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Ito Y, Takeuchi S, Tozawa T, Hisada S, Yamada Y, Kodera M, Kobayashi M, Shirahata M, Matsubara A. Anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis with possible complication of thrombotic microangiopathy. J Dermatol 2024; 51:448-452. [PMID: 37830409 DOI: 10.1111/1346-8138.17004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/05/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
This case study illustrates a 63-year-old Japanese woman who presented with anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis. She was administered a therapeutic regimen consisting of corticosteroids, tacrolimus, and cyclophosphamide. However, after a month of treatment, symptoms of confusion and depressive tendencies emerged, followed by the manifestation of hematuria, thrombocytopenia, and fragmented erythrocytes. A disintegrin-like and metalloprotease with thrombospondin type 1 motifs 13 activity was 45%. Thrombotic microangiopathy was contemplated, yet a definitive diagnosis remained elusive. She died 2 months after admission. Although the occurrence of thrombotic microangiopathy in patients with dermatomyositis is rare, the prognosis is poor, emphasizing the importance of prompt diagnosis and treatment.
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Affiliation(s)
- Yumi Ito
- Department of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Saki Takeuchi
- Department of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Takahisa Tozawa
- Department of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Satoko Hisada
- Department of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Yoshihiro Yamada
- Department of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Masanari Kodera
- Department of Dermatology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Masahiro Kobayashi
- Department of Respiratory Medicine, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Mizuho Shirahata
- Department of Hematology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
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Chotiyanonta JS, Onda K, Nowrangi MA, Li X, Xu X, Adams R, Lyketsos CG, Zandi P, Oishi K. Translating clinical notes into quantitative measures-a real-world observation on the response to cholinesterase inhibitors or selective serotonin reuptake inhibitors prescribed to outpatients with dementia using electronic medical records. Front Pharmacol 2023; 14:1177026. [PMID: 37234714 PMCID: PMC10206004 DOI: 10.3389/fphar.2023.1177026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Objective: Cholinesterase inhibitors (CEIs) are prescribed for dementia to maintain or improve memory. Selective serotonin reuptake inhibitors (SSRIs) are also prescribed to manage psychiatric symptoms seen in dementia. What proportion of outpatients actually responds to these drugs is still unclear. Our objective was to investigate the responder rates of these medications in an outpatient setting using the electronic medical record (EMR). Methods: We used the Johns Hopkins EMR system to identify patients with dementia who were prescribed a CEI or SSRI for the first time between 2010 and 2021. Treatment effects were assessed through routinely documented clinical notes and free-text entries in which healthcare providers record clinical findings and impressions of patients. Responses were scored using a three-point Likert scale named the NOte-based evaluation method for Treatment Efficacy (NOTE) in addition to the Clinician's Interview-Based Impression of Change Plus caregiver input (CIBIC-plus), a seven-point Likert scale used in clinical trials. To validate NOTE, the relationships between NOTE and CIBIC-plus and between NOTE and change in MMSE (Mini-Mental State Examination) before and after medication were examined. Inter-rater reliability was evaluated using Krippendorff's alpha. The responder rates were calculated. Results: NOTE showed excellent inter-rater reliability and correlated well with CIBIC-plus and changes in MMSEs. Out of 115 CEI cases, 27.0% reported improvement and 34.8% reported stable symptoms in cognition; out of 225 SSRI cases, 69.3% reported an improvement in neuropsychiatric symptoms. Conclusion: NOTE showed high validity in measuring the pharmacotherapy effects based on unstructured clinical entries. Although our real-world observation included various types of dementia, the results were remarkably similar to what was reported in controlled clinical trials of Alzheimer's disease and its related neuropsychiatric symptoms.
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Affiliation(s)
- Jill S. Chotiyanonta
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kengo Onda
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Milap A. Nowrangi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Xin Li
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Xin Xu
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Roy Adams
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Constantine G. Lyketsos
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Peter Zandi
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kenichi Oishi
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Richman Family Precision Medicine Center of Excellence in Alzheimer’s Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Chen G, Liu S, Wu H, Gan J, Wang X, Ji Y. Analysis of clinical characteristics of mirror and TV signs in Alzheimer's disease and dementia with Lewy bodies. J Int Med Res 2023; 51:3000605231156098. [PMID: 36794570 PMCID: PMC9936532 DOI: 10.1177/03000605231156098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE This study explored the clinical features of dementia with Lewy bodies (DLB) and Alzheimer's disease (AD) and analyzed the differences in neurologic syndromes, including mirror and TV signs, between different groups. METHODS Patients with AD and DLB (325 and 115, respectively) hospitalized in our institution were enrolled. We compared psychiatric symptoms and neurologic syndromes between the DLB and AD groups and within each subgroup, including the mild-moderate and severe subgroups. RESULTS The prevalence rates of visual hallucination, parkinsonism, rapid eye movement sleep behavior disorder, depression, delusion, and the Pisa sign were significantly higher in the DLB group than in the AD group. Furthermore, within the mild-moderate subgroup, the mirror sign and Pisa sign prevalence rates were significantly higher in the DLB group than in the AD group. In the severe subgroup, no significant difference was found in any neurologic sign between the DLB and AD groups. CONCLUSION Mirror and TV signs are rare and often disregarded because they are not usually invoked during routine inpatient or outpatient interviews. According to our findings, the mirror sign is uncommon in early AD patients but common in early DLB patients and should receive increased attention.
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Affiliation(s)
- Gang Chen
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China,Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative diseases, Tianjin Dementia Institute, Tianjin, China,Department of Interventional Vascular Surgery, Binzhou Medical University Hospital, Binzhou, Shandong Province, China
| | - Shuai Liu
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative diseases, Tianjin Dementia Institute, Tianjin, China
| | - Hao Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China,Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative diseases, Tianjin Dementia Institute, Tianjin, China
| | - Jinghuan Gan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaodan Wang
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative diseases, Tianjin Dementia Institute, Tianjin, China
| | - Yong Ji
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China,Department of Neurology, Tianjin Huanhu Hospital, Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative diseases, Tianjin Dementia Institute, Tianjin, China,Yong Ji, Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin 300350, China.
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Kawakami I, Arai T, Ikeda K, Niizato K, Oshima K, Akiyama H. Possible association of limbic tau pathology with psychosis or behavioral disturbances: Studies of two autopsied psychiatric patients. Neuropathology 2023; 43:44-50. [PMID: 36341554 DOI: 10.1111/neup.12870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/07/2022] [Accepted: 09/09/2022] [Indexed: 11/09/2022]
Abstract
Tauopathies, including Alzheimer's disease and primary age-related tauopathy (PART), present heterogeneous clinico-pathological phenotypes that include dementia, aphasia, motor neuron diseases, and psychiatric symptoms. PART is neuropathologically characterized by the presence of neurofibrillary tangles in limbic regions without significant Aβ deposition, but its clinical features have not yet been fully established. Here, we present two patients with distinct psychosis and behavioral symptoms. At autopsy, these patients showed tau pathologies that could not be classified as typical PART, although PART-like neurofibrillary tangles were present in limbic regions. Clinically, both patients were admitted to mental hospitals due to severe delusions or other neuropsychiatric/behavioral symptoms. The first case presented with hallucination, delusion, and apathy at age 70, and died of pancreatic cancer at age 75. He had neuronal cytoplasmic inclusions with selective accumulation of 3Rtau in the striatum and thorn-shaped astrocytes in the amygdala. The second case, who presented with abnormal behaviors such as wandering, agitation and disinhibition, exhibited limbic neurodegeneration with massive 4R tau-positive oligodendroglial inclusions in the medial temporal white matter. His age at onset was 73, and the duration of disease was 15 years. These findings support the notion that distinct limbic tau pathology with concomitant degeneration of the related neural circuits might induce specific psychosis and behavioral symptoms. This underlines the importance of neuropathological evaluation for both clinical education and practice in the fields of neuropathology and neuropsychiatry.
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Affiliation(s)
- Ito Kawakami
- Department of Psychiatry, Juntendo University School of Medicine, Tokyo, Japan.,Dementia Research Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.,Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Tetsuaki Arai
- Department of Psychiatry, University of Tsukuba, Tsukuba, Japan
| | - Kenji Ikeda
- Dementia Research Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | | | | | - Haruhiko Akiyama
- Department of Clinical Research, Yokohama Brain and Spine Center, Yokohama, Japan
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5
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Park Y, Shin SH, Byun SW, Lee ZY, Lee HY. Audiological and psychological assessment of tinnitus patients with normal hearing. Front Neurol 2023; 13:1102294. [PMID: 36712420 PMCID: PMC9878854 DOI: 10.3389/fneur.2022.1102294] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction This study was performed to assess identifiable abnormalities in tinnitus patients with normal hearing. Methods The medical records of subjective non-pulsatile tinnitus patients with normal hearing confirmed by conventional pure-tone audiometry who visited our tinnitus clinic between March 2020 and May 2022 were reviewed. The loudness discomfort level (LDL), extended high-frequency hearing loss (EHFHL), summating potential (SP)/action potential (AP) ratio, distortion product otoacoustic emission (DPOAE), thresholds of auditory brainstem response (ABR) wave V, somatic modulation, and psychiatric symptoms, such as anxiety, depression, and stress were evaluated by questionnaires. Results Decreased LDL (n = 48, 59.8%) was the most frequent finding, followed by EHFHL (n = 29, 35.4%), increased SP/AP ratio (n = 27, 32.9%), psychiatric symptoms (n = 24, 29.3%), decreased DPOAE (n = 17, 20.7%), somatic modulation (n = 8, 9.8%), and increased ABR threshold (n = 3, 3.7%); 75.6% of patients had one or more of these findings. The presence of psychiatric symptoms was independently associated with the Tinnitus Handicap Inventory (THI) score. Conclusion Tinnitus in patients with normal hearing may be accompanied by a combination of various subclinical abnormal audiological findings. However, the presence of psychiatric symptoms alone was independently associated with tinnitus distress.
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Matsuyama H, Matsuura K, Ishikawa H, Hirata Y, Kato N, Niwa A, Narita Y, Tomimoto H. Correlation between Serum Zinc Levels and Levodopa in Parkinson's Disease. Nutrients 2021; 13:4114. [PMID: 34836369 DOI: 10.3390/nu13114114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Long-term intake of potential zinc-chelating drugs may cause zinc deficiency. We postulated that zinc deficiency in Parkinson's disease (PD) patients was related to the intake of drugs such as levodopa. We investigated the relationship between zinc levels and levodopa administration period, dosage, and symptoms of zinc deficiency in PD patients. We measured serum zinc levels and analyzed correlations between serum zinc levels, the levodopa oral administration period, dosage, dosing frequency, and zinc deficiency symptoms including taste disorders. Data analyses were performed using Spearman's rank correlation coefficient. The mean serum zinc level was 60.5 ± 11.6 μg/dL. The mean administration period for levodopa was 8.0 ± 5.5 years, mean administration frequency 3.4 ± 0.9 times/d, and mean administration dose 420.6 ± 237.1 mg/d. Negative correlations between zinc levels and levodopa dosage and dosing frequency were found. Multiple regression analysis showed a significant correlation with the frequency of levodopa (β = -0.360, p = 0.007). No significant change in clinical symptoms was observed after zinc administration, but anxiety tended to improve. Our results indicated that frequent levodopa administration strongly influenced serum zinc levels which may have alleviating effects on psychiatric symptoms; therefore, preventing zinc deficiency can be important during PD treatment.
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Riquin E, Le Nerzé T, Pasquini N, Barth M, Prouteau C, Colin E, Amati Bonneau P, Procaccio V, Van Bogaert P, Duverger P, Bonneau D, Roy A. Psychiatric Symptoms of Children and Adolescents With Mitochondrial Disorders: A Descriptive Case Series. Front Psychiatry 2021; 12:685532. [PMID: 34354612 PMCID: PMC8329032 DOI: 10.3389/fpsyt.2021.685532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/24/2021] [Indexed: 12/27/2022] Open
Abstract
Background: Mitochondrial disorders (MD) are a group of clinically heterogeneous genetic disorders resulting from dysfunction of the mitochondrial respiratory chain. Cognitive impairment is a common feature in adults with MD and psychiatric symptoms are associated with MD in up to 70% of the adult population. The aim of this study is to describe the psychiatric profile in children and adolescents with MD by focusing on the description of psychiatric symptoms. Methods: A cohort of 12 children and adolescents was prospectively recruited between February 2019 and February 2020 in the Reference Center for Mitochondrial Disorders of Angers (France). Participants and their parents completed an anamnestic form to provide socio-demographic data and completed the Global Assessment of Functioning scale, the Brief Psychiatric Rating Scale, the Child Depression Inventory, the Revised Children's Manifest Anxiety Scale, and the Conner's Rating Scale to evaluate the inattention/hyperactivity symptoms as well as the Quality of Life scale. Results: Four children (33.3%) were diagnosed with depressive symptoms. With regarding to anxiety, 6 children (50%) reported anxiety issues during the psychiatric interview and 3 children (25%) were suffering from anxiety according to the RCMAS scale. Compared to other children with chronic illnesses, the individuals in our cohort reported a lower overall quality of life score and lower scores in physical and social subscales. Conclusion: Our study shows that MD can lead to psychiatric disorders in children and adolescents, in particular anxiety and depression, as well as poor quality of life. This highlights the need for regular psychiatric assessments in individuals with developing brains, such as children and adolescents. We do not, however, have data regarding the neuropsychological profile of this population.
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Affiliation(s)
- Elise Riquin
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
- University Angers, [CHU Angers], LPPL EA4638, Angers, France
- University Angers, [CHU Angers], INSERM, CNRS, MITOVASC, SFR ICAT, Angers, France
| | - Thomas Le Nerzé
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
| | - Natwin Pasquini
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
| | - Magalie Barth
- Department of Genetics and National Reference Center for Mitochondrial Disorders, University Hospital of Angers, Angers, France
| | - Clément Prouteau
- Department of Genetics and National Reference Center for Mitochondrial Disorders, University Hospital of Angers, Angers, France
| | - Estelle Colin
- University Angers, [CHU Angers], INSERM, CNRS, MITOVASC, SFR ICAT, Angers, France
- Department of Genetics and National Reference Center for Mitochondrial Disorders, University Hospital of Angers, Angers, France
| | - Patrizia Amati Bonneau
- Department of Genetics and National Reference Center for Mitochondrial Disorders, University Hospital of Angers, Angers, France
| | - Vincent Procaccio
- Department of Genetics and National Reference Center for Mitochondrial Disorders, University Hospital of Angers, Angers, France
| | - Patrick Van Bogaert
- Department of Pediatric Neurology, University Hospital of Angers, Angers, France
| | - Philippe Duverger
- Department of Child and Adolescent Psychiatry, University Hospital of Angers, Angers, France
- University Angers, [CHU Angers], LPPL EA4638, Angers, France
| | - Dominique Bonneau
- University Angers, [CHU Angers], INSERM, CNRS, MITOVASC, SFR ICAT, Angers, France
- Department of Genetics and National Reference Center for Mitochondrial Disorders, University Hospital of Angers, Angers, France
| | - Arnaud Roy
- University Angers, [CHU Angers], LPPL EA4638, Angers, France
- Reference Center for Learning Disabilities, University Hospital of Nantes, Nantes, France
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8
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Koç M, Tel H, Karakülah K. Determining care burden and psychiatric symptom level in caregiver of schizophrenia patient. Perspect Psychiatr Care 2021; 57:642-647. [PMID: 32705712 DOI: 10.1111/ppc.12588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/19/2020] [Accepted: 07/17/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE The present study was conducted to determine the care burden and psychiatric symptom levels of the caregivers of schizophrenic patients. DESIGN AND METHODS The caregivers of schizophrenic patients were included in this descriptive study. FINDINGS It was determined that there was a statistically significant difference in the care burden scores and the education, family type, and the presence of physical diseases of the caregivers (P < .05). It was determined that there was a statistically significant positive relation between age and care duration (r = .339, P = .001). PRACTICE IMPLICATIONS It is recommended that the family members are guided to plan activities that will allow the family members to relax and cover their own needs.
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Affiliation(s)
- Medine Koç
- Department of Nursing, Faculty of Health Sciences, Tokat Gaziosmanpasa University, Tokat, Turkey
| | - Havva Tel
- Department of Nursing, Faculty of Health Sciences, Cumhuriyet University, Sivas, Turkey
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Liu R, Fang X, Yu L, Wang D, Wu Z, Guo C, Teng X, Ren J, Zhang C. Gender Differences of Schizophrenia Patients With and Without Depressive Symptoms in Clinical Characteristics. Front Psychiatry 2021; 12:792019. [PMID: 35095605 PMCID: PMC8792946 DOI: 10.3389/fpsyt.2021.792019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/20/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives: To investigate the differences in psychotic symptoms and cognitive function in schizophrenics with and without depression and to compare gender differences in the correlation between depressive symptoms and clinical characteristics in those patients. Methods: A total of 190 schizophrenia patients and 200 healthy controls were recruited in the study. We used the Positive and Negative Symptom Scale (PANSS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to evaluate the psychiatric symptoms, depressive symptoms and cognitive function, respectively. Patients with CDSS score ≥7 were divided into depression group, and CDSS < 7 was viewed as without depression. Results: Patients with schizophrenia had lower total scores of RBANS and five subscale (immediate memory, visual span, verbal function, attention, and delayed memory) scores compared to healthy controls. In the case group, patients who concomitant with depression had higher PANSS scores (Ps < 0.001) and lower RBANS (Ps < 0.05) scores than those without depression. After gender stratification, PANSS total scores and subscale scores were significantly different between schizophrenics with and without depressive symptoms in both male and female groups (Ps < 0.001). For cognitive function, there were significant differences in RBANS total score and subscale scores except attention between female patients with and without schizophrenia but not in male schizophrenia patients. Furthermore, the correlation analysis showed that the total CDSS score was positively correlated with PANSS score (P < 0.001) and RBANS score in male and female groups (male: P = 0.010, female: P = 0.001). Conclusion: Our findings provided evidence supporting the gender differences in psychiatric symptoms and cognitive function between schizophrenia patients with and without depressive symptoms.
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Affiliation(s)
- Ruimei Liu
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Biochemical Pharmacology Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyu Fang
- Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Lingfang Yu
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Biochemical Pharmacology Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dandan Wang
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Biochemical Pharmacology Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zenan Wu
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Biochemical Pharmacology Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chaoyue Guo
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Biochemical Pharmacology Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinyue Teng
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Biochemical Pharmacology Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juanjuan Ren
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Biochemical Pharmacology Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Zhang
- Schizophrenia Program, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Biochemical Pharmacology Laboratory, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Janiri D, Petracca M, Moccia L, Tricoli L, Piano C, Bove F, Imbimbo I, Simonetti A, Di Nicola M, Sani G, Calabresi P, Bentivoglio AR. COVID-19 Pandemic and Psychiatric Symptoms: The Impact on Parkinson's Disease in the Elderly. Front Psychiatry 2020; 11:581144. [PMID: 33329124 PMCID: PMC7728715 DOI: 10.3389/fpsyt.2020.581144] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/28/2020] [Indexed: 12/14/2022] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic represents a condition of increased vulnerability and frailty for elderly patients with Parkinson's disease (PD). Social isolation may worsen the burden of the disease and specifically exacerbate psychiatric symptoms, often comorbid with PD. This study aimed at identifying risk/protective factors associated with subjective worsening of psychiatric symptomatology during the COVID-19 outbreak in a sample of individuals with PD aged 65 years or older. Methods: Patients with PD routinely followed at the outpatient clinic of Gemelli University Hospital, Rome, were assessed for subjective worsening of psychiatric symptoms through a dedicated telephone survey, after Italy COVID-19 lockdown. Patients' medical records were reviewed to collect sociodemographic and clinical data, including lifetime psychiatric symptoms and pharmacological treatment. Results: Overall, 134 individuals were assessed and 101 (75.4%) reported lifetime psychiatric symptoms. Among those, 23 (22.8%) presented with subjective worsening of psychiatric symptomatology during the COVID-19 outbreak. In this group, the most frequent symptom was depression (82.6%), followed by insomnia (52.2%). Subjective worsening of neurological symptoms (Wald = 24.03, df = 1, p = 0.001) and lifetime irritability (Wald = 6.35, df = 1, p = 0.020), together with younger age (Wald = 5.06, df = 1, p = 0.038) and female sex (Wald = 9.07 df = 1, p = 0.007), resulted as specific risk factors for ingravescence of psychiatric presentation. Lifetime pre-existing delusions, having received antipsychotics, and not having received mood stabilizer were also associated with subjective worsening of psychiatric symptomatology due to the COVID-19 pandemic. Conclusions: Individuals with PD and lifetime history of psychiatric symptoms may be exposed to increased vulnerability to the stressful effect of COVID-19 outbreak. Interventions aimed at reducing irritability and mood instability might have an indirect effect on the health of patients with PD during the COVID-19 pandemic.
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Affiliation(s)
- Delfina Janiri
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Department of Psychiatry and Neurology, Sapienza University of Rome, Rome, Italy
| | - Martina Petracca
- Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Lorenzo Moccia
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Tricoli
- Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carla Piano
- Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Bove
- Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Alessio Simonetti
- Department of Psychiatry and Neurology, Sapienza University of Rome, Rome, Italy
| | - Marco Di Nicola
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Calabresi
- Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Rita Bentivoglio
- Dipartimento Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Institute of Neurology, Università Cattolica del Sacro Cuore, Rome, Italy
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11
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Clausen H, Ruud T, Odden S, Benth JŠ, Heiervang KS, Stuen HK, Landheim A. Improved Rehabilitation Outcomes for Persons With and Without Problematic Substance Use After 2 Years With Assertive Community Treatment-A Prospective Study of Patients With Severe Mental Illness in 12 Norwegian ACT Teams. Front Psychiatry 2020; 11:607071. [PMID: 33424668 PMCID: PMC7785822 DOI: 10.3389/fpsyt.2020.607071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/11/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Persons with severe mental illness often face difficulties in accessing and receiving adequate services enabling them to live independently. Many have co-occurring substance use problems that increase the risk of adverse outcomes. Community-based service models have been implemented around the world, including assertive community treatment (ACT), but the knowledge of rehabilitation outcomes in different subgroups is limited. We aimed to explore rehabilitation outcomes among patients suffering severe mental illness with and without substance use problems who had received ACT services for at least 2 years. Additionally, we compared differences in changes between the two groups. Methods: A total of 142 patients who received services for 2 years from the first 12 Norwegian ACT teams were included. Eighty-four (59%) had problematic substance use, while 58 (41%) did not. Data regarding housing, activity, symptoms, functioning, and subjective quality of life were collected upon enrollment into ACT and at 2 years of follow-up. Clinician-rated scales and self-report questionnaires were used. Changes within the two groups and differences in change between the groups were assessed using generalized linear mixed models. Results: Both groups were more likely to have good housing, higher level of functioning, and less anxiety and depressive symptoms after 2 years. The odds of good housing among participants with problematic substance use increased only after adjusting for age and gender. Participants with problematic substance use had less severe symptoms, particularly negative and manic symptoms, while participants without problematic substance use reported improved satisfaction with life in general. Neither group experienced a change in having a meaningful daily activity, positive symptoms, practical and social functioning, or subjective quality of life. The reduction of manic symptoms in the substance use group was the only difference between the groups. Conclusion: After 2 years, patients with and without problematic substance use experienced improvements in several important domains. Furthermore, the improvements were similar in both groups for most outcomes. This may suggest that ACT has a place in the continued effort toward integrated and comprehensive community services empowering patients with severe mental illness to achieve and sustain an independent life, including marginalized groups with severe substance use.
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Affiliation(s)
- Hanne Clausen
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Torleif Ruud
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigrun Odden
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Kristin Sverdvik Heiervang
- Department of Research and Development, Division of Mental Health Services, Akerhus University Hospital, Lørenskog, Norway.,Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hanne Kilen Stuen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Anne Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.,Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
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12
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Tomiyasu K, Oshima T, Yoshii M, Suzuki H, Inamasu J, Izumi M. [Wilson's disease presenting as Asperger syndrome]. Rinsho Shinkeigaku 2019; 59:589-591. [PMID: 31474638 DOI: 10.5692/clinicalneurol.cn-001245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 24-year-old man, who had been treated for 3 years as Asperger syndrome in adolescence due to behavioral disturbances, lack of social awareness and inability to socialize, was referred to our hospital shortly after tremors developed. On the basis of clinical features, laboratory findings and the brain MRI, a diagnosis of Wilson's disease (WD) was made. WD was further confirmed by genetic testing (the mutation of ATP7B gene). He was started with trientine hydrochloride 500 mg/day, and after 1 year of follow-up, his psychiatric symptoms have improved. Since psychiatric symptoms may precede the neurological symptoms, the possibility of WD should be always considered in the differential diagnosis of psychiatric disorders in young adults.
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Affiliation(s)
| | - Takeo Oshima
- Department of Neurology, Saiseikai Utsunomiya Hospital
| | - Masami Yoshii
- Department of Neurology, Saiseikai Utsunomiya Hospital
| | - Hiromi Suzuki
- Department of Neurology, Saiseikai Utsunomiya Hospital
| | - Joji Inamasu
- Department of Neurosurgery, Saiseikai Utsunomiya Hospital
| | - Manabu Izumi
- Department of General Internal Medicine, Saiseikai Utsunomiya Hospital
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13
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Zhu L, Deng X, Lai Z, Xie N, Tan W. Paraneoplastic limbic encephalitis cured with nephron-sparing surgery in a patient with clear cell renal cell carcinoma: a case report. J Int Med Res 2019; 47:5318-5322. [PMID: 31510835 PMCID: PMC6833412 DOI: 10.1177/0300060519863524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Paraneoplastic limbic encephalitis (PLE) in association with clear cell renal cell carcinoma has never been reported in China. We herein describe a 54-year-old man with a 1-week history of headache and a 3-day history of psychiatric symptoms. Slight nuchal rigidity was found by physical examination. Imaging studies of the head were normal. Blood and cerebrospinal fluid antibody testing were both positive for N-methyl-D-aspartic acid antibodies. Subsequent contrast-enhanced computed tomography revealed a 5.2- × 4.2-cm left kidney mass with intense enhancement. Emergent laparoscopic nephron-sparing surgery was successfully performed. Immunohistochemistry revealed clear cell renal cell carcinoma. The patient’s status improved after the surgery, and he was discharged after 1 month of hospitalization. At the 6-month follow-up, magnetic resonance imaging showed no recurrence, and the patient was living independently. This case indicates the potential effect of nephron-sparing surgery in the treatment of PLE. Tumor screening should be performed early in patients with suspected PLE. Early surgical resection of the primary tumor can improve patients’ prognosis.
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Affiliation(s)
- Lunfeng Zhu
- Deptartment of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi 341000, China
| | - Xiaolin Deng
- Deptartment of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi 341000, China.,Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China
| | - Zhaohui Lai
- Deptartment of Neurology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi 341000, China
| | - Ning Xie
- Deptartment of Urology, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi 341000, China
| | - Wanlong Tan
- Department of Urology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, P. R. China
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14
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Sakamoto S, Kawai H, Okahisa Y, Tsutsui K, Kanbayashi T, Tanaka K, Mizuki Y, Takaki M, Yamada N. Anti-N-Methyl-D-Aspartate Receptor Encephalitis in Psychiatry. Acta Med Okayama 2019; 73:189-195. [PMID: 31235965 DOI: 10.18926/amo/56860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a recently-discovered autoimmune disorder in which antibodies target NMDAR in the brain. The number of reported cases of anti-NMDAR encephalitis has increased rapidly. Anti-NMDAR encephalitis can be mistakenly diagnosed as psychiatric disorders because many patients present with prominent psychiatric symptoms and visit psychiatric institutions first. Thus, psychiatrists should cultivate a better understanding of anti-NMDAR encephalitis. In this review, we present the mechanisms, epidemiology, symptoms and clinical course, diagnostic tests, treatment and outcomes of patients with anti-NMDAR encephalitis. Furthermore, we discuss the diversity of clinical spectra of anti-NMDAR encephalitis, and demonstrate a differential diagnosis of psychiatric disease from the perspective of psychiatry.
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Affiliation(s)
- Shinji Sakamoto
- Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558,
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15
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Tural Hesapcioglu S, Ercan F. Traditional and cyberbullying co-occurrence and its relationship to psychiatric symptoms. Pediatr Int 2017; 59:16-22. [PMID: 27314217 DOI: 10.1111/ped.13067] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 06/03/2016] [Accepted: 06/15/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND The effect of cyberbullying accompanied by traditional bullying on mental health has been less studied. In this study, the frequency, co-occurrence, and the relationship to psychiatric symptoms of traditional bullying and cyberbullying among bullies and victims are examined. METHODS All of the high schools in the province of Mus, Turkey were stratified according to Placement Test for High Schools admission points for 2014-2015. By choosing schools using simple random sampling, 1276 students were reached. Students were given the Brief Symptom Inventory and three separate scale assessments: peer bullying rating, cybervictimization, and cyberbullying scales. RESULTS High scores in all subscale scores of bullying and victimization were significantly related to higher depression, anxiety, low self-esteem, somatization, and hostility scores. For people who were exposed to cyberbullying in addition to traditional bullying, the severity of the psychiatric symptoms was significantly higher. For all psychiatric symptoms, major predictors were gender, total victimization score, and total cybervictimization score. Moreover, the bullying total score was among the predictors of low self-esteem and hostility. CONCLUSION Cybervictimization and cyberbullying occur less often than traditional bullying and victimization, but people who were exposed to or performed cyberbullying were also exposed to or performed traditional bullying. The addition of cyberbullying to traditional bullying is associated with more intense psychiatric symptoms.
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Affiliation(s)
- Selma Tural Hesapcioglu
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Filiz Ercan
- Child Development Program, Department of Health Nursing Services, Mus Alparslan University, Muş, Turkey
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16
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Fujishiro H, Iritani S, Sekiguchi H, Habuchi C, Torii Y, Matsunaga S, Ozaki N, Yoshida M, Fujita K. Hypochondriasis as an early manifestation of dementia with Lewy bodies: an autopsied case report. Psychogeriatrics 2016; 16:139-44. [PMID: 25919332 DOI: 10.1111/psyg.12128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/10/2015] [Accepted: 03/12/2015] [Indexed: 11/27/2022]
Abstract
Discrepancies between clinical and pathological diagnoses of dementia with Lewy bodies (DLB) may occur because the full disease progression remains unclear, especially during the early stage. Herein, we report the case of a 78-year-old Japanese man with hypochondriasis who had autopsy-confirmed limbic-type DLB pathology. He exhibited no core clinical features of DLB. We attempted to identify the clinicopathological correlations in the early stages of DLB. At the age of 77, he became hypochondriacal and exhibited progressive cognitive decline after the death of his wife. He was concerned about his poor physical condition, but hospital examinations did not identify any overtly abnormal findings. At 78 years of age, he consulted a neurologist with complaints of facial numbness and irritability. Neurological examination revealed no overt abnormality, and he scored 21 points on the Mini-Mental State Examination. Magnetic resonance imaging of the brain showed mild bilateral ventricular enlargement. The patient was clinically diagnosed as having possible Alzheimer's disease. Approximately 1 month after his consult, he died of acute pneumonia in a psychiatric hospital to which he had been admitted for severe aggressive behaviour. He exhibited no core clinical features pointing towards a clinical diagnosis of DLB. Neuropathological investigation revealed limbic-type Lewy body disease with concurrent minimum Alzheimer-type pathology, which corresponds to high-likelihood DLB pathology based on the Third Consortium DLB pathological criteria. The patient had minimum nigral degeneration, which is consistent with the absence of parkinsonism. This autopsied case suggests that some DLB patients exhibit hypochondriasis in the early stage of the disease, even if they lack the core clinical features of DLB.
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Affiliation(s)
- Hiroshige Fujishiro
- Department of Sleep Medicine, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Shuji Iritani
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hirotaka Sekiguchi
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Chikako Habuchi
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Youta Torii
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Shinji Matsunaga
- Department of Psychiatry, Okehazama Hospital Fujita Mental Care Center, Toyoake, Japan
| | - Norio Ozaki
- Department of Psychiatry, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Mari Yoshida
- Institute for Medical Science of Ageing, Aichi Medical University, Nagakute, Japan
| | - Kiyoshi Fujita
- Department of Psychiatry, Okehazama Hospital Fujita Mental Care Center, Toyoake, Japan
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17
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Iwasaki Y, Mori K, Ito M, Mimuro M, Yoshida M. Presenile onset of spinocerebellar ataxia type 1 presenting with conspicuous psychiatric symptoms and widespread anti-expanded polyglutamine antibody- and fused in sarcoma antibody-immunopositive pathology. Psychogeriatrics 2015; 15:212-7. [PMID: 25920043 DOI: 10.1111/psyg.12122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 08/05/2014] [Indexed: 10/23/2022]
Abstract
A 50-year-old Japanese man showed slowly progressive gait disturbance and dysarthria. Neurological examination 5 years after onset revealed slow eye movement with nystagmus as well as limb and truncal ataxia. Magnetic resonance imaging showed atrophy of the cerebellum and brainstem. Because genetic examination revealed CAG repeat expansion of the ataxin-1 gene, the patient was diagnosed with spinocerebellar ataxia type 1. Ten years after onset, he showed psychiatric symptoms with cognitive impairment, and antipsychotic drugs were administered. As psychiatric symptoms gradually worsened, particularly with regard to resisting nursing care and shouting, the doses of the drugs were increased. Although the clinicopathologic findings were generally identical to previously reported spinocerebellar ataxia type 1 cases with the exception of the conspicuous psychiatric symptoms, there are two notable immunohistochemical findings. Firstly, numerous anti-expanded polyglutamine antibody-immunopositive neuronal inclusions were extensively observed, including in the cerebral cortex and limbic system, but not in the Purkinje cells. Secondly, anti-fused in sarcoma antibody-immunopositive intranuclear inclusions were extensively observed. We posit that the anti-expanded polyglutamine antibody-immunopositive neuronal inclusions and possibly the anti-fused in sarcoma antibody-immunopositive inclusions, particularly those in the neocortex and limbic system, may correspond to the psychiatric symptoms and cognitive impairment that were observed in the patient.
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Affiliation(s)
- Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Keiko Mori
- Department of Neurology, Oyamada Memorial Spa Hospital, Yokkaichi, Japan
| | - Masumi Ito
- Department of Neurology, Oyamada Memorial Spa Hospital, Yokkaichi, Japan
| | - Maya Mimuro
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Nagakute, Japan
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18
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Abstract
Health-related quality of life (HRQoL) is a multidimensional concept that includes subjective reports of symptoms, side effects, functioning in multiple life domains, and general perceptions of life satisfaction and quality. Rather than estimating it from external observations, interview, or clinical assessment, it is best measured by direct query. Due to a perception that respondents may not be reliable or credible, there has been some reluctance to use self-report outcomes in psychiatry. More recently, and increasingly, HRQoL assessment through direct patient query has become common when evaluating a range of psychiatric, psychological, and social therapies. With few exceptions, psychiatric patients are credible and reliable reporters of this information. This article summarizes studies that highlight the development, validation, and application of HRQoL measures in psychiatry. Thoughtful application of these tools in psychiatric research can provide a much-needed patient perspective in the future of comparative effectiveness research, patient-centered outcomes research, and clinical care.
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Affiliation(s)
| | | | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
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19
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Park TW, Kim JK, Kim JR. Giant epidermal cyst in the posterior neck developing over 40 years: A case report. Exp Ther Med 2013; 7:287-289. [PMID: 24348807 PMCID: PMC3861182 DOI: 10.3892/etm.2013.1383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 10/31/2013] [Indexed: 11/28/2022] Open
Abstract
Conventional epidermal cysts are generally small, slow-growing, non-tender, dome-shaped lesions. An epidermal cyst is usually asymptomatic until it is infected or enlarged to the extent that it causes damage to adjacent anatomical structures. However, few cases of giant epidermal cysts in the neck have been reported. The present case reports a giant epidermal cyst in the posterior neck, which grew to an extremely large size for >40 years without inflammation or rupture, and was misdiagnosed as a large soft tissue neoplasm. The patient exhibited depression and developed social anxiety due to the negative cosmetic consequences of the large mass. The patient underwent excision of the mass. At the follow-up examination two years postoperatively, there were no local recurrence and the psychiatric symptoms of the patient were completely resolved. To the best of our knowledge, a giant epidermal cyst growing for >40 years has not previously been reported.
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Affiliation(s)
- Tae Won Park
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Jeonbuk 561-756, Republic of Korea ; Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Jeonbuk 561-756, Republic of Korea
| | - Jong Kil Kim
- Department of Orthopaedic Surgery, Chonbuk National University Medical School, Jeonju, Jeonbuk 561-756, Republic of Korea
| | - Jung Ryul Kim
- Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Jeonbuk 561-756, Republic of Korea ; Department of Orthopaedic Surgery, Chonbuk National University Medical School, Jeonju, Jeonbuk 561-756, Republic of Korea
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