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1.
BMJ Case Rep ; 13(10)2020 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-33012721

RESUMO

We present a case of non-convulsive status epilepticus in a 57-year-old woman with a schizoaffective disorder, without an antecedent seizure history, with two possible aetiologies including SARS-CoV-2 infection and clozapine uptitration. We discuss the presentation, investigations, differential diagnosis and management. In particular, we focus on the electroencephalogram (EEG) findings seen in this case and the electroclinical response to antiepileptic medication. We review the literature and discuss the relevance of this case to the SARS-CoV-2 global pandemic. We emphasise the importance of considering possible neurological manifestations of SARS-CoV-2 infection and highlight seizure disorder as one of the possible presentations. In addition, we discuss the possible effects of clozapine on the electroclinical presentation by way of possible seizure induction as well as discuss the possible EEG changes and we highlight that this needs to be kept in mind especially during rapid titration.


Assuntos
Antipsicóticos/efeitos adversos , Betacoronavirus , Clozapina/efeitos adversos , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Transtornos Psicóticos/tratamento farmacológico , Estado Epiléptico/etiologia , Clozapina/uso terapêutico , Diagnóstico Diferencial , Eletroencefalografia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Estado Epiléptico/fisiopatologia
2.
Psychiatr Danub ; 32(Suppl 1): 21-23, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890356

RESUMO

BACKGROUND: Tobacco use is one of the major causes of morbidity and mortality amoung patients suffering from psychotic disorders. The association between severe COVID-19 and tobacco use is still debated. The aim of this paper is to enhance the importance of providing up to date informations about nicotine and tobacco use in connection with the SARS-CoV-2-related conditions. METHODS: We present 3 cases of sudden tobacco use cessation in 3 long-term heavy smokers receiving mental health care for chronic psychotic disorders. Fear of severe form of COVID-19 was their principal motivation. Nicotine replacement therapy and quitline counseling were provided and no major withdrawal symptoms were declared. RESULTS: As mass media later wrongly presented tobacco use as a protective factor regarding COVID-19, all three patients resumed smoking. Rigorous counseling took advantage of psychotic symptoms to correct false informations and finally promote tobacco use cessation. CONCLUSIONS: The COVID-19 pandemic might paradoxically represent a great motivational factor to quit smoking, espacially when considering patients suffering from severe mental health disorders. Beyond the terrible suffering it causes, we illustrate with a case serie that this opportunity must be exploited by mental health professionals to improve quality and life expectancy of their patients.


Assuntos
Infecções por Coronavirus/psicologia , Pneumonia Viral/psicologia , Transtornos Psicóticos/terapia , Abandono do Uso de Tabaco/psicologia , Betacoronavirus , Aconselhamento , Humanos , Motivação , Pandemias , Dispositivos para o Abandono do Uso de Tabaco
3.
Psychiatr Danub ; 32(Suppl 1): 93-104, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890371

RESUMO

Mechanisms of cortical psychoses are approached by complementing big data-driven genetics and imaging with a putatively subverted neurovascular "reverse plumbing" by arteries. The "cortical spread" of grey matter loss in schizophrenia and the mid-pericallosal "congestion" in fMRI of periodic catatonia - treatable electromagnetically along arteries - are interpreted in terms of the fastest interstitial outflow through the Cerebral IntraMural Reverse Arterial Flow-engine (CIMURAF, Treviranus 2018-19) draining "waste" via arterio-adventitial lymphatics to the neck. Such repetitively sliding segments of CIMURAF are wrung downstream by muscles likely steered by the neurovascular pterygopalatine ganglion. At the pericallosal artery, along its ideal long straight segment, this likely happens diverging from the mid-callosum towards the front and the back. In the case of a convergent inversion a mid-callosal clash will result, which is observable in psychoses as a mid-callosal high-flow-spot simultaneously with hyper-perfusions of branches and "backwatering" of pial vessels with reactive waste - till date interpreted psycho-mathematically. CIMURAF might also accelerate the perivascular intrusion of MCs by flushing autocrine signals (of which electro-magnetism moves the dipoles) through a putative periadventitial counter-current. Psychoses plausible occur through tryptase-mediated attacks operated by mast cells against oligodendrocytes' cytoskeleton (Medic 2009) and probably via complement-4 (Schizophrenia WG, 2014) against neurons. Usually MCs are essential long-lived "orchestrators" of homeostases and immune or barrier defences interacting with nerves, immunocytes, organs, and routes. MCs after somatic programming as to "destination & destiny" (Treviranus 2017a, 6.2., 2018) rapidly intrude also into the brain's parenchyma, first within the lymphatics and then putatively by crossing-over to extraluminal arterial routes. MCs transverse the BBBs, while macrophages only trespass in "disease" (Faraco et al. 2017). Both can be "subverted" by a list of microbes (and putatively blown up by COVID-19 within walls). Enuresis and MCs' reactions to clozapine add to the interactive support from (epi-)genetics and imaging.


Assuntos
Mastócitos/imunologia , Transtornos Psicóticos/imunologia , Betacoronavirus , Barreira Hematoencefálica/imunologia , Infecções por Coronavirus , Gânglios , Humanos , Mastócitos/patologia , Pandemias , Pneumonia Viral
4.
Psychiatr Danub ; 32(Suppl 1): 200-206, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32890390

RESUMO

BACKGROUND: Gender is a crucial factor in the development of mental illnesses, with an essential influence on clinical characteristics and not only on the prevalence of each disorder. Gender differences in cannabinoid-related disorders are highlighted by different research fields (preclinical, clinical, socio-demographic studies), but few studies focused on differential symptom expression in cannabinoid-induced psychosis. This study aims at investigating qualitative and quantitative gender differences in specific psychopathological domains in a clinical sample of subjects affected by cannabinoid-induced psychotic disorder, without psychiatric comorbidity. SUBJECTS AND METHODS: The study was carried out at the Psychiatric Inpatient Service of General Hospital of Perugia (Italy). In this cross-sectional gender study, 28 inpatients were enrolled, 14 males (M) and 14 females (F). Participants were administered a psychometric battery consisting of 7 tests (PANSS, NDS-I, YMRS, HAM-D, HAM-A, AQ, SSI) in order to investigate 7 psychopathological domains (Psychosis, Dysphoria, Mania, Depression, Anxiety, Aggressive Behaviour and Suicide Ideation). Scores obtained at each test were compared between male and females by using Mann-Whitney U test (p<0.05). RESULTS: In this study, we observed that males present higher severity of psychotic symptoms, with prominent scores in PANSS positive and general psychopathology scale (p<0.001), and an important expression of aggressive behavior (p<0.001) compared with females. Female sample, instead, shows a greater expression of dysphoria and depressive domains (p<0.001) and a lower, but statistically significant, prevalence in the anxiety domains expression (p=0.01). By these observations, we could assert that in male group thought disorders are prominent. On the other hand, in female group affective disorder are prominent. CONCLUSIONS: This study confirmed how gender influences the phenomenic expression of psychiatric disorders. In line with the precision medicine paradigm, a further clarification of different clinical profiles based on gender would allow the choice of a personalized treatment plan with better efficacy and accuracy indices.


Assuntos
Transtorno Bipolar , Canabinoides , Psicoses Induzidas por Substâncias , Transtornos Psicóticos , Canabinoides/efeitos adversos , Estudos Transversais , Feminino , Humanos , Itália , Masculino
6.
Artigo em Russo | MEDLINE | ID: mdl-32929920

RESUMO

OBJECTIVE: To describe the structure of psychoses developed due to synthetic cannabinoids (Spice). MATERIAL AND METHODS: Forty-six men, aged 18-35 years, with psychosis during abstinence were studied and followed up for 2 years. RESULTS AND CONCLUSION: Four clinical variants with predominant delirious symptoms (27%) or hallucinatory symptoms (19%) or affective-delusions (21%) or mental automatisms (33%) were identified. The follow-up revealed the manifestations of schizophrenic process in 17% of the patients. Clinical and differential diagnostic characteristics of these variants in synthetic cannabinoids users are described.


Assuntos
Canabinoides , Transtornos Psicóticos , Adolescente , Adulto , Humanos , Masculino , Adulto Jovem
7.
Artigo em Russo | MEDLINE | ID: mdl-32929930

RESUMO

The changes in the concept of psychopathy in Russian psychiatry from the beginning of twentieth century through examples of several works of native psychiatrists: F.E. Rybakov, S.A. Sukhanov, P.B. Gannushkin, V.P. Osipov, T.I. Yudin are analyzed. The tendency to transformation of the concept of «general degenerative constitution¼ into the concept of relatively discrete types of psychopathic personalities is delineated. The understanding of «degenerative psychopathy¼ as unitary predisposition to the «degenerative psychoses¼, inborn disharmony of character with its multivarious innumerable variants and different forms of «deficiencies¼, including intellectual, is experiencing transformation to the numerically limited separated types of psychopathic personalities and pathological characters related to the appropriate more pronounced psychiatric diseases. This trend in the native psychiatry reflects also the general trends of understanding of psychopathies and pathological characters in Russian, German and French psychiatry and psychology.


Assuntos
Psiquiatria , Transtornos Psicóticos , Transtorno da Personalidade Antissocial , Caráter , Humanos , Federação Russa
11.
Crim Behav Ment Health ; 30(5): 256-267, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32896935

RESUMO

Liaison and Diversion (L&D) has twin objectives: improving mental health outcomes and reducing re-offending. Early diversion from police custody seems promising, but evidence of benefit is required to sustain such programmes. To test the hypothesis that contact with L&D services while in police custody would lead to improved mental health outcomes and a reduction in type and level of offending, we used a pre-post service use design. National Health Service (NHS) records in two counties were searched for evidence that patients had been involved with L&D services while in police custody during the period July 2009-December 2017. We defined January 2009-July 2014 as the pre-intervention period and any time after contact as the post-intervention period. Data from the Police National Computer were gathered for each period for these individuals, to assess their pre-post L&D contact offending histories. NHS Trust data were similarly gathered to assess their pre-post use of mental health legislation. 4,462 individuals were identified who had used L&D services in police custody. There were statistically significant reductions in the amount of offending following contact with the L&D service (whether one or two contacts), regardless of offence type. Statistically significant reductions were also observed in use of the four most commonly used legislative powers for detaining patients in hospital on mental disorder grounds, regardless of offending status (prolific/non-prolific). Our results indicate positive associations between the L&D interventions and change in offending and use of compulsory hospital detention. Whilst our research does not allow a direct causal relationship to be established in either area, the findings go beyond other impact assessments of L&D which have either been with small samples or relied only on qualitative data or expert opinion.


Assuntos
Criminosos/psicologia , Aplicação da Lei , Pessoas Mentalmente Doentes/psicologia , Polícia , Prisioneiros/psicologia , Adulto , Humanos , Estudos Longitudinais , Masculino , Transtornos Mentais/diagnóstico , Saúde Mental , Serviços de Saúde Mental , Transtornos Psicóticos , Medicina Estatal , Reino Unido
13.
Psiquiatr. biol. (Internet) ; 27(2): 68-70, mayo-ago. 2020.
Artigo em Espanhol | IBECS | ID: ibc-193249

RESUMO

OBJETIVO: El interés del caso es la documentación de las vicisitudes asistenciales de personas con TMG que se presentan con creencias religiosas inusuales (nuestra paciente era devota de Hare Krishna) y que además estén en una insólita situación de desaparición y necesidad de identificación policial. CASO CLÍNICO: Se trata de una mujer con diagnóstico de trastorno psicótico crónico, que fue ingresada en una Unidad de Hospitalización de Adultos de Psiquiatría por orden judicial. Transcurridas varias semanas de su ingreso, finalmente, fue identificada por la policía científica, donde constaba que se encontraba desaparecida desde hacía dos años en otra Comunidad Autónoma. RESULTADOS: Entre las personas sin hogar destaca una elevada prevalencia de trastorno mental, patología dual o ambos. En recientes estudios se encontraron las siguientes características sociodemográficas: mayor proporción de hombres, edad media, más sintomatología médica, bajo nivel de educación, mayor gravedad de síntomas psiquiátricos, con un deterioro funcional grave, periodos de más de 36 meses de estar sin hogar, y casi la mitad presentaban abuso de sustancias. Se encontró que el 78% de los pacientes tenían trastorno mental con psicosis. Además, en otro estudio, se objetivó que la mortalidad en mujeres indigentes de más de 45 años era más del doble de lo esperado. CONCLUSIONES: Sería conveniente mejorar las estructuras y procesos del trabajo comunitario, como se realiza en otros países de Europa, para poder atender a las personas sin hogar de una forma más adecuada, asegurando que reciben los servicios de salud que requieran


OBJECTIVE: The interest of this case is the documentation of the healthcare vicissitudes of people with Severe Mental Illness (SMI) who have unusual religious beliefs (our patient was a devotee of Hare Krishna), and who are also in an unusual situation of disappearance, and need of police identification. CLINICAL CASE: This is a woman diagnosed with chronic psychotic disorder, who was admitted to an Adult Psychiatric Ward by court order. After several weeks of admission, she was finally identified by the forensic police, stating that she had been missing for two years in another city. RESULTS: There is a high prevalence of mental disorder and/or dual disorder among the homeless. In recent studies the following sociodemographic characteristics were found: higher proportion of men, middle aged, more medical symptoms, low level of education, greater severity of psychiatric symptoms, with severe functional impairment, periods of more than 36 months of being homeless, and almost half had substance abuse. More than three-quarters (78%) of patients were found to have mental disorder with psychosis. Furthermore, in another study, it was found that mortality was more than double that expected in homeless women over 45 years old. CONCLUSIONS: It would be worthwhile to improve the structures and processes of community work, as has happened in other European countries, in order to be able to attend to the homeless in a more adequate way, ensuring that they receive the health services they deserve


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Transtornos Psicóticos/diagnóstico , Religião , Pessoas em Situação de Rua , Índice de Gravidade de Doença , Doença Crônica
15.
Lancet Psychiatry ; 7(9): 749-761, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32828165

RESUMO

BACKGROUND: Most individuals with schizophrenia-spectrum disorders have relapses, which increase the risk of morbidity and mortality. Because non-adherence to antipsychotic maintenance treatment could affect more than half of individuals with schizophrenia-spectrum disorders, psychosis relapse can often be confounded by unnoticed treatment interruption. Research of relapse during confirmed antipsychotic exposure has basic clinical and neurobiological implications, but data are scarce. We aimed to generate reliable estimates of incidence and predictors of relapse during assured antipsychotic treatment. METHODS: We did a systematic review and individual participant data (IPD) meta-analysis of clinical trials of long-acting injectable antipsychotics (LAIs) for psychosis relapse-prevention, following IPD-PRISMA guidelines. Datasets were identified by searching relevant repositories from inception to Aug 1, 2019. Each LAI group was reanalysed as a separate cohort, further identifying subcohorts of individuals with and without prospectively determined symptom remission (PSR). Summary incidence rate of relapse, incidence rate ratios (IRRs) of relapse between individuals with and without PSR, hazard ratios (HRs) of covariates on risk of relapse, and standardised mean difference (SMDs) in changes in overall functioning associated with relapse were generated by pooling results from the harmonised reanalysis of each study. This study is registered with PROSPERO, number CRD42019137439. FINDINGS: 19 treatment cohorts consisting of 5130 individuals (2938 with PSR, 2192 without PSR), with 3959·53 observed participant-years, were meta-analysed. Pooled incidence of relapse was 22·97 per 100 participant-years (14·76 per 100 participant-years for the PSR subcohort, 31·51 per 100 participant-years for the non-PSR subcohort), with an IRR of 0·19 (95% CI 0·07 to 0·54). Relapse was associated with functional decline (overall SMD -0·76, 95% CI -1·14 to -0·37; PSR SMD -0·52, 95% CI -0·80 to -0·21; non-PSR SMD -0·72, 95% CI -1·18 to -0·26). The strongest predictor of relapse was tardive dyskinesia at treatment onset (HR 2·39, 95% CI 1·05 to 5·42). INTERPRETATION: Despite the established efficacy of antipsychotics in preventing relapse, these data indicate that these drugs might not prevent subsequent exacerbations for a proportion of individuals whose illness is stabilised on continuous antipsychotic treatment. Tardive dyskinesia in particular might have pathophysiological implications for relapse. FUNDING: Northwell Health.


Assuntos
Antipsicóticos/administração & dosagem , Transtornos Psicóticos/prevenção & controle , Esquizofrenia/tratamento farmacológico , Ensaios Clínicos como Assunto , Preparações de Ação Retardada , Humanos , Injeções , Esquizofrenia/prevenção & controle , Prevenção Secundária
17.
S D Med ; 73(8): 346-349, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32809292

RESUMO

COVID-19 typically presents as severe pneumonia often requiring intubation and ICU management. Descriptions of the potential neurological symptoms in this disease state exist, but minimal research has been conducted on the prevalence of delirium. This case report describes a patient with no past psychiatric history who developed psychotic symptoms in the context of acute COVID-19 delirium. Clinicians should consider COVID-19 in their differential diagnosis with any patient who presents with psychotic symptoms, even in the absence of the typical COVID-19 symptoms of cough or fever. Rule out of COVID-19 via PCR should be completed on any new delirium case, and appropriate isolation of psychiatric patients should occur until negative results are obtained.


Assuntos
Infecções por Coronavirus/complicações , Delírio/virologia , Pneumonia Viral/complicações , Transtornos Psicóticos/virologia , Betacoronavirus , Infecções por Coronavirus/psicologia , Humanos , Pandemias , Pneumonia Viral/psicologia
18.
BMJ Case Rep ; 13(8)2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32784244

RESUMO

A 36-year-old previously healthy woman with no personal or family history of mental illness presented with new-onset psychosis after a diagnosis of symptomatic COVID-19. Her psychotic symptoms initially improved with antipsychotics and benzodiazepines and further improved with resolution of COVID-19 symptoms. This is the first case of COVID-19-associated psychosis in a patient with no personal or family history of a severe mood or psychotic disorder presenting with symptomatic COVID-19, highlighting the need for vigilant monitoring of neuropsychiatric symptoms in these individuals.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/psicologia , Pneumonia Viral/complicações , Pneumonia Viral/psicologia , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/psicologia , Adulto , Antipsicóticos/uso terapêutico , Diagnóstico Diferencial , Feminino , Humanos , Pandemias , Transtornos Psicóticos/tratamento farmacológico
19.
Artigo em Russo | MEDLINE | ID: mdl-32790981

RESUMO

OBJECTIVE: To verify a working hypothesis that thrombodynamic parameters of hypercoagulation and neuro-immune test correlate with the severity of catatonia in patients with autism spectrum disorder (ASD), and the combination of these indicators can predict the severity of catatonia with high accuracy and precision. MATERIAL AND METHODS: Twenty-four patients with ASD (22 boys and 2 girls) with infantile psychosis in childhood autism (ICD-10 F84.02) were studied. The median age of the patients was 5,5 years. Neuro-immune and thrombodynamics tests were performed. RESULTS AND CONCLUSION: Thrombodynamic parameters of clot growth rates from the activator (V, Vi and Vst) are significantly higher than their normal values. The values of the time of spontaneous clots occurrence (Tsp) are significantly less than the lower limit values for the norm (30 min). It was also shown that the activity of leukocyte elastase (LE) and the functional activity of the α1 protein inhibitor (α1-PI) are significantly higher than their normal values. The values of the levels of autoantibodies to S100 protein (aabS100B) and the basic myelin protein (aabOBM) are within the normal range. The initial clot growth rate (Vi) and the time of spontaneous clots occurrence (Tsp) significantly correlate with the severity of catatonia: Spearman's R is 0,55 for Vi (p=0,009) and -0,61for Tsp (p=0,002). Among the parameters of the neuro-immuno-test, only aabS100B indicator significantly correlates with the severity of catatonia. To increase the informative significance and accuracy of the contribution of the studied correlates of thrombodynamics and the neuro-immuno-test to the assessment of the severity of catatonia in children with ASD, a multivariate linear regression analysis was performed to construct a linear equation for the relationship between the severity of catatonia and correlates of thrombodynamics and a neuro-immuno-test. The determination coefficient R2, which determines the informational significance of the regression model, is 0,63. The remaining 37% is explained by unaccounted and not yet known factors.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Catatonia , Transtornos Psicóticos , Trombofilia , Criança , Pré-Escolar , Feminino , Humanos , Masculino
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