Psychosocial Basis of Human Sufferings and Poverty in Patients with Neurological and Psychiatric Disorders.

Neurological disorders and psychiatric ailments often lead to cognitive disabilities and low attainment of education, pivoting misconceptions, myths, and misbeliefs. Poverty and low educational attainment are intriguingly associated with poor awareness and perception of these diseases that add to the suffering. Poverty goes parallel with a low level of education and is intricately associated with neuropsychiatric ailments, which have the potential to spread transgenerationally. Robust education policies, proper government rules and regulations against the spread of disease-related myths and misconceptions, uplifting medical education in its true sense, voices against consanguinity, and programs to raise scientific perception about diseases can help to throw light at the end of this dark tunnel. In this article, the authors intend to 1) decipher the potential psychosocial basis of human suffering and poverty in patients with neurological and psychiatric disorders, and 2) discuss the apropos way-outs that would potentially mitigate suffering, and alleviate the economic burden and cognitive disabilities of families with neuropsychiatric diseases.

Spectrum of Anti-NMDA Receptor Antibody Encephalitis: Clinical Profile, Management and Outcomes.

BACKGROUND: Anti-N-methyl D-aspartate receptor (anti NMDAR) antibody encephalitis is an immune-mediated entity characterised by a constellation of neuro-psychiatric symptoms. OBJECTIVE: To describe clinical profile and treatment outcomes of patients with anti NMDAR antibody encephalitis. SETTINGS AND DESIGN: Subjects were selected by screening for all patients satisfying Graus et al.'s criteria for probable anti NMDAR antibody encephalitis, admitted in neurology department of a tertiary care centre in Eastern India. MATERIALS AND METHODS: A prospective, longitudinal study was conducted by identifying 25 patients with anti NMDAR antibodies in CSF and or serum, between September 2018 to February 2020. STATISTICAL ANALYSIS: Chi square test was used to compare variables. RESULTS: Out of 98 patients screened, 25 subjects (14 females: 11 male) were positive for anti NMDAR autoantibodies, with a mean age of 17 years. 13 subjects belonged to paediatric age group. Most common presenting feature was memory/learning deficit (88%) followed by behavioural abnormalities (84%) and seizures (68%). 11 patients (44%) patients needed escalation to second line therapy, rituximab. Seven (28%) and twelve (48%) patients underwent complete (mRS 0-1) and partial recovery (mRS 2-3) respectively, while 4 (16%) became disabled (mRS 4-5). Mortality was 8%. Paediatric population had a better outcome in terms of disability (p = 0.043). CONCLUSION: Anti NMDAR-Ab encephalitis is the most common cause of antibody positive autoimmune encephalitis worldwide. There are important clinical markers and investigational profiles which carry prognostic significance.

Status epilepticus and bilateral middle cerebral artery infarction: A rare presentation after viper bite.

Owing to the antihemostatic property of viper venom, hemorrhagic complications including intracerebral hemorrhage are the most commonly encountered after viper bite. Ischemic strokes have been rarely reported after viper envenomation, and its occurrence has been attributed to multiple mechanisms. Postsnakebite seizures are known to occur after neurotoxic bite. Here, we report the case of a viper bite victim who developed status epilepticus within 3 h after viper bite. He had only mild signs of local envenomation, and prolonged whole blood clotting time was the only manifestation of systemic envenomation. Subsequently, he was found to have developed right hemiparesis and global aphasia. Brain imaging revealed large infarcts in bilateral middle cerebral artery (MCA) territories. We report this as a unique case of viper bite which presented to the emergency room with status epilepticus. Moreover, bilateral MCA infarct, as was found in this case, is genuinely rare in scientific literature. Finally, the absence of overt features of envenomation makes this case stand out from other similar reported occurrences.

Résumé En raison de la propriété antihémostatique du venin de vipère, les complications hémorragiques, y compris l'hémorragie intracérébrale, sont les plus courantes. rencontré après morsure de vipère. Des AVC ischémiques ont rarement été signalés après une envenimation par vipère, et son apparition a été attribuée à mécanismes multiples Les crises d'épilepsie postnakebite se produisent après une piqûre neurotoxique. Ici, nous rapportons le cas d'une victime de morsure de vipère qui état de mal épileptique dans les trois heures suivant la piqûre des vipères. Il ne présentait que de légers signes d'envenimation locale et un temps de coagulation du sang total prolongé était la seule manifestation de l'envenimation systémique. Par la suite, il s'est avéré avoir développé une hémiparésie droite et une aphasie globale. L'imagerie cérébrale a révélé de grands infarctus dans les territoires bilatéraux de l'artère cérébrale moyenne (ACM). Nous rapportons cela comme un cas unique de morsure de vipère présenté à la salle d'urgence avec le statut épileptique. De plus, l'infarctus bilatéral à MCA, comme on l'a constaté dans ce cas, est vraiment rare dans littérature scientifique. Enfin, l'absence de caractéristiques évidentes d'envenimation fait que ce cas se distingue des autres cas similaires.

Young-onset sporadic Creutzfeldt-Jakob disease with atypical phenotypic features: a case report.

BACKGROUND: Sporadic Creutzfeldt-Jakob disease, with a mean survival of 6 months, is duly considered among the most fatal neurological disorders. Rapidly progressive dementia with multi-axial involvement of the nervous system is the known presentation. Although, the peak age at onset is between sixth and eighth decades, cases of young-onset sporadic Creutzfeldt-Jakob disease have also been reported in the literature. Interestingly, these young-onset cases were reported to have some features distinct from their older age group counterparts, such as slower progression as well as longer duration of illness, dominance of psychiatric manifestations at the onset, and relatively less prevalence of radiological and electroencephalographic abnormalities. CASE PRESENTATION: We describe here the case of a 42-year-old Asian woman from India who presented with cerebellar ataxia, pyramidal and extrapyramidal involvement, followed by rapidly progressive dementia along with myoclonus, all within a span of 1 month. Probable infective, metabolic, autoimmune, and paraneoplastic etiologies were ruled out. Magnetic resonance imaging of her brain revealed bilateral caudate nucleus hyperintensity in T2/fluid-attenuated inversion recovery sequence. Diffusion-weighted imaging revealed bilateral caudate and putaminal diffusion restriction plus ribbon pattern in bilateral parieto-occipital and insular cortex. Serial electroencephalography revealed diffuse slowing of background activity along with triphasic waves in short periodic interval. Cerebrospinal fluid was tested positive for 14-3-3 protein. Based on these findings, a diagnosis of sporadic Creutzfeldt-Jakob disease was made. CONCLUSION: Our patient represents an atypical clinical situation as she is much younger than the usual presentation of Creutzfeldt-Jakob disease and it progressed far too rapidly. Cognitive decline came late in the temporal sequence of clinical events; rather, the onset was dominated by features consistent with cerebellar ataxia and basal ganglia involvement. The presence of magnetic resonance imaging abnormality and electroencephalography changes are other rare findings in young-onset sporadic Creutzfeldt-Jakob disease.

Chorea-ballism as a dominant clinical manifestation in heteroplasmic mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes syndrome with A3251G mutation in mitochondrial genome: a case report.

BACKGROUND: Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes, the most common maternally inherited mitochondrial disease, can present with a wide range of neurological manifestations including both central and peripheral nervous system involvement. The most frequent genetic mutation reported in mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes syndrome is A3243G in MT-TL1 gene. Stroke-like episodes, dementia, epilepsy, lactic acidemia, myopathy, recurrent headaches, hearing impairment, diabetes, and short stature constitute the known presentations in this syndrome. Among the abnormal involuntary movements in mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes syndrome, myoclonus is the commonest. Other movement disorders, including chorea, are rarely reported in this disorder. CASE PRESENTATION: A 14-year-old South Asian boy from rural Bengal (India), born of a second degree consanguineous marriage, with normal birth and development history, presented with abnormal brief jerky movements involving his trunk and limbs, with recurrent falls for 10 months. We present here a case of heteroplasmic mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes syndrome with A3251G mutation, in which the clinical picture was dominated by a host of involuntary abnormal movements including chorea-ballism, myoclonus, and oromandibular dystonia in a backdrop of cognitive decline, seizure, and stroke-like episode. A final diagnosis was established by muscle biopsy and genetic study. Haloperidol was administered to control the involuntary movements along with introduction of co-enzyme Q, besides symptomatic management for his focal seizures. Six months into follow-up his seizures and abnormal movements were controlled significantly with slight improvement of cognitive abilities. CONCLUSION: The dominance of hyperkinetic movements in the clinical scenario and the finding of a point mutation A3251G in MT-TL1 gene make this a rare presentation.

Hemispheric venous dysgenesis in a woman presenting with seizures, weakness and parkinsonism.

This report describes an unusual case of a woman who developed progressive hemiparesis, seizures and hemiparkinsonism associated with MRI and angiographic evidence of chronic venous hypertension in the contralateral cerebrum and cerebellum. In the absence of inflammatory or veno-occlusive disorders, the patient's clinical and neuroradiological findings point to a developmental disorder, such as a hemispheric venous dysgenesis, as the underlying lesion.

Public-academic partnerships: integrating state psychiatric hospital treatment and clinical research.

Collaboration between state clinical treatment services and academic research is fertile ground for clinical research opportunities. Such joint initiatives require careful planning, including provisions for joint training, integration of research staff into clinical activities, and integration of clinical treatment staff into research activities. The authors describe the planning and development of a 24-bed research unit at the Nathan S. Kline Institute for Psychiatric Research, colocated on the same campus as Rockland Psychiatric Center, each of which is an independent facility operated by the New York State Office of Mental Health.

Psychometric properties of Bengali version of QOLIE-10 in epileptic patients.

UNLABELLED: Assessment of Quality of Life in Epilepsy has currently been emphasized to provide comprehensive care to patients. AIM: To develop and standardize and assess the psychometric properties of Bengali version of QOLIE-10 and to assess the relationship of quality of life with seizure variables and presence of psychiatric morbidity. DESIGN: English QOLIE-10 was translated into Bengali by a translation committee using translation-re-translation technique. Inter-rater reliability between the English and Bengali version was assessed during initial practice session held amongst 20 bilingual patients. It was found that item 3 (related to driving) was reported to have difficulty in answering by all the patients as none drove any vehicle. Thus, this item was dropped. The inter-rater reliability of the resultant 9 item scale was found to be high (kappa = 0.9). One hundred and seven epilepsy patients attending the Epilepsy clinic were selected for the study if they met the following criteria: age >15 years, duration of seizure >1 year, regular intake of antiepileptic drugs, presence of informant and ability to read Bengali. For each patient, demographic and clinical data (seizure frequency, last seizure date, seizure type as per record, medicine intake history and records of past investigations such as EEG) was collected. Each patient were administered QOLIE-9 (Bengali) and SRQ-24 Bengali version to screen for psychiatric morbidity. RESULTS: The Cronbach's Alpha coefficient for QOLIE-9 was 0.81, which did not improve if any item was dropped. All items showed strong correlation with the total score. The instrument showed stable factor structure with three factors (Limitation, Depression, Illness effects). However, the item with regard to memory problem did not fit into any of the factors. The QOLIE-9 total showed a significant correlation with the seizure frequency (r = 0.76**). SRQ positive (i.e., suspected psychiatric morbidity) cases had higher QOLIE-9 score (thus, poorer quality of life) in comparison to non-psychiatric cases. CONCLUSION: Bengali QOLIE-9 is a valid and reliable instrument to assess the quality of life in patients suffering from epilepsy.

A study of the safety, efficacy, and tolerability of switching from the standard delayed release preparation of divalproex sodium to the extended release formulation in patients with schizophrenia.

OBJECTIVE: To assess the safety, efficacy, and tolerability of switching from a multiple dose preparation of divalproex sodium delayed release (DR) to once-daily dosing with divalproex sodium extended release (ER) in patients with schizophrenia already receiving the standard DR formulation. METHOD: Thirty subjects with schizophrenia were switched from divalproex DR to a 4-week open-label treatment trial of the ER formulation. Baseline plasma levels of valproate were obtained 12 hours postdose. Patients were converted from divalproex DR to ER on a 1.0:1.0 mg basis (rounded up to the nearest 500-mg increment) if baseline valproate plasma levels were > or =85 microg/mL; otherwise, the conversion rate was 1.0:1.2 mg rounded up. Measured at baseline and end point were the Brief Psychiatric Rating Scale and the Udvalg for Kliniske Undersogelser Side Effect Rating Scale. End point plasma levels were obtained at both 12 and 24 hours postdose. RESULTS: Patients who switched from divalproex DR to ER had a small (and probably clinically insignificant) improvement noted on the total Brief Psychiatric Rating Scale at end point (mean change +/- SD = -2.3 +/- 5.4; t = -2.2538; df = 28; P = 0.0322) and on the Udvalg for Kliniske Undersogelser (mean change+/- SD = -2.2+/- 4.1; t = -2.7361; df = 26; P = 0.0111). Baseline and end point trough plasma levels were 80.1 +/- 20.4 and 73.1 +/- 24.2 microg/mL, respectively. Patients who converted on a 1.0:1.0 mg basis had lower end point valproate trough plasma levels than at baseline but did not experience deterioration on their psychopathology. For all patients, end point valproate peak and trough plasma levels were statistically significantly different (t = -3.8706; df = 27; P = 0.0006), but these differences were small in magnitude (mean +/- SD = 14.6 +/-19.6 microg/mL). Seven patients experienced spontaneously reported adverse events, but none required early termination from the protocol. CONCLUSIONS: Switching to a once-daily formulation of ER divalproex can be accomplished without a deterioration in psychopathology. The ER formulation of divalproex sodium appears well tolerated. A parallel group design will be necessary to confirm these findings.

Characteristics of assaultive behavior among psychiatric inpatients.

OBJECTIVE: The purpose of this study was to assess the extent to which psychosis, disordered impulse control, and psychopathy contribute to assaults among psychiatric inpatients. METHODS: The authors used a semistructured interview to elicit reasons for assaults from assailants and their victims on an inpatient research ward. Video monitoring provided supplemental information to confirm participants' identities and activities before and during the assault. RESULTS: Consensus clinical ratings indicated that approximately 20 percent of the assaults in this sample were directly related to positive psychotic symptoms. Factor analysis revealed two psychosis-related factors, one related to positive psychotic symptoms and the other to psychotic confusion and disorganization, as well as a third factor that differentiated impulsive from psychopathic assaults. CONCLUSIONS: Information obtained from interviews with assailants can reveal the underlying causes of specific assaults. This information is potentially useful in the selection of rational antiaggressive treatment strategies.