Vol 9, No 2 - Neuropsychiatric Manifestations of Neurodegenerative Disease
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linical neurologists and psychiatrists have long recognized the frequent occurrence of psychiatric condi- tions in the context of neurologic (brain) disease. Indeed, this frequent co-occurrence of psychiatric with neurologic symptoms should come as no surprise, since psychiatric disorders, such as schizophrenia and the mood disorders, can be induced by structural brain disease. Presumably, brain dysfunction from conditions that cause neurologic symptoms—such as seizures, and impairments in move- ment, sensation, speech, or language—also affects areas of the brain that regulate mood, emotion, cognition, and perception. For the most part, this branch of psychiatry, neuropsychiatry,1  has  lain  relatively  unexplored  until experiencing resurgence in the last few decades.A major reason for this lack of exploration was the use of psycho- logical explanations such as “reactions” to conceptualize why psychiatric symptoms occurred in the presence of neurologic symptoms. For example, it was asked, “How could a person with hemiparesis not also feel depressed?” Or,“How could someone with aphasia not also be cogni- tively impaired?” More recently, it has been recognized that it is the diseased brain in many instances that causes the psychiatric symptoms. This appreciation has opened up new avenues for understanding of these symptoms, and by extension of brain-behavior relationships in this S t a t e   o f   t h e   a r t C Copyright © 2007 LLS SAS.  All rights reserved www.dialogues-cns.org Psychiatric manifestations of neurologic disease: where are we headed? Constantin G. Lyketsos, MD, MHS; Nicholas Kozauer, MD; Peter V. Rabins, MD, MPH Neuropsychiatry represents a field of medicine situated at the crossroads of neurology and psychiatry, and deals with the interface of behavioral phenomena driven by brain dysfunction. Psychiatric symptoms are highly prevalent in these  conditions,  are  a  major  source  of  disability  and diminished quality of life, and potentially represent the tar- get of treatment interventions that stand to significantly decrease the suffering they generate. In this article, the dis- ease paradigm is explained, with particular attention to its role as an organizing principle for the field. Specific dis- eases including traumatic brain injury, stroke, Parkinson’s disease, Alzheimer’s disease, multiple sclerosis, and epilepsy are explored in relation to the presentation of multiple psychiatric phenotypes in each, associations with under- lying brain pathology, and existing treatment approaches. Finally, the article explores the inherent complexities in this area of research and proposes a framework for future work based on the understanding of phenomenology and associated  risk  factors,  the  involvement  of  the  rapidly advancing field of neuroscience, and targeted treatment development to serve as a road map for advancement in the field..     © 2007, LLS SAS Dialogues Clin Neurosci. 2007;9:111-124. Keywords: brain disease; depression; psychosis; traumatic brain injury; Alzheimer's disease, Parkinson's disease; stroke Author affiliations:  Division of Geriatric Psychiatry and Neuropsychiatry and Department  of  Psychiatry,  Johns  Hopkins  Bayview  (Constantin  G.  Lyketsos); Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine   (Constantin   G.   Lyketsos,   Nicholas   Kozauer,   Peter   V.   Rabins), Baltimore, Maryland, USA Address for correspondence: Constantine G. Lyketsos, MD, MHS, The Elizabeth Plank   Althouse   Professor,   Chair,   Department   of   Psychiatry,   Johns   Hopkins Bayview, 4940 Eastern Avenue, A4 Center, Room 458, Baltimore, MD 21224, USA (e-mail: kostas@jhmi.edu)