Prognostic factors, symptoms and consequences of dehydration and dyselectrolytemia in patients with terminal stomach cancer.

BACKGROUND: Dyselectrolytaemia and dehydration are common symptoms in people with terminal stomach cancer. AIMS: To determine factors related to dyselectrolytemia and dehydration in patients with terminal stomach cancer. METHODS: An analysis of 134 patients with terminal stomach cancer admitted to the palliative care unit was conducted, through an audit of the patients' medical records. The average age of women was 63.1 years and that of men was 64.9 years. FINDINGS: Dehydrated patients were more likely to: have dyselectrolytaemia; have a higher PS scale score; be taking opioids as an analgesic; have a high sodium concentration; experience dyspnoea, constipation, nausea and vomiting during hospitalisation; and require glucocorticoids administration both during and before hospitalisation. Patients with dyselectrolytaemia were more likely to: be admitted to the palliative care unit from the emergency department; experience cachexia and dehydration during hospitalisation and constipation at discharge; have a lower albumin level; and have a higher glucose level. Patients with dyselectrolytaemia also had a shorter duration of treatment and a 2.48 greater chance for death compared with those who did not have it. CONCLUSIONS: Knowledge of the adverse factors connected with dehydration and dyselectrolytaemia will allow health professionals to avoid dangerous clinical symptoms and prolong the life of those with terminal stomach cancer, as they might be able to foresee the occurrence of these conditions based on the medication the patient has been taking and symptoms they have been experiencing. Nurses will have a greater understanding of the importance of fluid therapy to resolve ionic disturbances and the need to address dehydration and dyselectrolytemia as a means to prolong and improve quality of life.

[Malignant catatonia in dementia with Lewy Body successfully treated with sismotherapy: A case report]. / Catatonie maligne compliquant une démence à corps de Lewy traitée par électro-convulsivo-thérapie : à propos d'un cas.

Malignant catatonia is a life-threatening syndrome, associated mostly with psychiatric diseases but also with neurological and neurodegenerative syndromes. We report the case of a 72-year-old patient, hospitalized for a major depressive episode with delusional symptoms, who presented a malignant catatonia. The patient had been transferred to an intensive care unit and treated with electroconvulsive therapy (ECT) leading to a rapid disappearance of the catatonic syndrome associated with a remission of the depressive symptoms. Complementary investigations helped us to secondarily diagnose a Lewy Body Dementia, which probably caused, associated with a treatment by haloperidol, the onset of catatonia. This case illustrates the need of an early diagnosis of neurodegenerative diseases in psychiatric outpatients and the importance of a quick management of catatonia, including ECT.

[Body dysmorphic disorder].

Body dysmorphic disorder is defined by a preoccupation of one or more non-existent or slight defects or flaws in the physical appearance. The prevalence is 1.7-2.4% in the general population with a higher incidence rate in women. The rate of suicidal ideation is as high as 80%, and up to 25% of the patients attempt to commit suicide. Comorbidities, such as obsessive compulsive disorder, depression, and anxiety, are frequent. These patients may seek cosmetic or dermatologic rather than psychological treatment. In the view of the high prevalence and risk of suicide, recognizing this disorder is important.

Delusional misidentification syndrome and other unusual delusions in advanced Parkinson's disease.

BACKGROUND: Unusual delusional syndromes are rare protean diseases with speculative etiopathogenic mechanisms. METHODS: Seven consecutive patients with advanced PD were evaluated over a 15-year period at the Movement Disorders Unit in the Neurology Service, Hospital de Clínicas, Federal University of Paraná, and the Paraná State Parkinson's Patients Association. RESULTS: We describe advanced Parkinson's disease patients presenting with unusual delusional syndromes, including cases of Ekbom, Othello, Capgras' and Diogenes syndromes, reduplicative paramnesia and mirrored-self misidentification. CONCLUSION: There are a few isolated reports of unusual neuropsychiatric disorders in patients with PD. We believe that these syndromes associated with advanced PD in elderly patients presenting with cognitive impairment and polypharmacy are probably often underestimated. Neurologists should be aware for these rare and treatable conditions.

The clinical significance of bilateral basal ganglia calcification presenting with mania and delusions.

The authors present the case of a 37-year-old man who developed a psychotic manic episode and was found to have bilateral basal ganglia calcification (BGC). The authors present this case report along with a discussion of the literature on the neuropsychiatry of BGC.

Association between promoter polymorphisms of the LIFR gene and schizophrenia with persecutory delusion in a Korean population.

Schizophrenia has been associated with an imbalance in inflammatory cytokines. Leukemia inhibitory factor receptor α (LIFR) is an integral component of the glycoprotein 130-LIFR signaling complex, which participates in signal transduction by members of the interleukin (IL)-6 cytokine family. The aim of this study was to investigate whether genetic polymorphisms of the LIFR gene are associated with schizophrenia in the Korean population. We also explored possible associations between the polymorphisms and the clinical symptoms of schizophrenia. We selected three single nucleotide polymorphisms (SNPs) (rs2071237 -200C/G, rs2071236 -254C/T and rs6862038 -962A/G) on the promoter region of the LIFR gene and recruited 204 schizophrenia patients and 367 control subjects from the Korean population. All patients were evaluated according to the Operational Criteria Checklist for Psychotic Illness. SNP genotyping was performed by direct sequencing. An analysis of multiple logistic regression models (co-dominant 1, co-dominant 2, dominant, recessive and overdominant) was performed to evaluate odds ratios (ORs), 95% confidence intervals (CIs) and p-values. No significant difference was revealed between schizophrenia patients and controls. However, a significant association was detected between the LIFR gene polymorphisms and schizophrenia patients with persecutory delusion (rs2071236, OR=2.18, 95% CI=1.20-3.94, P=0.009 in the overdominant model; rs6862038, OR=2.08, 95% CI=1.16-3.74, P=0.013 in the overdominant model). The present study suggests that the LIFR gene may be related to schizophrenia with persecutory delusion in the Korean population.

Anti-NMDA receptor encephalitis: an important differential diagnosis in psychosis.

We present four cases of confirmed anti-NMDA receptor encephalitis; three presented initially with serious psychiatric symptoms and the other developed significant psychiatric symptoms during the initial phase of illness. Brain biopsy findings of one patient are also described. Psychiatrists should consider anti-NMDA receptor encephalitis in patients presenting with psychosis and additional features of dyskinesias, seizures and catatonia, particularly where there is no previous history of psychiatric disorder.

COMT Val158Met-stress interaction in psychosis: role of background psychosis risk.

BACKGROUND: The interplay between the catechol-O-methyltransferase (COMT) Val158Met polymorphism and environmental stress may have etiological relevance for psychosis, but differential effects have been reported in healthy control and patient groups, suggesting that COMT Val158Met interactions with stress may be conditional on background genetic risk for psychotic disorder. METHODS: Patients with a nonaffective psychotic disorder (n = 86) and control participants (n = 109) were studied with the experience sampling method (a structured diary technique) in order to assess stress, negative affect and momentary psychotic symptoms in the flow of daily life. RESULTS: Multilevel analyses revealed significant three-way interactions between group status (patient or control), COMT genotype and stress in the model of negative affect (χ(2)(2) = 13.26, P < 0.01) as well as in the model of momentary psychotic symptoms (χ(2)(2) = 6.92, P < 0.05). Exploration of the three-way interaction revealed that in patients, COMT genotype moderated the association between stress and negative affect (χ(2)(4) = 11.50, P < 0.005), as well as the association between stress and momentary psychosis (χ(2)(4) = 12.79, P < 0.005). Met/Met genotype patients showed significantly increased psychotic and affective reactivity to stress in comparison to the Val/Met and Val/Val genotypes. In contrast, healthy controls did not display large or significant COMT Val158Met X stress interactions. CONCLUSIONS: Important differences exist in the effect of COMT Val158Met on stress reactivity, which may depend on background risk for psychotic disorder. Differential sensitivity to environmental stress occasioned by COMT Val158Met may be contingent on higher order interactions with genetic variation underlying psychotic disorder.

Adjunct treatment with levodopa in a patient with dementia with Lewy bodies, delusions and severe neuroleptic hypersensitivity syndrome.

We report on the treatment of a patient suffering from dementia with Lewy bodies who initially presented with severe neurological and psychopathological symptoms. After treating the patient with levodopa and clozapine, these symptoms remitted.

Neurophysiological characteristics of cognitive functions in patients with first episodes of endogenous psychosis.

This report presents studies of the neurophysiological correlates of the characteristics of cognitive disorders in patients with first psychotic episodes of endogenous psychosis at juvenile age. Three groups of patients were studied: those with a predominance of catatonic symptomatology (22 patients), those with a predominance of hallucinatory-delusional symptomatology (22 patients), and those with a predominance of affective-delusional symptomatology (24 patients), along with a group of psychologically healthy subjects (15 subjects). Parameters of auditory evoked potentials were analyzed using the oddball paradigm. The group with a predominance of catatonic disorders showed the greatest differences in the latent periods (LP) of the N200 and P300 components as compared with the other groups; patients with a predominance of hallucinatory-delusional symptomatology showed the most localized anomalies in the latent period of the P300 component; the group of patients dominated by affective-delusional symptomatology showed almost no increase in the latent period of the N200 component, though the extents of anomalies in the N100 component in responses to non-target signals and deviations in the P300 component were more marked than in the other groups. These characteristics of the neurophysiological correlates of cognitive functions in each group of patients supported the significance of evaluating the psychopathological structure of manifest psychotic episodes for determining the clinical typology.

Self-mutilation of the nose in a schizophrenic patient with Cotard syndrome.

Cotard syndrome is a rare condition, which its main symptom is nihilistic delusion. Self-mutilation of the nose is also a rare condition, which has not been seen in schizophrenic patients with Cotard syndrome. A single case is presented here. A 32-year-old woman who was diagnosed as having schizophrenia and believed that she was dead, cut the tip of her nose. She had no guilt feeling and described her act as a cosmetic surgery. We try to explain how various symptoms that seem to be very far from each other could exist side by side. Misinterpretation of her face is suggested to be the starting point in her complex symptoms.