Psychiatric Signs Research Articles

Evaluation of pitolisant, sodium oxybate, solriamfetol, and modafinil for the management of narcolepsy: a retrospective analysis of the FAERS database

ObjectiveNarcolepsy, a rare neurological disorder believed to have an autoimmune etiology, necessitates lifelong management. This study aimed to provide evidence supporting the safety of pharmacological treatment for narcolepsy.MethodsFive-year data on pitolisant, sodium oxybate, solriamfetol, and modafinil were extracted from the FDA Adverse Event Reporting System (FAERS) self-reporting database for the period spanning from 2019 to 2023. Various statistical methods, including the reporting odds ratio (ROR), proportional reporting ratio (PRR), Bayesian confidence propagation neural network analysis (BCPNN), and multi-item gamma Poisson shrinker (MGPS), were employed to quantify the signals. Finally, a comparative analysis was conducted between demographic data, outcomes, and inherent associations among the medications and the signals.ResultsAfter data analysis, we obtained 50 signals (a cumulative count of 762 cases) for pitolisant, 640 signals (corresponding to 46,962 cases) for sodium oxybate, 40 signals (equivalent to 1,228 cases) for solriamfetol, and finally, 72 signals (representing 632 cases) for modafinil. The majority of these patients were female. Psychiatric and nervous system disorders were identified as the predominant adverse drug events (ADEs). For sodium oxybate, it is crucial to consider psychiatric disorders (such as suicidal ideation), respiratory disorders (including sleep apnea syndrome and respiratory depression), and signs of pregnancy and congenital familial diseases. For solriamfetol, noteworthy new ADEs include drug inefficacy, suicidal ideation, restless legs syndrome, and somnambulism. Furthermore, a relationship has been observed between modafinil use and restricted fetal growth, spontaneous abortion, cognitive disorders, and drug inefficacy and abuse.ConclusionThe majority of observed adverse reactions in this study were consistent with those listed in the product instructions. However, potential novel or notable ADE signals were identified through real-world pharmacovigilance analysis. It is anticipated that this paper will offer additional information regarding safe and rational medication for narcolepsy.

An exploratory study of the damage markers NfL, GFAP, and t-Tau, in cerebrospinal fluid and other findings from a patient cohort enriched for suspected autoimmune psychiatric disease

There is growing evidence suggesting that immunological mechanisms play a significant role in the development of psychiatric symptoms in certain patient subgroups. However, the relationship between clinical red flags for suspected autoimmune psychiatric disease and signs of central nervous system (CNS) pathology (e.g., routine cerebrospinal fluid (CSF) alterations, CNS damage markers, neurophysiological or neuroimaging findings) has received limited attention. Here, we aimed to describe the prevalence and distribution of potential CNS pathologies in psychiatric patients in relation to clinical red flags for autoimmune psychiatric disease and psychiatric symptoms. CSF routine findings and CNS damage markers; neurofilament light chain protein (NfL), glial fibrillary acidic protein (GFAP) and total Tau (t-Tau), in CSF from 127 patients with psychiatric disease preselected for suspected immunological involvement were related to recently proposed clinical red flags, psychiatric features, and MRI and EEG findings. Twenty-one percent had abnormal routine CSF findings and 27% had elevated levels of CNS damage markers. Six percent had anti-neuronal antibodies in serum and 2% had these antibodies in the CSF. Sixty-six percent of patients examined with MRI (n = 88) had alterations, mostly atrophy or nonspecific white matter lesions. Twenty-seven percent of patients with EEG recordings (n = 70) had abnormal findings. Elevated NfL levels were associated with comorbid autoimmunity and affective dysregulation symptoms. Elevated t-Tau was associated with catatonia and higher ratings of agitation/hyperactivity. Elevated GFAP was associated with acute onset, atypical presentation, infectious prodrome, tics, depressive/anxiety symptom ratings and overall greater psychiatric symptom burden. In conclusion, preselection based on suspected autoimmune psychiatric disease identifies a population with a high prevalence of CSF alterations suggesting CNS pathology. Future studies should examine the value of these markers in predicting treatment responses.

Evaluation of Type I Interferon Treatment in Hospitalized COVID-19 Patients: A Retrospective Cohort Study.

Coronavirus disease 2019 (COVID-19) continues to cause morbidity and mortality worldwide; therefore, effective treatments remain crucial to controlling it. As interferon-alpha (IFN-α) and -beta (β) have been proposed as COVID-19 treatments, we sought to assess their effectiveness on respiratory, cardiovascular, neurological, and psychiatric signs and symptoms, as well as PASC and death, in hospitalized COVID-19 patients without multiple sclerosis (MS). Using a federated data research network (TriNetX), we performed a retrospective cohort study of hospitalized COVID-19 patients without MS who received IFN-α or -β treatment, comparing them to a similar cohort who did not receive treatment. Following propensity-score matched analyses, we demonstrate that hospitalized COVID-19 patients who were treated with IFN-α or -β had significantly higher odds of death. In contrast, there was no significant difference in any other outcomes between 1-30 days or 1 day to anytime afterward. Overall, hospitalized COVID-19 patients without MS who were treated with IFN-α or -β had similar short- and long-term sequelae (except for mortality) as those who did not receive treatment. The potential benefits of utilizing IFN-α or -β treatment as therapeutics remain to be realized, and our research highlights the need to explore repurposing drugs for COVID-19 using real-world evidence.

Clinical signs and symptoms of Wilson disease in a real-world cohort of patients in the United States: a medical chart review study

IntroductionThere are limited data from the United States regarding the real-world signs and symptoms of Wilson disease (WD). This retrospective, observational medical chart review was conducted to identify real-world characteristics of patients with WD in the United States, as well as WD signs and symptoms at diagnosis and over time.MethodsDe-identified clinical data were abstracted from medical charts of US patients diagnosed with WD between January 1, 2012, and June 30, 2017. Hepatic, neurologic, and psychiatric biochemical findings, signs, and symptoms were characterized at diagnosis and follow-up/during treatment.ResultsIn total, 225 WD patients were included in the study. The mean (SD) age at diagnosis was 24.7 (9.8) years, and 65.3% were male. Median (Q1–Q3) follow-up after diagnosis was 39.5 (33.8–60.4) months. The most common disease presentation at WD diagnosis was combined neurologic/psychiatric and hepatic (52.9%), followed by neurologic/psychiatric (20.0%), hepatic (16.9%), and asymptomatic (10.2%). Common clinical characteristics at diagnosis were Kayser-Fleischer rings (77.2%), low ceruloplasmin levels (95.2%), high hepatic copper (97.8%), elevated 24-hour urinary copper excretion (90.2%), and abnormal liver function tests (38.7%–85.1%). At diagnosis, the most common biochemical findings or hepatic sign/symptoms were abnormal liver enzymes (50.7%), abdominal pain (16.6%), and fatigue (15.7%). The most common neurologic signs/symptoms were headache (18.3%), dysarthria (17.4%), and ataxia (17.0%). Common psychiatric signs/symptoms included anxiety/depression/other mood changes (36.2%), emotional lability (12.8%), and increased irritability/anger outbursts (9.2%). Prevalence of biochemical abnormalities or signs/symptoms among patients at diagnosis and after ~1-year follow-up were neurologic (60.1% and 44.0%), hepatic (69.6% and 37.8%), and psychiatric (53.7% and 37.6%), respectively. Common new onset symptoms at ~1-year post-WD diagnosis were abnormal liver enzymes (5.6%), headache (6.2%), and anxiety/depression/other mood changes (7.2%).ConclusionsThese real-world, descriptive data highlight the clinical complexity and heterogeneity of WD and the need for better education about diagnostic testing and multidisciplinary support. Although rare, the neurologic, psychiatric, and hepatic signs/symptoms of WD have a substantial clinical impact.

Psycho-ophthalmology: A detailed review

ABSTRACT In many areas of diagnosis and treatment, psychiatry and ophthalmology overlap significantly. A patient who has had a great deal of psychological stress may exhibit vision loss. The results of neuro-ophthalmological testing might influence the psychiatric diagnosis and course of therapy. There is a wide range of psychiatric signs and symptoms noted in various ophthalmological disorders which an ophthalmologist witnesses every day. As a result, there is a great deal of overlap between the two disciplines methods to treatment. It goes without saying that the connection between psychiatry and ophthalmology has not gotten the attention it merits.

First application of next-generation sequencing in four families with Wilson disease in Morocco

BackgroundWilson disease is a rare autosomal recessive disorder characterized by toxic accumulation of copper in various organs, principally in the liver and brain. The disease can be manifested with hepatic, neurologic and ophthalmic signs and in a rare case with psychiatric, hematological, renal and skeletal signs; symptoms vary among and within families. Traditionally, Wilson disease was diagnosed on the basis of biochemical markers which include low ceruloplasmin levels and elevated urinary and hepatic copper. However, theses parameters are not specific and can been seen in other disorders. Genetic testing is now considering the most specific test allowing a precise diagnosis. In this study, we report the results of molecular analysis of four unrelated patients with Wilson disease from Morocco; we used a next-generation sequencing customized multigene panel to investigate the ATP7B gene for the four unrelated patients with Wilson disease.ResultsGenetic tests based on next-generation sequencing allow to the identification of four previously described variants. One in compound heterozygous state and three at homozygous state.ConclusionsOur results confirm the clinical diagnosis of Wilson disease in these reported families and have implications for their genetic counselling and clinical management. Diagnosis of Wilson disease is a major challenge in clinical practice, and Genetic testing of ATP7B gene should be recommended in patients with suspected Wilson disease.

Digital Mental Health: A Way Forward for Public Mental Health

Digital technology has an important role in health care, including mental health. This has the potential to achieve what contemporary mental health could not achieve in public mental health. The phenomenology of psychiatric disorders, psychiatric signs, and symptoms has got digital coloring and manifestations of psychological phenomena, which has led to the need for the categorization of new disorders as social media-related disorders. Technology has also provided new ways of fulfilling basic physiological needs in recent years ranging from feeling safe with gadgets to technological self-actualization. Digital phenotyping could aid in the early detection of illness and relapse and has technology for early intervention. Soon, ChatGPT will be used to create psychiatric history and assessments of patients and artificial intelligence and machine learning to diagnose and predict the prognosis of psychiatric disorders and rehabilitation. Social media is the new social support, and it can act as a platform for mass communication. The effectiveness of internet-based therapies compared to face-to-face therapies has to be closely examined. This article gives a futuristic bird’s-eye view of recent developments in digital mental health, its impact on phenomenology and the evolution of new psychiatric disorders, and its usefulness in mental health service delivery.

Atypical Presentation of Anxiety in a patient with Intellectual Disability: A case report and brief review of literature

OBJECTIVE: The diagnosis of psychiatric illness in patients with Intellectual Disability remains clinically challenging in several clinical situations owing to the patient’s limited intellectual functioning and adaptive behavior. Hence, this may lead to different and atypical manifestation of psychiatric symptoms and signs in these patients.
 METHOD: We present a case of a 17-year-old boy with moderate intellectual disability who presented to us with chief complaints of dysphagia for 2 months. Personal history indicative of delayed milestones and difficulty in learning simple tasks. Premorbid temperament revealed anxious traits in the child. On MSE affect was distressed, speech was decreased in volume, psychomotor activity was increased and thinking revealed pre-occupation with symptom. Intelligence revealed poor general fund of knowledge and poor arithmetic ability. Insight was absent (Grade I).
 RESULTS AND DISCUSSION: On the basis of history and MSE a provisional diagnosis of anxiety disorder, unspecified (F41.9) was kept. The patient was started on treatment Tab Mirtazapine 7.5mg ½ BD. The patient showed significant improvement following initiation of treatment. Patients with intellectual disability have difficulty in expressing their psychological symptoms in words at times and present with atypical symptoms of the underlying disorder. This delays their diagnosis and appropriate management. Due to lack of reporting of psychological symptoms patient often continues seeking treatment from general practitioners which leads to loss of time as well as money.
 CONCLUSION: Physicians and psychiatrists themselves need to be more watchful when evaluating a patient with intellectual disability due to the atypical presentation of symptoms.

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.

Psychiatric Signs Revealing Cerebral Thrombophlebitis: A Case Report

Cerebral thrombophlebitis (CT) corresponds to an obstruction of a cerebral vein by a clot. It is a less frequent pathology than cerebrovascular accidents (CVA) but is certainly not rare. Its diagnosis is more radiological (brain MRI being the reference examination) than clinical, given the heterogeneity of the symptoms. In most frequent cases, CVT is revealed by headaches, papilledema, epileptic seizures, or isolated intracranial hypertension. In other cases, the clinical signs are less obvious and can be presented by psychiatric signs, as in our patient's case. The treatment was primarily based on anticoagulant therapy and the evolution was marked by an improvement of all the symptoms.

Premorbid of depressive youth at clinical high-risk for psychosis

IntroductionEarly detection of psychosis is a promising area in preventive psychiatry. The use of early intervention can prevent the first episode psychosis and improve outcomes.ObjectivesIdentification of premorbid features of depressive patients at clinical high risk for psychosis (CHR) comparing with depressive patients without CHR in order to improve early recognition of the psychotic process.Methods219 young depressive in-patients with CHR criteria for SOPS with attenuated positive and attenuated negative symptoms and 52 young depressive in-patients without CHR were examined. Presence of obstetric complications, neurodevelopmental deviance, neurological and psychiatric signs at the premorbid stage, and the level of premorbid functioning on the PAS were examined.ResultsIt has been established that depressive patients at CHR and without CHR had some obstetric complications (57.5% and 40.4%, respectively). Neurodevelopmental deviance in the first year of live was in 57.5% patients with CHR. At the age of 3-5 sleep disorders, ADHD and phobias were more common in patients at CHR than without it (58.8% and 32.7%, p=0.014). In pubertal, patients at CHR were more likely to show depression symptoms, obsessions, and aggression - 90.4% versus 76.9% (p=0.029). On the PAS scale, a decrease of the level of premorbid functioning has been observed in two groups of patients with and without CHR from the age of 12: from 12 to 15 years, 0.4 and 0.3 (p=0.004), from 16 to 18 years, 0.47 and 0.37 (p 0.001).ConclusionsPremorbid functioning were worst in patients with CHR, which indicates the possibility of early clinical detection of psychosis.DisclosureNo significant relationships.

Frequency Of Peripheral Neuropathy in Chronic Hepatitis C Patients Presenting at Liaquat University Hospital, Hyderabad

Hepatitis C virus (HCV) and its infective pathogenic role leads to the psychiatric and neurological signs and symptoms. Therefore, close monitoring and regular follow-up is warranted. Objective: To find out the frequency of peripheral neuropathy among patients presenting at Liaquat University Hospital, Hyderabad, having Chronic Hepatitis C. Methods: The cross-sectional study included 359 patients with chronic HCV, aged 20 to 70 years, who presented to the Liaquat University Hospital's Hepatitis Clinic and Outpatient Department of General Medicine and Neurology. Non-probability - sequential sampling was used to choose patients. Patients were asked about demographic information and the duration of chronic HCV after giving informed written consent. The clinical examination was performed to see if there were any reduced tendon reflexes in all of the patient's extremities. To diagnose peripheral neuropathy based on nerve conduction velocity, all patients had an electrophysiological test using a simplified nerve conduction study (NCS) methodology (NCV). The research lasted six months, from June 2021 to December 2021. The information was examined via SPSS version 25.0. Results: There were 219 Men (61%) And 140 Females (39%) among the 359 Patients. The average age (SD) of the participants was 42.3 (8.7) years (range 22–70). HCV infection lasted 36 months on average (range 1–156). Out of 359 patients, 61 had clinical peripheral neuropathy (PN) (17%). Electrophysiological evidence of PN was present in all of these patients, electrophysiological investigation revealed subclinical PN in 19 more patients (5.3%). Conclusion: On the basis of the findings from this study, it can be concluded that a high prevalence of peripheral neuropathy is present among the patients with HCV in our locality. However, an electrophysiological examination should always be done to avoid underestimating PN, particularly in older HCV patients.

Acoustic and Facial Features From Clinical Interviews for Machine Learning-Based Psychiatric Diagnosis: Algorithm Development.

BackgroundIn contrast to all other areas of medicine, psychiatry is still nearly entirely reliant on subjective assessments such as patient self-report and clinical observation. The lack of objective information on which to base clinical decisions can contribute to reduced quality of care. Behavioral health clinicians need objective and reliable patient data to support effective targeted interventions.ObjectiveWe aimed to investigate whether reliable inferences—psychiatric signs, symptoms, and diagnoses—can be extracted from audiovisual patterns in recorded evaluation interviews of participants with schizophrenia spectrum disorders and bipolar disorder.MethodsWe obtained audiovisual data from 89 participants (mean age 25.3 years; male: 48/89, 53.9%; female: 41/89, 46.1%): individuals with schizophrenia spectrum disorders (n=41), individuals with bipolar disorder (n=21), and healthy volunteers (n=27). We developed machine learning models based on acoustic and facial movement features extracted from participant interviews to predict diagnoses and detect clinician-coded neuropsychiatric symptoms, and we assessed model performance using area under the receiver operating characteristic curve (AUROC) in 5-fold cross-validation.ResultsThe model successfully differentiated between schizophrenia spectrum disorders and bipolar disorder (AUROC 0.73) when aggregating face and voice features. Facial action units including cheek-raising muscle (AUROC 0.64) and chin-raising muscle (AUROC 0.74) provided the strongest signal for men. Vocal features, such as energy in the frequency band 1 to 4 kHz (AUROC 0.80) and spectral harmonicity (AUROC 0.78), provided the strongest signal for women. Lip corner–pulling muscle signal discriminated between diagnoses for both men (AUROC 0.61) and women (AUROC 0.62). Several psychiatric signs and symptoms were successfully inferred: blunted affect (AUROC 0.81), avolition (AUROC 0.72), lack of vocal inflection (AUROC 0.71), asociality (AUROC 0.63), and worthlessness (AUROC 0.61).ConclusionsThis study represents advancement in efforts to capitalize on digital data to improve diagnostic assessment and supports the development of a new generation of innovative clinical tools by employing acoustic and facial data analysis.

Postictal psychosis, a cause of secondary affective psychosis: A clinical description study of 77 patients

ObjectivePostictal psychosis (PIP) is a severe complication occurring at least in 2% of patients with epilepsy. Since the 19th century, psychiatrists have reported the specificity of PIP presentation, but descriptions did not clearly distinguish PIP from after-seizure delirium. This study aimed to provide a precise description of psychiatric signs occurring during PIP, and improve recognition of PIP. MethodsWe performed a review of clinical descriptions available in literature (48 patients), that we gathered with a retrospective multicentric case series of patients from three French epilepsy units (29 patients). For each patient, we collected retrospectively the psychiatric signs, and epilepsy features. ResultsWe found a high prevalence of persecutory (67.5%) and religious (55.8%) delusions, with almost systematic hallucinations (83.1%) and frequent mood disturbances (76.6%), especially euphoria. Severe consequences were not negligible (other-directed assault in 20.8%, self-directed in 13.0%). The type of delusion was associated with mood symptoms (p = 0.017). Episode onset was mainly sudden/rapid (90.9%), its duration was mostly between one and 14 days (64.9%) and the response to antipsychotic medication was good. Disorder was recurrent in more than a half of the sample (57.1% of patients with at least 2 episodes). ConclusionConsidering our findings, PIP resembles more an affective psychosis, than a purely psychotic disorder. The presence of affective signs differentiates PIP from other psychotic comorbidities in epilepsy. Additionally, resemblance between PIP and psychotic manic episode might help to discuss links between epilepsy and bipolar disorder.

Quality of Life in Children Diagnosed with Epilepsy: An Analysis of Comorbid Psychiatric Disorders, Psychiatric Symptoms of Parents and Family Functionality

Objective: The aim of this study is to evaluate the comorbid psychiatric disorders, psychiatric signs and symptoms of the mother and family functionality in children with epilepsy, as well as to examine the relationship between the mentioned variables and quality of life. Methods: The study was conducted with 31 children between the ages 8-11 with a diagnosis of epilepsy for at least 6 months and their mothers; and 30 healthy children of the similar age group and their mothers as the control group. Childhood Depression Inventory (CDI), Children State-Trait Anxiety Inventory (STAI-CH), Pediatric Quality of Life Inventory (PedsQL) was used for children in the Epilepsy and control groups, State-Trait Anxiety Inventory (STAI), Symptom Checklist-90-Revised (SCL-90-R) and Family Assessment Device (FAD) was used for mothers in both groups. Results: According to the results of our study the CDI scores of children in the epilepsy group were found to be significantly higher than of those in the control group. No significant difference was found between both groups in terms of their STAI-CH scores, as well as in terms of total STAI and SCL-90-R scores of mothers in both groups. However, the Ange and Hostility subscale scores of mothers in the epilepsy group were found to be significantly higher than of those in the control group. In addition, the PedsQL total and subscale points of children in the epilepsy group were found to be significantly lower than of those in the control group. Finally, a negative correlation has been detected between the PedsQL scores of the epilepsy group and the children's CDI and STAI-CH scores, the STAI and SCL-90-R scores of the mothers and the FAD scores. Moreover, it was determined that the depression level of the children in the epilepsy group had a significant effect on the quality of life. Conclusion: Our findings suggest a correlation between the quality of life in children with epilepsy and the psychiatric symptoms of children and mothers as well as family functionality.

Psychological symptoms related to COVID-19 pandemic and lockdown: A retrospective study from a tertiary care hospital in India

BACKGROUND: COVID-19 pandemic and lockdown together agitated the mind of the people of the entire world to a great extent. Currently, most of the research focuses on the physical impact of the pandemic and its management, however, little is known about its psychological impact. AIM: This study aims to evaluate the psychological symptoms related to the COVID-19 pandemic and lockdown on the patients who attended to psychiatry outpatients unit over the initial 3 months of lockdown in India. MATERIALS AND METHODS: A retrospective study was conducted at the mental health institute, and an exploratory analysis was performed. From the record section, case sheets were taken out and manually screened for keywords related to the COVID-19 pandemic and lockdown. The sociodemographic profile, psychiatric signs and symptoms, psychopathology, and final diagnosis were noted in a data sheet for the definitely related (DR) cases. The collected data from the case sheets were analyzed using descriptive statistics. RESULTS: Out of 6081 case sheets screened, 42 patients were DR to the COVID-19 pandemic and lockdown. The common psychiatric symptoms were insomnia (78.60%), anxiety (57.10%), and sadness (52.40%), and common psychiatric diagnoses were depressive disorder, anxiety disorder, and adjustment disorder. CONCLUSION: In addition to physical effects, the COVID-19 pandemic and lockdown together have a significant impact on the mental health of people. Besides handling the COVID-19 pandemic, it is also essential to provide psychological support to people at an earlier phase to prevent such mental health crises in the future.

A 19-year-old Woman with the Symptoms of Fever, General Rigidity and Consciousness Disturbance

<p>抗NMDA（N-methyl-D-aspartate）受體腦炎是當人體自身免疫系統產生的抗體攻擊大腦中的NMDA型谷氨酸受體所導致的自體免疫腦炎。發病初期會出現精神症狀，常沒有神經影像學，腦波或腦脊髓液檢查的異常。它很容易被誤診為原發性精神疾病或其他疾病，像是抗精神病藥物惡性症候群（Neuroleptic maligmant syndrome,NMS）、病毒性腦炎、惡性緊張症、藥物濫用、裝病等。抗NMDA受體腦炎症狀與NMS幾乎完全相似不容易被鑑別診斷。自2007年開始因免疫醫學的進步，才終於可以被明確診斷，在此之前有許多病人因為沒有被診斷出抗NMDA受體腦炎而終身被當成精神病人。本案例詳述一位19歲年輕女性出現急性精神異常症狀，自發病、治療、到確診為抗NMDA受體腦炎的經過，並探討疾病的經過、治療的反應及診斷的困難。</p> <p> </p><p>Anti N-methyl-D-aspartate antibody encephalitis (Anti-NMDA antibody encephalitis) develops when such antibody binds and damages NMDA receptors in the brain. Psychiatric symptoms and signs,such as hallucination, acute psychosis and delusional state, are often found as early clinical presentations,rather than brain lesion that can be found on neuroimaging. The CSF and EEG studies are often normal, thus such cases are easily misdiagnosed as acute psychosis, neuroleptic malignant syndrome (NMS), viral encephalitis, substance abuse, or malingering. In fact, the symptoms and signs of anti-NMDA antibody encephalitis and NMS are almost identical, making it especially difficult to diagnose. From Since 2007, thanks to the advances of Immunology, such autoimmune encephalitis is now able to be diagnosed accurately. In the past, lots of victims were treated as psychotics when anti-NMDA antibody was not able to be detected. In this case report, we illustrated the clinical presentation, disease progress, responses to treatment, and how the final diagnosis of anti-NMDA encephalitis was made on a 19 years old female who developed acute psychosis.</p> <p> </p>

PSYCHOSIS AS AN UNUSUAL BEGIN OF CREUTZFELDT – JAKOB

Creutzfeldt - Jakob disease (CJD) is an extremely rare and devastating disease characterized by rapid neurological deterioration in a healthy individual. The classic clinical presentation of CJD includes rapidly progressive dementia, myoclonus, pyramidal, extrapyramidal and cerebellar signs. Although it is less frequent that the disease begin with non-specific psychiatric signs.

The adverse events of ibogaine in humans: an updated systematic review of the literature (2015-2020).

Ibogaine is the main alkaloid of the African shrub Tabernanthe iboga. It produces hallucinogenic and psychostimulant effects, but it is currently known for the anti-addictive properties. Despite the potential therapeutic effects, several cases of fatalities and serious adverse events related to ibogaine/noribogaine use can be found in the literature. Most studies consist in case reports or were conducted under non-controlled settings, so causation cannot be clearly established. To update (2015-2020) the literature on the adverse events and fatalities associated with ibogaine/noribogaine administration. Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Eighteen studies were included in the final selection. Highly heterogeneous results were found in terms of kind of product used or the known dosages. The adverse events were classified in acute effects (< 24h), mainly cardiac (the most common was QTc prolongation), gastrointestinal, neurological, and clinical alterations, and long-lasting effects (> 24h), mainly persistent cardiac alterations, psychiatric, and neurological signs. There is a high need of phase I clinical trials that can describe the safety of different dosages of ibogaine with standardized products. Further research should perform clinical profiling of vulnerable populations, and design effective screening methods and clinical procedures.

Genetic Analysis and Literature Review of SNCA Variants in Parkinson's Disease.

Parkinson's disease (PD) is the fastest-growing neurodegenerative disorder. Aging, environmental factors, and genetics are considered as risk factors. The alpha-synuclein gene (SNCA), the first pathogenic gene identified in a familial form of PD, was indisputably involved as a heritable component for familial and sporadic PD. In this study, whole-exome sequencing and Sanger sequencing were performed to evaluate the association between the SNCA gene variants and PD. The genetic data of 438 clinically diagnosed patients with PD and 543 matched control populations of the Han Chinese were analyzed. The literature review of SNCA variants for 231 cases reported in 89 articles was extracted from the PubMed and the Movement Disorder Society Genetic mutation database. No potentially causative variant(s) in the SNCA gene, excepting two single-nucleotide nonsynonymous variants c.158C>T (p.A53V, rs542171324) and c.349C>T (p.P117S, rs145138372), were detected. There was no statistically significant difference in the genotypic or allelic frequencies for either variant between the PD group and the control group (all P > 0.05). No copy number variants of the SNCA gene were detected. The results of this study suggest that the variants in the exons of the SNCA gene may have less or no role in the development of PD in the Han Chinese populations. The literature review suggests that psychiatric signs and cognitive decline/dementia were more common among patients with SNCA duplication or triplication (psychiatric signs: χ2 = 7.892, P = 0.005; cognitive decline/dementia: χ2 = 8.991, P = 0.003).