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“Vetting” Service Dogs and Emotional Support Animals
by Ann L. McNary, JD Ms. McNary is a Senior Risk Manager at PRMS, Inc. Innov Clin Neurosci. 2017;15(1–2):49–51 This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS, Inc. (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation, education and onsite risk management audits, and other resources to healthcare providers to help improve patient outcomes and reduce professional liability risk. ...
Source: Innovations in Clinical Neuroscience - February 1, 2018 Category: Neuroscience Authors: ICN Online Editor Tags: Current Issue Practice Management Risk Management emotional support animal service animal Source Type: research

Wants Talk Psychotherapy but Cannot Talk: EMDR for Post-stroke Depression with Expressive Aphasia
CONCLUSION This is the first reported case demonstrating that EMDR can be effective for depression, even in those with severe expressive aphasia. In our case, there was no reluctance to disclose information, simply a neurological inability to do so. Through preparation, patience, perseverance, and plasticity (clinician flexibility, though perhaps also neuroplasticity), the patient’s PSD gradually improved, and she was able to reinvent her life within her limitations. ACKNOWLEDGMENTS The authors gratefully acknowledge Eugene Schwartz, E.C. Hurley, and Mark Hubner for providing consultation during patient care. REFEREN...
Source: Innovations in Clinical Neuroscience - February 1, 2018 Category: Neuroscience Authors: ICN Online Editor Tags: Case Report Current Issue Neurologic Systems and Symptoms Neurology Psychotherapy Stroke aphasia depression EMDR Source Type: research

Latest e-Edition of ICNS
Click here to access the latest e-edition PDFs can be downloaded and printed from the e-Editions. Click on the above issue, find the article, then click on the print command. For archived e-editions, click on the image above, then click on the folder icon at the top of the window.The post Latest e-Edition of ICNS appeared first on Innovations in Clinical Neuroscience. (Source: Innovations in Clinical Neuroscience)
Source: Innovations in Clinical Neuroscience - February 1, 2018 Category: Neuroscience Authors: ICNS Online Editor Tags: Assessment Tools Current Issue Drug Development Patient Assessment Psychiatry Psychopharmacology Scales Schizophrenia Trial Methodology Source Type: research

Editorial Message and Issue Highlights – Vol. 15, No. 1 –2, January-February 2018
Dear Colleagues: Welcome to the January-February 2018 issue of Innovations in Clinical Neuroscience (ICNS). This is a milestone year for us as it marks the beginning of our 15th year of publication! We are pleased to continue serving you, our valued readers and colleagues, by providing peer-reviewed, evidence-based information on the latest innovations in both research and clinical practice in the field of neuroscience. We’d like to thank those dedicated readers who have been with us since 2004, the year we launched the journal, and to welcome new readers who are just discovering ICNS and what it has to offer. We&rsq...
Source: Innovations in Clinical Neuroscience - February 1, 2018 Category: Neuroscience Authors: ICN Online Editor Tags: Current Issue Editor's Message: Issue Highlights Source Type: research

Pimavanserin: A Novel Drug Approved to Treat Parkinson ’s Disease Psychosis
Conclusion: Evidence suggests pimavanserin attenuates PDP symptoms with few adverse effects and little risk of worsening motor function. With limited treatment options for PDP, pimavanserin represents an important therapeutic innovation. KEYWORDS: Pimavanserin, ACP-103, Parkinson’s disease psychosis INTRODUCTION Parkinson’s disease (PD) is a prevalent disorder that affects approximately 40 to 1,000 persons/100,000, with increased occurrence in older individuals.[1] PD is characterized by progressive neurodegeneration that manifests in the early stages as mild cognitive impairment and moderate motor dysfunction,...
Source: Innovations in Clinical Neuroscience - February 1, 2018 Category: Neuroscience Authors: ICN Online Editor Tags: Current Issue Movement Disorders Neurology Parkinson's disease Psychiatry Psychopharmacology psychosis Review Schizophrenia ACP-103 Parkinson’s disease psychosis Pimavanserin Source Type: research

Effectiveness of Electroconvulsive Therapy (ECT) in Parkinsonian Symptoms: A Case Series
We describe their treatment and review the current literature on the use of ECT among patients with PD. CASE SERIES All six patients in our retrospective chart review received bitemporal modified brief pulse ECT. Prior to ECT, the patients underwent pre-ECT evaluation, which involved hemogram analysis, renal and liver function tests, fasting blood glucose analysis, chest X-ray (posteroanterior view), and serum electrolyte analysis, all of which were within the normal range for all six patients, and none of the patients showed evidence of raised intracranial pressure on fundoscopy examination. All patients provided written ...
Source: Innovations in Clinical Neuroscience - February 1, 2018 Category: Neuroscience Authors: ICN Online Editor Tags: Case Review Current Issue Depression Devices ECT Mental Disorders Mood Disorders Movement Disorders Neurology Parkinson's disease Psychiatry Technology Electroconvulsive therapy parkinson’s disease Source Type: research

Lower-extremity Dynamometry as a Novel Outcome Measure in a Double-blind, Placebo-controlled, Feasibility Trial of Intravenous Immunoglobulin (IVIG) for HIV-associated Myelopathy
by Jessica Robinson-Papp, MD, MS; Mary Catherine George, MM, PhD; Alexandra Nmashie, MD; Donald Weisz, PhD; and David M. Simpson, MD Drs. Robinson-Papp, George, Nmashie and Simpson are with the Department of Neurology and Dr. Weisz is with the Department of Neurosurgery—all from the Icahn School of Medicine at Mount Sinai in New York, New York. Innov Clin Neurosci. 2017;15(1–2):28–32 FUNDING: This investigator-initiated project was supported by a grant from CSL Behring. The project was also supported by Grant Number #UL1TR000067 from the National Center for Advancing Translational Sciences (NCATS), a comp...
Source: Innovations in Clinical Neuroscience - February 1, 2018 Category: Neuroscience Authors: ICN Online Editor Tags: Assessment Tools Current Issue Demyelinating Disease Movement Disorders Neurodegenerative Disease Neurology Original Research Primary Care Technology Trial Methodology Dynamometry human immunodeficiency virus (HIV) intravenous immu Source Type: research

The Benefit of Mirtazapine in the Treatment of Progressive Multifocal Leukoencephalopathy in a Young HIV-positive Patient: A Case Report
We report a young HIV-positive patient who suffered from progressive multifocal leukoencephalopathy caused by the human John Cunningham virus and showed objective clinical improvement after adding mirtazapine to the treatment regimen, an observation that is supported by the emerging literature. KEYWORDS: Progressive multifocal leukoencephalopathy (PML), acquired immunodeficiency syndrome (AIDS), human immunodeficiency virus (HIV), mirtazapine, highly active antiretroviral therapy (HAART) INTRODUCTION Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system caused by the huma...
Source: Innovations in Clinical Neuroscience - February 1, 2018 Category: Neuroscience Authors: ICN Online Editor Tags: Case Report CNS Infections Cognition Current Issue Neurologic Systems and Symptoms Primary Care Psychopharmacology acquired immunodeficiency syndrome (AIDS) highly active antiretroviral therapy (HAART) human immunodeficiency virus (HIV) Source Type: research

Cognitive Impairment Associated with Cancer: A Brief Review
CONCLUSION Cognitive impairment can affect daily functioning, quality of life, and capacity to work in patients with cancer and those in remission. Consequently, cognitive assessment is now an important and necessary part of a comprehensive oncological care plan. Cancer-related cognitive impairment might be due to the direct effects of the cancer itself, nonspecific factors, or comorbid conditions that are independent of the disease and/or due to the adverse effects of the treatment or combination of treatments given for the disease. The prevalence and extent of cognitive impairment associated with cancer is recognized but...
Source: Innovations in Clinical Neuroscience - February 1, 2018 Category: Neuroscience Authors: ICN Online Editor Tags: Cognition Current Issue Neuro oncology Neurology Review cancer chemotherapy cognitive impairment neuropsychological assessment treatment Source Type: research

Letter to the Editor: Pneumocephalus: Is the needle size significant?
Discussion. Pneumocephalus is defined by two mechanisms: a ball-valve and an inverted bottle concept.1 The ball-valve type implies positive pressure events, such as coughing or valsalva maneuvers, that prevent air escape. Tension pneumocephalus is included in this mechanism, causing a parenchymal mass effect. The inverted bottle theory includes a negative intracranial pressure gradient following cerebrospinal fluid drainage, relieved by air influx. A small pneumocephalus is usually sealed by blood clots or granulation, allowing spontaneous reabsorption and resolution.[1] Otherwise, the lateral positioning of a patient duri...
Source: Innovations in Clinical Neuroscience - February 1, 2018 Category: Neuroscience Authors: ICN Online Editor Tags: Assessment Tools CNS Infections Current Issue Letters to the Editor Neurologic Systems and Symptoms Neurology Stroke Traumatic Brain Injury epidural needle size Pneumocephalus spinal tap Source Type: research

Vol. 51 (December 28, 2017): New Discoveries in Neurodegenerative Diseases
Welcome to The Neuroscience Report where each week we will highlight a specific topic in neuroscience and provide you with links to 5 journal articles, 5 news articles, and 5 wildcard picks. Brought to you by Innovations in Clinical Neuroscience—your source for peer-reviewed, evidence-based information. This week’s topic: Discoveries in Neurodegenerative Diseases 5 Journal Articles Pathogenesis and progression of multiple sclerosis: the role of arachidonic acid-mediated neuroinflammation Down-regulation of MiR-9* in the peripheral leukocytes of Huntington’s disease patients The mirror neurons...
Source: Innovations in Clinical Neuroscience - December 25, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Neurodegenerative Disease The Neuroscience Report Source Type: research

Vol. 50 (December 20, 2017): Advances in Neuroscience
The latest in neuroscience—sorted and summarized for you Welcome to The Neuroscience Report where each week we will highlight a specific topic in neuroscience and provide you with links to 5 journal articles, 5 news articles, and 5 wildcard picks. Brought to you by Innovations in Clinical Neuroscience—your source for peer-reviewed, evidence-based information. This week’s topic: Advances in Neuroscience 5 Journal Articles Closing the loop on impulsivity via nucleus accumbens delta-band activity in mice and man   Can surgical simulation be used to train detection and classification of neu...
Source: Innovations in Clinical Neuroscience - December 20, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: The Neuroscience Report Source Type: research

Vol. 49 (December 11, 2017): Neurological Disorders
The latest in neuroscience—sorted and summarized for you Welcome to The Neuroscience Report where each week we will highlight a specific topic in neuroscience and provide you with links to 5 journal articles, 5 news articles, and 5 wildcard picks. Brought to you by Innovations in Clinical Neuroscience—your source for peer-reviewed, evidence-based information. This week’s topic: Neurological Disorders 5 Journal Articles Disease Modifying Treatments and Symptomatic Drugs for Cognitive Impairment in Multiple Sclerosis: Where Do We Stand? Inventory of Real World Data Sources in Parkinson’s...
Source: Innovations in Clinical Neuroscience - December 11, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: The Neuroscience Report neurological disorders Source Type: research

Hot Topics in Multiple Sclerosis
CLICK HERE TO ACCESS E-EDITION December 2017 Past Issues PDFs can be downloaded and printed from the e-Editions. Click on the above issue issue, find the article, then click on the print command. For archived e-editions, click on the image above, then click on the folder icon at the top of the window. November 2017The post Hot Topics in Multiple Sclerosis appeared first on Innovations in Clinical Neuroscience. (Source: Innovations in Clinical Neuroscience)
Source: Innovations in Clinical Neuroscience - December 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Multiple Sclerosis Neurodegenerative Disease Neurology Special Issues Supplements Source Type: research

Vol. 48 (November 30, 2017): Multiple Sclerosis
The latest in neuroscience—sorted and summarized for you Welcome to The Neuroscience Report where each week we will highlight a specific topic in neuroscience and provide you with links to 5 journal articles, 5 news articles, and 5 wildcard picks. Brought to you by Innovations in Clinical Neuroscience—your source for peer-reviewed, evidence-based information. This week’s topic: Multiple Sclerosis Journal Articles Primary Progressive Multiple Sclerosis: Putting Together the Puzzle The State of Multiple Sclerosis: Current Insight Into the Patient/Health Care Provider Relationship, Treatm...
Source: Innovations in Clinical Neuroscience - November 30, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Neurodegenerative Disease The Neuroscience Report multiple sclerosis Source Type: research

November –December: PANSS 30th Anniversary e-Edition
CLICK HERE TO ACCESS THE E-EDITION PDFs can be downloaded and printed from the e-Editions. Click on the above issue, find the article, then click on the print command. For archived e-editions, click on the image above, then click on the folder icon at the top of the window.The post November–December: PANSS 30th Anniversary e-Edition appeared first on Innovations in Clinical Neuroscience. (Source: Innovations in Clinical Neuroscience)
Source: Innovations in Clinical Neuroscience - November 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue antipsychotic drugs Positive and Negative Syndrome Scale (PANSS) schizophrenia Source Type: research

Precursors to the PANSS: The BPRS and its progenitors
Conclusion One definition of value is when a trademark is used as a generic; Kleenex and Jello come to mind. From that perspective, the BPRS became the name for numerous scales that went far beyond the original. Perhaps the distinction of the PANSS is that it changed the terrain by creating both a new name and a brand. With its remarkable utility in the development of new antipsychotic medications and other treatments in schizophrenia and psychotic disorders today, the PANSS will help to shape the future of assessment tools, and ultimately psychiatric research. References Kay SR, Fiszbein A, Opler LA. The positive an...
Source: Innovations in Clinical Neuroscience - November 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue Review 7-point Likert scale BPRS factor analysis of data PANSS psychometrics schizophrenia symptom assessment the Brief Psychiatric Rating Scale The Positive and Negative Syndrome Scale Source Type: research

A Developmental History of the Positive and Negative Syndrome Scale (PANSS)
Conclusion Since Moore’s initial efforts and discovery of five highly correlated syndromes, there have been different assessments created to evaluate symptom profiles, target populations, and drug efficacy. All of the scales discussed here strive to appropriately assess an individual’s symptoms and functioning. The advancements in assessments made by the discussed scientists, doctors, clinicians, and researchers discussed above paved the way for the future of understanding symptoms, treatment, and the overall state of knowledge for psychosis. Lorr contributed by stressing the importance of interrater reliabilit...
Source: Innovations in Clinical Neuroscience - November 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue Review Brief Psychiatric Rating Scale (BPRS) Inpatient Multidimensional Psychiatric Scale (IMPS) Multidimensional Scale for Rating Psychiatric Patients (MSRPP) Positive and Negative Syndrome Scale (PANSS) psychometrics psychosi Source Type: research

Using the Positive and Negative Syndrome Scale (PANSS) to Define Different Domains of Negative Symptoms: Prediction of Everyday Functioning by Impairments in Emotional Expression and Emotional Experience
In this study, as we did not use full information methods, we excluded cases that were missing information on any of the variables; the resulting sample size was 630 cases. We compared the demographic information for these cases to the 191 cases with at least one missing observation. There were no significant differences between the current sample and the previous sample. The PANSS reduced emotional experience factor and the PANSS reduced expression factor were significantly correlated with each other in this dataset (r=0.30, p
Source: Innovations in Clinical Neuroscience - November 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue Original Research factor analysis negative symptoms schizophrenia Source Type: research

Insight and Treatment Outcomes in Schizophrenia: Post-hoc Analysis of a Long-term, Double-blind Study Comparing Lurasidone and Quetiapine XR
Conclusion: In this post-hoc analysis, flexibly dosed lurasidone 40 to 160mg/d was found to be associated with significantly greater improvement in insight compared to flexibly dosed quetiapine XR 200 to 800mg/d over long-term treatment in patients with schizophrenia. Across treatment groups, improvement in insight and judgment was significantly associated with improvement in cognition, functional capacity, quality of well-being, and depressive symptoms over time. Keywords: Insight, schizophrenia, cognition, functional capacity, quality of well-being, depressive symptoms, lurasidone, quetiapine XR Innov Clin Neurosci. 2017...
Source: Innovations in Clinical Neuroscience - November 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue Original Research cognition depressive symptoms functional capacity insight lurasidone quality of well-being quetiapine XR schizophrenia Source Type: research

Negative Symptom Dimensions of the Positive and Negative Syndrome Scale Across Geographical Regions: Implications for Social, Linguistic, and Cultural Consistency
Conclusion: These results suggest that the Positive and Negative Syndrome Scale negative symptom factor can be better represented by a two-factor model than by a single-factor model. Additionally, the results show significant differences in responses to items representing the Positive and Negative Syndrome Scale expressive factors, but not the experiential factors, across regions. This could be due to a lack of equivalence between the original and translated versions, cultural differences with the interpretation of items, dissimilarities in rater training, or diversity in the understanding of scoring anchors. Knowing which...
Source: Innovations in Clinical Neuroscience - November 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue Original Research experiential deficits expressive deficits negative symptoms PANSS Positive and Negative Syndrome Scale schizophrenia Source Type: research

CNS Summit 2017 Abstracts of Poster Presentations
Conclusion: This novel technology discriminates and quantifies subtle differences in behavior and neurological impairments in subjects afflicted with neurological injury/disease. KINARM assessments can be incorporated into multi-center trials (e.g., monitoring stroke motor recovery: NCT02928393). Further studies will determine if KINARM Labs can demonstrate a clinical effect with fewer subjects over a shorter trial period. Disclosures/funding: Dr. Stephen Scott is the inventor of KINARM and CSO of BKIN Technologies.   Multiplexed mass spectrometry assay identifies neurodegeneration biomarkers in CSF Presenter: Chelsky...
Source: Innovations in Clinical Neuroscience - November 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Assessment Tools biomarkers Cognition Current Issue Drug Development General Genetics Medical Issues Neurology Patient Assessment Psychopharmacology Scales Special Issues Supplements Trial Methodology clinical trials CNS Su Source Type: research

September –October 2017 e-Edition
CLICK HERE TO ACCESS THE E-EDITION PDFs can be downloaded and printed from the e-Editions. Click on the above issue issue, find the article, then click on the print command. For archived e-editions, click on the image above, then click on the folder icon at the top of the window.  The post September–October 2017 e-Edition appeared first on Innovations in Clinical Neuroscience. (Source: Innovations in Clinical Neuroscience)
Source: Innovations in Clinical Neuroscience - September 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue Drug Development e-Edition Neurology Psychiatry Psychiatry and Neurology Trial Methodology central nervous system CNS ICNS Innovations in Clinical Neuroscience psychotherapy Source Type: research

A Case of Psychosis in a Patient with Secondary Adrenal Insufficiency: A Possible Etiological Role of a Hypocortisolemic-induced Increase in Proinflammatory Cytokines
We present a case of secondary adrenal insufficiency caused by a pituitary tumor. During the course of evaluation and treatment, the patient developed a psychotic episode. We will briefly review the condition of adrenal insufficiency and propose how hypocortisolemia can result in psychosis. Keywords: Psychosis, secondary adrenal insufficiency, hypocortisolemia, proinflammatory cytokines Innov Clin Neurosci. 2017;14(9–10):4–10 Incidentally found lesions of the pituitary gland, referred to as “pituitary incidentalomas,” are present in approximately 10 percent of individuals undergoing brain magnetic r...
Source: Innovations in Clinical Neuroscience - September 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Case Report Current Issue hypocortisolemia proinflammatory cytokines psychosis secondary adrenal insufficiency Source Type: research

An Open-Label Prophylaxis Study of Lithium Plus Extended-Release Carbamazepine (ERC-CBZ) Combination for Rapid Cycling Bipolar Disorder
by Sriram Ramaswamy, MD; David Driscoll, PhD; and Lynette M. Smith, PhD Dr. Ramaswamy is with the Department of Psychiatry, Creighton University School of Medicine, Omaha, Nebraska, and the VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska. Dr. Driscoll is with the VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska. Dr. Smith is with the College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska. Funding/financial disclosures: This work was supported by an investigator-initiated grant from Shire Pharmaceuticals. Keywords: carbamazepine, lithium, rapid cycling, bipolar disorde...
Source: Innovations in Clinical Neuroscience - September 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue Letters to the Editor bipolar disorder carbamazepine Lithium rapid cycling Source Type: research

Hot Topics in Neuroscience: Zika Microcephaly
Discussion Zika virus can be detected in almost all body fluids. Its various methods of transmission and sequelae have created global public health concerns. The virus can negatively affect neurologic outcomes of development at all stages of pregnancy; there is evidence to substantiate a significant association between zika infections during gestation and microcephaly.1–8 Despite the World Health Organization and CDC having developed guidelines for pregnant women, there is no proven link to fully verify the confirmed or potential neurological risks during a concurrent zika virus infection.7 It has recently been demon...
Source: Innovations in Clinical Neuroscience - September 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue Hot Topics in Neuroscience microcephaly zika Source Type: research

Top 10 Myths about Telepsychiatry
This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS, Inc. (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation, education and onsite risk management audits, and other resources to healthcare providers to help improve patient outcomes and reduce professional liability risk. The answers published in this column represent those of only one risk management consulting company. Other risk management c...
Source: Innovations in Clinical Neuroscience - September 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue Risk Management telepsychiatry Source Type: research

July –August e-edition
Click here to access e-Edition PDFs can be downloaded and printed from the e-Editions. Click on the above issue issue, find the article, then click on the print command. For archived e-editions, click on the image above, then click on the folder icon at the top of the window.  The post July–August e-edition appeared first on Innovations in Clinical Neuroscience. (Source: Innovations in Clinical Neuroscience)
Source: Innovations in Clinical Neuroscience - July 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue Drug Development e-Edition Neurology Psychiatry Psychiatry and Neurology Trial Methodology central nervous system CNS ICNS Innovations in Clinical Neuroscience psychotherapy Source Type: research

Immersive Virtual Reality Therapy with Myoelectric Control for Treatment-resistant Phantom Limb Pain: Case Report
Conclusions: Currently available immersive virtual reality technology with myolectric and motion tracking control may represent a possible therapy option for treatment-resistant phantom limb pain. Keywords: virtual reality, phantom limb pain, rehabilitation, amputation, therapy, pain Innov Clin Neurosci. 2017;14(7–8):3–7 Phantom limb pain (PLP), the sensation of pain in an absent limb, is a frequent complication after amputation, with reported prevalence rates ranging from 40 to 85 percent.1,2 While the exact mechanism of PLP remains to be elucidated, peripheral and central neural factors are thought to contrib...
Source: Innovations in Clinical Neuroscience - July 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Case Report Current Issue amputation pain phantom limb pain rehabilitation therapy virtual reality Source Type: research

Methadone Treatment of Opiate Addiction: A Systematic Review of Comparative Studies
Conclusion and Recommendations More intervention-based clinical trials are needed to provide a strong alternative candidate therapy for management of opiate use disorder. Buprenorphine, although a promising candidate, should be researched more regarding treatment retention and patient satisfaction before any conclusions can be made regarding its standard use for opiate substitution maintenance treatment of pregnant patients with opiate use disorder. Heroin-assisted treatment still cannot be considered in opiate addicts refractory to MMT; more data should be collected regarding efficacy in larger participant populations un...
Source: Innovations in Clinical Neuroscience - July 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue General Review buphernorphin heroin methadone opiate opiate addiction treatment withdrawal Source Type: research

Narcolepsy in Adolescence — A Missed Diagnosis: A Case Report
We report a case of an adolescent male who presented with all four cardinal symptoms of narcolepsy and had been misdiagnosed with epilepsy, psychosis, and depression. We discuss various issues regarding narcolepsy in children and adolescents. Keywords: narcolepsy, adolescence, misdiagnosis Innov Clin Neurosci. 2017;14(9–10):20–23 Introduction Narcolepsy is an uncommon sleep cycle disorder characterized by the tetrad of chronic excessive daytime sleepiness, cataplexy, hypnagogic hallucinations, and sleep paralysis.1 The cardinal symptom of paroxysmal sleep is seen in all patients, whereas other symptoms such as ...
Source: Innovations in Clinical Neuroscience - July 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Case Report Current Issue adolescence misdiagnosis narcolepsy Source Type: research

Trazodone for Insomnia: A Systematic Review
Conclusion. A review of the literature suggests that there are adequate data supporting the efficacy and general safety of the low-dose use of trazodone for the treatment of insomnia. keywords: insomnia, hypnotics, treatment, trazodone, sedative Keywords: insomnia, hypnotics, treatment, trazodone, sedative Innov Clin Neurosci. 2017;14(9–10):24–34 Introduction Insomnia is characterized by difficulty falling asleep, difficulty staying asleep, or waking too early1 and is associated with significant impairments in daytime activities, which might occur despite adequate opportunities for sleep.2–6 Primary insom...
Source: Innovations in Clinical Neuroscience - July 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue Review hypnotics insomnia sedative trazodone treatment Source Type: research

Editorial Message and Issue Highlights, May –June 2017
Dear Colleagues: Welcome to the May-June 2017 issue of Innovations in Clinical Neuroscience. We start the issue with the review article, “The Role and Treatment Implications of Peripheral and Central Processing of Pain, Pruritus, and Nausea in Heightened Somatic Awareness: A Review,” by Spiegel et al. Here, the authors describe and discuss human studies that explore acute neural transmission processes of pain, pruritus, and nausea, including how cortical and subcortical networks are activated by these symptoms. Based on the discussed research, the authors then describe potential treatment options for patients w...
Source: Innovations in Clinical Neuroscience - June 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue Editor's Message: Issue Highlights Amir H. Kalali Innovations in Clinical Neuroscience Source Type: research

The Role and Treatment Implications of Peripheral and Central Processing of Pain, Pruritus, and Nausea in Heightened Somatic Awareness: A Review
This article reviews the acute neural transmission of pain, pruritus, and nausea symptoms, which can begin in the periphery and/or viscera. The subsequent multiple pathways in the central nervous system that become involved in the processing of these symptoms are also discussed. The authors describe human brain imaging studies that have revealed consistent cortical and subcortical networks  activated by these symptoms, including sensory, limbic, and associative regions. In particular, the authors discuss information revealed by the studies regarding the primary somatosensory cortex, secondary somatosensory cortex, ant...
Source: Innovations in Clinical Neuroscience - June 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue Neurologic Systems and Symptoms Neurology Pain Review central processing nausea pruritus Source Type: research

Single Nucleotide Polymorphisms and the Central Nervous System: Potential Biomarkers in Identifying Suicide Risk
Conclusion Point of care testing (POC) with immediately available results becomes more important, especially in young adults in whom an escalation in the number and severity of self-destructive behaviors is increasingly associated with fatal outcomes. Other populations of concern would be the active duty military and veterans where suicides are also steadily rising and warrant close monitoring and predictive testing when available. At the very least, it behooves us as clinicians and scientists to further explore and clearly establish the relationship between SNPs and suicidal behaviors. Disclaimer The views expressed here ...
Source: Innovations in Clinical Neuroscience - June 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: biomarkers Current Issue Drug Development Genetics Psychiatry Review Suicidality CNS CYP2C19 CYP2D6 pharmacogenomics Single nucleotide polymorphism Single nucleotide polymorphisms SNP SNPs suicide risk Source Type: research

When the Opioid Medications Go Missing: Confidentiality and Safety in Adolescents
Conclusion Clinicians should be aware of state laws regarding consent for alcohol and substance use treatment for minors. While family participation is the ideal strategy for treatment, minors can invoke the right of confidentiality to bar clinicians from sharing information regarding substance use with their families. Clinicians should obtain appropriate consent for communications and maintain confidentiality when possible, but above all ensure the safety of the adolescent while providing optimal care. Advice from peers, hospital ethical committees, and/or attorneys is recommended in these situations. Acknowledgment The a...
Source: Innovations in Clinical Neuroscience - June 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Child Adol Mental Disorders Commentary Current Issue Ethics in Psychiatry Substance Use Disorders adolescents confidentiality diversion opioids safety Source Type: research

It ’s Time for Combination Therapies in Multiple Sclerosis
Conclusion In summary, MS?therapies that combine BBB-crossing molecules with peripherally acting MAbs should be a strategy of MS drug development. MS therapies that effectively limit or halt disease progression and improve overall treatment outcomes will need to address the disease mechanisms both inside and outside the CNS. It must also be recognized that the presence of lymphoid-follicle like structures are associated clinically with irreversible disability and, from a pathological perspective, show pronounced demyelination, microglial activation, and loss of neurites in the cerebral cortex.[14] Without addressing such f...
Source: Innovations in Clinical Neuroscience - June 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Commentary Current Issue Drug Development Multiple Sclerosis Neurodegenerative Disease Neurology Neuromuscular Disease Psychopharmacology Update on Blood Brain Barrier combination therapies cyclophosphamide disability status laquin Source Type: research

What Can I Do About a Negative Online Review?
Conclusion While the vast majority of online reviews about healthcare professionals are positive, it can be very frustrating to see false, negative, and/or unfair comments posted about one’s professionalism and/or treatment practices or that of one’s clinic. Keep in mind that there are very few options in terms of response, and some responses, such as filing a lawsuit against the poster, will likely not benefit the healthcare professional, and will very likely generate more attention to the accusations in the post. References Attorney General Cuomo secures settlement with plastic surgery franchise that flooded...
Source: Innovations in Clinical Neuroscience - June 1, 2017 Category: Neuroscience Authors: ICNS Online Editor Tags: Current Issue Practice Management Risk Management clinician-patient interaction HIPAA online reviews patient relationship Source Type: research

Editor ’s Message—Issue Highlights, March–April 2017
Dear Colleagues: Welcome to the March–April 2017 issue of Innovations in Clinical Neuroscience. We start this issue with an interesting case series by Shroff titled, “Human Embryonic Stem Cells in the Treatment of Autism: A Case Series.” Here, investigators administered human embryonic stem cell therapy to three children with autism spectrum disorder (ASD) in an effort to improve blood perfusion in their brains, which theorectically improve motor, social, and cognition skills. After 3 to 4 treatment phases (each 4 to 6 weeks long) that were separated by 4- to 8-month gap phases, the authors report that th...
Source: Innovations in Clinical Neuroscience - April 1, 2017 Category: Neuroscience Authors: ICN Online Editor Tags: Current Issue Editor's Message: Issue Highlights Amir H. Kalali Innovations in Clinical Neuroscience Source Type: research

Human Embryonic Stem Cells in the Treatment of Autism: A Case Series
Conclusion: The use of human embryonic stem cell therapy may be a safe and effective treatment for patients with autism spectrum disorder. Studies with larger sample sizes are needed to support the use of human embryonic stem cell therapy in this patient population. Introduction Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social disconnection, incomplete verbal and nonverbal communication, severely restricted interests, and display of stereotyped and repetitive obsessive behaviors.[1,2] The current diagnosis of ASD is based on the revised criteria in the fifth edition of the Diagnostic ...
Source: Innovations in Clinical Neuroscience - April 1, 2017 Category: Neuroscience Authors: ICN Online Editor Tags: Autism Behavioral and Cognitive Neurology Case Review Current Issue Neurologic Systems and Symptoms Pervasive Developmental Disorders brain related disorder hESC human embryonic stem cell neurodevelopmental disorder stem cell therapy Source Type: research

Interactive Voice Response and Text-based Self-report Versions of the Electronic Columbia-Suicide Severity Rating Scale Are Equivalent
Conclusion: These results support the validity and reliability of the new tablet-based electronic Columbia-Suicide Severity Rating Scale. This will allow the inclusion of the electronic Columbia-Suicide Severity Rating Scale in a wider range of clinical studies, particularly where a tablet is also being used to collect other study data. Introduction Prospective assessment of suicidal ideation and behavior (SIB) is a critical step in many clinical trials. The United States Food and Drug Administration (FDA) mandates prospective SIB in “all clinical trials involving any drug being developed for any psychiatric indicati...
Source: Innovations in Clinical Neuroscience - April 1, 2017 Category: Neuroscience Authors: ICN Online Editor Tags: Assessment Tools Current Issue Depression Devices Drug Development Evaluations Original Research Patient Assessment Psychiatry Scales Suicidality Technology Trial Methodology C-SSR Columbia-Suicide Severity Rating Scale elect Source Type: research

Liothyronine for Depression: A Review and Guidance for Safety Monitoring
Conclusion: With appropriate baseline and follow-up safety monitoring, liothyronine augmentation can be a safe and effective treatment for unipolar depression. Larger studies of longer duration assessing liothyronine efficacy with serotonin norepinephrine reuptake inhibitors and multimodal antidepressants are needed. Introduction Major depressive disorder (MDD) has a 12-month prevalence of 6.7 percent and a lifetime prevalence of 16.9 percent.[1,2] Treatment-resistant depression is defined as lack of response after trials of two or more antidepressants with different mechanisms of action for sufficient duration.[3] Such an...
Source: Innovations in Clinical Neuroscience - April 1, 2017 Category: Neuroscience Authors: ICN Online Editor Tags: Current Issue Depression Mood Disorders Psychiatry Psychopharmacology Review augmentation enhancement liothyronine T3 treatment-resistant depression Triiodothyronine Source Type: research

Neuroendocrine, Autonomic, and Metabolic Responses to an Orexin Antagonist, Suvorexant, in Psychiatric Patients with Insomnia
Conclusion: Suvorexant treatment resulted in overall improvement in the quality of sleep and the severity of anxiety and depression. This dual orexin antagonist may be related to autonomic functions and neuroendocrine systems, especially in the hypothalamus-pituitary-adrenal axis in psychiatric subjects. Introduction The hypothalamus plays a critical role in the integrated control of sleep/wakefulness, thermogenesis, and energy homeostasis, and the lateral hypothalamus area (LHA) in this region has been regarded as an important center for arousal and feeding.[1] The neuropeptide orexin A and orexin B (also known as hypocre...
Source: Innovations in Clinical Neuroscience - April 1, 2017 Category: Neuroscience Authors: ICN Online Editor Tags: Anxiety Disorders Current Issue Depression Original Research Psychiatry Psychopharmacology Sleep Disorders Autonomic nervous insomnia neuroendocrine orexin antagonist suvorexant Source Type: research

Redefining Acute Relapses in Multiple Sclerosis: Implications for Phase 3 Clinical Trials and Treatment Algorithms
Conclusion A better definition of what constitutes a relapse in MS is urgently needed. From a treatment perspective, the management of relapses, particularly in the emergency department (ED), is highly variable. In general, it is possible that patients are treated with steroids based on symptomatology and an ED physician’s evaluation. It is often difficult in the ED to ascertain baseline status or a deviation from it, and an MRI may or may not be performed in the ED owing to cost and availability. However, if objective MRI data are not the singular surrogate biomarker to validate BBB breach, false-positive cases are ...
Source: Innovations in Clinical Neuroscience - April 1, 2017 Category: Neuroscience Authors: ICN Online Editor Tags: Commentary Current Issue Devices Evaluations Multiple Sclerosis Neurology Technology acute relapse big data blood brain barrier imaging magnetic resonance imaging MRI MS Source Type: research

Managing Your Aging Patient Population
by Ann L. McNary, JD Ms. McNary is Senior Risk Manager at PRMS, Inc. in Arlington, Virginia. Innov Clin Neurosci. 2017;14(3–4)41–44 This ongoing column is dedicated to providing information to our readers on managing legal risks associated with medical practice. We invite questions from our readers. The answers are provided by PRMS, Inc. (www.prms.com), a manager of medical professional liability insurance programs with services that include risk management consultation, education and onsite risk management audits, and other resources to healthcare providers to help improve patient outcomes and reduce professio...
Source: Innovations in Clinical Neuroscience - April 1, 2017 Category: Neuroscience Authors: ICN Online Editor Tags: Current Issue Practice Management Risk Management geriatrics professional liability Source Type: research

Letter to the editor: Modafinil Augmentation Therapy in Patient with Traumatic Brain Injury
Discussion. TBI results in a complex alteration of various brain regions. Recent advances in neuroimaging studies support the hypothesis that symptomatology of TBI-induced depression and cognitive deficits are directly related to the altered functional connectivity between different brain networks.[2] The default mode network represents one of them. It has been previously proposed that this functional network mainly consists of the ventromedial prefrontal cortex, posterior cingulate/retrosplenial cortex, and inferior parietal lobule. The neurochemical underprint of this network is modulated by a combined input from cortica...
Source: Innovations in Clinical Neuroscience - April 1, 2017 Category: Neuroscience Authors: ICN Online Editor Tags: Current Issue Depression Editor's Message: Issue Highlights Neurology Traumatic Brain Injury augmentation modafinil TBI Source Type: research

CNS Summit 2016 Abstracts of Poster Presentations
Conclusion: Subjects with acutely exacerbated schizophrenia who were eligible for discharge from the inpatient setting and who completed the study demonstrated high rates of adherence using the mobile AI application. Subjects were able to easily use the technology. Use of the platform did not appear to increase the dropout rate. This study demonstrates the feasibility of using AI platforms to ensure high adherence, provide reliable adherence data, and rapidly detect nonadherence in CNS trials. Disclosures/funding: Adam Hanina and Laura Shafner are employees of AiCure, New York, New York, and consultants to Takeda. Xinxin D...
Source: Innovations in Clinical Neuroscience - February 1, 2017 Category: Neuroscience Authors: ICN Online Editor Tags: Assessment Tools biomarkers Cognition Current Issue Devices Drug Development Evaluations Genetics Medical Issues Neurology Patient Assessment Proceedings Psychiatry Psychopharmacology Scales Supplements Technology Trial M Source Type: research

Editor ’s Message: Issue Highlights, January–February 2017
Dear Colleagues: Welcome to the January–February 2017 issue of Innovations in Clinical Neuroscience. We start our 14th year of publication strong with an interesting and diverse issue we hope you enjoy as much as we did putting it together. In the review article by Dascal et al, “Virtual Reality and Medical Inpatients: A Systematic Review of Randomized, Controlled Trials,” the researchers evaluate the evidence supporting the use of virtual reality among patients in acute inpatient medical settings. The authors found that virtual reality in the medical setting has demonstrated some efficacy, but they concl...
Source: Innovations in Clinical Neuroscience - February 1, 2017 Category: Neuroscience Authors: ICN Online Editor Tags: Current Issue Editor's Message: Issue Highlights Source Type: research

Behavioral and Stereological Analysis of the Effects of Intermittent Feeding Diet on the Orally Administrated MDMA ( “ecstasy”) in Mice
In this study, we investigated the behavioral and histological outcomes of the effect of intermittent feeding on the orally administered MDMA in mice. Methods—The animals (male albino mice) were divided into four groups: ad libitum (AL), intermittent feeding (IF) (food given every other day), and AL and IF control groups. After five weeks, AL and IF groups were given a single oral dose of 20 or 60mg/kg MDMA. Behavior was assessed with the elevated plus-maze and the open field tests. Each of the treatment groups were then divided in to two groups: AL-AL (AL diet throughout), AL-IF (IF after MDMA administration), IF-IF...
Source: Innovations in Clinical Neuroscience - February 1, 2017 Category: Neuroscience Authors: ICN Online Editor Tags: Anxiety Disorders Behavioral and Cognitive Neurology Current Issue Original Research Psychiatry Substance Use Disorders Elevated plus-maze hippocampus intermittent feeding MDMA neuronal numerical density open field Source Type: research

MicroRNAs as Biomarkers for Psychiatric Conditions: A Review of Current Research
Conclusion Neural miRNAs are responsive to environmental, synaptic, and pathological changes and are actively secreted by cells as exosomes from brain into blood. While serum miRs cannot cross the blood brain barrier (BBB), naturally occurring exosomes are capable of crossing the BBB. These exosomes bear cell-type specific surface markers. Using a neural-specific surface marker, neural-derived exosomes can be successfully isolated and can be used as diagnostic markers for many psychiatric conditions. For example, brain-derived exosomes are fused with neuron-specific RVG peptide (rabies virus glycoprotein, a peptide known t...
Source: Innovations in Clinical Neuroscience - February 1, 2017 Category: Neuroscience Authors: ICN Online Editor Tags: biomarkers Bipolar Disorder Current Issue Depression Psychiatry Review Schizophrenia hippocampus messengerRNA (mRNA) MicroRNA (miR/miRNA) neurogenesis neuronal plasticity Source Type: research