Case report: Creutzfeldt-Jakob disease presenting with anxiety symptoms in a COVID-19 post-infection patient.

Creutzfeldt-Jakob Disease (CJD) is a rare, rapidly progressive, and fatal neurodegenerative disorder. We describe a man whose initial manifestations of CJD occurred shortly after contracting Coronavirus disease 2019 (COVID-19). He first developed anxiety and short-term memory loss a few weeks after a mild COVID-19 infection. He subsequently developed parkinsonism, eventually progressed to akinetic mutism, and passed away 5 months after symptom onset. This case highlights a potential temporal relationship between COVID-19 infection and the onset of neurodegenerative symptoms. Microglia and astrocytes in the central nervous system (CNS) and 'S1' spike proteins on SARS-CoV-2 are potential mediators in neuroinflammation and neurodegeneration.

Validating a functional near-infrared spectroscopy diagnostic paradigm for Major Depressive Disorder.

Reduced haemodynamic response in the frontotemporal cortices of patients with major depressive disorder (MDD) has been demonstrated using functional near-infrared spectroscopy (fNIRS). Most notably, changes in cortical oxy-haemoglobin during a Japanese phonetic fluency task can differentiate psychiatric patients from healthy controls (HC). However, this paradigm has not been validated in the English language. Therefore, the present work aimed to distinguish patients with MDD from HCs, using haemodynamic response measured during an English letter fluency task. One hundred and five HCs and 105 patients with MDD took part in this study. NIRS signals during the verbal fluency task (VFT) was acquired using a 52-channel system, and changes in oxy-haemoglobin in the frontal and temporal regions were quantified. Depression severity, psychosocial functioning, pharmacotherapy and psychiatric history were noted. Patients with MDD had smaller changes in oxy-haemoglobin in the frontal and temporal cortices than HCs. In both regions of interest, oxy-haemoglobin was not associated with any of the clinical variables studied. 75.2% and 76.5% of patients with MDD were correctly classified using frontal and temporal region oxy-haemoglobin, respectively. Haemodynamic response measured by fNIRS during an English letter fluency task is a promising biomarker for MDD.

Lithium Use in a Patient With Bipolar Disorder and End-Stage Kidney Disease on Hemodialysis: A Case Report.

Lithium has been implicated in causing chronic tubulointerstitial nephritis and decline in renal function. However, lithium still plays a role in stabilizing patients with bipolar disorder. We illustrated a case of a bipolar I disorder patient approaching end-stage kidney disease (ESKD) with other medical comorbidities. As her mental state was affecting her compliance with medical treatment, she was mentally and medically unwell. Our patient was hospitalized on two separate occasions, for 5 and 4 months respectively, and failed adequate trials of different psychotropics due to inefficacy or intolerable side effects. A decision was made between the psychiatrist, nephrologist, and cardiologist to use lithium with hemodialysis support, with good treatment response and improved mental state. This case has shown that lithium carbonate can still be prescribed in ESKD patients on hemodialysis. Daily monitoring of lithium levels in the initial phase of lithium and hemodialysis commencement for at least 2 weeks is imperative, reducing to three times per week pre-hemodialysis towards the end of discharge after three consecutive daily serum lithium levels have stabilized. Clinicians can also consider a target serum level of less than 0.6 mEq/L in maintenance treatment for bipolar disorder in patients on hemodialysis.

Cortical haemodynamic response measured by functional near infrared spectroscopy during a verbal fluency task in patients with major depression and borderline personality disorder.

BACKGROUND: Functional near infrared spectroscopy (fNIRS) provides a direct and quantitative assessment of cortical haemodynamic function during a cognitive task. This functional neuroimaging modality may be used to elucidate the pathophysiology of psychiatric disorders, and identify neurophysiological differences between co-occurring psychiatric disorders. However, fNIRS research on borderline personality disorder (BPD) has been limited. Hence, this study aimed to compare cerebral haemodynamic function in healthy controls (HC), patients with major depressive disorder (MDD) and patients with BPD. METHODS: fNIRS signals during a verbal fluency task designed for clinical assessment was recorded for all participants. Demographics, clinical history and symptom severity were also noted. FINDINGS: Compared to HCs (n = 31), both patient groups (MDD, n = 31; BPD, n = 31) displayed diminished haemodynamic response in the frontal, temporal and parietal cortices. Moreover, haemodynamic response in the right frontal cortex is markedly lower in patients with MDD compared to patients with BPD. INTERPRETATION: Normal cortical function in patients with BPD is disrupted, but not as extensively as in patients with MDD. These results provide further neurophysiological evidence for the distinction of patients with MDD from patients with BPD.