Back to table of contents Previous article Next article EditorialFull AccessA Season of Change for The Journal of Neuropsychiatry and Clinical NeurosciencesDavid B. Arciniegas, M.D., , Robert E. Hales, M.D., M.B.A., , Stuart C. Yudofsky, M.D., David B. Arciniegas, M.D., Deputy Editor, Robert E. Hales, M.D., M.B.A., Deputy Editor, Stuart C. Yudofsky, M.D., EditorPublished Online:29 Apr 2015https://doi.org/10.1176/appi.neuropsych.270301AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The Journal of Neuropsychiatry and Clinical Neurosciences is in its 27th year of publication. Through its nearly three decades of operation, it has become a premier venue for publishing articles on the psychiatric aspects of neurological conditions and the neurology of psychiatric disorders. Our latest impact factor is 2.77, our 5-year impact factor is 3.14, our current H-index is 85, and the articles in our journal have been collectively cited more than 41,000 times. Our readership base has expanded to more than 1,500 subscribers, including nearly 600 individual subscribers, more than 500 institutional subscribers, and more than 400 institutional subscribers with access to Journal of Neuropsychiatry and Clinical Neurosciences through the PsychiatryOnline program. The journal is home to many of the most highly cited articles in the field of neuropsychiatry, and our website is accessed more than 650,000 times annually. We also are honored to continue our more than 25 years of service as the official journal of the American Neuropsychiatric Association.While our successes are substantial, progress requires continued growth and periodic redevelopment. Toward that end, American Psychiatric Publishing (APP) began this publishing year with a new cover design and article layout aligned with others in its catalog. The table of contents of each issue now includes brief abstracts describing each article and highlights articles that address one or more of the Accreditation Council for Graduate Medical Education core competencies. Our peer review process has been expanded and expedited by shared use of ScholarOne with our sister journals in the APP catalog, enabling us to reduce the time from submission to first editorial decision to 20.5 days. During the last year, APP also instituted JNP in Advance, which makes articles available to subscribers and indexes them in PubMed within 12 weeks of their acceptance for publication. The creation of the Online Exclusives section of the journal enabled rapid movement of articles through our publication queue. Together, these maneuvers have positioned the Journal of Neuropsychiatry and Clinical Neurosciences to expeditiously publish cutting-edge neuropsychiatric research, scholarly reviews, and instructive cases. With regard to the cases in our Letters to the Editor section, this issue also marks the transition to a refined focus for these reports: novel clinical observations that inform usefully on the neuropsychiatric manifestations of neurological conditions and/or the neurology of psychiatric disorders.This issue also marks a time of renewal for the journal's Editorial Board. With deep gratitude and great respect, we thank our outgoing Editorial Board members for their many years of volunteer service to the journal: Consulting Editors Floyd Bloom, M.D., Eric R. Kandel, M.D., Solomon H. Synder, M.D., and the late Edward G. Jones, M.D., Ph.D.; and Associate Editors Nancy C. Andreasen, M.D., Ph.D., Joseph T. Coyle, M.D., Jeffrey L. Cummings, M.D., Dwight L. Evans, M.D., Robert C. Green, M.D., John M. Morihisa, M.D., Stephen Salloway, M.D., M.S., Randolph B. Schiffer, M.D., and Daniel R. Weinberger, M.D. All have been stalwart members of the journal's Editorial Board during its formative years, and we are honored by and deeply appreciative of their contributions to and support of the journal. We welcome new members of our Editorial Board, all of whom are Fellows of the American Neuropsychiatric Association: Deputy Editor C. Alan Anderson, M.D.; Consulting Editors C. Edward Coffey, M.D., Thomas W. McAllister, M.D., Fred Ovsiew, M.D., and Jonathan M. Silver, M.D.; and Associate Editors Sheldon Benjamin, M.D., Kevin J. Black, M.D., John J. Campbell, M.D., Miles Cunningham, M.D., Richard B. Ferrell, M.D., Laura A. Flashman, Ph.D., Yonas E. Geda, M.D., Daniel I. Kaufer, M.D., W. Curt LaFrance, M.D., Mario Mendez, M.D., Ph.D., David A. Silbersweig, M.D., Kaloyan S. Tanev, M.D., and Hal S. Wortzel, M.D. We look forward to working with them as stewards of the journal's editorial direction, operations, and peer-review process. We also wish to take this opportunity to convey our heartfelt gratitude to the many professionals who have provided peer review over the years. Their selfless contributions are essential to maintaining the high quality and scientific integrity of our journal.To paraphrase C.S. Lewis,1 growth is the synthesis of continuity and change. The contributions and goodwill of colleagues concluding their service to the journal, the energy brought by our new additions to our Editorial Board, the stalwart service of our many peer reviewers, and the freedom to move forward creatively in partnership with our colleagues at APP are the ingredients for continued growth and success of the Journal of Neuropsychiatry and Clinical Neurosciences. We are confident that this combination of continuity and change will enhance our work and provide you, our readers, with the stuff of professional sustenance and growth for many years to come.Reference1 Lewis CS: Hamlet, the Prince or the Poem? Proceedings of the British Academy (vol XXVIII). London, Humphrey Milford, 1942, p 16Google Scholar FiguresReferencesCited byDetailsCited ByEditor Emeritus of The Journal of Neuropsychiatry and Clinical Neurosciences: Stuart C. Yudofsky, M.D.David B. Arciniegas, M.D.27 January 2016 | The Journal of Neuropsychiatry and Clinical Neurosciences, Vol. 28, No. 1 Volume 27Issue 2 Spring 2015Pages 80-80 Metrics PDF download History Published online 29 April 2015 Published in print 1 April 2015

The American Psychiatric Publishing Textbook of Psychiatry - Libros de Medicina - Psiquiatria General - 199,00

Back to table of contents Previous article From the ExpertsFull AccessWhen Traumatic Brain Injury Is Complicated by Personality DisordersStuart C. Yudofsky, M.D.Stuart C. YudofskySearch for more papers by this author, M.D.Published Online:4 May 2012https://doi.org/10.1176/pn.47.9.psychnews_47_9_27-aStuart C. Yudofsky, M.D.If gold and diamonds are metaphors for sinew and muscle, Mrs. Helen Harcourt could have been an Olympic weight lifter. Bejeweled and attired in an opulence more appropriate for the coronation of English royalty than a visit to a commoner doctor, she nonetheless appeared anxious and vulnerable. “I must apologize for my husband’s not coming,” she lamented. “He changed his mind at the last minute.” Mrs. Harcourt acknowledged that her husband neither trusted nor liked psychiatrists. (Names and details of the case have been changed to protect the patient’s privacy.)“Has he ever ‘seen’ a psychiatrist?” I inquired.“No. But for many years before his skiing accident, I had asked him to go with me for couples counseling, but he always refused,” she replied.Eighteen months prior to his scheduled meeting with me, Mr. Harcourt, the president and CEO of an international energy company, was seriously injured while helicopter skiing in British Columbia. Not wearing a helmet, he suffered severe brain injury when he careened at high velocity into an ice-hardened snow bank. After three weeks he emerged from coma with manifestations of prefrontal and left-brain injury including right hemiparesis, a severe expressive aphasia, and neuropsychiatric symptoms including impulsivity, impaired social judgment, affective lability, and depression. His intellect and cognition were spared. Over the next year and a half, he worked diligently with his team of rehabilitation professionals and made excellent progress with articulated speech and ambulation. Nonetheless, Mr. Harcourt spent most of his time at home where he would have temper tantrums elicited by seemingly minor frustrations in which he would scream expletives and throw and break objects. He reacted especially vehemently to Mrs. Harcourt’s efforts to assist him when he lost his balance and fell.Diagnosis and TreatmentMr. Harcourt met criteria for the following DSM-IV-TR diagnoses:Axis I: (293.83) Mood disorder due to traumatic brain injury with a major depressive-like episode; and (301.1) personality change due to traumatic brain injury, aggressive typeAxis II: (301.81) Narcissistic personality disorderHis major depression responded to antidepressant treatment, as did his irritability and episodic dyscontrol to a combination of a lipid soluble beta-blocker and an anticonvulsant. To Mrs. Harcourt’s surprise, her husband became engaged in intensive, psychodyamically oriented psychotherapy. He gained insight into how his emotional responses to his critical, detached father and enveloping mother were directly related to his low self-esteem, constrained capacity for intimacy, poor quality of relationships, and impaired psychological adjustment to the physical limitations associated with traumatic brain injury (TBI).DiscussionAs highlighted in bold below, the case of Mr. Harcourt illuminates five principles about the care of patients (and their families) in which TBI is complicated by a personality disorder.For a multiplicity of reasons, the comorbidity of personality disorders and TBI is common. First, both conditions are highly prevalent. According to the Centers for Disease Control and Prevention, each year approximately 1.7 million people sustain traumatic brain injuries that result in 52,000 deaths, 275,000 hospitalizations, and 1,365,000 hospital visits. For many of the millions of survivors of TBI, there are chronic sequelae. The median prevalence of published studies of all personality disorders ranges from 11.55 percent to 12.26 percent, with narcissistic personality disorder comprising only about 0.61 percent of the population.Second, personality disorders can increase the risk for sustaining TBI, with examples including impulsivity, recklessness, irritability, and aggressiveness leading to physical altercations for people with antisocial personality disorder.TBI often intensifies the symptoms related to personality disorders and the associated reluctance to accept help and support from family members and mental health professionals.The suddenness and multifarious deleterious consequences of TBI and many other neuropsychiatric disorders almost invariably place enormous stress on family members and caregivers of the patient. When TBI occurs in the context of personality disorder, the familial and caregiver relationships with the patient are exceedingly complex. Interventions must be understood and effected in the context of the nature of the pre- and post-TBI relationships, which will be significantly influenced by the patient’s personality disorder.Given the complexities involved in the neuropsychiatric manifestations of brain injury complicated by personality disorder, it is essential that the psychiatrist be eclectic and flexible in treatments provided. In the case of Mr. Harcourt, I provided psychopharmacology; individual, supportive, and insight-oriented psychotherapy for both him and his wife; neuropsychiatric counseling/education (related to brain-based aspects and implications of TBI) for him and his family; couples counseling; and family counseling.Psychiatric treatment of patients with both TBI and a personality disorder is effective. Prior to his psychiatric care, Mr. Harcourt was severely impaired by the concomitants of TBI and narcissistic personality disorder, which also adversely affected his wife and children. The patient and the family unit were failing. The symptoms and signs of his mood disorder and organic dyscontrol responded within two months to psychopharmacological treatment. Couples counseling with Mr. and Mrs. Harcourt helped to reduce power struggles, identify and agree on strategies to reduce his risk-taking behavior, and avoid the unwieldy consequences of his maternal transference to his wife. Finally, individual psychotherapy of Mrs. Harcourt enabled her to understand the reasons for her vulnerabilities to entering and remaining in an exploitative demeaning relationship and how to change in ways that enabled independent growth and actualization of her potential and goals. At this time Mrs. Harcourt reports feeling “happy and successful as a wife, mother, and graduate student in neuroscience.” Interestingly, she tells me that she almost never wears jewelry these days. Stuart C. Yudofsky, M.D., is the D.C. and Irene Ellwood Professor and Chair of the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. He also holds the Drs. Beth K. and Stuart C. Yudofsky Presidential Chair in Neuropsychiatry, serves as the chair of the Department of Psychiatry at Methodist Hospital, and is editor of the Journal of Neuropsychiatry and Clinical Neurosciences. He is the author of Fatal Flaws: Navigating Destructive Relationships With People With Disorders of Personality and Character and, with Robert E. Hales, M.D., is coeditor of the Clinical Manual of Neuropsychiatry. APA members may purchase these books at a discount at www.appi.org. ISSUES NewArchived

*Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine; †Department of Psychiatry, The Methodist Hospital, Houston, TX; ‡Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine; and §Mental Health Services, Sacramento, CA. Send reprint requests to Stuart C. Yudofsky, MD, 1977 Butler Blvd, Suite E4.400, Houston, TX 77030. E-mail: [email protected]. Authors' note: Throughout the past three decades, John Talbott, MD, Editor of JNMD, has been a beloved mentor, distinguished colleague, and dear friend. We are honored to accept his invitation to comment upon an advertisement that appeared in the 1937 volume of this Journal, which is being acknowledged in celebration of the anniversary of the 200th volume of JNMD. The advertisement was for "Residencies in Neuropsychiatry" and comprised four newly-approved positions at the Menninger Clinic in Topeka, Kansas. The educational experience included "class work in neurology, neuropathology, psychiatry and psychoanalysis." We use this opportunity to review our previous work and publications regarding the definition of neuropsychiatry and critical events in the history of neuropsychiatry and to emphasize problems with the current concepts of psychiatry and neurology. In addition, we offer a template of what we believe to be an ideal vision for the future of training and practice in neuropsychiatry, neurology, and psychiatry.

Back to table of contents Previous article Next article Communications and UpdatesFull AccessThe Human Illnesses: Neuropsychiatric Disorders and the Nature of the Human BrainStuart C. Yudofsky, M.D.Stuart C. Yudofsky, M.D.Published Online:1 Sep 2011https://doi.org/10.1176/appi.ajp.2011.11030437AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail by WilliamsonPeter C., M.D., and AllmanJohn M., Ph.D. New York, Oxford University Press, 2011, 256 pp., $75.00."Man is the only animal that blushes—or needs to"—Mark TwainA vigorous yet unstable orphan, neuropsychiatry was conceived from the antipodal chromosomes of the Enlightenment's scientific revolution and of the Romantic Era's insurrection against such. As its very name implies, neuropsychiatry is both bridging and divisive. Objectivity, observation, description, empiricism, and rationality are pitched in a relentless, yet productive, struggle with the subjective, spiritual, irrational, intuitive, inventive, and imaginative. It is no wonder that the parent specialties of neurology and psychiatry both embrace and disown our subspecialty.Historically, "lesion" became, and in many ways remains, the lens of classical neurology. A severed anterior interosseous nerve (a motor branch of median nerve) leads to weakness of the flexor pollicis longus (the flexor muscle of the thumb) and of the flexor digitorum profundus (the flexor muscle of the distal phalanges of the thumb and index finger). Oh how intellectually satisfying, unless it afflicts you—the reader of this book review—and you wish to turn the page of this Journal with the affected hand. As applied to our understanding of the brain functions and dysfunctions conventionally subserved by neuropsychiatry and psychiatry—such as mood regulation, motivation, social behavior, reality testing, abstract thinking, judgment, and intelligence—lesion-based insights are both elusive and enlightening. Today, the lenses for lesion discovery in psychiatry and neuropsychiatry comprise functional brain imaging, cellular and molecular biology, basic neuroscience, and genetics. For example, components of complex brain-based disorders like depression have been illuminated by lesions such as a polymorphism within the promoter of a serotonin transporter gene that has been linked to psychosocial vulnerability to stressful experiences (1, 2). Nonetheless, neuropsychiatry must express and exert caution when advocating that this approach be applied to far more expansive terrains.In the preface to their book, Peter C. Williamson and John M. Allman articulate their ambitious intent: "Our thesis is that the neuronal pathways that underlie neuropsychiatric conditions mirror unique human capabilities. Determining how these capabilities are represented in the human brain not only tells us about what makes the human brain human but also provides a framework for understanding neuropsychiatric disorders in a new way, much the same as the circulatory system provided a framework for understanding heart failure at the beginning of medicine 400 years ago" (pp. vii–viii). Let us term this method "neuroanalysis." The distinguished authors draw upon and blend their extensive experience and remarkable scholarship in neuropsychiatry (Dr. Williamson) and in evolutionary biology (Dr. Allman) to accomplish this goal. If only, however, the computer were a pump.In the initial pursuit of their grand goal, the authors provide a cogent overview of basic neurodevelopment, regional structural and functional neuroanatomy, neurotransmitters, and neuronal circuits. Interspersed in this exploration are engaging facts and insights gleaned from evolutionary biology. For example, in depicting "unique aspects of the human brain," the authors reveal that Von Economo neurons, a vital class of neurons located in layer 5 of the anterior cingulate—in both cognitive and affective processing regions—and in the fronto-insular cortex can be found only in humans, great apes, elephants, and whales. The authors hypothesize that these neurons may be involved with the capacity for self-control through the recognition of having committed an error. They suggest that the anterior cingulate and fronto-insular cortex connect with areas of the brain storing information related to past experience and seemingly mediate social behaviors based on this experience.In chapters 4–7 of their text, the authors seine prominent and prototypical neuropsychiatric conditions through fine nettings of epidemiology, genetics, brain imaging, neuropsychology, neurobiology, and neuropathology in order to capture aspects of the CNS that might be uniquely human. The disorders considered are schizophrenia, bipolar disorder, autism, attention deficit hyperactivity disorder (ADHD), anorexia nervosa, and frontotemporal dementia. Often reconceptualizing the essences of the respective illnesses through recent evolutionary and neurobiologial advances, these explorations are exhilarating. For example, they convincingly posit that ADHD is a primary deficit in motivation rather than a deficit in attention. In making their case, the authors deftly review the recent research revelations about the neurocircuitry, neurogenetics, neurobiology, and neuropathology of the brain's primary reward system—the dopamine system—as it would relate to the symptoms and treatment of patients with ADHD.In chapters 8–12, Professors Williamson and Allman highlight and explicate what could be considered "hot topics" in the social, cognitive, and behavioral neurosciences from neuropsychiatric and evolutionary biological perspectives. Such intriguing concepts as "the social brain," "stimulus independent thought," and "default networks" are explored, and vexing questions such as "Do animals have a theory of mind?" are raised and answers tendered. Insights about the human brain are sought through the neuroanalysis of humor, empathy, disgust, embarrassment, and intuition in people with and without neuropsychiatric illness.This reviewer, however, was somewhat surprised by important foci of human thought and emotion that were not considered, such as music, art, poetry, storytelling, and religion/spirituality. These uniquely human preoccupations would also seem worthy probes to expose the "nature of the human brain." In the totality of their deliberations, there seems to be an imbalance between what is conventionally considered the "neuro" at the expense of the "psych." Notwithstanding this notion, the volume is a compact (168 pages of text, 61 pages of references), captivating, and current update of vital scientific advances that reflect upon the uniqueness of the human brain, mind, and condition. I highly recommend this book to students and practitioners of neurology, psychiatry, and neuropsychiatry as well as to others interested in understanding the unique nature of the remarkable human brain.Houston, Tex.Dr. Yudofsky is on the Board of Directors of Diamond Healthcare Corporation.Book review accepted for publication March 2011.References1. Caspi A , Sugden K , Moffitt TE , Taylor A , Craig IW , Harrington H , McClay J , Mill J , Martin J , Braithwaite A , Poulton R: Influence of life stress on depression: moderation by a polymorphism in the 5-HTT Gene. Science 2003; 301:386–389Crossref, Medline, Google Scholar2. Way BM , Taylor SE: The serotonin transporter promoter polymorphism is associated with cortisol response to psychosocial stress. Biol Psychiatry 2010; 67:487–492Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 168Issue 9 September 2011Pages 993-994 Metrics PDF download History Accepted 1 March 2011 Published online 1 September 2011 Published in print 1 September 2011

Back to table of contents previous chapternext chapter No AccessChapter 10.Aggressive DisordersEdited by:Stuart C. YudofskyM.D., Jonathan M. SilverM.D., Karen E. AndersonM.D.Stuart C. YudofskySearch for more papers by this authorM.D., Jonathan M. SilverSearch for more papers by this authorM.D., Karen E. AndersonSearch for more papers by this authorM.D.https://doi.org/10.1176/appi.books.9781585625154.da10AboutSectionsView chapterExcerptView Full Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View chapterSectionsDefinitions | Epidemiology | Clinical Assessment | Documenting Aggressive Behavior | Treatment | Conclusion | ReferencesExcerptThe onset of disorders such as stroke and traumatic brain injury (TBI) is often sudden but is frequently followed by persistent and disabling long-term neuropsychiatric consequences. Few posttraumatic neuropsychiatric symptoms and syndromes are more disruptive to interpersonal familial, societal, educational, and occupational functioning and activities than agitation, aggression, and violent behaviors. Agitation and irritability that occur in a patient during the acute stages of recovery from TBI not only endanger the safety of the patient and his or her caregivers but also predict increased lengths of hospital stay and impaired cognition (Bogner et al. 2001). As recovery continues, low frustration tolerance and explosive behavior may develop in response to minimal provocation or sometimes may occur without any warning at all. These behaviors may be limited to irritability or may include violent outbursts resulting in damage to property or assaults on others. In severe cases, it may be unsafe for individuals with aggressive disorders to remain in the community or with their families, and referral to long-term psychiatric or neurobehavioral facilities is sometimes required. All clinicians, and especially mental health professionals, need to be knowledgeable about and able to evaluate and treat neurologically induced agitation, irritability, aggression, and violence among their patients with TBI. Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Register for access Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Management of Adults With Traumatic Brain Injury Information© American Psychiatric Publishing History Published online 6 October 2014 Published in print 4 March 2013