Management of inappropriate sexual behaviors in dementia: a literature review

2010 ◽  
Vol 22 (5) ◽  
pp. 683-692 ◽  
Author(s):  
Inese Tucker
Keyword(s):  
Sexual Behavior ◽  
Sexual Behaviors ◽  
Case Reports ◽  
Case Series ◽  
Pharmacological Agents ◽  
Inappropriate Sexual Behavior ◽  
Wide Range ◽  
Case Series Report ◽  
Sexual Disinhibition ◽  
Psychoactive Medications

ABSTRACTBackground: This paper reviews published literature on the pharmacological and non-pharmacological treatment of inappropriate sexual behavior in dementia.Methods: A literature search of Psychinfo and Cochrane databases was performed and data from case reports and case series were analyzed.Results: No randomized controlled trials exist for any treatment of sexual disinhibition in dementia and there are no trials comparing different pharmacological agents. Case reports and case series report a wide range of pharmacotherapies as efficacious in the treatment of inappropriate sexual behaviors in dementia. There is only one case report of non-pharmacological strategies to manage inappropriate sexual behavior.Conclusions: Inappropriate sexual behaviors in dementia can be difficult to treat. Frequently, multiple psychoactive medications are used and many pharmacotherapies are trialed prior to finding an effective agent. More research is needed to clarify the usefulness of these medications and to identify non-pharmacological strategies to prevent unnecessary use of medications.

Tools for managing feline problem behaviours: Psychoactive medications

2018 ◽  
Vol 20 (11) ◽  
pp. 1034-1045 ◽  
Author(s):  
Sagi Denenberg ◽  
Maya Bräm Dubé
Keyword(s):  
Environmental Changes ◽  
Case Reports ◽  
Case Series ◽  
Optimal Solution ◽  
Evidence Base ◽  
Negative Consequences ◽  
Expert Opinions ◽  
Problem Behaviours ◽  
The Face ◽  
Psychoactive Medications

Practical relevance: When a cat is presented for evaluation of a problem behaviour, it is likely that the cat’s wellbeing is negatively affected by the condition. In addition, the owners and any other animals around the cat may also be experiencing negative consequences. When managing these cases, it is important to consider all options (including behaviour modification, environmental changes, medications) that can help to reach an optimal solution. Medication cannot teach the cat how to behave or change a particular behaviour; it can, however, reduce arousal, excitability, reactivity and anxiety. Rationale: The rationale for using psychoactive medications in behavioural medicine, or veterinary psychiatry, is to increase the wellbeing of the animal and to aid the owner and practitioner in managing problem behaviours. Medications should always be used as an adjunct to behavioural and environmental modification. Clinical challenges: Many psychoactive medications cannot be used in the face of certain physical illnesses or concurrently with other medications. Some medications may also have side effects, not be effective at the recommended dose or have a paradoxical effect. Furthermore, success is reliant on the owner being able to administer the medication. Aims: This article aims to guide practitioners by discussing questions such as how to choose the appropriate medication, how to dose it and how long to use it. The psychoactive medications most commonly used in feline medicine are reviewed, as well as some that are newer or less common. Evidence base: Data for the use of medications in cats is limited, with just a small number of clinical-, species- and problem-directed studies available, and a few more case series and case reports. Where feline-specific research is not available, the authors have drawn upon research published in other species, such as humans, dogs and rats, as well as anecdotal reports and expert opinions.

scholarly journals A comprehensive review on clinical and mechanistic pathophysiological aspects of COVID-19 Malady: How far have we come?

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Baila Shakaib ◽  
Tanzeel Zohra ◽  
Aamer Ikram ◽  
Muhammad Bin Shakaib ◽  
Amna Ali ◽  
...  
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Signs And Symptoms ◽  
Organ Damage ◽  
Underlying Disease ◽  
The Body ◽  
Host Cells ◽  
Irreversible Damage ◽  
Organ Systems ◽  
Wide Range

AbstractSince its outbreak in 2019, the coronavirus disease (COVID-19) has become a pandemic, affecting more than 52 million people and causing more than 1 million mortalities globally till date. Current research reveals a wide array of disease manifestations and behaviors encompassing multiple organ systems in body and immense systemic inflammation, which have been summarized in this review. Data from a number of scientific reviews, research articles, case series, observational studies, and case reports were retrieved by utilizing online search engines such as Cochrane, PubMed, and Scopus from December 2019 to November 2020. The data for prevalence of signs and symptoms, underlying disease mechanisms and comorbidities were analyzed using SPSS version 25. This review will discuss a wide range of COVID-19 clinical presentations recorded till date, and the current understanding of both the underlying general as well as system specific pathophysiologic, and pathogenetic pathways. These include direct viral penetration into host cells through ACE2 receptors, induction of inflammosomes and immune response through viral proteins, and the initiation of system-wide inflammation and cytokine production. Moreover, peripheral organ damage and underlying comorbid diseases which can lead to short term and long term, reversible and irreversible damage to the body have also been studied. We concluded that underlying comorbidities and their pathological effects on the body contributed immensely and determine the resultant disease severity and mortality of the patients. Presently there is no drug approved for treatment of COVID-19, however multiple vaccines are now in use and research for more is underway.

Temporal Bone Fractures Caused by Ballistic Projectiles: A Systematic Review

2020 ◽  
pp. 019459982096879
Author(s):  
Kenneth L. Kennedy ◽  
Elizabeth Cash ◽  
Jessica Petrey ◽  
Jerry W. Lin
Keyword(s):  
Temporal Bone ◽  
Bone Fractures ◽  
Case Reports ◽  
Case Series ◽  
Gunshot Wounds ◽  
Individual Case ◽  
Future Research ◽  
Wide Range ◽  
Intracranial Complications

Objective Ballistic injuries to the temporal bone are uncommon but devastating injuries that damage critical neurovascular structures. This review describes outcomes after ballistic injuries to the temporal bone and offers initiatives for standardized high-quality future research. Data Sources A systematic search of PubMed, Embase, and Cochrane. Review Methods Studies in the review included adults who experienced temporal bone fractures due to gunshot wounds and survived longer than 48 hours. Individual case reports were excluded. The various searches returned 139 results, of which 6 met inclusion criteria. Results Most of the included studies are case series with low-level evidence that report a wide range of outcomes and follow-up. Outcomes include demographic patient information, audiologic outcomes, vascular injuries, intracranial complications, facial nerve function, and surgical indications. Conclusion This review is the first to characterize the nature and progression of patients who experienced gunshot wounds to the temporal bone. Although all patients share an etiology of injury, they often have vastly different hospital courses and outcomes. This review provides a basis for future studies to guide care for these injuries, as most of the existing literature includes small dated case series.

POSSIBILITIES OF PROTON THERAPY IN THE TREATMENT OF PEDIATRIC SKULL BASE CHORDOMAS: A CASE SERIES REPORT

2021 ◽  
Vol 100 (3) ◽  
pp. 272-279
Author(s):  
N.A. Vorobyov ◽  
◽  
N.I. Martynova ◽  
D.A. Antipin ◽  
K.F. Boiko ◽  
...  
Keyword(s):  
Proton Therapy ◽  
Malignant Tumors ◽  
Case Reports ◽  
Case Series ◽  
Photon Radiation ◽  
High Dose ◽  
Primary Bone Tumors ◽  
Case Series Report ◽  
High Doses ◽  
Skull Base Chordomas

Chordomas are rare malignant tumors that account for no more than 4% of primary bone tumors. The incidence of chordomas in children does not exceed 5%. Tumor removal is the primary method of treatment, however, due to the high frequency of non-radical surgery, most patients require an adjuvant course of radiotherapy. Photon radiation therapy in doses of 50–60 Gy does not provide the required antitumor effect. At the same time, the use of a proton beam allows delivering a dose of 72 Gy or more with low toxicity. The article presents 4 clinical case reports of base-skull chordoma in children describing their own experience with proton therapy. An analysis of radiation exposure plans was carried out, with an evaluation of the main qualitative indicators characterizing the high-dose coverage of tumours and the radiation load on healthy tissues. The case reports described confirm that the technique of proton irradiation with a pencil beam makes it possible to safely administer ultra-high doses of radiation in close proximity to healthy tissues, including in children. Further improvement of the irradiation planning technique is required, which will improve the target coverage with a high dose of ionizing radiation.

854 Sexsomnia in a Divorce Proceeding and its Custody Implications

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A332-A332
Author(s):  
Madhuri Uppalapati ◽  
Kingman Strohl ◽  
Robert Sibilia
Keyword(s):  
Sexual Behavior ◽  
Sleep Apnea ◽  
Sexual Behaviors ◽  
Slow Wave Sleep ◽  
Case Reports ◽  
Marital Separation ◽  
Obstructive Sleep ◽  
Biological Children ◽  
History Of

Abstract Introduction Sexsomnia is a NREM parasomnia under the subtype of Confusional Arousals, defined as abnormal sexual behaviors emerging from partial arousals during slow-wave sleep. Case reports suggest that is more common in men. Precipitating factors include Obstructive Sleep Apnea, insufficient sleep, alcohol and fatigue/stress and history of NREM parasomnias. Report of case(s) A 37-year-old male with bruxism (using mouth guard) and anxiety for 7 years, who presented to the sleep clinic for a second opinion to discuss concerns around the safety of his children due to his sleep related sexual behavior. Sexsomnia was first noted with the stressors related to becoming a parent (fostering children and having biological children). Sexual behavior reported by the couple was mostly provoked with spouse’s touch during sleep. Behaviors ranging from fondling to aggressive sexual intercourse were reported to occur 1 to 3 times/week. There were no injuries during episodes which only occurred in the bedroom with the spouse and the patient was amnestic of his behavior. Due to marital discord provoked by other stressors, he began to sleep alone in the basement. A video-polysomnogram revealed no parasomnia, sleep apnea, or other sleep arousal disorders. Normal REM with atonia was observed. The patient was treated with Duloxetine 20mg for anxiety after the initial sleep visit. His condition contributed to marital separation. In the divorce proceedings, the spouse argued for denial of visitation rights related to his sleep-sexual behaviors noting that the children may be at risk. After separation, his anxiety and stress levels lowered in conjunction with therapy and medication. Follow up after 2 months found the patient asymptomatic. He placed an alarm on his bedroom door, to alert him and others during sleep. There are no published reports to provide a prediction as to whether his condition would-be supporting restrictions in overnight visitation by the foster and biological children. Conclusion In this case, there was a precedent condition (bruxism) and precipitating stress and anxiety, known to provoke NREM parasomnia. The absence of polysomnographic evidence is not unusual. Forensic repercussions, in particular prospective calculations of risk, are poorly described in the literature. Support (if any):

scholarly journals Neurologic Features Associated With SARS-CoV-2 Infection in Children: A Case Series Report

2021 ◽  
pp. 088307382198916
Author(s):  
Francisca Sandoval ◽  
Katherine Julio ◽  
Gastón Méndez ◽  
Carolina Valderas ◽  
Alejandra C. Echeverría ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Case Series ◽  
Neurologic Manifestations ◽  
Retrospective Case ◽  
Neurologic Symptoms ◽  
Clinical Presentations ◽  
Wide Range ◽  
Neurophysiological Studies ◽  
Case Series Report ◽  
Series Report

Introduction: Although multiple neurologic manifestations associated with SARS-CoV-2 infection have been described in adults, there is little information about those presented in children. Here, we described neurologic manifestations associated with COVID-19 in the pediatric population. Methods: Retrospective case series report. We included patients younger than 18 years, admitted with confirmed SARS-CoV-2 infection and neurologic manifestations at our hospital in Santiago, Chile. Demographics, clinical presentations, laboratory results, radiologic and neurophysiological studies, treatment, and outcome features were described. Cases were described based on whether they presented with predominantly central or peripheral neurologic involvement. Results: Thirteen of 90 (14.4%) patients admitted with confirmed infection presented with new-onset neurologic symptoms and 4 patients showed epilepsy exacerbation. Neurologic manifestations ranged from mild (headache, muscle weakness, anosmia, ageusia), to severe (status epilepticus, Guillain-Barré syndrome, encephalopathy, demyelinating events). Conclusions: We found a wide range of neurologic manifestations in children with confirmed SARS-CoV-2 infection. In general, neurologic symptoms were resolved as the systemic presentation subsided. It is essential to recognize and report the main neurologic manifestations related to this new infectious disease in the pediatric population. More evidence is needed to establish the specific causality of nervous system involvement.

scholarly journals A Systematic Review of the Cardiovascular Manifestations and Outcomes in the Setting of Coronavirus-19 Disease

2020 ◽  
Author(s):  
Samarthkumar Thakkar ◽  
Shilpkumar Arora ◽  
Ashish Kumar ◽  
Rahul Jaswaney ◽  
Mohammed Faisaluddin ◽  
...  
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Case Series ◽  
Inclusion Criteria ◽  
Mortality And Morbidity ◽  
Future Studies ◽  
Treatment And Prevention ◽  
Wide Range ◽  
Myocardial Infection ◽  
The Impact

The impact of coronavirus disease, 2019 (COVID-19), has been profound. Though COVID-19 primarily affects the respiratory system, it has also been associated with a wide range of cardiovascular (CV) manifestations portending extremely poor prognosis. The principal hypothesis for CV involvement is through direct myocardial infection and systemic inflammation. We conducted a systematic review of the current literature to provide a foundation for understanding the CV manifestations and outcomes of COVID-19. PubMed and EMBASE databases were electronically searched from the inception of the databases through April 27th, 2020. A second literature review was conducted to include major trials and guidelines that were published after the initial search but before submission. The inclusion criteria for studies to be eligible were case reports, case series, and observation studies reporting CV outcomes among patients with COVID-19 infection. This review of the current COVID-19 disease and CV outcomes literature revealed a myriad of CV manifestations with potential avenues for treatment and prevention. Future studies are required to understand on a more mechanistic level the effect of COVID-19 on the myocardium and thus provide avenues to improve mortality and morbidity.

scholarly journals Unusual Complications Following Left Ventricular Assisted Device Implantation: Case Series

2020 ◽  
Author(s):  
Amjad Shalabi ◽  
Erez Kachel ◽  
Yigal Kassif ◽  
Muin Faqeeh ◽  
Sergey Preisman ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Male Patient ◽  
Late Onset ◽  
Case Series ◽  
Left Ventricular ◽  
Long Term Results ◽  
Pump Failure ◽  
Wide Range ◽  
Case Series Report ◽  
Transcatheter Valve

Abstract Background:While left ventricular assisted devices (LVAD) have revolutionized the treatment of advanced heart failure, they are associated with a wide range of complications, including bleeding and infection which are the most common complications reported in the literature. Our case series report four unusual complications not related to gastrointestinal bleeding and infections and their management.Case presentation: A sixty one year old female after LVAD implantation with late onset of severe symptomatic aortic regurgitation treated by transfemoral transcatheter valve implantation (TAVI) with good long term results. A Seventy-five year old male patient with acute pump failure secondary to cable damage, who underwent urgent pump replacement. A forty-nine year old female patient with a history of myoma who developed massive uterine bleeding which was treated with emergent open hysterectomy after failed gonadotropin-releasing hormone therapy replacement. A fifty-seven year old male patient with device display failure one month after LVAD implantation without the ability to monitor speed, power consumption and blood flow.Conclusions:The incidence of LVAD complications not related to gastrointestinal bleeding and infections is variable and generally unexpected. It is important to know these complications and their management.

scholarly journals Unusual complications following left ventricular assisted device implantation: case series

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Amjad Shalabi ◽  
Erez Kachel ◽  
Yigal Kassif ◽  
Muin Faqeeh ◽  
Preisman Sergey ◽  
...  
Keyword(s):  
Male Patient ◽  
Late Onset ◽  
Case Series ◽  
Left Ventricular ◽  
Long Term Results ◽  
Management Options ◽  
Pump Failure ◽  
Wide Range ◽  
Case Series Report ◽  
Transcatheter Valve

Abstract Background While left ventricular assisted devices (LVAD) have revolutionized the treatment of advanced heart failure, they are associated with a wide range of complications, including bleeding and infection which are the most common complications reported in the literature. Our case series report four unusual complications not related to gastrointestinal bleeding and infections and their management. Case presentation A 61 year old female after LVAD implantation with late onset of severe symptomatic aortic regurgitation treated by transfemoral transcatheter valve implantation (TAVI) with good long term results. A 75 year old male patient with acute pump failure secondary to cable damage, who underwent urgent pump replacement. A 49 year old female patient with a history of myoma who developed massive uterine bleeding which was treated with emergent open hysterectomy after failed gonadotropin-releasing hormone therapy replacement. A 57 year old male patient with device display failure 1 month after LVAD implantation without the ability to monitor speed, power consumption and blood flow. Conclusions LVAD patients can be presented with a great variety of complications. Physicians should be aware of their manifestations and the management options.

scholarly journals Pharmacological Therapy of Vascular Malformations of the Gastrointestinal Tract

2006 ◽  
Vol 20 (3) ◽  
pp. 171-178 ◽  
Author(s):  
Andrew Szilagyi ◽  
Maged P Ghali
Keyword(s):  
Gastrointestinal Tract ◽  
Vascular Malformations ◽  
Case Reports ◽  
Case Series ◽  
Pharmacological Therapy ◽  
Deficiency Anemia ◽  
Recurrent Bleeding ◽  
Somatostatin Analogue ◽  
Pharmacological Agents ◽  
Prospective Trials

Vascular malformation (AVM) in the gastrointestinal tract is an uncommon, but not rare, cause of bleeding and iron deficiency anemia, especially in an aging population. While endoscopic coagulative therapy is the method of choice for controlling bleeding, a substantial number of cases require additional therapy. Adjunctive or even primary phamacotherapy may be indicated in recurrent bleeding. However, there is little evidence-based proof of efficacy for any agent. The bulk of support is derived from anecdotal reports or case series. The present review compares the outcome of AVM after no intervention, coagulative therapy or focus on pharmacological agents. Most of the literature encompasses two common AVMs, angiodysplasia and hereditary hemorrhagic telangiectasia. Similarly, the bulk of information evaluates two therapies, hormones (estrogen and progesterone) and the somatostatin analogue octreotide. Of these, the former is the only therapy evaluated in randomized trials, and the results are conflicting without clear guidelines. The latter therapy has been reported only as case reports and case series without prospective trials. In addition, other anecdotally used medications are discussed.

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