scholarly journals Autoimmune encephalitis: a potentially treatable cause of mental disorder

2014 ◽  
Vol 20 (2) ◽  
pp. 92-100 ◽  
Author(s):  
Hugh Rickards ◽  
Saiju Jacob ◽  
Belinda Lennox ◽  
Tim Nicholson
Keyword(s):  
Autoimmune Encephalitis ◽  
Mental States ◽  
Learning Objectives ◽  
First Episode ◽  
List Type ◽  
Type Number ◽  
Red Flags ◽  
Episode Psychosis ◽  
Autonomic Instability ◽  
Red Flag

SummaryAutoimmune encephalitides can present with altered mental states, particularly psychosis and delirium. Psychiatrists need to be particularly vigilant in cases of first-episode psychosis and to look out for other, sometimes subtle, features of encephalitis. Encephalitis related to N-methyl-d-aspartate (NMDA) receptor autoantibodies is the most common autoimmune cause of isolated psychosis, the second being related to voltage-gated potassium channel (VGKC)-complex antibodies. Psychiatrists should note ‘red flag’ signs of seizures, autonomic instability, movement disorders and sensitivity to antipsychotic medication (including neuroleptic malignant syndrome). They should also be aware that, in some cases, encephalitis is a non-metastatic manifestation of malignancy. Treatment primarily involves suppression of immunity and is often successful if delivered early. There is accumulating evidence that isolated psychiatric syndromes can be caused by autoimmunity and this could potentially signal a significant change in the approach to disorders such as schizophrenia. Psychiatrists and neurologists need to work together to diagnose, manage and understand this group of conditions.LEARNING OBJECTIVES•Consider ‘red flags' for the diagnosis of autoimmune encephalitis presenting to general psychiatric practice.•Understand the investigations required to diagnose autoimmune encephalitis.•Become familiar with the basics of treatment of autoimmune encephalitis.

scholarly journals Metabolic syndrome in psychiatry: advances in understanding and management

2014 ◽  
Vol 20 (2) ◽  
pp. 101-112 ◽  
Author(s):  
Cyrus S. H. Ho ◽  
Melvyn W. B. Zhang ◽  
Anselm Mak ◽  
Roger C. M. Ho
Keyword(s):  
Risk Factors ◽  
Metabolic Syndrome ◽  
Psychiatric Disorders ◽  
Psychiatric Patients ◽  
Learning Objectives ◽  
List Type ◽  
Type Number ◽  
Unhealthy Lifestyle ◽  
Definition Of ◽  
The Relationship

SummaryMetabolic syndrome comprises a number of cardiovascular risk factors that increase morbidity and mortality. The increase in incidence of the syndrome among psychiatric patients has been unanimously demonstrated in recent studies and it has become one of the greatest challenges in psychiatric practice. Besides the use of psychotropic drugs, factors such as genetic polymorphisms, inflammation, endocrinopathies and unhealthy lifestyle contribute to the association between metabolic syndrome and a number of psychiatric disorders. In this article, we review the current diagnostic criteria for metabolic syndrome and propose clinically useful guidelines for psychiatrists to identify and monitor patients who may have the syndrome. We also outline the relationship between metabolic syndrome and individual psychiatric disorders, and discuss advances in pharmacological treatment for the syndrome, such as metformin.LEARNING OBJECTIVES•Be familiar with the definition of metabolic syndrome and its parameters of measurement.•Appreciate how individual psychiatric disorders contribute to metabolic syndrome and vice versa.•Develop a framework for the prevention, screening and management of metabolic syndrome in psychiatric patients.

scholarly journals Time for a change of practice: the real-world value of testing for neuronal autoantibodies in acute first-episode psychosis

BJPsych Open ◽  
2018 ◽  
Vol 4 (4) ◽  
pp. 262-264 ◽  
Author(s):  
Thomas A. Pollak ◽  
Belinda R. Lennox
Keyword(s):  
Lumbar Puncture ◽  
Real World ◽  
Culture Change ◽  
Autoimmune Encephalitis ◽  
First Episode Psychosis ◽  
Acute Onset ◽  
First Episode ◽  
The Real ◽  
Episode Psychosis ◽  
Neuronal Autoantibodies

SummaryIt is time that all patients with acute-onset psychosis are screened for autoimmune encephalitis, that lumbar puncture becomes a routine psychiatric investigation and that immunotherapy is available in indicated cases. We call for a culture change in the management of psychosis by psychiatry.Declaration of interestNone.

How “DUP” and “EE” Predict the Dynamic OD Syndromes in the Long - Termcourse of Schizophrenia?

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Cechnicki ◽  
R. Polczyk ◽  
A. Bielańska
Keyword(s):  
Repeated Measures ◽  
First Episode ◽  
First Year ◽  
List Type ◽  
Type Number ◽  
Long Term Outcomes ◽  
Course Of Illness ◽  
Negative Syndrome

Objective:The study in Krakow investigated the way in which EE and DUP correlated with long term outcomes of the treatment and the course of illness.Subjects and methods:58 out of 80 DSM III schizophrenia diagnosed patients took part in 1, 3, 7 and 12 follow-up. The Follow-Up Chart, BPRS, and CFI were used. As the outcome criteria only dynamic of symptoms were included. The dynamic of the symptoms and the relation between DUP and EE were analyzed by repeated measures of ANOVA.Results:1.General, positive and negative syndromes decreased rapidly after the first hospitalization, and increased slightly between 7 and 12 yrs. (ps < 0.001). The negative syndrome decreased less rapidly during the first year.2.The dynamic of general and positive syndrome were modified by the DUP and by EE. In long DUP (general syndrome: p = 0.028; positive syndrome: p = 0.001) the dynamic was worse. High EE subjects had more severe syndromes at the admission. After the first hospitalization their results became as good as in the case of low EE (general syndrome: p = 0.004; positive syndrome: p = 0.044).3.The dynamic of negative syndrome was neither modified by DUP (p = 0.896) or by EE (p = 0.309).Conclusion:The dynamic of general and positive syndromes were modified by DUP during 12 years follow-up and by EE only in acute state in the first episode. The dynamic of negative syndrome was not modified by DUP and EE.

scholarly journals Managing delirium in everyday practice: towards cognitive-friendly hospitals

2014 ◽  
Vol 20 (6) ◽  
pp. 380-389 ◽  
Author(s):  
Henry O'Connell ◽  
Sean P. Kennelly ◽  
Walter Cullen ◽  
David J. Meagher
Keyword(s):  
Healthcare System ◽  
Clinical Care ◽  
Cognitive Disorder ◽  
Learning Objectives ◽  
Everyday Practice ◽  
List Type ◽  
Type Number ◽  
Hospital Environments ◽  
Cognitive Problems ◽  
The Way

SummaryProviding optimal healthcare for increasingly elderly hospital populations who have high rates of cognitive disorder is a great challenge. Using delirium as an example, we describe how improved management of acute cognitive problems through a multifaceted hospital-wide programme can promote cognitive-friendly hospital environments. A specific plan of action is described that spans interventions in day-to-day clinical care of individual patients all the way to wider organisational practices.Learning Objectives•Understand the concept of cognitive friendliness and how addressing the problem of delirium can contribute to this in our healthcare system.•Become more aware of specific aspects of a cognitive-friendly programme and how these can be implemented in practice.•Explore the key outstanding issues for research that can further enhance our awareness of cognitive-friendly practices.

scholarly journals The interface between general and forensic psychiatry: the present day

2014 ◽  
Vol 20 (5) ◽  
pp. 359-365 ◽  
Author(s):  
Vivek Khosla ◽  
Phil Davison ◽  
Harvey Gordon ◽  
Verghese Joseph
Keyword(s):  
Forensic Psychiatry ◽  
Clinical Care ◽  
Learning Objectives ◽  
List Type ◽  
Type Number ◽  
England And Wales ◽  
Adult Psychiatry ◽  
The Republic ◽  
Definition Of ◽  
The Uk

SummaryWith the subspecialisation of psychiatry in the UK, clinicians encounter problems at the interfaces between specialties. These can lead to tension between clinicians, which can be unhelpful to the clinical care of the patient. This article focuses on the interface between general and forensic psychiatry in England and Wales. The pattern of mental health services in England and Wales differs to an extent from those in Scotland, Northern Ireland and in the Republic of Ireland. Consequently, the interface between general and forensic psychiatry is subject to varying influences. Important interface issues include: the definition of a ‘forensic patient’; the remit and organisation of services; resources; clinical responsibility; and care pathways. This article also discusses a general overview of how to improve collaboration between forensic and general adult psychiatric services.Learning Objectives•Develop an understanding of important issues at the forensic/general adult psychiatry interface.•Be aware of areas of conflict that may arise at the forensic/general adult psychiatry interface.•Be aware of options for optimum cooperation at the interface.

How “DUP” and “ee” Predict the Dynamic OD Syndromes in the Long - Termcourse of Schizophrenia?

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Cechnicki ◽  
R. Polczyk ◽  
A. Bielańska
Keyword(s):  
Repeated Measures ◽  
First Episode ◽  
First Year ◽  
List Type ◽  
Type Number ◽  
Long Term Outcomes ◽  
Course Of Illness ◽  
Negative Syndrome

Objective:The study in Krakow investigated the way in which EE and DUP correlated with long term outcomes of the treatment and the course of illness.Subjects and methods:58 out of 80 DSM III schizophrenia diagnosed patients took part in 1, 3, 7 and 12 follow-up. the Follow-Up Chart, BPRS, and CFI were used. as the outcome criteria only dynamic of symptoms were included. the dynamic of the symptoms and the relation between DUP and EE were analyzed by repeated measures of ANOVA.Results:1.General, positive and negative syndromes decreased rapidly after the first hospitalization, and increased slightly between 7 and 12 yrs. (ps < 0.001). the negative syndrome decreased less rapidly during the first year.2.The dynamic of general and positive syndrome were modified by the DUP and by EE. in long DUP (general syndrome: p = 0.028; positive syndrome: p = 0.001) the dynamic was worse. High EE subjects had more severe syndromes at the admission. after the first hospitalization their results became as good as in the case of low EE (general syndrome: p = 0.004; positive syndrome: p = 0.044).3.The dynamic of negative syndrome was neither modified by DUP (p = 0.896) or by EE (p = 0.309).Conclusion:The dynamic of general and positive syndromes were modified by DUP during 12 years follow-up and by EE only in acute state in the first episode. the dynamic of negative syndrome was not modified by DUP and EE.

P01-345-Prevalence and impact of cannabis use disorders in adolescents with early onset first episode psychosis

2011 ◽  
Vol 26 (S2) ◽  
pp. 347-347
Author(s):  
B. Schimmelmann ◽  
S. Cotton ◽  
P. Conus ◽  
S. Kupferschmid ◽  
P. McGorry ◽  
...  
Keyword(s):  
Early Onset ◽  
First Episode Psychosis ◽  
Cannabis Use ◽  
Effect Sizes ◽  
Medium Effect ◽  
First Episode ◽  
List Type ◽  
Episode Psychosis ◽  
Cannabis Use Disorders ◽  
The Impact

ObjectivePrevious studies on the impact of cannabis use disorders (CU) on outcome in psychosis were mostly based on non-representative samples, have often not controlled for confounders and rarely focused on adolescents. Thus, the aims of the present study were to assess;(i) prevalence of CU;(ii) pre-treatment and baseline differences between CU and those without CU (NCU); and(iii) the impact of baseline and course of CU on 18-month outcomes in a representative cohort of adolescents with early onset first episode psychosis (EOP).MethodThe sample comprised 99 adolescents (age 14 to 18) with EOP (onset age 14 to 17), admitted to the Early Psychosis Prevention and Intervention Centre in Australia. Data were collected from medical files using a standardized questionnaire.ResultsPrevalence of lifetime CU was 65.7%, baseline CU 53.5%, and persistent CU 26.3%. Baseline CU compared to NCU was associated with higher illness-severity, lower functioning, less insight, lower premorbid functioning and longer duration of untreated psychosis. Compared to both NCU and those who decreased or stopped CU during treatment, only persistent CU was linked to worse outcomes and more service disengagement. Effect sizes were medium controlling for relevant confounders. Medication non-adherence did not explain the link between persistent CU and worse outcome.ConclusionsThe prevalence of CU in adolescents with EOP is high, while only persistent CU use was associated with worse outcome with medium effect sizes. Specific needs of adolescent patients with respect to cannabis interventions within integrated care settings should be addressed in future studies.

scholarly journals A Novel Analytical Framework for Dynamic Quaternion Ship Domains

2012 ◽  
Vol 66 (2) ◽  
pp. 265-281 ◽  
Author(s):  
Ning Wang
Keyword(s):  
Traffic Congestion ◽  
Mental States ◽  
Analytical Framework ◽  
List Type ◽  
Model Structure ◽  
Simulation Studies ◽  
Motion Model ◽  
Type Number ◽  
Wind Force ◽  
Input Variables

In this paper, a novel analytical framework for Dynamic Quaternion Ship Domain (DQSD) models has been initially proposed via the Quaternion Ship Domain (QSD) model structure. Unlike previous ship domains, the proposed DQSD model is able to capture essential subjectivity and objectivity of ship domains. To be specific, the significant characteristics are as follows: (1)The proposed DQSD model is integrated by three independent submodels of ship, human and circumstance, which are determined by ship manoeuvrability, navigator's states, and navigation circumstance, respectively.(2)The ship manoeuvrability derived from the MMG-type ship motion model is employed to establish the ship submodel which identifies the DQSD scale.(3)A novel navigator reliability model is proposed to realize the human submodel which defines the ship domain shape with navigator ability, physical and mental states being input variables.(4)In addition, visibility, wind force, wave and traffic congestion are incorporated into the circumstance submodel which is employed to zoom in or out of the DQSD-type ship domain.Finally, the well-known Esso Osaka tanker model is used to conduct simulation studies on various typical stationary and dynamic situations, and comparative investigations with each other have been comprehensively analysed. Simulation results demonstrate that the DQSD model can capture critical dynamics of ship domains and undoubtedly be effective and superior to previous ship domains in terms of performance and accuracy.

scholarly journals The critical period

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
M. Birchwood
Keyword(s):  
Critical Period ◽  
Psychotic Symptoms ◽  
First Episode ◽  
List Type ◽  
Episode Psychosis ◽  
Follow Up Studies ◽  
Long Term Follow Up ◽  
Ecological Risk Factors

Aim:Evidence from long-term follow-up studies of schizophrenia and from the ‘new epidemiology’ of psychoses has forced us to rewrite the textbooks and challenge accepted wisdom. In this paper I aim to review the concept of my ‘Critical Period’ in the long-term trajectory of schizophrenia.Method:I will review long-term follow-up studies of first episode psychosis.Results:Studies suggest that:a.the course of the psychoses is very variable;b.much of this variability is laid down during the ‘prodromal’ and first 3 - 5 years following the first episode;c.the ‘disability’ plateaus quickly, much of it occuring before the positive symptoms develop (the ‘symptom-disability gap’) butd.the psychosocial and ecological risk factors that have now been uncovered, suggest a more protean, malleable process in the development of psychosis, as witnessed, for example by the considerable number of ‘at risk’ individuals with low-level, but disabling psychotic symptoms, who escape psychosis (the misnomer of the ‘false positive’).Conclusion:This picture presents a fresh take on my concept of the ‘critical period’ with implications for public health and prevention.

Sign in / Sign up

Export Citation Format

Share Document