Excessive Talkativeness Research Articles

COVID-19 Infection Induced Mania

Coronavirus Disease 2019 (COVID-19) infection or Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, is associated with various psychiatric consequences, which are because of various types of stressors, may be fear of infection or social isolation, hospitalization, death and so on. In the present case report, a 44-year-old female with a history of pentazocine addiction and no known history of previous psychiatric illness was admitted to the Emergency Ward with vacant, withdrawn look, unnatural fixed posture, mutism, refusal to eat. These symptoms developed after discharge from another hospital where she was treated for COVID-19 induced severe pneumonia (resolving). The very next day, the patient demonstrated excessive talkativeness and jovial mood with echolalia. The patient was treated symptomatically and recovered without the use of any antipsychotics. This report highlights the probability of the mania like symptoms being linked to COVID-19 (SARS-CoV-2 infection) highlighting the need for assessment of various psychiatric manifestations during COVID-19 infection.

Acute and Maintenance Treatment of Bipolar Depression.

The World Health Organization reported a lifetime prevalence of 2.4% for BD-I, BD-II and sub-threshold types of bipolar disorder (BD). Depressive episodes are more common than manic episodes for many BD patients. Studies show that depressive mood persists in 2/3 of life, even if they are under treatment. It may be difficult to diagnose BD in the event of depression in the first episode. The correct diagnosis and the treatment can be delayed for 6–8 years, and even longer if disorder starts in adolescence. It is reported that 40% of the patients who were initially diagnosed as unipolar were later diagnosed as BD. The features that enable us to diagnose BD depressive episode: 1) family history of BD or psychosis 2) early onset with depression 3) cyclothymic temperament characteristics 4) four or more depressive episodes in 10 years 5) agitation, anger, insomnia, irritability, excessive talkativeness or other ‘mixed’ or hypomanic features or psychotic symptoms during depressive episode, 6) clinical ‘worsening’ caused by the appearance of mixed symptoms after AD treatment 7) suicidal thoughts and attempts 8) substance abuse 9) hypersomnia in the depressive episode or sleeping too much during the day, overeating, psychomotor agitation. The number of studies conducted on BD depressive treatment is limited, the information was obtained by excluding this group from the studies or by compiling the information obtained from the treatment of unipolar depression. In this review, acute and maintenance treatment of the depressive episodes of BD will be discussed according to the treatment algorithms.

ФОРМУВАННЯ РИТОРИЧНОЇ КУЛЬТУРИ УЧНЯ ПОЧАТКОВОЇ ШКОЛИ ЗАСОБАМИ ПАРЕМІОЛОГІЇ: КОНЦЕПТУАЛЬНИЙ АСПЕКТ

The article deals with paremias as a means of forming the rhetorical culture of primary school pupils. A large group of proverbs and sayings has been found to contain guidelines for the rules of communication that our people have produced over the centuries. First of all, national folklore condemns; excessive talkativeness; false and cruel words. Instead, it appreciates prudent true language.The paremological fund actualizes contextual antonyms such as conversation – reason, conversation – act, conversation – truth. Universal ethical opposition good – evil is also reflected in the paremias concerning the rules of communication. The good word inspires, supports, warms the soul, and the evil word destroys and degrades.An important conceptual guideline in paremies is “silence is often better than speaking”. These paremies give a direct indication of the behavior of the communication, but also to a certain extent stimulate the comprehension of what is heard, of the experience, and not of empty talk.Separately distinguish the often actualized negative model word - not gender, which seeks to eliminate the identity of the word and something frivolous, irrelevant.The lexical-semantic groups “arms”, “musical instrument”, “bird”, “food”, “textilе, embroidery technique”, “treasure, money” are the donor zones for the metaphorization of the word. Such metaphorical models convey the word’s ability to hurt like a weapon; its elusiveness, like that of a bird; properties sound beautifully borrowed from musical instruments; fat and sweetness inherent in food; beauty and fluidity of embroidery and value for money.Different types of work with paremias will not only promote speech development, but will also familiarize students with the rules of rhetorical communication, enhance their communicative culture.

Cerebellar involvement in warts Hypogammaglobulinemia immunodeficiency myelokathexis patients: neuroimaging and clinical findings

BackgroundWarts Hypogammaglobulinemia Immunodeficiency Myelokathexis (WHIM) syndrome is a primary immunodeficiency characterized by recurrent bacterial infections, severe chronic neutropenia, with lymphopenia, monocytopenia and myelokathexis which is caused by heterozygous gain of functions mutations of the CXC chemokine receptor 4 (CXCR4). WHIM patients display an increased incidence of non-hematopoietic conditions, such as congenital heart disease suggesting that abnormal CXCR4 may put these patients at increased risk of congenital anomalies.Studies conducted on CXCR4 and SDF-1-deficient mice have demonstrated the role of CXCR4 signaling in neuronal cell migration and brain development. In particular, CXCR4 conditional knockout mice display abnormal cerebellar morphology and poor coordination and balance on motor testing.ResultsIn order to evaluate a possible neurological involvement in WHIM syndrome subjects, we performed neurological examination, including International Cooperative Ataxia Rating Scale, cognitive and psychopathological assessment and brain Magnetic Resonance Imaging (MRI) in 6 WHIM patients (age range 8–51 years) with typical gain of functions mutations of CXCR4 (R334X or G336X). In three cases (P3, P5, P6) neurological evaluation revealed fine and global motor coordination disorders, balance disturbances, mild limb ataxia and excessive talkativeness. Brain MRI showed an abnormal orientation of the cerebellar folia involving bilaterally the gracilis and biventer lobules together with the tonsils in four subjects (P3, P4, P5, P6). The neuropsychiatric evaluation showed increased risk of internalizing and/or externalizing problems in four patients (P2, P3, P4, P6).ConclusionsTaken together, these observations suggest CXCR4 gain of function mutations can be associated with cerebellar malformation, mild neuromotor and psychopathological dysfunction in WHIM patients.

Enteric psychosis-revisiting an uncommon manifestation of a common disease

Enteric fever is known to be caused by Salmonella typhi, and uncommonly by Salmonella paratyphi A, B and C. It may have atypical manifestations, which may lead to diagnostic delays. Amongst atypical presentations, neuropsychiatric alterations remain rare and often under diagnosed. A 38year old male presented to emergency department with 3days history of fever with headache and behavioural changes since 2days. He had excessive talkativeness associated with visual and auditory hallucinations. On neurological examination he was conscious, oriented but was excessively talkive. Initial tests for an infective aetiology were negative. Three days later, blood culture showed growth of Salmonella paratyphi A. His symptoms significantly improved after treatment with Ceftriaxone.

"Mania": An unusual presentation of craniopharyngioma.

Sir, Craniopharyngioma usually presents with of increased intracranial pressure, such as headache and vomiting, or with visual worsening.[12] We present a 13-year-old female who came to us with symptoms suggestive of hyperactivity, excessive talkativeness, echolalia, increased speed of talking, overfamiliarity with unknown persons, smelling objects and wandering behavior, over cheerfulness, persistent irritability, overdemanding, singing, dancing, increased appetite, and decreased sleep. She was diagnosed to have first episode mania and was started on sodium valproate and olanzapine. However there was no improvement in the clinical condition of the patient even after 3 weeks of medication. In view of nonimprovement, she was further investigated with computed tomography (CT) head. CT head showed large sellar suprasellar lesion with calcification and obstructive hydrocephalus [Figure 1]. Her anterior pituitary hormonal profile was normal. Her visual acuity and fields were normal. Patient initially underwent right-sided medium pressure ventriculoperitoneal shunt. This was followed by right pterional craniotomy and gross total excision of the tumor. Postoperatively, patient recovered well, and had no fresh neurological deficits. Her manic symptoms improved significantly. Histopathology revealed features suggestive of adamantinomatous craniopharyngioma. At 6 months follow-up, she did not have any manic symptoms, and she was not on any medications. Follow-up magnetic resonance imaging did not show any residual tumor [Figure 1].Figure 1: Preoperative axial noncontrast computed tomography scan (a and b) shows sellar suprasellar lesion with areas of calcification and hydrocephalous. Postoperative T2-weighted image axial (c) and coronal (d) images show gross total tumor decompression with normal ventriclesMood disorders or anxiety disorders are rare presentations of childhood craniopharyngioma.[3] Majority of patients with craniopharyngioma who present with behavioral disturbances are adults. The case described is that of 13-year-old female who on initial presentation met criteria for mania. She did not have any symptoms of raised intracranial pressure, or visual disturbances, and hence was treated on the lines of a mood disorder. Mania is a very rare presentation of craniopharyngioma, and to the best of our knowledge, until now only two cases have been described in literature.[45] The possibility of manic symptoms is speculated to be due to hypothalamo-pituitary disturbances because of the compression of the hypothalamus and pituitary stalk. Other possibility of explaining the affective symptoms could be the involvement of the right temporal lobe in this condition, when the tumor has parasellar extension. Craniopharyngioma can rarely manifest as mania and the treatment of the underlying condition may leads to total remission of the psychiatric symptoms. Keeping this in view, it is necessary to have detailed neurological assessment in psychiatric patients, and imaging in the patients who do not have remission on medication.

Presence of autism, hyperserotonemia, and severe expressive language impairment in Williams-Beuren syndrome.

BackgroundDeletion of the Williams-Beuren syndrome (WBS) critical region (WBSCR), at 7q11.23, causes a developmental disorder commonly characterized by hypersociability and excessive talkativeness and often considered the opposite behavioral phenotype to autism. Duplication of the WBSCR leads to severe delay in expressive language. Gene–dosage effects on language development at 7q11.23 have been hypothesized.MethodsMolecular characterization of the WBSCR was performed by fluorescence in situ hybridization and high-resolution single-nucleotide polymorphism array in two individuals with severe autism enrolled in a genetic study of autism who showed typical WBS facial dysmorphism on systematic clinical genetic examination. The serotonin transporter promoter polymorphism (5-HTTLPR, locus SLC6A4) was genotyped. Platelet serotonin levels and urinary 6-sulfatoxymelatonin excretion were measured. Behavioral and cognitive phenotypes were examined.ResultsThe two patients had common WBSCR deletions between proximal and medial low copy repeat clusters, met diagnostic criteria for autism and displayed severe impairment in communication, including a total absence of expressive speech. Both patients carried the 5-HTTLPR ss genotype and exhibited platelet hyperserotonemia and low melatonin production.ConclusionsOur observations indicate that behaviors and neurochemical phenotypes typically associated with autism can occur in patients with common WBSCR deletions. The results raise intriguing questions about phenotypic heterogeneity in WBS and regarding genetic and/or environmental factors interacting with specific genes at 7q11.23 sensitive to dosage alterations that can influence the development of social communication skills. Thus, the influence of WBSCR genes on social communication expression might be dramatically modified by other genes, such as 5-HTTLPR, known to influence the severity of social communication impairments in autism, or by environmental factors, such as hyperserotonemia, given that hyperserotonemia is found in WBS associated with autism but not in WBS without autism. In this regard, WBS provides a potentially fruitful model with which to develop integrated genetic, cognitive, behavioral and neurochemical approaches to study genotype–phenotype correlations, possible gene–environment interactions and genetic background effects. The results underscore the importance of considering careful clinical and molecular genetic examination of individuals diagnosed with autism.

Autistic disorder in patients with Williams-Beuren syndrome: a reconsideration of the Williams-Beuren syndrome phenotype.

BackgroundWilliams-Beuren syndrome (WBS), a rare developmental disorder caused by deletion of contiguous genes at 7q11.23, has been characterized by strengths in socialization (overfriendliness) and communication (excessive talkativeness). WBS has been often considered as the polar opposite behavioral phenotype to autism. Our objective was to better understand the range of phenotypic expression in WBS and the relationship between WBS and autistic disorder.MethodologyThe study was conducted on 9 French individuals aged from 4 to 37 years old with autistic disorder associated with WBS. Behavioral assessments were performed using Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) scales. Molecular characterization of the WBS critical region was performed by FISH.FindingsFISH analysis indicated that all 9 patients displayed the common WBS deletion. All 9 patients met ADI-R and ADOS diagnostic criteria for autism, displaying stereotypies and severe impairments in social interaction and communication (including the absence of expressive language). Additionally, patients showed improvement in social communication over time.ConclusionsThe results indicate that comorbid autism and WBS is more frequent than expected and suggest that the common WBS deletion can result in a continuum of social communication impairment, ranging from excessive talkativeness and overfriendliness to absence of verbal language and poor social relationships. Appreciation of the possible co-occurrence of WBS and autism challenges the common view that WBS represents the opposite behavioral phenotype of autism, and might lead to improved recognition of WBS in individuals diagnosed with autism.

Behavioral features in young adults with FG syndrome (Opitz–Kaveggia syndrome)

Opitz and Kaveggia [Opitz and Kaveggia (1974); Z Kinderheilkd 117:1-18] reported on a family of five affected males with distinctive facial appearance, mental retardation, macrocephaly, imperforate anus, and hypotonia. Risheg et al. [Risheg et al. (2007); Nature Genetics 39:451-453] identified an identical mutation (p.R961W) in MED12 in six families with Opitz-Kaveggia syndrome, including a surviving affected man from the original family reported in 1974. The previously described behavior phenotype of hyperactivity, affability, and excessive talkativeness is very frequent in young boys with FG syndrome, along with socially oriented, attention-seeking behaviors. We present case studies of five adult males who were previously published with the clinical diagnosis of FG syndrome and then subsequently proven by Risheg et al. [Risheg et al. (2007); Nature Genetics 39:451-453] to have the recurrent p.R961W mutation. These individuals had episodic and longstanding behavior patterns, sometimes aggressive or self-abusing, that occurred more frequently in puberty and early adulthood. We try to describe the triggers for these behaviors, indicate how these behaviors change with advancing age, and suggest specific recommendations and interventional strategies based on the clinical histories of affected adolescent males with FG syndrome [Graham et al., 2008; Clark et al., 2009]. Young men who exhibit these behaviors may benefit from a careful examination to detect medical problems, use of mood stabilizers if needed, and/or behavioral intervention. The transition to a community living situation can be challenging without careful planning and timely behavioral intervention. They remain impulsive and can have aggressive outbursts when making the transition to adult life, but these challenges can be managed, as demonstrated by these clinical histories.

Behavior of 10 patients with FG syndrome (Opitz–Kaveggia syndrome) and the p.R961W mutation in the MED12 gene

Opitz and Kaveggia [Opitz and Kaveggia (1974); Z Kinderheilk 117:1-18] reported on a family of five affected males with distinctive facial appearance, mental retardation, macrocephaly, imperforate anus and hypotonia. Risheg et al. [Risheg et al. (2007); Nat Genet 39:451-453] identified an identical mutation (p.R961W) in MED12 in six families with Opitz-Kaveggia syndrome, including a surviving affected man from the family reported in 1974. The previously defined behavior phenotype of hyperactivity, affability, and excessive talkativeness is very frequent in young boys with this mutation, along with socially oriented, attention-seeking behaviors. We present case studies of two older males with FG syndrome and the p.R961W mutation to illustrate how their behavior changes with age. We also characterize the behavior of eight additional individuals with FG syndrome and this recurrent mutation in MED12 using the Vineland Adaptive Behavior Scales 2nd edition, the Reiss Profile of Fundamental Goals and Motivation Sensitivities, and the Achenbach Child Behavior Checklist. Males with this MED12 mutation had deficits in communication skills compared to their socialization and daily living skills. In addition, they were at increased risk for maladaptive behavior, with a propensity towards aggression, anxiety, and inattention. Based on the behavior phenotype in 10 males with this recurrent MED12 mutation, we offer specific recommendations and interventional strategies. Our findings reinforce the importance of testing for the p.R961W MED12 mutation in males who are suspected of having developmental and behavioral problems with a clinical phenotype that is consistent with FG syndrome.

Clinical experience in the evaluation of 30 patients with a prior diagnosis of FG syndrome

Background:FG syndrome (FGS) is an X-linked disorder characterised by mental retardation, hypotonia, particular dysmorphic facial features, broad thumbs and halluces, anal anomalies, constipation, and abnormalities of the corpus callosum. A...

Hypomanic mood in a child patient treated with interferon-α 2a: Case report

We report on a male child born in Rumania, adopted by an Italian family, and who at 10 years of age was submitted to interferon-α 2a therapy for chronic hepatitis B. About 30 days after the beginning of the treatment he developed hypomanic mood and psychogenic seizures. Psychological evaluation showed hyperactivity, distractibility, excessive talkativeness, grandiosity and racing thoughts. Temperamental traits were characterized by an elevated emotionality. The patient was successfully administered risperidone and cognitive-behavioral therapy; six months of treatment with interferon led to positive outcome of hepatitis B. Since affective symptoms may occur in children treated with IFN, a careful evaluation of psychiatric disturbances and adequate intervention are needed.

Use of Intravenous Valproate in a Patient With Neuroleptic Malignant Syndrome

Back to table of contents Previous article Next article LetterFull AccessUse of Intravenous Valproate in a Patient With Neuroleptic Malignant SyndromeRahul R. Tadke, M.D., DNB, and Praveen Suryavanshi, MBBS, DPMRahul R. TadkeSearch for more papers by this author, M.D., DNB, and Praveen SuryavanshiSearch for more papers by this author, MBBS, DPMPublished Online:1 Feb 2006AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail SIR: A 22-year-old woman was admitted through casualty, with a history of altered behavior for approximately 15 days and history of fever, rigidity, tremors, and one episode of incontinence for a few days. The patient had autonomic disturbances, was partly oriented to time and place, and general condition was moderate.History given by a close relative about cheerfulness, excessive talkativeness, singing songs, reduced need for sleep, and grandiose ideation for approximately 2 weeks indicated an episode of mania. The patient received an injection of haloperidol intramuscularly to control the behavior a few days before, prior to the onset of new symptoms.A clinical diagnosis of neuroleptic malignant syndrome (NMS) was made, although other differentials of delirium due to general medical condition, including meningitis, were also considered.Baseline investigations were within normal limits, and total leukocytes count of 9000/cmm and the CSF study was inconclusive. Serum creatinine phosphokinase (CPK) levels were 3850 U/liter, suggestive of N.M.S. and this confirmed the diagnosis.Injection valproate was administered intravenously 250 mg on the first day and then 250 mg 12 hourly from the next day. A clonazepam tablet was also administered when needed. The following day, dramatic improvement in this patient, was observed. She was well oriented to time, place and person, and the rigidity had markedly reduced. Tremors were minimal, and there was no fever. After 6 days, the patient had minimal rigidity and mild tremors. There were no behavioral disturbances barring mild euphoria.Repeat serum CPK levels after 10 days was 30 U/liter (well within normal limits) and other baseline investigations were within normal limits. The patient was later switched to oral sodium valproate, and there were no features of NMS. The serum valproate level was 87 mcg/ml after 2 weeks.Intravenous valproate has been used for catatonia.1 In this isolated case (by chance), intravenous valproate was found to be effective in the symptoms of NMS.2,3There was no fear of the reemergence of psychotic features, which is common with bromocriptine. The strict monitoring as required for bromocriptine was also not needed. It serves a dual purpose for controlling manic features in patients of bipolar disorder.4 Even a substitute novel (atypical) antipsychotic (although less) carries the risk of NMS.Panjabrao Deshmukh Medical College , Department of Psychiatry, Amravati , Maharashtra, IndiaReferences1 Kruger S, Braunig P: Intravenous valproic acid in the treatment of severe catatonia J Neuropsychiatry Clin Neurosci. 2001; 13(2):303-304Google Scholar2 Lauterbach EC: Valproate for catatonia: need for caution in patients on SSRIs and antipsychotics.: J Neuropsychiatry Clin Neurosci. 2002;14(1):84-86Google Scholar3 Spehlmann R, Norcross K, Rasmus SC, et al: Improvement of stiff-man syndrome with sodium valproate. Neurology. 1981; 31(9):1162-113Google Scholar4 Grunze H, Erfurth A, Amann B, et al: Intravenous valproate loading in acutely manic and depressed bipolar I patients. J Clin Psychopharmacol 1999; 19(4):303–309Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByNeuroleptic Malignant Syndrome19 July 2016 | Annals of Pharmacotherapy, Vol. 50, No. 11Comment: Neuroleptic Malignant Syndrome Versus Serotonin Syndrome: The Search for a Diagnostic Tool13 March 2012 | Annals of Pharmacotherapy, Vol. 46, No. 4Neuroleptic Malignant Syndrome Following Levomepromazine DiscontinuationHisashi TaniiM.D., Ph.D.,Keiichi SakaM.D.,Ken InoueM.D., Ph.D.,Motohiro OkadaM.D., Ph.D.,1 April 2010 | The Journal of Neuropsychiatry and Clinical Neurosciences, Vol. 22, No. 2 Volume 18Issue 1 February 2006Pages 131-132 Metrics PDF download History Published online 1 February 2006 Published in print 1 February 2006

Clinical and behavioral characteristics in FG syndrome

FG syndrome is a rare X-linked recessive form of mental retardation, first described by Opitz and Kaveggia in 1974. Based on over 50 reported cases, FG syndrome is associated with agenesis of the corpus callosum, minor facial anomalies (high, broad forehead with frontal cowlick, ocular hypertelorism, down-slanted palpebral fissures, and small cupped auricles), relative macrocephaly, broad thumbs and halluces, and prominent fetal fingertip pads. Affected individuals manifest neonatal hypotonia and severe constipation, which usually resolves during mid-childhood. The hypotonia with joint hyperlaxity evolves into spasticity with joint contractures in later life. Affability, hyperactivity, and excessive talkativeness are noted frequently in patients with FG syndrome. Recently, we described three additional families (six additional patients) with FG syndrome who support the localization of a gene for the FG syndrome in chromosome region Xq12-q21 [Graham JM Jr, Tackels D, Dibbern K, Superneau D, Rodgers C, Corning K, Schwartz CE. 1998. Am J Med Genet 80:145-156.]. Using these same families and one additional sporadic case of FG syndrome, we compared behavioral and personality characteristics of 6 FG boys with other boys with syndromic and nonsyndromic mental retardation: eight with Down syndrome, seven with Prader-Willi syndrome, eight with nonspecific mental retardation, and 13 with Williams syndrome. Using the Vineland Adaptive Behavior Scales, the Reiss Personality Profiles, and the Achenbach Child Behavior Checklist, parents were asked to characterize the behavior and personality of their boys from ages 4 to 10 years. When compared with Williams syndrome, the FG boys had fewer internalizing behaviors and were significantly less anxious and withdrawn but had similar socially oriented, attention-seeking behaviors. On the Reiss Profile, FG boys were also quite similar to Williams syndrome boys. On the Vineland Scales, FG boys demonstrated significant relative strengths in their socialization skills, consistent with their personality, tending to confirm previous descriptions of their personalities.