Neuropsychiatric Disturbances, Self-Mutilation and Malingering in the French Armies during World War I: War Strain or Cowardice?

Between 1914 and 1918, war strain appeared under a number of guises and affected, to varying extents, the majority of French soldiers. The most frequent form of war strain was war psychoneurosis, but war strain also induced more paroxystic disorders, such as acute episodes of terror, self-mutilation, induced illnesses and even suicide. Fear was the constant companion of soldiers of the Great War: soldiers were either able to tame it or overwhelmed by an uncontrollable fear. Nonetheless, over the course of the war, some aspects of fear were recognised as syndromes. 

The French health service poorly anticipated the major consequences of war strain, as with many other types of injuries. After the establishment of wartime neuropsychiatric centres, two main medical stances emerged: listening to soldiers empathetically on the one hand and applying more repressive management on the other. For many physicians, the psychological consequences of this first modern war were synonymous with malingering or cowardice in the face of duty. 

The stance of French military physicians in relation to their command was not unequivocal and remained ambivalent, swaying between medico-military collusion and empathy towards soldiers experiencing psychological distress. The ubiquity of suspected malingering modified the already porous borders between neuropsychiatric disorders and disobedience. 

Several war psychoneurotic soldiers were sentenced by councils of war for deserting their posts in the face of the enemy and were shot. Many soldiers suspected of self-mutilation or suffering from induced illnesses were also sentenced and executed without an expert assessment of their wound or their psychological state.

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By:  Tatu L, Bogousslavsky J.

Front Neurol Neurosci. 2016 Apr 1;38:143-154

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Neuropsychological Impairment and Its Association with Violence Risk in Japanese Forensic Psychiatric Patients

Background

In Japan, the legislation directing treatment of offenders with psychiatric disorders was enacted in 2005. Neuropsychological impairment is highly related to functional outcomes in patients with psychiatric disorders, and several studies have suggested an association between neuropsychological impairment and violent behaviors. However, there have been no studies of neuropsychological impairment in forensic patients covered by the Japanese legislation. This study is designed to examine the neuropsychological characteristics of forensic patients in comparison to healthy controls and to assess the relationship between neuropsychological impairment and violence risk.

Methods

Seventy-one forensic patients with psychiatric disorders and 54 healthy controls (matched by age, gender, and education) were enrolled. The CogState Battery (CSB) consisting of eight cognitive domains, the Iowa Gambling Task (IGT) to test emotion-based decision making, and psychological measures of violence risk including psychopathy were used.

Results

Forensic patients exhibited poorer performances on all CSB subtests and the IGT than controls. For each group, partial correlational analyses indicated that poor IGT performance was related to psychopathy, especially antisocial behavior. In forensic patients, the CSB composite score was associated with risk factors for future violent behavior, including stress and noncompliance with remediation attempts.

Conclusion

Forensic patients with psychiatric disorders exhibit a wide range of neuropsychological impairments, and these findings suggest that neuropsychological impairment may increase the risk of violent behavior. Therefore, the treatment of neuropsychological impairment in forensic patients with psychiatric disorders is necessary to improve functional outcomes as well as to prevent violence.

Below:  Magnitude of impairment in forensic patients relative to healthy controls on each CSB measure

Below:  The IGT net scores for the 5 blocks for forensic patients and healthy controls

Full article at:   http://goo.gl/TpZu9X

By:  

Hirofumi Nishinaka, Kenji Hashimoto

Division of Clinical Neuroscience, Center for Forensic Mental Health, Chiba University, Chiba, Japan

Jun Nakane

National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan

Takako Nagata, Mayu Omori, Naotsugu Hirabayashi

Department of Psychiatry, National Center of Neurology and Psychiatry, Tokyo, Japan

Atsushi Imai, Noriomi Kuroki, Noriko Sakikawa, Osamu Kuroda

Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan

Yoshito Igarashi

Division of Law and Psychiatry, Center for Forensic Mental Health, Chiba University, Chiba, Japan

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Apathy Is Associated with Lower Mental and Physical Quality of Life in Persons Infected with HIV

HIV infection is associated with lower health-related quality of life (HRQoL), which is influenced by immunovirological factors, negative affect, neurocognitive impairment, and functional dependence. Although apathy is a common neuropsychiatric sequela of HIV infection, emerging findings regarding its unique role in lower HRQoL have been mixed. 

The present study was guided by Wilson and Cleary's (1995), model in examining the association between apathy and physical and mental HRQoL in 80 HIV+ individuals who completed a neuromedical examination, neuropsychological assessment, structured psychiatric interview, and a series of questionnaires including the SF-36. Apathy was measured using a composite of the apathy subscale of the Frontal Systems Behavioral Scale and the vigor-activation subscale of the Profile of Mood States. 

Independent of major depressive disorder, neurocognitive impairment, functional status, and current CD4 count, apathy was strongly associated with HRQoL. Specifically, apathy and CD4 count were significant predictors of physical HRQoL, whereas apathy and depression were the only predictors of mental HRQoL. 

All told, these findings suggest that apathy plays a unique role in HRQoL and support the importance of assessing and managing apathy in an effort to maximize health outcomes among individuals with HIV disease.

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By:  Kamat R1, Woods SP1,2, Cameron MV1, Iudicello JE1; HIV Neurobehavioral Research Program (HNRP) Group.

• 1 Department of Psychiatry , University of California , San Diego , CA , 92093 , USA.
• 2 Department of Psychology , University of Houston , Houston , TX , 77004 , USA 

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Neuropsychological Impairment in Acute HIV and the Effect of Immediate Antiretroviral Therapy

To investigate neuropsychological performance (NP) during acute HIV infection (AHI) before and after combination antiretroviraltherapy (cART).

Prospective study of Thai AHI participants examined at 3 and 6 months after initiation of cART.

Thirty-six AHI participants were evaluated pre-cART at median 19 days since HIV exposure and 3 and 6 months after cART with the Grooved Pegboard test, Color Trails 1 & 2 (CT1, CT2), and Trail Making Test A. Raw scores were standardized to 251 age- and education-matchedHIV-uninfected Thais. To account for learning effects, change in NP performance was compared with that of controls at 6 months. Analyses included multivariable regression, nonparametric repeated measures analysis of variance, and Mann-Whitney U test.

Baseline NP scores for the AHI group were within normal range (z-scores range: -0.26 to -0.13). NP performance improved on CT1, CT2, and Trail Making Test A in the initial 3 months (P < 0.01) with no significant change during the last 3 months. Only improvement in CT1 was greater than that seen in controls at 6 months (P = 0.018). Participants who performed >1 SD below normative means on ≥2 tests (n = 8) exhibited higher baseline cerebrospinal fluid HIV RNA (P = 0.047) and had no improvement after cART.

Most AHI individuals had normal NP performance, and early cART slightly improved their psychomotor function. However, approximately 25% had impaired NP performance, which correlated with higher cerebrospinal fluid HIV RNA, and these abnormalities were not reversed by early cART possibly indicating limited reversibility of cognitive impairment in a subset of AHI individuals.

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By:  Kore I1, Ananworanich J, Valcour V, Fletcher JL, Chalermchai T, Paul R, Reynolds J, Tipsuk S, Ubolyam S, Rattanamanee S, Jagodzinski L, Kim J, Spudich S.

• 1*Yale University School of Medicine, New Haven, CT; †SEARCH, The Thai Red Cross AIDS Research Center, Bangkok, Thailand; ‡US Military HIVResearch Program, Walter Reed Army Institute of Research, Silver Spring, MD; §Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD; ‖University of California, San Francisco, CA; ¶Missouri Institute of Mental Health, University of Missouri, St. Louis, MO; #Yale Center for Analytical Sciences, New Haven, CT; and **HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand. 

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Neurological Response to cART vs. cART plus Integrase Inhibitor and CCR5 Antagonist Initiated during Acute HIV

To compare central nervous system (CNS) outcomes in participants treated during acute HIV infection with standard combination antiretroviral therapy (cART) vs. cART plus integrase inhibitor and CCR5 antagonist (cART+).

Design: 24-week randomized open-label prospective evaluation.

Participants were evaluated then randomized to initiate cART (efavirenz, tenofovir, and either emtricitabine or lamivudine) vs. cART+ (cART plus raltegravir and maraviroc) during acute HIV and re-evaluated at 4, 12 and 24 weeks. We examined plasma and CSF cytokines, HIV RNA levels, neurological and neuropsychological findings, and brain MRS across groups and compared to healthy controls.

At baseline, 62 participants were in Fiebig stages I-V. Randomized groups were similar for mean age (27 vs. 25, p = 0.137), gender (each 94% male), plasma log₁₀ HIV RNA (5.4 vs. 5.6,p = 0.382), CSF log₁₀ HIV RNA (2.35 vs. 3.31, p = 0.561), and estimated duration of HIV (18 vs. 17 days, p = 0.546). Randomized arms did not differ at 24 weeks by any CNS outcome. Combining arms, all measures concurrent with antiretroviral treatment improved, for example, neuropsychological testing (mean NPZ-4 of -0.408 vs. 0.245, p<0.001) and inflammatory markers by MRS (e.g. mean frontal white matter (FWM) choline of 2.92 vs. 2.84, p = 0.045) at baseline and week 24, respectively. Plasma neopterin (p<0.001) and interferon gamma-induced protein 10 (IP-10) (p = 0.007) remained elevated in participants compared to controls but no statistically significant differences were seen in CSF cytokines compared to controls, despite individual variability among the HIV-infected group.

A 24-week course of cART+ improved CNS related outcomes, but was not associated with measurable differences compared to standard cART.

Below: Change in neuropsychological testing performance (NPZ-4) over 24 weeks by randomized arm. Participants demonstrate improvement with no differences noted by arm.

Full article at:  http://goo.gl/NSOLWz

By: 

Victor G. Valcour, Collin L. Adams, Joanna M. Hellmuth

Department of Neurology, University of California San Francisco, San Francisco, California, United States of America

Serena S. Spudich

Department of Neurology, Yale University, New Haven, Connecticut, United States of America

Napapon Sailasuta

Huntington Medical Research Institutes, Pasadena, California, United States of America

Nittaya Phanuphak, James L. K. Fletcher, Eugene D. M. B. Kroon, Peeriya Prueksakaew, SEARCH 010/RV 254 Study Group

South East Asia Research Collaboration with Hawaii, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand

Sukalaya Lerdlum, Jintanat Ananworanich

Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Eugene D. M. B. Kroon

Department of Retrovirology, Armed Forces Research Institute of Medical Sciences, United States Component, Bangkok, Thailand

Linda L. Jagodzinski, Bonnie M. Slike, Jerome H. Kim, Jintanat Ananworanich

United States Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America

Isabel E. Allen

Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, United States of America

Bonnie M. Slike, Jintanat Ananworanich

Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States of America

 

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