Diagnosis of posttraumatic stress disorder after surgery for primary rhegmatogenous retinal detachment.

PURPOSES: To investigate the prevalence of posttraumatic stress disorder (PTSD) in patients who underwent surgery for primary rhegmatogenous retinal detachment and to explore variables associated with the disorder. METHODS: Subjects eligible for the study were patients aged 18 years or older, who underwent surgery for primary rhegmatogenous retinal detachment at the Goldschleger Eye Institute, from January 1, 2004, to December 31, 2009, and were followed for at least 1 month. Study patients were screened for the existence of PTSD symptoms via a telephone survey, and positively identified patients were asked to undergo a structured psychiatric interview. Posttraumatic stress disorder was assessed by the Clinician Administered PTSD Scale, and the 25-item National Eye Institute visual function questionnaire (NEI-VFQ-25) was used as a measure of vision-related quality of life. Objective clinical measures were obtained from the patient's medical records. Clinical variables were compared between PTSD-diagnosed patients, patients who were screened for PTSD but were found to be PTSD negative in the interview (false-positive group), and patients who were found negative for PTSD in the screening survey. RESULTS: Of the 547 eligible patients, 366 were enrolled in the study. Nine patients (2.5%) met the criteria for PTSD diagnosis. Posttraumatic stress disorder patients reported significantly more traumatic events in their past (P = 0.015), and for these patients, NEI-VFQ-25 composite score was significantly lower (P < 0.001). Clinical measures were not found as independent risk factors for PTSD prediction. CONCLUSION: Posttraumatic stress disorder may develop in the aftermath of primary rhegmatogenous retinal detachment. Previous traumatic events and NEI-VFQ-25 scores were found as independent risk factors for PTSD prediction.

The different faces of Creutzfeldt-Jacob disease CJD in psychiatry.

OBJECTIVE: Creutzfeldt-Jacob Disease (CJD) is a rapidly progressive spongiform disease of the central nervous system. Psychiatric symptoms, though considered rare, can be the presenting symptoms of CJD and impose diagnosis difficulties. We reviewed prospectively our database to identify the frequency of psychiatric symptoms as identifying symptoms among our community. METHODS: We included all patients in Sheba Medical Center who were diagnosed with CJD between the years 2006 and 2012. Data were collected retrospectively. RESULTS: Twenty-three patients with CJD were admitted to our hospital during this 6-year period. Among them, 10 (44%) were diagnosed first as "psychiatric patients" due to psychiatric presenting symptoms. CONCLUSION: In our series, the frequency of misleading psychiatric symptom was 44%. Clinicians should therefore include CJD in their differential diagnoses of new onset dementia, particularly when associated psychosis and depression symptoms persist and worsen, despite standard psychiatric treatments.

Pharmacological management of treatment-resistant obsessive-compulsive disorder.

Once considered rare and resistant to treatment, obsessive-compulsive disorder (OCD) has now emerged as a common, yet often unrecognized, psychiatric condition. Treatment with selective serotonin reuptake inhibitors (SSRIs) is effective in 40-60% of patients with OCD. Management of the remaining 40-60% of patients with treatment-resistant OCD is challenging. We review up-to-date evidence focusing on strategies for treatment-resistant OCD, including increasing the dose of SSRI, switching to another SSRI, augmentation with antipsychotics, and the use of serotonin noradrenaline (norepinephrine) reuptake inhibitors (SNRIs) and monoamine oxidase inhibitors (MAOIs). Finally, we provide a flow chart, which includes nonpharmacological interventions such as cognitive-behavioural therapy, family interventions and physical interventions such as neurosurgery and deep brain stimulation, alongside the pharmacological strategies.