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British Medical Journal Jun 1948
Topics: Anesthetics; Convulsive Therapy; Electricity; Electroconvulsive Therapy; Humans; Stupor
PubMed: 18865967
DOI: 10.1136/bmj.1.4562.1156 -
Electrolyte & Blood Pressure : E & BP Nov 2006Hypernatremia reflects a net water loss or a hypertonic sodium gain, with inevitable hyperosmolality. Severe symptoms are usually evident only with acute and large... (Review)
Review
Hypernatremia reflects a net water loss or a hypertonic sodium gain, with inevitable hyperosmolality. Severe symptoms are usually evident only with acute and large increases in plasma sodium concentrations to above 158-160 mmol/l. Importantly, the sensation of intense thirst that protects against severe hypernatremia in health may be absent or reduced in patients with altered mental status or with hypothalamic lesions affecting their sense of thirst and in infants and elderly people. Non-specific symptoms such as anorexia, muscle weakness, restlessness, nausea, and vomiting tend to occur early. More serious signs follow, with altered mental status, lethargy, irritability, stupor, and coma. Acute brain shrinkage can induce vascular rupture, with cerebral bleeding and subarachnoid hemorrhage. However, in the vast majority of cases, the onset of hypertonicity is low enough to allow the brain to adapt and thereby to minimize cerebral dehydration. Organic osmolytes accumulated during the adaptation to hypernatremia are slow to leave the cell during rehydration. Therefore, if the hypernatremia is corrected too rapidly, cerebral edema results as the relatively more hypertonic ICF accumulates water. To be safe, the rate of correction should not exceed 12 mEq/liter/day.
PubMed: 24459489
DOI: 10.5049/EBP.2006.4.2.66 -
Schizophrenia Bulletin Apr 2021In 1921, at the age of 65, 6 years after completing the final edition of his textbook, 22 years after first proposing the concept of dementia praecox (DP), and 1 year...
In 1921, at the age of 65, 6 years after completing the final edition of his textbook, 22 years after first proposing the concept of dementia praecox (DP), and 1 year before retiring from clinical work, Emil Kraepelin completed the last edition of his "Introduction to Clinical Psychiatry," which contained a mini-textbook for students, 10 pages of which were devoted to DP. This work also included a series of new detailed case histories, 3 of which examined DP. This neglected text represents a distillation of what Kraepelin judged, near the end of his long career, to be the essential features of DP. The relevant text and case histories are translated into English for the first time. Kraepelin did not define DP solely by its chronic course and poor prognosis, acknowledging that remissions and even full recovery might be possible. His clinical description emphasized the frequency of bizarre delusions and passivity symptoms. He recognized the heterogeneity of the clinical presentations, outlining 6 subtypes of DP, including dementia simplex, depressive and stuporous dementia, and an agitated and circular DP. Kraepelin's original concept of DP was not impervious to change and expanded somewhat, especially with the inclusion of Diem's concept of simple DP. He also reviews several contributions of Bleuler, including his concept "latent schizophrenia." He writes poignantly of the psychological consequences of DP. His 3 DP cases, for advanced students, included simple DP, "periodic catatonic," and "speech confusion."
Topics: History, 20th Century; Humans; Psychiatry; Schizophrenia; Textbooks as Topic
PubMed: 33320201
DOI: 10.1093/schbul/sbaa177 -
Clinical Autonomic Research : Official... Aug 2021Dyskinesia-hyperpyrexia syndrome (DHS) is a rare but life-threatening disease. The clinical manifestations of this syndrome overlap substantially with Parkinson... (Review)
Review
PURPOSE
Dyskinesia-hyperpyrexia syndrome (DHS) is a rare but life-threatening disease. The clinical manifestations of this syndrome overlap substantially with Parkinson hyperpyrexia syndrome and serotonin syndrome and are often confused by clinicians. The purpose of this review was to enable clinicians to recognize this syndrome and thereby reach a correct diagnosis and provide optimal treatments to improve prognosis in clinical practice.
METHODS
Using the methodology described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we conducted a literature search of the PubMed, Embase, and MEDLINE databases using keywords in titles and abstracts of published literature. Quality assessment was performed using the modified Newcastle-Ottawa scale.
RESULTS
A total of 11 patients obtained from nine publications were included in this systematic review. All of the cases occurred in patients with advanced Parkinson's disease (PD) of long disease duration. High ambient temperature was the most common trigger of this syndrome. Hyperpyrexia and dyskinesias were present in all cases. The consciousness disturbances of this syndrome included confusion, hallucination, and lethargy or stupor. Autonomic dysfunction (except for hyperpyrexia) is uncommon in DHS, and only two patients presented with tachycardia. The treatment of this syndrome included supportive interventions (including rehydration, anti-pyretic and anti-infection treatments, and maintaining electrolyte balance), dopaminergic drug reduction and sedation. Two patients died due to DHS.
CONCLUSIONS
We summarized the triggers, clinical features, and treatments of all reported dyskinesia-hyperpyrexia syndrome cases, proposed guiding diagnostic criteria, and established a flow chart to guide diagnoses to quickly identify these three syndromes in clinical practice.
Topics: Dyskinesias; Humans; Parkinson Disease; Syndrome
PubMed: 33826041
DOI: 10.1007/s10286-021-00801-w -
Frontiers in Psychiatry 2022The external clinical manifestations (psychopathology) and internal subjective experience (phenomenology) of catatonia are of clinical importance but have received...
BACKGROUND
The external clinical manifestations (psychopathology) and internal subjective experience (phenomenology) of catatonia are of clinical importance but have received little attention. This study aimed to use a large dataset to describe the clinical signs of catatonia; to assess whether these signs are associated with underlying diagnosis and prognosis; and to describe the phenomenology of catatonia, particularly with reference to fear.
METHODS
A retrospective descriptive cross-sectional study was conducted using the electronic healthcare records of a large secondary mental health trust in London, United Kingdom. Patients with catatonia were identified in a previous study by screening records using natural language processing followed by manual validation. The presence of items of the Bush-Francis Catatonia Screening Instrument was coded by the investigators. The presence of psychomotor alternation was assessed by examining the frequency of stupor and excitement in the same episode. A cluster analysis and principal component analysis were conducted on catatonic signs. Principal components were tested for their associations with demographic and clinical variables. Where text was available on the phenomenology of catatonia, this was coded by two authors in an iterative process to develop a classification of the subjective experience of catatonia.
RESULTS
Searching healthcare records provided 1,456 validated diagnoses of catatonia across a wide range of demographic groups, diagnoses and treatment settings. The median number of catatonic signs was 3 (IQR 2-5) and the most commonly reported signs were mutism, immobility/stupor and withdrawal. Stupor was present in 925 patients, of whom 105 (11.4%) also exhibited excitement. Out of 196 patients with excitement, 105 (53.6%) also had immobility/stupor. Cluster analysis produced two clusters consisting of negative and positive clinical features. From principal component analysis, three components were derived, which may be termed parakinetic, hypokinetic and withdrawal. The parakinetic component was associated with women, neurodevelopmental disorders and longer admission duration; the hypokinetic component was associated with catatonia relapse; the withdrawal component was associated with men and mood disorders. 68 patients had phenomenological data, including 49 contemporaneous and 24 retrospective accounts. 35% of these expressed fear, but a majority (72%) gave a meaningful narrative explanation for the catatonia, which consisted of hallucinations, delusions of several different types and apparently non-psychotic rationales.
CONCLUSION
The clinical signs of catatonia can be considered as parakinetic, hypokinetic and withdrawal components. These components are associated with diagnostic and prognostic variables. Fear appears in a large minority of patients with catatonia, but narrative explanations are varied and possibly more common.
PubMed: 35677876
DOI: 10.3389/fpsyt.2022.886662 -
Frontiers in Psychiatry 2022Catatonia is a neuropsychiatric syndrome, with important psychomotor features, associated with schizophrenia and other psychiatric disorders. The syndrome comprises...
OBJECTIVE
Catatonia is a neuropsychiatric syndrome, with important psychomotor features, associated with schizophrenia and other psychiatric disorders. The syndrome comprises multiple symptoms including abnormal motor control, behaviors, volition, and autonomic regulation. Catatonia assessment relies on clinical rating scales and clinicians familiar with the catatonia exam. However, objective instrumentation may aid the detection of catatonia. We aimed to investigate the relationship between movement parameters derived from actigraphy and expert ratings of catatonia symptoms measured by the Bush Francis Catatonia Rating Scale (BFCRS) and the Northoff Catatonia scale (NCS).
METHODS
Eighty-six acutely ill inpatients with schizophrenia spectrum disorders were assessed with the BFCRS, the NCS, and 24 h continuous actigraphy. Non-wear and sleep periods were removed from the actigraphy data prior to analysis. Associations between total catatonia scores, derived from both BFCRS and NCS, and actigraphy parameters as well as between single BFCRS items and actigraphy parameters were calculated using Spearman's rank correlation and non-parametric ANCOVAs (Quade's ANCOVAs), respectively.
RESULTS
Both higher BFCRS total scores ( = 0.369, = 0.006) and NCS total scores ( = 0.384, = 0.004) were associated with lower activity levels (AL). Higher scores on single BFCRS items such as or were linked to lower AL (: = 17.388, < 0.001, η = 0.175; : = 7.849, = 0.001, η = 0.162) and lower metabolic equivalents of task (MET).
CONCLUSION
Specific catatonia symptoms such as and can be measured with actigraphy. This may aid the detection, staging, and monitoring of catatonia in clinical settings.
PubMed: 36061273
DOI: 10.3389/fpsyt.2022.880747 -
Epigenomics Mar 2018As the 'third brain' the placenta links the developing fetal brain and the maternal brain enabling study of epigenetic process in placental genes that affect infant... (Review)
Review
As the 'third brain' the placenta links the developing fetal brain and the maternal brain enabling study of epigenetic process in placental genes that affect infant neurodevelopment. We described the characteristics and findings of the 17 studies on epigenetic processes in placental genes and human infant neurobehavior. Studies showed consistent findings in the same cohort of term healthy infants across epigenetic processes (DNA methylation, genome wide, gene and miRNA expression) genomic region (single and multiple genes, imprinted genes and miRNAs) using candidate gene and genome wide approaches and across biobehavioral systems (neurobehavior, cry acoustics and neuroendocrine). Despite limitations, studies support future work on molecular processes in placental genes related to neurodevelopmental trajectories including implications for intervention.
Topics: Arousal; Attention; Brain; CpG Islands; DNA Methylation; Epigenesis, Genetic; Female; Fetal Development; Fetus; Genome, Human; Humans; Infant; Infant Behavior; Lethargy; MicroRNAs; Motor Activity; Neurogenesis; Neurosecretory Systems; Placenta; Pregnancy
PubMed: 29381081
DOI: 10.2217/epi-2016-0171 -
Cureus May 2020Most commonly seen with alcohol use disorder in the developed world, Wernicke's encephalopathy (WE), a disorder caused by thiamine deficiency can be readily missed in...
Most commonly seen with alcohol use disorder in the developed world, Wernicke's encephalopathy (WE), a disorder caused by thiamine deficiency can be readily missed in the setting of other predisposing conditions such as malnutrition, the most common cause worldwide. We present a case of a 21-year-old female with sudden progressive decline in her level of alertness and mentation along with severe hypothermia who had clinical features and imaging findings consistent with WE in the setting of pancreatitis and chronic gastritis. WE should be suspected in all patients who present with altered mental status (AMS) and who are at an increased risk of malnutrition despite a normal or high body mass index, so that treatment with thiamine may be initiated and further neurologic sequelae can be averted.
PubMed: 32582501
DOI: 10.7759/cureus.8242 -
British Medical Journal Jul 1975A patient was admitted to hospital with an apparent psychiatric disturbance. When she became stuporous the cerebrospinal fluid was cultured but proved sterile. The latex...
A patient was admitted to hospital with an apparent psychiatric disturbance. When she became stuporous the cerebrospinal fluid was cultured but proved sterile. The latex test showed that serum was positive for cryptococcal antigens, and cryptococcal meningoencephalitis was diagnosed. Amphotericin B was given but when she developed a toxic reaction it was replaced by flucytosine. She responded well to flucytosine alone and no side effects appeared on continued treatment. Cryptococcal meningitis may present as a psychiatric disturbance, and serological tests are invaluable aids to diagnosis.
Topics: Adult; Cerebrospinal Fluid; Cryptococcosis; Cryptococcus neoformans; Female; Flucytosine; Humans; Latex Fixation Tests; Meningoencephalitis; Mental Disorders
PubMed: 1095135
DOI: 10.1136/bmj.3.5975.75 -
Medicina (Kaunas, Lithuania) May 2019Acute food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated allergy and is characterized by repetitive profuse vomiting episodes, often in... (Review)
Review
Acute food protein-induced enterocolitis syndrome (FPIES) is a non-IgE-mediated allergy and is characterized by repetitive profuse vomiting episodes, often in association with pallor, lethargy, and diarrhea, presenting within 1-4 h from the ingestion of a triggering food. In 2017, the international consensus guidelines for the diagnosis and management of FPIES were published. They cover all aspects of this syndrome, which in recent decades has attracted the attention of pediatric allergists. In particular, the consensus proposed innovative diagnostic criteria. However, the diagnosis of acute FPIES is still currently discussed because the interest in this disease is relatively recent and, above all, there are no validated panels of diagnostic criteria. We propose some ideas for reflection on the diagnostic and suspicion criteria of acute FPIES with exemplary stories of children certainly or probably suffering from acute FPIES. For example, we believe that new definitions should be produced for mild forms of FPIES, multiple forms, and those with IgE-mediated symptoms. Moreover, we propose two clinical criteria to suspect acute FPIES and to refer the child to the diagnostic oral food challenge.
Topics: Animals; Cattle; Child; Child, Preschool; Dietary Proteins; Enterocolitis; Female; Food Hypersensitivity; Humans; Infant; Lethargy; Male; Milk
PubMed: 31141916
DOI: 10.3390/medicina55060216