Cognitive changes in alcohol-induced psychotic disorder.

AIMS: This study aimed to explore the neuro-cognitive deficits of alcohol-induced psychotic disorder as compared to the cognitive deficits of uncomplicated alcohol dependence. METHODS: Participants were recruited from the acute psychiatric admission wards of the Department of Psychiatry, University of Stellenbosch and Stikland and Tygerberg Academic Hospitals in the Western-Cape, South Africa. Participants who met DSM IV TR criteria (American Psychiatric Association. Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DC, 2000) for Alcohol Dependence and for alcohol-induced psychotic disorder, respectively, were included. Participants who met criteria for another current DSM IV TR Axis I disorder were excluded. A structured interview was done prior to neuropsychological assessment to ascertain current mental state and to obtain relevant demographic detail and history. Neuropsychological assessments were performed and supervised by clinical psychologists at either Tygerberg or Stikland Hospital. RESULTS: The groups were matched demographically with similar period of abstinence prior to assessment. The alcohol-induced psychotic disorder group experienced first psychotic symptoms at age 35. The results reflected statistically significant differences on tasks measuring immediate memory; recall upon delay; exaggeration of memory difficulty and abstract thinking. CONCLUSION: This study concurs with earlier literature that some cognitive deficits are greater in alcohol-induced psychotic disorder compared to uncomplicated alcohol dependence.

Resting brain perfusion in alcohol-induced psychotic disorder: a comparison in patients with alcohol dependence, schizophrenia and healthy controls.

INTRODUCTION: Alcohol-induced psychotic disorder (AIPD), also known as alcohol hallucinosis, is a rare complication of alcohol abuse. The underlying pathophysiology is poorly understood, and the disorder needs to be differentiated from alcohol withdrawal delirium and schizophrenia. No brain-imaging studies in AIPD have been reported to date. Case reports of brain imaging in AIPD suggest possible dysfunction in the thalamus, basal ganglia, frontal lobes and cerebellum. Our aim was to prospectively compare resting brain perfusion (rCBF) in patients with AIPD, uncomplicated alcohol dependence, schizophrenia and healthy volunteers. METHODS: Single photon emission computed tomography (SPECT) was utilized to compare rCBF in patients with AIPD (n=19), schizophrenia (n=16), uncomplicated alcohol dependence (n=20) and healthy volunteers (n=19). RESULTS: Increased rCBF was demonstrated in the right calcarine area in patients with AIPD compared to healthy volunteers, with a trend towards increased rCBF to the frontal and temporal lobes and the right pallidum. Decreased left sided rCBF to the putamen, parietal, mid-frontal and mid-temporal lobes and heterogenous flow to the cerebellum were demonstrated in patients with AIPD when compared to patients with uncomplicated alcohol dependence. The left posterior cingulate and right cerebellum showed higher and lower rCBF respectively in patients with AIPD compared to patients with schizophrenia. CONCLUSION: Our findings implicate the right occipital lobe and possibly the cerebellum in the pathogenesis of AIPD and have similarities with those previously reported in alcohol withdrawal. Reduced rCBF to the frontal lobes, thalamus and basal ganglia in AIPD as suggested in previous case reports could not be confirmed.

A retrospective review of trends and clinical characteristics of methamphetamine-related acute psychiatric admissions in a South African context.

OBJECTIVE: Epidemiological studies indicate that methamphetamine (MA) abuse poses a major challenge to health in the Western Cape. The objectives of this study were to retrospectively assess the trends, clinical characteristics and treatment demand of MA-related admissions to a psychiatric ward in this region. METHOD: The clinical records of patients admitted to an acute psychiatric admission ward at Tygerberg Hospital from 1 January 2002 to 30 June 2002 and 1 January 2006 to 30 June 2006, were retrospectively reviewed. Admission numbers including those of adolescent and adult substance users were compared for both study periods. Study samples comparing demographic profile, admission status, length of stay, psychopathology, treatment requirements and referral pattern to other disciplines between MA users and non-users were collected for the 2006 period. RESULTS: There was a significant (p <0.01) increase in adolescent substance user admissions between the study periods. A significant (p <0.01) increase in adolescent and adult MA user admissions was also noted. MA users were significantly (p = 0.04) younger than non-MA users, whilst the former presented mainly with psychotic features associated with aggression, requiring involuntary admission of an average of 8 weeks. MA users required significantly (p = 0.007) more benzodiazepines compared to non-MA users. CONCLUSION: Although MA use is relatively recent to the Western Cape, its adverse psychiatric effects and consequences have become a major challenge. These effects in both adolescent and adult patient populations and the associated impact on psychiatric services demand urgent intervention strategies as well as prospective study.

Resting brain perfusion in social anxiety disorder: a voxel-wise whole brain comparison with healthy control subjects.

INTRODUCTION: Social anxiety disorder (SAD) is a condition characterised by fears of social interaction and performance situations. SAD may be related to a dysregulation or hyperactivity of cortico-limbic circuitry. This is the first voxel-based whole brain study comparing resting function in SAD to a normal control group. METHODS: Resting perfusion in adult subjects with generalised SAD was compared with healthy adult volunteers using Statistical Parametric Mapping (SPM). In subjects with SAD, correlations were also sought between resting perfusion and clinical severity measured using the total Liebowitz Social Anxiety Scale (LSAS). RESULTS: Twenty-eight subjects with SAD were compared with 19 healthy volunteers. SAD subjects had increased resting perfusion in the frontal cortex and right cerebellum, and decreased perfusion in the pons, left cerebellum, and right precuneus. Total LSAS correlated positively with left frontal cortex resting perfusion, and negatively with right fusiform and right lingual perfusion. CONCLUSION: This study demonstrated increased resting frontal function in social anxiety disorder that is consistent with its hypothesised role in the modulation of excessive limbic activity in anxiety disorders. The correlation of posterior cortical resting function with the severity of SAD symptoms may point to defective perception of self and others.

Catatonia: an open prospective series with carbamazepine.

In view of reports in the literature that catatonia responds well to benzodiazepines, and the possible association between catatonia and seizure disorders, an open prospective study was conducted to explore the possibility that catatonia may be successfully treated with carbamazepine. Patients meeting DSM-IV criteria for catatonia were challenged with lorazepam IMI and their response assessed. Non-responders, partial responders and patients who had a recurrence of symptoms were put on a trial of carbamazepine and their response assessed. Nine patients were assessed at our unit. Six of the 9 had a complete, but transient response to lorazepam. All of the patients were given a trial of carbamazepine: 4 had a complete resolution of catatonic symptoms, 1 had a partial resolution and 4 patients did not show a significant improvement. Carbamazepine seems to be an effective treatment, both in the acute phase, and as maintenance in a subgroup of retarded catatonic patients.

Serotonergic agents in the treatment of hypothalamic obesity syndrome: a case report.

The hypothalamic obesity syndrome is characterized by hyperphagia and excessive weight gain in the presence of demonstrable hypothalamic injury. There have been no previous reports describing the use of serotonergic agents in this condition. We report on a patient with severe hyperphagia and obesity secondary to a hypothalamic lesion, who was treated with consecutive courses of fluoxetine and fenfluramine. Neither treatment resulted in a reduction in food intake or weight. Treatment of hypothalamic obesity with serotonergic agents appears to be of little value, probably because they exert their effect via intact serotonergic-sensitive hypothalamic nuclei.

Screening for syphilis and neurosyphilis in acute psychiatric admissions.

The value of blood screening for syphilis and cerebrospinal fluid (CSF) screening for neurosyphilis in acute psychiatric admissions is assessed. Of 1,296 patients, 248 (19%) had evidence of previous or current syphilis as shown by a positive Treponema pallidum haemagglutination test, and 68 (5.2%) had potentially treatable syphilis as shown by a positive Venereal Disease Research Laboratory (VDRL) titre. CSF examination was performed on 169 patients with a positive blood test. Seventeen (i.e. 1.3% of all patients included in the study) met our criteria for neurosyphilis. The best predictor for neurosyphilis was the presence of a reactive serum VDRL. However, it is recommended that all patients with a positive blood test and symptoms that could possibly be ascribed to neurosyphilis undergo CSF examination.