Neuropsychiatric Manifestations In Patients Research Articles

Neuropsychiatric manifestations in patients with Systemic Lupus Erythematosus: A case series

Neuropsychiatric systemic lupus erythematosus (NPSLE) can affect both the brain and spinal cord and present with variable neurologic manifestations, including 19 neurologic syndromes according to the ACR (American College of Rheumatology), leading to diverse neurological and psychiatric symptoms ranging from nonspecific symptoms like a headache to devastating symptoms such as seizures and stroke, making NPSLE an important accomplice in morbidity and mortality, which are seen in SLE population. Its management options are still inadequately optimized due to its challenging diversity in presentation, reflecting a range of different pathogenic mechanisms. A better understanding of SLE presentation might improve the present options for managing NPSLE. Here we report a series of five female patients with NPSLE. Out of the five presented cases, four patients have neurological features as an initial manifestation of SLE, which is considered uncommon. The first case of a 50-year-old female patient who had aseptic meningitis presented with headache, back pain, and lower limb weakness associated with numbness after 11 years of being diagnosed with SLE. The second case is of a 20-year-old female patient who had a generalized tonic-clonic seizure with the acute manifestation of hypertensive urgency and posterior reversible encephalopathy syndrome (PRES) as an initial manifestation of SLE. The third case is of a 38-year-old female patient who presented with an acute focal seizure as an initial manifestation of SLE. In the last two cases, a 38-year-old and a 19-year-old female patient presented with an ischemic stroke as the initial manifestation of SLE. On a final note, clinicians should always have SLE in mind as a differential diagnosis when it comes to acute neurological features presenting in any patient with SLE manifestations.

Neuropsychiatric manifestations in patients with long COVID in Veracruz, Mexico

Neuropsychiatric manifestations in patients with long COVID in Veracruz, Mexico

Neuropsychiatric adverse reactions in patients treated with denosumab: two case reports and a review of data from the FDA Adverse Event Reporting System (FAERS).

Denosumab is a human monoclonal antibody indicated for patients with osteoporosis and a high risk of fractures. It targets RANKL, the receptor activator of NF-κB (RANK) ligand, blocking RANKL-RANK interaction and leading to rapid osteoclast-mediated bone resorption inhibition. But RANK is widely expressed in neurons, microglia, and astrocytes. RANKL/RANK/NF-κB system can play an important role in the neuroinflammatory response, depressive behavior, memory impairments, and neurotrophism. We present two well-documented case reports of recurrent neuropsychiatric manifestations in patients treated with denosumab and a descriptive review of similar cases reported to the Food and Drug Administration Adverse Event Reporting System (FAERS) database between 2012 and 2022. Only those reported by healthcare professionals, coding denosumab as the only suspected drug, were retained. An 81-year-old woman with pre-existing mild cognitive impairment suffered two acute confusional episodes and another 81-year-old woman with depression in remission suffered two depressive recurrences with anxiety and psychomotor inhibition, in both cases following sequential administrations of denosumab without underlying calcium/phosphate imbalance. Scores on Naranjo Adverse Drug Reaction Probability Scale were 6 and 7, respectively, suggesting a probable causal relationship. Of the 91,151 cases with denosumab exposure reported to FAERS, 5.7% were related to psychiatric/neurological disorders and 23.8% of these corresponded to cognitive impairment, depressive/mood disturbances, or psychomotor retardation. Denosumab may cause transient but severe neuropsychiatric symptoms by several mechanisms involving RANKL blockade and subsequent immuno-inflammatory changes, at least in subjects with pre-existing neurobiological vulnerability. We recommend caution and careful monitoring of these patients following denosumab administrations.

Clinical and serological predictors of neuropsychiatric manifestations in patients with systemic lupus erythematosus

IntroductionSystemic lupus erythematosus is a chronic autoimmune disease with variable severity, neuropsychiatric manifestations comprise a wide spectrum of syndromes defined according to its central and peripheral involvement. Many pathophysiological mechanisms have been involved in the development of these manifestations, such as the disruption of the blood-brain barrier and the cellular toxicity related to autoantibodies such as anti-aquaporin, anti-ribosomal P and anti-phospholipids. Predictive elements to identify neuropsychiatric compromise will be explored by predictive models in this article. Methodology and methodsRetrospective cross-sectional study, predictive models such as decision trees, naive Bayesian, K-nearest neighbours and generalized linear models were used for the analysis, the best model was selected. Results122 patients were included, of whom 100 (81.9%) were women and 22 (18.1%) men, the prevalence of neuropsychiatric compromise was 59%, anxiety disorders, headache and mood disorders being the most frequent. In the bivariate analysis, oral ulcers (OR 2.52, 95% CI 1.09–6.08 p = 0.02), non-scarring alopecia (OR 4.06, 95% CI 1.76–9.68 p = <0.01), arthritis (OR 2.5, 95% CI 0.99–6.94 p = 0.04), leukopenia (OR 2.81, 95% CI 1.18–7.09 p = 0.04) and patients without accumulated damage measured by the SLICC/ACR-DI damage score (2.1, 95% CI 0.98–4.93 p = 0.01), were associated with greater neuropsychiatric compromise. The best prediction model was the decision tree model, in which non-scarring alopecia, oral ulcers and anti-Ro/SSA antibodies behaved as independent variables related to neuropsychiatric compromise with a precision of 75.6%. ConclusionsThe prevalence of neuropsychiatric involvement in lupus was 59%, the independent variables that best predict these manifestations were anti-Ro/SSA seropositivity, non-scarring alopecia, and oral ulcers through decision trees.

Neuropsychiatric manifestations in patients with long COVID in Mexico.

Neuropsychiatric manifestations in patients with long COVID in Mexico.

Neurological and Psychiatric Disorders in Patients with Rheumatic Heart Disease: Unveiling what is Beyond Cardiac Manifestations.

Background:Rheumatic heart disease (RHD) is the most serious manifestation of rheumatic fever, which may also affect the brain. The current study assessed the prevalence of neuropsychiatric manifestations in patients with RHD, including clinical features associated with basal ganglia motor dysfunction (BGMD).Methods:We conducted neurologic and psychiatric assessments in consecutive patients with RHD referred to a tertiary center for heart valve diseases. Echocardiography was performed to assess the pattern of valvular involvement and RHD severity. Validated questionnaires for the evaluation of cognition, depression, anxiety, and obsessive-compulsive symptoms (OCS) were applied. BGMD was clinically defined by the presence of hyperkinetic movement disorders.Results:Fifty patients with age of 43.2 ± 10.8 years, 84% female, were included. Mitral valve was affected in 47 patients (94%), and 21 of them (42%) also had aortic valve involvement. Chorea (22%), chronic tics (18%), OCS (48%), major depression (34%), generalized anxiety disorder (54%), cognitive complaints (66%), migraine (52%) and seizures (18%) were frequently reported. The factors associated with BGMD were age (p = 0.018), major depression (p = 0.013), and Yale-Brown Obsessive Compulsive (Y-BOCS) score (p = 0.011). The severity of heart disease was not associated with BGMD.Conclusions:Neuropsychiatric manifestations are frequent in RHD patients, which may persist up to three decades after acute rheumatic fever. Age, major depression and severity of OCS were independently associated with BGMD. These manifestations deserve a close attention of clinicians and researchers dealing with adult patients with RHD.

Shared pathological mechanisms of systemic lupus erythematosus and affective disorders

The high prevalence and variability of neurological and psychiatric symptoms in systemic lupus erythematosus has become the basis for emphasizing the special neuropsychiatric form of the disorder. Affective disorders (pathological changes in mood and anxiety) are the second most common neuropsychiatric manifestations in patients with systemic lupus erythematosus. However, the current nomenclature primarily focuses on the general clinical manifestations of affective disorders in neuropsychiatric form systemic lupus erythematosus, without evaluating the problems of their etiopathogenesis. Thereby, the aim of this review is the integration of information on the pathological mechanisms of depression and anxiety in patients with systemic lupus erythematosus. The available data on the biological aspects of the anxiety and depression in systemic lupus erythematosus indicate that the complex pathological models may be the best approach for studying, diagnosing, and treating comorbid pathology. The latter can be based on expanding the existing clinical categories, supplementing them with data on pathological mechanisms specific to particular sub-cohorts of patients. Such an approach can provide the specific and most effective preventive, diagnostic and therapeutic measures for each category of patients.

Neuro-psychiatric manifestations in patients with systemic lupus erythematosus: A systematic review and results from the Swiss lupus cohort study.

ObjectivesSystemic lupus erythematosus (SLE) is a systemic autoimmune disease associated with neuro-psychiatric (NP) manifestations. Frequency and patterns of neuro-psychiatric systemic lupus erythematosus (NPSLE) vary substantially between patients. We conducted a systematic review (SR) of the literature and examined prevalence and characteristics of NPSLE in the Swiss SLE cohort study (SSCS).MethodsThe SR search was performed between January 1999 and January 2020. We included prospective/cross-sectional studies focusing on NPSLE. We secured study characteristics, cohort compositions and frequencies of NP manifestations, assessed heterogeneity across reports and investigated sources of variation using meta-regression models. Regarding the SSCS, we reviewed all patients included and classified NP manifestations.ResultsThe SR searches identified 530 studies. We included 22 studies in our meta-analysis, the mean frequency of NPSLE ranged from 10.6% to 96.4%. The frequency of NPSLE in the SSCS was 28.1%. Severe events including cerebrovascular insults, seizures and psychosis appeared in 7.1%, 5.3% and 6.5% respectively. There was a linear relationship between duration of SLE and cumulative incidence of NPSLE.ConclusionsThe spectrum of NPSLE is very broad. The diagnostic work-up and rates of reported manifestations varied substantially across studies. We call for concerted efforts and consensus regarding definitions of NPSLE that will facilitate accurate diagnosis and attribution to SLE, particularly with a view to timely intervention and patient outcomes.

COVID-19 y salud mental

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiological agent of the coronavirus 2019 (COVID-19) disease, which has caused a pandemic in 2020. This healthcare crisis has had a significant repercussion on the mental health of people who have had the disease itself, those who have undergone restrictive lockdowns, and healthcare professionals who have been working directly or indirectly in patient care. Although the pathological mechanisms related to neuropsychiatric manifestations in patients with COVID-19 are currently unknown, different methods of action through which the central nervous system could be affected have been proposed, including direct or indirect methods. Among them, inflammatory activation through what is known as a “cytokine storm,” which is present in both COVID-19 and some mental disorders, seems to play a fundamental role. We also analyze the effects the pandemic has had on the general population, which has had to be remain in lockdown, as well as on healthcare professionals who have been working.

Neuropsychiatric Correlates of Narcolepsy.

The complex nature of narcolepsy symptoms, along with the use of stimulants and anticataplectic medications, poses diagnostic difficulties in terms of underlying neuropsychiatric comorbidities. This study reviews recent evidence for the association between narcolepsy and neuropsychiatric disorders. We also critically analyze studies that have addressed the neuropsychiatric correlates of patients with narcolepsy, with a discussion of the possible pathophysiological mechanisms linking narcolepsy and neuropsychiatric disorders. Neuropsychiatric manifestations are common among patients with narcolepsy as narcolepsy and some neuropsychiatric disorders share common clinical features. This may create challenges in making the correct diagnosis, and hence result in a delay in starting appropriate treatment. Comorbid neuropsychiatric manifestations in patients with narcolepsy include depression, anxiety, psychosis, rapid eye movement (REM) sleep behavior disorder, and cognitive impairment. Although hypocretin deficiency has been proposed as a pathophysiological mechanism underlying both narcolepsy and neuropsychiatric disorders, further research is necessary to identify the exact mechanisms. Narcolepsy patients often manifest comorbid neuropsychiatric symptoms, which makes the diagnosis difficult. Therefore, it is essential to address neuropsychiatric symptoms in the clinical care of patients with narcolepsy.

Survey assessing the prevalence and severity of neuropsychiatric manifestations in patients living with Fabry disease

Survey assessing the prevalence and severity of neuropsychiatric manifestations in patients living with Fabry disease

Valacyclovir toxicity in peritoneal dialysis

Valacyclovir (Prodrug) an antiviral agent is not well cleared by peritoneal dialysis and can cause neuropsychiatric manifestations in patient with renal failure on peritoneal dialysis and having Herpes Zoster infection being treated with this drug. Methodology followed for the collection of data and literature review was by using a medline search using the terms Acyclovir, nervous system effects, Valacyclovir, neurotoxicity and peritoneal dialysis. The representative case discussed is about an elderly gentleman with chronic renal failure on CCPD presenting with hallucinations, altered sensorium and restlessness following treatment with Valacyclovir 1000 mg three times per oral daily who was admitted and evaluated. It is of vital importance to consider the differential diagnosis of Herpes zoster encephalitis in the differential diagnosis of these patients as it is difficult to rule it out. The mechanism of this drug induced neurotoxicity is thought to be probably, the accumulation of serum carboxymethoxymethyl guanidine (CMMG), a toxic metabolite of valacyclovir.As peritoneal dialysis is not very effective in removal of this drug, it is thought to be beneficial to change to Hemodialysis for short duration so as to clear the drug from the system as shown in the case and in the discussion. Safe doses in peritoneal dialysis are not clearly delineated. Extreme precaution must be exercised while prescribing these group of anti-viral drugs in patients with CKD and especially those on peritoneal dialysis. If such a patient does manifest neuropsychiatric symptoms it is necessary to immediately stop the drug concerned. Methods to increase the excretion of the drug must be employed immediately or to remove it by intensification of PD or ideally to aggressively remove it by means of hemodialysis. Moreover there is a paucity of similar reports in the literature.

Neuropsychiatric Systemic Lupus Erythematosus: From the Standpoint of Department of Neurology

Neuropsychiatric manifestations in patients with systemic lupus erythematosus (SLE), termed neuropsychiatric SLE (NPSLE), encompass a wide variety of neurological and psychiatric characteristics. A neuropsychiatric event may precede an SLE diagnosis; therefore, physicians must screen for SLE in patients presenting with neuropsychiatric symptoms, if they are not already diagnosed with this condition. For assessing patients with SLE who present with neuropsychiatric symptoms, it is important to first determine whether the symptoms are caused by SLE (primary NPSLE), whether they are a complication of a therapy, or whether they are caused by other comorbidities. Accurate attribution of neuropsychiatric symptoms is vital for selecting therapeutic interventions.

Neuropsychiatric manifestations in patients with HIV treated with antiretroviral drugs versus untreated

IntroductionUntreated patients for H.I.V can present various types of neuropsychiatric syndromes (NPS): subclinical cognitive symptoms, behavioral changes, agitation, personality changes, dementia complex associated with H.I.V and delirium, depressive disorder, bipolar affective disorder or manic episode. However, it is controversial whether antiretroviral induce NPS, or on the contrary, when there are patients will evolve into an AIDS stage for therapeutic resistance or noncompliance.AimsDescribe qualitatively and quantify the epidemiological point of the main subclinical and NPS symptoms in patients untreated and treated with antiretroviral drugs and their frequencies. Propose pharmacological treatments for each of the specified conditions.MethodsSearch in PubMed with the words “Neuropsychiatric and antiretroviral therapy” by applying the limits: full and free texts, past 10 years, Human, English language and adults; research liaison psychiatry textbooks.ResultsResults yielded 381 articles with the criteria selecting 102, the most relevant for the purposes of work. They chose four most relevant chapters in the literature.ConclusionsThe most effective treatment of NPS in unmedicated patients is to start antiretroviral therapy; only if it does not improve them should be introduced psychiatric drugs as if they were functional. 50% of treated with efavirenz patients will develop NPS in the early days with gradual decrease. The dropout rate associated with these adverse events varies from 2.6–16%. Treatment of these NPS a challenge by the existence of numerous drug interactions, it is essential to know to deal with these entities to improve the quality of life of people with this chronic disease.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Neuropsychiatric morbidity in HIV/ AIDS

Human-immunodeficiency (HIV) virus is a neurotropic virus that enters the central nervous system by crossing blood brain barrier early in infection. HIV virus independently infects and destroys neuronal cells causing neuropsychiatric morbidity ranging from psychiatric illnesses to cognitive deficits. Several research studies have consistently reported higher prevalence of neuropsychiatric manifestations in patients with HIV/ AIDS. Further, there is an urgent need to sensitize health care providers regarding the relationship between HIV/ AIDS and neuropsychiatric morbidity to empower them to screen for psychiatric diseases.An early identification and treatment of psychiatric conditions in patients with HIV will help to improve compliance to anti-retroviral therapy, &amp; coping with stress of living with HIV thereby improving quality of life. The review discusses prevalence of psychiatric morbidity in patients with HIV/ AIDS.

Neuropsychiatric Lupus in clinical practice.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease involving multiple organs, characterized by the production of autoantibodies and the development of tissue injury. The etiology of SLE is partially known, involving multiple genetic and environmental factors. As many as 50% of patients with SLE have neurological involvement during the course of their disease. Neurological manifestations are associated with impaired quality of life, and high morbidity and mortality rates. Nineteen neuropsychiatric syndromes have been identified associated with SLE, and can be divided into central and peripheral manifestations. This article reviews major neuropsychiatric manifestations in patients with SLE and discusses their clinical features, radiological findings and treatment options.

Neuropsychiatric manifestations in patients with systemic lupus erythematosus: A study from Iran.

Background:Neuropsychiatric systemic lupus erythematosus (NPSLE) is a serious and well-known complication of systemic lupus erythematosus (SLE). There is limited evidence about the prevalence of NPSLE and its manifestations in Iran. The aim of this study was to study clinical and demographic characteristics of patients with NPSLE in an Iranian population.Materials and Methods:This was a cross-sectional study that was undertaken in two referral Clinics of Neurological and Rheumatological Disorders in Alzahra Hospital, Isfahan, Iran. Between March 2004 and June 2010, medical records of registered patients with SLE were examined. NPSLE was characterized using the American College of Rheumatology case definitions. Descriptive statistics and logistic regression were performed for statistical assessment.Results:Among 556 patients with SLE, 121 (21.7%) patients were diagnosed as NPSLE and enrolled in the study. Of whom, 94 patients were female (77.7%) and 27 patients were male (22.3%) with a female to male ratio of 3.48:1. The most common NPSLE manifestations were headache (38.8%), cerebrovascular disease (CVD) (38.8%) and seizure (26.4%). Thirty-nine patients have psychiatric disorders. Among them, 32 patients (26.4%) have periods of psychosis and mood disorder was found in 6 patients (5%).Conclusions:We identified NPSLE manifestations in 21.7% of patients; headache and CVD were the most frequent neurological manifestations. Continued studies into the pathogenesis of neurological involvement in patients with SLE are warranted.

Epilepsy and Other Neuropsychiatric Manifestations in Children and Adolescents with 22q11.2 Deletion Syndrome.

Background and Purpose22q11.2 deletion syndrome (22q11.2DS) is the most common microdeletion syndrome. Epilepsy and other neuropsychiatric (NP) manifestations of this genetic syndrome are not uncommon, but they are also not well-understood. We sought to identify the characteristics of epilepsy and other associated NP manifestations in patients with 22q11.2DS.MethodsWe retrospectively analyzed the medical records of 145 child and adolescent patients (72 males and 73 females) with genetically diagnosed 22q11.2DS. The clinical data included seizures, growth chart, psychological reports, development characteristics, school performance, other clinical manifestations, and laboratory findings.ResultsOf the 145 patients with 22q11.2DS, 22 (15.2%) had epileptic seizures, 15 (10.3%) had developmental delay, and 5 (3.4%) had a psychiatric illness. Twelve patients with epilepsy were classified as genetic epilepsy whereas the remaining were classified as structural, including three with malformations of cortical development. Patients with epilepsy were more likely to display developmental delay (odds ratio=3.98; 95% confidence interval=1.5-10.5; p=0.005), and developmental delay was more common in patients with structural epilepsy than in those with genetic epilepsy.ConclusionsPatients with 22q11.2DS have a high risk of epilepsy, which in these cases is closely related to other NP manifestations. This implies that this specific genetic locus is critically linked to neurodevelopment and epileptogenesis.

A Case of Acute Inflammatory Demyelinating Polyradiculoneuropathy in a Patient with Systemic Lupus Erythematosus

Neuropsychiatric manifestations in patients with systemic lupus erythematosus are fairly common, with a prevalence of 37∼95%. Among 19 neuropsychiatric manifestations, acute inflammatory demyelinating polyradiculoneuropathy (AIDP) is quite rare, and is characterized by progressive, symmetric muscle weakness accompanied by absent or depressed deep tendon reflexes. Generally, plasma exchange and intravenous immunoglobulin are the main treatment modalities. Here, we report a case of AIDP in a 29-year-old SLE patient, who was fully recovered with a treatment of high-dose glucocorticoid and immunosuppressive agents. Ours case suggests that AIDP should be treated differently in SLE patients to avoid disastrous results.

AB0432 Overlapping neuropsychiatric manifestations in patients with systemic lupus erythematosus

BackgroundSystemic lupus erythematosus (SLE) is a systemic disease of the connective tissue that is characterized bydamages of all organs and systems. Lesions of the nervous system in relation to the...