1 Abstracts Presented at the International Neuropsychological Society, the Swiss Neuropsychological Society (SVNP) and the German Neuropsychological Society (GNP) Meeting Zurich July 26-30, 2006 Zurich, Switzerland WEDNESDAY AFTERNOON, JULY 26, 2006 Symposium l/3:00-4:30 PM characterize pathology in patients with complex neuropsychiatric presentations. This part of the symposium will focus on providing specific examples of convergence in the data of diverse modalities in Using Neuropsychological, qEEG and SPECT Data the clinical care of refractory psychiatric patients. In our laboratories, to Direct Pharmacological and Neurosurgical we utilize a combination of tools in order to obtain converging data as Treatment in Refractory Psychiatric Disorders related to specific symptom clusters. We routinely use a combination of qEEG, evoked potentials, brain SPECT/PET, MRI/CT, and objective behavioral evaluation focusing on cognitive processes as Host: Angelos Halaris well as mood regulation. We developed a technique whereby we combine qEEG with SPECT/PET, which captures brain electrical activity as well as perfusion/metabolism, and correlate these profiles to structural features defined by MRI/CT. We have found that in many cases individual assessment modalities would not have sufficed M. PRIMEAU, C. BLODGETT DYCUS . Neuropsychological for appropriate interpretation of the data. Examples of diagnostic Evaluation as a Means to Direct Psychiatric Interve ntion. results, treatment decisions, and clinical outcomes will illustrate this Question: When is a psychiatrist like a blind man touching an principle. elephant? Answer: When the patient has a refractory psychiatric Correspondence: Angelos Halaris, M.D.,Ph.D. , APA, ACNP, disorder. Treatment targeted to a presenting symptom, such as Professor, Psychiatry and Behavioral Neurosciences, Loyola depression, may not be working because the patient’s condition is University Health System, 2160 S. First Ave. Maywood, IL 60153, US. neuropsychiatrically complex, “a different animal.” One way to shine E-mail: [email protected] a brighter light on the patient’s illness is to utilize neuropsychological assessment. Patients with prominent mood or behavioral symptoms may in fact have a primary dysfunction of neurocognitive networks, T. POPRAWSKI. Psychopharmacological Intervention Based on due to developmental or acquired injury, that helps account for their presenting symptoms and indicates a different course of treatment. Neurological Investigations. Psychiatrists working with patients responding poorly to treatment Neuropsychological evaluation of refractory psychiatric patients is will reach a fork in the road: should they try polypharmacy and helpful to both the patient and the referring psychiatrist for several megapharmacy, risking iatrogenic impairment, or put aside the DSM reasons. First, it allows for a detailed analysis of behavioral and re-diagnose? In this part of the symposium, selected cases symptoms, inclusive of mood, personality, and cognitive originally presenting with major depression, aggression, bipolar abnormalities, which may not be evident on psychiatric exam. disorder, substance abuse, sociopathic behavior, or posttraumatic Additionally, a neuropsychological assessment quantifies behavior, stress disorder will be discussed to illustrate the use of the which is important in order to evaluate changes with treatment and interdisciplinary neurobehavioral work-up in guiding decisions about over time. Neuropsychological test protocols for this patient pharmacotherapy. Results of qEEG, SPECT, and/or population will be outlined. In addition, research investigat ing neuropsychological evaluations in these patients identified CNS neuropsychological abnormalities on the Rey Complex Figure in a dysfunction that altered the case conceptualization and prompted trials group of diverse psychiatric patients will be presented. The argument of medications, such as psychostimulants, anticonvulsants, and will be made that patient characterization incorporating the vasodilating agents, that proved to be more efficacious than standard neurocognitive profile, in combination with neurophysiological and care for their presenting symptoms. neuroanatomical abnormalities, will permit the clinician to see the big Correspondence: Angelos Halaris, M.D.,Ph.D. , APA, ACNP, picture and utilize more effective treatment than the traditional Professor, Psychiatry and Behavioral Neurosciences, Loyola nosology and interview-based diagnosis would suggest. University Health System, 2160 S. First Ave. Maywood, IL 60153, US. Correspondence: Angelos Halaris, M.D.,Ph.D. , APA, ACNP, E-mail: [email protected] Professor, Psychiatry and Behavioral Neurosciences, Loyola University Health System, 2160 S. First Ave. Maywood, IL 60153, US. E-mail: [email protected] D. ANDERSON. Future Directions in Neurosurgical Intervention, Vagal Nerve Stimulation and Deep Brain Stimulation, for Psychiatric Patients. The neurosurgical intervention of deep brain stimulation may improve L. KONOPKA . Functional Neuroimaging, qEEG and SPECT, as behavioral symptoms such as essential tremor by imposing electrical a Means to Direct Psychiatric Intervention. fields that modulate neural activity. This is accomplished by The use of quantitative analytical tools in neuropsychiatry is implanting electrodes into specific targets in the brain and controlling becoming more routine. These tools include neuroimaging as well as current to those targets by means of an impulse generator. This same neurobehavioral analysis and testing. Each individual modality has method can be applied to other symptoms of neuronal dysregulation, inherent strengths and weaknesses, and no one tool is sufficient to like those found in refractory psychiatric patients. Current research is Downloaded from https://www.cambridge.org/core. IP address: 170.106.202.58, on 30 Sep 2021 at 17:29:55, subject to the Cambridge Core terms of use, available at https://www.cambridge.org/core/terms. https://doi.org/10.1017/S1355617706069955 2 invest igating stimulation of the anterior limb of the internal capsule part of an intervention outcome. In many cases where such and the nucleus accumbens as a means of the treating symptoms of psychosocial measures are used, they are often inappropriate for the obsessive-compulsive disorder and major depression. This study, thereby impeding positive findings. As with cognitive presentation will address the issues of patient selection for measures, psychosocial measures need to be considered in terms of neurosurgical intervention, the mechanism of action of this approach, specific hypotheses of their relationship to the intervention, and the preliminary outcomes in the patient series, and the special attention needs to be paid to the population under study. multidisciplinary collaboration needed for this approach to treating Considerations in choosing neuropsychological and psychosocial refractory psychiatric patients. Future research will include methods measures in cognitive intervention studies will be discussed with use that more specifically determine which patients would benefit from of examples. this novel intervention based on characterization of CNS functioning Correspondence: Professor Dr. Ronald M. Ruff, San Francisco as well as on severity of psychosocial impairment. Clinical Neurosciences, 909 Hyde Street, San Francisco CA 94109, Correspondence: Angelos Halaris, M.D.,Ph.D. , APA, ACNP, US. E-mail: Ron Ruff <[email protected]> Professor, Psychiatry and Behavioral Neurosciences, Loyola University Health System, 2160 S. First Ave. Maywood, IL 60153, US. E-mail: [email protected] Paper Session 1/3:00-4:30 p.m. Symposium 2/3:00-4:30 p.m. Attention Chair: Peter Brugger Clinical Rehabilitation Research: Challenges and Guidelines I.A. HEBER, J.T. VALVODA, T. KUHLEN, & B. FIMM. Differential Effects of Low Arousal on Overt and Covert Orienting in Virtual Space Alertness and visuo-spatial attention are controlled by overlapping Host: Ronald Ruff neural networks and interact on a functional level. Symptoms of neglect might be a consequence of lesions of either of them and can be reduced by alertness training. In healthy subjects, individual R. RUFF. Methodological Challenges in Rehabilitation Research differences in alertness state or general capacity can modulate and Potential Solutions. pseudoneglect. Since visuo-spatial asymmetries in neglect patients The aim of this presentation is to address the following four questions: might be limited to either peripersonal or extrapersonal space, thus (1) How can the treatment effects be separated from spontaneous showing the respective dissociation of dorsal and ventral processing in recovery? A conflict can emerge between the clin ical need to the brain, we assessed both the influence of the level of arousal as introduce treatment in the early stages and the traditional research well as the spatial depth of the stimuli on the distribution of visuo- design of waiting for the healing process to plateau before introducing spatial attention in healthy subjects. 20 male adults performed an cognitive remediation. The difficulty of determining the optimal time overt and a covert orienting task in a Virtual-Reality-environment at for intervention (early, middle, and late) will be discussed in the four points in time (9 p.m., 1 a.m., 5 a.m. and 9 a.m.) during 26 hours context of juxtaposing single case design with group multiple baseline of wakefulness. Stimuli were presented in peripersonal and design. (2) What