Organic Syndrome Research Articles

Predictive Factors of the Use of Rituximab and Belimumab in Spanish Lupus Patients.

Objectives: To analyze the characteristics and the predictive factors of the use of rituximab and belimumab in daily practice in patients from the inception cohort Registro Español de Lupus (RELES). Material and methods: The study included 518 patients. We considered patients treated with biologics who received at least one dose of rituximab or belimumab, and possible indications of those manifestations registered at the same time or in the previous 2 months of the start of the therapy. Results: In our cohort, 37 (7%) patients received at least one biological treatment. Rituximab was prescribed in 26 patients and belimumab in 11. Rituximab was mainly prescribed for hemolytic anemia or thrombocytopenia (11 patients, 42%), lupus nephritis and neuropsychiatric lupus (5 patients each, 19%). Belimumab was mostly used for arthritis (8 patients, 73%). In the univariate analysis, the predictive factors at diagnosis for the use of biologic therapy were younger age (p = 0.022), a higher SLEDAI (p = 0.001) and the presence of psychosis (p = 0.011), organic mental syndrome (SOCA) (p = 0.006), hemolytic anemia (p = 0.001), or thrombocytopenia (p = 0.01). In the multivariant model, only younger age, psychosis, and hemolytic anemia were independent predictors of the use of biologics. Conclusions: Rituximab is usually given to patients with hematological, neuropsychiatric and renal involvement and belimumab for arthritis. Psychosis, hemolytic anemia and age at the diagnosis of lupus were independent predictive factors of the use of biological agents. Their global effects are beneficial, with a significant reduction in SLE activity and a low rate of side effects.

ДЕЛИРИЙ У БОЛЬНЫХ В КРИТИЧЕСКИХ СОСТОЯНИЯХ

Delirium is an acute, reversible organic mental syndrome characterized by disturbance of attention and cognitive function, increased or decreased psychomotor activity and a violation of the cycle of sleep and wakefulness. Delirium is a serious, complex problem that is associated with adverse outcomes, including an increase of mortality in medical hospitals. Given the scale of the problem, the solution should be a priority for clinicians and researchers. Delirium increases mortality in patients of ICU, duration of hospitalization, the cost of treatment and the risk of developing cognitive impairment.

Relationship of Cognition, Depression and Anxiety to Glycemic Control in Older Adults with Diabetes

Objective: This study aimed to assess the relationship of cognition, depression and anxiety to glycemic control in elders with diabetes. DM is a chronic medical condition. Its control depends on adherence to medical therapy and making decisions related to lifestyle changes. This decision making capacity is affected by many factors including cognition and psychological status. Design: It was a case control study. Setting: It was done in Ain Shams University Hospital inpatients and DM outpatient clinic, Cairo, Egypt. Participants: Of the one hundred diabetic patients aged ≥ 60 years, 50 had Hemoglobin A1c (HbA1c) ≥ 7.5 (cases) and 50 had Hb A1c 7.5 (controls). Measurements: Cognition was assessed using minimental status examination (MMSE) test, Mattis Organic Mental Syndrome Screening Examination (MOMSSE) and Cambridge Cognitive Examination (CAMCOG) test. Geriatric depression scale-15 (GDS-15) was performed for depression assessment, while anxiety was assessed by DSM IV criteria. Laboratory investigations included: fasting blood sugar (FBS), post-prandial blood sugar (PPBS), glycated haemoglobin (Hb A1c), low density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, and triglycerides (TG). Results: Significant difference was found between the two groups regarding scores of cognitive tests: MMSE score (p = 0.004); below average (p = 0.02) and average scores (p = 0.05) of MOMSSE; CAMCOG score (p = 0.015); and CAMCOG divided items score including orientation (p = 0.003), comprehension (p = 0.005), expression (p = 0.020), attention (p = 0.002), and abstraction (p = 0.008) as well as depression screening scores (P = 0.002). Using Receiver Operating Characteristic, CAMCOG had better sensitivity and MOMSSE had better specificity. Conclusion: Cognitive impairment was associated with poor glycemic control, and impairment in attention and abstraction, related to executive function, functions were found to be associated with poor glycemic control. These functions may be more needed in self management of DM and hence affected glycemic control. Depression was associated with poor glycemic control but anxiety was not.

N015 Dexmedetomidine in Management of Agitated Delirium in the Postoperative Cardiac Surgery Patient

Delirium is a reversible organic mental syndrome whose chief characteristic is anxiety. When excessive motor activity is associated with delirium it is referred to as agitated delirium. Delirium occurs in 80% of intensive care unit (ICU) patients and is associated with prolonged length of stay (LOS) and increased mortality. In the postoperative cardiac surgery patient agitated delirium can result in difficulty breathing causing ventilator dyssynchony, hypertension, tachycardia, and combative behaviour. The risk of prolonged ventilation and integrity of sternal incisions are very real complications.The diagnosis and pharmacological management of delirium is an important quality of care issue for the postop cardiac surgery patient. Pharmacoeconomics involves the right drug, the right dose, at the right time and by the right route. Typically neuroleptics such as haloperidol and a combination of benzodiazepines namely ativan are used to treat delirium but neither have any analgesia properties. Dexmedetomidine (Dex) has a rapid onset and provides sedation and analgesia with no respiratory depression and can be used as a bridge to weaning mechanical ventilation.A review of two challenging patients will be used to describe our experience using Dex as an alternative to managing postoperative delirium. The pharmacologic management in the cardiac surgical patient in these times of economic constraints has stimulated interest in early extubation or fast track pathways. A brief discussion on a study with Dex will be discussed. Delirium is a reversible organic mental syndrome whose chief characteristic is anxiety. When excessive motor activity is associated with delirium it is referred to as agitated delirium. Delirium occurs in 80% of intensive care unit (ICU) patients and is associated with prolonged length of stay (LOS) and increased mortality. In the postoperative cardiac surgery patient agitated delirium can result in difficulty breathing causing ventilator dyssynchony, hypertension, tachycardia, and combative behaviour. The risk of prolonged ventilation and integrity of sternal incisions are very real complications. The diagnosis and pharmacological management of delirium is an important quality of care issue for the postop cardiac surgery patient. Pharmacoeconomics involves the right drug, the right dose, at the right time and by the right route. Typically neuroleptics such as haloperidol and a combination of benzodiazepines namely ativan are used to treat delirium but neither have any analgesia properties. Dexmedetomidine (Dex) has a rapid onset and provides sedation and analgesia with no respiratory depression and can be used as a bridge to weaning mechanical ventilation. A review of two challenging patients will be used to describe our experience using Dex as an alternative to managing postoperative delirium. The pharmacologic management in the cardiac surgical patient in these times of economic constraints has stimulated interest in early extubation or fast track pathways. A brief discussion on a study with Dex will be discussed.

Are atypical depression, borderline personality disorder and bipolar II disorder overlapping manifestations of a common cyclothymic diathesis?

The constructs of atypical depression, bipolar II disorder and borderline personality disorder (BPD) overlap. We explored the relationships between these constructs and their temperamental underpinnings. We examined 107 consecutive patients who met DSM-IV criteria for major depressive episode with atypical features. Those who also met the DSM-IV criteria for BPD (BPD+), compared with those who did not (BPD-), had a significantly higher lifetime comorbidity for body dysmorphic disorder, bulimia nervosa, narcissistic, dependent and avoidant personality disorders, and cyclothymia. BPD+ also scored higher on the Atypical Depression Diagnostic Scale items of mood reactivity, interpersonal sensitivity, functional impairment, avoidance of relationships, other rejection avoidance, and on the Hopkins Symptoms Check List obsessive-compulsive, interpersonal sensitivity, anxiety, anger-hostility, paranoid ideation and psychoticism factors. Logistic regression revealed that cyclothymic temperament accounted for much of the relationship between atypical depression and BPD, predicting 6 of 9 of the defining DSM-IV attributes of the latter. Trait mood lability (among BPD patients) and interpersonal sensitivity (among atypical depressive patients) appear to be related as part of an underlying cyclothymic temperamental matrix.

Definition und epidemiologische Übersicht des Delirs bei älteren Patienten

Delirium in the elderly is a transient, mostly reversible organic-mental syndrome with acute confusion, cognitive impairment, decline of vigilance, increased or reduced psychomotor activity and a disturbed sleep-wake-cycle. The etiology of delirium is multifactorial. The prevalence of delirium at hospital admission ranges from 14 to 24 percent. In addition, the incidence of developing delirium during hospitalisation ranges from 5 to 56 percent. Further, a close association between delirium and increased mortality rate has been documented. Unfortunately, if not specifically looked for, delirium often remains undiscovered by patients, physicians and nurses. Recent scientific work demonstrates the important effects of delirium both on an individual and societal level, as well as on the health-care system.

Toxoplasmosis encephalitis in patients with AIDS

Toxoplasmosis encephalitis developed in three male homosexuals with AIDS. Clinical symptoms of encephalitis began with a nonspecific organic mental syndrome. In two cases there developed late focal symptoms. There were light to moderately severe generalized EEG changes with additional focal signs. CSF findings and toxoplasmosis titres were not diagnostically altered. Computed tomography demonstrated multiple areas of decreased density in cortex and cerebellum. Administration of pyrimethamine and sulfamethoxydiazine to the three patients brought about clinical improvement within a few days and regression of abnormal CT changes within a few weeks of onset of treatment. One patient died after an encephalitis recurrence: autopsy demonstrated toxoplasma pseudocysts in immediate proximity to small necrotic foci in the brain. The possibility of toxoplasma encephalitis should be considered in AIDS patients who develop an organic mental syndrome. Often the diagnosis can only be made after response to a trial of toxoplasmosis treatment.

Effect of Cataract Surgery on Cognitive Function in Older Adults

To assess whether cataract surgery has an effect on cognitive function in older adults. Longitudinal. Assessment of patients seen in eye clinics. Patients with no cataract (n=92), patients with cataract who elected surgery (n=122), and patients with cataract who declined surgery (n=87). At baseline and 1-year follow-up visits, the following information was obtained: demographic, health behavior, general health status, medication use, depressive symptoms, cognitive function, and visual function information. This information was compared within and between groups at baseline and follow-up visits. Mattis Organic Mental Syndrome Screening Examination scores at baseline and follow-up varied across the three groups, with the cataract/no surgery group having the highest scores (more cognitive impairment) and the no-cataract group having the lowest scores (less cognitive impairment). For the within-group analysis, at follow-up, the cataract/no surgery group and the cataract/surgery group had significantly less cognitive impairment (P<.001), whereas the no-cataract group experienced no change. For those with cataract, there were no associations between changes in visual function and cognitive function. Improvement in cognitive function may occur after cataract surgery but cannot be attributed to the cataract surgery per se or to improved visual function. Clinicians may find this information useful when discussing the nonvisual outcomes of cataract surgery with patients.

Mitochondrial DNA sequence analysis of patients with ‘atypical psychosis’

Although classical psychopathological studies have shown the presence of an independent diagnostic category, 'atypical psychosis', most psychotic patients are currently classified into two major diagnostic categories, schizophrenia and bipolar disorder, by the Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria. 'Atypical psychosis' is characterized by acute confusion without systematic delusion, emotional instability, and psychomotor excitement or stupor. Such clinical features resemble those seen in organic mental syndrome, and differential diagnosis is often difficult. Because patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) sometimes show organic mental disorder, 'atypical psychosis' may be caused by mutations of mitochondrial DNA (mtDNA) in some patients. In the present study whole mtDNA was sequenced for seven patients with various psychotic disorders, who could be categorized as 'atypical psychosis'. None of them had known mtDNA mutations pathogenic for mitochondrial encephalopathy. Two of seven patients belonged to a subhaplogroup F1b1a with low frequency. These results did not support the hypothesis that clinical presentation of some patients with 'atypical psychosis' is a reflection of subclinical mitochondrial encephalopathy. However, the subhaplogroup F1b1a may be a good target for association study of 'atypical psychosis'.

Delirium: la confusión de los clínicos

Delirium or acute confusional state is a condition that lies within the boundaries of psychiatry and other medical specialties. It is defined as a syndrome characterized by a fluctuating cognitive impairment of acute onset. The pathogenesis is multifactorial and it frequently appears in elderly patients admitted to general hospitals. Delirium carries a high mortality and it prolongs hospital stay. Its diagnosis if often overlooked and the treatment is inadequate or belated. This article discusses the most efficient procedures to diagnose and treat delirium. The review was based on a systematic search in the literature using the key words delirium, acute mental syndrome, acute confusional state and organic mental syndrome. Articles were selected according to their relevance and methodological accuracy.

Pharmacologic management of integrative brain failure.

Integrative brain failure is often a comorbidity of critical illness, and although not uncommon, is perhaps the least understood of all the various organ failure phenomena. Factors that contribute to integrative brain failure include inadequate management of pain, stress, anxiety, and the several underlying mechanisms that create agitation in the intensive care unit patient. Delirium, a resultant organic mental syndrome, is reversible when promptly recognized and aggressively managed. The nurse who is astute in clinical assessments and skillful in the management of the environment of care can prevent and control states of anxiety, irritability, restlessness, and sleep disturbances that contribute to the development of delirium.

Early recognition of delirium: review of the literature

• This review focuses on delirium and early recognition of symptoms by nurses.• Delirium is a transient organic mental syndrome characterized by disturbances in consciousness, thinking and memory. The incidence in older hospitalized patients is about 25%.• The causes of delirium are multi‐factorial; risk factors include high age, cognitive impairment and severity of illness.• The consequences of delirium include high morbidity and mortality, lengthened hospital stay and nursing home placement.• Delirium develops in a short period and symptoms fluctuate, therefore nurses are in a key position to recognize symptoms.• Delirium is often overlooked or misdiagnosed due to lack of knowledge and awareness in nurses and doctors. To improve early recognition of delirium, emphasis should be given to terminology, vision and knowledge regarding health in ageing and delirium as a potential medical emergency, and to instruments for systematic screening of symptoms.

Early recognition of delirium: review of the literature.

This review focuses on delirium and early recognition of symptoms by nurses. Delirium is a transient organic mental syndrome characterized by disturbances in consciousness, thinking and memory. The incidence in older hospitalized patients is about 25%. The causes of delirium are multi-factorial; risk factors include high age, cognitive impairment and severity of illness. The consequences of delirium include high morbidity and mortality, lengthened hospital stay and nursing home placement. Delirium develops in a short period and symptoms fluctuate, therefore nurses are in a key position to recognize symptoms. Delirium is often overlooked or misdiagnosed due to lack of knowledge and awareness in nurses and doctors. To improve early recognition of delirium, emphasis should be given to terminology, vision and knowledge regarding health in ageing and delirium as a potential medical emergency, and to instruments for systematic screening of symptoms.

Visual risk factors for driving difficulty among older drivers

This study sought to evaluate associations between visual function and self-reported difficulty with driving tasks. Drivers ( N=384) between the ages of 55 and 85 were selected from ophthalmology practices and optometry clinics; three out of four of the sample had cataracts and the remaining were cataract-free. Information on driving exposure and difficulty was obtained via self-report. Visual functional status of all participants was measured with respect to acuity, contrast sensitivity, disability glare and useful field of view. Cognitive impairment was evaluated using the Mattis Organic Mental Syndrome Screening Examination. The results show a pattern of difficulty in high-risk driving situations among those with decreased visual acuity and contrast sensitivity, even after adjustments for age, gender, weekly mileage, and cognitive impairment.

Constant Observation in the General Hospital

Constant observation (CO) is a technique in which continuous one-to-one monitoring is used to assure the safety and well-being of an individual patient or others. This study reviewed 115 patient charts in a tertiary-care hospital to determine the correlates and predictors of the financial cost of CO. The mean duration for CO was 13.9 days with a median of 7.5 days. The cost average was $3,415 per incident with a range of $144-$68,500. The median cost was $1,872. The most common diagnosis was organic mental syndrome. Significant predictors of CO were disorientation, psychiatric medication used, and absence of alcohol use.

Treatment of ataxia in isolated vitamin E deficiency caused by α-tocopherol transfer protein deficiency

Dysfunction of the α-tocopherol transfer protein causes ataxia with isolated vitamin E deficiency. A 14-year-old male patient presented with ataxia and mental symptoms caused by a homozygous (552G→A) α-tocopherol transfer protein mutation. After initiation of high-dosage α-tocopherol therapy, the organic mental syndrome disappeared and cognitive function improved rapidly. Neurologic recovery, however, was slow and incomplete. (J Pediatr 1999;134:240-4)

Development and preliminary validation of the Concise Neuropsychological Screening Inventory (CNSI): A clinical tool for use in psychiatric settings

We describe the development and preliminary validation of the Concise Neuropsychological Screening Inventory (CNSI), designed to afford clinical psychologists working in psychiatric settings a simple, rapid, and objective assessment of 10 vital left- and right-hemisphere brain functions: (1) Receptive and Expressive Language, (2) Orientation, (3) Attention/Concentration/Immediate Memory, (4) Recent Auditory and Visual Memory, (5) Remote Memory, (6) Motor/Sensory/Tactile Functioning, (7) Visual/Spatial/Motor Integration, (8) Academic Functioning, (9) Intellectual Processes, and (10) Judgment and Reasoning. Preliminary findings suggest that the CNSI can discriminate patients diagnosed with organic mental syndrome from patients with various psychiatric disorders, including chronic schizophrenia (i.e., specificity in screening). Moreover, with regard to predicting neuropsychological differences among various diagnostic groups, the CNSI is superior to some of the most commonly employed tests by psychologists in psychiatric settings (e.g., WAIS-R Digit Span, Digit Symbol, and Bender-Gestalt).

Prevalence of psychological morbidity in terminally-ill cancer patients

The aim of this study was to obtain objective data on the type and frequency of psychological and psychiatric problems in terminally ill patients and determine the influence of various factors on prevalence of adjustment disorder (ie., sociodemographics, awareness of the diagnosis, clinical variables, performance status, degree of pain). Between 1990–1993 410 patients attending Gdańsk Hospice were examined. The following results were obtained; 40% showed a normal response to cancer, and, of the remaining 60%, 37% showed psychological morbidity connected with the carcinoma. Better adaptation to the disease was observed in elderly patients who were usually unaware of their medical status. In the group with an organic mental syndrome most were in the final stage of their terminal illness. Adaptation disorders appeared mostly in younger women under 60 years of age, the more highly educated, those with breast cancer and those who were aware of the medical situation. It was noted that such patients made more complaints of severe pain and tended to be less tolerant of pain. This group therefore requires the most intensive emotional support, counselling or psychotherapy.

Prevalence of psychological morbidity in terminally‐ill cancer patients

The aim of this study was to obtain objective data on the type and frequency of psychological and psychiatric problems in terminally ill patients and determine the influence of various factors on prevalence of adjustment disorder (ie., sociodemographics, awareness of the diagnosis, clinical variables, performance status, degree of pain). Between 1990–1993 410 patients attending Gdańsk Hospice were examined. The following results were obtained; 40% showed a normal response to cancer, and, of the remaining 60%, 37% showed psychological morbidity connected with the carcinoma. Better adaptation to the disease was observed in elderly patients who were usually unaware of their medical status. In the group with an organic mental syndrome most were in the final stage of their terminal illness. Adaptation disorders appeared mostly in younger women under 60 years of age, the more highly educated, those with breast cancer and those who were aware of the medical situation. It was noted that such patients made more complaints of severe pain and tended to be less tolerant of pain. This group therefore requires the most intensive emotional support, counselling or psychotherapy.

Relative Rates of Dementia By Multiple Case Definitions, Over Two Prevalence Periods, In Three Sociocultural Groups

Relative Rates of Dementia By Multiple Case Definitions, Over Two Prevalence Periods, In Three Sociocultural Groups