Differential Diagnosis Of Psychiatric Disorders Research Articles

The significance of cerebrospinal fluid analysis in the differential diagnosis of 564 psychiatric patients: Multiple sclerosis is more common than autoimmune-encephalitis

The analysis of cerebrospinal fluid (CSF) is an essential tool for the differential diagnosis of psychiatric disorders caused by autoimmune inflammation or infections. Clear guidelines for CSF analysis are limited and mainly available for schizophrenia and dementia. Thus, insights into CSF changes in psychiatric patients largely derive from research.We analyzed the clinical and CSF data of 564 psychiatric patients without pre-existing neurological diagnoses from March 1998 to April 2020. Primary aim was to detect previously undiagnosed neurological conditions as underlying cause for the psychiatric disorder.Following CSF analysis, 8 % of patients (47/564) were diagnosed with a neurological disorder. This was the case in 12.0 % (23/193) of patients with affective disorders, 7.2 % (19/262) of patients with schizophrenia, and 4.0 % (23/193) of patients with anxiety disorders. The predominant new diagnoses were multiple sclerosis (19/47) and autoimmune encephalitis (10/47). Abnormal CSF findings without any implications for further treatment were detected in 17.0 % (94/564) of patients.Our data indicates that CSF analysis in patients suffering from psychiatric disorders may uncover underlying organic causes, most commonly multiple sclerosis and autoimmune encephalitis. Our findings imply that the incorporation of CSF analysis in routine psychiatric assessments is potentially beneficial.

Possible effect of natural light on emotion recognition and the prefrontal cortex: A scoping review of near-infrared (NIR) spectroscopy.

Near-infrared (NIR) spectroscopy, also known as functional NIR spectroscopy (fNIRS), is a tool for measuring the hemodynamic response of the prefrontal cortex (PFC) by using NIR light, enabling a noninvasive indirect neural activity assessment. The application of fNIRS in emotion recognition or the differential diagnosis of psychiatric disorders of depressive patients, including major depressive disorder, bipolar disorder and schizophrenia, has previously been reported. Although the use of fNIRS has gradually expanded in cognitive neuroscience studies, few researchers have focused on the effects of light exposure in fNIRS studies. In addition, to the best of our knowledge, there are no scoping reviews of fNIRS studies on light exposure. Because light is an important topic in cognitive neuroscience and psychiatry, we evaluated fNIRS studies on light exposure in humans. We reviewed 10 papers in their entirety. Bright light (BR) modulates fear, and the color differences showed no significance in 1 study, whereas other studies delved extensively into the effects of colored light, finding some individual hemodynamic responses. In our study, we highlighted that the effects of natural light have not been studied using fNIRS. Light is becoming a critical topic in cognitive neuroscience and psychiatry, and fNIRS is critical for improving public health and managing psychiatric disorders.

Can disorders of subjective time inform the differential diagnosis of psychiatric disorders? A transdiagnostic taxonomy of time.

Time is a core aspect of psychopathology with potential for clinical use and early intervention. Temporal experience, perception, judgement and processing are distorted in various psychiatric disorders such as mood (depression and mania), anxiety, autistic, impulse-control, dissociative and attention-deficit/hyperactivity disorders. Can these disorders of time be used as early diagnostic or predictive markers? To answer this question, we develop a Transdiagnostic Taxonomy of (disordered) Time (TTT) that maps on to the symptomatological, phenomenal, perceptual and functional descriptions of each underlying disorder in a 2 × 2 × 2 state space. Temporal distortions may precede functional decline, and so assist efforts at early detection and intervention in at-risk groups. Firstly, this article integrates a psychological model of how time is processed with a subjective or phenomenological model of how time is experienced or perceived. Secondly, the integrated combined model of time is then used to heuristically map major psychiatric disorders on to the basic elements of temporal flow and integration. The TTT systematically describes the basic temporal nature of eight diagnostic categories of psychiatric illness. It differentiates between diagnoses primarily associated with distorted "macro-level" phenomenal temporal experiences (i.e. anxiety, dissociation/PTSD, depression, and mania) from those primarily related to distorted 'micro-level' temporal processing (i.e. psychotic, impulse-control, autistic and attention-deficit/hyperactivity disorders). The TTT allows differential diagnostic classification of various psychiatric disorders in terms of a possible underlying time disorder, making it useful for future diagnostic and predictive purposes using novel techniques of temporal processing, time perception, passage of time, and time perspective.

Sporadic Creutzfeldt-Jakob Disease in the Differential Diagnosis of Psychiatric Disorders: Two Case Reports

Sporadic Creutzfeldt-Jakob Disease in the Differential Diagnosis of Psychiatric Disorders: Two Case Reports

Benefits of using culturally unfamiliar stimuli in ambiguous emotion identification: A cross-cultural study

A novel emotion recognition task that employs photos of a Japanese mask representing a highly ambiguous stimulus was evaluated. As non-Asians perceive and/or label emotions differently from Asians, we aimed to identify patterns of task-performance in non-Asian healthy volunteers with a view to future patient studies. The Noh mask test was presented to 42 adult German participants. Reaction times and emotion attribution patterns were recorded. To control for emotion identification abilities, a standard emotion recognition task was used among others. Questionnaires assessed personality traits. Finally, results were compared to age- and gender-matched Japanese volunteers. Compared to other tasks, German participants displayed slowest reaction times on the Noh mask test, indicating higher demands of ambiguous emotion recognition. They assigned more positive emotions to the mask than Japanese volunteers, demonstrating culture-dependent emotion identification patterns. As alexithymic and anxious traits were associated with slower reaction times, personality dimensions impacted on performance, as well. We showed an advantage of ambiguous over conventional emotion recognition tasks. Moreover, we determined emotion identification patterns in Western individuals impacted by personality dimensions, suggesting performance differences in clinical samples. Due to its properties, the Noh mask test represents a promising tool in the differential diagnosis of psychiatric disorders, e.g. schizophrenia.

Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) Scales as predictors of psychiatric diagnoses

The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) is an alternative version of the MMPI-2 and is useful for the differential diagnosis of psychiatric disorders. This study sought to assess the relationship between MMPI-2 Scale scores and psychiatric diagnoses, and to identify the scales that best predicted that a diagnosis would be assigned. The sample was comprised of participants who were administered the MMPI-2 between 2001 and 2010 at a university-based psychological services center, and participants were divided into diagnostic categories based on Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition, Text Revision diagnoses. Categories with enough participants to conduct statistical analyses were examined; these categories included participants who were diagnosed with substance-related disorders, depressive disorders, anxiety disorders, and participants who were not given a psychiatric diagnosis. The Substance-Related Disorders category was not significantly correlated with any scale but was best predicted by Cynicism (RC3) and Substance Abuse (SUB). The Depressive Disorders category was significantly correlated with Emotional/Internalizing Dysfunction (EID), Demoralization (RCd), Low Positive Emotions (RC2), and Self-Doubt (SFD) Scales, and was best predicted by RCd. The Anxiety Disorders category did not significantly correlate with any scale but was best predicted by Infrequent Somatic Responses (Fs) and Gastrointestinal Complaints (GIC). The No Diagnosis category was negatively correlated with Infrequent Responses–Revised (F-r), EID, RCd, Helplessness/ Hopelessness (HLP), and Cognitive Complaints (COG), and was best predicted by EID. This study offers important information regarding scales that best predict psychiatric disorders and adds to the research that suggests that the MMPI-2-RF can aid clinicians in the differentiation of psychiatric disorders.

Psychopharmacological Treatment of Patients with HIV/AIDS

CME Educational Objectives 1. Apply knowledge of the epidemiology and complex differential diagnosis of psychiatric disorders in HIV to the selection of psychopharmacological agents. 2. Know and apply understanding of drug-drug and drug-disease interactions in prescribing psychiatric medications to HIV/AIDS patients. 3. Utilize understanding of the considerable research literature concerning psychopharmacological treatment in HIV/AIDS. Knowledge of psychopharmacology is critical to the management of patients with human immunodeficiency virus (HIV) infection, due to the prevalence of pre-morbid psychopathology and substance use disorders (SUDs); HIV-associated neurocognitive disorders (HAND); somatic symptoms such as pain and fatigue, and neuroendocrine problems, all of which impact quality of life.

Overview of Intellectual/Developmental Disabilities

Patients with intellectual/developmental disabilities (IDD) present many challenges to mental health professionals. The capacity to work with such patients requires a working knowledge of IDD as well as an awareness and understanding of the factors that affect the clinical presentation of mental health disorders across the spectrum of IDD.

Progressive supranuclear palsy misdiagnosed as depression and catatonic schizophrenia

Introduction: Motor deficits of progressive supranuclear palsy (PSP) are well known, but psychiatric symptoms are less recognized. While PSP is routinely considered in the differential diagnosis of Parkinsonian disorders, it usually is not considered in the differential diagnosis of psychiatric disorders.

Psychiatrische und neuropsychologische Auffälligkeiten bei Patienten mit Morbus Fabry: Literaturübersicht

Fabry Disease (FD) is an X-linked lysosomal storage disorder (prevalence about 1 : 100 000) caused by a genetic defect associated with a lack of alpha-galactosidase A (alpha-GAL) enzyme activity. As a consequence, neutral glycosphingolipides can not be cleaved and metabolized, and accumulate in lysosomes of several tissues, particularly in vascular endothelium and smooth muscle cells. The most prominent symptoms comprise pain attacks and acroparesthesia, angiokeratoma, corneal opacity, renal and cardiac dysfunction, hypo- and anhidrosis, gastrointestinal symptoms, and cerebrovascular dysfunction with vertigo, headache, and cerebral ischemia. Characteristic symptoms of FD can occur in male and female patients with the same prevalence, while females with FD seem to be less severely affected. The course of untreated illness is progressive with considerable interindividual variability. Since 2001 two enzyme replacement therapies are approved which can possibly stop the disease progress and alleviate symptoms. The very few reports and clinical observations have shown that a very high proportion of FD patients develop neuropsychiatric symptoms. However, accurate data are lacking. Although the pathophysiologic mechanisms are quite unknown, it is surmised that sphingolipid deposits in the endothelium of small cerebral vessels lead to regional cerebral ischemia accompanied by neuropsychiatric symptoms and deficits. Furthermore, patients with FD are chronically distressed by pain attacks and additional somatic and psychological impairment. Frequently, pain attacks are triggered by psychosocial stress. The high interindividual variability can, thus, also be interpreted on the basis of existing stress and coping models. The present paper will review the presently available psychiatric and neuropsychological findings in FD and will discuss difficulties associated with classification and differential diagnosis of psychiatric disorders occurring in patients with FD.

Case Study: Trauma-Related Hallucinations

Proper differential diagnosis of psychiatric disorders with psychotic symptoms is imperative, as the treatment implications of the various conditions are quite different. A case study of a 5-year-old abused child with posttraumatic stress disorder is presented to illustrate some of the characteristic features of psychotic symptoms in traumatized children. Literature reviewed suggests that trauma-related hallucinations frequently contain content which is related to children's life experiences, are exacerbated by "triggers" and safety concerns, resolve with psychotherapy or psychosocial interventions, and are resistant to standard neuroleptic treatments. They are also associated with unique clinical, familial, developmental, and psychobiological correlates, and they require multifaceted treatment interventions.

The psychiatric presentations of Wilson's disease

We reviewed the records of 42 patients with Wilson's disease participating in a zinc acetate treatment protocol and interviewed 17 of them. Five of the patients studied were asymptomatic. A significant number of symptomatic patients (64.8%) reported psychiatric symptoms at the time of initial presentation. These symptoms were severe enough to warrant psychiatric intervention in almost half of all symptomatic patients before the diagnosis of Wilson's disease was made. Personality changes, particularly irritability and aggression, were most commonly described (45.9%), followed by depression (27%). Cognitive changes, anxiety, psychosis, and catatonia, while less frequent, also occurred. These data underscore the need to include Wilson's disease in the differential diagnosis of psychiatric disorders.

Single photon emission computed tomography (SPECT) with [123I]IMP in the differential diagnosis of psychiatric disorders

Single photon emission computed tomography (SPECT) with [123I]N-isopropyl iodoamphetamine--[123I]IMP--was used to study regional cerebral blood flow (rCBF) in 94 psychiatric patients and six controls. Patients with dementias had distinct brain-image patterns, consistent with the expected neuropathology. Major depressives had decreased cortical and subcortical rCBF. Increased caudate rCBF was observed in schizophrenics and other psychoses with positive symptoms. SPECT is a practical method of functional brain imaging with potential in the differential diagnosis of neuropsychiatric disorders. Further studies are needed to assess the effect of other variables on brain-image patterns.