Selective serotonin reuptake inhibitors-induced delirium: a case review.

BACKGROUND: Many commonly used medications are associated with causing delirium, especially those with notable direct effects on the brain. Selective serotonin reuptake inhibitors (SSRIs) are probably the most often prescribed antidepressants and are known for their favourable side-effect profile. METHODS: Medline and Toxline databases were searched for case reports of delirium caused by SSRIs. Twelve cases were reviewed in addition to our case of escitalopram-induced delirium in old age. RESULTS: Only five cases of delirium due to SSRIs as the main or most probable etiologic factor were published in the last two decades. In two cases SSRI seems a possible additional cause of delirium in combination with other psychotropic medication. CONCLUSIONS: Although SSRIs are considered safe, they can still cause delirium in an ageing patient even when SSRI was previously used without considerable side effects.

Decreased platelet serotonin concentration in Alzheimer's disease with involuntary emotional expression disorder.

Alzheimer's disease (AD) is a progressive neurodegenerative disorder manifested by progressive decline in cognitive functions. A variety of behavioral disturbances appear very often in AD which might be associated with altered function of serotoninergic system. The aim of the study was to determine platelet serotonin (5-HT) concentrations in 49 patients with AD (NINCDS-ADRDA and DSM-IV-TR criteria) subdivided in three groups: (a) patients with aggressive behavior, (b) patients with involuntary emotional expression disorder (IEED) and (c) patients without aggression or IEED (controls). Platelet 5-HT concentrations were measured using ELISA. Platelet 5-HT concentrations were significantly lower in patients with AD and co-existing IEED compared to AD patients with aggressive behavior or control patients. No significant difference in platelet 5-HT concentrations was found between patients expressing aggressive behavior and controls. Our results suggest disruptions in serotoninergic system in AD patients with comorbid IEED but not with aggressive behavior and support the presumption that platelet 5-HT concentration is a suitable and easy measured peripheral indicator of some behavioral and psychological symptoms of AD.

Memantine may affect pseudobulbar affect in patients with Alzheimer's disease.

OBJECTIVE: Behavioural symptoms are common in moderate to severe Alzheimer's disease (AD) and are improved by memantine with the most pronounced effect on agitation/aggression. Dextromethorphan in combination with quinidine is the only drug approved by US Food and Drug Administration for the treatment of pseudobulbar affect (PBA) on the basis of efficacy in patients with multiple sclerosis or amyotrophic lateral sclerosis. The aim of our study was to evaluate the efficacy of memantine on PBA in patients with AD. METHODS: In a prospective, double-blind, case-control study to assess PBA with pathological laughter and crying scale patients were administered memantine (final dose of 20 mg daily) or citalopram (20 mg once daily), each for 10 weeks. The number of episodes of involuntary emotional expression, Neuropsychiatric Inventory (NPI) and Overt Aggression Scale-Modified (OAS-M) total scores were also recorded. Furthermore, the platelet serotonin (5-HT) concentration was measured. RESULTS: Although memantine had beneficial effects on PBA, it also had a crucial impact on behavioural symptoms, especially aggression and agitation (to an average of 3.5 times higher end-point scores on OAS-M and increase of NPI total scores for an average of 114% of initial value). Therefore, the study was prematurely stopped. In addition, we had evidenced a drop of platelet 5-HT concentration (to an average of 73% of initial value). CONCLUSION: Surprisingly, our research showed the opposite action of memantine on neuropsychiatric symptoms as expected. In a limited number of AD patients with PBA, memantine had a beneficial effect on involuntary emotional expression, but it potentiated agitation/aggression, irritability and caused a crucial drop of the platelet 5-HT concentration.

Social behaviour vs. psychiatric features of frontotemporal dementia - Clinical report of two cases.

Behavioural disturbances are prominent in frontotemporal dementia (FTD), a focal, non-Alzheimer type of dementia. Although most patients with FTD present with socially inappropriate behaviour, compulsive-like acts, poor insight and disinhibition, the presence of psychiatric features including delusions, hallucinations, and paranoia can lead to a misclassification of FTD as psychiatric disorder. In the absence of cognitive deficits non-experts fail to recognize these social changes as dementia symptoms. We report two individuals who met current clinical criteria for behavioural or frontal variant FTD (bv-FTD), with the aim of distinguishing between psychotic symptoms and the often bizarre personality and behaviour change found in FTD. Also we review the literature on the noncognitive neuropsyhiatric manifestation of this disorder. Clinical findings presented, and a literature review, indicate that psychotic symptoms are rare in FTD. Better awareness of behavioural symptoms in clinical practice is necessary in order to avoid misdiagnosis of FTD as psychiatric disorder.

Care for people with dementia in Slovenia.

The number of patients with dementia in Slovenia will increase 33% in the next ten years. Unfortunately, networks offering different activities for demented patients are still insufficiently developed, although in the last ten years a significant improvement has been observed in all areas of care (diagnosis, treatment, day care centres, nursing homes, and non-governmental organizations). The article provides a short overview of developing care for persons with dementia in Slovenia.

Event-related potentials elicited by distractors in an auditory oddball paradigm in schizophrenia.

Patients with schizophrenia are affected more adversely than healthy controls by distracting conditions, due to their inability to adequately apportion attentional resources to targets or distractors. We attempted to re-evaluate the effects of distractors in 25 patients with chronic schizophrenia and in 12 controls. They performed an auditory target-detection task with 1500 Hz tone distractors and an additional control condition where a 1500-Hz tone was used as the target. The rate of target misses for patients with schizophrenia was 3.79% in non-distractor conditions and 14.79% in distractor conditions. Significantly reduced N100 responses to distractors and distractor condition targets were found. P300 responses to all target stimulus categories were reduced, but P300 responses to distractors were equal to those in the control group. There was a reduction of P300 amplitudes to distractors in both groups; however, only the control group showed significant enlargement of P300 amplitude when the distractors became the target stimuli. There is evidence that patients with schizophrenia tend to be less able to allocate their attentional resources adequately to target vs. distractor stimuli. When the distractors became the target stimuli, their responses remained unchanged, which suggests their inability to appropriately integrate stimulus information with contextual information.

Olanzapine induced neuroleptic malignant syndrome--a case review.

Neuroleptic malignant syndrome is the rarest and the most serious of the neuroleptic induced movement disorders. Although potent neuroleptics are more frequently associated with NMS, atypical antipsychotic drugs may also be a cause of NMS. Three databases were searched using the terms 'olanzapine' and 'neuroleptic' 'malignant syndrome'. Case reports were selected and reviewed from among all articles that fulfilled the search criteria. Twenty six cases were reviewed. Twenty cases fulfilled the criteria published by Sachdev et al. Olanzapine was the most probable cause of NMS in 16 cases. The absence of rigidity was described in only two of 16 highly probable olanzapine induced NMS cases, which is not as often as it is reported in clozapine associated NMS (36%). It was found that prior NMS is an important risk factor in NMS.