scholarly journals Parkinsonism in the psychiatric setting: an update on clinical differentiation and management

2020 ◽  
Vol 2 (1) ◽  
pp. e000034
Author(s):  
Alice Powell ◽  
Lara Gallur ◽  
Leslie Koopowitz ◽  
Michael William Hayes
Keyword(s):  
Drug Exposure ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Extensive Literature ◽  
Duration Of Treatment ◽  
Drug Induced ◽  
Psychiatric Setting ◽  
Psychiatric Conditions ◽  
Long Term Prognosis

Parkinsonism is seen frequently in patients with psychiatric conditions. Drug-induced parkinsonism (DIP) is the second most common cause of parkinsonism in the general population after Parkinson’s disease (PD) but a range of rarer aetiologies, some of them reversible, should also be considered in patients of all ages. DIP is more common in older patients, as are neurodegenerative diseases that may produce parkinsonism and it is relatively more likely that drug exposure could be unmasking an underlying process in this population. There is an extensive literature on differentiating DIP from PD but clinical features can be indistinguishable and many proposed investigations are not readily available. Aside from cessation of the responsible medication, there is no clear consensus on treatment strategies or duration of treatment. Practically, a delicate balance must be achieved between ameliorating parkinsonism and avoiding recurrent psychosis. Long-term prognosis in the setting of DIP remains unclear. We review the features that may differentiate DIP from other causes of parkinsonism in patients with psychiatric illness, provide an update on relevant investigations and discuss management strategies. The use of atypical antipsychotics for a broad range of indications highlights the ongoing relevance of DIP.

No-reflow in native coronaries and vein grafts: the role of drugs and distal protection

2018 ◽  
pp. 557-568
Author(s):  
Giovanni Luigi De Maria ◽  
Adrian Banning
Keyword(s):  
Treatment Strategies ◽  
Coronary Intervention ◽  
Vein Grafts ◽  
No Reflow ◽  
Percutaneous Coronary ◽  
Long Term Prognosis ◽  
Distal Protection ◽  
Successful Prevention

Restoration of normal coronary bloodflow and relieving myocardial ischaemia is the main goal of percutaneous coronary intervention (PCI). However, whilst reducing an epicardial coronary stenosis by balloon dilatation may appear to be a relatively easy task, subsequent detrimental changes in bloodflow can paradoxically result in reduced/impaired myocardial perfusion. This condition of mismatch between post-PCI epicardial coronary patency and impaired myocardial reperfusion is defined as slow-flow or no-reflow. It is typically caused by and related to the presence of a damaged, dysfunctional, and/or obstructed coronary microvasculature. When no-reflow occurs, it has an adverse effect on the subsequent mid- and long-term prognosis as it is associated with a higher risk of reinfarction, arrhythmias, heart failure, and a higher in-hospital and long-term cardiac mortality. Frustratingly, nearly four decades after the first PCI, there is still uncertainty about the pathophysiology of no-reflow and a need to define successful prevention and treatment strategies.

Treatment of medication-overuse headache: A systematic review

Cephalalgia ◽  
2015 ◽  
Vol 36 (4) ◽  
pp. 371-386 ◽  
Author(s):  
Chia-Chun Chiang ◽  
Todd J Schwedt ◽  
Shuu-Jiun Wang ◽  
David W Dodick
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Treatment Strategies ◽  
Preventive Treatment ◽  
Early Discontinuation ◽  
Level Of Evidence ◽  
Preventive Medication ◽  
Long Term Prognosis ◽  
Acute Headache

Introduction The objective of this review is to provide an evidence-based discussion of different treatment strategies for medication-overuse headache (MOH). Method We searched PubMed for articles discussing the treatment and prognosis of MOH published between 2004 and August 2014. Titles, abstract and articles were reviewed systematically. The level of evidence provided by each study of the included articles was determined according to the American Academy of Neurology Clinical practice guideline manual. We discuss the level of evidence to support the early discontinuation/withdrawal of overused medications, the level of evidence to support the use of preventive treatment, the short- and long-term prognosis, and the outcome according to the class of drug overused in patients diagnosed with MOH. Results The initial search resulted in 1313 articles; 68 articles met our inclusion criteria and were discussed. The level of evidence to support early discontinuation of overused medications alone is low due to the absence of controlled studies. Adding preventive medication to early discontinuation led to a better outcome than early discontinuation alone. For patients with chronic migraine (CM) and medication overuse (MO), there are large randomized control trials supporting the use of onabotulinumtoxinA and topiramate without early discontinuation of overuse; however, the evidence is limited since data were obtained from post hoc analysis. Conclusion Considering current available evidence and the systemic toxicity of overusing acute headache medication, we suggest discontinuation of the overused medication with the addition of preventive medication. Appropriately sized, randomized controlled trials evaluating the safety and long-term efficacy of preventive medication plus early discontinuation of overuse vs preventive medication alone vs early discontinuation of overuse alone are needed.

Central Neurocytoma

Neurosurgery ◽  
2012 ◽  
Vol 72 (3) ◽  
pp. 407-414 ◽  
Author(s):  
Jin Wook Kim ◽  
Dong Gyu Kim ◽  
In Kyeong Kim ◽  
Yong Hwy Kim ◽  
Seung Hong Choi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Clinical Outcomes ◽  
Functional Outcomes ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Central Neurocytoma ◽  
Tumor Control ◽  
Seizure Outcome

Abstract BACKGROUND: A thorough investigation of the long-term outcomes of central neurocytoma (CN) after different treatments is required to establish optimal management strategies. OBJECTIVE We retrospectively reviewed the long-term clinical outcomes of patients with CN according to various treatments and suggest treatment strategies based on 30 years of experience in a single institution. METHODS: Fifty-eight consecutive patients with CN were treated at our institution between 1982 and 2008. Patient demographics, overall survival, local control rates according to multimodal treatments, and functional outcomes were evaluated. The mean clinical and radiological follow-up periods were 119 months (range, 18-304 months) and 98 months (range, 13-245 months), respectively. RESULTS: The initial treatment modality was classified into 4 subgroups: operation only (34 patients), operation followed by radiation therapy (7 patients) or radiosurgery (7 patients), and radiosurgery alone (10 patients). The actuarial overall survival was 91% at 5 years and 88% at 10 years. The actuarial overall survival and local tumor control rate did not differ significantly according to the various treatments and the initial extent of the surgical resection. However, functional outcomes, such as the postoperative seizure outcome at the last follow-up, differed according to the surgical approach. CONCLUSION: The long-term clinical outcomes of CN after multimodal treatment seem to be excellent. Our study suggests that treatment strategies for CN should focus on the patient's quality of life, as well as on tumor control, because of the benign nature of CN.

scholarly journals Current Clinical Concepts: Clinical Management of Patellar Tendinopathy

2021 ◽  
Author(s):  
Adam B. Rosen ◽  
Elizabeth Wellsandt ◽  
Mike Nicola ◽  
Matthew A. Tao
Keyword(s):  
Effective Treatment ◽  
Clinical Management ◽  
Management Strategies ◽  
Treatment Strategies ◽  
Patellar Tendinopathy ◽  
Load Management ◽  
Evidence Based ◽  
Effective Treatment Option ◽  
Treatment Interventions

ABSTRACT Patellar tendinopathy is a common, yet misunderstood pathoetiology afflicting a variety of patient populations. This lack of unified understanding affects the capability of clinicians to provide effective treatment interventions. Patients with tendinopathy often report long-term and low to moderate levels of pain, diminished flexibility, and strength, as well as decreased physical function. Load-management strategies combined with exercise regimens focused on progressive tendon loading are the most effective treatment option for patients with patellar tendinopathy. This review will provide an evidence-based approach to patellar tendinopathy, including its pathoetiology, evaluation, and treatment strategies.

The Identification and Management of Malingering in Clinical Settings

2020 ◽  
Author(s):  
Lauren Dent ◽  
Scott Simpson
Keyword(s):  
Psychological Symptoms ◽  
Neuropsychological Testing ◽  
Clinical Settings ◽  
Factitious Disorder ◽  
Financial Gain ◽  
Adaptive Choice ◽  
Psychiatric Conditions ◽  
Long Term Prognosis ◽  
External Incentives

Malingering is the “intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives.” Malingering is difficult to identify and a challenge for physicians to manage. There are innumerable incentives for malingering, including financial gain, housing, and controlled substances. Although there is no definitive way to identify malingering, clues that suggest malingering include inconsistencies in history and exam, discrepancies among collateral informants, and the results of neuropsychological testing. By recognizing how malingering may be a rational, adaptive choice for patients to address their needs, psychiatrists can preserve the doctor-patient relationship and build an alliance to achieve the patient’s goals in a more productive manner. Pitfalls for clinicians treating malingering patients include burnout, aversive countertransference reactions, and inadequate treatment of comorbid medical or psychiatric conditions. Psychiatrists must also be attentive to appropriate documentation and personal safety. The long-term prognosis of malingering patients is not well understood. This review contains 5 figures, 7 tables, and 95 references. Key words: malingering, external incentive, forensic psychiatry, factitious disorder, antisocial personality disorder, countertransference, confrontation 

Long-term prognosis of asymptomatic individuals with spontaneous or drug-induced type 1 electrocardiographic phenotype of Brugada syndrome

2011 ◽  
Vol 44 (3) ◽  
pp. 346-349 ◽  
Author(s):  
Konstantinos P. Letsas ◽  
Reinhold Weber ◽  
Michael Efremidis ◽  
Panagiotis Korantzopoulos ◽  
Klaus Astheimer ◽  
...  
Keyword(s):  
Brugada Syndrome ◽  
Drug Induced ◽  
Long Term Prognosis ◽  
Asymptomatic Individuals

Severe cutaneous presentation of hydralazine-induced ANCA vasculitis without renal or pulmonary involvement, complicated by DIC

2021 ◽  
Vol 14 (5) ◽  
pp. e238609
Author(s):  
Mae Xintong Huo ◽  
Alzira Rocheteau M Avelino ◽  
Gurpreet Singh
Keyword(s):  
Intensive Therapy ◽  
Antineutrophil Cytoplasmic Antibody ◽  
Pulmonary Involvement ◽  
High Dose ◽  
Diagnostic Challenge ◽  
Drug Induced ◽  
Mucosal Involvement ◽  
Ulcerative Lesions ◽  
Long Term Prognosis

Hydralazine is a common arterial vasodilator used in the management of congestive heart failure and hypertension. It can be associated with drug-induced lupus and less commonly antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). Drug-induced AAV typically has a favourable long-term prognosis. It is not commonly associated with primary skin involvement, as most cases also have notable kidney and lung disease. Cases with isolated skin findings are rare. We present a rare case of a 60-year-old woman on long-term hydralazine who presented with AAV with primary skin and mucosal involvement, in the form of diffuse bullous and ulcerative lesions, which posed a diagnostic challenge. Her hospital course was marked by several complications including disseminated intravascular coagulation. She required intensive therapy with high-dose steroids, plasmapheresis and rituximab. She tolerated immunosuppression well and with multidisciplinary supportive care, she recovered well and was able to be discharged from the hospital.

Treatment strategies for encephalopathy related to status epilepticus during slow sleep, a narrative review of the literature

2020 ◽  
Vol 31 (7) ◽  
pp. 793-802
Author(s):  
Ke Zhang ◽  
Yu Yan ◽  
Tangfeng Su
Keyword(s):  
Status Epilepticus ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Epileptic Activity ◽  
Neurodevelopmental Deficits ◽  
Slow Sleep ◽  
Long Term Prognosis ◽  
Insight Into ◽  
Review Current

AbstractEncephalopathy related to Status Epilepticus during slow Sleep (ESES) is an age-dependent syndrome characterized by the appearance of neuropsychological and behavioral disorders associated with extreme activation of epileptic activity during sleep. The major goal of therapy in ESES is to prevent neuropsychological deficits. Effective therapy to reduce seizures and resolve the EEG pattern of status epilepticus during sleep (SES) may be crucial to improve long-term prognosis. However, whether to improve neurodevelopmental deficits by suppressing or eliminating SES remains unknown. The purpose of this article is to review current therapeutic options in ESES, in order to provide better alternatives. Treatment options consist of antiepileptic drugs, steroids, immunoglobulins, the ketogenic diet, and surgery. Maybe therapy targeted mechanisms can be developed with deep insight into the etiology of ESES.

scholarly journals Peripartum cardiomyopathy

2011 ◽  
Vol 2 (3) ◽  
pp. 161
Author(s):  
Rodolfo Citro ◽  
Roberta Giudice ◽  
Marco Mirra ◽  
Rosa Paolillo ◽  
Chiara Paolillo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Systolic Dysfunction ◽  
Treatment Strategies ◽  
Current Treatment ◽  
Peripartum Cardiomyopathy ◽  
Multicenter Trials ◽  
Autoimmune Processes ◽  
Long Term Prognosis

Peripartum cardiomyopathy is an uncommon form of congestive heart failure associated with systolic dysfunction of left ventricle. The onset is characterised by symptoms of heart failure occurring between the last month of pregnancy and 5-6 months postpartum. The early diagnosis and the institution of medical treatment for this disease are essential because the inadequate management may affect the patient’s long-term prognosis and can lead to severe complications, including death.Currently its aetiology is not completely understood. Many aetiopathogenetic hypotheses have been formulated: inflammation, viral agents, autoimmune processes. In the last years, evidences aroused for a role of prolactin and its 16 kDa metabolite in reducing cardiomyocite metabolic activity and contraction. In this article we have reviewed the current literature with special emphasis on the role of prolactin and the related current treatment strategies. In particular, bromocriptine appears promising, even if women need to be informed that the drug stops the production of breastmilk. Further researchers, such as large multicenter trials, are needed to decide the best treatment for the women suffering of this disease.

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