Caution for psychiatrists: malignant hyperthermia risks with the anesthetic agent succinylcholine (Suxamethonium) during electroconvulsive therapy.

BACKGROUND: Malignant hyperthermia is a potentially lethal condition triggered by specific anesthetic drugs, especially a depolarizing muscle relaxant of succinylcholine (Suxamethonium). Despite the frequent use of succinylcholine with electroconvulsive therapy (ECT), there has been no reported case of potentially lethal malignant hyperthermia following ECT. In addition, the time interval between the administration of succinylcholine and the onset of malignant hyperthermia has not been outlined in the context of ECT. CASE PRESENTATION: We present the case of a 79-year-old woman suffering from severe depression, who experienced severe malignant hyperthermia due to succinylcholine administration during an ECT session. She presented with a high fever of 40.2 °C, tachycardia of 140/min, hypertension with a blood pressure exceeding 200 mmHg, significant muscle rigidity, and impaired consciousness. These symptoms emerged two hours after ECT, which occurred in a psychiatric ward rather than an operating room, and reached their peak in less than 24 h. She was given 60 mg of dantrolene, which quickly reduced the muscular rigidity. Subsequently, she received two additional doses of 20 mg and 60 mg of dantrolene, which brought her fever down to 36.2 °C and completely eased her muscle rigidity within two days after ECT. CONCLUSIONS: This is the first reported case of potentially lethal malignant hyperthermia after ECT. In addition, it highlights the delayed onset of malignant hyperthermia following an ECT procedure, emphasizing the necessity for psychiatrists to recognize its onset even after the treatment. In the light of potentially lethal consequences of malignant hyperthermia, it is critically important for psychiatrists to closely monitor both intraoperative and postoperative patient's vital signs and characteristic physical presentations, promptly identify any symptomatic emergence, and treat it immediately with dantrolene.

Articulatory-based Phonemic Paraphasia in Conduction Aphasia: A Dysfunction in Phoneme-to-Articulation Conversion Uncovered Through Crossed Aphasia.

Phonemic paraphasia, a common characteristic of conduction aphasia, has traditionally been attributed to phonological representation dysfunction. An alternative hypothesis posits that phonemic paraphasia arises from difficulty converting phonemes into their corresponding articulatory maneuvers. However, detailed case studies supporting this theory have been lacking. In this report, we present the case of a 61-year-old right-handed man with right temporo-parietal infarction who exhibited crossed aphasia characterized by typical conduction aphasia symptoms (eg, relatively fluent speech with intact comprehension, frequent phonemic paraphasia, and pronounced difficulties in oral repetition) in the absence of distorted articulation, syllable segmentation, and prosody impairment. Despite the frequent occurrence of phonemic paraphasia and articulatory challenges, our patient's phonological representations remained relatively intact. His phonemic paraphasia was often self-corrected to produce correct responses, a feature known as conduit d'approche. During the oral repetition of individual mora (ie, the smallest unit of speech in Japanese), we observed that the patient consistently traced the corresponding Hiragana phonetic symbol accurately, despite his difficulties in articulation. We substantiated this phenomenon through objective assessment and posit that it resulted from an unusual separation of language functions in crossed aphasia-specifically, a disconnection between phonological representations in the right temporo-parietal cortex and speech articulation engrams in the left hemisphere. In this case of conduction aphasia, articulatory-based phonemic paraphasia may be viewed as an inability to convert phonemes into the appropriate articulatory maneuvers rather than as phonological representation dysfunction or apraxia of speech.

Investigating the Link Between Subjective Depth Perception Deficits and Objective Stereoscopic Vision Deficits in Individuals With Acquired Brain Injury.

Individuals with acquired brain injury have reported subjective complaints of depth perception deficits, but few have undergone objective assessments to confirm these deficits. As a result, the literature currently lacks reports detailing the correlation between subjective depth perception deficits and objective stereoscopic vision deficits in individuals with acquired brain injury, particularly those cases that are characterized by a clearly defined lesion. To investigate this relationship, we recruited three individuals with acquired brain injury who experienced depth perception deficits and related difficulties in their daily lives. We had them take neurologic, ophthalmological, and neuropsychological examinations. We also had them take two types of stereoscopic vision tests: a Howard-Dolman-type stereoscopic vision test and the Topcon New Objective Stereo Test. Then, we compared the results with those of two control groups: a group with damage to the right hemisphere of the brain and a group of healthy controls. Performance on the two stereoscopic vision tests was severely impaired in the three patients. One of the patients also presented with cerebral diplopia. We identified the potential neural basis of these deficits in the cuneus and the posterior section of the superior parietal lobule, which play a role in vergence fusion and are located in the caudal region of the dorso-dorsal visual pathway, which is known to be crucial not only for visual spatial perception, but also for reaching, grasping, and making hand postures in the further course of that pathway.

Live two-way video versus face-to-face treatment for depression, anxiety, and obsessive-compulsive disorder: A 24-week randomized controlled trial.

AIM: Live two-way video, easily accessible from home via smartphones and other devices, is becoming a new way of providing psychiatric treatment. However, lack of evidence for real-world clinical setting effectiveness hampers its approval by medical insurance in some countries. Here, we conducted the first large-scale pragmatic, randomized controlled trial to determine the effectiveness of long-term treatment for multiple psychiatric disorders via two-way video using smartphones and other devices, which are currently the primary means of telecommunication. METHODS: This randomized controlled trial compared two-way video versus face-to-face treatment for depressive disorder, anxiety disorder, and obsessive-compulsive disorder in the subacute/maintenance phase during a 24-week period. Adult patients with the above-mentioned disorders were allocated to either a two-way video group (≥50% video sessions) or a face-to-face group (100% in-person sessions) and received standard treatment covered by public medical insurance. The primary outcome was the 36-Item Short-Form Health Survey Mental Component Summary (SF-36 MCS) score. Secondary outcomes included all-cause discontinuation, working alliance, adverse events, and the severity rating scales for each disorder. RESULTS: A total of 199 patients participated in this study. After 24 weeks of treatment, two-way video treatment was found to be noninferior to face-to-face treatment regarding SF-36 MCS score (48.50 vs 46.68, respectively; p < 0.001). There were no significant differences between the groups regarding most secondary end points, including all-cause discontinuation, treatment efficacy, and satisfaction. CONCLUSION: Two-way video treatment using smartphones and other devices, was noninferior to face-to-face treatment in real-world clinical settings. Modern telemedicine, easily accessible from home, can be used as a form of health care.

Pneumonia Risk Increased by Dementia-Related Daily Living Difficulties: Poor Oral Hygiene and Dysphagia as Contributing Factors.

OBJECTIVE: Although pneumonia is the leading cause of death among patients with dementia, the specific underlying causes remain unclear. In particular, the potential connection between pneumonia risk and dementia-related daily living difficulties, such as oral hygiene practice and mobility impairment, and the use of physical restraint as a management practice, has not been extensively studied. METHODS: In our retrospective study, we included 454 admissions corresponding to 336 individual patients with dementia who were admitted to a neuropsychiatric unit due to behavioral and psychological symptoms. The admissions were divided into two groups: those who developed pneumonia while hospitalized (n=62) and those who did not (n=392). We investigated differences between the two groups in terms of dementia etiology, dementia severity, physical conditions, medical complications, medication, dementia-related difficulties in daily living, and physical restraint. To control potential confounding variables, we used mixed effects logistic regression analysis to identify risk factors for pneumonia in this cohort. RESULTS: Our study found that the development of pneumonia in patients with dementia was associated with poor oral hygiene, dysphagia, and loss of consciousness. Physical restraint and mobility impairment showed a weaker, nonsignificant association with the development of pneumonia. CONCLUSIONS: Our findings suggest that pneumonia in this population may be caused by two primary factors: increased pathogenic microorganisms in the oral cavity due to poor hygiene, and an inability to clear aspirated contents due to dysphagia and loss of consciousness. Further investigation is needed to clarify the relationship between physical restraint, mobility impairment, and pneumonia in this population.

Development of Self-made Gestures as an Adaptive Strategy for Communication in an Individual With Childhood Apraxia of Speech.

Individuals with childhood apraxia of speech often exhibit greater difficulty with expressive language than with receptive language. As a result, they may benefit from alternative modes of communication. Here, we present a patient with childhood apraxia of speech who used pointing as a means of communication at age 2 » years and self-made gestures at age 3½, when he had severe difficulties speaking in spite of probable normal comprehension abilities. His original gestures included not only word-level expressions, but also sentence-length ones. For example, when expressing "I am going to bed," he pointed his index finger at himself (meaning I ) and then put both his hands together near his ear ( sleep ). When trying to convey the meaning of "I enjoyed the meal and am leaving," he covered his mouth with his right hand ( delicious ), then joined both of his hands in front of himself ( finish ) and finally waved his hands ( goodbye ). These original gestures and pointing peaked at the age of 4 and then subsided and completely disappeared by the age of 7, when he was able to make himself understood to some extent with spoken words. The present case demonstrates an adaptive strategy for communication that might be an inherent competence for human beings.

A Selective Hand Posture Apraxia in an Individual With Posterior Cortical Atrophy and Probable Corticobasal Syndrome.

A selective impairment for making hand postures that are required to use specific tools has rarely been reported in individuals with acquired brain injury, and such an impairment has not been documented at all in individuals with degenerative disorders. We describe an individual with posterior cortical atrophy and probable corticobasal syndrome who was unable to use tools because of an inability to make the proper hand posture required for each tool. This individual was, however, able to use the tools properly once her hand postures were corrected, and her ability to manipulate the tools (ie, timing, arm posture, and amplitude) was intact. Also, she had no difficulty with a test of her manipulation knowledge. Areas of hypoperfusion observed by single-photon emission computerized tomography included the anterior intraparietal sulcus in the left parietal lobe, which is an area that has been proposed to control hand postures. This selective impairment might be explained by the reasoning-based hypothesis for apraxia, which attributes hand posture errors in the absence of manipulation errors to dysfunction in one of the three independent pathways that subserve tool use, rather than the manipulation-based hypothesis for apraxia, which attributes hand posture errors to impaired manipulation knowledge. This is the first case with a degenerative disorder that revealed a selective impairment for making hand postures for tool use, which might be explained mainly by apraxia of hand postures along with visuospatial dysfunction (simultanagnosia) and/or sensory disturbance.

Word recall process and physiological activation in the tip-of-the-tongue state: Comparison of young and middle-aged groups.

To clarify the feeling of knowing a name but not being able to recall it, known as having a "tip-of-the-tongue" (TOT) experience, we proposed a TOT model consisting of three stages combining a face recognition model and autonomic sympathetic nerve activity. Since TOT increases with age, we compared two age groups: young (N = 27, M = 20.4 ± 1.5 years) and middle-aged (N = 29, M = 58.5 ± 8.0 years). Experiment 1 showed that successfully naming low-frequency common names increased the skin conductance response (SCR) value, and the time to reach the maximum SCR value was longer. Experiment 2 was a naming task for face photographs. The younger group showed higher SCR values during successfully naming, while the middle-aged group showed similar SCR values for successfully naming and experiencing TOT. Both groups had the longest time to reach maximum SCR in TOT. In this study, physiological arousal of TOT was not affected by aging.

Apathy Level, Disinhibition, and Psychiatric Conditions Are Related to the Employment Status of People With Traumatic Brain Injury.

IMPORTANCE: An understanding of the potential prognostic factors as they relate to the employment status of people with traumatic brain injury (TBI) is necessary so that occupational therapy practitioners can provide the most effective treatment. OBJECTIVE: To examine the impact of apathy, disinhibition, and psychiatric conditions on employment status after TBI. DESIGN: An observational study conducted from March 2015 to March 2020. SETTING: Cognitive dysfunction clinics associated with two general hospitals in Japan. PARTICIPANTS: Japanese people of working age (N = 110, ages 18-65 yr) with TBI. Outcomes and Measures: As an outcome indicator, each participant's employment status was rated on a 3-point scale (i.e., 3 = regular employment, 2 = welfare employment [employed as a person with disabilities or undergoing vocational training in the Japanese welfare employment system, for which a worker is paid under either system], 1 = unemployment). Psychiatric, neuropsychological, and physical assessments were measured as explanatory variables. The impact of various factors on employment status was investigated using linear discriminant regression analysis. RESULTS: The level of apathy, disinhibition, and incidence of psychiatric conditions after TBI, as well as age and years postinjury, were related to employment status. Conclusion and Relevance: Although this is a cross-sectional study, interventions for apathy and disinhibition, as well as management of psychiatric conditions, are recommended to help improve employment status among people with TBI. What This Article Adds: The employment status of people with TBI is related more to apathy, disinhibition, and psychiatric conditions than to intelligence, memory function, or executive function.

Severe diaphoresis and fever during alcohol withdrawal cause hypovolemic shock: case report.

BACKGROUND: Several fatal medical complications have been associated with alcohol withdrawal, such as seizure, cardiac arrhythmia, and takotsubo cardiomyopathy. However, there have been no reports on hypovolemic shock during alcohol withdrawal, although two physical signs of alcohol withdrawal, i.e., diaphoresis and fever, can lead to hypovolemia and its medical consequences. CASE PRESENTATION: We describe a patient with alcohol use disorder who exhibited hypovolemic shock and its associated acute renal failure during alcohol withdrawal with severe diaphoresis and fever even though he had consumed almost the full amount of food he was offered. Given his excessive diaphoresis and fever that were related to alcohol withdrawal, his water intake was insufficient. Infusion with extracellular fluid resolved all these medical issues. CONCLUSIONS: The increased adrenergic activity associated with alcohol withdrawal might substantially increase a patient's water-intake requirement through diaphoresis and fever and may cause severe hypovolemia and its associated medical complications.

Forced Gazing: A Stimulus-bound Behavior.

We studied four patients with acquired brain injury who were compelled to gaze at a moving object or the face of an individual who came into their sight, especially the person's eyes. The patients continued to gaze at the object or person until it disappeared from their sight. This behavior, referred to as forced gazing, is related to visual groping (part of the instinctive grasp reaction), and, together with a similar sign of visual grasping, constitutes a spectrum of visual stimulus-bound behaviors. In addition to forced gazing, the patients exhibited a primitive reflex such as a grasp or sucking reflex. Each of the patients had lesions in the bilateral frontal lobes of the brain. We considered forced gazing to be a stimulus-bound behavior, in which patients become extremely dependent on a specific external stimulus. As gaze-related communication is considered one of the bases of an infant's social development, forced gazing may have its basis in innate human behavior that might manifest itself under specific pathological circumstances such as bilateral frontal-lobe damage.

Numeric input operation on electronic devices among individuals with visuospatial working memory impairment.

ABSTRACTIn human-computer interactions, higher-level visuospatial function is likely needed to effectively use the interface. The aim of this study is to clarify whether individuals with visuospatial defects can use electronic devices effectively. We quantitatively and qualitatively analyzed the ability of seven individuals with Bálint syndrome and seven individuals with left-unilateral spatial neglect (USN) to input a digit sequence into a flat touch interface. Control groups consisted of seven individuals with memory deficits and 11 healthy individuals. Participants with Bálint syndrome took longer and had more hesitations than the USN group and the two control groups to input numerical sequences (Steel-Dwass test, p < .01). In addition, participants with Bálint syndrome had a high percentage of hesitations for exploration of the button array on the interface relative to USN and the memory deficit group (Fisher's exact test, p < .05). Regarding neuropsychological data, participants with Bálint syndrome had a lower score for visuospatial working memory than participants with USN and the memory deficits control group (Steel-Dwass test, p < .01). The results shed some light on the relation between visuospatial working memory deficits and the spatial perception of interface layouts and spatial control during electronic device operation.

Pisa syndrome induced by switching of a choline-esterase inhibitor treatment from donepezil to galantamine: a case report.

BACKGROUND: Pisa syndrome (PS) is characterized by an abnormally sustained posture, with flexion of the body and head to one side and slight rotation of the trunk. Although PS most commonly arises as an adverse effect of antipsychotic drugs, choline-esterase inhibitors (ChEIs) are also sometimes known to induce PS. Despite the fact that the precise mechanism remains unclear, cholinergic-dopaminergic imbalance has been considered as a possible pathophysiologic mechanism underlying the genesis of PS. CASE PRESENTATION: We hereby report the case of a 60-year-old woman with Alzheimer's disease who presented with the signs of PS after her treatment was switched to galantamine, a type of ChEI, even though she had received donepezil, another type of ChEI, for 5 years without any complications. To the best of our knowledge, this is the first report of PS associated with treatment switch from one to another type of ChEI. Galantamine, but not other ChEIs, can enhance striatal dopamine release through allosteric modulation of the nicotinic acetylcholine receptor, and has weaker muscarinic effects than donepezil. Therefore, we propose two novel hypotheses to explain the development of PS, as follows; galantamine, which enhances dopamine release, can induce imbalance of dopamine levels in the striatum of patients with dementia, resulting in PS, and the weaker muscarinic effects of the drug could be one of the factors predisposing to the development of PS. CONCLUSION: The present case suggests that treatment with galantamine is associated with a higher risk of development of PS than that with other ChEIs, such as donepezil, despite the pharmacological profile of galantamine as a dopamine modulator. Also, this report provides novel insight into another plausible mechanism underlying the development of PS, besides cholinergic-dopaminergic imbalance, namely, dopamine imbalance in the striatum with muscarinic-nicotinic imbalance.

PET-detectable tau pathology correlates with long-term neuropsychiatric outcomes in patients with traumatic brain injury.

Tau deposits is a core feature of neurodegenerative disorder following traumatic brain injury (TBI). Despite ample evidence from post-mortem studies demonstrating exposure to both mild-repetitive and severe TBIs are linked to tau depositions, associations of topology of tau lesions with late-onset psychiatric symptoms due to TBI have not been explored. To address this issue, we assessed tau deposits in long-term survivors of TBI by PET with 11C-PBB3, and evaluated those associations with late-life neuropsychiatric outcomes. PET data were acquired from 27 subjects in the chronic stage following mild-repetitive or severe TBI and 15 healthy control subjects. Among the TBI patients, 14 were diagnosed as having late-onset symptoms based on the criteria of traumatic encephalopathy syndrome. For quantification of tau burden in TBI brains, we calculated 11C-PBB3 binding capacity (cm3), which is a summed voxel value of binding potentials (BP*ND) multiplied by voxel volume. Main outcomes of the present study were differences in 11C-PBB3 binding capacity between groups, and the association of regional 11C-PBB3 binding capacity with neuropsychiatric symptoms. To confirm 11C-PBB3 binding to tau deposits in TBI brains, we conducted in vitro PBB3 fluorescence and phospho-tau antibody immunofluorescence labelling of brain sections of chronic traumatic encephalopathy obtained from the Brain Bank. Our results showed that patients with TBI had higher 11C-PBB3 binding capacities in the neocortical grey and white matter segments than healthy control subjects. Furthermore, TBI patients with traumatic encephalopathy syndrome showed higher 11C-PBB3 binding capacity in the white matter segment than those without traumatic encephalopathy syndrome, and regional assessments revealed that subgroup difference was also significant in the frontal white matter. 11C-PBB3 binding capacity in the white matter segment correlated with the severity of psychosis. In vitro assays demonstrated PBB3-positive tau inclusions at the depth of neocortical sulci, confirming 11C-PBB3 binding to tau lesions. In conclusion, increased 11C-PBB3 binding capacity is associated with late-onset neuropsychiatric symptoms following TBI, and a close correlation was found between psychosis and 11C-PBB3 binding capacity in the white matter.

Scooping Rice Into a Glass and Putting a Cell Phone in the Refrigerator: Action Slips in an Individual With a Diffuse Axonal Injury.

A 39-year-old man with a diffuse axonal injury self-presented to the cognitive function clinic of the Ashikaga Red Cross Hospital complaining of behavioral errors in his daily life, such as scooping hot rice into a glass instead of a bowl or forgetting to turn off the gas stove after cooking. This type of error has been referred to as an action slip-a form of unintentional behavioral error that occurs when an individual attempts to perform an automatic and/or familiar task. In this case, action slips occurred nine times a day on average and had a serious and long-term impact on the man's daily quality of life. To reduce the impact of action slips, we created a one-on-one cognitive intervention that used a combination of mnemonic strategies, such as verbalizing his actions as he carried them out, and external aids, including a waist pouch, a voice-controlled artificial intelligence (AI) speaker, and an AI key finder. After 3 years of intervention, the man reported some improvement in his daily activities and a reduction in the number of action slips. Thus, intervention strategies for individuals with a diffuse axonal injury may benefit from targeting action slips. To our knowledge, this is the first detailed description of action slips in an individual with a diffuse axonal injury.

Forced person-following: a new type of stimulus-bound behavior.

We report a new type of stimulus-bound behavior, denoted forced person-following, which we documented for a patient with hypoxic encephalopathy following a suicide attempt with carbon monoxide poisoning. The patient's brain was damaged in the bilateral frontal, parietal, and temporal lobes and in the basal ganglia. The patient was compelled to follow any person who came into his sight and would continue to do so until the person went out of his sight. The patient also exhibited certain primitive reflexes. The forced person-following exhibited by our patient appears to be a consequence of stimulus-bound behavior due to frontal lobe dysfunction and, to a lesser degree, severe cognitive dysfunctions, e.g., visuospatial deficits, which are related to damage in posterior cortices. The unique behavior exhibited by this patient might contribute to our understanding of innate human behavior.

Prognostic factors for long-term improvement from stroke-related aphasia with adequate linguistic rehabilitation.

In the past decade, several studies have reported potential prognostic factors for aphasia after stroke. However, these reports covered no more than 1 year after stroke onset, even though patients often continue to improve over longer periods. The present study included 121 patients with aphasia who received cognitive-based linguistic rehabilitation for at least 2 years post-onset. All were right-handed and had a lesion only in the left hemisphere. Aphasia outcome was predicted using multiple linear regression analysis. Age at onset, lesion in the left superior temporal gyrus including Wernicke's area, and baseline linguistic abilities including aphasia severity and both phonological and semantic functions were significant predictors of long-term aphasia outcome. These findings suggest that the long-term outcome of aphasia following adequate linguistic rehabilitation can be predicted by age at onset, lesion area, and baseline linguistic abilities and that linguistic rehabilitation is particularly recommended for younger individuals with aphasia.

Dementia trajectory for patients with logopenic variant primary progressive aphasia.

BACKGROUND: The timing of progression of logopenic variant primary progressive aphasia (lvPPA) to severe dementia has not been elucidated. To address this shortcoming, 10 patients with lvPPA were continuously followed. METHODS: Patients were assessed with the annual rate of change in the Clinical Dementia Rating (CDR) sum of boxes and period from lvPPA onset to the onset of benchmark signs, including mild, moderate, or severe dementia, episodic memory deficits, topographical disorientation, difficulties with using controls for electronic appliances, and conceptual apraxia. When severe dementia was evident, we also investigated the incidence of severe cognitive and behavioral signs such as neologistic jargon, difficulties in recognizing family members, pica, and mirror sign. RESULTS: The mean time for patients to reach a particular CDR was as follows: CDR of 1, 4.1 ± 1.3 years post-onset; CDR 2, 5.7 ± 1.6 years; CDR 3, 7.3 ± 1.6 years. The annual rate of change in the CDR sum of boxes was 3.4 ± 1.1, corresponding to 1.7 years for the CDR to increase by 1.0. Difficulties with using electronic controls began at 3.3 ± 1.6 years, episodic memory deficits at 4.0 ± 2.0 years, topographical disorientation at 5.2 ± 2.1 years, and conceptual apraxia at 5.5 ± 2.1 years. For patients who progressed to severe dementia, six could not recognize family members, five exhibited pica, three experienced mirror sign, and one developed neologistic jargon. CONCLUSIONS: Our results suggest that patients with lvPPA progress rapidly to dementia and develop conceptual apraxia, episodic memory deficits, visuospatial deficits, and semantic memory deficits.

Remarkable behavioural signs and progressive non-fluent aphasia in a patient with adult-onset leucoencephalopathy with axonal spheroids and pigmented glia.

Adult-onset leucoencephalopathy with axonal spheroids and pigmented glia (ALSP), also known as hereditary diffuse leucoencephalopathy with spheroids (HDLS), is a progressive neurocognitive disorder that predominantly affects the cerebral white matter, mainly the frontal subcortical areas and the corpus callosum. Patients with ALSP are clinically characterized by a gradual onset of cognitive and behavioural dysfunction and personality changes, followed by motor impairments such as gait disturbance and bradykinesia. Given the disease-related degenerative changes of the frontal white matter, it is no wonder that patients with ALSP present with behavioural symptoms and non-fluent aphasia, which are found in patients with frontotemporal lobar degeneration. However, behavioural symptoms and non-fluent aphasia in a patient with ALSP have rarely reported in detail. Here, we describe a patient with ALSP who initially presented with remarkable behavioural signs and non-fluent primary progressive aphasia, which resembled symptoms of frontotemporal lobar degeneration. The present case suggests that ALSP should be included in the differential diagnosis for frontotemporal lobar degeneration.

Catatonic Stupor in Schizophrenic Disorders and Subsequent Medical Complications and Mortality.

OBJECTIVE: Although catatonia can occur secondary to a general medical condition, catatonia itself has been known to lead to various medical compolications. Although case reports on the association of catatonia with subsequent medical complications have been documented, no comprehensive large-scale study has been performed. To investigate specific medical complications after catatonia, we conducted a retrospective cohort study of specific medical complications of schizophrenia patients with catatonia. METHODS: The 1719 schizophrenia inpatients in our study were categorized into two groups: the catatonia group, i.e., those who exhibited catatonic stupor while they were hospitalized, and the noncatatonia group, i.e., those who never exhibited catatonic stupor. Differences between the two groups in the occurrence of subsequent medical complications were examined using linear and logistic regression analyses, and models were adjusted for potentially confounding factors. RESULTS: The catatonia group had an increased risk for mortality (odds ratio = 4.8, 95% confidence interval = 2.0-10.6, p < .01) and certain specific medical complications, i.e., pneumonia, urinary tract infection, sepsis, disseminated intravascular coagulation, rhabdomyolysis, dehydration, deep venous thrombosis, pulmonary embolism, urinary retention, decubitus, arrhythmia, renal failure, neuroleptic malignant syndrome, hypernatremia, and liver dysfunction (all p values < .01, except for deep venous thrombosis, p = .04 in the multiple linear regression analysis). CONCLUSIONS: Catatonic stupor in schizophrenia substantially raises the risk for specific medical complications and mortality. Hyperactivity of the sympathetic nervous system, dehydration, and immobility, which are frequently involved in catatonia, might contribute to these specific medical complications. In catatonia, meticulous care for both mental and medical conditions should be taken to reduce the risk of adverse medical consequences.