Psychiatry and clinical neurosciences
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Psychiatry Clin. Neurosci. · Apr 2008
ReviewReward pathways in Parkinson's disease: clinical and theoretical implications.
The mesolimbic and mesocortical circuits are particularly involved in reward-related behavior in humans. Because these systems may be in some way altered in Parkinson's disease (PD), it is likely that some psychiatric manifestations of PD, such as hedonistic homeostatic dysregulation and pathological gambling, as well as impulsive decision making, may be ascribed to their involvement. The aim of the current article was to review recent literature on this topic in order to analyze whether these disturbances share a common ground and whether actual theoretical frameworks on addiction prove a useful tool for their interpretation. ⋯ Further studies are needed to analyze why, despite a common ground, only some patients develop those neuropsychiatric complications described here.
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Psychiatry Clin. Neurosci. · Aug 2000
Review Case ReportsDepression in multiple system atrophy: a case report.
A 53-year-old woman who developed depression as the first symptom of multiple system atrophy was treated. Depression was followed successively by autonomic failure, parkinsonism and cerebellar ataxia. ⋯ As for depression, scores on the Zung scale and the Hamilton scale improved from 58 to 49 and from 30 to 22, respectively, This case is remarkable in that depression preceded neurologic dysfunction and was managed successfully by antiparkinsonian medication. A common underlying disturbance may be responsible for the depression and neurologic dysfunction in multiple system atrophy.
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Suicide risk assessment may well be the most complex clinical task that mental health professionals face. Tests have shown to be of little use. To confront this complexity, assessment and prediction are best seen as interwoven with understanding suicide, a multi-dimensional malaise. ⋯ Transference and countertransference issues in assessment are noted. A case illustration to aid in clinical insight is provided. It is concluded that all assessment and prediction of suicide risk ultimately depends on the skill of the clinician.