17, 18 For this reason, an effort is under way to understand whether pharmacologic therapy should be initiated after certain types of stroke to prevent the onset of depression. Poststroke GAD has been described in as many as a quarter of acute stroke patients. Patients exhibit worry, restlessness, fatigue, poor concentration, and sleep disturbance without sadness, depression, or anhedonia. These anxiety symptoms can be very debilitating, and empirically respond well Inhibitors,research,lifescience,medical to traditional

antianxiety therapies. However, few randomized trials have been conducted, and much more knowledge is needed in this area. IEED is a disorder of emotional expression seen in a range of neurologic Inhibitors,research,lifescience,medical diseases, but perhaps best described in its occurrence after stroke.19 Patients are prone to emotional displays provoked by nonspecific or inappropriate stimuli; in some cases, inappropriate emotional expression is spontaneous and without provocation. The classic description is of an emotional display such as laughing or crying, with the patient describing a lack of feeling a congruent mood change. These episodes are uncontrollable and irresistible, slow to resolve, and can be severe and disabling. Sometimes laughter and crying occur together. The frequency of IEED after stroke is of the order of 10% to Inhibitors,research,lifescience,medical 20%. No clear

relationship has been found with specific hemispheric lesions, and IEED after stroke can persist for many months. Randomized trials have suggested that nortriptyline and selective serotonin reuptake inhibitor (SSRI) antidepressants can Inhibitors,research,lifescience,medical lead to reduction of these debilitating

symptoms.20 More recently, randomized trial evidence suggests that dextromethorphan, combined with quinidine to reduce CHIR99021 GSK-3 dextromethorphan metabolism, is also effective for IEED.21 The reason for this benefit with dextromethorphan is unclear, but it may have to do with the known activity of the drug as a sigma receptor agonist. This also supports the idea that IEED may not be an affective disturbance but may be indeed a regulatory Inhibitors,research,lifescience,medical problem – a form of executive dysfunction where regulatory control of emotions by the frontal subcortical loops is lost. Parkinson’s disease PD22 has been associated with cognitive disorders, affective disorders, psychotic phenomena, impulse control disorders, and problematic repetitive behaviors. In an era Anacetrapib where the motor symptoms can be relatively well controlled with L-dopa in the early and middle stages of PD, the psychiatric syndromes are often a major source of disability, distress, and quality of life impairment for both patients and caregivers. Most patients with PD experience some cognitive impairment, with 25% to 40% developing dementia over the course of their illness. Longitudinal studies suggest that the type and severity of cognitive disturbances is stagedependent.