brain regions undergo progressive tissue loss during the early phases of schizophrenia, regional pattern of these changes remain unclear.

Longitudinal MRI data were obtained from 18 (12 males and 6 females) patients with first-episode schizophrenia and 20 (11 males and 9 females) healthy controls and at baseline and follow-up with mean scan interval of 2.7 years. To compare gray matter changes over time between patients and controls were evaluated with voxel-based morphometry (VBM) using SPM8 following the longitudinal DARTEL protocol.

In both groups of patient and control longitudinal gray mater reduction was observed in various brain regions including lateral and medial frontal regions and superior temporal region. Excessive decrease in gray matter was found in patients as compared to healthy controls in the left superior temporal region and right inferior frontal region.

Our findings suggest that there are differing longitudinal gray matter changes in patients with schizophrenia during the early phases of the illness as compared to healthy individuals.

Idiopathic basal ganglia calcification (IBGC) is a neuropathological finding known to manifest motor disturbance, cognitive impairment and psychiatric symptoms. Pathophysiology of psychiatric symptoms, however, remains controversial. Previous biochemical study suggests that dopaminergic impairment is involved in IBGC. We therefore performed positron emission tomography (PET) to elucidate the pre- and postsynaptic dopaminergic function and glucose metabolism in two IBGC patients.

Case 1 is a 44 years old woman presented with disorganized thought, echolalia, verbigeration and parkinsonism. She was administered bitemporal electro-convulsive therapy (ECT). Case 2 is a 35 years old woman with persecutory delusion. Computed tomography showed bilateral symmetric calcification of striatum, globus pallidus and dentate nucei. Other causes of intracranial calcification were excluded. PET scans were obtained using [11C]-labeled 2β-carbomethoxy-3β-(4-flurophenyl)-tropane, [11C]-labeled raclopride and [18F] fluorodeoxyglucose.

The decreased binding potential was severe in bilateral head of caudate nuclei and anterior putamen. In case 1, the decline was also found in posterior putamen. There were widespread decreases of glucose uptake in frontal, temporal and parietal cortices bilaterally in case 1. Significant hypometabolism was observed in the right frontal, temporal and parietal cortices. After the ECT session, the previous areas of significant hypometabolism in the right hemisphere had improved. In case 2, there was no significant change of glucose metabolism in cerebral cortex.

The difference in affected region within basal ganglia might be associated with the diverse clinical pictures in IBGC. Particularly, in the psychiatric manifestation, dopaminergic dysfunction in caudate nucleus and anterior putamen could be participated.

Fronto-temporal connections have long been thought to be involved in schizophrenia. Two fronto-temporal connections of interest are uncinate fasciculus (UF) and cingulum bundle (CB), which recently have been investigating using Diffusion Tensor Imaging (DTI), a new technique that affords an opportunity to evaluate white matter fiber integrity in vivo. Using this technique, we previously reported abnormalities in UF and CB in chronic patients. Additionally, we noted that schizotypal personality disordered subjects showed UF but not CB abnormalities.

Here, we sought to determine whether or not UF and CB white matter integrity are altered at initial onset of illness, and are specific to schizophrenia. We evaluated twelve first-episode schizophrenia, 12 first-episode affective psychosis and 12 controls using DTI on a 1.5T magnet. Fractional anisotropy (FA) and mean diffusivity (Dm) were used to quantify water diffusion, and cross-sectional area was defined with a directional threshold method.

Findings showed bilateral reduction of UF FA, but not Dm, in first-episode schizophrenia compared with controls and first-episode affective psychotic patients. For CB, there were no statistically significant group differences for either FA or Dm.

These findings suggested that UF white matter integrity, but not CB white matter integrity, is altered at initial onset of schizophrenia and may be specific to schizophrenia. In contrast, CB abnormalities are not present at first episode of schizophrenia and may reflect progressive changes that occur over the course of the illness. The latter will need to be investigated using a longitudinal design.

Impaired self-awareness has been noted as a core feature of schizophrenia. Recent neuroimaging studies examining self-referential process in schizophrenia have yielded inconsistent results. We aimed to examine the self-referential neural network using the self- and other-evaluation tasks in schizophrenia.

Fifteen schizophrenia patients and fifteen age-, sex- and parental education-matched healthy subjects underwent functional magnetic resonance imaging. Subjects were required to make a decision whether the sentence described their own personal trait (self-evaluation) and that of their close friends (other-evaluation).

Both patients and healthy groups showed significant activation in multiple brain regions including the medial- and lateral-prefrontal, temporal and parietal cortices during self- and other-evaluation tasks. The control subjects showed higher activations in left posterior cingulate and parahippocampal gyri during self-evaluation than other-evaluation, whereas there was no difference in activated regions between self- and other-conditions in the patients. As compared with the controls, the patients showed higher activations in the right superior frontal and right supramarginal gyri during self-evaluation.

These findings provide evidence for neural basis for deficits in self-awareness in schizophrenia and may underlie core clinical symptomatology of schizophrenia.

It has been said that nearly 30% of the patients with Alzheimer’ disease (AD) manifest loss of appetite, which might increase cognitive impairments and the incidence of neuropsychiatric symptoms, and malnutrition. As a result, a vicious cycle decreases functionality and quality of life in patients with AD. Cholinesterase inhibitors (ChEIs) is the first-line drugs in the treatment of AD. On the one hand, appetite or weight loss can be seen due to gastrointestinal side effects in the treatment of ChEIs. On the other hand, there are some reports in clinical-settings that patients with AD treated with rivastigmine transdermal patch showed the improvement of appetite loss.

To evaluate the efficacy of rivastigmine transdermal patch in AD patients with poor appetite.

In this 16-weeks, multicenter prospective study, patients with mild to moderate AD, who manifest loss of appetite and began to receive rivastigmine transdermal patch therapy, were enrolled. The amount of food, total time-eating, body weight, Mini Mental State Examination (MMSE) and Neuropsychiatric Inventory (NPI) were evaluated.

The amount of food eaten by treated patients significantly increased 10.5% at 8 weeks after the initiation of rivastigmine transdermal patch therapy.

This preliminary results might show favourable effects of rivastigmine transdermal patch therapy on AD patients with loss of appetite.

Study supported by Ono pharmaceutical co.

Transnasal inferior meatal antrostomy is increasingly used for the treatment of post-Caldwell–Luc mucoceles in maxillary sinus. This study aimed to report the outcomes after inferior meatal antrostomy with a mucosal flap for recurrent mucoceles.

The records of patients who had undergone transnasal inferior meatal antrostomy with or without a mucosal flap were reviewed.

Transnasal endoscopic inferior meatal antrostomy with or without a mucosal flap was performed in 21 and 49 patients, respectively. No complications were observed. A closing of the antrostomy was found in 9 (18.4 per cent) of the 49 patients who underwent antrostomy without a mucosal flap. No closings were observed in the 21 patients who underwent antrostomy with a mucosal flap. There was a significant difference in the rate of closing for surgery with and without the mucosal flap.

Transnasal endoscopic inferior meatal antrostomy with a mucosal flap is a safe method for the treatment of post-Caldwell–Luc maxillary mucoceles that effectively prevents recurrence.