Characterisation and outcome of neuropsychiatric symptoms in patients with anti-NMDAR encephalitis

2020 ◽  
Vol 32 (2) ◽  
pp. 92-98
Author(s):  
Miguel Restrepo-Martinez ◽  
Jesus Ramirez-Bermudez ◽  
Leo Bayliss ◽  
Mariana Espinola-Nadurille
Keyword(s):  
Rating Scale ◽  
Neuropsychiatric Symptoms ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Prospective Longitudinal Study ◽  
Aspartate Receptor ◽  
Immune Mediated ◽  
The Mean ◽  
Prospective Longitudinal ◽  
Receptor Antibodies

AbstractBackground:Encephalitis due to anti-N-methyl-D-aspartate receptor antibodies (ANMDARE) is the most frequent immune-mediated encephalitis. It is distinguished by the subacute onset of neuropsychiatric symptoms.Objective:To evaluate the characteristic neuropsychiatric symptoms and their outcome in patients diagnosed with ANMDARE.Methods:This was a prospective, longitudinal study in patients with a diagnostic suspicion of ANMDARE that presented to the National Institute of Neurology from March 2018 to February 2019. A comparative analysis of two groups (positive N-methyl-D-aspartate receptor [NMDAR] vs. negative NMDAR antibodies in cerebrospinal fluid [CSF]) was done on admission and at discharge. Neuropsychiatric systematic assessments included the Neuropsychiatric Inventory Questionnaire, the Bush Francis Catatonia Rating Scale, the Confusion Assessment Method Severity, the Montreal Cognitive Assessment, and the Overt Agitation Severity Scale.Results:24 individuals were analysed: 14 had positive NMDAR antibodies, and 10 had negative NMDAR antibodies in CSF. On admission, agitation/aggression, euphoria/exaltation, and disinhibition were more common in patients with positive antibodies. Excited catatonia and delirium were diagnosed more frequently in patients with positive antibodies. At discharge, there was an important decrease in neuropsychiatric symptoms, but substantial cognitive impairment remained. The mean hospitalisation length was 41.71 (SD 39.33) days for patients with definitive ANMDARE (p 0.259).Conclusions:Neuropsychiatric symptoms profile in ANMDARE was associated with the early onset of euphoria/exaltation and disinhibition, accompanied by marked psychomotor agitation. When ANMDARE was suspected, the presence of excited-type catatonia and delirium showed a tendency to predict definitive ANMDARE. At discharged, most patients recovered from catatonia, delirium, and psychosis, but marked cognitive symptoms, anxiety, and depression persisted at discharge.

Risk Factors and Incidence of Postoperative Delirium in Patients Undergoing Laryngectomy

2019 ◽  
Vol 161 (5) ◽  
pp. 807-813 ◽  
Author(s):  
Yiru Wang ◽  
Huiqian Yu ◽  
Hui Qiao ◽  
Chan Li ◽  
Kaizheng Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Delirium ◽  
Rating Scale ◽  
Multivariable Analysis ◽  
Diagnostic Algorithm ◽  
Target Population ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Factors Associated ◽  
The Mean

Objective To explore the risk factors and incidence of postoperative delirium (POD) in patients undergoing laryngectomy for laryngeal cancer. Study Design Prospective cohort study. Setting Shanghai Eye, Ear, Nose, and Throat Hospital, Fudan University. Subjects and Methods A total of 323 patients underwent laryngectomy from April 4, 2018, to December 28, 2018. Perioperative data were collected. The primary outcome was the presence of POD as defined by the Confusion Assessment Method diagnostic algorithm. Univariate and multivariable logistic regression analyses were used to identify risk factors associated with POD. Results Of the patients who underwent laryngectomy during the study period, 99.1% were male, with a mean age of 60.0 years. Of these patients, 28 developed POD, with most episodes (88.1%) occurring during the first 3 postoperative days. The type of POD was hyperactive in 7 cases and hypoactive in 21 cases. The mean duration of POD was 1 day. The mean Delirium Rating Scale-Revised-98 score (a measure of POD severity) was 11.5. For the multivariable analysis, risk factors associated with POD included advanced cancer stage, lower educational level, higher American Society of Anesthesiologists classification, and intraoperative hypotension lasting at least 30 minutes. Intraoperative dexmedetomidine use was protective against POD. Conclusion This study identified risk factors associated with POD, providing a target population for quality improvement initiatives. Furthermore, intraoperative dexmedetomidine use can reduce POD.

The effect of sickle cell anemia on the linear growth of Nigerian children

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Ugo Nnenna Chikani ◽  
Adaobi Bisi-Onyemaechi ◽  
Ijeoma Ohuche ◽  
Justus Onu ◽  
Shalewa Ugege ◽  
...  
Keyword(s):  
Sickle Cell ◽  
Linear Growth ◽  
Clinical Care ◽  
Growth Failure ◽  
Age At Diagnosis ◽  
Height Velocity ◽  
Prospective Longitudinal Study ◽  
High Prevalence ◽  
The Mean ◽  
Prospective Longitudinal

Abstract Objectives Despite the high prevalence of children with sickle cell anaemia (SCA) in West Africa, there is paucity of data on the height velocity and prevalence of growth failure in SCA patients. With advances in clinical care of SCA patients, could there be a spatial and secular trend in the growth pattern of these children? Hence, the compelling needs to embark on this study. The objectives of the study were to determine the prevalence of growth failure among patients with SCA and its correlation with age, gender and age at diagnosis. Methods A Prospective longitudinal study of a cohort of sickle cell anaemic paediatric patients from Pediatrics SCA Clinic, University of Nigeria Teaching Hospital, Ituku Ozalla. Patients were enrolled over a period of two years using a non-parametric convenient sampling method. Their heights were measured at baseline, three months, six months and at 12 months intervals and subsequently plotted on a standard WHO growth chart. The height velocities at different monthly intervals were calculated and compared with the WHO standard normal linear growth rates) for children (used as control) to identify those with GF. (i.e. <10th percentile). The main outcome measures were the mean height velocities at different months' intervals calculated and compared using the repeated measurement analysis of variance (ANOVA) and the Wilcoxon signed test. Results A cohort of 316 children aged 1–18 years with SCA was evaluated with a male preponderance of 161 (57.4%). The mean age and age at diagnosis were 11.04 ± 5.56 and 4.2 ± 1.7 years, respectively. The prevalence of growth failure and short stature was 84.7%. The burden of GF was highest among post-pubertal participants (94.1%). The most important predictor of growth velocity deficit was age (R2=0.045, standard β coefficient = −0.22, t=−03.51, p=0.001). Conclusions The study demonstrated high prevalence of growth failure in children and adolescents with SCA which intensified with advancement in age and older age at diagnosis.

scholarly journals A Five Year Longitudinal Study of the Educational Environment in a Newly Integrated Medical Curriculum

2019 ◽  
Vol 19 (4) ◽  
pp. 335
Author(s):  
Syed I. Shehnaz
Keyword(s):  
Longitudinal Study ◽  
United Arab Emirates ◽  
Medical Curriculum ◽  
Educational Environment ◽  
Traditional Curriculum ◽  
Prospective Longitudinal Study ◽  
Significant Difference ◽  
The Mean ◽  
Prospective Longitudinal ◽  
Course Of Study

Objectives: The College of Medicine at Gulf Medical University (GMU), Ajman, United Arab Emirates, was subjected to a curricular reform, which shifted the institution from a traditional curriculum to a hybrid, studentcentred, integrated curriculum. There are no previous studies analysing the consequences of such a curricular modification on the educational environment (EE). Therefore, this study aimed to analyse the EE of a pioneer cohort of the innovative curriculum over their five-year course of study. Methods: This prospective longitudinal study was conducted between September 2009 and September 2013 at the College of Medicine. The Dundee Ready Education Environment Measure questionnaire was completed by a pioneer cohort of students at the start of each academic session for five consecutive years. The mean overall, subscale and individual statement scores were evaluated using the Kruskal-Wallis and Wilcoxon-rank sum tests. Results: A total of 178 responses were collected (response rate: 90.4%). The mean overall score throughout the five years of study was 130/200. A significant difference in the scores (P <0.05) was observed as the students proceeded through the course. The overall and subscale scores were significantly higher in the first and final years of study. Analysis of the statements recognised the medical knowledge of the teachers’ and students’ awareness of empathy and social interactions as persistent strengths of the college over the entire course of study. A curricular overload, a want for support systems for stressed students, students’ waning interest levels and assessment strategies emerged as areas that warranted further attention. Conclusion: The pioneer cohort of the new curriculum rated their EE as positive throughout their five years of study at GMU. An examination of individual statements revealed the programme’s strengths and areas for improvement for the institution.Keywords: Curriculum; Environment; Longitudinal Study; Medical Students; Perception; Undergraduate Medical Education; United Arab Emirates.

Evaluation of point-of-care thumb-size bispectral electroencephalography device to quantify delirium severity and predict mortality

2021 ◽  
pp. 1-8
Author(s):  
Takehiko Yamanashi ◽  
Kaitlyn J. Crutchley ◽  
Nadia E. Wahba ◽  
Eleanor J. Sullivan ◽  
Katie R. Comp ◽  
...  
Keyword(s):  
Rating Scale ◽  
Point Of Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Negative Group ◽  
Positive Group ◽  
Prediction Of Mortality ◽  
Eeg Data ◽  
Poor Outcomes ◽  
Screening Scale

Background We have developed the bispectral electroencephalography (BSEEG) method for detection of delirium and prediction of poor outcomes. Aims To improve the BSEEG method by introducing a new EEG device. Method In a prospective cohort study, EEG data were obtained and BSEEG scores were calculated. BSEEG scores were filtered on the basis of standard deviation (s.d.) values to exclude signals with high noise. Both non-filtered and s.d.-filtered BSEEG scores were analysed. BSEEG scores were compared with the results of three delirium screening scales: the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU), the Delirium Rating Scale-Revised-98 (DRS) and the Delirium Observation Screening Scale (DOSS). Additionally, the 365-day mortalities and the length of stay (LOS) in the hospital were analysed. Results We enrolled 279 elderly participants and obtained 620 BSEEG recordings; 142 participants were categorised as BSEEG-positive, reflecting slower EEG activity. BSEEG scores were higher in the CAM-ICU-positive group than in the CAM-ICU-negative group. There were significant correlations between BSEEG scores and scores on the DRS and the DOSS. The mortality rate of the BSEEG-positive group was significantly higher than that of the BSEEG-negative group. The LOS of the BSEEG-positive group was longer compared with that of the BSEEG-negative group. BSEEG scores after s.d. filtering showed stronger correlations with delirium screening scores and more significant prediction of mortality. Conclusions We confirmed the usefulness of the BSEEG method for detection of delirium and of delirium severity, and prediction of patient outcomes with a new EEG device.

scholarly journals Patterns of bruising in preschool children—a longitudinal study

2015 ◽  
Vol 100 (5) ◽  
pp. 426-431 ◽  
Author(s):  
Alison M Kemp ◽  
Frank Dunstan ◽  
Diane Nuttall ◽  
M Hamilton ◽  
Peter Collins ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Preschool Children ◽  
Social Deprivation ◽  
Multilevel Modelling ◽  
Bleeding Disorders ◽  
Prospective Longitudinal Study ◽  
The Mean ◽  
Data Collections ◽  
Prospective Longitudinal ◽  
Over Time

IntroductionThis study aims to identify the prevalence and pattern of bruises in preschool children over time, and explore influential variablesMethodsProspective longitudinal study of children (<6 years) where bruises were recorded on a body chart, weekly for up to 12 weeks. The number and location of bruises were analysed according to development. Longitudinal analysis was performed using multilevel modelling.Results3523 bruises recorded from 2570 data collections from 328 children (mean age 19 months); 6.7% of 1010 collections from premobile children had at least one bruise (2.2% of babies who could not roll over and 9.8% in those who could), compared with 45.6% of 478 early mobile and 78.8% of 1082 walking child collections. The most common site affected in all groups was below the knees, followed by ‘facial T’ and head in premobile and early mobile. The ears, neck, buttocks, genitalia and hands were rarely bruised (<1% of all collections). None of gender, season or the level of social deprivation significantly influenced bruising patterns, although having a sibling increased the mean number of bruises. There was considerable variation in the number of bruises recorded between different children which increased with developmental stage and was greater than the variation between numbers of bruises in collections from the same child over time.ConclusionsThese data should help clinicians understand the patterns of ‘everyday bruising’ and recognise children who have an unusual numbers or distribution of bruises who may need assessment for physical abuse or bleeding disorders.

Psycho-Oncology in Portugal: It is Different from the Rest of the World?

2016 ◽  
Vol 33 (S1) ◽  
pp. S497-S497
Author(s):  
G. Da Ponte ◽  
M. Lobo ◽  
T. Neves ◽  
A. Paiva
Keyword(s):  
Psychiatric Disorders ◽  
Psychiatric Treatment ◽  
Geographic Location ◽  
District General Hospital ◽  
Prospective Longitudinal Study ◽  
The World ◽  
The Mean ◽  
Competing Interest ◽  
One Year ◽  
Prospective Longitudinal

IntroductionPsycho-Oncology (PO) is a specific psychiatric approach to cancer patients. The main psychiatric disorders observed are delirium and adjustment disorders (AD) and the most frequent treatments used are pharmacologic and psychotherapeutic.With regard to the type of cancer, the most frequent in Portugal are breast, digestive and prostate.ObjectiveAnalyze the activity of PO in a district general hospital in Portugal.AimsDemonstrate that the main core in PO is similar in the world.MethodsProspective longitudinal study, during one year.ResultsThe sample had 130 patients (369 evaluations), mainly male, with the mean age of 64.22 years. The most frequent psychiatric diagnoses were delirium (56 cases; 43%) and AD (44; 34%) and the main interventions used were pharmacologic and psycho-education. The most common frequent cancers were digestive (54; 42%), urologic (16; 12%) and breast (15; 11%). This high frequency of urologic cancer was interpreted as a consequence of the sample and its geographic location, but it was also a reflection of the large number of requests made by this specialty. The majority of cancers had an advanced stage (84% vs 16%) that can be explained by the sample but also by health culture in Portugal, which is reflected in the inpatient services: Oncology (51; 39%) and Palliative Care (25; 19%).ConclusionsThe type of psychiatric disorders and treatments offered in PO is preserved around the world. The authors propose to do more studies, namely if the relation with others specialties affects psychiatric treatment of the patient.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Efficacy and Tolerability of Aripiprazole Intramuscular as Maintenance Treatment in Patients with Paranoid Schizophrenia

2017 ◽  
Vol 41 (S1) ◽  
pp. S280-S280
Author(s):  
B. Serván ◽  
A. Montes ◽  
M. Machín ◽  
P. Gómez ◽  
J. García-Albea ◽  
...  
Keyword(s):  
Relapse Rate ◽  
Negative Symptoms ◽  
Rating Scale ◽  
Paranoid Schizophrenia ◽  
Tolerability Profile ◽  
Prospective Longitudinal Study ◽  
Therapeutic Adherence ◽  
Significant Difference ◽  
Previously Treated ◽  
Prospective Longitudinal

IntroductionPatients suffering from paranoid schizophrenia, require long-term anti-psychotic treatment, which provide, in addition to adequate efficacy both positive and negative symptoms, a good safety and tolerability profile that would ensure adequate adherence to prevent relapse.ObjectivesTo analyze the efficacy, tolerability and therapeutic adherence over a year after the introduction of aripiprazole depot in patients diagnosed with paranoid schizophrenia previously treated with other oral or depot anti-psychotics [1,2,3].MethodsOne-year prospective longitudinal study with a sample size of 23 patients diagnosed with schizophrenia in outpatient treatment. Study variables (baseline, 6 and 12 months): Brief Psychiatric Rating Scale (BPRS), clinical global impression (CGI), mean dose of aripiprazole depot, previous treatments, adherence, relapse rate, prolactin levels, sexual dysfunction, BMIs.ResultsTwenty-three patients (71% men, 29% women) diagnosed with paranoid schizophrenia were identified. Improvement was obtained in the different study variables with statistically significant difference (P ≤ 0.05).ConclusionsFollowing the introduction of aripiprazole depot in patients diagnosed with schizophrenia previously treated with other oral or depot anti-psychotics in our study, we conclude that maintaining therapeutic efficacy a better tolerability and safety profile, better therapeutic adherence and consequently lower relapse rate were achieved.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Delirium classification by the diagnostic and statistical manual – a moving target

2015 ◽  
Vol 27 (6) ◽  
pp. 881-882 ◽  
Author(s):  
Karin J. Neufeld
Keyword(s):  
Rating Scale ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Classification Systems ◽  
Diagnostic Systems ◽  
Delirium Assessment ◽  
Diagnostic And Statistical Manual ◽  
Dsm 5 ◽  
Medical Inpatients ◽  
Dsm Iv

The following paper, entitled “A Comparison of Delirium Diagnosis in Elderly Medical Inpatients using the CAM, DRS-R98, DSM-IV and DSM-5 Criteria” by Adamis and colleagues, reports the results of a single delirium assessment of 200 medical inpatients, aged 70 years and older. The aim was to compare the prevalence of delirium using two different diagnostic classification systems (DSM-5 and DSM-IV) and two commonly used research tools (Confusion Assessment Method and the Delirium Rating Scale-Revised ‘98). This editorial focuses on the comparison of the two versions of the DSM. The authors conclude that, while both diagnostic systems identify a core concept of delirium, the DSM-IV criteria are the most inclusive of the four approaches and the DSM-5, the most restrictive, identifying a prevalence of 19.5% and 13%, respectively in this sample. Furthermore, they conclude that these two systems do not appear to detect the same patients: only 14 of 26 (54%) individuals identified as delirious by the more exclusive DSM-5 criteria were also identified as such by DSM-IV.

scholarly journals The Diagnostic and Prognostic Value of Neurofilament Heavy Chain Levels in Immune-Mediated Optic Neuropathies

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Axel Petzold ◽  
Gordon T. Plant
Keyword(s):  
Optic Neuritis ◽  
Heavy Chain ◽  
Prognostic Value ◽  
Visual Outcome ◽  
High Serum ◽  
Healthy Controls ◽  
Prospective Longitudinal Study ◽  
Immune Mediated ◽  
Prospective Longitudinal ◽  
Diagnostic And Prognostic Value

Background. Loss of visual function differs between immune-mediated optic neuropathies and is related to axonal loss in the optic nerve. This study investigated the diagnostic and prognostic value of a biomarker for neurodegeneration, the neurofilament heavy chain (NfH) in three immune-mediated optic neuropathies.Methods. A prospective, longitudinal study including patients with optic neuritis due to multiple sclerosis (MSON,n=20), chronic relapsing inflammatory optic neuritis (CRION,n=19), neuromyelitis optica (NMO,n=9), and healthy controls (n=28). Serum NfH-SMI35 levels were quantified by ELISA.Findings. Serum NfH-SMI35 levels were highest in patients with NMO (mean0.79±1.51 ng/mL) compared to patients with CRION (0.13±0.16 ng/mL,P=0.007), MSON (0.09±0.09,P=0.008), and healthy controls (0.01±0.02 ng/mL,P=0.001). High serum NfH-SMI35 levels were related to poor visual outcome.Conclusions. Blood NfH-SMI35 levels are of moderate diagnostic and more important prognostic value in immune-mediated optic neuropathies. We speculate that longitudinal blood NfH levels may help to identify particular disabling events in relapsing conditions.

scholarly journals Prognostic factors and clinical outcome in a rare form of spastic paraplegia (Spoan syndrome): a 10-year follow-up

2019 ◽  
Author(s):  
Cláudia R. C. Galvão ◽  
Priscilla M. A. Cavalcante ◽  
Ricardo Olinda ◽  
Zodja Graciani ◽  
Mayana Zatz ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Clinical Outcome ◽  
Statistical Significance ◽  
Hand Function ◽  
Age At Onset ◽  
Spastic Paraplegia ◽  
Prospective Longitudinal Study ◽  
The Mean ◽  
Prospective Longitudinal

Abstract Background: Spastic paraplegia, optic atrophy and neuropathy (Spoan syndrome) is an autosomal recessive disease with approximately 70 cases recorded in Brazil and Egypt. Methods: This is a prospective longitudinal study performed with 47 patients affected with Spoan syndrome of seven communities of Rio Grande do Norte (Brazil) to investigate prognostic factors and clinical outcome based on comparative data obtained from a 10-year follow-up. Results: The mean age of the participants was 47.21±12.42 years old, and the mean ages at loss of ambulation and hand function were 10.78±5.55 and 33.58±17.47 years old, respectively. Spearman’s correlation analysis between the score on the Modified Barthel Index and the investigated variables evidenced statistical significance for age (p<0.001) and right- and left-hand grip strength (p=0.042 and p=0.021, respectively). Statistical significance was not evidenced for the remainder of the variables, including age at onset of symptoms (p=0.634), age at loss of ambulation (p=0.664) and age at loss of hand function (p=0.118). Conclusions: Our analysis allows asserting that the participants exhibited slight dependence until age 35. The greatest losses occurred from ages 35 to 41, and starting at 50, practically all patients become completely dependent. In fact, age is the main prognostic factor of impaired motor function among Spoan syndrome patients.

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