Depressed subjects have deficits in facialemotion recognition that resemble the deficits found in persons with focal right hemisphere brain damage. To locate the brain regions responsible for this problem, the authors imaged regional cerebral blood flow (rCBF) with H2O15 positron emission tomography in 10 mood-disordered patients, as well as in 10 age- and sex-matched healthy comparison subjects, while the subjects matched photographs for facial emotion or, as a control, facial identity. While matching faces for emotion, mood-disordered subjects had decreased rCBF activation bilaterally in their temporal lobes, as well as in the right insula, compared with healthy comparison subjects. Abnormal function of limbic and paraiimbic regions may partially explain the facial emotion-recognition deficits previously noted in depressed subjects.

The last 4 years have seen a rapid burst of development of medications used to treat epileptic seizures. While none of these medications has replaced the “standards” in the field, they collectively offer additional treatment options for patients, particularly for those with difficult-to-control seizures. As experience with these novel medications grows, each will occupy its own niche in the treatment strategy for patients with epilepsy.

The association between obsessive-compulsive (OC) symptoms and schizophrenia has been discussed in the literature for many decades. Recent studies, which have been more systematic than earlier reports and benefited from more rigorous diagnostic criteria, have generated results that contradict earlier findings. The current consensus is that OC symptoms are seen in a significant number of patients with schizophrenia, and indicate a poor prognosis. These recent studies also suggest that OC symptoms are more than just expressions of persistent schizophrenic psychosis, and that they share characteristics with obsessive-compulsive disorder (OCD). This article discusses the arguments supporting the possibility that OC symptoms are either manifestations of comorbid OCD, or are characteristics of a distinct subtype of schizophrenia.

People with epilepsy live and struggle every day with social issues that are relatively minor for people without epilepsy. Apprehension about securing and maintaining one's job or getting a driver's license is significantly greater for the person with epilepsy. Misconceptions held by the general public about epilepsy contribute to and often compound the difficulties and fears experienced by people with epilepsy. Because different people in society react to seizures in different ways, it is important to foster a supportive environment for people with epilepsy. This can be achieved by health care providers and families of people with epilepsy, who can help minimize the negative and inaccurate perceptions that are prevalent regarding people with epilepsy, and maximize their opportunities to integrate successfully into society.

While obsessive-compulsive (OC) symptoms in schizophrenia have been reported for many years, they have achieved only limited recognition and, perhaps for this reason, few studies their pharmacological treatment have been carried out. One suggested treatment approach is the use of different agents for different symptoms. In this article, we review the small number of published studies and case reports regarding this multi-pharmacological method of treatment for OC symptoms in schizophrenia. While each study used a somewhat different patient population and provided varying and limited information concerning patient sample, study design, and results, some tentative conclusions and treatment recommendations may be drawn from their findings.

Recent studies of the pathogenesis of autism have suggested that this disorder may have an autoimmune basis in some patients. Observations have been made regarding cellular and humoral immune dysfunction, abnormalities associated with the complement system and major histocompatibility complex gene expression, differences in soluble mediators of the immune response, and the presence of antibrain and antimyelin autoantibodies. In this article, we review these experimental and clinical observations, and examine preliminary efforts using immunomodulatory therapies to treat autism.

Recent advances in functional neuroimaging (including positron emission tomography, single-photon emission tomography, and fast magnetic resonance imaging) have allowed better understanding of the brain regions involved in regulating normal and pathological moods. Repetitive transcranial magnetic stimulation (rTMS) has the ability to stimulate or temporarily impair brain regions, which makes it a powerful tool for directly testing theories of the neurologic basis of mood regulation.

Cognitive impairment is considered a central feature of schizophrenia. Many aspects of cognition are impaired in schizophrenia. Careful evaluation of the relationship between cognitive impairment and the other symptoms of schizophrenia has revealed several important findings. In this article, we discuss these findings, the effects of typical neuroleptic therapy on cognitive impairment, and important issues to address in cognitive enhancement studies in schizophrenia.

Over the past half century, a number of advances have been made in surgical approaches to treating refractory temporal lobe epilepsy. This article explains some of the newer approaches and provides support for selective amygdalohippocampectomy. Appropriate preoperative workup, including various invasive monitoring techniques, is also described.

Epilepsy in children and adolescents is associated with a higher rate of comorbid psychiatric disorders than other chronic childhood illnesses. This article describes various psychiatric disorders that occur in children and their effects on brain development, neurologic and intellectual function, and psychological adaptation for children and their families.

During the last 30 years, several studies in psychiatric genetics have been conducted. These include a series of clinical and family-oriented studies on genetic factors in schizophrenia, alcoholism, and manic-depressive disorder. Since these trials have taken place, great emphasis has been placed on the hypothesis that psychiatric disorders could have a genetic vulnerability. This hypothesis is supported by significant advancements in biological and mathematical analysis methods, as well as by the large number of epidemiological and diagnostic studies on the prevalence of psychiatric disorders in patients' families. This article provides on overview of this research.

Many other hypotheses have been raised by the optimism of research, but are often followed by experimental failures. There are several pitfalls in methods, ranging from sample selection to genotyping to statistical analysis methods. Finally, the interpretations of the results often have been misunderstood. Nonetheless, this body of research contributes to future genetic perspectives in psychiatry.

Clinical experience and systematic inquiry demonstrate that many patients with mood and anxiety disorders remain symptomatic despite standard interventions. These observations have prompted the search for alternative pharmacotherapeutic treatment options. Anticonvulsants, including valproic acid and carbamazepine, have demonstrated benefit for a number of psychiatric conditions. Recently, clinical and research attention has focused on the use of the new anticonvulsants gabapentin and lamotrigine as alternatives to standard pharmacotherapies for the treatment of mood and anxiety disorders. This paper reviews the experience to date with these agents in the treatment of psychiatric conditions. Gabapentin demonstrates promise for the treatment of panic and generalized anxiety, while both gabapentin and lamotrigine appear useful as mood stabilizers in the treatment of bipolar disorder.

Past research has established that traditional neuroleptic treatment improves attentional functioning in schizophrenic (SZ) patients. The present investigation expands on this finding by examining attentional improvement in nine acute SZ patients treated with either the novel neuroleptic ziprasidone or aripiprazole over a 4-week inpatient period. Twelve SZ in patients receiving typical neuroleptic treatment over the same time period served as controls. The results revealed that while all patients showed marked attentional improvement from medication-free baseline to week 4 of treatment, the SZ patients who received novel antipsychotics showed significant improvement on immediate recall and reaction time measures. These results suggest that novel neuroleptic treatment, perhaps through preferential activation of the prefrontal cortical pathways, improves SZ patients' information processing speed and efficiency.

The emergence of repetitive transcranial magnetic stimulation (rTMS) as a relatively noninvasive probe of cortical function provides an opportunity to explore the relationships between regional brain activity and symptomatology across neuropsychiatric illnesses. In this article, we briefly review evidence from functional neuroimaging studies (principally those using positron emission tomography [PET] or single-photon emission computed tomography [SPECT]) and other studies suggesting regional brain involvement in anxiety disorders, specifically obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD). We also review an initial controlled study conducted by our group using rTMS as a probe of prefrontal mechanisms in OCD. This discussion is not intended to be comprehensive, but rather to provide examples of disorders that, based on current knowledge, might be good candidates for the use of rTMS as a probe. In addition, we present case reports from pilot studies of rTMS in three patients with different primary anxiety disorder diagnoses, which illustrate some of the issues involved in such studies, as well as the effects observed. The possibility that rTMS may have therapeutic potential in anxiety disorders is also discussed.