Resolution of Inappropriate Sexual Behavior in an Elderly Male with Intellectual Disability with Memantine: Case Report, and Review of the Literature

Mapping Intimacies ◽

10.21203/rs.3.rs-197230/v1 ◽

2021 ◽

Author(s):

Zeba Hasan Hafeez

Keyword(s):

Sexual Behavior ◽

Intellectual Disability ◽

White Male ◽

Elderly Male ◽

Inappropriate Sexual Behavior ◽

Medical Tests ◽

Aspartate Receptor ◽

Psychiatric Conditions ◽

New Onset

Abstract BackgroundMemantine is a non-competitive N-methyl-d-aspartate receptor antagonist approved for the treatment of moderate to severe Alzheimer's disease (AD). However, given its involvement of glutamate pathways, monotherapy as well as combination with other medications has been found to be effective in a number of psychiatric conditions (1). Resolution of new onset inappropriate sexual behavior (ISB) with memantine in a 67 year old male with intellectual disability (ID) is presented.Case presentationA 67 year old, white male with ID with a full scale IQ of 68, was treated in psychiatry long term for intermittent agitation and anxiety. At age 65, he manifested ISB which was not controlled with non pharmacologic measures and various medications. ISB resolved when memantine was added to his concurrent psychotropics and gradually increased to 10 mg BID. There was a recurrence of ISB after two years which remitted when memantine was increased to 25 mg. Based on clinical follow ups and serial MOCAs over three years, it was determined that this patient did not have a major neurocognitve disorder.ConclusionISB and its treatment is an understudied subject in individuals with intellectual disability. Resolution of new onset ISB in a 67 year old male with intellectual disability and comorbid mood disorder, is a previously unreported therapeutic effect of memantine. His ISB resolved with the addition of memantine 20 mg daily after multiple failed trials of various classes of psychotropics. Two years later, reemergence of ISB subsided with memantine 25 mg which is a higher than the recommended dose of this medication. Additional studies would be helpful in determining the maximum dose of this medication given its therapeutic efficacy at 25 mg daily which was well tolerated with stable medical tests.

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RESOLUTION OF INAPPROPRIATE SEXUAL BEHAVIOR IN AN ELDERLY MALE WITH MAJOR NEUROCOGNITIVE DISORDER AND DEVELOPMENTAL DELAY WITH MEMANTINE

American Journal of Geriatric Psychiatry ◽

10.1016/j.jagp.2020.01.109 ◽

2020 ◽

Vol 28 (4) ◽

pp. S83

Author(s):

Zeba Hasan Hafeez

Keyword(s):

Sexual Behavior ◽

Developmental Delay ◽

Neurocognitive Disorder ◽

Elderly Male ◽

Inappropriate Sexual Behavior

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Drug prevention programs during adolescence may have long-term benefits against risky sexual behavior

PsycEXTRA Dataset ◽

10.1037/e546592010-008 ◽

2010 ◽

Keyword(s):

Sexual Behavior ◽

Risky Sexual Behavior ◽

Prevention Programs ◽

Drug Prevention

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Faculty Opinions recommendation of Diagnostic value of N-methyl-D-aspartate receptor antibodies in women with new-onset epilepsy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1168394.630572 ◽

2009 ◽

Author(s):

Massimo Pandolfo ◽

Chantal Depondt

Keyword(s):

Diagnostic Value ◽

Aspartate Receptor ◽

Receptor Antibodies ◽

New Onset

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The Co-Occurrence of Autism and Gender Diversity

The Oxford Handbook of Autism and Co-Occurring Psychiatric Conditions ◽

10.1093/oxfordhb/9780190910761.013.11 ◽

2020 ◽

pp. 197-211

Author(s):

Jill C. Fodstad ◽

Rebecca Elias ◽

Shivali Sarawgi

Keyword(s):

Gender Dysphoria ◽

Gender Diversity ◽

Gender Nonconforming ◽

Medical Interventions ◽

Gender Diverse ◽

Nonbinary Gender ◽

Psychiatric Conditions ◽

The Common ◽

And Gender

Gender diversity refers to gender expressions and/or gender identity experiences that vary from the common experiences of gender. Gender-diverse people may be gender nonconforming, gender nonbinary, gender fluid, gender exploring, transgender, and so forth. Some gender-diverse individuals experience gender dysphoria and/or gender incongruence and may require gender-affirming supports, including gender-affirming medical interventions. The co-occurrence of autism and gender diversity has been highlighted in a series of studies internationally as well as through rich community expressions. Studies in gender-referred individuals reveal high rates of autism traits as well as high rates of existing autism diagnoses. Studies in autistic populations reveal greater gender diversity characteristics. The long-term course of gender diversity in autistic individuals is poorly understood. Clinical guidelines have been developed for adolescents with the co-occurrence, but much work remains: No gender-related measures have been developed and tested for use in neurodiverse populations, no programs exist to support gender-diverse neurodiverse adults, and little is known about co-occurring mental health profiles, risks, or protective factors for people with the co-occurrence. The inclusion of this chapter on co-occurring autism and gender diversity within a book on “co-occurring psychiatric conditions” is problematic, because gender diversity is not a “psychiatric condition,” but instead a form of human diversity. The diagnosis of Gender Dysphoria is useful only insomuch as it allows individuals to obtain necessary gender-related supports. The authors’ choice to include this chapter in this book reflects a compromise, motivated by the need for educating both autism and gender specialists in this common co-occurrence.

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Long-Term Care Financing for an Aging Population: The Experience of Singapore

Innovation in Aging ◽

10.1093/geroni/igaa057.101 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 31-31

Author(s):

Ngee Choon Chia ◽

Huijun Cynthia Chen

Keyword(s):

Long Term Care ◽

Transition Probabilities ◽

Aging Population ◽

Elderly Male ◽

Term Care ◽

Cash Benefit ◽

Opt Out ◽

Insurance Rate ◽

Long Term Care Insurance

Abstract Singapore has a rapidly aging population. Long-term care (LTC) is one of the largest financial risks facing elderly in Singapore. Singapore implemented Eldershield, a long-term care insurance scheme which provided defined cash benefit payouts in the event of severe disability; but capped at a maximum of six years. Eldershield enrolled people at age 40, but offered an opt-out option. As of 2015, 65% of those aged 40 to 83 opted to be covered by Eldershield, making Singapore as having the highest voluntary LTC insurance rate in the world. This paper uses an actuarial multi-state disability model and calibrates the transition probabilities and duration-of-stay at various health (disability) states to assess the adequacy and comprehensiveness of Eldershield. The time-limited cash benefit design in Eldershield helped defray about 13% of LTC costs. Removing the time cap will help defray 23% and 26% of the LTC costs for elderly male and female respectively. Furthermore, the simulation results demonstrate that relaxing the trigger benefit and having staggered payouts will improve the adequacy of long-term care insurance. The experience of Singapore’s LTC insurance offers insights into the challenges of designing an insurance that tends to occur at higher age and insuring against a cost that could range from zero to a significantly large sum over a long period. Even with the enhanced Careshield Life, which provides cash payouts for life, other policy designs, for example caregiver grants, may be needed to ensure more adequate financing of long-term care.

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Long-term impact of new-onset atrial fibrillation complicating acute myocardial infarction on heart failure: insights from the NOAFCAMI-SH registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.1750 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S.L Xu ◽

J Luo ◽

H.Q Li ◽

Z.Q Li ◽

B.X Liu ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Natural Science ◽

Funding Source ◽

Onset Atrial Fibrillation ◽

New Onset

Abstract Background New-onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on subsequent heart failure (HF) is still not well studied. We aimed to investigate the relationship between NOAF following AMI and HF hospitalization. Methods This retrospective cohort study was conducted between February 2014 and March 2018, using data from the New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai registry, where all participants did not have a documented AF history. Patients with AMI who discharged alive and had complete echocardiography and follow-up data were analyzed. The primary outcome was HF hospitalization, which was defined as a minimum of an overnight hospital stay of a participant who presented with symptoms and signs of HF or received intravenous diuretics. Results A total of 2075 patients were included, of whom 228 developed NOAF during the index AMI hospitalization. During up to 5 years of follow-up (median: 2.7 years), 205 patients (9.9%) experienced HF hospitalization and 220 patients (10.6%) died. The incidence rate of HF hospitalization among patients with NOAF was 18.4% per year compared with 2.8% per year for those with sinus rhythm. After adjustment for confounders, NOAF was significantly associated with HF hospitalization (hazard ratio [HR]: 3.14, 95% confidence interval [CI]: 2.30–4.28; p<0.001). Consistent result was observed after accounting for the competing risk of all-cause death (subdistribution HR: 3.06, 95% CI: 2.18–4.30; p<0.001) or performing a propensity score adjusted multivariable model (HR: 3.28, 95% CI: 2.39–4.50; p<0.001). Furthermore, the risk of HF hospitalization was significantly higher in patients with persistent NOAF (HR: 5.81; 95% CI: 3.59–9.41) compared with that in those with transient NOAF (HR: 2.61; 95% CI: 1.84–3.70; p interaction = 0.008). Conclusion NOAF complicating AMI is strongly associated with an increased long-term risk of heart. Cumulative incidence of outcome Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): 1. National Natural Science Foundation of China, 2. Natural Science Foundation of Shanghai

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Catatonia secondary to anti-N-methyl-D-aspartate receptor (NMDAr) encephalitis: a review

CNS Spectrums ◽

10.1017/s1092852919001573 ◽

2019 ◽

Vol 25 (4) ◽

pp. 475-492 ◽

Cited By ~ 2

Author(s):

Inês Marques Macedo ◽

João Gama Marques

Keyword(s):

Disease Management ◽

Literature Review ◽

Clinical Setting ◽

Neuropsychiatric Symptoms ◽

Initial Symptom ◽

Know How ◽

Aspartate Receptor ◽

Nmdar Encephalitis ◽

Psychiatric Conditions ◽

Possible Cause

AbstractAnti-N-methyl-D-aspartate receptor (NMDAr) encephalitis is a relatively recent autoimmune entity, as it was first described in 2007. Given that it is a condition with neuropsychiatric symptoms, its initial symptom is frequently psychiatric in nature. Hence, psychiatrists are often the first physicians to assess these patients and, as so, must recognize this type of encephalitis as a possible cause. Catatonia may be inaugural or develop throughout the course of the disease. Management of patients with anti-NMDAr encephalitis is based on etiologic treatment with immunotherapy and removal of the associated tumor, if any. However, these catatonic patients may have variable responses to etiologic treatment, sometimes with refractory catatonic symptoms, which attests to the necessary urgency to know how to manage these patients. In the clinical setting, physicians appear to be using guidelines originally created to the management of catatonia due to primary psychiatric conditions. In this literature review, catatonia was historically contextualized and anti-NMDAr encephalitis overall described. Finally, catatonia secondary to this type of encephalitis was discussed.

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