Muscarinic targets for cognition in Schizophrenia; ADHD comorbidity; perinatal risks, treatment resistance and SRIs; and brain lesions presenting as psychiatric illness.

This month's CNS Spectrums examines cholinergic mechanisms of cognitive dysfunction in schizophrenia, how attention-deficit/hyperactivity disorder (ADHD) may complicate the course of other psychiatric illness, whether serotonin reuptake inhibitors (SRIs) may induce spontaneous abortions, treatment-resistant obsessivecompulsive disorder (OCD), and how silent brain lesions can present as psychiatric illness. Patients with organic lesions in neurologically silent brain areas sometimes present only with psychiatric symptoms such as depression, anxiety disorders, schizophrenia, anorexia nervosa, or cognitive dysfunction. Admoas Bunevicius, MD, and colleagues present eight cases of patients with brain lesions, including meningiomas, intracerebral cysts, anaplastic oligodendrogliomas, multiform glioblastomas, and occlusive hydrocephalus, who for a significant period of time were diagnosed and treated for psychiatric disorders (such as Alzheimer's disease, schizoaffective disorder, schizophrenia, depression, and organic emotional lability disorder). When neurologic symptoms developed they underwent neuroimaging studies and organic brain lesions were diagnosed. Further treatment required neurosurgical interventions. These cases show that brain tumors can be neurologically silent for periods of time and manifest as psychiatric disorders. Neuroimaging studies are needed when the presentation or course of illness is unusual, or atypical changes in mental status or neurologic symptoms and signs develop. Missing such an organic lesion can have a huge impact on both the patient and clinician. Thus, organic lesions can present as functional illness, functional illnesses such as ADHD can complicate the course of other psychiatric disorders, neurocognitive impairment can complicate the course of schizophrenia, and medications for depression can be used in combination for,treatment resistance and can cause perinatal complications. The alert physician needs be alert to these complex clinical presentations. Maternal exposure to post-tricyclic antidepressants during pregnancy might be associated with an increased risk of poor birth, obstetrical, and neonatal outcomes. Among these complications, the occurrence of spontaneous abortions represents one of the most dramatic events for the pregnant woman. Salvatore Gentile, MD, reviewes all primary data studies investigating the rate of spontaneous abortions in women treated with SRIs during pregnancy. Information from the reviewed studies are scarce and methodologically inadequate to draw definitive conclusions about the risk of spontaneous abortions associated with serotoninergic antidepressant exposure during early pregnancy. Alternatively, parameters such as teratogenic risk or liability