Autoimmune-related psychosis

2019 ◽  
pp. 161-168
Author(s):  
Belinda Lennox
Keyword(s):  
Rapid Detection ◽  
Psychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
Neuropsychiatric Disorder ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
Inpatient Psychiatry ◽  
Presenting Symptoms ◽  
First Descriptions

Autoimmune encephalitis is a neuropsychiatric disorder. While it is generally managed by neurologists, many of the presenting symptoms and most of the challenges in management are psychiatric. The description of psychiatric symptoms as part of the presenting symptoms of encephalitis dates back to the first descriptions of the disorder. The more recent discovery of autoimmune causes of encephalitis has particular relevance for psychiatry: there is significant overlap between the initial presentation of encephalitis with other core psychiatric disorders such as depression and psychosis. The particular challenge for inpatient psychiatry is to screen and detect these disorders early. The current evidence indicates that the rapid detection and delivery of immunotherapy, rather than the use of psychiatric treatments, is associated with better long-term outcomes for patients. Conversely, the risks of not detecting encephalitis are of long-term disability, or even death in a proportion of patients. This chapter describes the evolution in understanding of autoimmune encephalitis, the characteristics associated with particular antibodies, and the investigations and management of patients with autoimmune encephalitis from a psychiatric perspective.

scholarly journals Anti-NMDAR encephalitis for psychiatrists: the essentials

2021 ◽  
pp. 1-7
Author(s):  
Matthew Beattie ◽  
John Goodfellow ◽  
Maria Oto ◽  
Rajeev Krishnadas
Keyword(s):  
Psychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
Female Adolescents ◽  
Resonance Imaging ◽  
Long Term Outcomes ◽  
Optimal Care ◽  
Aspartate Receptor ◽  
Nmdar Encephalitis ◽  
Uncommon Condition

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis predominantly presents with psychiatric symptoms. Psychiatrists need to be alert to this diagnostic possibility, especially in female adolescents and young adults, as exemplified by the real (de-identified) case outlined below. Earlier diagnosis and immunotherapy improves long-term outcomes. Collaboration with neurology colleagues is essential for optimal care. ‘Red flags’ for autoimmune encephalitis and ‘diagnostic clues’ act as helpful aide memoires for this uncommon condition. The gold standard for testing is the detection of NMDAR antibodies in cerebrospinal fluid, but serum can be tested as a more accessible (but less reliable) preliminary step. The results of routine blood tests, magnetic resonance imaging of the head and electroencephalograms can be normal or show non-specific changes. Diagnostic criteria exist to define probable and definite cases. Immunotherapy for anti-NMDAR encephalitis is effective for many patients, but recovery is prolonged and relapses can occur.

scholarly journals Transorbital Endoscopic Surgery for Sphenoid Wing Meningioma: Long-Term Outcomes and Surgical Technique

2020 ◽  
Vol 81 (04) ◽  
pp. 357-368
Author(s):  
N. Goncalves ◽  
D.E. Lubbe
Keyword(s):  
Minimally Invasive ◽  
Endoscopic Surgery ◽  
Case Series ◽  
Surgical Approaches ◽  
Benign Tumors ◽  
Long Term Outcomes ◽  
Invasive Approach ◽  
Visual Outcomes ◽  
Presenting Symptoms

AbstractSphenoid wing meningiomas are benign tumors that can result in proptosis, visual impairment, and pain. Traditional open surgical approaches are associated with significant morbidity. Transorbital endoscopic surgery has been developed as a minimally invasive approach to gain access to these tumors and address the main presenting symptoms. Case series reporting transorbital endoscopic resection of sphenoid wing meningiomas using combined endonasal, pre-caruncular, and extended superior eyelid approaches have demonstrated stable and/or improved short- and medium-term visual outcomes. Earlier medial optic nerve decompression appears to result in more favorable long-term visual outcomes. Transorbital endoscopic surgery therefore represents an emerging minimally invasive alternative to deal with these challenging lesions.

scholarly journals Long-term consequences of acute kidney injury: a narrative review

2020 ◽  
Author(s):  
Joana Gameiro ◽  
Filipe Marques ◽  
José António Lopes
Keyword(s):  
Acute Kidney Injury ◽  
Patient Outcomes ◽  
Kidney Injury ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
Increased Risk ◽  
Follow Up Care ◽  
Risk Of Progression

Abstract The incidence of acute kidney injury (AKI) has increased in the past decades. AKI complicates up to 15% of hospitalizations and can reach up to 50–60% in critically ill patients. Besides the short-term impact of AKI in patient outcomes, several studies report the association between AKI and adverse long-term outcomes, such as recurrent AKI episodes in 25–30% of cases, hospital re-admissions in up to 40% of patients, an increased risk of cardiovascular events, an increased risk of progression of chronic kidney disease (CKD) after AKI and a significantly increased long-term mortality. Despite the long-term impact of AKI, there are neither established guidelines on the follow-up care of AKI patients, nor treatment strategies to reduce the incidence of sequelae after AKI. Only a minority of patients have been referred to nephrology post-discharge care, despite the evidence of improved outcomes associated with nephrology referral by addressing cardiovascular risk and risk of progression to CKD. Indeed, AKI survivors should have specialized nephrology follow-up to assess kidney function after AKI, perform medication reconciliation, educate patients on nephrotoxic avoidance and implement strategies to prevent CKD progression. The authors provide a comprehensive review of the transition from AKI to CKD, analyse the current evidence on the long-term outcomes of AKI and describe predisposing risk factors, highlight the importance of follow-up care in these patients and describe the current therapeutic strategies which are being investigated on their impact in improving patient outcomes.

Balloon Eustachian tuboplasty for Eustachian tube dysfunction: report of long-term outcomes in a UK population

2020 ◽  
Vol 134 (1) ◽  
pp. 34-40
Author(s):  
A E L McMurran ◽  
G E Hogg ◽  
S Gordon ◽  
P M Spielmann ◽  
S E Jones
Keyword(s):  
Eustachian Tube ◽  
Practical Experience ◽  
Eustachian Tube Dysfunction ◽  
Long Term Outcomes ◽  
Presenting Symptoms ◽  
Tube Dysfunction ◽  
One Year ◽  
The Uk ◽  
Balloon Eustachian Tuboplasty

AbstractBackgroundBalloon Eustachian tuboplasty is a surgical management option for Eustachian tube dysfunction; it has shown promising results in studies worldwide, but has had limited uptake in the UK. This study reports long-term outcomes for patients offered balloon Eustachian tuboplasty for chronic dilatory and baro-challenge-induced Eustachian tube dysfunction, and describes practical experience gained from its implementation.MethodsBalloon Eustachian tuboplasty was conducted in 25 patients (36 ears) with Eustachian tube dysfunction over three years. Information on presenting symptoms and signs, audiometric findings, tympanometry, and Eustachian Tube Dysfunction Questionnaire-7 scores were recorded pre- and post-operatively with a minimum follow up of one year.ResultsSixteen (64 per cent) of the 25 patients demonstrated symptom resolution after balloon Eustachian tuboplasty according to the Eustachian Tube Dysfunction Questionnaire-7. Fourteen (64 per cent) of the 22 patients with a type B or C tympanogram pre-operatively, had a type A trace post-operatively. Fifteen (75 per cent) of 20 patients with pre-operative conductive hearing loss showed improvement post-operatively, and 11 (50 per cent) of 22 patients with pre-operative middle-ear effusion or tympanic membrane retraction showed resolution.ConclusionBalloon Eustachian tuboplasty can improve subjective and objective measures of Eustachian tube dysfunction, and provide longer-term resolution.

Residual symptoms and long-term outcomes after all-cause autoimmune encephalitis in adults

2021 ◽  
pp. 120124
Author(s):  
Hesham Abboud ◽  
Farren Briggs ◽  
Robin Buerki ◽  
Mohamed Elkasaby ◽  
Guadalupe Fernandez BacaVaca ◽  
...  
Keyword(s):  
Autoimmune Encephalitis ◽  
Long Term Outcomes ◽  
Residual Symptoms

scholarly journals Current Status of Distal Embolization in Femoropopliteal Endovascular Interventions

2018 ◽  
Vol 52 (6) ◽  
pp. 440-447 ◽  
Author(s):  
Alessandro Cannavale ◽  
Mariangela Santoni ◽  
Marianna Gazzetti ◽  
Carlo Catalano ◽  
Fabrizio Fanelli
Keyword(s):  
Management Strategies ◽  
Major Amputation ◽  
Current Status ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
Distal Embolization ◽  
Endovascular Interventions ◽  
Atherosclerotic Lesions ◽  
Short And Long Term

The application of advanced endovascular techniques in very complex femoropopliteal atherosclerotic lesions has shown to expose patients to a higher risk of distal embolization (DE). This complication can affect both the short- and long-term outcomes, leading to worsening ischemia, early minor/major amputation, and longer hospital stay. Recently, there has been an increasing body of evidence on pathophysiology and clinical–radiological management of DE that however has not been systematically addressed by guidelines. The aim of this review was to analyze the current evidence outlining definition and classification, risk assessment, prevention, and management strategies of DE in femoropopliteal endovascular interventions.

Enhanced recovery after cardiac surgery and its impact on outcomes: A systematic review

Perfusion ◽  
2021 ◽  
pp. 026765912198895
Author(s):  
Yi Zhang ◽  
Jun Heng Chong ◽  
Amer Harky
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Enhanced Recovery ◽  
Controlled Trial ◽  
Postoperative Outcomes ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
Recent Emergence ◽  
Cardiac Society

Background and Aim: Enhanced Recovery After Surgery (ERAS) protocols are a series of perioperative interventions well-established in improving the care and outcomes of patients. With recent emergence of studies on its implementation in cardiac surgery, this paper represents the first systematic review on current evidence of ERAS efficacy in this field. Methods: Two reviewers independently searched through Pubmed, Cochrane, Google Scholar, Web of Science, Embase and Scopus. Comparative studies with controls that described the implementation of ERAS in all types of cardiac operations from 2001 to 2020 were included. Data extracted included patient demographics, components of ERAS protocol described, types of cardiac surgery, and postoperative outcomes. Results: In the final analysis, nine studies were included, of which there were one randomized controlled trial (RCT), one quasi-experiment and seven retrospective/prospective studies. Significant improvement in hospital and ICU length of stay, as well as reduction in postoperative opioid consumption were demonstrated. No increase in postoperative complications were reported. Conclusion: ERAS in cardiac surgery has shown to be potentially safe and effective in improving certain postoperative outcomes. However, the evidence is limited by the lack of high-quality RCTs. We also found the lack of practice of class 1 recommended interventions set forth by the ERAS Cardiac Society. Furthermore, majority of studies only evaluated the immediate postoperative outcomes of patients, and not the long-term outcomes. RCTs that fully implement measures recommended by the ERAS Cardiac Society, with assessments on both immediate and long-term outcomes, are warranted.

scholarly journals Medium- to long-term outcomes of botulinum toxin A for idiopathic overactive bladder

2016 ◽  
Vol 9 (1) ◽  
pp. 3-10 ◽  
Author(s):  
David Eldred-Evans ◽  
Arun Sahai
Keyword(s):  
Botulinum Toxin ◽  
Overactive Bladder ◽  
Botulinum Toxin A ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
High Quality ◽  
Toxin A ◽  
Multiple Treatment

Botulinum toxin A (BoNT-A) has become an important therapeutic tool in the management of refractory overactive bladder (OAB). Over the last decade, there have been growing numbers of patients receiving repeat injections and these outcomes have begun to be reported in large, high-quality cohorts. This article reviews the current evidence for the medium- to long-term use of BoNT-A in adults with idiopathic detrusor overactivity (IDO) receiving repeat injections. We find that medium-term outcomes are encouraging but long-term outcomes are not as extensively reported. There is high-quality evidence that efficacy following the first injection persists across multiple treatment cycles. There are no additional safety concerns from repeat injections up to six treatment cycles. However, there is a need for further data to confirm the efficacy and safety of BoNT-A beyond the follow-up period in the current literature.

Acute Postoperative Pain

2017 ◽  
Author(s):  
Kelly Zach ◽  
Julio A. Gonzalez-Sotomayor
Keyword(s):  
Postoperative Pain ◽  
Patient Characteristics ◽  
Current Evidence ◽  
Long Term Outcomes ◽  
Acute Postoperative Pain ◽  
Analgesic Regimen ◽  
Potential Benefits ◽  
Short And Long Term ◽  
Selection Of

Inadequate management of acute postoperative pain increases morbidity and mortality. Poorly controlled pain results in delayed hospital discharge and may lead to the development of chronic pain. Current evidence supports the implementation of a multimodal analgesic regimen, where different pharmacologic and nonpharmacologic interventions are used. The selection of the different components of this multimodal analgesic approach should consider their potential benefits and limitations, as well as the unique patient characteristics and the surgical procedure. It is the responsibility of the perioperative health care provider to formulate an optimal pain management strategy to ultimately enhance patient satisfaction and improve short- and long-term outcomes.

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