There is a really interesting edition of ‘The American Journal of Psychiatry’ – the June 2011 edition which is freely available here. The podcast is clearly narrated. Firstly there is a discussion of a case of postpartum psychosis. What is particularly interesting is that it deviates from the more typical case in terms of the lady’s disorientation and the Liaison psychiatrist is alert to the possibility of something else going on. After a few crucial questions some tests are undertaken and it turns out to be a Urea Cycle Disorder. For the interested reader the podcast is well worth listening as it elaborates further on the management in this case and is a useful reminder of the importance of the more unusual differentials in atypical cases. Hyperammonaemia was identified and treated with an accompanying improvement in the mental state (which incidentally was only partially responsive to antipsychotics prior to the diagnosis being made). There is brief coverage of Star D study of parents of children with major depression, a comparison of oral and depot antipsychotics as well as an investigation of opiate dependence and decision making.
There is also a discussion of an interesting study which finds a relationship between ADHD and deficient emotional self-regulation. In the study which looked at people with ADHD and their families, the researchers found that there was a homogenous group that manifested both ADHD and deficient emotional self-regulation. The researchers suggest that it would be useful to further characterise this group. In another study, the researchers investigated conduct disorders with onset in adolescence. There has been some suggestion that in contrast with early onset conduct disorder the adolescent onset conduct disorder would be influenced more strongly by the environment than genetics. However in their study they found that the group with adolescent onset conduct disorder had reduced grey matter volume in the Amygdala and in the Right Ventral Insular Cortex compared to a healthy control group. As the Amygdala has been associated with fear conditioning they suggest that some of the associations may be explained by these findings. It’s very interesting to find the association with the Insular Cortex which is very strongly linked with emotions. In the discussion they suggest that these findings may go some way to explaining a blunted response to stress. These latter two study findings are helping to build up a useful picture of emotional disorders with significant behavioural associations and it will be interesting to follow research in this area.
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