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1.
Oxid Med Cell Longev ; 2021: 5520059, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34484562

RESUMO

Due to the increase of stress-related memory impairment accompanying with the COVID-19 pandemic and financial crisis, the prevention of cognitive decline induced by stress has gained much attention. Based on the evidence that an anthocyanin-rich mulberry milk demonstrated the cognitive enhancing effect, we hypothesized that it should be able to enhance memory in working-age volunteers who are exposed to working stress. This study is an open-label, two-arm randomized study. Both men and women volunteers at age between 18 and 60 years old were randomly assigned to consume the tested product either 1 or 2 servings daily for 6 weeks. All subjects were assessed for cortisol, acetylcholinesterase (AChE), monoamine oxidase (MAO), monoamine oxidase type A (MAO-A), and monoamine oxidase type B (MAO-B) in saliva, and their working memory was determined both at baseline and at a 6-week period. The results showed that the working memory of subjects in both groups was enhanced at the end of the study period together with the reduction of saliva cortisol. The suppression of AChE, MAO, and MAO-A was also observed in subjects who consumed the tested product 2 servings daily. Therefore, we suggest the memory enhancing effect of an anthocyanin-rich mulberry milk. The possible mechanism may occur primarily via the suppression of cortisol. In addition, the high dose of mulberry milk also suppresses AChE, MAO, and MAO-A.


Assuntos
Antocianinas/farmacologia , Memória de Curto Prazo/efeitos dos fármacos , Morus , Estresse Ocupacional , Extratos Vegetais/farmacologia , Acetilcolinesterase/efeitos dos fármacos , Acetilcolinesterase/metabolismo , Adulto , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Monoaminoxidase/efeitos dos fármacos , Monoaminoxidase/metabolismo , Morus/química
2.
Geriatr Gerontol Int ; 21(6): 472-477, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33851502

RESUMO

AIM: Behavioral and psychological symptoms of dementia (BPSD) are common in patients with moderate-severe dementia and have negative impacts on both patients and caregivers. There is a lack of a tool for caregivers to monitor patients' BPSD by themselves. This study aimed to develop and validate a mobile application for caregivers to use in monitoring BPSD. METHODS: A total of 104 pairs of patients with moderate-severe dementia and their caregivers completed the study. The Neuropsychiatric Inventory (NPI) was modified and digitally transformed to a caregiver-rating mobile application to quantify nine domains of BPSD for their frequency and impact on the emotion of the caregivers. Data collected from the application were compared with the paper-and-pencil NPI for prevalence, concurrent validity (Spearman's rho) and internal consistency (Cronbach's alpha). RESULTS: The application was able to detect 93% of BPSD compared with the NPI. Concurrent validity was good-very good when compared with the Frequency × Severity score (ρ = 0.77, P < 0.001) and the burden score (ρ = 0.85, P < 0.001) from the NPI. Levels of internal consistency were acceptable for both frequency (α = 0.73) and impact (α = 0.79) scores. 80% of the caregivers reported that the application was "very likely to be helpful in caregiving". CONCLUSIONS: The mobile application for monitoring BPSD in patients with moderate-severe dementia had an excellent sensitivity, and good-very good validity and consistency. The caregivers had a positive perception of the application as an aid in caregiving. Geriatr Gerontol Int 2021; 21: 472-477.


Assuntos
Demência , Aplicativos Móveis , Sintomas Comportamentais/diagnóstico , Sintomas Comportamentais/etiologia , Cuidadores , Demência/diagnóstico , Humanos , Escalas de Graduação Psiquiátrica
3.
Dement Geriatr Cogn Disord ; 44(1-2): 45-54, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28675901

RESUMO

BACKGROUND/AIMS: Prior studies of late-onset Alzheimer disease (AD) have reported that cerebrospinal fluid (CSF) tau levels correlate with hippocampal/medial temporal lobe atrophy. These findings suggest that CSF tau indices in AD may reflect tau-related neurodegeneration in the medial temporal lobe. However, it remains uncertain whether elevated CSF tau levels in the clinically heterogeneous subtypes of early-onset AD (EOAD; amnestic, posterior cortical atrophy [PCA], and logopenic progressive aphasia [LPA]) are attributable to similar underlying mechanisms. METHODS: We identified 41 EOAD patients (18 amnestic, 14 with LPA, and 9 with PCA) with CSF and brain MRI data. Semiquantitative ratings were used to assess medial temporal lobe atrophy and PCA, which were compared to CSF biomarker indices. RESULTS: Lower CSF tau levels were seen in PCA relative to amnestic EOAD and LPA, but similar ratings for medial temporal lobe atrophy and PCA were seen across the groups. After adjustments for demographics and cognitive performance, both total (p = 0.004) and hyperphosphorylated (p = 0.026) tau levels correlated with medial temporal lobe atrophy across this EOAD cohort. CONCLUSIONS: These results replicate prior findings in late-onset AD and support the hypothesis that CSF tau levels primarily reflect tau-related neurodegenerative changes in the hippocampus/medial temporal lobe across the clinical subtypes of EOAD.


Assuntos
Doença de Alzheimer/diagnóstico , Peptídeos beta-Amiloides/líquido cefalorraquidiano , Hipocampo/patologia , Lobo Temporal , Proteínas tau/líquido cefalorraquidiano , Idoso , Atrofia/patologia , Biomarcadores/líquido cefalorraquidiano , Estudos de Coortes , Feminino , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estatística como Assunto , Lobo Temporal/diagnóstico por imagem , Lobo Temporal/patologia
4.
Cortex ; 92: 81-94, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28458182

RESUMO

Impaired attribution of animacy (state of living or being sentient) and of agency (capability of intrinsically-driven action) may underlie social behavior disturbances in behavioral variant frontotemporal dementia (bvFTD). We presented the Heider and Simmel film of moving geometric shapes to 11 bvFTD patients, 11 Alzheimer's disease (AD) patients, and 12 healthy controls (HCs) and rated their recorded verbal responses for animacy attribution and agency attribution. All participants had skin conductance (SC) continuously recorded while viewing the film, and all dementia participants underwent magnetic resonance imaging (MRI) for regions of interest. The bvFTD patients, but not the AD patients, were impaired in animacy attribution, compared to the HCs. In contrast, both bvFTD and AD groups were impaired in agency attribution, compared to the HCs, and only the HCs had increasing SC responsiveness during viewing of the film. On MRI analysis of cortical thicknesses, animacy scores significantly correlated across groups with the right pars orbitalis and opercularis; agency scores with the left inferior and superior parietal cortices and the supramarginal gyrus; and both scores with the left cingulate isthmus involved in visuospatial context. These findings suggest that bvFTD is specifically associated with impaired animacy attribution from right inferior frontal atrophy. In contrast, both dementias may have impaired agency attribution from left parietal cortical atrophy and absent SC increases during the film, a sympathetic indicator of attribution of a social "story" to the moving shapes. These findings clarify disease-related changes in social attribution and corroborate the neuroanatomical origins of animacy and agency.


Assuntos
Doença de Alzheimer/diagnóstico por imagem , Demência Frontotemporal/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/patologia , Doença de Alzheimer/fisiopatologia , Atrofia , Mapeamento Encefálico/métodos , Feminino , Demência Frontotemporal/patologia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos
5.
J Neuropsychiatry Clin Neurosci ; 29(2): 183-185, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27707194

RESUMO

Behavioral variant frontotemporal dementia (bvFTD) may result in psychotic-like speech without other psychotic features. The authors identified a bvFTD subgroup with pressure of speech, tangentiality, derailment, clanging/rhyming, and punning associated with the right anterior temporal atrophy and sparing of the left frontal lobe.


Assuntos
Demência Frontotemporal/complicações , Distúrbios da Fala/etiologia , Idoso , Feminino , Demência Frontotemporal/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Entrevista Psiquiátrica Padronizada , Pessoa de Meia-Idade , Testes Neuropsicológicos , Distúrbios da Fala/diagnóstico por imagem
6.
Cogn Neuropsychiatry ; 22(1): 28-38, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27903133

RESUMO

INTRODUCTION: Socioemotional dysfunction distinguishes behavioural variant frontotemporal dementia (bvFTD) from other dementias. Patients with bvFTD not only have early social impairment and emotional blunting, but they also have agnosia of their socioemotional dysfunction. METHODS: To investigate the relationship between agnosia and dysfunction, we assessed self-knowledge of socioemotional dysfunction with an emotional quotient (EQ) scale administered to 12 patients with bvFTD and a comparison group of 12 age-matched patients with Alzheimer's disease (AD), and compared these self-ratings to caregiver ratings of social dysfunction and emotional blunting. RESULTS: The bvFTD patients self-rated as having higher EQs than the AD patients, particularly higher self-ratings of their Social Skills, an EQ subscale which correlated with increased emotional blunting. On within-groups analysis, the bvFTD patients' high self-ratings of their EQ Appraisal of Emotions correlated with increased socioemotional dysfunction, whereas all of the AD patients' self-ratings correlated appropriately with their degree of dysfunction. CONCLUSIONS: Large socioemotional agnosia scores (EQ minus function) distinguishes bvFTD from AD. Additionally, in bvFTD, agnosia specifically for their ability to appreciate others' emotions correlates with the degree of socioemotional dysfunction, suggesting a role for socioemotional agnosia in increasing socioemotional dysfunction.


Assuntos
Agnosia , Doença de Alzheimer/psicologia , Demência Frontotemporal/psicologia , Transtornos do Humor/psicologia , Escalas de Graduação Psiquiátrica , Idoso , Doença de Alzheimer/complicações , California , Feminino , Demência Frontotemporal/complicações , Humanos , Masculino , Transtornos do Humor/complicações , Sensibilidade e Especificidade , Inquéritos e Questionários
7.
Case Rep Psychiatry ; 2016: 9782702, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27840761

RESUMO

Pathological hair-pulling or trichotillomania, which is commonly associated with anxiety and depression, obsessive-compulsive disorder, and neurodevelopmental disorders, has been rarely associated with dementing illnesses. Investigators have not clarified the neural correlates and treatment of trichotillomania in dementia. We report a patient who developed an early-onset cognitive decline with genetic, cerebrospinal fluid biomarker and structural and functional neuroimaging studies consistent with Alzheimer's disease. Eight years into her disease, she developed severe, repetitive hair-pulling behavior leading to marked hair loss, along with other repetitive and "frontal" behaviors. Selective serotonin reuptake inhibitors (SSRIs) were ineffective in controlling her hair-pulling behavior, which subsequently responded to quetiapine 150 mg/day. This patient and a review of the literature suggest that trichotillomania may be a compulsive-related symptom in dementias of different etiologies as they involve frontal areas and release primitive grooming behavior from frontostriatal dysfunction. Dopamine blockade, rather than SSRIs, may be effective in managing trichotillomania in dementia.

8.
J Geriatr Psychiatry Neurol ; 29(6): 344-351, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27647788

RESUMO

BACKGROUND: While much disinhibition in dementia results from generalized impulsivity, in behavioral variant frontotemporal dementia (bvFTD) disinhibition may also result from impaired social cognition. OBJECTIVE: To deconstruct disinhibition and its neural correlates in bvFTD vs. early-onset Alzheimer's disease (eAD). METHODS: Caregivers of 16 bvFTD and 21 matched-eAD patients completed the Frontal Systems Behavior Scale disinhibition items. The disinhibition items were further categorized into (1) "person-based" subscale which predominantly associated with violating social propriety and personal boundary and (2) "generalized-impulsivity" subscale which included nonspecific impulsive acts. Subscale scores were correlated with grey matter volumes from tensor-based morphometry on magnetic resonance images. RESULTS: In comparison to the eAD patients, the bvFTD patients developed greater person-based disinhibition ( P < 0.001) but comparable generalized impulsivity. Severity of person-based disinhibition significantly correlated with the left anterior superior temporal sulcus (STS), and generalized-impulsivity correlated with the right orbitofrontal cortex (OFC) and the left anterior temporal lobe (aTL). CONCLUSIONS: Person-based disinhibition was predominant in bvFTD and correlated with the left STS. In both dementia, violations of social propriety and personal boundaries involved fronto-parieto-temporal network of Theory of Mind, whereas nonspecific disinhibition involved the OFC and aTL.

9.
J Alzheimers Dis ; 53(1): 327-35, 2016 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-27163801

RESUMO

BACKGROUND: Gaze and eye contact is a critical aspect of social interaction. Patients with behavioral variant frontotemporal dementia (bvFTD) may exhibit abnormally prolonged stare toward human faces. OBJECTIVE: To study characteristics of social gaze in patients with bvFTD compared to age and education matched-patients with early-onset Alzheimer's disease (eAD) and healthy controls (HC). METHOD: Fifty picture stimuli were presented to each participant (bvFTD = 12, eAD = 18, HC = 13). Each stimuli contained two properties: face (facial versus non-facial) and valence (positive, negative, and neutral). The "facial" stimuli contained human faces. The participants Visual Fixation Time (VFT) was measured for each picture stimuli of interest (per facial expressions on the Facial Action Coding System). A linear mixed-effects regression model with participant-level of random effects was used to compare VFTs between groups. RESULTS: The patients with bvFTD showed significantly prolonged VFTs to faces than the patients with eAD and the HC, regardless of valence (all p < 0.01). There were no differences in VFTs for non-facial stimuli between patients with bvFTD and eAD. However, patients with bvFTD and eAD had significantly prolonged VFTs to negative non-facial stimuli than the HC (p = 0.006 and 0.019, respectively). CONCLUSION: Patients with bvFTD exhibited a prolonged stare toward human faces. This prolonged visual facial grasp may contribute to the disturbed social interactions of patients with bvFTD and can help distinguish them from those with Alzheimer's disease and other conditions. Additionally, both dementia groups tended to stare at negative stimuli whether faces or non-faces.


Assuntos
Movimentos Oculares/fisiologia , Face , Demência Frontotemporal/complicações , Força da Mão/fisiologia , Reconhecimento Visual de Modelos/fisiologia , Idoso , Expressão Facial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Estimulação Luminosa , Análise de Regressão , Estatísticas não Paramétricas
10.
Am J Alzheimers Dis Other Demen ; 31(4): 326-32, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26646114

RESUMO

Traditional neuropsychological batteries may not distinguish early behavioral variant frontotemporal dementia (bvFTD) from Alzheimer's disease (AD) without the inclusion of a social behavioral measure. We compared 33 participants, 15 bvFTD, and 18 matched patients with early-onset AD (eAD), on the Social Norms Questionnaire (SNQ), neuropsychological tests and 3-dimensional T1-weighted magnetic resonance imaging (MRI). The analyses included correlations of SNQ results (total score, overendorsement or "overadhere" errors, and violations or "break" errors) with neuropsychological results and tensor-based morphometry regions of interest. Patients with BvFTD had significantly lower SNQ total scores and higher overadhere errors than patients with eAD. On neuropsychological measures, the SNQ total scores correlated significantly with semantic knowledge and the overadhere subscores with executive dysfunction. On MRI analysis, the break subscores significantly correlated with lower volume of lateral anterior temporal lobes (aTL). The results also suggest that endorsement of social norm violations corresponds to the role of the right aTL in social semantic knowledge.


Assuntos
Doença de Alzheimer/patologia , Demência Frontotemporal/patologia , Testes Neuropsicológicos/estatística & dados numéricos , Normas Sociais , Doença de Alzheimer/diagnóstico por imagem , Demência Frontotemporal/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Semântica , Inquéritos e Questionários , Lobo Temporal/patologia
11.
Neuropsychologia ; 78: 73-9, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26432341

RESUMO

Behavioral changes in dementia, especially behavioral variant frontotemporal dementia (bvFTD), may result in alterations in moral reasoning. Investigators have not clarified whether these alterations reflect differential impairment of care-based vs. rule-based moral behavior. This study investigated 18 bvFTD patients, 22 early onset Alzheimer's disease (eAD) patients, and 20 healthy age-matched controls on care-based and rule-based items from the Moral Behavioral Inventory and the Social Norms Questionnaire, neuropsychological measures, and magnetic resonance imaging (MRI) regions of interest. There were significant group differences with the bvFTD patients rating care-based morality transgressions less severely than the eAD group and rule-based moral behavioral transgressions more severely than controls. Across groups, higher care-based morality ratings correlated with phonemic fluency on neuropsychological tests, whereas higher rule-based morality ratings correlated with increased difficulty set-shifting and learning new rules to tasks. On neuroimaging, severe care-based reasoning correlated with cortical volume in right anterior temporal lobe, and rule-based reasoning correlated with decreased cortical volume in the right orbitofrontal cortex. Together, these findings suggest that frontotemporal disease decreases care-based morality and facilitates rule-based morality possibly from disturbed contextual abstraction and set-shifting. Future research can examine whether frontal lobe disorders and bvFTD result in a shift from empathic morality to the strong adherence to conventional rules.


Assuntos
Doença de Alzheimer/psicologia , Demência Frontotemporal/psicologia , Princípios Morais , Doença de Alzheimer/patologia , Encéfalo/patologia , Feminino , Demência Frontotemporal/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Processos Mentais , Pessoa de Meia-Idade , Testes Neuropsicológicos , Tamanho do Órgão , Índice de Gravidade de Doença
12.
J Alzheimers Dis ; 47(4): 985-93, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26401777

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is the most established environmental risk factor for Alzheimer's disease (AD), but it is unclear if TBI is specifically associated with early-onset AD (EOAD). OBJECTIVE: To evaluate the relationship between TBI and EOAD (<65 years). METHODS: We identified 1,449 EOAD, 4,337 late-onset AD (LOAD), and corresponding EOAD-matched and LOAD-matched normal controls (NC) in the National Alzheimer's Coordinating Center Uniform (NACC) database and compared the prevalence of any history of TBI as well as measures of cognition, function, behavior, and neuropathology. For validation, we determined TBI prevalence among 115 well-characterized clinic patients with EOAD. RESULTS: Part A: The prevalence of any TBI in the NACC-database EOAD participants (13.3%) was comparable to that observed in the clinic EOAD patients (13.9%) but significantly higher than in the NACC-database LOAD participants (7.7% ; p <  0.0001) and trended to higher compared to EOAD-matched NC (11.1% ; logistic regression p = 0.053). Part B: When we compared EOAD patients with documented non-acute and non-residually impairing TBI to EOAD without a documented history of prior TBI, those with TBI had significantly more disinhibition. Part C: Autopsies did not reveal differences in AD neuropathology based on a history of TBI. CONCLUSIONS: These findings suggest, but do not establish, that TBI is a specific risk factor for EOAD and may lead to disinhibition, a feature that often results from the frontal effects of head injury. This study recommends further research on the effects of TBI in EOAD in larger numbers of participants.


Assuntos
Doença de Alzheimer/epidemiologia , Lesões Encefálicas/epidemiologia , Idade de Início , Doença de Alzheimer/complicações , Doença de Alzheimer/psicologia , Lesões Encefálicas/complicações , Lesões Encefálicas/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prevalência , Fatores de Risco , Estados Unidos/epidemiologia
13.
J Geriatr Psychiatry Neurol ; 28(4): 239-48, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26251109

RESUMO

The clock-drawing test (CDT) is widely used in clinical practice to diagnose and distinguish patients with dementia. It remains unclear, however, whether the CDT can distinguish among the early-onset dementias. Accordingly, we examined the ability of both quantitative and qualitative CDT analyses to distinguish behavioral variant frontotemporal dementia (bvFTD) and early-onset Alzheimer disease (eAD), the 2 most common neurodegenerative dementias with onset <65 years of age. We hypothesized that executive aspects of the CDT would discriminate between these 2 disorders. The study compared 15 patients with bvFTD and 16 patients with eAD on the CDT using 2 different scales and correlated the findings with neuropsychological testing and magnetic resonance imaging. The total CDT scores did not discriminate bvFTD and eAD; however, specific analysis of executive hand placement items successfully distinguished the groups, with eAD exhibiting greater errors than bvFTD. The performance on those executive hand placement items correlated with measures of naming as well as visuospatial and executive function. On tensor-based morphometry of the magnetic resonance images, executive hand placement correlated with right frontal volume. These findings suggest that lower performance on executive hand placement items occurs with involvement of the right dorsolateral frontal-parietal network for executive control in eAD, a network disproportionately affected in AD of early onset. Rather than the total performance on the clock task, the analysis of specific errors, such as executive hand placement, may be useful for early differentiation of eAD, bvFTD, and other conditions.


Assuntos
Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Função Executiva , Demência Frontotemporal/diagnóstico , Demência Frontotemporal/psicologia , Testes Neuropsicológicos , Doença de Alzheimer/fisiopatologia , Feminino , Demência Frontotemporal/fisiopatologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
14.
Arch Clin Neuropsychol ; 29(8): 793-805, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25331776

RESUMO

Early social dysfunction is a hallmark symptom of behavioral variant frontotemporal dementia (bvFTD); however, validated measures for assessing social deficits in dementia are needed. The purpose of the current study was to examine the utility of a novel informant-based measure of social impairment, the Socioemotional Dysfunction Scale (SDS) in early-onset dementia. Sixteen bvFTD and 18 early-onset Alzheimer's disease (EOAD) participants received standard clinical neuropsychological measures and neuroimaging. Caregiver informants were administered the SDS. Individuals with bvFTD exhibited greater social dysfunction on the SDS compared with the EOAD group; t(32) = 6.32, p < .001. The scale demonstrated preliminary evidence for discriminating these frequently misdiagnosed groups (area under the curve = 0.920, p = <.001) and internal consistency α = 0.977. The SDS demonstrated initial evidence as an effective measure for detecting abnormal social behavior and discriminating bvFTD from EOAD. Future validation is recommended in larger and more diverse patient groups.


Assuntos
Doença de Alzheimer/diagnóstico , Demência Frontotemporal/diagnóstico , Escalas de Graduação Psiquiátrica/normas , Psicometria/instrumentação , Transtornos do Comportamento Social/diagnóstico , Idoso , Doença de Alzheimer/complicações , Feminino , Demência Frontotemporal/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Transtornos do Comportamento Social/etiologia
15.
J Psychosom Res ; 73(6): 448-51, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23148813

RESUMO

OBJECTIVES: To study the clinical characteristics and outcomes of psychosis and its clinical correlation with disease activity in Thai systemic lupus erythematosus (SLE) patients. METHODS: From 750 SLE patients, 36 episodes of psychosis or psychotic depression in SLE patients were retrospectively identified between June 1999 and June 2009 at Srinagarind Hospital, Khon Kaen University. The clinical characteristics, laboratory analyses, disease activity, treatments and outcomes were studied. RESULTS: A total of 35 SLE patients had 36 psychotic episodes that consisted of 29 psychotic episodes and 7 psychotic depressive episodes. Eleven episodes (30.6%) occurred during the first manifestation of lupus. Psychotic symptoms included persecutory delusion (50%), bizarre delusion (44.4%), third person auditory hallucinations (44.4%) and visual hallucinations (36.1%). Twenty four episodes (67%) were associated with active lupus in CNS and other organs. All patients received immunotherapy and psychotropic treatments. Psychosis and depressive psychosis were treated with antipsychotics and antidepressants for a mean duration of 71 and 410 days. One death resulted from suicide, and one of thirty four cases (2.9%) had a reoccurrence within a mean follow-up period of 44 months. CONCLUSION: About one-third of the psychotic episodes occurred during the first manifestation of lupus. Persecutory delusion, bizarre delusion, third person auditory hallucination, and visual hallucination were common. During psychotic episodes, lupus activity was active in other parts of CNS and organs in 67% of patients. Depressive psychosis required psychotropic treatment longer than psychosis alone. The psychiatric outcome was very favorable. Most of psychotic episodes (97.1%) were fully remitted and rarely showing recurrences.


Assuntos
Lúpus Eritematoso Sistêmico/psicologia , Transtornos Psicóticos/etiologia , Adulto , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Feminino , Humanos , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Masculino , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/psicologia , Tailândia , Resultado do Tratamento
16.
J Med Assoc Thai ; 95 Suppl 7: S156-62, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23130448

RESUMO

BACKGROUND: There is a paucity of data on intentional self-harm and suicide in Thailand. It is crucial to re-evaluate the burden and health outcomes. OBJECTIVE: To measure the character and burden of acts of intentional self-harm in the Thai hospitalized population. MATERIAL AND METHOD: Acts of intentional-self harm were categorized using ICD 10 classification. All of inpatient-related data were analyzed using SPSS 17. RESULTS: Overall intentional self-harm in 2010 led to 24,924 hospitalizations and 854 deaths; an incidence of 35.6/100,000 people with the highest level in two age groups: 18-25 and 26-40 year-olds. Self-poisoning (89%) was the most common method and pesticide was the leading used chemical agents. The total cost of treatment was 149,672,190 baht and the mean length of stay was 2.9 +/- 6.7 days. The mortality rate increased as the population got older with the highest rate being 10.6% for 70-79 year-olds. In 33.8% of cases, psychiatric co-diagnosis were found with anxiety disorders was the leading comorbidity. CONCLUSION: The incidence of intentional self-harm was medium to high, compared to other East Asians countries. Self-poisoning by exposure to pesticides was the most common self-harm method. Age over 60 had the highest mortality rate. Having a psychiatric co-diagnosis was common.


Assuntos
Hospitalização/estatística & dados numéricos , Comportamento Autodestrutivo/epidemiologia , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Fatores de Risco , Comportamento Autodestrutivo/psicologia , Tailândia/epidemiologia
17.
J Med Assoc Thai ; 95 Suppl 7: S229-34, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23130460

RESUMO

BACKGROUND: To date, only small, selected groups of elderly hospitalized with mental and behavioral disorders (EHMBD) have been studied. Since no national epidemiological studies have been published, the recent advent of universal healthcare in Thailand makes doing such a study timely for improving the medical curricula and service provision. OBJECTIVE: To analyze the epidemiology of the EHMBD in the year 2010 of Thailand. MATERIAL AND METHOD: The data analyzed were gathered from Medical Expense Reimbursement forms submitted for the fiscal year 2010. The particular focus of this research was on elderly inpatient aged 60 years and over with ICD-10 (for 2010) diagnosis: F00-F99 Mental and Behavioral Disorders. The authors extracted and analyzed the number of in-patient department (IPD) admissions, psychiatric diagnoses, length of hospital stays, hospital charges and mortality rate. Data were analyzed using SPSS 17 for Windows. RESULTS: In 2010, EHMBD accounted for 11,418 admissions which was 1.56 admission per 1000 elderly people or 13.9% of overall admission (19 years and over). Of the 11,418 admission, 44 died (0.39%). The mean in-patient charges/admission in Thai Baht (SD) for the EHMBD with any F00-F99 diagnosis was 12,896 (51,659). The average range of stay was 8.3 +/- 22.2 days. The leading diagnosed clusters of behavioral and mental disorders were organic mental disorders (F00-F09: 23.8%), neurotic, stress-related and somatoform disorders (F40-F48: 21.1%); and mental and behavioral disorders due to use of alcohol (F10: 20.3%). Alcohol use disorders among the elderly resulted in four times more men being hospitalized than women. Regarding the F30-F39 cluster mood (affective) disorders, the prevalence of depressive episodes increased with age and bipolar affective disorder decreased with age. CONCLUSION: The prevalence of hospitalization among the elderly with mental and behavioral disorders was about one-eighth that of all admission of adult from 19 years old. Death was an uncommon result. The most common psychiatric diagnoses were organic mental disorders, neurotic, stress-related and somatoform disorders and mental and behavioral disorders due to use of alcohol.


Assuntos
Transtornos Mentais/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Preços Hospitalares/estatística & dados numéricos , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Classificação Internacional de Doenças , Tempo de Internação/estatística & dados numéricos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Tailândia/epidemiologia
18.
Am J Alzheimers Dis Other Demen ; 27(7): 468-73, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22892657

RESUMO

Dementia with Lewy bodies (DLB) is commonly associated with excessive daytime somnolence (EDS). Modafinil is a wakefulness-promoting agent that is considered to have limited interaction with the dopaminergic system. As individuals with DLB are predisposed to psychotic symptoms that might be exacerbated by dopaminergic stimulation, modafinil is considered to be an attractive option for the treatment of EDS in DLB. We describe 2 cases in which administration of modafinil exacerbated agitation and hallucinations in DLB, and we also review data that may explain the mechanisms underlying this effect. In both cases, psychotic symptoms emerged concomitantly with modafinil administration and remitted following its discontinuation. Although definitive data regarding the benefits and adverse effects of modafinil for the treatment of EDS in DLB await controlled prospective randomized studies, our observations warrant caution regarding its use in this context.


Assuntos
Acatisia Induzida por Medicamentos , Compostos Benzidrílicos/efeitos adversos , Estimulantes do Sistema Nervoso Central/efeitos adversos , Distúrbios do Sono por Sonolência Excessiva/tratamento farmacológico , Doença por Corpos de Lewy , Psicoses Induzidas por Substâncias , Idoso , Idoso de 80 Anos ou mais , Compostos Benzidrílicos/uso terapêutico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Distúrbios do Sono por Sonolência Excessiva/etiologia , Humanos , Doença por Corpos de Lewy/complicações , Doença por Corpos de Lewy/psicologia , Masculino , Modafinila
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