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1.
Rev Med Liege ; 75(11): 754-758, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33155451

RESUMO

The article describes a clinical case of catatonic syndrome. We describe the manifestations of the syndrome, its diagnostic criteria and associated scales. The modalities of the challenge test, constituting a diagnostic test, and first line treatment are detailed. Clinical and paraclinical investigations are proposed to determine the etiology. The benzodiazepine withdrawal as an etiology of catatonic syndrome is detailed.


Assuntos
Catatonia , Síndrome de Abstinência a Substâncias , Benzodiazepinas/efeitos adversos , Catatonia/induzido quimicamente , Catatonia/diagnóstico , Catatonia/tratamento farmacológico , Humanos , Síndrome de Abstinência a Substâncias/diagnóstico , Síndrome de Abstinência a Substâncias/etiologia
2.
BMC Psychiatry ; 20(1): 349, 2020 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-32620087

RESUMO

BACKGROUND: Megalencephalic leukoencephalopathy with subcortical cysts (MLC), or Van der Knaap disease, is a rare spongiform leukodystrophy that is characterized by macrocephaly, progressive motor dysfunction, and mild mental retardation. It is very rare for mental illness such as psychotic disorders, affective disorders and anxiety disorders to occur in MLC. CASE PRESENTATION: A 17-year-old boy was admitted to our hospital after he developed symptoms of depressive state with catatonia after being diagnosed as having MLC with confirmed MLC1 mutation. His catatonic symptoms were improved with administration of olanzapine and sertraline and he was discharged after 4 months. Several months later, he became hypomanic. He was diagnosed with bipolar II disorder. Mood swings were controlled with the administration of carbamazepine. CONCLUSIONS: This case is the first report of bipolar disorder during the clinical course of MLC. This case indicate the possibility that MLC influences the development of bipolar disorder in MLC, however, further studies involving more patients are required to clarify this.


Assuntos
Transtorno Bipolar/diagnóstico , Encéfalo/diagnóstico por imagem , Catatonia/complicações , Cistos , Depressão/complicações , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central , Adolescente , Transtorno Bipolar/tratamento farmacológico , Transtorno Bipolar/genética , Catatonia/diagnóstico , Cistos/diagnóstico , Cistos/genética , Depressão/diagnóstico , Feminino , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central/diagnóstico , Doenças Desmielinizantes Hereditárias do Sistema Nervoso Central/genética , Humanos , Imagem por Ressonância Magnética , Megalencefalia
4.
Pediatrics ; 145(6)2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32471843

RESUMO

Down syndrome disintegrative disorder (DSDD), a developmental regression in children with Down syndrome (DS), is a clinical entity that is characterized by a loss of previously acquired adaptive, cognitive, and social functioning in persons with DS usually in adolescence to early adulthood. Initially reported in 1946 as "catatonic psychosis," there has been an increasing interest among the DS community, primary care, and subspecialty providers in this clinical area over the past decade. This condition has a subacute onset and can include symptoms of mood lability, decreased participation in activities of daily living, new-onset insomnia, social withdrawal, autistic-like regression, mutism, and catatonia. The acute phase is followed by a chronic phase in which baseline functioning may not return. No strict criteria or definitive testing is currently available to diagnose DSDD, although a comprehensive psychosocial and medical evaluation is warranted for individuals presenting with such symptoms. The etiology of DSDD is unknown, but in several hypotheses for regression in this population, psychological stress, primary psychiatric disease, and autoimmunity are proposed as potential causes of DSDD. Both psychiatric therapy and immunotherapies have been described as DSDD treatments, with both revealing potential benefit in limited cohorts. In this article, we review the current data regarding clinical phenotypes, differential diagnosis, neurodiagnostic workup, and potential therapeutic options for this unique, most disturbing, and infrequently reported disorder.


Assuntos
Atividades Cotidianas/psicologia , Transtorno Autístico/epidemiologia , Transtorno Autístico/psicologia , Síndrome de Down/epidemiologia , Síndrome de Down/psicologia , Adolescente , Transtorno Autístico/diagnóstico , Catatonia/diagnóstico , Catatonia/epidemiologia , Catatonia/psicologia , Criança , Deficiências do Desenvolvimento/diagnóstico , Deficiências do Desenvolvimento/epidemiologia , Deficiências do Desenvolvimento/psicologia , Síndrome de Down/diagnóstico , Feminino , Humanos , Masculino , Transtornos do Humor/diagnóstico , Transtornos do Humor/epidemiologia , Transtornos do Humor/psicologia , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/psicologia , Literatura de Revisão como Assunto
5.
BMJ Case Rep ; 13(4)2020 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-32321729

RESUMO

Worldwide, millions of children and adolescents are suffering due to a lack of efficient mental healthcare. Although some progress has been made to address the mental health problems in this age group, currently, even developed countries fail in providing psychiatric patients with the best practice care. We present a case of a Portuguese adolescent with a first episode of psychosis in whom multiple social and environmental risk factors were identified as triggers to his clinical presentation, as well as fundamental determinants of prognosis in the short and long term. In this case, we demonstrate how social determinants, including poverty, family dysfunction and difficulties in accessing appropriate mental healthcare, strongly influence the development, maintenance and prognosis in early psychosis during adolescence. Furthermore, we consider the implications of an absence of community-based mental healthcare and rehabilitation services and reasons for why this may complicate the management and limit opportunities to this patient population.


Assuntos
Saúde do Adolescente , Catatonia/diagnóstico , Transtornos Psicóticos/diagnóstico , Determinantes Sociais da Saúde , Adolescente , Criança , Saúde Global , Humanos , Masculino , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/provisão & distribução , Portugal/epidemiologia , Saúde Pública , Fatores de Risco
6.
J Psychiatr Pract ; 25(6): 481-484, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31821227

RESUMO

Tacrolimus, a potent posttransplant immunosuppressant, has been associated with major neuropsychiatric complications, including catatonia and psychosis. We report a novel case of tacrolimus-induced encephalopathy that developed 16 years after renal transplantation while the drug was at a therapeutic level. Discontinuation of tacrolimus and switching to an alternative immunosuppressant resulted in significant clinical improvement over 1 week. Our experience illustrates the possibility of acute neurotoxicity from tacrolimus even when the patient has tolerated the drug for 16 years and drug levels are within the therapeutic range. This case also highlights the importance of collaboration between psychiatry and transplant clinicians.


Assuntos
Catatonia/induzido quimicamente , Imunossupressores/efeitos adversos , Transplante de Rim , Complicações Pós-Operatórias/induzido quimicamente , Tacrolimo/efeitos adversos , Idoso , Antipsicóticos/uso terapêutico , Catatonia/diagnóstico , Catatonia/tratamento farmacológico , Ciclosporina/uso terapêutico , Eletroencefalografia , Feminino , Moduladores GABAérgicos/uso terapêutico , Humanos , Lamotrigina/uso terapêutico , Lorazepam/uso terapêutico , Complicações Pós-Operatórias/tratamento farmacológico
7.
MMW Fortschr Med ; 161(Suppl 7): 7-11, 2019 12.
Artigo em Alemão | MEDLINE | ID: mdl-31828672

RESUMO

BACKGROUND: Catatonia is still a poorly understood, quite common, but often overlooked clinical picture. Consequences for patients are inadequate treatment, prolonged hospital stays and more serious complications. METHOD: In this overview, the causes for an underdiagnosis are presented and measures for their prevention named, help for the differential diagnostic classification of catatonia is offered and the treatment is briefly explained. RESULTS AND CONCLUSIONS: Catatonia is primarily associated with schizophrenia, but is also observed in other diseases such as neuroleptic malignant syndrome (MNS), in encephalitis and also in systemic diseases. Underdiagnosis can be avoided by simple measures such as a thorough physical examination, observance of verbal and non-verbal signs of catatonia, and psychiatric consultations in general hospitals. For the treatment of acute catatonia, the high-dose administration of benzodiazepines and electroconvulsive therapy are recommended.


Assuntos
Catatonia , Eletroconvulsoterapia , Síndrome Maligna Neuroléptica , Benzodiazepinas/uso terapêutico , Catatonia/diagnóstico , Catatonia/terapia , Humanos
8.
J Psychiatr Pract ; 25(5): 383-390, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31505524

RESUMO

Encephalitis related to antibodies against the N-methyl-D-aspartate receptor (NMDAr) is a recently described clinical entity in which IgG autoantibodies against the NR1 subunit of the NMDAr lead to the appearance of complex neuropsychiatric symptoms. As psychiatric symptoms predominate in early stages, anti-NMDAr encephalitis is frequently mistaken as a primary psychiatric disorder which delays treatment and has serious consequences for patients. This report presents the case of a 24-year-old woman with a subacute onset of psychotic and catatonic symptoms in whom current diagnostic criteria for probable anti-NMDAr encephalitis were not fulfilled. On the basis of the red flags that have been proposed to raise suspicion of anti-NMDAr encephalitis, a study of fluorodeoxyglucose positron emission tomography was requested and demonstrated bilateral occipital hypometabolism consistent with clinical suspicion of anti-NMDAr encephalitis. Once the appropriate treatment was established, the patient recovered completely. This case supports the need to maintain clinical suspicion of anti-NMDAr encephalitis, even when conventional diagnostic tests have been normal. Psychiatrists should be familiar with this entity to promote timely diagnosis and prompt treatment.


Assuntos
Catatonia , Ovariectomia/métodos , Transtornos Psicóticos/diagnóstico , Receptores de N-Metil-D-Aspartato/imunologia , Teratoma , Adulto , Encefalite Antirreceptor de N-Metil-D-Aspartato/sangue , Encefalite Antirreceptor de N-Metil-D-Aspartato/genética , Encefalite Antirreceptor de N-Metil-D-Aspartato/psicologia , Autoanticorpos/sangue , Catatonia/diagnóstico , Catatonia/etiologia , Córtex Cerebral/diagnóstico por imagem , Córtex Cerebral/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Neoplasias Ovarianas/imunologia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Tomografia por Emissão de Pósitrons/métodos , Teratoma/imunologia , Teratoma/patologia , Teratoma/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
9.
Acta Psychiatr Scand ; 140(6): 574-585, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31436311

RESUMO

OBJECTIVES: To examine the prospective temporal stability of acute and transient psychotic disorders (ATPDs) and analyze whether there are clinical, psychopathological, or sociodemographic characteristics that predict ATPD diagnostic stability. METHOD: We conducted a prospective, 2-year, observational study of patients presenting a first-episode ATPD. A multivariate logistic regression model was developed to identify independent variables associated with ATPD diagnostic stability. Well-established predictive factors of diagnostic stability, as well as all the psychopathological features included in the ICD-10 Diagnostic Criteria for Research (DCR) descriptions of ATPD, were analyzed. RESULTS: Sixty-eight patients with a first episode of ATPD completed the study with a diagnostic stability rate as high as 55.9% (n = 38) at the end of the follow-up period. Multivariate analysis revealed that diagnostic stability was independently significantly associated with the baseline presence of motility disturbances (OR = 6.86, 95% CI = 1.10-42.62; P = 0.039), the absence of hallucinations (OR = 5.75, 95% CI = 1.51-21.98; P = 0.010), and the absence of schizophrenic features (OR = 7.13, 95% CI = 1.38-36.90; P = 0.019). CONCLUSION: A symptom checklist assessing these psychopathological features would enable early identification of those subjects whose initial ATPD diagnosis will remain stable over time.


Assuntos
Catatonia/diagnóstico , Alucinações/diagnóstico , Transtornos Psicóticos/diagnóstico , Esquizofrenia/diagnóstico , Doença Aguda , Adulto , Catatonia/etiologia , Feminino , Seguimentos , Alucinações/etiologia , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Prognóstico , Transtornos Psicóticos/complicações , Esquizofrenia/complicações , Adulto Jovem
12.
Australas Psychiatry ; 27(5): 491-495, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31310153

RESUMO

OBJECTIVE: This article describes how the onset of bvFTD can be heralded by psychiatric symptoms. METHOD: Case reports are described with reference to the relevant literature review. RESULTS: Three patients were admitted with psychiatric symptoms, including depression, mania, psychosis and catatonia. Two had been previously diagnosed with a psychiatric disorder. All three were diagnosed with probable bvFTD. CONCLUSION: bvFTD is an important differential diagnosis to consider when patients present with atypical psychiatric symptoms.


Assuntos
Demência Frontotemporal/diagnóstico , Transtornos Mentais/diagnóstico , Idoso , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/etiologia , Transtorno Bipolar/fisiopatologia , Catatonia/diagnóstico , Catatonia/etiologia , Catatonia/fisiopatologia , Depressão/diagnóstico , Depressão/etiologia , Depressão/fisiopatologia , Diagnóstico Diferencial , Feminino , Demência Frontotemporal/complicações , Demência Frontotemporal/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/fisiopatologia
13.
Asian J Psychiatr ; 44: 13-17, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31302436

RESUMO

BACKGROUND: The prevalence of catatonia varies with the setting and type of rating scale used to measure catatonia. Catatonia, initially subsumed under schizophrenia, now is increasingly recognized in association with affective disorders. AIM: We aimed to examine the prevalence of catatonia in an acute psychiatric inpatient unit in a tertiary center in India. METHODS: Study subjects (n = 300) were randomly selected from amongst the inpatients over one year and evaluated within 24 h of admission using BFCRS and NCS, besides a sociodemographic and clinical proforma. During the inpatient stay MINI PLUS 5.0 was applied. RESULTS: Among 300 inpatients recruited, 88 (29.3%) demonstrated at least one catatonic sign in either of the rating scales. As per the diagnostic cut-offs defined by BFCRS and NCS, the prevalence of catatonia syndrome was 49 (16.3%) and 32 (10.6%) respectively. The prevalence rates as per ICD-10 criteria and DSM-5 criteria were 19% and 5.3% respectively. The two most frequently noted signs - staring and withdrawal, were not listed as signs in either the ICD-10 or DSM V. The prevalence of catatonic symptoms was different in psychotic disorders in contrast to affective disorders. Severity of catatonia was associated with younger age, lesser duration of primary illness and prior episodes of catatonia. CONCLUSIONS: The prevalence of catatonia varies from 5.3% to 19% based on the criteria used. Identification warrants use of structured instruments. Catatonia is more severe in the initial years of illness, those with prior episodes of catatonia and in the younger age group.


Assuntos
Catatonia/epidemiologia , Hospitais Psiquiátricos/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Catatonia/diagnóstico , Feminino , Humanos , Índia/epidemiologia , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Adulto Jovem
14.
Clin Neurol Neurosurg ; 184: 105375, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31147176

RESUMO

Catatonia is a well-described clinical syndrome characterized by features that range from mutism, negativism and stupor to agitation, mannerisms and stereotype. Causes of catatonia may range from organic brain disorders to psychiatric conditions. Despite a characteristic syndrome, catatonia is grossly under diagnosed. The reason for missed diagnosis of catatonia in neurology setting is not clear. Poor awareness is an unlikely cause because catatonia is taught among conditions with deregulated consciousness like vegetative state, locked-in state and akinetic mutism. We determined the proportion of catatonia patients correctly identified by neurology residents in neurology emergency. We also looked at the alternate diagnosis they received to identify catatonia mimics. Twelve patients (age 22-55 years, 7 females) of catatonia were discharged from a single unit of neurology department from 2007 to 2017. In the emergency department, neurology residents diagnosed none of the patients as catatonia. They offered diagnosis of extrapyramidal syndrome in 7, meningitis in 2, and conversion reaction, acute psychosis/encephalopathy and non-convulsive status epilepticus in one each. Their final diagnosis at discharge was catatonia due to general medical condition in 6 (progressive supranuclear palsy in 2, post-status epilepticus, uremic encephalopathy, glioblastoma multiforme and tuberculous meningitis in one each), catatonia due to major depression in 4, schizophrenia and idiopathic catatonia in one each. Extrapyramidal syndrome appeared as common mimic of catatonia. The literature reviewed also revealed the majority of organic catatonia secondary to causes that are usually associated with extrapyramidal features. Therefore, we suggest that neurologists should consider catatonia in patients presenting with extrapyramidal syndromes.


Assuntos
Catatonia/diagnóstico , Serviço Hospitalar de Emergência/normas , Neurologistas/normas , Neurologia/normas , Adulto , Catatonia/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurologia/métodos , Alta do Paciente/tendências , Adulto Jovem
15.
Lancet Psychiatry ; 6(7): 610-619, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31196794

RESUMO

Catatonia is a psychomotor syndrome associated with several psychiatric and medical conditions. Psychomotor signs range from stupor to agitation, and include pathognomonic features such as verbigeration and waxy flexibility. Disturbances of volition led to the classification of catatonia as a subtype of schizophrenia, but changes in nosology now recognise the high prevalence in mood disorders, overlap with delirium, and comorbidity with medical conditions. Initial psychometric studies have revealed three behavioural factors, but the structure of catatonia is still unknown. Evidence from brain imaging studies of patients with psychotic disorders indicates increased neural activity in premotor areas in patients with hypokinetic catatonia. However, whether this localised hyperactivity is due to corticocortical inhibition or excess activity of inhibitory corticobasal ganglia loops is unclear. Current treatment of catatonia relies on benzodiazepines and electroconvulsive therapy-both effective, yet unspecific in their modes of action. Longitudinal research and treatment studies, with neuroimaging and brain stimulation techniques, are needed to advance our understanding of catatonia.


Assuntos
Encéfalo/fisiopatologia , Catatonia/fisiopatologia , Rede Nervosa/fisiopatologia , Catatonia/diagnóstico , Humanos , Vias Neurais/fisiopatologia
16.
Encephale ; 45(5): 391-396, 2019 Nov.
Artigo em Francês | MEDLINE | ID: mdl-31227209

RESUMO

OBJECTIVES: Catatonia is a transnosographic syndrome described by K. Kahlbaum in 1874. Catatonia can be life-threatening due to its complications and in case of malignant catatonia. Safe and effective treatments have been identified (benzodiazepines and electro-convulsive-therapy). The prevalence of this syndrome is important and represents about 10% of inpatients in an acute psychiatric ward. However, this syndrome appears to remain under-diagnosed and poorly known. We were, therefore, interested in the current knowledge of French psychiatry residents and young psychiatrists as well as the education they had received about catatonia. METHODS: A questionnaire was submitted to French psychiatry residents and young psychiatrists with fewer than 5 years of experience. It included questions about knowledge of the symptoms, complications, causes and treatments of catatonia. Participants were also asked about their confidence in the management of a patient with catatonia and about the number of catatonic patients they had already met. The type of lecture and teaching about catatonia was also assessed. RESULTS: Among the 376 psychiatrists that completed the questionnaire, 37.5% never had received any specific teaching about catatonia. Concerning the 62.5% who benefited from a specific lecture, this was mainly delivered as part of psychiatry DES. Heterogeneity in the education delivery on the French territory had been highlighted. In addition, participants' knowledge of catatonic syndrome seems incomplete. However, knowledge of catatonic symptoms and first intention treatments was significantly better among respondents who were part of the "with education" group. The confidence in catatonia recognition and management, as well as the number of catatonic patients they met, are also significantly higher in the group "with education". CONCLUSION: Specific education seems to improve the knowledge of young doctors and their ability to diagnose and treat catatonic patients. This education remains poorly provided and heterogeneous on the French territory. Catatonia deserves a place in the teaching program of the psychiatry DES, thus to become systematic.


Assuntos
Catatonia/diagnóstico , Internato e Residência , Psiquiatria/educação , Adulto , Benzodiazepinas/uso terapêutico , Catatonia/epidemiologia , Catatonia/psicologia , Catatonia/terapia , Competência Clínica , Currículo , Eletroconvulsoterapia , Feminino , França , Humanos , Masculino , Prevalência , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Inquéritos e Questionários , Síndrome
18.
BMC Psychiatry ; 19(1): 123, 2019 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-31014303

RESUMO

BACKGROUND: Catatonia is a neuropsychiatric syndrome characterized by diverse psychomotor abnormalities, including motor dysregulation and behavioral and affective disturbances. Once thought to occur primarily in the context of schizophrenia, recent data suggest most cases of catatonia develop in individuals with depressive or bipolar disorders. Moreover, catatonia may ensue in general medical and neurological conditions, as well as due to a variety of pharmaceuticals, drugs of abuse, and toxic agents. At one time considered rare in pediatric patients, evidence now suggests catatonia is both underrecognized and undertreated in this population, where it carries an elevated risk of morbidity and mortality. Here we present the case of a child with steroid-resistant nephrotic syndrome who developed catatonia due to cyclosporine A-related neurotoxicity. CASE PRESENTATION: A 9-year-old African-American boy with no psychiatric history and a 9-month history of nephrotic syndrome due to focal segmental glomerulosclerosis was admitted to the local children's hospital for management of mutism, posturing, insomnia, gait abnormalities, and somatic delusions. Seven days prior to admission, his cyclosporine plasma concentration was elevated at 1224 ng/mL (therapeutic range: 100-200 ng/mL). Upon admission, cyclosporine was discontinued and psychiatry was consulted, diagnosing catatonia. The patient subsequently received propofol 80 mg IV resulting in a transient lysis of catatonia. Over a lengthy hospitalization, the patient's catatonia was initially treated with lorazepam, quetiapine being added later to target psychosis. All signs and symptoms of catatonia resolved, and the patient was eventually tapered off both lorazepam and quetiapine with no return of symptoms more than 6 months later. CONCLUSIONS: To our knowledge, this case represents the first reported instance of cyclosporine A-induced catatonia in a patient with steroid-resistant nephrotic syndrome. It illustrates the importance of maintaining vigilance for signs and symptoms of cyclosporine A-related neurotoxicity (including catatonia) in patients with steroid-resistant nephrotic syndrome. In addition, it highlights the challenges faced by clinicians in jurisdictions that prohibit the use of electroconvulsive therapy in pediatric patients.


Assuntos
Antifúngicos/efeitos adversos , Catatonia/induzido quimicamente , Catatonia/diagnóstico , Ciclosporina/efeitos adversos , Síndrome Nefrótica/diagnóstico , Síndrome Nefrótica/tratamento farmacológico , Esteroides/uso terapêutico , Criança , Resistência a Medicamentos , Humanos , Masculino
19.
J Dev Behav Pediatr ; 40(3): 237-238, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30907773

RESUMO

CASE: Thomas is a 12-year-old boy with autism spectrum disorder who presents to his primary care clinician with symptoms of worsening mood in the last 3 months. On review of his last school testing, his cognitive abilities are found to be within the average range, with a relative vulnerability with his processing speed. He can speak in sentences to communicate and answer questions, but he rarely picks up on conversational bids. He has had difficulties developing friendships and often prefers to play by himself.Thomas has a long history of some features of anxiety and depression for which it was recommended that he establish care with a therapist, but his family has had a hard time finding a provider for him. At this visit, the mother reports that for the past several months he has been more anxious, sad, and easily overwhelmed. He seems irritable at home and school and cries often. His family has been advocating for him to receive increased school supports, as school is a source of anxiety for him, but there are no recent changes in school services. There is a family history of both anxiety and depression. Given his worsening mood functioning, Thomas was started on selective serotonin reuptake inhibitor (SSRI) medication in addition to again recommending a therapist. Weekly phone call check-ins and an in-person clinic visit in 1 month are planned.About 1 month after starting the SSRI medication, he is still not showing any improvement in mood functioning, and his family reports he seems more "sluggish" than usual. There are no side effects reported with the medication, and the dose is increased to see whether it will help. However, about 2 weeks later, he is seen again in the clinic because there are increasing concerns. He continues to be "sluggish." During the clinic visit, he lies down on the examination table, sometimes holding his head off the edge of the table, which he has never done before. He responds very slowly to the questions and often says "I don't know, I don't know," almost in an automatic way. His mother reports that he is now engaging in some repetitive hand movements which he had not done previously. He is no longer able to shower independently. He is still eating and drinking adequately. What would you do next?


Assuntos
Transtorno do Espectro Autista , Catatonia/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Catatonia/epidemiologia , Catatonia/fisiopatologia , Criança , Comorbidade , Humanos , Masculino
20.
Asian J Psychiatr ; 41: 5-12, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30836326

RESUMO

Patients with progressive cognitive decline mostly suffer from degenerative disease and carry a relatively poor prognosis. But small groups among these patients have a potentially treatable cause of illness and therefore every patient with dementia needs to be considered treatable unless proved otherwise. This group can be identified only by high degree of suspicion based on clinical clues. We have evaluated the validity of some simple clinical clues which we noticed in our patients with immune mediated dementias. The Panic score, Epsworth sleepiness score, catatonic symptoms and history of seizures were compared between 23 and 11 patients with serologically confirmed anti-NMDA antibody and anti-VGKC antibody associated encephalitis respectively. They were compared with 20 patients with probable behavioral variant of Frontotemporal dementia (bvFTD) and 20 patients with probable Alzheimer's disease (AD). Chi-square test was used to compare across the groups and there was significant difference (P < 0.05) across the 4 groups comprising anti NMDA encephalitis, anti VGKC encephalitis, FTD and AD among the four variables (Panic scores, Catatonic symptoms, Epsworth sleepiness score and seizures) studied. Our study revealed that panic and sleepiness is highly significant when tested across all groups and catatonia showed a trend towards NMDA and when compared with degenerative dementia versus immune mediated syndromes all the 4 parameters were highly significant This simple bedside TRIAD of panic, sleepiness with either of catatonia or seizures if found in patients it is appropriate to order antibody assessment before anything else is planned. This needs to be evaluated in a larger sample.


Assuntos
Doenças Autoimunes do Sistema Nervoso , Catatonia , Disfunção Cognitiva , Demência , Distúrbios do Sono por Sonolência Excessiva , Encefalite , Transtorno de Pânico , Adulto , Idoso , Encefalite Antirreceptor de N-Metil-D-Aspartato/complicações , Encefalite Antirreceptor de N-Metil-D-Aspartato/diagnóstico , Encefalite Antirreceptor de N-Metil-D-Aspartato/imunologia , Doenças Autoimunes do Sistema Nervoso/complicações , Doenças Autoimunes do Sistema Nervoso/diagnóstico , Doenças Autoimunes do Sistema Nervoso/imunologia , Catatonia/diagnóstico , Catatonia/etiologia , Catatonia/fisiopatologia , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Demência/diagnóstico , Demência/etiologia , Demência/fisiopatologia , Progressão da Doença , Distúrbios do Sono por Sonolência Excessiva/diagnóstico , Distúrbios do Sono por Sonolência Excessiva/etiologia , Distúrbios do Sono por Sonolência Excessiva/fisiopatologia , Encefalite/complicações , Encefalite/diagnóstico , Encefalite/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/diagnóstico , Transtorno de Pânico/etiologia , Transtorno de Pânico/fisiopatologia , Canais de Potássio de Abertura Dependente da Tensão da Membrana/imunologia
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