Psychomotor Excitement Research Articles

Neutrophil-Lymphocyte Ratio in Patients With Acute Schizophrenia.

Introduction Schizophrenia symptom severity is linked to neuroinflammation. Certain blood cell indexes such as neutrophil-lymphocyte ratio (NLR) and neutrophil-albumin ratio (NAR) have been used as biomarkers in various diseases, including schizophrenia. In acute clinical practice, it is challenging to decide whether to provide intravenous antipsychotic treatment in some cases due to the lack of objective biomarkers of psychiatric symptoms. The NLR of individuals with schizophrenia is thought to be associated with disease severity, and changes in NLR may reflect a patient's response to antipsychotic treatment. We investigated the application of NLR as a biomarker for identifying acute severity and determining acute treatment response in patients withschizophrenia. Methods We retrospectively examined 251 inpatients diagnosed with schizophrenia and classified them according to treatment (intravenous haloperidol vs. oral antipsychotic medication during the acute phase) and investigated their NLR and NAR while receiving inpatient care. Results A total of 48 inpatients were given intravenous haloperidol to manage their acute symptoms; 208 were given oral antipsychotics. The intravenous haloperidol group experienced more severe symptoms, such as agitation and disorganized thinking, during the acute phase. Further, those who received intravenous haloperidol had significantly higher Clinical Global Impression-Severity (CGI-S) scores than the oral antipsychotic group. NLR and NAR were also significantly higher in the haloperidol intravenous group. Conclusion Elevated NLR and NAR could be easily measured in patients with psychomotor agitation who should be treated at any facility. Further, they are useful biomarkers for determining disease severity and the effects of treatment on psychomotor excitement in patients who require intravenous haloperidol.

A three-dimensional model of neural activity and phenomenal-behavioral patterns.

How phenomenal experience and behavior are related to neural activity in physiology and psychopathology represents a fundamental question in neuroscience and psychiatry. The phenomenal-behavior patterns may be deconstructed into basic dimensions, i.e., psychomotricity, affectivity, and thought, which might have distinct neural correlates. This work provides a data overview on the relationship of these phenomenal-behavioral dimensions with brain activity across physiological and pathological conditions (including major depressive disorder, bipolar disorder, schizophrenia, attention-deficit/hyperactivity disorder, anxiety disorders, addictive disorders, Parkinson's disease, Tourette syndrome, Alzheimer's disease, and frontotemporal dementia). Accordingly, we propose a three-dimensional model of neural activity and phenomenal-behavioral patterns. In this model, neural activity is organized into distinct units in accordance with connectivity patterns and related input/output processing, manifesting in the different phenomenal-behavioral dimensions. (1) An external neuralunit, which involves the sensorimotor circuit/brain's sensorimotor network and is connected with the external environment, processes external inputs/outputs, manifesting in the psychomotor dimension (processing of exteroception/somatomotor activity). External unit hyperactivity manifests in psychomotor excitation (hyperactivity/hyperkinesia/catatonia), while external unit hypoactivity manifests in psychomotor inhibition (retardation/hypokinesia/catatonia). (2) An internal neuralunit, which involves the interoceptive-autonomic circuit/brain's salience network and is connected with the internal/body environment, processes internal inputs/outputs, manifesting in the affective dimension (processing of interoception/autonomic activity). Internal unit hyperactivity manifests in affective excitation (anxiety/dysphoria-euphoria/panic), while internal unit hypoactivity manifests in affective inhibition (anhedonia/apathy/depersonalization). (3) An associative neuralunit, which involves the brain's associative areas/default-mode network and is connected with the external/internal units (but not with the environment), processes associative inputs/outputs, manifesting in the thought dimension (processing of ideas). Associative unit hyperactivity manifests in thought excitation (mind-wandering/repetitive thinking/psychosis), while associative unit hypoactivity manifests in thought inhibition (inattention/cognitive deficit/consciousness loss). Finally, these neural units interplay and dynamically combine into various neural states, resulting in the complex phenomenal experience and behavior across physiology and neuropsychiatric disorders.

Development of Practice Guidelines for Peripartum Depression in Primary Healthcare

Abstract Background Antenatal and postpartum major depressive episode (MDE) according to Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) is defined as either daily sustained sad mood or lack of enjoyment or desire for a minimum two weeks plus four associated manifestations (only three if the two major symptoms are present): 1) Unintentional notable slimming up or down; 2) Sleepiness or sleeplessness; 3)Tiredness sensation; 4) Guilty or futility sensation; 5) Declined concentration capacity; 6) Frequent suicidal thoughts or 7) Psychomotor excitation or delay, that start throughout pregnancy or during the first 4 weeks postpartum respectively. Objective To develop Egyptian practice guidelines for peripartum depression in Primary Healthcare (PHC). Methods The current study was conducted thorough Delphi technique by participation of Thirteen experts at psychiatry and family medicine specialties from different governmental universities, Ministry of Health and Population (MOHP), World Health Organization (WHO) and World Organization of Family Doctors (WONCA) via email thorough three consecutive phases of Delphi technique. Results The current study recommended health education programs, provision of awareness about physical exercise’s importance for prevention of antenatal and postnatal depression, adding telephone- based peer support for the preventive measures of the antenatal depression and family therapy for the postpartum depression prevention. Screening for all the pregnant women every trimester by patient health questionnaire II and screening for all the new mothers every well child clinic visit in the first year after delivery by Edinburg Postpartum Depression Scale (EPDS). Diagnosis by beck depression inventory II questionnaire and Postpartum Depression Screening Scale (PDSS) for antenatal and postnatal depression respectively with post diagnosis evaluation for: 1) Comorbid anxiety; 2) Bipolar disorder; 3) Thoughts of harming intrauterine fetus or newborns; 4) Suicidal thoughts and 5) Psychotic features. Cognitive Behavioral Therapy (CBT) for treatment of mild cases and CBT with half dose sertraline for moderate cases of antenatal depression. Cognitive Behavioral Therapy (CBT) for mild cases, CBT and the usual dose sertraline for moderate cases with no hormonal therapy for any patient. Referral for patients with: 1) severe depression; 2) comorbid anxiety; 3) bipolar disorder; 4) thoughts of harming intrauterine fetus or newborns; 5) suicidal thoughts; 6) psychotic features; 7) substance abuse. Conclusion development of Egyptian practice guidelines for peripartum depression in PHC. Wide dissemination of the practice guidelines to all the Egyptian PHC facilities via a suitable method and training programs for the family physicians on practicing these guidelines must be ensured.

Анализ клиники, подходов к терапии и исходов при делирии, вызванном воздействием синтетических катинонов: систематический обзор

INTRODUCTION: One of the important disorders that can be induced by using synthetic cathinones (SC) is delirium, differentiated from other psychotic complications in ICD-11. The article presents a systematic review of the literature with the aim to describe the symptoms, the effectiveness of empirical approaches to therapy and probable outcomes of delirium induced by SC. The analysis of scientific publications in eLibrary, CNKI, PubMed, Scopus databases was performed using search by keywords. In accordance with the recommendations of PRISMA, 23 articles were selected. CONCLUSION: Most of the articles found were about MDPV-induced delirium. No exact dose range of SC that can cause delirium is specified. Delirium is more often described after prolonged use of SC (for 1 month), in more rare cases after a single use. In most cases delirium develops within a few hours after intake of SC and is associated with intoxication, rather than with withdrawal syndrome. The clinical picture of the studied conditions, besides the triad of the main symptoms of delirium, includes psychomotor excitement with pronounced sympathicotonia, in the vast majority of cases psychotic symptoms (acute sensory delirium with paranoid syndrome, true visual hallucinations, insomnia, aggressiveness expressed in the form of hetero- or autoaggression) are also present. Of highest effectiveness is therapy with benzodiazepines and antipsychotics with the use of detoxification and general resuscitation measures. Most of the described cases of delirium resulted in complete recovery, deaths were associated with serotonin syndrome, suicides, accidents against the background excitement and acute somatic diseases with the underlying sympathicotonia.

Correlates of aggressive behavior in the moroccan context

IntroductionViolence among the mentally ill population has long been a subject of stigma, and controversy. Clinicians’ ability to assess the violent potential is still limited.ObjectivesThe objective of this work is to identify the positively correlated indicators of aggressive behavior in patients admitted to hospital emergency departments.MethodsIt is a retrospective and descriptive paper based on the records of patients admitted to the emergency department of Arrazi University Psychiatric Hospital in Salé during a one-month period.The psychiatric diagnosis was formulated using the DSM-5 diagnostic criteria and Violent behavior was assessed using the Modified Overt Aggression Scale (MOAS). The existence of aggressive behavior was defined by a MOAS score ≥3.We used SPSS 15 to analyse resultsResultsSixty-five case files were selected during the study month. The average age was 35.3 (19;64).The mean of our sample MOAS aggression scale score was 31.5 [0; 79] and 90% of patients had a score ≥ 3 (image 1)Among the 65 admissions, heteroaggressive risk was the most frequent reason for hospitalization (N=53), followed by psychomotor excitement. IMAGE 2Statistical analysis revealed a significant association between high MOAS scores and substance use, history of suicide attempt, educational level and socioeconomic levelImage:Image 2:ConclusionsIn the current research, the prevalence of aggressive behavior was high among these patients, which may be due to the conditions of psychiatric hospitalization in our region, which is often reserved for the most serious and dangerous patients.Disclosure of InterestNone Declared

Recurrence and profile of reconsultants: descriptive study of 162 patients

IntroductionEmergency psychiatric consultation requests present certain specificities both in the situations encountered and in their management, due to a close relationship between the consultant and his environment. They do not only correspond to psychiatric emergencies, in the strict sense of the term, but also to psychological emergencies with their possible social dimension. They require an adapted response that can be decisive for the futureObjectivesTo determine the epidemiological and clinical characteristics of patients reconsultants in the emergency medical department.MethodsThis is a cross-sectional study, conducted over a period of 12 months, from 01 April 2020 to 31 March 2021, in the emergency medical department of Mahdia University Hospital.ResultsDuring the study period, 162 reconsultations for psychiatric emergencies were recorded. the age ranged from 18 to 61 years with an average of 35 years. The level of education was primary or secondary in 78.8% of cases. The majority of reconsultants had single marital status (70%). The absence of professional activity and social security coverage was found in 72.3 and 49% of cases respectively. The presence of family and personal psychiatric history was noted in 29.8% and 91.5% of reconsultants respectively. Heteroaggressiveness followed by instability were the most frequently encountered reasons for consultations with 23.4% and 12.8% of cases respectively. The presence of a triggering factor was found in 63.8% of cases where problems with the main support group followed by those related to the social environment and those related to access to health services were the most reported with 49.23 and 13% respectively. The syndromic psychiatric diagnoses were, in decreasing order of frequency, psychomotor excitement (23.4%), delusional syndrome (17%), dissociative syndrome (12.8%) and somatic conversion (12.8). For reconsultants, relational approach and/or injectable treatment were the most used therapeutic means immediatly (49%). Neuroleptics and benzodiazepines were prescribed in 38% and 13% of cases, respectively. The decision to hospitalize in a psychiatric department concerned 45% of reconsultants.ConclusionsReferral decisions favored the organization of ambulatory follow-up, with a decrease in the rate of hospitalization. These results make it possible to identify the evolutionary trends of the population consulting in emergencyDisclosure of InterestNone Declared

Massive intoxication due to cocaine adulterated with carfentanil

To identify the causal agent of the massive intoxication occurred in February 2022 in Buenos Aires, with 98 hospitalized victims and 24 deaths. The first victims presented the following signs: miosis, shock, sensory depression, respiratory distress (bradypnea), psychomotor excitement, seizures, and cardiorespiratory arrest. Some showed a typical opiomimetic sign: “wood chest”. Given the parasympathetic signs, the victims were treated with Naloxone at high doses, responding favourably and with a continuous infusion drip of 10 mg in 250 mL at a flow rate of 11 mL/h. The latter to prevent them from deteriorating when they waked up. All the cases had in common having inhaled a line of cocaine acquired from the same dealer. Seized powder samples were preliminarily analysed by HPTLC and UPLC-DAD (Acquity System-Waters Corp, USA). A cocaine standard (LGC Std, Lot. 979337, USA) was used. Subsequently, for the detailed analysis of components, a fractionation was made by extracting the soluble components in chloroform and the soluble and insoluble fractions were analysed by 1H and 13 C NMR on a Bruker A Neo 500 spectrometer (1H 500 MHz, 13C 125 MHz). The chloroform insoluble fraction was further analysed by LC-MS with exact mass detection on a Bruker micrOTOF-Q II spectrometer coupled to an Agilent 1200 HPLC. Structure confirmation was performed by MRM (multiple reaction monitoring), and MS/MS fragmentation. UPLC-DAD analysis showed a purity of 51.6% for COC, the rest being mostly sorbitol as cutting material (confirmed by NMR, as noted below). In the soluble fraction, where the spectra were measured in deuterochloroform solution, the NMR spectra showed the characteristic signals of cocaine hydrochloride and small amounts of cinnamyl cocaine (CIN) that usually accompanies cocaine hydrochloride and truxillines. (The latter very important to infer the origin of cocaine). In the insoluble fraction the main component was identified as sorbitol from its 1H and 13C NMR spectra (in DMSO-d6). A small remnant of cocaine and cinnamyl cocaine (CIN) was also observed. On the other hand, this fraction was analysed by LC-MS, observing 7 relevant peaks: cocaine, benzoylecgonine, cinnamyl cocaine (cis and trans), truxillines and a minor component of m/z 395.2316 that corresponds to the formula C24H31N2O3 (calculated 395,2329) coincident with the [M + H]+ quasi-molecular ion of carfentanil. Structure confirmation was performed by MRM, and fragmentation by MS/MS of the M + H ion, observing the characteristic fragments of the carfentanil structure including the two confirmatory ions of m/z 335.2123 (calculated for C22H27N2O+ 335,2118) and m/z 246.1489 (calculated for C15H20NO2+ 246,1489). Quantitative analysis was performed by NMR for the COC/CIN ratio and from LC-MS for the CIN/Carfentanil ratio. Giving an estimated result of 30 μg/100 mg of pure cocaine. The toxic dose for humans is unknown, although would be less than 1 mg based on animal studies and known fentanyl lethal cases (estimated lethal dose is 20 μg) (Casale et al., 2017). The therapeutic treatment followed by the victims and the results observed allowed us to focus on opiomimetics, as the most relevant factor in the cause of the 24 deaths. The high-resolution methods applied allowed us to confirm cocaine in a percentage of purity close to half of the total powder. Carfentanil was confirmed by MRM analysis and in an amount of approximately 30 μg/100 mg of pure cocaine. Based on the data collected in the case, the consumption of cocaine was about 200 mg, therefore, in the proportion of purity, each line contained about 30 μg of carfentanil. So, for 400 mg of powder consumed, carfentanil would be found at 60 μg. Therefore, we estimated the toxic dose for this episode between 30–60 μg.

Manic episode following SARS-COV-2 Infection

IntroductionIn December 2019, infection with the novel coronavirus (SARS-CoV-2) was first reported in the city of Wuhan, China. Although generally recognized for its often fatal respiratory problems, other neuropsychiatric complications are receiving increasing attention.ObjectivesWe will try through a clinical case to explain the psychiatric disorders in the context of this infection, and to highlight the two main explanatory theories of psychiatric disorders, in relation with the SARS-Cov-2 infection.MethodsWe report here a case of SARS-CoV-2 infection in a 54-year-old female patient with no specific pathological history, including psychiatric, who presented a fever, anosmia, and asthenia in the absence of any respiratory signs. Her PCR came back positive and her chest CT scan was normal.The patient was treated with paracetamol with vitamin C,with good clinical improvement. She came 15 days later to the psychiatric emergency room with psychomotor excitement. The patient was motorically unstable, could not hold still, her mimicry was hypermobile, contact with her was familiar, she was logorrheic with flight of ideas,she verbalized multiple projects, her mood was euphoric and her sleep was disturbed. Her blood tests were unremarkable.ResultsThe diagnosis of manic episode was retained, and the patient was put on Olanzapine 10 mg, sodium Valproate 1g and Lorazepam 2.5 mg in degression with good clinical improvement.ConclusionsAlthough the data in the literature remain scarce concerning the impact of this virus on mental health, we will try through this clinical case to explain the psychiatric disorders in the context of this viral epidemic, due to stress and inflammation.DisclosureNo significant relationships.

Les parakinésies. Phénoménologie des mouvements anormaux intrinsèques aux psychoses endogènes

Abnormal movements are long known to be intrinsic to some forms of endogenous psychoses. Spontaneous dyskinesia are the ones observed by naïve first episode patients and at-risk subjects. Yet, these are only the rediscovery of more complex phenomena denoted as “parakinesias”, which had been described and documented by extensive kinetographic recordings and long-term observations decades before the introduction of neuroleptics. Unfortunately, they were largely neglected by mainstream psychiatry to the point of privation in the French and English literature. Renewed interest in psychomotor phenomena deems it timely to remind the neuropsychiatric community about that concept. Parakinesias consist of various deformations of psychomotor sequences which, for descriptive purpose, can be separated into parakinesias, i.e. abnormal, dyskinetic-like movements, and parakinetic psychomotricity (PPM). Parakinesias are a form of hyperkinetic movement disorder that is quite specific to endogenous psychoses. Parakinesias can be described as pseudo-reactive and pseudo-expressive motions, i.e. they resemble psychomotor gestures that are not only occurring inappropriately, but that are also somewhat distorted. These deformities do not only affect parakinesias but also the individual style of psychomotor outputs resulting in PPM. Gestures and mimics lose their naturalness and become awkward, disharmonious, stiff, mannered, and bizarre. Parakinetic distortions increase over time, so that parakinesias lose their expressiveness and have a more choreiform appearance. They also become more uniform and stereotyped. PK are prevailing in the upper face and the axial and proximal musculature of the upper body. They are not experienced as self-dystonic or alien by the patients, who are not aware of them, even when their attention is drawn to them. Finally, PK are more frequent and manifest as the level of psychomotor excitement is increased whereas they are attenuated up to disappear under high affinity antipsychotics. In non-naive patients, parakinesias might be mistaken for tardive dyskinesia. When they resemble distorted facial expressions, they fit with the concept of “grimacing” whereas PPM is partly captured by the concept of “mannerism”. The goal of this paper is to enhance recognition of parakinesias beyond grimacing and spontaneous dyskinesias. They deserve to be known by clinicians, especially for their prognostic value. From a general perspective, parakinesias and PPM allow to formulate new hypotheses of psychomotor phenomena that ought to be debated, investigated, and tested.

Laboratory Confirmation of Human Rabies by RT-PCR and qRT-PCR Bamako: Report of a Case in a 4-Year-Old Girl at the Mali Hospital

Rabies is a zoonotic disease of viral origin transmitted mainly to humans by biting or licking the injured skin of sick animals. It is an untreatable disease that is fatal once it has been declared. Worldwide, 59,000 cases of rabies-related deaths are recorded each year. The diagnosis of rabies is clinical, biological, and anatomopathological. The aim was to establish the laboratory confirmation capacity for human rabies in Mali. The patient, a Malian female, aged four years, was bitten by a dog around her house in district sixth of Bamako near national road number six in 2020. The patient visited the doctor after a two-month bite. However, she was neither referred to the health center for an effective therapeutic measure nor vaccination (post-exposure prophylaxis). The patient was presented with psychomotor excitation, hypersalivation, aerophobia, and hydrophobia symptoms and visited a Malian hospital named “Hospital of Mali”. The patient was admitted with a history of animal bites and symptoms of rabies, and the patient was classified as a probable rabies case. The patient was then referred to an infectious disease physician and hospitalized. After referring the patient to the infectious disease physician, the physician sent oral swab and cerebrospinal fluid (CSF) samples to confirm to the Laboratory of Applied Molecular Biology. Human rabies was confirmed (RT-PCR) by the zoonotic unit of the Laboratory of Applied Molecular Biology. Diagnosis and therapy of human rabies without post-exposure management after a dog bites were still challenging. It was possible to confirm the human rabies case in Mali by RT-PCR and qRT-PCR.

Bipolar disorder and multiple sclerosis

IntroductionMultiple sclerosis (MS) is an inflammatory demyelinating illness characterized not only by severe neurological symptoms and somatic signs but also by psychiatric symptoms. Psychiatric comorbidity is common in MS. However, the incidence of psychiatric comorbidity remains understudied.ObjectivesTo discuss the relationship of psychiatric disorder to neurologic dysfunction in MS through a clinical case.MethodsPresentation of a clinical case of bipolar disorder in a 45-year-old woman with MS, followed by a literature review.Results We reported a case of a 45-year-old woman, who was followed in neurology for MS since the age of twenty-five. She was stable under monthly treatment. She was referred by her neurologist for psychomotor excitement, insomnia, feeling of well being, and sexual disinhibition. The symptoms were present for three weeks. At the interview, she was euphoric, disinhibited, she had logorrhea and did not verbalize delirium. An attack of multiple sclerosis was ruled out. The patient did not report any history of psychiatric illness, epilepsy, head trauma, or use of psychoactive substances. We retained the diagnosis of bipolar disorder (manic episode). Divalproex sodium and olanzapine were prescribed with significant improvement of symptoms.ConclusionsThis reported case is interesting since it highlights the possible association between multiple sclerosis and bipolar disorder. Further investigations are needed to identify potential shared risk factors between these pathologies to improve patients’ outcomes.

Adult Emergence Agitation: A Veteran-Focused Narrative Review.

Emergence agitation (EA) is a self-limited state of psychomotor excitement during awakening from general anesthesia. EA is confined to the emergence period as consciousness is restored, which sharply distinguishes it from other postoperative delirium states. Sporadic episodes of EA may become violent with the potential for harm to both patients and caregivers, but the long-term consequences of such events are not fully understood. Current literature on EA in adults is limited to small-scale studies with inconsistent nomenclature, variable time periods that define emergence, a host of different surgical populations, and conflicting diagnostic criteria. Therefore, true incidence rates and risk factors are unknown. In adult noncardiac surgery, the incidence of EA is approximately 19%. Limited data suggest that young adults undergoing otolaryngology operations with volatile anesthetic maintenance may be at the highest risk for EA. Currently suggested EA mechanisms are theoretical but might reflect underblunted sympathetic activation in response to various internal (eg, flashbacks or anxiety) or external (eg, surgical pain) stimuli as consciousness returns. Supplemental dexmedetomidine and ketamine may be utilized for EA prevention. Compared to the civilian population, military veterans may be more vulnerable to EA due to high rates of posttraumatic stress disorder (PTSD) manifesting as violent flashbacks; however, confirmatory data are limited. Nonetheless, expert military medical providers suggest that use of patient-centered rapport tactics, PTSD trigger identification and avoidance, and grounding measures may alleviate hyperactive emergence phenomena. Future research is needed to better characterize EA in veterans and validate prophylactic measures to optimize care for these patients. This narrative review provides readers with an important framework to distinguish EA from delirium. Furthermore, we summarize current knowledge of EA risk factors, mechanisms, and adult management strategies and specifically revisit them in the context of veteran perioperative health. The anesthesiology care team is ideally positioned to further explore EA and develop effective prevention and treatment protocols.

小脳腫瘍摘出術後の小脳性認知・情動症候群を背景に生じた精神運動興奮に対して多角的アプローチが有効であった一例

小脳腫瘍摘出術後の小脳性認知・情動症候群を背景に生じた精神運動興奮に対して多角的アプローチが有効であった一例

The origin of our modern concept of mania in texts from 1780 to 1900.

The development of the modern concept of mania is explored by a review and analysis of 28 psychiatric texts in English, French, and German published in Western Europe and North America from 1780 to 1900. From 1780 until the 1820s, mania was consistently viewed as a disorder of reasoning/judgment manifest by total insanity and/or the state of undifferentiated fury. For the next 30 years, the consensus shifted, and mania was understood to be largely a disorder of elevated mood. This concurrence of opinion broke down around 1860. For the remaining years of the 19th century, the mood-based model of mania competed for dominance with the view that mania arose primarily from accelerated mental processes and to a lesser degree that mania resulted from psychomotor excitation. While most authors advocated for one of these three positions, a number suggested that two or all three of these processes were central to the etiology of mania. Faculty psychology played an important role in these discussions, providing a framework within which to place the mental disturbance considered foundational to the manic syndrome. When the viewpoints shifted away from mania as a primary disorder of judgment, new approaches were needed to understand the emergence of grandiose delusions. Utilizing the concept of understandability, a number of authors suggested that manic delusions could arise directly from a euphoric mood. The history of mania shares some important similarities and differences with the history of melancholia during this same period. Both histories suggest that our major psychiatric categories evolved through a complex process involving both observations of symptoms, signs and course, and conceptual developments and a priori theories.

Intrinsic brain activity of subcortical-cortical sensorimotor system and psychomotor alterations in schizophrenia and bipolar disorder: A preliminary study

ObjectiveAlterations in psychomotor dimension cut across different psychiatric disorders, such as schizophrenia (SCZ) and bipolar disorder (BD). This preliminary study aimed to investigate the organization of intrinsic brain activity in the subcortical-cortical sensorimotor system in SCZ (and BD) as characterized according to psychomotor dimension. MethodIn this resting-state functional magnetic resonance imaging (fMRI) study, functional connectivity (FC) between thalamus and sensorimotor network (SMN), along with FC from substantia nigra (SN) and raphe nuclei (RN) to basal ganglia (BG) and thalamic regions, were investigated by using an a-priori-driven and dimensional approach. This was done in two datasets: SCZ patients showing inhibited psychomotricity (n = 18) vs. controls (n = 19); SCZ patients showing excited psychomotricity (n = 20) vs. controls (n = 108). Data from a third dataset of BD in inhibited depressive or manic phases (reflecting inhibited or excited psychomotricity) were used as control. ResultsSCZ patients suffering from psychomotor inhibition showed decreased thalamus-SMN FC toward around-zero values paralleled by a concomitant reduction of SN-BG/thalamus FC and RN-BG/thalamus FC (as BD patients in inhibited depression). By contrast, SCZ patients suffering from psychomotor excitation exhibited increased thalamus-SMN FC toward positive values paralleled by a concomitant reduction of RN-BG/thalamus FC (as BD patients in mania). ConclusionsThese findings suggest that patients exhibiting low or high levels of psychomotor activity show distinct patterns of thalamus-SMN coupling, which could be traced to specific deficit in SN- or RN-related connectivity. Notably, this was independent from the diagnosis of SCZ or BD, supporting an RDoC-like dimensional approach to psychomotricity.

Detailed assessment and risk factor analysis of corticosteroid-induced psychiatric disorders in pediatric, adolescent, and young adult patients undergoing induction or consolidation therapy for hematologic malignancy.

Corticosteroid-induced psychiatric disorders (CIPDs) represent an adverse effect that can cause severe emotional and behavioral problems. The aim of the present study was to assess the incidence and risk factors of CIPDs. A retrospective analysis of 92 pediatric and young adult patients with hematologic malignancies was conducted. The incidence of CIPDs in patients receiving a treatment regimen with prednisolone or dexamethasone was 64.9% and 77.5%, respectively, both of which were significantly higher than that in patients not receiving corticosteroids. Independent risk factors and adjusted odds ratios (95% confidence intervals) related to severe CIPD were 2.15 (1.11-4.18) for dexamethasone (using prednisolone as the reference) and 0.81 (0.75-0.87) for age, suggesting that the odds increase with decreasing age. Frequently observed symptoms, respectively in terms of behavioral and emotional problems were defiance, crying, psychomotor excitement, dysphoria, irritability, and depression. To our knowledge, this is the first report to mention the risk factors and characteristics for clinical symptoms of CIPDs during the developmental process. Healthcare professionals should predict and prepare for psychiatric adverse events prior to chemotherapy in the clinical settings, especially in patients in younger age and receiving a treatment regimen with dexamethasone.

Central anticholinergic syndrome (CAS) in anesthesiology: a narrative review

Psychomotor excitation, delayed recovery of consciousness after general anesthesia – well-known conditions. But only in the literature of Germany, it was first isolated in a separate central anticholinergic syndrome (CAS). This article discusses the main aspects and symptoms that will help to differentiate this syndrome with other conditions, and the methods for relief of this state.

Abnormal Functional Relationship of Sensorimotor Network With Neurotransmitter-Related Nuclei via Subcortical-Cortical Loops in Manic and Depressive Phases of Bipolar Disorder.

Manic and depressive phases of bipolar disorder (BD) show opposite psychomotor symptoms. Neuronally, these may depend on altered relationships between sensorimotor network (SMN) and subcortical structures. The study aimed to investigate the functional relationships of SMN with substantia nigra (SN) and raphe nuclei (RN) via subcortical-cortical loops, and their alteration in bipolar mania and depression, as characterized by psychomotor excitation and inhibition. In this resting-state functional magnetic resonance imaging (fMRI) study on healthy (n = 67) and BD patients (n = 100), (1) functional connectivity (FC) between thalamus and SMN was calculated and correlated with FC from SN or RN to basal ganglia (BG)/thalamus in healthy; (2) using an a-priori-driven approach, thalamus-SMN FC, SN-BG/thalamus FC, and RN-BG/thalamus FC were compared between healthy and BD, focusing on manic (n = 34) and inhibited depressed (n = 21) patients. (1) In healthy, the thalamus-SMN FC showed a quadratic correlation with SN-BG/thalamus FC and a linear negative correlation with RN-BG/thalamus FC. Accordingly, the SN-related FC appears to enable the thalamus-SMN coupling, while the RN-related FC affects it favoring anti-correlation. (2) In BD, mania showed an increase in thalamus-SMN FC toward positive values (ie, thalamus-SMN abnormal coupling) paralleled by reduction of RN-BG/thalamus FC. By contrast, inhibited depression showed a decrease in thalamus-SMN FC toward around-zero values (ie, thalamus-SMN disconnection) paralleled by reduction of SN-BG/thalamus FC (and RN-BG/thalamus FC). The results were replicated in independent HC and BD datasets. These findings suggest an abnormal relationship of SMN with neurotransmitters-related areas via subcortical-cortical loops in mania and inhibited depression, finally resulting in psychomotor alterations.

RARE CAUSES OF ISCHEMIC STROKE. FEATURES OF ACUTE STROKE IN PATIENTS WITH DISSECTION OF THE GREAT VESSELS

Purpose of the study . Identification of the main causes of ischemic stroke in patients with aortic dissection, features of the clinical picture, the choice of optimal tactics for the management of such patients. Patients and methods . During 2017, 11 patients with aortic dissection were hospitalized for emergency indications and underwent complex, surgical interventions. In 4 patients, the reason for hospitalization was ischemic stroke, in 7 patients, the onset of the disease was manifested by chest pain. Subsequently, in all cases, ischemic stroke developed within 48 hours from the onset of pain symptoms. Fatal outcomes occurred in 5 (45.45%). Results . All patients were operated on for aortic dissection. Various types of surgery were performed. The best results were achieved with a hybrid operation — prosthetics of the aortic arch with endoprosthetic replacement of the de­scending aorta. The main reason for the development of ischemic stroke with aortic dissection and surgery for its elimi­nation is the development of brain malfunction. The cause of death was the dissemination of the dissection into the vis­ceral arteries with the development of multiple organ failure or aortic rupture of the aorta with hemo tamponade. Conclusion . As a rule, several pools of blood supply to the brain, episodes of psychomotor excitement are involved in the dissection of the aorta and branches of the aortic arch, cognitive impairments are progressing, since cortical branch­es of the brain are usually involved. With the timely assignment of neuroprotective therapy, revascularization, early complex rehabilitation, there is a significant positive dynamics of neurological status, restoration of cognitive functions.

Allergy to chlorpromazine and valproic acid following carbamazepine hypersensitivity in a patient with an HLA-B*4601 allele

A 73-year-old man, exhibiting psychomotor excitement after traumatic brain injury, developed allergic cutaneous eruptions and hepatic inflammation that did not resolve after the cessation of carbamazepine (CBZ). Fusing maculopapular erythema was observed in the face, neck, presternal region, and bilaterally in the forearms and feet. A drug-induced lymphocyte stimulation test revealed hypersensitivity to chlorpromazine (CPZ) and valproic acid (VPA), as well as to CBZ. The allergic reaction with eosinophilia to CPZ and VPA was suspected to have emerged following CBZ hypersensitivity, since previous treatment with CPZ and VPA prior to the introduction of CBZ had not been associated with adverse reactions earlier in the course of treatment. Recent studies have indicated linkages between severe CBZ hypersensitivity – but not mild CBZ hypersensitivity – and specific leukocyte antigens, HLA-B*1502 and HLA-A*3101, in Asian and European populations. The present case exhibited the HLA-B*4601 allele, which is associated with a high relative risk for the development of CBZ-induced maculopapular eruptions in Japanese and Han Chinese populations. Although cross-hypersensitivity among aromatic compounds, including CBZ and CPZ, is well-established, data regarding CBZ allergy-associated hypersensitivity to VPA are limited. In the present case, a cutaneous allergy to mianserin (a tetracyclic antidepressant) was also observed later in the course of treatment, suggesting additional cross-reactivity exists among aromatic psychotropic drugs. Thus, the association between the HLA-B*4601 allele and allergic reactions to VPA, aromatic psychotropic drugs, and CBZ should be further examined in future studies.