Childhood maltreatment on psychiatric symptoms and drug efficacy in patients with schizophrenia / 西安交通大学学报(医学版)

【Objective】 To explore the effect of childhood maltreatment on clinical symptoms and early efficacy of antipsychotics in patients with schizophrenia. 【Methods】 Totally 73 schizophrenic patients were divided into mild maltreatment group(n=42) and severe maltreatment group(n=31) according to the Child Trauma Questionnaire(CTQ). The Positive and Negative Symptom Scale(PANSS) and Clinical Global Impression(CGI) were measured and compared between the two groups at baseline and 3 weeks after antipsychotic treatment to analyze the correlation between child maltreatment experience and mental symptoms and the response to early treatment of antipsychotics. 【Results】 PANSS positive factor score(P=0.026) and cognitive deficit factor score (P=0.042) were significantly higher in severe abuse group than in mild abuse group. The positive factor was significantly positively correlated with emotional abuse factor in CTQ score(r=0.257, P=0.028), and the cognitive deficit factor was significantly positively correlated with emotional neglect factor(r=0.283, P=0.015). After antipsychotic treatment, the reduction rate of PANSS negative factor in severe abuse group was significantly lower than that in mild abuse group(P=0.035), and had the highest correlation with CTQ physical abuse factor(r=-0.302, P=0.011). 【Conclusion】 The severity of childhood maltreatment experienced by schizophrenic patients is more related to positive symptoms and cognitive deficits, and more childhood maltreatment experience will affect the improvement of negative symptoms by antipsychotics, suggesting a poor prognosis.

Related factors of relapse based on positive and negative syndrome scale among schizophrenics in Shanghai communities / 上海预防医学

ObjectiveTo explore the relapse status based on the positive and negative syndrome scale （PANSS Scale） and related factors of schizophrenics in Shanghai communities， and to analyze the association between socio demographic characteristics， lifestyles， clinical characteristics and relapse. MethodsA dynamic cohort prospective study design was used in this study. From March 2018 to February 2019， a total of 189 schizophrenics in Xuhui， Hongkou， Changning， Jiading， Songjiang and Baoshan districts were enrolled successively. Baseline questionnaires were conducted through face-to-face interviews at baseline， which contained social demographic information， lifestyle information and clinical information. A follow-up was conducted every 2 weeks for a measurement of PANSS Scale for a total of 6 months. Relapse was assessed by a PANSS score increase of ≥25% from baseline （or an increase of 10 points or more if the baseline score was ≤40 points）. Univariate and multivariate Cox regression models were used to analyze the associations between relapse status （assessed by PANSS Scale） and socio demographic characteristics， lifestyles， and clinical characteristics， respectively. ResultsA total of 165 community schizophrenics completed baseline and follow-up surveys， with a loss to follow-up rate of about 12.7%. After exclusion of sociodemographic and clinical information deficits， 132 patients were included in the analysis totally， with an average age of 48.18±12.67 years， among whom 41.67% were male. Totally 33 patients relapsed during the 6-month follow-up period， with a relapse rate of 25.0%. After adjusting for gender， family history， age， employment， education， marital status， smoking， drinking， exercise frequency， medication compliance， insight， social function， violence history， stress recent events， adverse drug reactions and baseline scores of PANSS Scale， risk factors of relapse included the following four factors： age below 40 years （HR=4.47， 95%CI： 1.15-17.40）， primary school or below （HR=7.11， 95%CI： 1.54-32.83）， unemployed （HR=8.34， 95%CI： 1.78-38.98）， and adverse drug reactions （HR=5.02， 95%CI： 1.75-14.37）. ConclusionWe should pay attention to the risk factors such as age， education， employment and adverse drug reactions， in order to identify high-risk patients and to conduct timely interventions during the relapse management of schizophrenics in Shanghai community.

Status and correlates of sleep quality in schizophrenia inpatients / 中华健康管理学杂志

Objective:To explore the status and correlates of sleep quality in hospitalized patients with schizophrenia.Methods:A total number of 269 schizophrenia inpatients were recruited from 7 hospitals including Peking University Sixth Hospital, Zhumadian Second People′s Hospital and Liaocheng Fourth People′s Hospital from August 2019 to March 2021. The Brief Psychiatric Rating Scale (BPRS), the Pittsburgh Sleep Quality Index (PSQI), the 9-item Patient Health Questionnaire (PHQ-9), the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the suicide module of Mini-International Neuropsychiatric Interview were evaluated. Poor sleep quality was determined by the score of more than 5 according to PSQI, all patients were divided into groups of poor and normal sleep quality. The general demographic data and clinical characteristics of two groups were compared, and the correlates of sleep quality were obtained by Spearman correlations and multiple logistic regression.Results:The prevalence of poor sleep quality in schizophrenia inpatients was up to 44.6% (120/269). Compared with normal sleep quality group, inpatients with poor sleep quality had higher rates of alcohol consumption history, use of benzodiazepines (BZDs) and current suicide risk, and BPRS total score, factor scores (thinking disorders, anxious-depression, hostile-suspiciousness and activation), PHQ-9 and GAD-7 scores were also higher (all P<0.05). Spearman correlation analyses showed that PSQI total score were significantly positively correlated with BPRS total score ( r=0.323), PHQ-9 score ( r=0.553), GAD-7 score ( r=0.456) and current suicide risk level ( r=0.320) (all P<0.001). Multiple logistic regression showed that history of alcohol consumption ( OR=2.897, 95% CI: 1.002-8.372), use of BZDs ( OR=3.181, 95% CI: 1.548-6.534), thinking disorders ( OR=1.563, 95% CI: 1.015-2.406), comorbidity with depression ( OR=4.968, 95% CI: 1.869-13.202), and current suicide risk ( OR=2.496, 95% CI: 1.360-4.581) were independently correlated with poor sleep quality (all P<0.05). Conclusion:Poor sleep quality is common in hospitalized patients with schizophrenia, and history of alcohol consumption, use of BZDs, thinking disorders, comorbidity with depression and current suicide risk are independent correlates of poor sleep quality.

Phenotypic diversity of hereditary sensory and autonomic neuropathy type IE: a case series and review of the literature

@#Objective: DNA methyltransferase 1 (DNMT1) is crucial to maintaining methylation during DNA replication and DNA repair. DNMT1 mutations have been identified in two neurological syndromes, including hereditary sensory and autonomic neuropathy type IE (HSAN IE) with dementia and hearing loss and autosomal dominant cerebellar ataxia, deafness and narcolepsy. It is likely that DNMT1 mutations lead to various symptoms of the central and peripheral nervous system. The aim of this study was to examine the clinical characteristics, especially the initial symptoms, in the cases of DNMT1 mutations. Methods: We investigated the clinical manifestation and examination findings of four cases of HSAN IE from one family with the DNMT1 mutation c.1531Y>C (p.Try511His). Results: All four cases exhibited sensory neuropathy, cerebellar ataxia, and hearing loss, all of which were demonstrated by the audiograms. The initial symptoms of the four cases included hearing loss (n=1), gait disturbance (n=1), and depressive mood (n=2). Depressive symptoms are reported in some cases with HSAN IE, however, there are currently no published reports that describe them as primary symptoms. The CSF orexin level was measured in three cases, revealing normal values in two cases and intermediate values in one case, in which the patient exhibited rapid eye movement (REM) sleep behavior disorder. Conclusion: Our findings suggest that in cases with HSAN IE or the DNMT1 mutation, psychiatric symptoms should be taken into account as one of the initial manifestations of the disease.

Psychiatric Symptoms and Clinical Diagnosis in High School Students Exposed to the Sewol Ferry Disaster

BACKGROUND: Two hundred and fifty 11th grade students and teachers from Danwon High School drowned, during a school trip, in the Sewol Ferry Disaster. The goal of this study was to investigate the experiences of the psychiatrists who volunteered and provided psychiatric services to the students at Danwon High School. METHODS: From the second day to the 138th day after the disaster, pro bono psychiatrists provided post-disaster interventions to the 10th and 12th-grade Danwon High School students who did not attend the trip. Officially, 167 psychiatrists conducted outreach in approximately 550 encounters. The study questionnaires were distributed retrospectively to psychiatric volunteers who conducted outreach at Danwon High School. We surveyed the pro bono psychiatrists about their experiences, including the students' chief complaints, psychiatric problems, clinical diagnoses, and psychiatrists' treatment recommendations. RESULTS: We reached 72 (43.1%) of the 167 volunteers, and they reported on 212 (38.6%) of the 550 encounters. The common chief complaints were mental health problems, companion problems, and family problems. The most frequent psychiatric symptoms were anxiety (76.89%), depressive mood (51.42%), and concentration difficulty (50.94%). The most frequent clinical diagnoses of the students were normal reaction (41.04%), acute stress disorder (24.53%), adjustment disorder (17.92%), anxiety disorders (9.43%), and posttraumatic stress disorder (6.60%). More than half of the students needed “additional counseling/therapy” (41.04%) or “referral to psychiatric treatment” (14.15%). CONCLUSION: During the acute aftermath of the Sewol Ferry Disaster, volunteer psychiatrists were able to provide services. These services included psychiatric assessments, crisis counseling, psychological first aid, and referrals for ongoing care. More than half of the students were perceived to have a psychiatric diagnosis, and a substantial proportion of students needed further treatment. Future research should focus on the short- and long-term effects of psychiatric interventions and the characterization of post-disaster mental health needs and service provision patterns.

Psychiatric Symptoms after Taking Oseltamivir in a Child and Its Causality Assessment

Oseltamivir is an antiviral medication prescribed to prevent and treat influenza A and B. A case from a community pharmacy in Korea was reported for an adverse event associated with oseltamivir administration. A 20-month-old boy had psychiatric symptoms after receiving 2 doses of oseltamivir. Therefore, an evaluation of whether the psychiatric symptoms were caused by oseltamivir was required. To determine whether the adverse event resulted from the administrated medication or other factors, three tools were used: the Naranjo scale, the Korean causality assessment algorithm (Ver.2), and the World Health Organization-Uppsala Monitoring Center (WHO-UMC) criteria. The psychiatric symptoms occurred after oseltamivir administration, and were attenuated after oseltamivir termination. A possible cause of the psychiatric symptoms is high fever, but information on the body temperature of the patient was not sufficient. Therefore, it was unclear whether there were other nonpharmacological causes of adverse drug reaction. For these reasons, in terms of causality, the results evaluated by the three tools represented, “possible”, “probable”, and “probable/likely”, respectively.

A cross-sectional study on behavioural and psychological symptoms of dementia in elderly and its impact on quality of life in a tertiary care hospital

Background: Historically, the word dementia was derived from Latin word ‘dementatus’, which means ‘out of one’s mind’. There were 24.3 million people with dementia in the world and 4.6 million are being added every year. Present study was done to evaluate the behavioral and psychological symptoms of dementia in elderly patients and its impact on their quality of life.Methods: It was a hospital based descriptive, cross-sectional study. 100 cognitively impaired patients in the age group of 60 years and above were enrolled. The socio-demographic profile, severity of dementia on MMSE; behavioral disturbances on BPSD; psychiatric illness on NPI; agitation on CMAI and their impact on quality of life, and disability were assessed on WHOQOL-Bref and WHO DAS 2.0 scales, respectively.Results: Out of 110 patients that were screened, 100 participated in the study (response rate 91%). Majority of subjects (53%) were illiterate and belongs to rural background (57%). Mean dementia severity score was 17.01±4.439 SD which was of mild to moderate level. Overall mean age was 68.16±8.16 SD and negatively related (r= -0.652; F=27.044, p<0.001) but weakly associated to severity of dementia. There was a statistically significant increase in the NPI scores with increase in dementia severity (Item score F=91.754, p<0.001 and distress score F=81.647, p<0.001). There was significant increase in agitation/aggression (CMAI) with an increase in severity of dementia. BPSD on NPI item score was weakly related (r=0.757) and caused increase in disability but decrease in quality of life. Dementia severity as per MMSE score was negatively related to WHO DAS disability (r= -0.863), BPSD on NPI item (r= -0.797) and agitation/aggression on CMAI (r= -0.587). WHOQOL-Bref decreases with increase in severity of dementia and disability.Conclusions: Dementia severity was of mild to moderate level and it increased with age. Most common psychiatric symptom was agitation/aggression (76%) and least common was hallucinations (12%). BPSD causes significant decrease in quality of life and an increase in severity of disability.

Changes in Physical Function, Fatigue, and Psychiatric Symptoms in Patients with Hematological Malignancy Undergoing Chemotherapy and Low-intensity Exercise Training

<p>This study aimed to investigate the changes in physical function, fatigue, and psychiatric symptoms in patients with hematological malignancy undergoing chemotherapy and low-intensity exercise training. Sixty-two hospitalized patients with hematological malignancy undergoing chemotherapy and low-intensity exercise were recruited. At the time of exercise initiation and hospital discharge, grip strength, knee extension muscle strength, maximum walking speed, Eastern Cooperative Oncology Group (ECOG) performance status, a measure of functional independence, cancer fatigue pain, and hospital anxiety and depression were evaluated. When longitudinal data were analyzed in each group, changes in grip strength and knee extension muscle strength were unevenly distributed: some patients showed a decrease in knee extension strength. On the other hand, maximum walking speed, the measure of functional independence, and ECOG performance status were maintained or improved in more than 90% of the patients. Results of fatigue, anxiety, and depression tended to show an improvement in female patients, but not in male patients. In conclusion, physical function was maintained in nearly all patients with hematological malignancy undergoing chemotherapy and low-intensity exercise training. Sex differences were found in changes of fatigue, anxiety, and depression.</p>

Distribution of psychiatric disturbances and relevant factors in patients with multiple system atrophy / 中华神经科杂志

Objective To study the clinical distribution characteristics of psychiatric symptoms in patients with multiple system atrophy ( MSA ) and analyze the influence factors of neuropsychiatric symptoms.Methods Twelve psychiatric symptoms were evaluated in 47 patients with MSA by the Neuropsychiatric Inventory of the Chinese version ( CNPI ) .The occurrence rate and distribution were evaluated.The correlation between the neuropsychiatric symptoms and the clinical features including gender , age, education duration, disease course, cognitive level, Unified Multiple System Atrophy Rating Scale part 3 ( UMSARS-Ⅲ) score, Unified Parkinson's Disease Rating Scale part 3 ( UPDRS-Ⅲ) score, Hamilton Depression Rating Scale ( HAMD) score, Hamilton Anxiety Scale ( HAMA) score, MSA subtype and levodopa and benserazide usage dose was also analyzed .Results A total of 74.5%( 35/47 ) of the MSA patients presented at least one kind of psychiatric symptoms .The most common neuropsychiatric symptoms were depression (66.0%, 31/47) and sleep disorder (63.8%, 30/47), while the symptom of euphoria was not found.The highest mean score was found for depression ( mean score:5.23 ±1.67 ) .The CNPI scores of MSA patients were negatively correlated to the education duration and Simple Mental State Examination (MMSE) score (r=-0.238, -0.334 respectively, both P<0.01).The CNPI scores of MSA patients were positively correlated to the disease course and HAMD score ( r=0.308, 0.307 respectively, both P<0.01) .The CNPI scores of MSA patients had no relevance to the gender , age, UMSARS-Ⅲscore, UPDRS-Ⅲscore, MSA subtype and levodopa and benserazide dosage ( all P>0.05). Multiple liner regression analysis showed that HAMA and MMSE scores had the greatest impact on CNPI (r2 =0.196, 0.270, respectively, both P=0.000) .Conclusions The incidence of neuropsychiatric symptoms is high and varied in patients with MSA .The neuropsychiatric symptoms were more severe in MSA patients with lower cognitive levels and longer disease courses .

Effects of a Horticultural Therapy Program on Self-efficacy, Stress Response, and Psychiatric Symptoms in Patients with Schizophrenia / 정신간호학회지

PURPOSE: The study was done to investigate effects of a horticultural therapy program on self-efficacy, stress response, and psychiatric symptoms in patients with schizophrenia. METHODS: The research design was a quasi-experimental research with a nonequivalent control group non-synchronized pre-posttest. The participants were recruited from patients with schizophrenia admitted to 1 mental hospital located in D City. The research was carried out from August 3 to September 25, 2012. To test the effects of the horticultural therapy program, the participants were divided into two groups, an experimental group (29) and a control group (26). The horticulture therapy was provided to the experiment group for 60 minutes/session twice a week, for 8 weeks. Data were analyzed using Fisher's exact probability test, χ2-test, and t-test with the SPSS/WIN 12.0 program. RESULTS: After attending the horticultural therapy program, the first hypothesis was verified as the score for self-efficacy in the experimental group was significantly higher than the control group (t=2.12, p=.039). The 3rd hypothesis was verified as the score for PANSS in the experimental group was significantly lower than the control group (t=-5.20, p<.001). CONCLUSION: These results indicate that the horticultural therapy program enhanced self-efficacy and lessened psychiatric symptoms in patients with schizophrenia.

Psychiatric Symptoms in a Patient with Influenza A (H1N1) Treated with Oseltamivir (Tamiflu): A Case Report

Oseltamivir is the most common antiviral drug used to treat and prevent influenza. Epidemiological studies performed in Japan, the United States, and the United Kingdom indicate that oseltamivir may cause psychiatric symptoms; however, the underlying mechanism has not been elucidated. In South Korea, interest in oseltamivir has increased with the spread of the new influenza virus; however, no case report or investigation of psychiatric symptoms associated with the drug has been reported to date. Here, we report a case o0f a 22-year-old male who complained of mood swings, suicidal feelings, auditory hallucinations, memory deterioration, and insomnia after taking oseltamivir.

Relationship between Internet Game Addiction and Psychiatric Symptoms in a Child and Adolescent Psychiatric Clinic

OBJECTIVES: The aim of this study was to examine the relationship between internet game addiction and psychiatric symptoms. METHODS: A total of 447 adolescents who were recruited from a child and adolescent psychiatric clinic of university hospital completed a self-report questionnaire consisting of Korean Internet Addiction Self-scale (K-scale), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Korean-Attention-Deficit Hyperactivity Disorder Rating Scale (K-ARS), and Adolescent Happiness Index (AHI). They were classified into three internet user groups, non-addicted group (below or equal to 94), potential risk group (95 to 107) and high risk group (above or equal to 108) according to K-scale total score. RESULTS: Significant mean differences in BDI, BAI, K-ARS, and AHI scores were observed among the three groups. The BDI, BAI and K-ARS scores showed positive correlation with K-score. The AHI score showed negative correlation with K-score. CONCLUSION: Findings of this study suggest that depression, anxiety, inattention, hyperactivity/impulsivity, and happiness are associated with internet game addiction.

A Pilot Study: Association between Minor Physical Anomalies in Childhood and Future Mental Problems

OBJECTIVE: This study aims to investigate association between early recognizable minor physical abnormality (MPA) during childhood is associated with mental health problems in young adults. METHODS: In 1984, 169 preschool children in central Taiwan underwent a detailed physical examination for subtle abnormalities (MPA). Fourteen years later, the Brief Symptom Rating Scale (BSRS) and Chinese Health Questionnaire (CHQ) were used to measure specific psychiatric symptoms. RESULTS: There is an association between MPA during childhood and adult characterized with interpersonal sensitivity, anxiety, depression and paranoid mental health symptoms. CONCLUSION: The signs of childhood MPA can be easily identified and should be regarded as risk factors when predicting mental disorder. Mental health professionals should consider MPAs as important signs for possible development of emotional problems.

A Pilot Study: Association between Minor Physical Anomalies in Childhood and Future Mental Problems

OBJECTIVE: This study aims to investigate association between early recognizable minor physical abnormality (MPA) during childhood is associated with mental health problems in young adults. METHODS: In 1984, 169 preschool children in central Taiwan underwent a detailed physical examination for subtle abnormalities (MPA). Fourteen years later, the Brief Symptom Rating Scale (BSRS) and Chinese Health Questionnaire (CHQ) were used to measure specific psychiatric symptoms. RESULTS: There is an association between MPA during childhood and adult characterized with interpersonal sensitivity, anxiety, depression and paranoid mental health symptoms. CONCLUSION: The signs of childhood MPA can be easily identified and should be regarded as risk factors when predicting mental disorder. Mental health professionals should consider MPAs as important signs for possible development of emotional problems.

Effects of quetiapine and risperidone in the treatment of behavior and psychiatric symptom of dementia / 中国基层医药

Objective To investigate the effects of quetiapine and risperidone in the treatment of behavior and psychiatric symptom of dementia(BPSD).Methods 56 cases of Alzheimer's disease and vascular dementia pa- tients were all met for the classification and diagnostic criteria for mental illness in China(CCMD-3)and randomly divided into two groups(27 in quetiapine group,29 in risperidone group),experimental dosage were 0.05～0.3g/d and 1～2mg/d,respectively.The treatment lasted for 8 weeks.Results The total efficiency of quetiapine was 66.67% and that of risperidone was 65.5%,and the statistical difference was significant.As for the adverse effects, there was no significant difference,but incidence of EPS in quetiapine group was less than that of risperidone group. Conclusion Quetiapine can be widely administrated in clinic application as the high efficacy of control BPSD with low minor adverse effect.

A Follow Up Study of Brain Evoked Potentials in Patients with Post-Traumatic Stress Disorder / 中国心理卫生杂志

Objective:To investigate the status of brain evoked potentials (BEP) and the relationship between BEP and psychiatric symptoms before and after treatment in patients with post-traumatic stress disorder (PTSD). Methods: P_(300), auditory evoked potential (AEP), visual evoked potential (VEP) of BEP, Symptom Checklist-90 (SCL-90) and Impact of Event Scale (IES) were used to evaluate 86 patients with PTSD (PTSD group) and 56 normal controls (control group), PTSD patients were followed up with the same markers after 3.5 months treatment.Results:Compared with the control group, PTSD patients showed delayed latency and increased amplitude of P_(300)-P_3, delayed AEP-N_2 latency, and delayed VEP-P_2 latency. Shortened latency and decreased amplitude of P_(300)-P_3, and shorted VEP-P_2 latency were found after treatment. The mostly items of BEP were significantly related to psychical symptoms before treatment, and the changes of BEP were significantly related to the alleviation of psychical symptoms after treatment.Conclusion:BEP might be state markers of PTSD. The clinical application of BEP in PTSD is emphasized.

Effect of Job Stress on Psychiatric Symptoms: Focused on Gender Difference of Mediation Effect of Self-Esteem / 신경정신의학

OBJECTIVES: The purpose of this study was to identify the mediation effect of gender difference and self-esteem level between job stress and psychiatric symptom. METHODS: Male and female subjects participated in this study and filled out the Korean version of Job Stress Inventory(K-OSI), Beck's Depression Index(BDI), State-Trait Anxiety Inventory(STAI), Symptom Check List-90-Revised(SCL-90-R) and Rosenberg's Self-Esteem Scale(RSES). To explore the relationships between job stress and psychiatric symptom, a series of correlational analysis and ANOVAs were conducted to identify mediation effects self esteem level to job stress experience. RESULTS: In males, the perceived job stress level of role boundary scale was positively correlated with depressive, anxiety, psychosomatic symptoms. And role insufficiency was positively correlated with depressive and anxiety symptoms, too. In addition, the interaction effect of self-esteem was significant and the interaction effect of self-esteem was significant. It means high level of self-esteem had buffering effect of job stress on psychiatric symptoms. In females, the perceived job stress level of physical environment scale was positively correlated with depressive symptoms and role overload was positively correlated with psychosomatic symptoms. There was no significant interaction effect of self-esteem identified. CONCLUSIONS: The perceived job stresses related to role boundary and role insufficiency were important factors which result in psychiatric symptoms in males, while physical environment and role overload were important factors in females. In addition, high self esteem had buffering effects of job stresses on psychiatric symptoms, only in males not in females.

Psychiatric Symptoms and Monoamine Neurotransmitter in Serum of PCOS with Infertility Patients / 中国临床心理学杂志

Objective:To explore the concentration of monoamine neurotransmitter in serum and psychiatric symptoms such as anxiety and depression in infertility patients with and without PCOS(No-PCOS),and the relationship between them.Methods:30 infertility with PCOS were selected as experimental group(EG) and 30 infertility patients without PCOS as control group(CG).They were administered Symptom Checklist(SCL-90).Their monoamine neurotransmitter in serum were determined including norepinephrine(NE),3-methoxy-4-hydroxyphenylglycol(MHPG),5-hydroxytryptamine(5-HT),5-hydroxyindoleacetic acid(5-HIAA),dopamine(DA),homovanillic acid(HVA) and dihydroxy-phenyl acetic acid(DOPAC).Results:The findings indicated that the scores in anxiety and depression subscales of SCL-90 were significantly higher in the PCOS group than those in the No-PCOS(P

SPECT Findings on Psychiatric Symptoms in Alzheimer's Disease

OBJECTIVES: The course of Alzheimer's disease is often complicated by psychiatric symptoms including depression, delusion and hallucination. And these psychiatric symptoms may be due to neuropathological changes of the disease itself. This study examined whether psychiatric symptoms in Alzheimer's disease are associated with cerebral perfusion using single photon emission computed tomography (SPECT). METHODS: Supratentorial transaxial perfusion measurements were obtained in frontal, anterior temporal, posterior temporoparietal and occipital cortical areas in both hemispheres, in a baseline population of 29 mild to moderately impaired AD patients. We interviewed all the patients and their primary caregivers to assess their current and past psychiatric functioning. To compare the SPECT findings, all the patients were divided into two groups by presence of depression, delusion, hallucination and illusion, of which symptoms were explored separately. RESULTS: The patients with hallucination had hypoperfusion of both the posterior temporoparietal and the occipital regions of interest, compared with scans of the patients without hallucination. And in other symptom profiles, there was no difference in SPECT findings between the patients with symptoms and without symptoms. CONCLUSION: Psychotic patients with Alzheimer's disease had a pattern of cerebral perfusion deficits, which is different from that of nonpsychotic patients. This finding suggests that specific patterns of cerebral dysfunction probably be related to the specific psychiatric symptoms in Alzheimer's disease.

Non-convulsive partial seizure presenting with psychiatric symptoms

A 46-year-old man presented with a six-month history of recurrent episodes of abnormal behaviors characterized by agitation, anxiety, aggression, impulsion, and depression. They were not accompanied by obvious convulsions. Brain MRI demonstrated cerebromalacia from previous traumatic brain injury in both frontal and left anterior temporal lobe. Interictal EEG showed a focal seizure disorder arising from both temporal areas. Following antiepileptic medication, the abnormal behaviors disappeared. These results suggest that non-convulsive status epilepticus or a cluster of seizures could account for prolonged behavioral disturbances.