scholarly journals Agitation and apathy increase risk of dementia in psychiatric inpatients with late-onset psychiatric symptoms

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yuan Shao ◽  
Haiyun Xu ◽  
Jian Wang ◽  
Xijian Dai ◽  
Wei Liang ◽  
...  
Keyword(s):  
Motor Behavior ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Neuropsychiatric Symptoms ◽  
Psychiatric Inpatients ◽  
First Episode ◽  
Psychiatric Ward ◽  
Initial Symptom ◽  
Middle Aged ◽  
Increased Risk

Abstract Background A diagnosis of dementia in middle-aged and elder people is often complicated by physical frailty and comorbid neuropsychiatric symptoms (NPSs). Previous studies have identified NPSs as a risk factor for dementia. The aim of this study was to figure out to what extent individual NPS and certain demographic factors increased the risk of dementia in middle-aged and senior psychiatric inpatients. Methods One hundred twenty-seven middle-aged and senior patients admitted to psychiatric wards for late-onset (age ≥ 50 years) psychiatric symptoms were included and categorized into dementia or non-demented psychiatric disorders (NDPD). The patients’ demographic information and medical records were collected during the first hospitalization and subjected to statistical analyses. Results 41.73% of the registered psychiatric inpatients were diagnosed as dementia in which Alzheimer’s disease (AD) was the dominant subtype. The NDPD group consisted of nine individual diagnoses, except for schizophrenia. The frequencies of dementia inpatients increased with first episode age while that of NDPD inpatients decreased with first episode age. In the enrolled inpatients, most of dementia patients were males while females accounted for a higher proportion of NDPD patients. 58.49% of enrolled dementia inpatients presented cognitive deficit (CD) as the initial symptom while the remaining 41.51% showed NPS as initial symptom. Of the 12 NPSs, agitation and apathy greatly and significantly increased risk of dementia in psychiatric inpatients with late-onset psychiatric symptoms. Conclusions These results added evidence that the demented patients admitted to psychiatric ward are more likely to be male, older first episode age, and have characteristic NPS including aberrant motor behavior (AMB), hallucinations, agitation, irritability and apathy. Further, this study emphasized the importance of agitation and apathy of NPSs functioning as risk factors of dementia in these inpatients.

Subtle neuropsychiatric symptoms of glioblastoma multiforme misdiagnosed as depression

2020 ◽  
Vol 13 (3) ◽  
pp. e233208
Author(s):  
Raphael Jerome Leo ◽  
Jill N Frodey ◽  
Matthew L Ruggieri
Keyword(s):  
Glioblastoma Multiforme ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Neuropsychiatric Symptoms ◽  
Diagnostic Assessment ◽  
Atypical Symptoms ◽  
Presenting Symptoms ◽  
Primary Brain Tumours ◽  
Psychiatric Disturbances

Glioblastoma multiforme (GBM) is the most common of the aggressive primary brain tumours arising in adults and has a dire prognosis. Neuropsychiatric symptoms can vary significantly among afflicted persons; psychiatric disturbances may be the predominant presenting symptoms. Distinguishing between functional psychiatric disorders, particularly depression, from other subtle neuropsychiatric disturbances that may accompany GBM can be challenging. The authors present a clinical case and review of the literature in an attempt to highlight the special considerations that should be taken into account when evaluating patients who present with late-onset or atypical symptoms, refractory psychiatric symptoms, or subtle neurological disturbances signalling the need for diagnostic assessment, particularly neuroimaging, for the presence of a tumour. Early diagnosis is critical for improvement in quality of life.

scholarly journals A Case of Lung Cancer with Brain Metastasis following Late-Onset Bipolar Disorder

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Shin-Heng Shen ◽  
Shwu-Hua Lee
Keyword(s):  
Lung Cancer ◽  
Bipolar Disorder ◽  
Brain Metastasis ◽  
Late Onset ◽  
Brain Magnetic Resonance Imaging ◽  
Mood Stabilizers ◽  
Mental Condition ◽  
Whole Body ◽  
First Episode ◽  
Psychiatric Ward

Objective. To describe a case of lung cancer with brain metastasis in a patient who developed new late-onset bipolar disorder 2 years previously. Background. The typical onset age of bipolar disorder is approximately 20, and the first episode is usually a depressive episode. It is still not clear which age-specific factors contribute to the underlying risk. Materials and Methods. A 65-year-old male patient presented with a new-onset manic episode characterized by labile mood, impulsivity, decreased need for sleep, and grandiosity. He was diagnosed with late-onset bipolar disorder after excluding other possible physiological conditions. He was hospitalized in the acute psychiatric ward, and a combination of mood stabilizers and antipsychotics was prescribed. His mental condition improved, and he remained stable for 2 years. However, he experienced abrupt cognitive decline for 2 months and was referred to the emergency room for physiological examination. Results. The patient was diagnosed with lung cancer with brain metastasis by brain magnetic resonance imaging and whole-body positron emission tomography. Conclusion. In geriatric patients, who are at high risk of multiple medical conditions, excluding secondary causes of bipolar disorder is important.

Increased Risk for Dementia in Elderly Psychiatric Inpatients with Late-Onset Major Depression

2000 ◽  
Vol 188 (4) ◽  
pp. 242-243 ◽  
Author(s):  
Gil Zalsman ◽  
Dov Aizenberg ◽  
Mayanit Sigler ◽  
Eitan Nahshony ◽  
Leon Karp ◽  
...  
Keyword(s):  
Major Depression ◽  
Late Onset ◽  
Psychiatric Inpatients ◽  
Increased Risk

Post-Thrombotic Syndrome and Quality-of-Life after Venous Thromboembolism in Young and Middle-Aged Women

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2309-2309 ◽  
Author(s):  
Maria Ljungqvist ◽  
Margareta Holmstrom ◽  
Helle Kieler ◽  
Gerd Larfars
Keyword(s):  
Quality Of Life ◽  
Venous Thromboembolism ◽  
First Episode ◽  
Common Complication ◽  
Middle Aged ◽  
Post Thrombotic Syndrome ◽  
Increased Risk ◽  
History Of

Abstract Introduction: Post-thrombotic syndrome (PTS) is the most common complication after a venous thromboembolism (VTE). PTS is a chronic condition affecting health-related quality-of-life (QoL). In this study we aimed to determine the risk of PTS and how it affects QoL after a first episode of VTE in young and middle-aged women. Methods: We conducted a cohort study, including 1438 women with a first episode of VTE. Patients were recruited from 'Thrombo Embolism Hormonal Study' (TEHS), a Swedish nation-wide case-control study on risk factors for VTE in women 18-65 years of age. Consecutive patients with a first episode of deep vein thrombosis (DVT) in the lower leg or pulmonary embolism (PE) were included between 2002 and 2009. In 2011 all women still living in Sweden were followed up through a questionnaire. PTS was measured using self-reported Villalta score and Veins-QoL was used to measure QoL. Results: After a median follow-up time of 6 years 1049 patients accepted participation in the follow-up study. The reported prevalence of PTS was 20 % for all patients, 28 % among women with a previous episode of a proximal DVT, 19 % among women with a previous distal DVT and 12 % among women with PE. Women with a history of leg symptoms before the first VTE-event had a higher risk of PTS (OR 3.5 (95% CI 2.5 - 4.8), with a prevalence of 32% compared to 12% in women with no history of leg symptoms. Obese women were at increased risk of PTS (OR 1.9, 95% CI 1.4 - 2.7) compared to non-obese. Similar women with proximal DVT (OR 1.6, 95% CI 1.1 - 2.3) and ipsilateral recurrence (OR 3.8, 95% CI 1.9 - 7.7) had increased risk of PTS. Patients with PTS scored lower on Veins-QoL (44 vs. 52, p < 0.01). Conclusions: PTS is a common complication of VTE. Women with a history of leg-symptoms before time of VTE-diagnosis have more than 3-fold increased risk of PTS. Occurrence of PTS significantly reduces QoL. Disclosures No relevant conflicts of interest to declare.

QTc Interval in psychiatric inpatients: A retrospective study

2017 ◽  
Vol 41 (S1) ◽  
pp. S468-S468
Author(s):  
N. Brondino ◽  
L. Fusar-Poli ◽  
M. Rocchetti ◽  
M. Besozzi ◽  
A. Mori ◽  
...  
Keyword(s):  
Psychiatric Patients ◽  
Psychiatric Inpatient ◽  
Torsade De Pointes ◽  
Psychiatric Inpatients ◽  
Mood Stabilizers ◽  
Psychiatric Ward ◽  
Qtc Interval ◽  
Qtc Prolongation ◽  
Increased Risk ◽  
Significant Difference

IntroductionSeveral psychotropic medications (i.e. antipsychotics, antidepressant) have been recently associated with QTc prolongation. Despite literature data report only mild prolongation of QTc following the use of antidepressants or typical antipsychotics, post-marketing studies have clearly evidenced an increased risk of QTc prolongation and potentially lethal arrhythmias (i.e. torsade de pointes) in psychiatric patients.ObjectivesWe aimed to evaluate the prevalence of prolonged QTc and to identify potential predictors influencing QTc in a psychiatric inpatient population.MethodsMedical records of 200 patients admitted to our psychiatric ward between 2007 and 2012 were retrospectively reviewed.ResultsPrevalence of prolonged QTc at admission was very low (0.1%). No significant differences in QTc interval were observed between patients taking or not antipsychotics (P = 0.66), mood stabilizers (P = 0.36), or antidepressants (P = 0.07). A statistically significant difference was observed between patients on depot formulation and patients who were taking oral antipsychotic (P = 0.02). However, the pharmaceutical class of the medications appeared not significant.ConclusionsWe observed a very low rate of QTc prolongation in psychiatric inpatients at admission. Surprisingly we did not find a significant effect of specific medications; however, in our sample intramuscular formulation was associated with lower QTc interval.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Comparing the Neuropsychiatric Profile of Patients with Alzheimer Disease Who Present Spared versus Impaired Executive Functioning

2011 ◽  
Vol 2011 ◽  
pp. 1-5 ◽  
Author(s):  
Ezequiel Gleichgerrcht ◽  
Anabel Chade ◽  
Teresa Torralva ◽  
María Roca ◽  
Facundo Manes
Keyword(s):  
Alzheimer Disease ◽  
Executive Functioning ◽  
Neuropsychological Tests ◽  
Motor Behavior ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Significant Difference ◽  
Repetitive Motor ◽  
Shed Light

Background. A “dysexecutive” group of patients with Alzheimer disease (AD) has been previously identified, and these patients have been found to present higher frequency of psychiatric symptoms and more pronounced functional impact. This study aimed at evaluating the frequency of neuropsychiatric symptoms in patients with early AD who present with impaired executive functioning.Methods. Thirty patients with early AD diagnosis were divided into a spared (SEF) and an impaired (IEF) executive functioning group according to their performance scores on neuropsychological tests. Their closest relatives or caregivers completed the Cambridge behavioral inventory (CBI), which assesses behavioral symptoms grouped into 13 categories.Results. A significant difference was exclusively found between SEF and IEF in terms of the frequency of stereotypies and repetitive motor behavior (U=60.5,P=.024).Conclusions. The presence of stereotypies could be associated with a dysexecutive profile in AD patients. These results shed light on the role of frontal circuitry in the expression of motor symptoms in AD and prompt for further research that will contribute to the differential diagnosis both of different subtypes of AD and other types of dementia.

scholarly journals Frontotemporal Dementia and Late-Onset Bipolar Disorder: The Many Directions of a Busy Road

2021 ◽  
Vol 12 ◽  
Author(s):  
Mari N. Maia da Silva ◽  
Fábio Henrique de Gobbi Porto ◽  
Pedro Maranhão Gomes Lopes ◽  
Catarina Sodré de Castro Prado ◽  
Norberto Anízio Ferreira Frota ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Psychiatric Disorder ◽  
Frontotemporal Dementia ◽  
Late Onset ◽  
Current Knowledge ◽  
Severe Depression ◽  
First Episode ◽  
Considerable Proportion ◽  
Clinical Genetic ◽  
Increased Risk

It is a common pathway for patients with the behavioral variant of frontotemporal dementia (bvFTD) to be first misdiagnosed with a primary psychiatric disorder, a considerable proportion of them being diagnosed with bipolar disorder (BD). Conversely, not rarely patients presenting in late life with a first episode of mania or atypically severe depression are initially considered to have dementia before the diagnosis of late-onset BD is reached. Beyond some shared features that make these conditions particularly prone to confusion, especially in the elderly, the relationship between bvFTD and BD is far from simple. Patients with BD often have cognitive complaints as part of their psychiatric disorder but are at an increased risk of developing dementia, including FTD. Likewise, apathy and disinhibition, common features of depression and mania, respectively, are among the core features of the bvFTD syndrome, not to mention that depression may coexist with dementia. In this article, we take advantage of the current knowledge on the neurobiology of these two nosologic entities to review their historical and conceptual interplay, highlighting the clinical, genetic and neuroimaging features that may be shared by both disorders or unique to each of them.

scholarly journals Late-Onset Psychiatric Manifestations Revealing Limbic Encephalitis: a Case Report of a 48 Years Old Man

2021 ◽  
Vol 2 ◽  
pp. 8-12
Author(s):  
Meriem Regaya ◽  
Badii Amamou ◽  
Amjed Ben Haouala ◽  
Ahmed Mhalla ◽  
Ferid Zaafrane ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Late Onset ◽  
Brain Magnetic Resonance Imaging ◽  
Autoimmune Encephalitis ◽  
Psychiatric Ward ◽  
Temporal Region ◽  
Atypical Symptoms ◽  
Psychiatric Manifestations ◽  
First Time

Psychiatric symptoms of late-onset are often atypical and an organic origin that remains to be eliminated at first. Still, many somatic etiologies like encephalitis remains poorly understood and multidisciplinary management is necessary. We present the case of a man hospitalized for the first time in the psychiatric ward of Monastir Tunisia at the age of 48 for behavioral disorders with atypical symptoms, Brain Magnetic resonance imaging showed bilateral signal abnormalities of the internal temporal region and hippocampal left lesions, suggestive of encephalitis. The autoimmune origin has been strongly suspected and the determination of "onco-neuronal" antibodies and specifically the assay of anti Ma1 and anti Ma2 antibodies were positive. These elements lead us to evoke autoimmune encephalitis and immunotherapy was initiated for the patient.

Thrombophilia and risk of VTE recurrence according to the age at the time of first VTE manifestation

VASA ◽  
2015 ◽  
Vol 44 (4) ◽  
pp. 313-323 ◽  
Author(s):  
Lea Weingarz ◽  
Marc Schindewolf ◽  
Jan Schwonberg ◽  
Carola Hecking ◽  
Zsuzsanna Wolf ◽  
...  
Keyword(s):  
Factor V Leiden ◽  
Cox Proportional Hazards ◽  
First Episode ◽  
Factor V ◽  
Factor V Leiden Mutation ◽  
Younger Patients ◽  
Risk Of Recurrence ◽  
G20210a Mutation ◽  
Increased Risk ◽  
The Impact

Abstract. Background: Whether screening for thrombophilia is useful for patients after a first episode of venous thromboembolism (VTE) is a controversial issue. However, the impact of thrombophilia on the risk of recurrence may vary depending on the patient’s age at the time of the first VTE. Patients and methods: Of 1221 VTE patients (42 % males) registered in the MAISTHRO (MAin-ISar-THROmbosis) registry, 261 experienced VTE recurrence during a 5-year follow-up after the discontinuation of anticoagulant therapy. Results: Thrombophilia was more common among patients with VTE recurrence than those without (58.6 % vs. 50.3 %; p = 0.017). Stratifying patients by the age at the time of their initial VTE, Cox proportional hazards analyses adjusted for age, sex and the presence or absence of established risk factors revealed a heterozygous prothrombin (PT) G20210A mutation (hazard ratio (HR) 2.65; 95 %-confidence interval (CI) 1.71 - 4.12; p < 0.001), homozygosity/double heterozygosity for the factor V Leiden and/or PT mutation (HR 2.35; 95 %-CI 1.09 - 5.07, p = 0.030), and an antithrombin deficiency (HR 2.12; 95 %-CI 1.12 - 4.10; p = 0.021) to predict recurrent VTE in patients aged 40 years or older, whereas lupus anticoagulants (HR 3.05; 95%-CI 1.40 - 6.66; p = 0.005) increased the risk of recurrence in younger patients. Subgroup analyses revealed an increased risk of recurrence for a heterozygous factor V Leiden mutation only in young females without hormonal treatment whereas the predictive value of a heterozygous PT mutation was restricted to males over the age of 40 years. Conclusions: Our data do not support a preference of younger patients for thrombophilia testing after a first venous thromboembolic event.

Improving outcomes: Factors influencing help-seeking behaviors in immigrants and ethnic minorities with first-episode psychosis

2016 ◽  
Vol 13 (03) ◽  
pp. 152-157
Author(s):  
A. O. Berg ◽  
K. Leopold ◽  
S. Zarafonitis-Müller ◽  
M. Nerhus ◽  
L. H. Stouten ◽  
...  
Keyword(s):  
Mental Health ◽  
Help Seeking ◽  
Service Use ◽  
First Episode Psychosis ◽  
Pathways To Care ◽  
First Episode ◽  
Factors Influencing ◽  
Increased Risk ◽  
Episode Psychosis ◽  
The Hague

Summary Background: Immigrants have increased risk of a poor recovery from first episode psychosis (FEP). Early treatment can improve prognosis, but having an immigrant background may influence pathways to care. Method: We present research of service use and factors influencing treatment outcome in immigrants with FEP. Service use was assessed in in-patients at an early intervention center in Berlin, Germany. Duration of untreated psychosis and beliefs about illness was assessed in a FEP study in Oslo, Norway and cognitive functioning in patients with FEP schizophrenia from the regular mental health services in The Hague, the Netherlands. The proportion of immigrants in Berlin and Oslo was at level with the local populations, while the proportion in The Hague appeared to be higher. Result: There were clear indications that mental health literacy, probably based in different cultural expectations, were lower in first generation immigrants (FGI). Findings regarding clinical insight were ambiguous. There were also indications that FGI had more cognitive problems, based in higher stress levels or in cognitive styles. Early psychosis services must take issues of immigration and ethnicity into consideration.

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