These findings suggest that monitoring studies increase the risk for postictal psychiatric events, which neurologists need to be familiar with, as they represent important morbidity associated with these studies.

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Objective In spite of growing numbers of elderly there are few treatment studies on late-life bipolar disorder (BD). This was a 12-week prospective, open-label trial to assess efficacy and tolerability of adjunct asenapine in non-demented elderly (≥60 years) with sub-optimal previous response to BD treatments. Methods Asenapine was initiated at 5 mg/day and titrated as tolerated. Effects on global psychopathology were measured with Clinical Global Impression, Bipolar version (CGI-BP) and the Brief Psychiatric Rating Scale (BPRS). Mood polarity severity was measured with the Hamilton Depression Rating Scale (HAM-D), Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS). Other outcomes included the WHO-Disability Assessment Schedule II (WHO-DAS II). Results Fifteen individuals were enrolled (mean age 68.6, SD 6.12), 53% female, 73% Caucasian, 13% African-American, 7% Asian). There were 4/15 (27%) individuals who prematurely terminated study while 11/15 (73%) completed study. There were significant improvements from baseline on BPRS (P<.05), on CGI overall (P<.01), and on CGI mania (P<.05) and depression (P<.01) sub-scales. Mean dose of asenapine was 11.2 (SD 6.2) mg/day. The most common reported side effects were gastrointestinal discomfort (n=5, 33%), restlessness (n=2, 13%), tremors (n=2, 13%), cognitive difficulties (n=2, 13%), and sluggishness (n=2, 13%). Conclusions Elders with BD had global improvements on asenapine. Most reported adverse effects were mild and transient, but adverse effects prompted drug discontinuation in just over one-quarter of patients. While risks vs. benefits in older people must always be carefully considered, asenapine may be a treatment consideration for some non-demented geriatric BD patients.

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Induction procedures have been employed by some neurologists as a method of attempting to determine whether paroxysmal events experienced by the patient are psychogenic in origin. Although various techniques are used, those involving injection of intravenous saline and placebo patches are the focus of this article because they involve deception of the patient and raise the greatest ethical concerns. Issues of potential harm to the patient are examined in light of the typical psychological profile of patients who have psychogenic seizures. In addition, reliability of the procedure, possible benefit to the patient, and alternatives to using the procedure are considered. Finally, the question of whether there is ethical justification to consider induction procedures as an acceptable exception to informed consent is discussed. The authors argue that there is little if any justification for using induction procedures involving placebos, and that when the procedure is considered justifiable it should be done only if examination by a mental health professional discloses no psychological contraindications to proceeding and if a debriefing of the patient explaining the process and purpose of the induction is to take place following the procedure.

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