ABSTRACTS - World Psychiatric Association

PO3.46.
DEFICIT OF LEARNING AND MEMORY FUNCTION
CAUSED BY A LESION IN THE MEDIAL AREA
OF LEFT PUTAMEN: A CASE ANALYSIS
Si Yun Shu, Zhouyi Guo, Songhao Liu, Yongming Wu,
Xinmin Bao, Hong Li
Department of Neurobiology, College of Optoelectronic
Information, South China Normal University; Department
of Neurology, Nanfang Hospital, Southern Medical University,
Guangzhou, China
Lesions in memory-related brain regions very often cause deficits in
learning and memory. The hippocampus, the prefrontal cortex, the
amygdala and the basal nucleus of Meynert have been shown to be
memory-related structures in the brain. Shu et al. discovered a group
of fusiform neurons at the medial margin of the neostriatum in rats,
cat, monkey and human brains and named it the marginal division of
the neostriatum (MrD). The MrD was identified as contributing to
learning and memory in rats. We present a unique case of a lesion
located in the left MrD area that confirms this anatomic region’s role
in learning and memory in this report. A 13-year-old boy was hit by a
car and admitted in our hospital. He was in his first year of junior high
school and ranked no. 7 in his class of 50 children. He was discharged
after the trauma recovered. Six months later, the patient complained
of learning and memory difficulties. He was in second year of junior
high school and had dropped the rank from seventh to fortieth in his
class of 50 children. Magnetic resonance imaging revealed a focus of
encephalomalecia in the medial left putamen without other lesions in
his brain. A Chinese Stanford-Binet Intelligence Scale revealed significant
deficit in memory. These findings support the importance of the
medial part of the putamen in patients complaining of memory deficits
not explained by alternative etiologies.
PO3.47.
NEUROPSYCHOLOGICAL PERFORMANCE
IN ADULTS WITH CHRONIC EPILEPSY
ON MULTI-ANTIEPILEPTIC DRUG TREATMENT
F. Constantinidou, S. Papacostas, D. Themistocleous, M. Nicou
University of Cyprus, Nicosia; Cyprus Institute for Neurology
and Genetics, Cyprus
The primary objective of this study was to investigate verbal learning,
working memory, and executive functioning abilities in Greek-Cypriots
with epilepsy. This study is part of the first systematic research program
exploring neuropsychological performance and quality of life
issues in Greek-Cypriots with epilepsy. Thirty-five Greek-Cypriot
adults with chronic epilepsy (ages 18-55) were matched to 35 neurologically
normal adults on age, gender, and education levels. All participants
with epilepsy were recruited from the Cyprus Institute of Neurology
and Genetics and received antiepileptic therapy. A battery of
neuropsychological tests and two quality of life assessments were
implemented. Participants were screened for global cognitive decline
and clinical depression. Mixed model MANOVA (a=.05) results indicated
that the performance of participants with epilepsy was significantly
lower than that of normal cohorts on repeated verbal learning
tasks (RAVLT). Pairwise (a=.05) comparisons demonstrated that performance
was lower on both verbal and non-verbal working memory
measures, a=.05 (digit span forward/backwards, visual span forward/backwards,
Rey Complex Figure Test, and paragraph recall
immediate/delayed). In addition, performance was significantly lower
(a=.05) on executive functioning and mental fluency tasks (COWAT,
Symbol Digits Modalities Test, Trails A and B). Performance on executive
tests correlated significantly (a=.05) with memory performance.
Results indicate that chronic epilepsy hampers verbal learning and
memory performance despite of the focus of the epileptic activity. Furthermore,
the reduction in executive functioning which interferes with
the use of active memory strategies contributes to the memory impairment
observed in the present study. Finally, the implications of
antiepileptic drug therapy on neurocognitive performance will be discussed.
PO3.48.
PUNDING AFTER BILATERAL SUBTHALAMIC
NUCLEUS STIMULATION IN PARKINSON’S DISEASE
S. Bernardi, S. Ramat, L.M. Raglione, P. Marini, F. Ammannati,
S. Sorbi, S. Pallanti
Department of Psychiatry, Mount Sinai School of Medicine,
New York, NY, USA; University of Florence, Italy; Institute
of Neurosciences, Florence, Italy
“Punding” is the term used to describe a stereotypic motor behavior,
in which there is an intense fascination with repetitive purposeless
movements, such as taking apart mechanical objects, handling common
objects as if they were new and entertaining, constantly picking
at oneself, etc. As a phenomenon with features of both impulsivity
and compulsivity, punding neurobiology is currently being explored.
In order to evaluate the pathophysiology of punding and specifically
the glutamatergic role in this phenomenon, we screened a population
of Parkinson’s disease (PD) patients that attended an ambulatory for
subthalamic nucleus deep brain stimulation (STN DBS). We conducted
a patient-and-caregiver-completed punding survey with 24 consecutive
patients, using a modified version of a structured interview.
Patients completed the Unified Parkinson’s Disease Rating Scale
(UPDRS), the Obsessive Compulsive Inventory and the Sheehan Disability
Scale. Five (20.8%) of the 24 subjects were identified as punders,
three men (60%) and two women. The punders were comparable
to the nonpunders in terms of age, disease duration, hour/night
sleeping, obsessive compulsive symptoms, distress, total daily dose of
L-dopa equivalent units, decrement in daily L-dopa equivalent units
permitted by DBS and the impact of DBS on overall “on” and “off”
motor function. The punder and nonpunder groups statistically differed
only with regard to time distance from DBS implantation: on
average the punders started bilateral STN DBS 1.96 years before the
nonpunder group. Punding, defined as a disinhibition of motor learning
programs, may be induced by STN DBS, and its prevalence is
much more common than previously suspected. In our sample punding
was ego-syntonic, non-disruptive, “cue elicited” and characterized
by low craving.
PO3.49.
TREATMENT OF CHRONIC PAIN
WITH BUPRENORPHINE IN A VETERAN
WITH TRAUMATIC BRAIN INJURY
A. Alao, C. Chung
Polytrauma System of Care, Veterans Affairs Hospital;
Department of Psychiatry, SUNY Upstate Medical University,
Syracuse, NY, USA
We report a case of a 27-year-old Iraq War veteran with no previous
psychiatric history who sustained severe traumatic brain injury (TBI)
following a blast injury from an improvised explosive device. The
patient subsequently suffered severe anxiety symptoms controlled only
with combined therapy with benzodiazepines and venlafaxine. Even
more disabling, the patient also experienced intractable headache and
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