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1.
Artigo em Inglês | MEDLINE | ID: mdl-31642549

RESUMO

OBJECTIVES: his study investigated the risk factors leading to serious suicide attempts with high medical severity. METHODS: Nine hundred and eighty-two patients who visited the emergency room after attempting suicide were divided into two groups: suicide attempters with high medical severity (25.3%) and those with low medical severity (74.7%). Demographic variables, clinical characteristics, and factors related to each suicide attempt were compared between the two groups. Multivariate logistic regression analysis was conducted to investigate risk factors for high medical severity in patients' current suicide attempts. RESULTS: The results show that suicide attempters with high medical severity had more severe depression and psychological disturbances such as agitation, intense emotions, and self-reproach. Suicide attempters with high medical severity also had more serious risk factors for suicide such as repetitive/intense/continuous thoughts of suicide, suicidal planning, and a stronger wish to die. School/work problems and physical illnesses were related to high medical severity with more lethal methods. Logistic regression demonstrated that school/work problems, total risk rating, severity of suicidal ideation, and agitation were risks for more serious suicide attempts, whereas more frequent lifetime suicide attempts were a protective factor. CONCLUSION: This study demonstrates that suicide attempters with high medical severity had more severe psychopathologies and risk factors related to suicidal behavior than those with low medical severity.

2.
Nat Commun ; 9(1): 5229, 2018 12 06.
Artigo em Inglês | MEDLINE | ID: mdl-30523329

RESUMO

Analysis of sleep for the diagnosis of sleep disorders such as Type-1 Narcolepsy (T1N) currently requires visual inspection of polysomnography records by trained scoring technicians. Here, we used neural networks in approximately 3,000 normal and abnormal sleep recordings to automate sleep stage scoring, producing a hypnodensity graph-a probability distribution conveying more information than classical hypnograms. Accuracy of sleep stage scoring was validated in 70 subjects assessed by six scorers. The best model performed better than any individual scorer (87% versus consensus). It also reliably scores sleep down to 5 s instead of 30 s scoring epochs. A T1N marker based on unusual sleep stage overlaps achieved a specificity of 96% and a sensitivity of 91%, validated in independent datasets. Addition of HLA-DQB1*06:02 typing increased specificity to 99%. Our method can reduce time spent in sleep clinics and automates T1N diagnosis. It also opens the possibility of diagnosing T1N using home sleep studies.


Assuntos
Algoritmos , Narcolepsia/fisiopatologia , Fases do Sono/fisiologia , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Cadeias beta de HLA-DQ/análise , Humanos , Masculino , Pessoa de Meia-Idade , Narcolepsia/diagnóstico , Narcolepsia/imunologia , Polissonografia , Sensibilidade e Especificidade , Fases do Sono/imunologia , Adulto Jovem
4.
J Clin Sleep Med ; 13(12): 1441-1444, 2017 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-29117886

RESUMO

STUDY OBJECTIVES: Narcolepsy is a chronic disorder with numerous adverse long-term consequences including increased obesity, high mortality rates, and decreased quality of life. With emerging attention to the long-term course of the disorder and importance of accurate diagnosis, the diagnostic stability of the Multiple Sleep Latency Test (MSLT)-the mostly frequently used test to identify narcolepsy-is often challenged. METHODS: In this study, we compared the baseline and follow-up demographic characteristics and body mass index (BMI) of patients with narcolepsy type 1. Moreover, MSLT results from repeated tests conducted on 48 patients with narcolepsy type 1 were compared, with mean follow-up of approximately 10 years. RESULTS: BMI from the baseline to the follow-up visit was significantly increased in the participants. There were no significantly different parameter changes in MSLT results. CONCLUSIONS: MSLT has good test-retest validity in patients with narcolepsy type 1. Close surveillance for the detection and management of obesity is warranted in clinical settings.


Assuntos
Índice de Massa Corporal , Narcolepsia/fisiopatologia , Latência do Sono/fisiologia , Adulto , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Polissonografia/estatística & dados numéricos , República da Coreia
5.
Psychiatry Investig ; 14(5): 698-702, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29042898

RESUMO

Previous studies reported some relationships between donepezil treatment and hippocampus in Alzheimer's disease (AD). However, due to methodological limitations, their close relationships remain unclear. The aim of this study is to predict treatment response to donepezil by utilizing the automated segmentation of hippocampal subfields volumes (ASHS) in AD. Sixty four AD patients were prescribed with donepezil and were followed up for 24 weeks. Cognitive function was measured to assess whether there was a response from the donepezil treatment. ASHS was implemented on non-responder (NR) and responder (TR) groups, and receiver operator characteristic (ROC) analysis was conducted to evaluate the sensitivity, specificity, and accuracy of hippocampal subfields in predicting response to donepezil. The left total hippocampus and the CA1 area of the NR were significantly smaller than those of the TR group. The ROC curve analysis showed the left CA1 volumes showed highest area under curve (AUC) of 0.85 with a sensitivity of 88.0%, a specificity of 74.0% in predicting treatment response to donepezil treatment. We expect that hippocampal subfields volume measurements that predict treatment responses to current AD drugs will enable more evidence-based, individualized prescription of medications that will lead to more favorable treatment outcomes.

6.
Clin Psychopharmacol Neurosci ; 15(1): 9-18, 2017 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-28138105

RESUMO

Attention-deficit hyperactivity disorder (ADHD) is notorious for its debilitating consequences and early age of onset. The need for early diagnosis and intervention has frequently been underscored. Previous studies have attempted to clarify the bidirectional relationship between ADHD and sleep problems, proposing a potential role for sleep problems as early predictors of ADHD. Sleep deprivation, sleep-disordered breathing, and circadian rhythm disturbances have been extensively studied, yielding evidence with regard to their induction of ADHD-like symptoms. Genetic-phenotypic differences across individuals regarding the aforementioned sleep problems have been elucidated along with the possible use of these characteristics for early prediction of ADHD. The long-term consequences of sleep problems in individuals with ADHD include obesity, poor academic performance, and disrupted parent-child interactions. Early intervention has been proposed as an approach to preventing these debilitating outcomes of ADHD, with novel treatment approaches ranging from melatonin and light therapy to myofunctional therapy and adjustments of the time point at which school starts.

7.
Psychiatry Investig ; 13(3): 364-9, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27247605

RESUMO

Parkinson's disease dementia (PDD) is notorious for its debilitating clinical course and high mortality rates. Consequently, various attempts to investigate predictors of cognitive decline in Parkinson's disease (PD) have been made. Here we report a case of a 75-year-old female patient with PD who visited the clinic with complaints of recurrent visual hallucinations and cognitive decline, whose symptoms were ameliorated by the titration of rivastigmine. Imaging results showed pronounced diffuse cortical amyloid deposition evidenced by 18F-florbetaben amyloid positron emission tomography (PET) imaging. This observation suggests that pronounced amyloid deposition and visual hallucinations in PD patients could be clinically significant predictors of cognitive decline in PD patients. Future research should concentrate on accumulating more evidence for possible predictors of cognitive decline and their association with PD pathology that can enable an early intervention and standardized treatment in PDD patients.

8.
Sleep Med ; 21: 165-70, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-26922621

RESUMO

OBJECTIVE: Sleep problems are common among patients with attention-deficit hyperactivity disorder (ADHD), and are considered major causes of behavioral and cognitive dysfunction in ADHD patients. In the present study, we investigated the relationship between sleep parameters and cognitive function in drug-naïve children with ADHD. METHODS: Twenty-eight patients were recruited to participate in the study, and a polysomnography was used to measure sleep parameters of the subjects. Cognitive measurements were collected, utilizing the Wechsler Intelligence Scale for Children-III (WISC-III), and the Matching Familiar Figure Test for Korean Children (MFFT-KC), while behavioral characteristics of the subjects were assessed using Conners' Global Index-Parent version (CGI-P). Descriptive statistics were calculated for demographic data, sleep parameters, and neurocognitive characteristics of ADHD patients. Spearman's correlation analyses were performed to determine the association between sleep parameters and neurocognitive measures. Moreover, multiple regression analyses were used to identify the best predictors of cognitive function among the various sleep parameters. RESULTS: The regression analyses revealed several meaningful correlations, suggesting that slow wave sleep, stage 2 sleep, REM sleep, and limb movement index with arousals (LMAs) as predictors of cognitive function in ADHD patients. CONCLUSION: Based on our study results, sleep parameters and cognitive function were closely associated in ADHD patients; further research should be directed at clarifying this crucial link.


Assuntos
Nível de Alerta , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Cognição , Polissonografia/métodos , Sono REM/fisiologia , Criança , Feminino , Humanos , Masculino , Testes Neuropsicológicos/estatística & dados numéricos , Transtornos do Sono-Vigília
9.
Asia Pac Psychiatry ; 8(1): 80-6, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26477349

RESUMO

INTRODUCTION: The objective of this study was to compare the sociodemographic and clinical variables of suicide attempters and completers and to identify risk and protective factors for suicide completion. METHODS: Subjects (n = 320) visiting to the emergency room were classified into two groups: suicide attempters (n = 222) and suicide completers (n = 98). Univariate analyses and logistic regression models were used to explore the differences between suicide attempters and completers and to identify risk factors for suicide completion. RESULTS: The results showed that compared with suicide attempters, suicide completers were older, male, having alcohol use disorders, having comorbid health problems, having severe suicide ideation, and using severe suicide methods such as hanging and jumping from a height. Using multiple logistic regression model, risk factors predicting suicide completion were comorbid medical illness, and intense suicide ideation. Factor that served as protective factors against suicide completion was female. DISCUSSION: This study demonstrated that suicide completers have more severe clinical profile than suicide attempters. Decreasing intensity of suicide ideation and treating comorbid medical illness of suicide attempters might be important in preventing them from suicide completion. It is important that the implementation of suicide preventive programs focused on alcoholism is useful in decreasing suicide rates further. Moreover, suicide completers used highly lethal methods, our results indicate that our country should make greater efforts to decrease hanging and jumping from a height.


Assuntos
Alcoolismo/epidemiologia , Transtorno Bipolar/epidemiologia , Transtorno Depressivo/epidemiologia , Ideação Suicida , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Asfixia , Comorbidade , Overdose de Drogas , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Proteção , República da Coreia/epidemiologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Suicídio/psicologia , Suicídio/estatística & dados numéricos , Tentativa de Suicídio/psicologia
10.
Clin Psychopharmacol Neurosci ; 13(3): 308-15, 2015 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-26598591

RESUMO

OBJECTIVE: The present study aimed to investigate predictors for planned suicide attempters. METHODS: This study included 1,003 patients who attempted suicide and visited emergency department. They were divided into two groups, planned suicide attempters (SAs; n=133 [13.3%]) and impulsive SAs (n=870, [86.7%]), and the demographic variables, clinical characteristics, factors related to suicide, and psychiatric resources of the groups were compared. RESULTS: Major depressive disorder and substance use disorders were more common among planned SAs than among impulsive SAs. Additionally, the planned SAs were older, more likely to be divorced, separated or widowed, and more likely to have comorbid medical illnesses, severe depression, higher suicidality, and self-blaming tendencies than the impulsive SAs. Financial problems and physical illnesses were more common in planned SAs but interpersonal conflicts were more frequent in impulsive SAs. Planned SAs had fewer previous suicide attempts but these were more serious suicide attempts. The presence of the hope to die, a written will, and suicidal ideation of a repetitive, intense, and continuous nature were predictive of planned SAs. CONCLUSION: The present findings demonstrated that planned SAs had more severe psychopathology and medical illnesses than impulsive SAs. Therefore, screening for depression, substance use disorders, and suicidal plans among old and medically ill patients may be important for preventing suicide attempts.

11.
BMC Health Serv Res ; 15: 388, 2015 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-26376978

RESUMO

BACKGROUND: The aim of this study was to evaluate the effect of an Assertive Community Treatment (ACT) program on psychiatric symptoms, global functioning, life satisfaction, and recovery-promoting relationships among individuals with mental illness. METHODS: Participants were patients at the Suwon Mental Health Center. Thirty-two patients were part of the ACT program and 32 patients matched for age, sex, and mental illness were in a standard case-management program and served as a control group. Follow-up with patients occurred every 3 months during the 15 months after a baseline interview. Participants completed the Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning (GAF) Scale, Life Satisfaction Scale, and Recovery-Promoting Relationship Scale (RPRS). RESULTS: No significant differences were noted in the sociodemographic characteristics of the ACT and the case-management group. According to the BPRS, the ACT group showed a significant reduction in symptom severity, but the ACT program was not significantly more effective at reducing psychiatric symptoms from baseline to the 15-month follow-up compared to the case-management approach. The ACT group showed more significant improvement than the control group in terms of the GAF Scale. Both groups showed no significant differences in the change of life satisfaction and in the change of recovery-promoting relationships. We observed a significant increase in recovery-promoting relationships in the control group, but the degree of change of recovery-promoting relationships through time flow between groups was not significantly different. DISCUSSION: In this study, we observed that ACT was significantly better at improving the GAF than case management and that participation in ACT was associated with a significant decrease in BPRS scores. However, ACT did not demonstrate an absolute superiority over the standard case-management approach in terms of the BPRS and the measures of life satisfaction and recovery-promoting relationships. CONCLUSIONS: ACT may have some advantages over a standard case management approach.


Assuntos
Serviços Comunitários de Saúde Mental , Transtornos Mentais , Adolescente , Adulto , Administração de Caso , Feminino , Seguimentos , Hospitais Psiquiátricos , Humanos , Entrevistas como Assunto , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Pesquisa Qualitativa , República da Coreia , Inquéritos e Questionários , Adulto Jovem
12.
Int J Endocrinol ; 2015: 591729, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25861266

RESUMO

The levels of several hormones fluctuate according to the light and dark cycle and are also affected by sleep, feeding, and general behavior. The regulation and metabolism of several hormones are influenced by interactions between the effects of sleep and the intrinsic circadian system; growth hormone, melatonin, cortisol, leptin, and ghrelin levels are highly correlated with sleep and circadian rhythmicity. There are also endogenous circadian mechanisms that serve to regulate glucose metabolism and similar rhythms pertaining to lipid metabolism, regulated through the actions of various clock genes. Sleep disturbance, which negatively impacts hormonal rhythms and metabolism, is also associated with obesity, insulin insensitivity, diabetes, hormonal imbalance, and appetite dysregulation. Circadian disruption, typically induced by shift work, may negatively impact health due to impaired glucose and lipid homeostasis, reversed melatonin and cortisol rhythms, and loss of clock gene rhythmicity.

13.
Psychiatry Res ; 227(2-3): 160-5, 2015 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-25908264

RESUMO

Refusing to attend school is a serious problem that could lead to psychopathology. We aimed to: (1) prospectively observe the actual development of school refusal behavior according to a history of separation anxiety symptoms (SAS) and (2) explore factors for predicting school refusal behavior in children who were just beginning primary school. The participants were 277 children, aged 6-7 years, who were expected to enter primary school in 2 months. The parents were surveyed about the child׳s history of SAS and their behavior. The children were questioned about anxiety symptoms. The children were surveyed about whether school refusal behavior developed or not after they entered primary school. Of the 248 children who responded to the follow-up survey, 7.66% of children met the criteria for school refusal behavior during the 3 months after entering school. We found no significant differences in the occurrence of school refusal behavior according to the children׳s SAS history. Familial risk factors for school refusal behavior included low parental educational level and a working mother. School refusal behavior by first graders cannot be fully explained by the expression of SAS and could be implicated in a more complex psychopathology.


Assuntos
Ansiedade de Separação/diagnóstico , Comportamento Infantil/psicologia , Transtornos Mentais/diagnóstico , Instituições Acadêmicas , Estudantes/psicologia , Ansiedade de Separação/psicologia , Criança , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pais , Estudos Prospectivos , Fatores de Risco
14.
Am J Hum Genet ; 96(1): 136-46, 2015 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-25574827

RESUMO

Type 1 narcolepsy, a disorder caused by a lack of hypocretin (orexin), is so strongly associated with human leukocyte antigen (HLA) class II HLA-DQA1(∗)01:02-DQB1(∗)06:02 (DQ0602) that very few non-DQ0602 cases have been reported. A known triggering factor for narcolepsy is pandemic 2009 influenza H1N1, suggesting autoimmunity triggered by upper-airway infections. Additional effects of other HLA-DQ alleles have been reported consistently across multiple ethnic groups. Using over 3,000 case and 10,000 control individuals of European and Chinese background, we examined the effects of other HLA loci. After careful matching of HLA-DR and HLA-DQ in case and control individuals, we found strong protective effects of HLA-DPA1(∗)01:03-DPB1(∗)04:02 (DP0402; odds ratio [OR] = 0.51 [0.38-0.67], p = 1.01 × 10(-6)) and HLA-DPA1(∗)01:03-DPB1(∗)04:01 (DP0401; OR = 0.61 [0.47-0.80], p = 2.07 × 10(-4)) and predisposing effects of HLA-DPB1(∗)05:01 in Asians (OR = 1.76 [1.34-2.31], p = 4.71 × 10(-05)). Similar effects were found by conditional analysis controlling for HLA-DR and HLA-DQ with DP0402 (OR = 0.45 [0.38-0.55] p = 8.99 × 10(-17)) and DP0501 (OR = 1.38 [1.18-1.61], p = 7.11 × 10(-5)). HLA-class-II-independent associations with HLA-A(∗)11:01 (OR = 1.32 [1.13-1.54], p = 4.92 × 10(-4)), HLA-B(∗)35:03 (OR = 1.96 [1.41-2.70], p = 5.14 × 10(-5)), and HLA-B(∗)51:01 (OR = 1.49 [1.25-1.78], p = 1.09 × 10(-5)) were also seen across ethnic groups in the HLA class I region. These effects might reflect modulation of autoimmunity or indirect effects of HLA class I and HLA-DP alleles on response to viral infections such as that of influenza.


Assuntos
Cadeias beta de HLA-DP/genética , Antígenos de Histocompatibilidade Classe I/genética , Narcolepsia/genética , Alelos , Grupo com Ancestrais do Continente Asiático , Estudos de Casos e Controles , Estudos de Coortes , Grupo com Ancestrais do Continente Europeu , Feminino , Loci Gênicos , Antígenos HLA-B/genética , Antígenos HLA-B/metabolismo , Antígenos HLA-DP/genética , Antígenos HLA-DP/metabolismo , Cadeias beta de HLA-DP/metabolismo , Cadeias alfa de HLA-DQ/genética , Cadeias alfa de HLA-DQ/metabolismo , Antígenos HLA-DR/genética , Antígenos HLA-DR/metabolismo , Haplótipos , Antígenos de Histocompatibilidade Classe I/metabolismo , Humanos , Vírus da Influenza A Subtipo H1N1/genética , Masculino , Fatores de Risco
15.
J Psychiatr Res ; 61: 81-8, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25498133

RESUMO

Several genetic and environmental factors place youth offspring of parents with bipolar disorder (BD) at high risk for developing mood and anxiety disorders. Recent studies suggest that anxiety symptoms, even at subclinical levels, have been associated with an increased risk for developing BD. The brain-derived neurotrophic factor (BDNF) gene has been implicated in the pathophysiology of both BD and anxiety disorders. We aimed to explore whether anxiety in BD offspring was associated with the BDNF Val66Met polymorphism. 64 BD offspring (mean age: 13.73 (S.D. 3.45) M = 30, F = 34) and 51 HC (mean age: 13.68 (S.D. 2.68) M = 23, F = 28) were compared on presence of the met allele and on scores from the Multidimensional Anxiety Scale for Children (MASC). To assess family function, we used the Family Adaptability and Cohesion Evaluation Scales (FACES-IV). The Baron & Kenny method was the statistical approach used to examine the moderating effects between variables. BD offspring showed higher levels of overall anxiety than did the HC group. BD offspring with the val/val genotype showed higher levels of anxiety than BD offspring with other genotypes. No significant levels of anxiety or its association with BDNF genotype were found in the HC group. BD offspring group showed significantly more family dysfunction when compared with the HC group and the family dysfunction moderated the association between the BDNF genotype and anxiety symptoms. This study demonstrated the potential interplay of three factors: BD offspring, anxiety symptoms and family dysfunction.


Assuntos
Transtornos de Ansiedade/genética , Transtorno Bipolar/genética , Fator Neurotrófico Derivado do Encéfalo/genética , Filho de Pais Incapacitados/psicologia , Família/psicologia , Adolescente , Adulto , Criança , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Pais/psicologia , Polimorfismo de Nucleotídeo Único , Fatores de Risco , Adulto Jovem
16.
Neuropsychiatr Dis Treat ; 10: 1799-805, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25258537

RESUMO

OBJECTIVES: Attention-deficit hyperactivity disorder (ADHD) is characterized by inattentive and impulsive behavior. Many ADHD patients reportedly have cognitive dysfunction and sleep problems, including longer sleep latency, lower sleep efficiency, and shorter total sleep time. The purpose of this study was to examine neurocognitive functions and nocturnal sleep parameters in patients with ADHD, using a cognitive function test and actigraphy. METHODS: Subjects included 37 male patients with ADHD and 32 controls (7-12 years of age). For each participant, we determined intelligence quotient (IQ) and administered the Matching Familiar Figures Test (MFFT) and 72-hour actigraphy. The relationships between sleep parameters and cognitive functions were assessed. RESULTS: ADHD patients significantly differed from controls in several cognitive functions and sleep variables. In the MFFT, response error rate (P<0.001) and error counts (P=0.003) were significantly increased in ADHD patients compared with control children. MFFT response latency was significantly shorter in ADHD patients than in controls (P<0.001). In addition, sleep latency (P=0.01), wake after sleep onset (WASO) (P<0.001), and fragmentation index (P<0.001) were evaluated by actigraphy and found to be significantly increased in patients with ADHD compared with controls. However, no significant differences in total sleep time or sleep efficiency were observed. WASO and response error rates were positively correlated in patients with ADHD (rho =0.52, P=0.012). Furthermore, fragmentation index sleep variables were significantly positively correlated with response error (rho =0.44, P=0.008) and response latency rates (rho =0.4, P=0.018) in the MFFT. Reaction error rate was significantly associated with the fragmentation index (beta =0.94, P=0.024). CONCLUSION: Patients with ADHD had more sleep problems, including significantly increased sleep latency, WASO, and fragmentation index, and poorer cognitive function, compared with controls. Some of these sleep problems, including WASO and the fragmentation index, were positively correlated with impulsivity, illustrated by the cognitive function tests in patients with ADHD. However, further studies with large sample sizes and the addition of polysomnography and determination of ADHD subtypes should be performed to confirm our results regarding sleep and cognitive problems in patients with ADHD.

17.
J Clin Sleep Med ; 10(9): 1011-8, 2014 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-25142772

RESUMO

OBJECTIVE: Cases of narcolepsy in association with psychotic features have been reported but never fully characterized. These patients present diagnostic and treatment challenges and may shed new light on immune associations in schizophrenia. METHOD: Our case series was gathered at two narcolepsy specialty centers over a 9-year period. A questionnaire was created to improve diagnosis of schizophrenia or another psychotic disorder in patients with narcolepsy. Pathophysiological investigations included full HLA Class I and II typing, testing for known systemic and intracellular/synaptic neuronal antibodies, recently described neuronal surface antibodies, and immunocytochemistry on brain sections to detect new antigens. RESULTS: Ten cases were identified, one with schizoaffective disorder, one with delusional disorder, two with schizophreniform disorder, and 6 with schizophrenia. In all cases, narcolepsy manifested first in childhood or adolescence, followed by psychotic symptoms after a variable interval. These patients had auditory hallucinations, which was the most differentiating clinical feature in comparison to narcolepsy patients without psychosis. Narcolepsy therapy may have played a role in triggering psychotic symptoms but these did not reverse with changes in narcolepsy medications. Response to antipsychotic treatment was variable. Pathophysiological studies did not reveal any known autoantibodies or unusual brain immunostaining pattern. No strong HLA association outside of HLA DQB1*06:02 was found, although increased DRB3*03 and DPA1*02:01 was notable. CONCLUSION: Narcolepsy can occur in association with schizophrenia, with significant diagnostic and therapeutic challenges. Dual cases maybe under diagnosed, as onset is unusually early, often in childhood. Narcolepsy and psychosis may share an autoimmune pathology; thus, further investigations in larger samples are warranted.


Assuntos
Narcolepsia/complicações , Transtornos Psicóticos/complicações , Esquizofrenia/complicações , Adolescente , Adulto , Idoso , Anticorpos Antinucleares/análise , Antipsicóticos/uso terapêutico , Criança , Diagnóstico Diferencial , Ensaio de Imunoadsorção Enzimática , Feminino , Alucinações/complicações , Teste de Histocompatibilidade/métodos , Humanos , Masculino , Narcolepsia/diagnóstico , Polissonografia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico , Esquizofrenia/diagnóstico , Esquizofrenia/tratamento farmacológico , Inquéritos e Questionários
18.
J Epilepsy Res ; 4(1): 34-7, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24977131

RESUMO

Mirror focus is one of the evidence of progression in epilepsy, and also has practical points for curative resective epilepsy surgery. The mirror foci are related to the kindling phenomena that occur through interhemispheric callosal or commissural connections. A mirror focus means the secondary epileptogenic foci develop in the contralateral hemispheric homotopic area. Thus mirror foci are mostly reported in patients with temporal or frontal lobe epilepsy, but not in occipital lobe epilepsy. We have observed occipital lobe epilepsy with mirror focus. Before epilepsy surgery, the subject's seizure onset zone was observed in the left occipital area by ictal studies. Her seizures abated for 10 months after the resection of left occipital epileptogenic focus, but recurred then. The recurred seizures were originated from the right occipital area which was in the homotopic contralateral area. This case can be an evidence that occipital lobe epilepsy may have mirror foci, even though each occipital lobe has any direct interhemispheric callosal connections between them.

19.
Neuropsychiatr Dis Treat ; 10: 641-3, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24790446

RESUMO

Abnormalities in thyroid function are associated with many psychiatric symptoms. We present a report of a 15-year-old girl who was admitted to the psychiatry inpatient unit with symptoms of suicidal behavior, irritability, and impulsivity. One year previously, she had become more short-tempered, and had started to cut her wrists impulsively. Laboratory tests revealed subclinical hyperthyroidism. She was treated with anxiolytic and antithyroid drugs, and her suicidal ideation and irritability resolved. This case demonstrates that subclinical hyperthyroidism can be associated with suicidal behavior as well as overt hyperthyroidism. Early intervention is required to prevent suicidal behavior in patients with subclinical hyperthyroidism.

20.
JAMA Neurol ; 70(7): 891-902, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23649748

RESUMO

IMPORTANCE: Narcolepsy, a disorder associated with HLA-DQB1*06:02 and caused by hypocretin (orexin) deficiency, is diagnosed using the Multiple Sleep Latency Test (MSLT) following nocturnal polysomnography (NPSG). In many patients, a short rapid eye movement sleep latency (REML) during the NPSG is also observed but not used diagnostically. OBJECTIVE: To determine diagnostic accuracy and clinical utility of nocturnal REML measures in narcolepsy/hypocretin deficiency. DESIGN, SETTING, AND PARTICIPANTS: Observational study using receiver operating characteristic curves for NPSG REML and MSLT findings (sleep studies performed between May 1976 and September 2011 at university medical centers in the United States, China, Korea, and Europe) to determine optimal diagnostic cutoffs for narcolepsy/hypocretin deficiency compared with different samples: controls, patients with other sleep disorders, patients with other hypersomnias, and patients with narcolepsy with normal hypocretin levels. Increasingly stringent comparisons were made. In a first comparison, 516 age- and sex-matched patients with narcolepsy/hypocretin deficiency were selected from 1749 patients and compared with 516 controls. In a second comparison, 749 successive patients undergoing sleep evaluation for any sleep disorders (low pretest probability for narcolepsy) were compared within groups by final diagnosis of narcolepsy/hypocretin deficiency. In the third comparison, 254 patients with a high pretest probability of having narcolepsy were compared within group by their final diagnosis. Finally, 118 patients with narcolepsy/hypocretin deficiency were compared with 118 age- and sex-matched patients with a diagnosis of narcolepsy but with normal hypocretin levels. MAIN OUTCOME AND MEASURES: Sensitivity and specificity of NPSG REML and MSLT as diagnostic tests for narcolepsy/hypocretin deficiency. This diagnosis was defined as narcolepsy associated with cataplexy plus HLA-DQB1*06:02 positivity (no cerebrospinal fluid hypocretin-1 results available) or narcolepsy with documented low (≤ 110 pg/mL) cerebrospinal fluid hypocretin-1 level. RESULTS: Short REML (≤15 minutes) during NPSG was highly specific (99.2% [95% CI, 98.5%-100.0%] of 516 and 99.6% [95% CI, 99.1%-100.0%] of 735) but not sensitive (50.6% [95% CI, 46.3%-54.9%] of 516 and 35.7% [95% CI, 10.6%-60.8%] of 14) for patients with narcolepsy/hypocretin deficiency vs population-based controls or all patients with sleep disorders undergoing a nocturnal sleep study (area under the curve, 0.799 [95% CI, 0.771-0.826] and 0.704 [95% CI, 0.524-0.907], respectively). In patients with central hypersomnia and thus a high pretest probability for narcolepsy, short REML remained highly specific (95.4% [95% CI, 90.4%-98.3%] of 132) and similarly sensitive (57.4% [95% CI, 48.1%-66.3%] of 122) for narcolepsy/hypocretin deficiency (area under the curve, 0.765 [95% CI, 0.707-0.831]). Positive predictive value in this high pretest probability sample was 92.1% (95% CI, 83.6%-97.0%). CONCLUSIONS AND RELEVANCE: Among patients being evaluated for possible narcolepsy, short REML (≤15 minutes) at NPSG had high specificity and positive predictive value and may be considered diagnostic without the use of an MSLT; absence of short REML, however, requires a subsequent MSLT.


Assuntos
Peptídeos e Proteínas de Sinalização Intracelular/deficiência , Narcolepsia/diagnóstico , Neuropeptídeos/deficiência , Polissonografia/métodos , Transtornos do Sono-Vigília/diagnóstico , Sono REM/fisiologia , Adolescente , Adulto , Idoso , Cataplexia/diagnóstico , Feminino , Cadeias beta de HLA-DQ/genética , Humanos , Peptídeos e Proteínas de Sinalização Intracelular/líquido cefalorraquidiano , Masculino , Pessoa de Meia-Idade , Narcolepsia/líquido cefalorraquidiano , Narcolepsia/genética , Neuropeptídeos/líquido cefalorraquidiano , Orexinas , Curva ROC , Sistema de Registros , Transtornos do Sono-Vigília/líquido cefalorraquidiano , Transtornos do Sono-Vigília/classificação , Adulto Jovem
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