ABSTRACT
BACKGROUND: Psychiatric disorders are associated with a more severe course of COVID-19. COVID-19 can also lead to psychiatric symptoms. AIM: To gain insight into vulnerabilities and protective factors for the course of COVID-19 in a Dutch (neuro)psychiatric population. METHOD: Patients were divided into three groups: patients with pre-existent mental disorders without and with new (neuro)psychiatric symptoms (NPS) during COVID-19 and patients without pre-existent mental disorders who developed de novo NPS during COVID-19. We summarize the characteristics of each group and compare the subgroups with inferential statistics. RESULTS: 186 patients were included in the case register. Patients with NPS showed a more severe course of COVID-19. Mortality in patients with NPS was higher in patients with pre-existent mental disorders compared to patients without pre-existent mental disorders. The most frequently reported de novo psychiatric symptoms during COVID-19 were delirium (46-70%), anxiety (53-54%) and insomnia (18-42%). CONCLUSION: NPS might be an expression of a more severe COVID-19 episode. In patients who developed NPS during COVID-19 we found evidence for a higher mortality risk in patients with pre-existent mental disorders. Extra vigilance for neuropsychiatric symptoms during COVID-19 is warranted.
Subject(s)
COVID-19 , Mental Disorders , Sleep Initiation and Maintenance Disorders , Humans , Mental Disorders/epidemiology , Mental Disorders/psychology , Anxiety/epidemiology , Anxiety/psychology , Anxiety DisordersABSTRACT
Primary progressive aphasia (PPA) is a form of dementia in which brain circuits responsible for language and speech show progressive impairments. Based on consensus criteria PPA is divided into 3 main variants: a nonfluent/agrammatic, a semantic and a logopenic variant. Each variant has specific clinical characteristics, including neuropsychiatric symptoms, and is associated with different neuropathological findings. We describe a 51-year-old man with neuropsychiatric symptoms and progressive language disturbances. The diagnosis PPA was established after an extensive work-up in a psychiatric clinic. We describe which factors contributed to this complex diagnostic process and discuss why knowledge of this disorder is relevant for psychiatrists.
Subject(s)
Aphasia, Primary Progressive , Aphasia, Primary Progressive/diagnosis , Humans , Language , Male , Middle Aged , Semantics , SpeechABSTRACT
Acute dystonia is a side-effect associated with the use of antipsychotics. We describe the case of a 75-year-old patient with late-onset schizophrenia who used clozapine. During a hospital admission due to pneumonia, she developed a form of acute dystonia consisting of a rotational torticollis, which disappeared rapidly after treatment with biperiden. Blood examination showed an increase of the clozapine level, probably due to the infection. This case report shows that acute dystonia, although very rare, can occur during treatment with clozapine; therefore awareness is needed of the circumstances that can alter clozapine levels.
Subject(s)
Dystonia/diagnosis , Dystonia/etiology , Infections/complications , Aged , Antipsychotic Agents/adverse effects , Antipsychotic Agents/therapeutic use , Clozapine/adverse effects , Clozapine/therapeutic use , Female , Humans , Schizophrenia/drug therapyABSTRACT
BACKGROUND: Our knowledge about auto-immune limbic encephalitis is increasing rapidly and it is now evident that patients with this disease can present with psychiatric symptoms. AIM: To propose practical guidelines for the recognition and diagnosis of an underlying auto-immune limbic encephalitis in patients with acute psychiatric symptoms. METHOD: We studied recent reviews on the topic and had discussions with psychiatrists, a neurologist and a neuroimmunologist in order to reach consensus. RESULTS: Auto-immune limbic encephalitis is a rather rare but important diagnostic consideration in patients with acute psychiatric symptoms. We describe the different steps in the diagnostic work-up and mention features that can point to an underlying auto-immune encephalitis. These include atypical psychiatric symptoms, seizures, movement disorders and autonomic instability. CONCLUSION: Since patients with autoimmune limbic encephalitis often present with psychiatric symptoms, curative treatment is often available and the prognosis depends on the delay from presentation to treatment, psychiatrists should be aware of the signs of an underlying autoimmune encephalitis which have been described in this article.
