Abstract: Moyamoya disease is a cerebrovascular disorder of unknown etiology characterized by progressive unilateral or bilateral stenosis of the distal internal carotid arteries, frequently extending to the anterior and middle cerebral arteries. Cerebral angiogram reveals fragile compensatory collateral vessels forming along the base of the brain, resembling a diagnostic “puff of smoke”—moyamoya in Japanese. The prevalence of moyamoya is highest in Korea, Japan, and China, although awareness of the disease has resulted in its increased characterization in other countries. In Japan, the incidence rate is estimated at 0.54 per 100,000 individuals, with a female-to-male ratio of 1.98. Illness onset follows a bimodal distribution with a large peak centered at approximately age 5 and a smaller peak at age 40. A family history of the disease is present in up to 15% of identified patients, and in this group the mean age at symptomatic onset is lower than in sporadic cases of moyamoya disease, indicating genetic anticipation. Moyamoya disease may also occur secondary to atherosclerosis, autoimmune illness, neoplasms, Down’s syndrome, or irradiation, among other conditions, referred to as moyamoya syndrome.
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The participant will formulate a recognition of symptoms of moyamoya disease in psychiatric patients as well as an approach to treatment.
This program is designed for all psychiatrists in clinical practice, residents in Graduate Medical Education programs, medical students interested in psychiatry, and other physicians who wish to advance their current knowledge of clinical medicine.
Estimated Time to Complete
Duration: 1 hour
Begin Date: April 1, 2019
End Date: March 31, 2021
How to Earn Credit
In order to earn CME credit, subscribers should read through the material presented in the article. After reading the article, complete the quiz and submit your evaluation and study hours (up to 1 AMA PRA Category 1 Credit™). A score of 60% or higher is required to receive credit.
The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
The APA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Faculty and Planner Disclosures
Title: Psychiatric Comorbidity in Moyamoya Disease and Preliminary Guidelines For Treatment
Authors: Misty Richards, M.S., M.D., Adrienne Grzenda, M.D., Ph.D., Evelyn Nelson, M.D., Michael Gitlin, M.D.
Affiliations: Department of Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (M.R., A.G., E.N., M.G.).
Disclosures: The authors report no financial relationships with commercial interests.
Discussion of unapproved or investigational use of products*: No.
*APA policy requires disclosure by CME authors of unapproved or investigational use of products discussed in CME programs. Off-label use of medications by individual physicians is permitted and common. Decisions about off-label use can be guided by scientific literature and clinical experience.
Ned H. Kalin, M.D. (Editor-in-Chief, AJP); Carolyn Rodriguez, M.D., Ph.D. (Deputy Editor, AJP); Michael D. Roy (Editorial Director, AJP); Michael A. Pogachar (Online Content Manager, Journals). Dr. Kalin has served as a consultant to the Board of Scientific Advisors, the Pritzker Neuropsychiatric Disorders Research Consortium, and the Skyland Trail Advisory Board and as Councilor, Society of Biological Psychiatry. Dr. Rodriguez has served as a consultant to Allergan, Blackthorn, Epiodyne, and Rugen. Mr. Roy and Mr. Pogachar report no financial relationships with commercial interests.
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