Psychiatric Features Research Articles

Neuropsychological correlates of visual hallucinatory phenomena in Lewy body disease

AbstractObjectivesVisual hallucinations (VH) ranging from minor to complex, are the most common psychiatric feature of Lewy Body Disease (LBD). Despite their high prevalence and poor prognostic implications instigating extensive research, the precise mechanisms underlying VH remain unclear. Cognitive impairment (CI) is a risk factor and a consistent correlate of VH in LBD. To help shed light on their underlying mechanisms, this study investigates the pattern of CI across the spectrum of VH in LBD.Methods30 LBD patients with minor VH (MVH), 13 with complex VH (CVH) and 32 without VH were retrospectively compared on the domains of higher‐order visual processing, memory, language and executive functioning. The VH groups were further stratified to investigate whether phenomenological subtypes have distinct cognitive correlates.ResultsLBD patients with CVH were impaired on the visuo‐spatial and executive functioning domains relative to controls. LBD patients with MVH were also impaired on the visuo‐spatial domain. No differences emerged in cognitive domains affected between patient groups endorsing specific hallucinatory phenomena.ConclusionA pattern of CI indicating fronto‐subcortical dysfunction in combination with posterior cortical involvement is implicated in the genesis of CVH. Moreover, this posterior cortical dysfunction may precede the occurrence of CVH as indicated by selective visuo‐spatial deficits in LBD patients with MVH.

Psychiatric features in NMDAR and LGI1 antibody-associated autoimmune encephalitis.

Patients with autoimmune encephalitis (AE) often developed psychiatric features during the disease course. Many studies focused on the psychiatric characteristic in anti-NMDAR encephalitis (NMDAR-E), but anti-LGI1 encephalitis (LGI1-E) had received less attention regarding the analysis of psychiatric features, and no study compared psychiatric characteristic between these two groups. The clinical data of AE patients (62 NMDAR-E and 20 LGI1-E) who developed psychiatric symptoms were analyzed in this study. In NMDAR-E, the most common higher-level feature was "behavior changes" (60/62, 96.8%) and the lower-level feature "incoherent speech" was observed in 33 patients (33/62, 53.2%), followed by "agitation" (29/62, 46.8%) and "incongruent laughter/crying" (20/62, 32.3%). Similar to NMDAR-E, "behavior changes" was most common in LGI1-E (17/20, 85.0%), but the features of suicidality, eating, and obsessive-compulsive were not reported. The top three lower-level features were visual hallucinations (9/20, 45.0%), incoherent speech (8/20, 40.0%), and mood instability (7/20, 35.0%). The comparative study found that "incongruent laughter/crying", in lower-level features, was more frequently observed in NMDAR-E (32.3% vs. 0%, p = 0.002). Moreover, the Bush Francis Catatonia Rating Scale (BFCRS) assessing the catatonic symptoms in NMDAR-E were higher than LGI1-E, but the 18 item-Brief Psychiatric Rating Scale (BPRS-18) showed no difference in the two groups. In summary, both NMDAR-E and LGI1-E often developed psychiatric symptoms. In contrast with LGI1-E, the psychiatric feature "incongruent laughter/crying" was more frequently associated with NMDAR-E, and catatonic symptoms were more severe in NMDAR-E.

Mood disturbances in Parkinson's disease: From prodromal origins to application of animal models

Parkinson's disease (PD) is a complex illness with a constellation of environmental insults and genetic vulnerabilities being implicated. Strikingly, many studies only focus on the cardinal motor symptoms of the disease and fail to appreciate the major non-motor features which typically occur early in the disease process and are debilitating. Common comorbid psychiatric features, notably clinical depression, as well as anxiety and sleep disorders are thought to emerge before the onset of prominent motor deficits. In this review, we will delve into the prodromal stage of PD and how early neuropsychiatric pathology might unfold, followed by later motor disturbances. It is also of interest to discuss how animal models of PD capture the complexity of the illness, including depressive-like characteristics along with motor impairment. It remains to be determined how the underlying PD disease processes contributes to such comorbidity. But some of the environmental toxicants and microbial pathogens implicated in PD might instigate pro-inflammatory effects favoring α-synuclein accumulation and damage to brainstem neurons fueling the evolution of mood disturbances. We posit that comprehensive animal-based research approaches are needed to capture the complexity and time-dependent nature of the primary and co-morbid symptoms. This will allow for the possibility of early intervention with more novel and targeted treatments that fit with not only individual patient variability, but also with changes that occur over time with the evolution of the disease.

Refining patterns of MEF2C effects in white matter microstructure and psychiatric features.

Several GWAS reported Myocyte Enhancer Factor 2 C (MEF2C) gene associations with white matter microstructure and psychiatric disorders, and MEF2C involvement in pathways related to neuronal development suggests a common biological factor underlying these phenotypes. We aim to refine the MEF2C effects in the brain relying on an integrated analysis of white matter and psychiatric phenotypes in an extensively characterized sample. This study included 870 Brazilian adults (47% from an attention-deficit/hyperactivity disorder outpatient clinic) assessed through standardized psychiatric interviews, 139 of which underwent a magnetic resonance imaging scan. We evaluated variants in the MEF2C region using two approaches: 1) a gene-wide analysis, which uses the sum of polymorphism effects, and 2) SNP analyses, restricted to the independent variants within the gene. The outcomes included psychiatric phenotypes and fractional anisotropy for brain images. Results: The gene-wide analyses pointed to a nominal association between MEF2C and the Temporal Portion of the Superior Longitudinal Fasciculus (SLFTEMP). The SNP analysis identified four independent variants significantly associated with SLFTEMP and one (rs4218438) with Substance Use Disorder. Our findings showing specific associations of MEF2C variants with temporal-frontal circuitry components may help to elucidate how the MEF2C gene underlies a broad range of psychiatric phenotypes since these regions are relevant to executive and cognitive functions.

Prospects of etiopathogenetic treatment of Huntington’s disease

Huntington’s disease is a serious inherited neurodegenerative disorder characterized by of motor, cognitive and psychiatric features. The disease is caused by an abnormally expanded CAG repeat expansion in the HTT gene and the production of mutant huntingtin protein.The disease usually manifests in adulthood, but the manifestation in childhood and youth is also described, which is noted in 5–10 % of cases. The disease predominantly affects the neostriatum, resulting in a characteristic clinical picture.The most promising approaches to etiotropic therapy of Huntington’s disease are a number of DNA- (CRISPR/Cas9 system) and RNA-directed methods (antisense oligonucleotides, RNA interference), methods that directly reduce the level of mutant gentingtin (chimera molecules), as well as approaches based on inactivating the DNA mismatch repair system using the FAN1 enzyme.

Abstract Number ‐ 217: Case Study: Snowball strokes

Introduction 55 year old RH female, PMH of hypothyroidism and gastric bypass who presented with complaints of 1–2 weeks of “feeling foggy in the head”, dizziness, and unsteady gait. The patient’s husband said she had delayed responses. She denied headache, vision change, or hearing loss. Exam was without focal neurologic deficit, NIHSS of 0.Though CTA head and neck were unremarkable, MRI Brain showed multiple scattered small acute or subacute infarcts involving the corpus callosum. This distribution was thought to suggest a central embolic source. The patient was admitted for stroke workup which was unrevealing including: Normal echocardiogram including bubble study. Her symptoms progressed and she was unable to find outpatient follow up. Two weeks later, she presented again but this time with progressive generalized weakness. At the time of her initial discharge, the patient was ambulatory with her walker, however upon re‐admission the patient required a wheelchair. Exam showed flaccid bilateral lower extremities, brisk reflexes, bilateral Hoffman’s and Babinski signs.Repeat MRI Brain was concerning for Susac syndrome with new lesions in the corpus callosum. CSF showed pleocytosis with markedly elevated protein (WBC 8, protein 153, glucose 55). Treatment with Solu‐Medrol 1000 mg q12h IV, then IVIG 0.4 kg/mg/day both for 5 days, Rituximab 1000mg for 2 days, then transition to prednisone 80 mg /day and CellCept 1000mg BID. She returned 14 days after with confusion, regression of prior gait improvement, and repeat MRI Brain showed additional new multifocal strokes. She repeated 3 days of 1000mg IV Solu‐Medrol, then was treated with cyclophosphamide due to clinical progression. Fluorescein angiography showed evidence of branch retinal artery occlusions bilaterally. She was placed on a prednisone taper from 80mg/day to 40mg/day over the course of the 2 months, with the plan to continue Cellcept 1000mg BID for 2 years. Methods NA‐ Single case study Results NA‐Single case study Conclusions Susac syndrome is an autoimmune disorder, affecting microvasculature of the brain, retina and cochlea. A triad of symptoms: encephalopathy, branch retinal artery occlusions, and hearing loss is classic, though only 13% have the complete triad at onset. It is often associated with headaches, psychiatric features (paranoia), bilateral cochlear hearing loss, and vertigo. It typically occurs in women 20–40 years of age. Brain MRI WO shows white‐matter disturbance, frequently mistaken for Multiple Sclerosis, however the main difference is that the corpus callosum is always affected with lesions that resemble “snowballs”, or “holes”. Treatment for Susac syndrome is immunosuppression, with high‐dose corticosteroids, also with IVIG, Mycophenolate mofetil, and Cyclophosphamide.

Psychiatric Symptoms & Misdiagnosis Of Frontotemporal Dementia: A Case Report

IntroductionFrontotemporal dementia (FTD) is the second most common type of dementia seen between 45-65 years of age and affects the frontal and/or temporal lobes. FTD is clinically characterized by progressively the change in behavior, personality, and language dysfunctions. Clinical features of FTD include restlessness, disinhibition, apathy, blunted affect, avolition, social withdrawal, impulsiveness, and loss of executive function. Most patients with FTD act as socially inappropriate behaviors, not talking much, compulsive-like acts, poor insight, and psychiatric features including hallucinations and paranoid delusions. According to symptoms, the diagnosis of FTD may be confused with depression, mania, or schizophrenia.ObjectivesIn this case report, we wanted to draw attention that FTD should be considered in the differential diagnosis of late-onset psychosis.MethodsA 53-year-old female, married, uneducated, and not having children patient has applied to our clinic with complaints, that started a year ago, about social withdrawal, activity, decreased sense of purpose, neglecting personal hygiene, not eating well, and acting inappropriately and impulsively.The patient reported that she was walking out of the house for hours, having profanity speeches, and forgetfulness.She was admitted to the psychiatry hospital a year ago and discharged with a diagnosis of bipolar disorder.Brain MRI showed atrophy of frontal and anterior temporal structures bilaterally. PET scan demonstrated left frontal, parietal, and temporal hypo perfusion of the brain.In our clinical observation, she had apathy, inappropriate jokes, lack of eye contact, flat affect, lack of gesturing when communicating, unable to respond to questions, and visual hallucinations.ResultsDue to the similarity of the clinical resemblance of BPAD and FTD, the diagnosis of FTD can be confusing. In this case, amnesia and sudden onset of the symptoms with rapid destruction may help the diagnosis of FTD.Psychosis symptoms in our clinical observation also suggested the diagnosis of psychosis. However, its atypical course and early-onset psychosis symptoms brought us closer to organic pathology. Investigations of structural and functional brain imaging may help support the diagnosis.Image:Image 2:ConclusionsPsychiatric symptoms in FTD may cause misdiagnosis. Organic pathologies should be kept in mind, especially in late and sudden onset symptoms.Disclosure of InterestNone Declared

Neuropsychiatric presentations of hypocortisolaemia - a literature review

IntroductionPatient populations in psychiatry can have low cortisol for many reasons such as adrenalitis, secondary adrenal insufficiency and poor compliance with glucocorticoid replacement therapies. A literature review in 2005 highlighted the prevalence of neuropsychiatric features in those with low cortisol. Unfortunately, this has received little to no attention in the wider literature and hypocortisolaemia is often overlooked as a cause of neuropsychiatric presentations in clinical practice.ObjectivesReview the literature to understand what psychiatric features hypocortisolaemic patients present with and any themes between cases.MethodsA literature review on neuropsychiatric presentations of hypocortisolaemia was performed using PUBMED and Google Scholar. English language studies from 2005 to October 2022 were included and searched for using the following term: (Hypocortisolaemia* OR “Low-cortisol” OR Addisons OR Adrenal-crisis OR “Adrenal insufficiency”) AND (Psychiatric OR Hallucination OR Neuropsychiatric OR “Neuropsychiatric symptoms” OR Pyschosis*). Citations in relevant papers were also reviewed.Results7 case reports were identified, 5 male (71%) and 2 female (29%) with an average age of 42 (28-63). The cause was identified as Addisons’ disease in 4 patients (57%) and secondary adrenal insufficiency in 3 patients (43%). Hallucination or delusion was the most prevalent symptom with 86% of patients initially presenting with it, followed by depression (43%) and speech abnormality (14%). In all cases, basic blood sets (Full blood count, urea & electrolytes and liver function tests) were done in an initial assessment. 6 patients presented with hyponatraemia, and 4 of these patients had hyponatraemia as their only abnormality within their U&E profile. In one patient this delayed their diagnosis by several years. One patient developed psychosis again when being treated with glucocorticoid therapy. In 4 patients, adrenal pathology was not suspected and cortisol was not tested until initial differentials were investigated and ruled out.ConclusionsFurther case reports highlight psychosis being a key feature of hypocortisolaemia that presents initially with neuropsychiatric symptoms. Cortisol levels should be considered in initial investigations of psychosis if hyponatraemia is discovered even in the absence of hyperkalaemia to help aid an earlier diagnosis. A rebound psychosis may be seen once starting glucocorticoid therapy. Additionally, there should be consideration of neuropsychiatric monitoring in stable psychiatric patients undergoing cortisol treatment.Disclosure of InterestNone Declared

Encephalitis matters

Mental-health issues are the focus of this year's World Encephalitis Day, on Feb 22. On this date, in line with their Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders, WHO will release a meeting report on Why Encephalitis Matters.1WHO. Why encephalitis matters: meeting report (in press).Google Scholar Suicide is one of the top three causes of death in children and young adults.2WHOSuicide.https://www.who.int/news-room/fact-sheets/detail/suicideDate: June 17, 2021Date accessed: January 25, 2023Google Scholar In people with a neurological disorder, suicide rates might double those of people without a neurological disorder.3Erlangsen A Stenager E Conwell Y et al.Association Between Neurological Disorders and Death by Suicide in Denmark.JAMA. 2020; 323: 444-454Crossref PubMed Scopus (46) Google Scholar In fact, more than 37% of survivors of encephalitis report that they had thought about or attempted suicide4Abdat Y Butler M Zandi M et al.Mental health outcomes of encephalitis, an international web-based study.medRxi. 2023; (published online Feb 7.) (preprint).https://doi.org/10.1101/2023.02.03.23285344Google Scholar and about 12% of patients affected by autoimmune encephalitis had suicidal behaviours during the early stages of their illness, and nearly half of them carried out a suicide attempt.5Tellez-Martinez A Restrepo-Martinez M Espinola-Nadurille M et al.Suicidal thoughts and behaviors in anti-NMDAR encephalitis: psychopathological features and clinical outcomes.J Neuropsychiatry Clin Neurosci. 2023; (in press).Google Scholar The mental health issues associated with neurological diseases are usually treatable,6Gold SM Köhler-Forsberg O Moss-Morris R et al.Comorbid depression in medical diseases.Nat Rev Dis Primers. 2020; 6: 69Crossref PubMed Scopus (116) Google Scholar but the psychiatric sequelae of encephalitis have been far less investigated than neurological outcomes; hence, the need for more research addressing their nature, causes, and effects.7Hansen N Timäus C Autoimmune encephalitis with psychiatric features in adults: historical evolution and prospective challenge.J Neural Transm. 2021; 128: 1-14Crossref PubMed Scopus (7) Google Scholar Mental health issues following encephalitis might be caused by the biological effects of inflammation on the brain during the acute stages of the disease, by psychological responses to traumatic ill-health, or by adverse effects of treatments. Stigma about mental health can be a barrier for patients and families to speaking up, and we hope that, on this World Encephalitis Day, we get closer to addressing it. Famous landmarks and buildings around the world have agreed to light up in red on Feb 22, from Niagara Falls in Canada to the Dancing House in Prague, Czech Republic. Careful risk assessment can help reduce the impact of suicidal thoughts and behaviours; anyone affected by encephalitis and mental health concerns should know that these conditions are often treatable.

Deep phenotypic analysis of psychiatric features in genetically defined cohorts: application to XYY syndrome

BackgroundRecurrent gene dosage disorders impart substantial risk for psychopathology. Yet, understanding that risk is hampered by complex presentations that challenge classical diagnostic systems. Here, we present a suite of generalizable analytic approaches for parsing this clinical complexity, which we illustrate through application to XYY syndrome.MethodWe gathered high-dimensional measures of psychopathology in 64 XYY individuals and 60 XY controls, plus additional interviewer-based diagnostic data in the XYY group. We provide the first comprehensive diagnostic description of psychiatric morbidity in XYY syndrome and show how diagnostic morbidity relates to functioning, subthreshold symptoms, and ascertainment bias. We then map behavioral vulnerabilities and resilience across 67 behavioral dimensions before borrowing techniques from network science to resolve the mesoscale architecture of these dimensions and links to observable functional outcomes.ResultsCarriage of an extra Y-chromosome increases risk for diverse psychiatric diagnoses, with clinically impactful subthreshold symptomatology. Highest rates are seen for neurodevelopmental and affective disorders. A lower bound of < 25% of carriers are free of any diagnosis. Dimensional analysis of 67 scales details the profile of psychopathology in XYY, which survives control for ascertainment bias, specifies attentional and social domains as the most impacted, and refutes stigmatizing historical associations between XYY and violence. Network modeling compresses all measured symptom scales into 8 modules with dissociable links to cognitive ability, adaptive function, and caregiver strain. Hub modules offer efficient proxies for the full symptom network.ConclusionsThis study parses the complex behavioral phenotype of XYY syndrome by applying new and generalizable analytic approaches for analysis of deep-phenotypic psychiatric data in neurogenetic disorders.

A Century of Progress on Wilson Disease and the Enduring Challenges of Genetics, Diagnosis, and Treatment.

Wilson disease (WD) is a rare, inherited metabolic disorder manifested with varying clinical presentations including hepatic, neurological, psychiatric, and ophthalmological features, often in combination. Causative mutations in the ATP7B gene result in copper accumulation in hepatocytes and/or neurons, but clinical diagnosis remains challenging. Diagnosis is complicated by mild, non-specific presentations, mutations exerting no clear effect on protein function, and inconclusive laboratory tests, particularly regarding serum ceruloplasmin levels. As early diagnosis and effective treatment are crucial to prevent progressive damage, we report here on the establishment of a global collaboration of researchers, clinicians, and patient advocacy groups to identify and address the outstanding challenges posed by WD.

Augmenting DSM-5 diagnostic criteria with self-attention-based BiLSTM models for psychiatric diagnosis

BackgroundMost previous studies make psychiatric diagnoses based on diagnostic terms. In this study we sought to augment Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnostic criteria with deep neural network models to make psychiatric diagnoses based on psychiatric notes. MethodsWe augmented DSM-5 diagnostic criteria with self-attention-based bidirectional long short-term memory (BiLSTM) models to identify schizophrenia, bipolar, and unipolar depressive disorders. Given that the diagnostic criteria for psychiatric diagnosis include a certain symptom profile and functional impairment, we first extracted psychiatric symptoms and functional features with two approaches, including a lexicon-based approach and a dependency parsing approach. Then, we incorporated free-text discharge notes and extracted features for psychiatric diagnoses with the proposed models. ResultsThe micro-averaged F1 scores of the two automatic annotation approaches were greater than 0.8. BiLSTM models with self-attention outperformed the rule-based models with DSM-5 criteria in the prediction of schizophrenia and bipolar disorder, while the latter outperformed the former in predicting unipolar depressive disorder. Approaches for augmenting DSM-5 criteria with a self-attention-based BiLSTM outperformed both pure rule-based and pure deep neural network models. In terms of classification of psychiatric diagnoses, we observed that the performance for schizophrenia and bipolar disorder was acceptable. ConclusionThis DSM-5-augmented deep neural network models showed good performance in identifying psychiatric diagnoses from psychiatric notes. We conclude that it is possible to establish a model that consults clinical notes to make psychiatric diagnoses comparably to physicians. Further research will be extended to outpatient notes and other psychiatric disorders.

Parallel learning and cognitive flexibility impairments between Fmr1 knockout mice and individuals with fragile X syndrome.

Fragile X Syndrome (FXS) is a monogenic condition that leads to intellectual disability along with behavioral and learning difficulties. Among behavioral and learning difficulties, cognitive flexibility impairments are among the most commonly reported in FXS, which significantly impacts daily living. Despite the extensive use of the Fmr1 knockout (KO) mouse to understand molecular, synaptic and behavioral alterations related to FXS, there has been limited development of translational paradigms to understand cognitive flexibility that can be employed in both animal models and individuals with FXS to facilitate treatment development. To begin addressing this limitation, a parallel set of studies were carried out that investigated probabilistic reversal learning along with other behavioral and cognitive tests in individuals with FXS and Fmr1 KO mice. Fifty-five adolescents and adults with FXS (67% male) and 34 age- and sex-matched typically developing controls (62% male) completed an initial probabilistic learning training task and a probabilistic reversal learning task. In males with FXS, both initial probabilistic learning and reversal learning deficits were found. However, in females with FXS, we only observed reversal learning deficits. Reversal learning deficits related to more severe psychiatric features in females with FXS, whereas increased sensitivity to negative feedback (lose:shift errors) unexpectedly appear to be adaptive in males with FXS. Male Fmr1 KO mice exhibited both an initial probabilistic learning and reversal learning deficit compared to that of wildtype (WT) mice. Female Fmr1 KO mice were selectively impaired on probabilistic reversal learning. In a prepotent response inhibition test, both male and female Fmr1 KO mice were impaired in learning to choose a non-preferred spatial location to receive a food reward compared to that of WT mice. Neither male nor female Fmr1 KO mice exhibited a change in anxiety compared to that of WT mice. Together, our findings demonstrate strikingly similar sex-dependent learning disturbances across individuals with FXS and Fmr1 KO mice. This suggests the promise of using analogous paradigms of cognitive flexibility across species that may speed treatment development to improve lives of individuals with FXS.

Anti-NMDA Receptor Autoimmune Encephalitis: Diagnosis and Management Strategies.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most recognized form of autoimmune encephalitis. It is characterized by a constellation of neurologic and psychiatric features along with positive NMDAR antibody, which is more sensitive and specific in CSF than serum. All patients should be screened at least once for neoplasm, with ovarian teratoma being found in most tumor-related cases. In the acute phase, first-line immunotherapy, often a combination of high-dose steroids, immunoglobulins, and/or plasma exchange, is strongly recommended. When first-line therapy fails, escalation to second-line immunotherapy, particularly rituximab, can further improve outcomes and prevent relapses. In refractory cases, additional complementary immunotherapies, such as cyclophosphamide, bortezomib and/or tocilizumab may be considered. Relapses occur in 10-30% of cases, mostly within the first two years from onset. Individuals should be followed up to determine if chronic maintenance therapy is required.

Kleine Levin Syndrome: Is it just a sleep disorder? A review of psychiatric features during symptomatic and asymptomatic periods

Kliene Levin syndrome (KLS) is a peculiar sleep disorder of youth, consisting of idiopathic periodic hypersomnia attacks associated with behavioral and sometimes psychiatric symptoms during an attack. With the growing awareness of the syndrome and a steep rise in published cases, it became evident that psychiatric abnormalities may be present before the onset of hypersomnic events, in between events and first appear following years after complete recovery. Those observations suggest that psychiatric morbidity may be part of the symptomatology of KLS. In the present paper the results of a systematic literature search of publications using the key words KLS with psychiatric features, Atypical KLS, KLS like, KLS mimic and sleeping beauty syndrome will be discussed, in attempt to support the view that KLS is indeed a neuropsychiatric disorder and not just a sleep disorder of youth. Moreover, the recognition that KLS might imitate psychosis and other psychiatric disorders in which periodic hypersomnia is present, may decrease the number of KLS patients in whom the correct diagnosis may be delayed or totally missed.

Social cognition deficits are associated with lower quality of life in cervical dystonia: A single centre study

Background and objectivesPatients with cervical dystonia (CD) demonstrate significant non-motor symptoms including sensory, psychiatric and cognitive features. It has been shown that the non-motor symptoms have a major influence on quality of life. Social cognition, particularly deficits in Theory of Mind (ToM), can affect the development of interpersonal relationships, understanding of social situations and can affect patient outcomes.We used the “Faux Pas” measure of social cognition to assess ToM in patients with CD and compared this with quality of life, disease severity and psychiatric symptoms. MethodsPatients with adult-onset idiopathic isolated cervical dystonia were assessed using the “Faux Pas” questionnaire. Validated questionnaires were used to assess mood symptoms (BAI/BDI and HADS) and quality of life (CDIP-58). Disease-specific disability, motor severity and psychosocial symptoms were measured using TWSTRS2. Faux pas results were compared with published healthy control values. Results32 participants (19 female) were included with a mean age of 57.7 years. 20 participants met criteria for excess mood symptoms (anxiety and/or depression). Mean CDIP-58 was 31.9. There was no relationship between faux pas outcomes and motor severity. However, correlation analyses showed that participants who performed worse on the faux pas questionnaire had lower quality of life. ConclusionThe non-motor symptoms, including social cognition, are often neglected. We have demonstrated that low quality of life in CD is associated with to abnormal social cognition. Clinicians should be mindful of these symptoms, particularly in patients reporting low treatment satisfaction.

Neurologic and psychiatric features of impending neurodegeneration in iRBD

IntroductionIdiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) is linked to Parkinson’s disease and other alpha-synucleinopathies, but various subsets of iRBD may not carry equal risk (i.e., those with depression are at higher risk than those without). Here, we prospectively focus on neurologic and psychiatric aspects of subjects with iRBD, in an attempt to determine what factors are prominent in those who undergo phenoconversion as opposed to those who do not. MethodsWe analyzed data from the “REM Sleep Behavior Disorder Associations with Parkinson’s Disease Study (RAPiDS)” cohort both at baseline and then at follow-up evaluations (1 to 3 years later) utilizing several neurologic batteries, including the Movement Disorder Society’s Unified Parkinson’s Disease Rating Scale (MDS-UPDRS), the Montreal Cognitive Assessment (MoCA), the Questionnaire for Impulsive-Compulsive Disorders in Parkinson’s Disease (QUIP), the 10-M Walk Test (10MWT), and the Epworth Sleepiness Scale. Determination of phenoconversion was ascertained from physical examination and medical chart review from the initial evaluation onward. ResultsOf those who completed both evaluations, there were 33 subjects with iRBD, with an average age of 63.1 ± 12.8 years, with 9 women and 24 men. Of these, 8 (24%) iRBD subjects developed neurodegenerative illness, and demonstrated multiple areas of neurologic and psychiatric signs and symptoms, such as speech and movement problems as well as anxiety and depression. ConclusionsOur data adds to the literature regarding risk of phenoconversion in those with iRBD. Further study will be needed, but it is clear that not all subjects with iRBD present the same risk for neurodegeneration.

PS-R03-11: ANTI-NMDA RECEPTOR ENCEPHALITIS: SEIZURES AND PSYCHOSIS: A CASE REPORT ABOUT 18-YEAR OLD ADMITTED AT ARMMC

Introduction: Anti-NMDA receptor encephalitis is one of many autoimmune diseases that need further recognization. Its signs and symptoms are indefinite and there is no specific pathognomic sign that can be use to properly diagnosed the disease immediately. Therefore more often these patients are prone to misdiagnosis. Many reports claimed that it is directly associated with ovarian teratomas in women though in some reports it can also be seen in males. This case helps in further recognizing anti-NMDA receptor encephalitis especially in our country where there are only few cases reported. Case: The case presented is about an 18-year old female from Mindoro Philippines who was previously well and had sudden changes in behavior with seizures episodes. Patient had consult at their local hospital where she was being treated as a case of viral meningitis but apparently no improvement was noted and subsequently transferred to a tertiary hospital in Metro Manila for further evaluation and management. During her hospital stay at Amang Rodriguez Memorial Medical Center patient presented as seizures with abnormal psychiatric features where she was eventually suspected to have anti-NMDA (anti-N-methyl-D-aspartate) receptor encephalitis but further testing was done initially to rule out other neurologic diseases. Almost all laboratories and radiologic tests turn out to be normal hence a video electroencephalogram (EEG) was requested and result was that the patient is suggestive to have the said disease. Definitive test for anti-NMDA receptor encephalitis was done which turned out positive. The patient was then treated as a case of anti-NMDA receptor encephalitis and manage accordingly. Improvement was noted and the patient was then discharged subsequently. Conclusion: There may be increasing cases of anti-NMDA receptor encephalitis worldwide further research must still be done to be able to understand its features diagnose and manage it appropriately. And since it is more common in young adult females anti-NMDA receptor encephalitis must be suspected and be taken into consideration when there is a patient who presented with sudden changes in behavior with psychosis and seizures.

Somatic symptoms and related disorders in a large cohort of people with epilepsy: A cohort study.

This study was undertaken to characterize somatic symptoms and related disorders (SSD) in epilepsy. Adults with epilepsy under active follow-up at a tertiary epilepsy center were consecutively enrolled. The diagnosis of SSD was performed by an experienced psychologist based on the structured clinical interview for Statistical Manual of Mental Disorders, 5th edition. Detailed social/demographic data, epilepsy features, psychiatric features, life quality, disability, and economic burden were collected and compared between people with SSD and those without. Bodily distress syndrome checklist, Somatic Symptom Disorder-B Criteria Scale, Patient Health Questionnaire-9, and Generalized Anxiety Disorder seven-item scale (GAD-7) were used to evaluate SSD individuals' somatic symptoms, symptom-related psychological distress, and depressive and anxious symptoms. Quality of life and disability were assessed by Quality of Life in Epilepsy Inventory 31 (QOLIE-31) and World Health Organization Disability Assessment Schedule V.2.0 (WHO DAS 2.0). A risk prediction nomogram was generated using least absolute shrinkage and selection operator (LASSO) analysis and validated. One hundred fifty of 631 participants (24%) were diagnosed with SSD. In people with SSD, the top three most common somatic symptoms were memory impairment, headache, and dizziness (85%, 80%, and 78%, respectively), and multiple systems were involved in most (82%) people with SSD. Compared with people without SSD, those with SSD had lower QOLIE-31 total scores, and higher WHO DAS 2.0 scores and disease economic burdens. LASSO analysis suggested that a history of severe traumatic brain injury, hippocampal sclerosis, low seizure worry and medication effects scores on QOLIE-31, multiple systems affected by somatic symptoms, and a high GAD-7 score were risk factors of SSD. The nomogram was validated for good accuracy in the training and testing cohorts. SSD are likely to be a common comorbidity in epilepsy and harm epilepsy prognosis. Our risk prediction nomogram was successfully developed but needs further validation in larger cohorts.

Psychiatric co-morbidity of drug-resistant epilepsy in Veterans

ObjectivePsychiatric conditions are frequently co-morbid in epilepsy and studies examining Veterans with epilepsy suggest this population may present with unique psychiatric and clinical features Drug-resistant epilepsy (DRE) may confer a greater risk of psychiatric dysfunction; however, there is a paucity of literature documenting this. To expand our clinical understanding of Veterans with DRE, we assessed a comprehensive Veterans Health Administration (VHA)-wide sample, describing psychiatric conditions, medications, and healthcare utilization. MethodsPsychiatric and hospitalization data were collected on 52,579 Veterans enrolled in VHA healthcare between FY2014-2ndQtr.FY2020 from the VHA Corporate Data Warehouse administrative data. Data examined include psychiatric diagnosis, psychotropic medication use, and utilization of hospital services. ResultsAt least one psychiatric diagnosis was present in 70.2% of patients, while 49.8% had two or more diagnoses. Depression (51.7%), posttraumatic stress disorder (PTSD) (38.8%), and anxiety (38.0%) represented the most common psychiatric co-morbidities. Psychiatric medication use was present in 73.3%. Emergency room (ER) visits were highest in those with suicidality (mean 14.9 visits), followed by bipolar disorder (10.3), and schizophrenia (12.1). Psychiatric-related hospitalizations were highest for schizophrenia (mean 2.5 admissions) and bipolar disorder (2.3). Females had more psychiatric diagnoses (2.4 vs. 1.6, p < 0.001), psychiatric medications (3.4 vs. 2.3, p < 0.001), and ER utilization than males (6.9 vs. 5.5, p < 0.001). SignificanceA substantial psychiatric burden exists among Veterans with DRE. Compared to prior epilepsy literature, results suggest that Veterans with DRE evidence more prevalent psychiatric comorbidity, emergency care usage, and inpatient psychiatric admissions. Females were especially impacted, with greater rates of psychiatric conditions and treatment. Considering the relationship of psychiatric comorbidities in epilepsy with psychosocial functioning and quality of life, our findings highlight the need for screening and provision of services for those with DRE.