Refractory Psychosis After Carbon Monoxide Poisoning: a Case Report.

We report a case of refractory psychosis after carbon monoxide poisoning in a 65-year-old woman who attempted suicide by charcoal burning in 2018. On discharge from hospital, she was bedbound, tube-fed, and had limited verbal output. In early 2019, she was able to resume oral feeding and her physical condition improved. However, she started to have paranoid ideas and auditory hallucinations. She was diagnosed as having organic brain syndrome and was prescribed with quetiapine 300 mg every night. Because of the poor clinical response, quetiapine was switched to olanzapine 20 mg every night and augmented with amisulpride and valproate sodium. However, she remained distressed, psychotic, and suicidal. She was then prescribed with clozapine 300 mg every night. Her symptoms improved despite residual auditory hallucinations remained, but she was less distressed about them.

Electrocardiographic Monitoring of Psychiatric In-patients Taking Antipsychotic Medications.

OBJECTIVE: To assess the adherence to guidelines for electrocardiographic (ECG) monitoring in Hong Kong psychiatric in-patients who have been prescribed antipsychotic medications. METHODS: In-patients who had been prescribed antipsychotic drugs on hospital admission during the baseline audit period of 15 April 2015 to 16 July 2015 and the re-audit period of 28 January 2016 to 30 April 2016 were included. Quality improvement interventions were delivered after the baseline audit. ECG monitoring adherence was categorised as full adherence (ECG before taking antipsychotics), partial adherence (ECG after taking antipsychotics), or non-adherence (no ECG during hospital stay). Overall compliance was defined as full adherence plus partial adherence. RESULTS: The baseline audit and re-audit included 378 and 422 patients, respectively. Overall compliance with ECG monitoring increased significantly from the baseline audit to re-audit (40.2% vs. 69.9%; p < 0.001). Case-doctors having the grade of resident was associated with stronger adherence to ECG monitoring in both audits. CONCLUSION: Adherence to ECG monitoring guidelines for in-patients who are prescribed antipsychotic drugs is low in Hong Kong, and junior doctors (residents) demonstrate stronger adherence than moresenior doctors.

Foot pain in community-dwelling older people: an evaluation of the Manchester Foot Pain and Disability Index.

OBJECTIVES: The objectives of this study were (i) to examine the psychometric properties of the Manchester Foot Pain and Disability Index (MFPDI) in community-dwelling older people, and (ii) to determine the correlates of disabling foot pain in this age-group. METHODS: A questionnaire consisting of medical history, the MFPDI, the Goldberg Anxiety and Depression Scale (GADS) and the Medical Outcomes Study Short Form 36 (SF-36) was administered to a sample of 301 community-dwelling people (117 men, 184 women) aged between 70 and 95 yr (mean 77.2, s.d. 4.9), who also underwent a clinical assessment of foot problems. RESULTS: Using the MFPDI case definition, 108 people (36%) were found to have disabling foot pain. Within this subgroup, the MFPDI had high internal consistency (Cronbach's alpha=0.89). Principal components analysis revealed a four-factor structure representing the constructs of functional limitation, pain intensity, concern about appearance, and activity restriction, which explained 62% of the variance in the original items. Participants with disabling foot pain were more likely to report pain in the back, hips, knees and hands or wrists, and exhibited flatter feet and less range of motion in the ankle joint. The MFPDI and its subscales were significantly associated with scores on the GADS depression subscale and the general health and mental health components of the SF-36. CONCLUSIONS: These findings confirm the high prevalence of disabling foot pain in older people, and suggest that the MFPDI is a suitable tool for assessing foot pain in this population.

Different rates of age-related loss for four murine monoaminergic neuronal populations.

The age-related loss of locus coeruleus (LC) noradrenergic neurons, substantia nigra compacta (SNc) dopaminergic neurons, dopaminergic retinal amacrine (rAm) neurons and raphe serotonergic neurons, identified using antibodies against tyrosine hydroxylase (TH) and serotonin (5HT) was investigated in C57B1 mice aged 8 to 104 weeks. The neuronal somata were counted and their locations three-dimensionally reconstructed from serial sections alternately immunoreacted or Nissl stained. Nonlinear estimation analysis showed that decaying exponential equations best fitted the plots of neuronal numbers versus age and each subtype was lost according to different exponential constants of -0.015, -0.013, -0.004 and -0.001 for LC TH+, SNc TH+, rAm TH+ and raphe 5HT+ neurons, respectively. Neurons were lost from all different subregions within the nuclei or the retinae. Counts of immediately adjacent TH-immunoreacted and Nissl-stained sections through the LC at different ages indicate that the neuronal loss was due to neuronal death rather than loss of TH immunoreactivity. The markedly different rates of age-related neuronal loss for the four monoaminergic subtypes offer a model to study the underlying molecular and cellular mechanisms.

MPTP produces reversible disappearance of tyrosine hydroxylase-containing retinal amacrine cells.

To determine whether 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) alters the tyrosine hydroxylase (TH) immunoreactivity of murine dopaminergic retinal amacrine cells, 8-10-week-old C57BL/6J mice were treated with i.p. with saline or cumulative doses of MPTP ranging from 10 to 300 mg/kg. Paraformaldehyde-fixed retinal whole mounts and cross sections were examined using immunochemistry with a tyrosine hydroxylase (TH) or a choline acetyltransferase (ChAT) polyclonal antibody and an avidin-biotin peroxidase reaction. Both TH+ amacrines and ChAT+ retinal neurons showed somal and process morphology and distributions that were commensurate with previous studies of the same or several related species. At 20 days following the MPTP treatment, there was a loss of TH+ amacrines according to a logarithmic relationship relative to MPTP dosage. The loss ranged from 18 to 87% for the dosage range without any decrease in the numbers of ChAT+ neurons. The TH+ amacrines were deleted randomly from the retinas without any peripheral-central predilection. By 273 days after MPTP treatment, the number of TH+ amacrines had returned to values found for age-matched controls demonstrating that the loss of TH immunoreactivity was reversible and occurred without destruction of TH+ amacrines. Computer densitometry revealed that the MPTP-treated TH+ amacrines were divided into two distinct populations: one with normal TH immunodensity levels and a second with TH immunodensity levels below our detection capability. Increasing the MPTP dosage increased the proportion of TH amacrines in the second population. The transient and completely reversible disappearance in the number of TH+ amacrines: (1) appears to form the basis for the decreased concentrations of dopamine and the loss of catecholamine fluorescent neurons previously described for MPTP-treated mouse retinae; (2) may underlie the defects in the electroretinograms of MPTP-treated monkeys, and (3) may result as a response to neurite damage similarly to the alterations in protein synthesis in other central neurons following axonal damage.