Muddying the waters? A false positive case of autoimmune psychosis

2020 ◽  
pp. 103985622096504
Author(s):  
Sarangan Ketheesan ◽  
Georgia Bertram ◽  
Robert Adam ◽  
Anne Stark ◽  
James G Scott
Keyword(s):  
Psychotic Disorders ◽  
Signs And Symptoms ◽  
Psychosocial Problems ◽  
Antibody Testing ◽  
Laboratory Findings ◽  
Antineuronal Antibodies ◽  
Neurological Signs ◽  
Iatrogenic Harm ◽  
Treatment Refractory ◽  
Autoimmune Psychosis

Objective: To discuss challenges with the diagnosis of autoimmune psychosis (AP) in people with chronic psychotic disorders. Method: We present a case of a 23-year-old man with an exacerbation of treatment-refractory psychosis after receiving intravenous immunoglobulin (IVIG) for suspected AP, diagnosed 4 years after the onset of psychosis. We highlight the diagnostic and management challenges in such cases. Results: The diagnosis of AP in people with long-standing illness relies on the interpretation of non-specific clinical and laboratory findings in individuals with psychosocial problems and challenges of acceptance and adherence to complex medical investigations and treatments. Equivocal results from investigations undertaken without logical clinical reasoning can lead to inappropriate interventions that are costly and can cause iatrogenic harm. Conclusion: Psychiatrists should restrict screening for antineuronal antibodies in people with chronic psychosis to those with higher risk features such as persistent treatment refractory symptoms with concurrent neurological signs and symptoms. Further research informing the clinical circumstances for antineuronal antibody testing is needed.

scholarly journals AB0702 PITFALLS IN THE DIAGNOSIS OF COVID-19 – EXPERIENCES FROM A RHEUMATOLOGY OUTPATIENT CLINIC

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1383.2-1383
Author(s):  
S. G. Werner ◽  
H. E. Langer ◽  
P. Höhenrieder ◽  
R. Chatelain
Keyword(s):  
Outpatient Clinic ◽  
Virus Disease ◽  
Disease Onset ◽  
Signs And Symptoms ◽  
Contact Tracing ◽  
Igg Antibodies ◽  
Antibody Testing ◽  
Antibody Titers ◽  
Rheumatology Outpatient

Background:PCR (Polymerase Chain Reaction) is generally considered the gold standard for confirming the diagnosis in the early stages of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection. However, in our rheumatology outpatient clinic we observed a significant discrepancy between clinical evidence of COVID-19 and PCR results.Objectives:Aim of this retrospective study was to analyze the significance of PCR and serologic tests in the diagnosis of COVID-19 (Corona Virus Disease 2019) in a cohort of patients with rheumatic diseases.Methods:Between March 2020 and January 2021, 35 patients with a history of established COVID-19 or typical signs and symptoms were identified on the occasion of a routine rheumatology follow-up examination in our institution. Previous diagnostic work-up in external facilities (results of PCR or antibody testing, imaging) was documented. Antibody ELISA-tests (IgG, IgA, IgM, Euroimmun) were performed in patients reporting typical signs and symptoms of COVID-19 in the past.Results:PCR diagnostics had been performed in 15/35 patients (43%), in 13/35 (39%) at the onset of the first symptoms, in 2 subjects only 2 months later. PCR was positive in 7/13 (54%) of those tested early, but negative in the two patients tested later. In 29/35 patients (83%) SARS-CoV-2-ELISA tests were performed on the occasion of the routine rheumatologic examination (interval between first symptoms and testing on average 98 days, median86, range 4-283 days). In two of the initially negative individuals the second PCR was positive. ELISA tests were positive in all patients. SARS-CoV-2 IgM antibodies were positive in only two patients (however 55 and 71 days after disease onset), n=8/29 (28%) IgG only, n=9/29 (31%) IgG and IgA, n=12/29 (41%) IgA only. In these subjects, IgG antibodies did not develop even in the further course. Antibody titers were in part very high, but in part also very low (only just above the normal value), so even low titers were diagnostic obviously. In all patients with negative PCR, ELISA was positive and retrospectively led to confirmation of the diagnosis. Only in 13/35 patients (37%) diagnosis had been made with the onset of the first symptoms or in the course of clinically manifest disease and had led to appropriate quarantine measures and contact tracing by the health authorities. In contrast, in the majority of patients (63%), the diagnosis of COVID-19 infection was only made retrospectively on the occasion of a routine rheumatologic follow-up. However, 5 of these 22 patients (23%) had quarantined themselves during the symptomatic phase. Titer histories were available from 12 patients. The titer became negative in 7 patients, after a mean of 188 days (median 202, min 51, max 296 days), and remained positive in 5 individuals (mean 190 days, median 191, min 122, max 260 days). The change of the titer was independent of disease severity or antirheumatic therapy.Conclusion:The results suggest that the importance of PCR in the diagnosis of COVID-19 may be overestimated. Therefore, antibody testing for SARS-CoV-2 should be performed in cases of clinical suspicion and negative PCR. In antibody diagnostics, special features were observed compared to other viruses, in particular, in some patients only low antibody titers or the absence of seroconversion with lack of development of IgG antibodies. Normalization of antibody titers in some patients supports the recommendation to vaccinate even after expired COVID-19 disease.Disclosure of Interests:None declared

scholarly journals Psychosis Without Meaning: Creating Modern Clinical Psychiatry, 1950 to 1980

2021 ◽  
Author(s):  
Joel T. Braslow
Keyword(s):  
Clinical Psychiatry ◽  
Life Histories ◽  
Psychotic Disorders ◽  
Clinical Care ◽  
Signs And Symptoms ◽  
Primary Treatment ◽  
Social Contexts ◽  
Clinical Practices ◽  
State Hospitals ◽  
1960S And 1970S

AbstractOver the last fifty years, American psychiatrists have embraced psychotropic drugs as their primary treatment intervention. This has especially been the case in their treatment of patients suffering from psychotic disorders such as schizophrenia. This focus has led to an increasing disregard for patients’ subjective lived-experiences, life histories, and social contexts. This transformation of American psychiatry occurred abruptly beginning in the late 1960s and 1970s. My essay looks the ways these major transformations played themselves out in everyday clinical practices of state hospital psychiatrists from 1950 to 1980. Using clinical case records from California state hospitals, I chronicle the ways institutional and ideological forces shaped the clinical care of patients with psychotic disorders. I show there was an abrupt rupture in the late 1960s, where psychiatrists’ concerns about the subjective and social were replaced by a clinical vision focused on a narrow set of drug-responsive signs and symptoms. Major political, economic, and ideological shifts occurred in American life and social policy that provided the context for this increasingly pharmacocentric clinical psychiatry, a clinical perspective that has largely blinded psychiatrists to their patients’ social and psychological suffering.

Deadly nightshade (Atropa belladonna) intoxication: an analysis of 49 children

2003 ◽  
Vol 22 (12) ◽  
pp. 665-668 ◽  
Author(s):  
Hüseyin Çaksen ◽  
Dursun Odabaş ◽  
Sinan Akbayram ◽  
Yaşar Cesur ◽  
Şükrü Arslan ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Signs And Symptoms ◽  
Atropa Belladonna ◽  
Laboratory Findings ◽  
Severe Intoxication ◽  
Symptoms And Signs

Deadly nightshade (Atropa belladonna) intoxication has been infrequently reported in both children and adults in the literature. In this article, the clinical and laboratory findings of 49 children with acute deadly nightshade intoxication are reviewed. Our purpose was to enlighten the findings of deadly nightshade intoxication in childhood. The most common observed symptoms and signs were meaningless speech, tachycardia, mydriasis, and flushing. None of the children required mechanical ventilation or died in our series. The patients were categorized into two groups, mild/moderate and severe intoxication. Children with and without encephalopathy were accepted as severe and mild/moderate intoxication, respectively. While 43 children were placed in the group of mild/moderate intoxication, six were in severe intoxication group. We found that meaningless speech, lethargy, and coma were more common, but tachycardia was less common in the severe intoxication group (children with encephalopathy) (P B-0.05). In the treatment, neostigmine was used in all children because of no available physostigmine in our country. In conclusion, our findings showed that the initial signs and symptoms of acute deadly nightshade intoxication might be severe in some children, but no permanent sequel and death were seen in children. We also showed that meaningless speech, lethargy, coma, and absence of tachycardia were ominous signs in deadly nightshade intoxication in childhood. Lastly, we suggest that neostigmine may be used in cases of deadly nightshade intoxication if physostigmine cannot be available.

General Practice Recruitment for People at Risk of Schizophrenia: The Buckingham Experience

2000 ◽  
Vol 34 (1_suppl) ◽  
pp. A131-A136 ◽  
Author(s):  
Ian R. H. Falloon
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Primary Care ◽  
At Risk ◽  
General Practice ◽  
Early Detection ◽  
Psychotic Disorders ◽  
Community Sample ◽  
Signs And Symptoms ◽  
Psychotic Episode

Objective The process of detecting people at high risk of schizophrenia from a community sample is a major challenge for prevention of psychotic disorders. The aim of this paper is to describe early detection procedures that can be implemented in primary care settings. Methods A selected literature review is supplemented by experiences and data obtained during the Buckingham Integrated Mental Health Care Project. Results General medical practitioners have been favoured as the agents most likely to prove helpful in detecting the key risk factors that predict the onset of schizophrenic disorders, as well as in recognising the earliest signs and symptoms of these conditions. However, the practical problems of screening for multiple and subtle risk factors in general practice are substantial, and general practitioners (GPs) often have difficulty recognising the earliest signs of a psychotic episode. A range of strategies to assist GPs detect early signs of psychosis in their patients are considered. Conclusions It is feasible to implement primary care setting early detection procedures for people at risk of schizophrenia. Implementation is aided by the use of a brief screening questionnaire, training sessions and case supervision; and increased collaboration with mental health services and other community agencies.

scholarly journals A patient distance metric for neurology

2020 ◽  
Author(s):  
Daniel B Hier ◽  
Jonathan Kopel ◽  
Steven U Brint ◽  
Donald C Wunsch II ◽  
Gayla R Olbricht ◽  
...  
Keyword(s):  
Nearest Neighbor ◽  
Signs And Symptoms ◽  
Diagnostic Error ◽  
K Nearest Neighbor ◽  
Bipartite Matching ◽  
Nearest Neighbor Classifier ◽  
Neurological Signs ◽  
Neurological Patients ◽  
Machine Readable ◽  
Neighbor Classifier

Abstract Objective: Neurologists lack a metric for measuring the distance between neurological patients. When neurological signs and symptoms are represented as neurological concepts from a hierarchical ontology and neurological patients are represented as sets of concepts, distances between patients can be represented as inter-set distances.Methods:We converted the neurological signs and symptoms from 721 published neurology cases into sets of concepts with corresponding machine-readable codes. We calculated inter-concept distances based a hierarchical ontology and we calculated inter-patient distances by semantic weighted bipartite matching. We evaluated the accuracy of a k-nearest neighbor classifier to allocate patients into 40 diagnostic classes.Results:Within a given diagnosis, mean patient distance differed by diagnosis, suggesting that across diagnoses there are differences in how similar patients are to other patients with the same diagnosis. The mean distance from one diagnosis to another diagnosis differed by diagnosis, suggesting that diagnoses differ in their proximity to other diagnoses. Utilizing a k-nearest neighbor classifier and inter-patient distances, the risk of misclassification differed by diagnosis.Conclusion:If signs and symptoms are converted to machine-readable codes and patients are represented as sets of these codes, patient distances can be computed as an inter-set distance. These patient distances given insights into how homogeneous patients are within a diagnosis (stereotypy), the distance between different diagnoses (proximity), and the risk of diagnosis misclassification (diagnostic error).

The incidence and clinical manifestations of human brucellosis in a referral hospital in Southern Saudi Arabia between 2015 and 2019

2021 ◽  
Author(s):  
Mutasim E. Ibrahim ◽  
Mohammad S. Al-Shahrani
Keyword(s):  
Saudi Arabia ◽  
Joint Pain ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Referral Hospital ◽  
Human Brucellosis ◽  
Local Health Authority ◽  
Local Health ◽  
Laboratory Findings ◽  
Body Ache

AbstractWe determined the incidence and clinical manifestations of human brucellosis from patients who attended a referral hospital in South of Saudi Arabia. A record-based retrospective study was conducted from January 2015 to December 2019 at King Abdulla Hospital, Bisha, Saudi Arabia. Information on patients’ demographic characteristics, detailed records of signs and symptoms, and the laboratory findings were reviewed. Of 6,586 patients included, 15.8% (n = 1,041) were infected with brucellosis. The age of infected individuals ranged from five to 95 years, with an average of 35.1 ± 21.2 years. Most infected patients were male (72.3%). Young adults (26–44 years) were the most common age group with the disease (34.1%). The annual rate of infection significantly decreased (P < 0.0001) from 33.2% in 2015 to 12.5% in 2019. An escalating number of brucellosis cases was seen in the spring and peaked during the summer. Fever (35.3%), joint pain (25.5%), generalized body ache (10.7%), and neurological symptoms (10.0%) were the most frequent clinical manifestation associated with brucellosis. Joint pain was commonly found among children (44.4%). Neurological findings were more frequent among adult patients. The study concluded that brucellosis is endemic in Southern Saudi Arabia and needs local health authority to implement preventive and educational program measures. Infected patients may present with diverse, nonspecific clinical manifestations that require intuition from clinicians to detect the disease.

Neurological Presentation of Severe Dengue in Children From a Colombian Hyperendemic Area

2020 ◽  
Author(s):  
Jaime E. Castellanos ◽  
Paula Esteban ◽  
Juanita Panqueba-Salgado ◽  
Daniela Benavides-del-Castillo ◽  
Valentina Pastrana ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Hypovolemic Shock ◽  
University Hospital ◽  
Severe Dengue ◽  
Laboratory Findings ◽  
Dengue Disease ◽  
Neurological Signs ◽  
Csf Analysis ◽  
Neurological Patients ◽  
The University

Abstract Objective: Dengue transmission is sustained in Colombia with increasing prevalence mainly in children. This work was aimed to describe a cases series of children diagnosed with dengue presenting neurological disease in the Huila province of Colombia. Eleven pediatric febrile patients confirmed to dengue disease and presenting neurological signs were studied in the University Hospital of Neiva, Huila province. Clinical and laboratory findings, CSF cytochemical analysis, neurology images, and serology and molecular studies were performed. Results. Viral RNA was detected in all patients’ sera by RT-PCR. Nine out of 11 were primary infections. Tonic-clonic seizures (73%), consciousness alterations (27%), irritability (27%) and ataxia (18%) were the most frequent neurological signs. None of the patients had plasma leakage, hypovolemic shock or liver disease, confirming the encephalitis diagnosis. Diagnostic images did not show abnormal findings neither bacterial or fungal infections were detected in CSF analysis. All patients survived without sequelae except in one patient that presented ataxia for months. In conclusion, we described a group of children with neurological signs during severe dengue disease as the main finding, indicating the importance of include dengue as a differential diagnosis in neurological patients from endemic areas.

scholarly journals Clinical, epidemiological, and laboratory characteristics of mild-to-moderate COVID-19 patients in Saudi Arabia: an observational cohort study

2020 ◽  
Vol 25 (1) ◽  
Author(s):  
Abbas Al Mutair ◽  
Saad Alhumaid ◽  
Waad N. Alhuqbani ◽  
Abdul Rehman Z. Zaidi ◽  
Safug Alkoraisi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Signs And Symptoms ◽  
C Reactive Protein ◽  
Laboratory Findings ◽  
Moderate Severity ◽  
Reactive Protein ◽  
X Ray Imaging ◽  
Collaborative Studies ◽  
Observational Cohort ◽  
Treatment Procedures

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) emerged from China in December 2019 and has presented as a substantial and serious threat to global health. We aimed to describe the clinical, epidemiological, and laboratory findings of patients in Saudi Arabia infected with SARS-CoV-2 to direct us in helping prevent and treat coronavirus disease 2019 (COVID-19) across Saudi Arabia and around the world. Materials and methods Clinical, epidemiological, laboratory, and radiological characteristics, treatment, and outcomes of pediatric and adult patients in five hospitals in Riyadh, Saudi Arabia, were surveyed in this study. Results 401 patients (mean age 38.16 ± 13.43 years) were identified to be SARS-CoV-2 positive and 80% of cases were male. 160 patients had moderate severity and 241 were mild in severity. The most common signs and symptoms at presentation were cough, fever, fatigue, and shortness of breath. Neutrophil and lymphocyte counts, aspartate aminotransferase, C-reactive protein, and ferritin were higher in the COVID-19 moderate severity patient group. Mild severity patients spent a shorter duration hospitalized and had slightly higher percentages of abnormal CT scans and X-ray imaging. Conclusions This study provides an understanding of the features of non-ICU COVID-19 patients in Saudi Arabia. Further national collaborative studies are needed to streamline screening and treatment procedures for COVID-19.

Suspected myelinolysis following rapid correction of hyponatremia in a dog

1999 ◽  
Vol 35 (6) ◽  
pp. 493-497 ◽  
Author(s):  
RK Churcher ◽  
AD Watson ◽  
A Eaton
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Neurological Dysfunction ◽  
Laboratory Findings ◽  
Neurological Signs ◽  
Therapeutic Guidelines ◽  
Chronic Hyponatremia ◽  
Iatrogenic Damage ◽  
Gastrointestinal Parasitism ◽  
Rapid Correction

A dog developed signs of neurological dysfunction five days after rapid correction of severe electrolyte derangements, including hyponatremia, caused by gastrointestinal parasitism (i.e., trichuriasis). History, laboratory findings, and onset of neurological signs following correction of hyponatremia led to a diagnosis of myelinolysis. Myelinolysis is a noninflammatory, demyelinating brain disease caused by sudden, upward osmotic shifts in central nervous system plasma, often a result of rapid correction of chronic hyponatremia. The pathogenesis is complex, but recovery is possible. Iatrogenic damage due to myelinolysis can be avoided by adherence to therapeutic guidelines for correction of chronic hyponatremia.

Somatic Treatments for Psychotic Disorders

2016 ◽  
Author(s):  
Justin C. Ellison ◽  
Jason B. Rosenstock ◽  
Michael J. Marcsisin
Keyword(s):  
Side Effects ◽  
Electroconvulsive Therapy ◽  
Gold Standard ◽  
Psychotic Disorders ◽  
Mood Stabilizers ◽  
Positive Symptoms ◽  
Second Generation Antipsychotics ◽  
Treatment Refractory ◽  
Long Acting ◽  
Somatic Therapies

A variety of somatic therapies can be used to treat individuals suffering from psychosis. Most commonly, providers will prescribe antipsychotics, which generally block dopamine receptors and are particularly useful at reducing positive symptoms. Second-generation antipsychotics have fewer movement side effects than older agents do, but they are more expensive and have more metabolic side effects. Long-acting injectable (LAI) antipsychotics can be useful for improving outcomes, especially in non-adherent patients, and clozapine is the gold standard for treatment-refractory psychosis. Other agents may be useful for adjunct therapy, or in early psychosis, such as antidepressants, mood stabilizers, and benzodiazepines. In this chapter, we will also review other somatic therapies such as electroconvulsive therapy (ECT) and other neuromodulation approaches.

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