Saturday, December 15, 2012

Compulsive carnival song whistling

Another fascinating research article!

Compulsive carnival song whistling following cardiac arrest: a case study

A. Rosaura PolakJasper W. van der PaardtMartijn FigeeNienke VulinkPelle de KoningMiranda Olff andDamiaan Denys
BMC Psychiatry 2012, 12:75 doi:10.1186/1471-244X-12-75


Compulsivity is the repetitive, irresistible urge to perform a behavior, the experience of loss of voluntary control over this intense urge and the tendency to perform repetitive acts in a habitual or stereotyped manner. Compulsivity is part of obsessive-compulsive disorder (OCD), but may occasionally occur as stand-alone symptom following brain damage induced by cardiac arrest. In this case report, we describe a patient who developed compulsivity following cardiac arrest. We review diagnostic options, underlying mechanisms and possible treatments.

Case presentation

A 65-year-old man presented at our clinic with continuous compulsive whistling following cardiac arrest. Neither obsessive-compulsive symptoms, nor other psychiatric complaints were present prior to the hypoxic incident. An EEG showed diffuse hypofunction, mainly in baso-temporal areas. Treatment with clomipramine resulted in a decrease of whistling.


This case report illustrates de novo manifestation of compulsivity following cardiac arrest and subsequent brain damage and gives additional information on diagnostic options, mechanisms and treatment options. Differential diagnosis between stereotypies, punding, or OCD is difficult. Compulsivity following brain damage may benefit from treatment with serotonin reuptake inhibitors. This finding enhances our knowledge of treatments in similar cases.

Tuesday, December 11, 2012

Why it's ok for Richard to touch Joan

Denman A, Wilkinson R. Applying conversation analysis to traumatic brain injury: Investigating touching another person in everyday social interaction. Disabil Rehabil. 2011;33(3):243-252

PURPOSE: Touching others, particularly the opposite sex, is a relatively common and problematic behaviour evident in many people with traumatic brain injury (TBI), in particular males. Here, we analyse this behaviour in a man with TBI (Richard) who regularly engages in inappropriate touching of women. The article draws on video-recordings of two naturally occurring social interactions between Richard and Joan (one of his carers) to analyse all six instances within these interactions where Richard touches Joan. METHOD: The recordings were made by leaving a video-recorder in Richard's home where he is supported by members of a care team. The socio-linguistic method of conversation analysis was used to transcribe and analyse the data. RESULTS: The analysis shows that each of the six instances of the touching behaviour occurred not as a random or isolated event in the interaction but rather in accompaniment with talk as part of a particular conversational action. Specifically, the conversational action in each case was produced in an emphatic or heightened style, with this style constituted by Richard touching Joan as well as by his use of a number of other resources such as eye gaze and the use of stress. CONCLUSIONS: The analysis suggests that the touching behaviours in this case were linked not so much to physical opportunities (which were available through much of these interactions) but rather to what conversational action was being produced at that particular sequential context within the interaction. For example, several instances of touching occurred as part of emphatically produced conversational actions where a previous, non-emphatic, production of that action had not been accepted or responded to by Joan. Clinical implications, such as suggestions for prophylactic management on the part of those interacting with people with TBI, are discussed.

Maple syrup urine disease. Who knew?

I've been tasked with sorting through thousands of articles in order to contribute to a systematic review on the treatment of psychiatric disorders in traumatic brain injury patients. Through this process I've stumbled upon a few fascinating and sometimes "out there" articles. For the next couple of weeks I'll be posting up abstracts that really caught my eye. We begin with Mescka and colleagues 2011 study on maple syrup urine disease; it's not what you think.

Maple syrup urine disease (MSUD) is an autosomal recessive inborn error of metabolism caused by deficiency of the activity of the mitochondrial enzyme complex branched-chain alpha-keto acid dehydrogenase (BCKAD) leading to accumulation of the branched-chain amino acids (BCAA) leucine, isoleucine and valine and their corresponding branched-chain alpha-keto acids. Affected patients present severe brain dysfunction manifested such as ataxia, seizures, coma, psychomotor delay and mental retardation. The mechanisms of brain damage in this disease remain poorly understood.

Mescka, C., Moraes, T., Rosa, A., Mazzola, P., Piccoli, B., Jacques, C., Dalazen, G., Coelho, J., Cortes, M., Terra, M., Regla Vargas, C., & Dutra-Filho, C. (2011). In vivo neuroprotective effect of L-carnitine against oxidative stress in maple syrup urine disease Metabolic Brain Disease, 26 (1), 21-28 DOI: 10.1007/s11011-011-9238-x