Since the literature suggests EI causes neuropsychological sequelae, it is worth using MRI imaging techniques to examine any structural abnormalities and cerebral lesions. Irregularities observed on MRI scans are generally unique to each EI case, however white matter hyperintensities found on fluid-attenuated inversion recovery image sequences are a common factor. The latter three of the case studies cited all report WMH specifically in the cerebral corticospinal tract. EI has also been known to cause hypoxia, which is characterized by cytotoxic edema in the cortex of the central region and the basal ganglia.The average lamppost in a densely populated city, such as New York City, works on a single-phase 120 V/240 V 60 Hz, AC received from a nearby three-phase generator. The patient received an electrical shock after submerging his hands in a puddle on a sidewalk charged with stray voltage from a nearby lamppost. Workers from the electrical company in the area testified that exposed ends of an electrical cable of a lamppost were causing 8 V of stray voltage. Using the information we know about wet skin resistance, we can also assume that the patient’s hand had a resistance of 1000 X, while the patient’s internal body had a resistance of 300 X. Rearranging Eq. , we calculate the current passing through the patient’s hand to be approximately 8 mA, while the current passing through the internal body is approximately 26 mA. However since salt water is more conductive than pure water, this would have potentially lowered the resistivity of the patient’s hand, causing the current passing through his hands to be comparatively higher and thus accounting for the no-let-go phenomenon he experienced. To examine the validity of this approximation,growers equipment we consider the patient’s dog that went into seizure upon stepping in the charged puddle.

A study done by Woodbury investigated the stimulus parameters needed to induce electroshock seizures on rats, and found that at 60 Hz AC, the current needed to promote seizures was 17.7 mA. This is extremely similar to the current needed, 16 mA, to induce the no-let-go phenomenon in the average male. Thus we can assume with substantial confidence that the current passing through the patient’s hand was roughly around 16 mA AC.At age 10, the patient was treated for meningitis. One week after the electrical injury, the 37-year-old patient received a brain MRI that reported no abnormalities. Six years after the injury, the patient had another brain MRI, which was sent to our laboratory. Since the cavitation of his right lateral ventricle is prominent on T1 multi-planar reconstruction and T2 FLAIR MRI sequences , it is highly probable that this particular abnormality was not derived from the patient’s childhood meningitis, otherwise it would have been observed by his former radiologist. MRI DTI analysis done on adult meningitis reports increased FA values in cortical regions, while analysis done on neonatal meningitis reports increased FA values in leptomeningeal regions and decreased FA values in periventricular white matter regions. However, to date, there are no studies that report white matter abnormalities found in adults with childhood meningitis, or studies that have assessed high diffusion anisotropy sequelae in patients with a history of meningitis.At the time of the neuropsychological exam, the patient was taking multiple medications that could have potentially affected cognitive performance. An investigation of these potential effects was conducted. Depressed patients treated with Bupropion scored similarly to normal, healthy controls on neuropsychiatric tests that assessed verbal memory, visual memory, finger tapping, and symbol digital coding. On the dominant finger-tapping test, our patient scored in 5th percentile, while on the coding subtest, he scored in the 10th percentile. The patient’s visual and verbal memory scores were average. In a study that assessed the neuropsychiatric effects of Hydrocodone, subjects that had taken hydrocodone performed 10% worse than the mean on the motor performance test, while no variance was found on simple and complex reaction time tests. Our patient scored in the 2nd percentile on the motor and processing speed index. In a study done on 38 patients taking Clonazepam, 8 patients experienced behavioral side effects while 30 patients did not.

The mean absolute discrepancy between VIQ and PIQ of the 8 patients was 17.5 points, while the discrepancy between VIQ and PIQ of the 30 patients who did not experience behavioral side effects was 6.5 points. Our patient’s VIQ and PIQ difference was 20 points. No study has been done on the effects of memantine on cognitive behavior for patients without Alzheimer’s disease , but for patients with AD, memantine improved language and memory scores in comparison to a placebo group. Gonzalez measured the effects of cannabis on cognitive performance by determining overall indexes of neuropsychological performance and running individual neuropsychological tests . Habitual cannabis users performed 1/5th a standard deviation worse than controls in overall index scores, and had performed significantly worse on memory tests. The patient’s performance on memory tests and his full scale IQ were rated average. No effects of melatonin on neurocognitive performance were found. No effects of gabapentin on neurocognitive performance were found.The patient shows significant increase in the right lateral ventricle volume on quantitative volumetric analysis, which can also be seen in his T1 MPR and T2 FLAIR MRI image sequences . This right-sided volumetric increase would also be consistent with the 20-point discrepancy of the VIQ and the PIQ since the right side of the brain is more closely associated with the PIQ and the left side of the brain is more closely associated with VIQ. The increased right-sided lateral ventricle would also be consistent with the more prominent right-sided ROIs found on MRI DTI analysis such as right-sided posterior internal capsule, external capsule and arcuate abnormalities. Right-sided abnormalities in areas such as the posterior internal capsule, shown in Fig. 1, would also be compatible with the chronic neuropathy in his left arm since the right side of the brain regulates the left side of the body. Reisner noted that delayed myelopathy after electrical injury has been established in the literature, and that possible mechanisms include glutamatergic hyper stimulation leading to oxidative stress.Common psychiatric problems, including conduct disorder, depression and anxiety, are important risk factors for alcohol and marijuana use in adolescence. The consistent link between common psychiatric problems and substance use has led researchers and practitioners to suggest that by intervening early in adolescence to treat psychiatric disorders, we could reduce substance use problems by late adolescence. However, two key questions need to be answered before we can conclude that intervening on psychiatric problems will be an effective strategy to reduce substance use in adolescence.

First, do adolescents who exhibit an increase in their psychiatric problems exhibit a subsequent increase in their substance use? Longitudinal studies provide consistent evidence that youth with higher levels of psychiatric problems are more likely to engage in substance use during adolescence 3. Etiologic theories to explain this comorbidity are based on causal pathway models, in which conduct disorder, depression, and anxiety result in substance use. Frequent explanations for these relationships are that children and adolescents with conduct disorder gravitate towards social environments that facilitate problem behaviors such as substance use and that drugs like alcohol and marijuana are used to self-medicate or alleviate persistent symptoms of sadness and anxiety. However, existing studies have primarily examined whether youth with higher levels of psychiatric problems are more likely to use and abuse substances ,plant benches rather than examining whether adolescents tend to increase their level of substance use during periods when their psychiatric problems increase . The latter approach represents a more direct examination of the self-medication hypothesis, where adolescents increase their substance use in an attempt to manage emerging psychiatric problems. Few longitudinal studies have examined the association between intra-individual changes in mental health problems and substance use. By examining within-individual change, causal inference is enhanced because selection effects and all factors that vary between individuals are ruled out as potential confounds. It also provides a better indication of whether treating an adolescent’s psychiatric problems could potentially lead to a reduction in his substance use. The second key question is: Are there sensitive periods during adolescence when psychiatric problems play a particularly strong role in shaping substance use? Cerdá and colleagues found no evidence that there was a sensitive period in which acute and chronic psychiatric problems were more strongly related to the onset of alcohol and marijuana use from childhood to late adolescence. Specifically, both recent and cumulative conduct disorder problems were associated with earlier alcohol and marijuana use onset in a cohort of boys followed from ages, whereas cumulative, but not recent, depression problems were associated with earlier alcohol use onset. However, there was no particular age of substance use initiation when psychiatric problems mattered the most. In contrast, Maslowsky and colleagues 10 and Gibbons and colleagues 11 found evidence indicating that early conduct problems were a stronger predictor of alcohol and marijuana use in late adolescence than conduct problems in middle adolescence. However, these three studies focused on between-individual differences in psychiatric problems and substance use. Therefore, it is unclear whether there is a specific developmental period during adolescence when youth are more likely to escalate their drug and alcohol use in response to emerging psychiatric problems.

One way to effectively address these two key questions is to use longitudinal data to examine whether youth tend to increase the frequency of their substance use after they experience an increase in their psychiatric problems, and test whether this association changes across development. This type of within-person change analysis eliminates the possibility that time-stable individual differences such as genotype, race/ethnicity, personality traits, family history of psychiatric problems and substance dependence, and parenting problems can explain the association between changes in psychiatric problems and substance use across adolescence. Hence, it controls for all unmeasured time-invariant confounders. In addition, measured time-varying confounders can also be included as control variables . Using this approach, researchers have shown that change in alcohol abuse or dependence and nicotine dependence in early adulthood predicted change in major depression in a birth cohort in New Zealand. Additionally, increasing frequency of cannabis use was associated with concurrent increasing depression problems in four Australasian birth cohorts. But to our knowledge, no research has used this approach to establish the directionality of the relationship between common psychiatric problems and substance use: that is, to evaluate whether an increase in conduct disorder, depression and anxiety problems leads to a subsequent increase in alcohol and marijuana use; an increase in alcohol and marijuana use leads to a subsequent increase in conduct disorder, depression and anxiety; or a reciprocal relationship exists between psychiatric problems and substance use. Thus, the aims of the present study are to address the following questions: do adolescents experience an increase in the frequency and quantity of their alcohol and marijuana use following an increase in conduct disorder, depression, and anxiety problems? Are there specific periods during adolescence when increases in these mental health problems are more strongly related to escalations in substance use than others? We examine these questions in a longitudinal urban sample of males followed from ages 13 to 19, with yearly measures of psychiatric problems and substance use quantity and frequency. To establish the directionality of these associations, we examine both whether increases in alcohol and marijuana follow increases in conduct disorder, depression, and anxiety, and whether increases in conduct disorder, depression, and anxiety follow increases in alcohol and marijuana use. Data are from the youngest cohort of the Pittsburgh Youth Study. This sample has been described in depth elsewhere.Briefly, participants included first-grade boys enrolled in 31 public schools in Pittsburgh in 1987-1988.The screen involved assessing the boys’ conduct problems using ratings collected from the parents, teachers, and the boys themselves. Boys whose composite conduct problem scores fell within the upper 30th percentile, together with an approximately equal number of participants randomly selected from the remaining end of the distribution, were selected for longitudinal follow-up . The sample is predominantly Black and White with 3% Asian, Hispanic, and mixed-race. Participants were assessed annually or semi-annually, depending on the measure, for thirteen years.