scholarly journals Late Onset Bipolar Disorder due to a Lacunar State

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Elena Antelmi ◽  
Margherita Fabbri ◽  
Lucia Cretella ◽  
Maria Guarino ◽  
Andrea Stracciari
Keyword(s):  
Bipolar Disorder ◽  
Basal Ganglia ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Type Ii ◽  
Psychiatric Consultation ◽  
Limb Weakness ◽  
Recent Onset ◽  
New Onset

Objective.To describe a patient with a new onset bipolar disorder (BD) type II, secondary to a lacunar state.Background.Poststroke BD is rare and mainly associated with lesion in the prefrontal-striatal-thalamic circuit.Materials and Methods.A 51-year-old woman came to our attention for a mood disorder of recent onset. At 49, she had suffered acute left-sided limb weakness that improved spontaneously four days later. Arterial hypertension was subsequently diagnosed. After 6 months, she began to suffer from alternating brief periods of expansive and elevated mood with longer periods of depressed mood, with a suicide attempt. We performed extensive laboratory and instrumental investigations, as well as, psychiatric consultation, and a cognitive assessment, which was repeated 9 months later.Results.Brain magnetic resonance disclosed leukoaraiosis and a lacunar state of the basal ganglia. Transcranial Doppler showed a patent foramen ovale. A psychiatric consultation led to the diagnosis of BP type II. Neuropsychological evaluation detected deficits in attention/executive functions, verbal fluency, and memory. Nine months later, after specific psychiatric therapy, the psychiatric symptoms were remarkably improved.Conclusion.Our case sheds light on the role of the basal ganglia in mood disorders and the importance of ruling out brain injury in late onset BP.

scholarly journals On Neuropsychiatric Manifestations of Basal Ganglia Injury: A Report of Three Cases and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-11
Author(s):  
Heela Azizi ◽  
Alexander Kilpatrick ◽  
Olaniyi Olayinka ◽  
Olusegun Poopola ◽  
Maleeha Ahmad ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Clinical Evidence ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Psychotic Symptoms ◽  
Motor Processing ◽  
Neuropsychiatric Manifestations ◽  
Affective Disturbances ◽  
Visual Disturbances

The basal ganglia have been considered to primarily play a role in motor processing. A growing body of theoretical and clinical evidence shows that in addition to the motor functions the basal ganglia play a key role in perceptual and visual disturbances. This role may be evident in patients with basal ganglia pathology and subsequent manifestation of symptoms that include cognitive, perceptual, and affective disturbances. We present three cases with basal ganglia pathology that demonstrate affective and psychotic symptoms. Two of the cases presented with late onset psychotic disturbances suggesting likely neurological etiologies. The third case presented with treatment refractory psychosis and symptoms that are rare for a diagnosis of schizophrenia. The role of incidental bilateral basal ganglia calcifications in all the cases is discussed. A review of current literature highlighting various neuropsychiatric manifestations of basal ganglia pathologies in various patients with psychiatric symptoms is presented.

Late-onset schizophrenia

2020 ◽  
pp. 671-694
Author(s):  
Ellen E. Lee ◽  
Baichun Hou ◽  
Ipsit V. Vahia ◽  
Dilip V. Jeste
Keyword(s):  
Risk Factors ◽  
Differential Diagnosis ◽  
Life Events ◽  
Genetic Risk ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Sociodemographic Factors ◽  
Sensory Loss ◽  
Adverse Life Events

Late-onset schizophrenia remains an understudied subtype of schizophrenia, despite growing recognition of its impact and distinction from early-onset schizophrenia. This chapter reviews the existing literature on late-onset schizophrenia including beginning with the nomenclature and epidemiology. Then we provide a review of key risk factors and correlates—including genetic risk, sex differences, comorbid sensory loss and physical illness, cognitive and psychiatric symptoms, sociodemographic factors, adverse life events, neuropathology, and inflammation. The chapter ends with clinical issues, including symptoms, differential diagnosis, treatments, and prognosis. Recent studies have examined the role of oestrogen treatments and a new therapy for tardive dyskinesia therapy as well as inflammatory mechanisms in schizophrenia.

Late-onset bipolar disorder: What else?

2016 ◽  
Vol 33 (S1) ◽  
pp. S121-S121
Author(s):  
C.P. Ferreira ◽  
S. Alves ◽  
C. Oliveira ◽  
M.J. Avelino
Keyword(s):  
Elderly Patient ◽  
Bipolar Disorder ◽  
Treatment Guidelines ◽  
Late Onset ◽  
Mood Stabilizer ◽  
The Elderly ◽  
First Episode ◽  
Therapeutic Implications ◽  
Psychiatric Conditions ◽  
New Onset

IntroductionGeriatric-onset of a first-episode mania is a rare psychiatric condition, which may be caused by a heterogeneous group of non-psychiatric conditions. To confirm late-onset bipolar disorder (LOBD) diagnosis, secondary-mania causes should be ruled out.ObjectivesTo provide a comprehensive review reporting prevalence, features, differential diagnosis, comorbidity and treatment of LOBD.MethodsThe literature was systematically reviewed by online searching using PubMed®. The authors selected review papers with the words “Late-onset mania” and/or “Late-onset bipolar” in the title and/or abstract published in the last 10 years.Results and discussionWith population ageing, LOBD is becoming a more prevalent disorder. Clinical presentation may be atypical and confounding, making the diagnosis not always obvious. Several non-psychiatric conditions must be considered in an elderly patient presenting with new-onset mania, namely stroke, dementia, hyperthyroidism or infection causing delirium. Only then LOBD diagnosis may be done, making that an exclusion diagnosis. Comorbidities, such as hypertension or renal insufficiency are often present in the elderly and must be taken into account when choosing a mood stabilizer.ConclusionsLOBD remains a complex and relatively understudied disorder with important diagnostic and therapeutic implications. This diagnosis must be kept in mind for every elderly patient presenting with new-onset mania. Further investigations could contribute to a better understanding of LOBD etiopathogenesis and to set out better treatment guidelines.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The role of white matter damage in late onset bipolar disorder

Maturitas ◽  
2011 ◽  
Vol 70 (2) ◽  
pp. 160-163 ◽  
Author(s):  
Ariadna Besga ◽  
Monica Martinez-Cengotitabengoa ◽  
Itxaso González-Ortega ◽  
Miguel Gutierrez ◽  
Sara Barbeito ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
White Matter ◽  
Late Onset ◽  
White Matter Damage

Association Between HbA1c and Number of Episodes in Individuals with Bipolar Disorder

2017 ◽  
Vol 41 (S1) ◽  
pp. S115-S115
Author(s):  
F. Fellendorf
Keyword(s):  
Bipolar Disorder ◽  
Glucose Metabolism ◽  
Psychiatric Symptoms ◽  
Type Ii ◽  
Impaired Glucose Metabolism ◽  
Course Of Illness ◽  
Diabetes Mellitus Type Ii ◽  
Somatic Comorbidities ◽  
Competing Interest ◽  
Hba1c Levels

IntroductionBipolar disorder (BD) is associated with an impaired glucose metabolism (IGM) leading to diabetes mellitus Type II (DM). DM influences the medical state of BD individuals and leads to increased mortality. However, there is evidence that IGM is associated with psychiatric symptoms, as well.AimThe study aimed to investigate the association between IGM and number of episodes and their ratio in individuals with BD, separated for gender.MethodsHbA1c levels from fasting blood were measured of 162 individuals (46% females) with BD. Furthermore, clinical parameters e.g. number of depressive and (hypo)manic episodes were gathered.ResultsAfter adjustment for illness duration and BMI there was a positive correlation in male individuals between HbA1c and number of depressive (M = 13.86, SD = 14.67; r = .308, P < 0.05) as well as (hypo)manic episodes (M = 17.23, SD = 24.24; r = 0.263, P < 0.05). There was no association in females as well as between HbA1c levels and ratio of episodes.ConclusionAssociations between HbA1c and number of episodes in male individuals with BD were found. As there are correlations between IGM and somatic comorbidities as well as the course of illness the treatment of glucose metabolism is important in BD. However, number of episodes might have an impact on the glucose metabolism due to inflammation processes, but further investigations have to focus on the direction of the found correlation. As gender differences are known in different pathways, they should be considered in research, diagnosis and therapy.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

The role of vascular risk factors in late onset bipolar disorder

2007 ◽  
Vol 22 (8) ◽  
pp. 733-737 ◽  
Author(s):  
Hari Subramaniam ◽  
Michael S. Dennis ◽  
E. Jane Byrne
Keyword(s):  
Risk Factors ◽  
Bipolar Disorder ◽  
Late Onset ◽  
Vascular Risk Factors ◽  
Vascular Risk

scholarly journals Atypical presentation of late-onset Sandhoff disease : A case report

2021 ◽  
Vol 74 (11-12) ◽  
pp. 425-429
Author(s):  
András Salamon ◽  
László Szpisjak ◽  
Dénes Zádori ◽  
István Lénárt ◽  
Zoltán Maróti ◽  
...  
Keyword(s):  
Case Report ◽  
Lower Limb ◽  
Psychiatric Symptoms ◽  
Age Of Onset ◽  
Late Onset ◽  
Brain Mri ◽  
Residual Activity ◽  
Sandhoff Disease ◽  
Limb Weakness ◽  
Hexb Gene

Sandhoff disease is a rare type of hereditary (autosomal recessive) GM2-gangliosidosis, which is caused by mutation of the HEXB gene. Disruption of the β subunit of the hexosaminidase (Hex) enzyme affects the function of both the Hex-A and Hex-B isoforms. The severity and the age of onset of the disease (infantile or classic; juvenile; adult) depends on the residual activity of the enzyme. The late-onset form is characterized by diverse symptomatology, comprising motor neuron disease, ataxia, tremor, dystonia, psychiatric symptoms and neuropathy. A 36-year-old female patient has been presenting progressive, symmetrical lower limb weakness for 9 years. Detailed neurological examination revealed mild symmetrical weakness in the hip flexors without the involvement of other muscle groups. The patellar reflex was decreased on both sides. Laboratory tests showed no relevant alteration and routine electroencephalography and brain MRI were normal. Nerve conduction studies and electromyography revealed alterations corresponding to sensory neuropathy. Muscle biopsy demonstrated signs of mild neurogenic lesion. Her younger brother (32-year-old) was observed with similar symptoms. Detailed genetic study detected a known pathogenic missense mutation and a 15,088 base pair long known pathogenic deletion in the HEXB gene (NM_000521.4:c.1417G>A; NM_000521:c.-376-5836_669+1473del; double heterozygous state). Segregation analysis and hexosaminidase enzyme assay of the family further confirmed the diagnosis of late-onset Sandhoff disease. The purpose of this case report is to draw attention to the significance of late-onset Sandhoff disease amongst disorders presenting with proximal predominant symmetric lower limb muscle weakness in adulthood.

Clinical overlap between behavioral variant of frontotemporal dementia and bipolar disorder: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S335-S336 ◽  
Author(s):  
P. Oliveira ◽  
C. Roque ◽  
V. Santos ◽  
N. Madeira
Keyword(s):  
Bipolar Disorder ◽  
Frontotemporal Dementia ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Single Photon ◽  
Photon Emission ◽  
Interpersonal Behavior ◽  
Psychotic Symptoms ◽  
Emission Computed Tomography ◽  
Global Pattern

The behavioral variant of frontotemporal dementia (FTD) often begins with psychiatric symptoms, including changes in personal conduct and/or interpersonal behavior. Prior to developing cognitive impairment, differentiating FTD from primary psychiatric disorders might be challenging.This work presents a case of a manic episode with psychotic features in a 61-year-old man, whom personality changes and daily life difficulties arouse and persist after optimal management of the active manic and psychotic symptoms. Neuropsychological assessment detailed severe deficits among visuospatial and planning performances. Structural neuroimaging (CT-scan) primary revealed a global pattern of brain volume reduction. Severe perfusion deficits on frontal and both parietal lobes were shown on 99mTc-HMPAO single-photon emission computed tomography (SPECT). The hypothesis of probable FTD (behavioral variant) was established.The present case highlights how putative atypical and late-onset forms of bipolar disorder (BD) might instead progress to FTD. Several links are being advanced between the BD and FTD, for instance the close involvement of the C9ORF72 gene in a group of BD patients which progresses to dementia. These relations have actually been on focus recently. The field is however still relatively unexplored.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Acupuncture for the Treatment of Depression and Physical Symptoms in Chronic Bipolar Disorder: A Case Report

2020 ◽  
Vol 13 ◽  
pp. 117954762096737
Author(s):  
Yuto Matsuura ◽  
Yoshinori Watanabe ◽  
Hiroshi Taniguchi ◽  
Yoshihisa Koga ◽  
Fumiko Yasuno ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Case Report ◽  
Acupuncture Treatment ◽  
Psychiatric Symptoms ◽  
Physical Symptoms ◽  
Pharmacological Intervention ◽  
Therapeutic Effects ◽  
Type Ii ◽  
Self Rating ◽  
Mixed Features

Introduction: Bipolar disorder (BD) is typically treated by pharmacotherapy. However, pharmacotherapy alone is often not adequate to cope with the variety of symptoms associated with BD. The present case report describes the therapeutic effects of manual acupuncture on a patient with chronic BD, and multiple concurrent physical symptoms, that did not improve with standard pharmacotherapy. Case: A 41-year-old woman with type II BD presented with depression, anxiety, and multiple physical symptoms. Her symptoms had first appeared 12 years prior, and she was diagnosed with type II BD 3 years after symptom onset. Although she received standard treatment, including medication and psychotherapy, her symptoms did not improve. Acupuncture treatment aimed at improving psychiatric and physical symptoms was performed weekly for 12 weeks. Depression and anxiety symptoms were evaluated using the Himorogi Self-Rating Depression Scale (HSDS) and Himorogi Self-Rating Anxiety Scale (HSAS) respectively. A visual analog scale (VAS) was used to evaluate physical symptoms including diarrhea, insomnia, and general malaise. Outcome measures were evaluated before each treatment. Results: Throughout the course of the acupuncture intervention, no changes were made to the patient’s psychotropic medication regimen. HSDS and HSAS scores decreased after 12 weeks of acupuncture treatment and improvements in all physical symptoms, as measured by the VAS, were observed. Furthermore, psychiatric symptoms with hypomanic or mixed features were not exacerbated. Conclusions: In this patient, acupuncture was effective in improving psychiatric and physical symptoms of type II BD. This non-pharmacological intervention may be a viable option for the treatment of BD-associated symptoms.

scholarly journals Acute Psychosis Associated with Subcortical Stroke: Comparison between Basal Ganglia and Mid-Brain Lesions

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Aaron McMurtray ◽  
Ben Tseng ◽  
Natalie Diaz ◽  
Julia Chung ◽  
Bijal Mehta ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Psychiatric Symptoms ◽  
Symptomatic Relief ◽  
Acute Onset ◽  
Brain Lesions ◽  
Psychotic Symptoms ◽  
History Of ◽  
The Brain ◽  
Brain Ischemic Stroke ◽  
New Onset

Acute onset of psychosis in an older or elderly individual without history of previous psychiatric disorders should prompt a thorough workup for neurologic causes of psychiatric symptoms. This report compares and contrasts clinical features of new onset of psychotic symptoms between two patients, one with an acute basal ganglia hemorrhagic stroke and another with an acute mid-brain ischemic stroke. Delusions and hallucinations due to basal ganglia lesions are theorized to develop as a result of frontal lobe dysfunction causing impairment of reality checking pathways in the brain, while visual hallucinations due to mid-brain lesions are theorized to develop due to dysregulation of inhibitory control of the ponto-geniculate-occipital system. Psychotic symptoms occurring due to stroke demonstrate varied clinical characteristics that depend on the location of the stroke within the brain. Treatment with antipsychotic medications may provide symptomatic relief.

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