By Simon Ducharme, Bruce H. Price, Mykol Larvie, Darin D. Dougherty, and Bradford C. Dickerson | American Journal of Psychiatry | September 1, 2015

Summary:

Frontotemporal dementia (FTD) describes a heterogeneous group of neurodegenerative diseases featuring various combinations of behavioral changes, language abnormalities, social cognitive impairment, and executive function deficits. FTD is divided into two major clinical syndromes: the behavioral variant (bvFTD) (1) and the language variants referred to as primary progressive aphasias (2).

Identifying bvFTD is challenging because symptoms can be subtle in the early stages, and they may combine features that are traditionally within the realm of psychiatry (e.g., personality changes, lack of empathy, compulsions) and others usually seen by neurologists (e.g., aphasia, cognitive impairments). Patients are often first evaluated in general psychiatric settings, and about 50% are initially diagnosed with a primary psychiatric illness (3).

Knowledge about FTD has grown exponentially over the past 10 years, and it is crucial for psychiatrists to include bvFTD as part of their differential diagnosis in a wide range of adult psychiatric disorders. In this article, we review the clinical approach to bvFTD, focusing in particular on the differential diagnosis between bvFTD and primary psychiatric disorders.

Read the full paper here.

A delusional episode, or a personality disorder distinguished by lack of empathy, remorse, and inhibition? Psychosis and psychopathy are two distinct diagnoses whose risk of violence is often confused or conflated.

On Thursday, February 19, 2015, CLBB presented a McLean Hospital Grand Rounds titled “Psychosis vs. Psychopathy: Navigating the Risk of Violence in the Clinical and Courtroom.” Clinical and legal experts used case-study to distinguish the on-set, pathophysiology, symptoms and effective interventions for each diagnosis, and characterize the risk of violence.

This Grand Rounds presented case studies and discussion by Joseph Stoklosa, MD, medical director for McLean’s schizophrenia and bipolar program; Judge Roanne Sragow, first justice for the Cambridge District Court; Larry Seidman, MD, neuropsychologist and expert on early psychosis; and CLBB co-director Bruce Price, MD, McLean Chief of Neurology. CLBB co-director Judith Edersheim, JD, MD, forensic psychiatrist, served as moderator.

The Grand Rounds took place from 12-1pm in Pierce Hall, inside the Service Building, at McLean Hospital.

Watch video of the entire “Psychosis vs. Psychopathy” event below, or explore past events on juvenile justice, pain, memory, and criminal responsibility, on CLBB’s Vimeo channel.

As of fall 2014, CLBB Director of Law & Ethics Rebecca W. Brendel, JD, MD, will join the Harvard Medical School Center for Bioethics to lead the development of a new Master’s Program in Bioethics. Originally established as the Division of Medical Ethics, The Center was rebranded in spring 2014 to serve as a convener for faculty who will collaborate with the ethics services at the HMS affiliates and with ethics programs at schools throughout Harvard University. Dr. Brendel will develop and then lead the new Master’s Program in Bioethics at HMS.

The Master of Bioethics Degree, beginning fall 2015, will combine resources from the Center for Bioethics, Harvard teaching hospitals, and departments across the University in a one-year full time course of study and is open to working professionals holding a terminal degree in any discipline. A core group of applicants is expected from medicine, law, nursing, public health, social work, public policy, scientific and biotechnology research, journalism, and business.

Dr. Brendel is Assistant Professor of Psychiatry at Harvard Medical School and Director of Law & Ethics at CLBB. An expert consult-liaison psychiatrist and ethicist, Dr. Brendel has published widely on issues including voluntary psychiatric hospitalization (2014), evaluation of capacity to appoint a healthcare proxy (2013), and legal issues including mandatory reporting and informed consent (2010).

Dr. Brendel will be stepping down as Clinical Director of the Home Base Program — a collaboration of the Red Sox Foundation and MGH — in order to step into the new role at the Center for Bioethics.  Continue reading »

On March 4, 2010, CLBB Co-Directors Judith Edersheim and Bruce Price delivered the Psychiatry Grand Rounds talk at UMass Medical School. The talk discussed the implications the emerging field of cognitive neuroscience may have on the clinical and legal landscapes.

Video of the event is included below in its entirety and at our Vimeo page. Continue reading »

On January 21, 2010, the Center for Law, Brain & Behavior led a conversation among three experts on deception to discuss the past and future of lie detection, and how neuroscience might (or might not) contribute to a better way to tell truth from deception. Continue reading »