scholarly journals Misidentification of Acute Psychiatric Symptoms in the Emergency Room: Clinical Experience in China

2021 ◽  
Vol 11 ◽  
Author(s):  
Fang Liu ◽  
Jianjun Chen ◽  
Yang Du ◽  
Wenxia Jiang ◽  
Lei Gong ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Room ◽  
Clinical Characteristics ◽  
Sleep Disturbances ◽  
Clinical Symptoms ◽  
Psychiatric Symptoms ◽  
Neurological Diseases ◽  
Clinical Manifestations ◽  
Neuropsychiatric Inventory ◽  
Abnormal Behaviors

Introduction: Patients who come to the emergency department because of acute psychiatric symptoms are often not admitted to the correct department timely. The purpose of this study is to identify the clinical characteristics of patients with acute psychiatric symptoms in order to achieve early and correct triage in the emergency room.Methodology: We conducted a cross-analysis of inpatients who first came to the emergency department with acute psychiatric symptoms and then admitted to the department of neurology or psychiatry between years 2012 and 2018. Among them, 70 patients were rediagnosed and retransferred, with 38 patients to the department of neurology and 32 patients to the department of psychiatry. The clinical characteristics, laboratory examination, and Neuropsychiatric Inventory (NPI) were analyzed.Results: Patients who were rediagnosed with neurological diseases were more prone to have somatic symptoms (headache, dizziness) (P < 0.05). Because of the atypical early clinical manifestations in the emergency room, fever and positive neurological signs do not necessarily represent the diagnosis of neurological diseases. On the other hand, the absence of these manifestations does not guarantee the diagnosis of psychiatric illness. According to NPI, abnormal behaviors, changes in appetite, and sleep disturbances were more obvious in patients with neurological diseases (P < 0.05), whereas patients with psychiatric disorders often showed prominent irritability (P < 0.05).Conclusions: Acute psychiatric symptoms are usually complex and diverse. The triage and diagnosisshould be based on multiple factors. After triage, clinical symptoms should be dynamically observed.

Basic Clinical Syndromes and Definitions

2018 ◽  
pp. 1-21
Author(s):  
Aparna Pendurthi ◽  
Maxim Mokin
Keyword(s):  
Emergency Department ◽  
Acute Stroke ◽  
Clinical Characteristics ◽  
Clinical Presentation ◽  
Clinical Manifestations ◽  
Transient Ischemic Attacks ◽  
Stroke Patients ◽  
Duration Of Symptoms ◽  
Surgical Interventions ◽  
Clinical Syndromes

The goal for neurological evaluation in the Emergency Department is to appropriately route potential acute stroke patients toward medical or surgical interventions in the most expedient manner possible. This chapter focuses on familiarizing the reader with main stroke subtypes and clinical manifestations associated with specific syndromes. Acute neurologic episodes being evaluated in the emergent setting for stroke workup can be divided into broad categories based on duration of symptoms, clinical presentation, and findings from basic imaging. This chapter explores the most common of these stroke syndromes and discusses the classification and clinical characteristics of transient ischemic attacks and ischemic and hemorrhagic strokes.

scholarly journals Chronic gastroduodenal pathology in schoolchildren: the clinical picture and features of the course

2021 ◽  
Vol 1 (1) ◽  
pp. 111-117
Author(s):  
Sh. T. Turdieva ◽  
D. K. Ganieva ◽  
Kh. B. Abdurashidova
Keyword(s):  
Helicobacter Pylori ◽  
Sleep Disturbances ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Blood Analysis ◽  
Immunochromatographic Test ◽  
Respiratory Test ◽  
Loss Of Appetite ◽  
Ph Metry

The aim of the study was to study the course and clinical manifestations of chronic gastroduodenal pathology (CGDP) in schoolchildren.Materials and methods. Clinically examined 286 children and adolescents from 6 to 15 years old with СGDP. The research methods included collection of anamnestic data, instrumental and functional (esophagogastroduodenoscopy, pH-metry), clinical and laboratory (general blood analysis, coprology), and Helicobacter pylori infection was tested by respiratory test and fecal immunochromatographic test.Result. Studies have shown that the main clinical manifestations of СGDP in children were dyspeptic syndrome, vegetovascular dysfunction, and pain syndrome, against the background of objectively visible signs of anemia. Symptoms were more characteristic in patients with СGDP from vegetovascular dysfunction: loss of appetite (83.6%), fatigue (83.2%), recurrent headaches (62.2%), and sleep disturbances (59.1%). Among dyspeptic disorders, unstable stools (85%), periodic nausea (57.7%), belching (56.6%), and a feeling of heaviness in the epigastric region after eating (56.3%) prevailed. Clinical symptoms more pronounced in children with chronic gastritis.Conclusion. For schoolchildren with CGDP, vegetovascular dysfunction (98.9%) with severe dyspeptic disorders (100%) and pain (79%), against the background of objective signs of anemia (53%), is more characteristic. In adolescents is more often a less symptomatic.

scholarly journals Experience of a Neuro-Emergency Expert in the Emergency Department during One Year of the COVID-19 Pandemic

2021 ◽  
Vol 18 (18) ◽  
pp. 9461
Author(s):  
Yong-Won Jung ◽  
Sang-Ook Ha ◽  
Jin-Hyouk Kim ◽  
Won-Seok Yang ◽  
Young-Sun Park
Keyword(s):  
Emergency Department ◽  
Clinical Characteristics ◽  
Neurological Diseases ◽  
Altered Mental Status ◽  
Motor Weakness ◽  
The Mean ◽  
One Year ◽  
Ct And Mri ◽  
Paroxysmal Positional Vertigo

We aimed to evaluate the overall clinical characteristics of patients treated by a neuro-emergency expert dedicated to the emergency department (ED) as an attending neurologist during the COVID-19 pandemic. We included adult patients who visited the ED between 1 January and 31 December 2020 and were treated by a neuro-emergency expert. We retrospectively obtained and analyzed the data on patients’ clinical characteristics and outcome. The neuro-emergency expert treated 1155 patients (mean age, 62.9 years). The proportion of aged 18–40 years was the lowest, and the most common modes of arrival were public ambulance (50.6%) and walk-in (42.3%). CT and MRI examinations were performed in 94.4 and 33.1% of cases, respectively. The most frequent complaints were dizziness (31.8%), motor weakness (24.2%), and altered mental status (15.8%). The ED diagnoses were acute ischemic stroke (19.8%), benign paroxysmal positional vertigo (14.2%), vestibular neuritis (9.9%), and seizure (8.8%). The mean length of stay in the ED was 207 min. Of the patients, 55.0% were admitted to the hospital, and 41.8% were discharged for outpatient follow-up. Despite the longer stay and the complexity and difficulty of neurological diseases during the COVID-19 pandemic, the accurate diagnosis and treatment provided by a neuro-emergency expert can be presented as a good model in the ED.

Neurogenic dysfunction of the lower urinary tract (neurogenic bladder)

2021 ◽  
Vol 26 (5) ◽  
pp. 61-72
Author(s):  
Yu. N. Sorokin
Keyword(s):  
Urinary Tract ◽  
Neurogenic Bladder ◽  
Lower Urinary Tract ◽  
Neural Control ◽  
Clinical Symptoms ◽  
Neurological Diseases ◽  
Clinical Manifestations ◽  
Neurogenic Dysfunction ◽  
The Brain ◽  
Lower Urinary

The lecture presents information about the central and peripheral structures that provide innervation and regulation of the functions of the lower urinary tract — the bladder and urethra. The mechanisms of regulation of the functions of accumulation and retention of urine (reservoir function) and emptying of the bladder (evacuation function) are shown.Neural control of urination is organized in the form of a hierarchical system. The spinal centers are the executive structures, and the cerebral centers are the controlling structures. Involuntary implementation of the act of urination occurs through segmental sympathetic and parasympathetic mechanisms. The regulation of these functions and voluntary urination are carried out by the central mechanisms of the brain — the actuation of the urination reflex is under strict volitional control, which makes it possible to plan the emptying of the bladder in a socially acceptable place and time.The information on the clinical symptoms of neurogenic dysfunction of the lower urinary tract (neurogenic bladder) is reviewed. The features of clinical manifestations depending on the level of damage to neural structures and in various neurological diseases are shown. Methods for assessing urodynamics and treatment directions for neurogenic dysfunction of the lower urinary tract are presented.

Anosognosia and Its Relation to Psychiatric Symptoms in Early-Onset Alzheimer Disease

2017 ◽  
Vol 30 (3) ◽  
pp. 170-177 ◽  
Author(s):  
Bora Yoon ◽  
Yong S. Shim ◽  
Yun Jeong Hong ◽  
Seong Hye Choi ◽  
Hee Kyung Park ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
Disease Severity ◽  
Early Onset ◽  
Sleep Disturbances ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Neuropsychiatric Inventory ◽  
Clinical Dementia Rating ◽  
Frontal Lobe Functions ◽  
The Individual

Background: We investigated differences in the prevalence of anosognosia and neuropsychiatric symptoms (NPSs) characteristics according to disease severity in patients with early-onset Alzheimer disease (EOAD). Methods: We recruited 616 patients with EOAD. We subdivided participants into 2 groups based on the presence or absence of anosognosia and then again by Clinical Dementia Rating (CDR) scale. We compared the differences in the Neuropsychiatric Inventory (NPI) scores according to anosognosia and disease severity. Results: The percentage of patients with anosognosia in each CDR group steadily increased as the CDR rating increased (CDR 0.5 8.6% vs CDR 1 13.6% vs CDR 2 26.2%). The NPI total score was significantly higher in patients with anosognosia in the CDR 0.5 and 1 groups; by contrast, it had no association in the CDR 2 group. Frontal lobe functions were associated with anosognosia only in the CDR 0.5 and 1 groups. After stratification by CDR, in the CDR 0.5 group, the prevalence of agitation ( P = .040) and appetite ( P = .013) was significantly higher in patients with anosognosia. In the CDR 1 group, patients with anosognosia had a significantly higher prevalence of delusions ( P = .032), hallucinations ( P = .048), and sleep disturbances ( P = .047). In the CDR 2 group, we found no statistical difference in the frequency of symptoms between patients with and without anosognosia. Conclusion: These results confirm that the prevalence of anosognosia as well as the individual NPS and cognitive functions associated with it differ according to EOAD severity.

scholarly journals Clinical characteristics and neuroimaging findings of seven patients with Dyke Davidoff Masson syndrome

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bing Wang ◽  
Wentao Jiang ◽  
Weiqiang Yan ◽  
Jianhong Tian ◽  
Jianxing Xu ◽  
...  
Keyword(s):  
Mental Retardation ◽  
Behavioral Disorders ◽  
Clinical Characteristics ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Clinical Manifestations ◽  
Cerebral Atrophy ◽  
Facial Asymmetry ◽  
Compensatory Hypertrophy ◽  
Neuropsychiatric Manifestations

Abstract Background DDMS is a rare disease diagnosed by clinical and radiological characteristics. But the complexity of radiological and clinical manifestations of DDMS has become a challenge diagnostically. To date, the reported cases with DDMS had highly varied clinical manifestations including seizures, contralateral hemiplegia/hemiparesis, facial asymmetry, mental retardation, etc. In addition to typical clinical findings, some new characteristics have been recently added to the spectrum of DDMS. However, few cases have been reported to be associated with neuropsychiatric symptoms according to the literature. This study aimed to investigate the neuropsychiatric manifestations associated with Dyke-Davidoff-Masson syndrome (DDMS) and related imaging findings. Methods This study included 7 patients diagnosed with DDMS between 2014 and 2020. The clinical characteristics, neuropsychiatric manifestations, and radiological results were retrospectively evaluated. Results Seven patients (five males and two females) with a mean age of 28.0 ± 9.73 (range 15.0–41.0) years were included. Five patients were admitted to the psychiatric unit due to psychological and behavioral disorders. Two patients were referred to the neurology unit mainly due to epilepsy. Six patients had epileptic seizures, 4 had hemiplegia, 3 had mental retardation, 2 patients had external ear deformities, and 2 had facial asymmetry. Neuropsychiatric symptoms were presented in 6 (85.7 %) cases. Cases 2–6 developed affective disorders. Deficits in verbal communication, impairment of social interaction, lack of insight, adulia and hypobulia appeared in cases 1–4. Schizophrenia with apathy, and epileptic schizoid psychosis were observed in cases 4 and 5 respectively. Case 6 had behavioral disorders, hyperactivity, tic disorder, mental retardation, anxiety, catatonic symptoms and suicidal tendency. Case 7 had seizures and mental retardation, and no psychiatric symptoms were presented. Radiological examinations showed unilateral cerebral atrophy, enlarged lateral ventricles, and various compensatory hypertrophy of the skull in all cases. The midline structure has shifted to the affected side in 5(71.4 %) cases. Atrophy of the basal ganglia or brain stem was observed in 4(57.1 %) cases. Conclusions The hallmark imaging manifestations of DDMS facilitated the diagnosis in most cases. This study illustrated that a variety of psychoneurotic disorders and ear abnormalities were correlated with DDMS.

scholarly journals Clinical Characteristics of Asymptomatic Patients with SARS-CoV-2 in Zhejiang: An Imperceptible Source of Infection

2020 ◽  
Vol 2020 ◽  
pp. 1-5 ◽  
Author(s):  
Wei Dai ◽  
Xinmiao Chen ◽  
Xiaoting Xu ◽  
Zhefeng Leng ◽  
Wenwen Yu ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Clinical Symptoms ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Transmission Risk ◽  
Asymptomatic Group ◽  
Symptomatic Group ◽  
Source Of Infection ◽  
Asymptomatic Patients ◽  
Novel Coronavirus

Objective. Coronavirus disease 2019 (COVID-19), caused by the novel coronavirus SARS-CoV-2, was first identified in December 2019 in Wuhan, China, and has since spread globally, resulting in an ongoing pandemic. However, the study of asymptomatic patients is still rare, and the understanding of its potential transmission risk is still insufficient. In this study, epidemiological investigations were conducted in the Zhejiang province to understand the epidemiology and clinical characteristics of asymptomatic patients with COVID-19. Methods. This retrospective study was carried out on 22 asymptomatic patients and 234 symptomatic patients with COVID-19 who were hospitalized in Zhejiang Duodi Hospital from January 21 to March 16, 2020. The characteristics of epidemiology, demography, clinical manifestations, and laboratory data of mild patients were compared and analyzed. Results. The median age was 28 years in asymptomatic patients and 48 years in symptomatic patients. The proportion who were female was 77.3% in asymptomatic patients and 36.3% in symptomatic patients (p<0.001). The proportion of patients with coexisting diseases was 4.5% in asymptomatic patients and 38.0% in symptomatic patients (p=0.002). The proportion of patients with increased CRP was 13.6% in the asymptomatic group and 61.1% in the symptomatic group (p<0.001). The proportion of patients received antiviral therapy was 45.5% in the asymptomatic group and 97.9% in the symptomatic group (p<0.001). The proportion of patients received oxygen therapy was 22.7% in the asymptomatic group and 99.1% in symptomatic patients (p<0.001). By March 16, 2020, all patients were discharged from the hospital, and no symptoms had appeared in the asymptomatic patients during hospitalization. The median course of infection to discharge was 21.5 days in asymptomatic patients and 22 days in symptomatic patients. Conclusions. Asymptomatic patients are also infectious; relying only on clinical symptoms, blood cell tests, and radiology examination will lead to misdiagnosis of most patients, leading to the spread of the virus. Investigation of medical history is the best strategy for screening asymptomatic patients, especially young people, women, and people without coexisting disease, who are more likely to be asymptomatic when infected. Although the prognosis is good, isolation is critical for asymptomatic patients, and it is important not to end isolation early before a nucleic acid test turns negative.

scholarly journals Insights into the Pathophysiology of Psychiatric Symptoms in Central Nervous System Disorders: Implications for Early and Differential Diagnosis

2021 ◽  
Vol 22 (9) ◽  
pp. 4440
Author(s):  
Giulia Menculini ◽  
Elena Chipi ◽  
Federico Paolini Paoletti ◽  
Lorenzo Gaetani ◽  
Pasquale Nigro ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Impulse Control ◽  
Psychiatric Symptoms ◽  
Neurological Diseases ◽  
Clinical Manifestations ◽  
Obsessive Compulsive ◽  
Clinical Onset ◽  
Brain Circuits

Different psychopathological manifestations, such as affective, psychotic, obsessive-compulsive symptoms, and impulse control disturbances, may occur in most central nervous system (CNS) disorders including neurodegenerative and neuroinflammatory diseases. Psychiatric symptoms often represent the clinical onset of such disorders, thus potentially leading to misdiagnosis, delay in treatment, and a worse outcome. In this review, psychiatric symptoms observed along the course of several neurological diseases, namely Alzheimer’s disease, fronto-temporal dementia, Parkinson’s disease, Huntington’s disease, and multiple sclerosis, are discussed, as well as the involved brain circuits and molecular/synaptic alterations. Special attention has been paid to the emerging role of fluid biomarkers in early detection of these neurodegenerative diseases. The frequent occurrence of psychiatric symptoms in neurological diseases, even as the first clinical manifestations, should prompt neurologists and psychiatrists to share a common clinico-biological background and a coordinated diagnostic approach.

scholarly journals Perioperative cannabis use: a longitudinal study of associated clinical characteristics and surgical outcomes

2020 ◽  
pp. rapm-2020-101812
Author(s):  
Jenna McAfee ◽  
Kevin F Boehnke ◽  
Stephanie M Moser ◽  
Chad M Brummett ◽  
Jennifer F Waljee ◽  
...  
Keyword(s):  
Surgical Outcomes ◽  
Clinical Characteristics ◽  
Sleep Disturbances ◽  
Clinical Symptoms ◽  
Elective Surgery ◽  
Cannabis Use ◽  
Self Report ◽  
Opioid Use ◽  
Benzodiazepine Use ◽  
Pain Symptoms

BackgroundDespite increases in cannabis use generally and for pain management, data regarding cannabis use in patients undergoing surgery are lacking. This study examined the prevalence of cannabis use among patients undergoing elective surgery and explored differences in clinical characteristics and surgical outcomes between cannabis users and non-cannabis users.MethodsThis prospective study included 1335 adults undergoing elective surgery. Participants completed self-report questionnaires preoperative and at 3-month and 6-month postsurgery to assess clinical characteristics and surgical outcomes.ResultsOverall, 5.9% (n=79) of patients reported cannabis use (53.2% medical, 19.0% recreational and 25.3% medical and recreational). On the day of surgery, cannabis users reported worse pain, more centralized pain symptoms, greater functional impairment, higher fatigue, greater sleep disturbances and more symptoms of anxiety and depression versus non-cannabis users (all p<0.01). Additionally, a larger proportion of cannabis users reported opioid (27.9%) and benzodiazepine use (19.0%) compared with non-cannabis users (17.5% and 9.2%, respectively). At 3 and 6 months, cannabis users continued to report worse clinical symptoms; however, both groups showed improvement across most domains (p≤0.05). At 6 months, the groups did not differ on surgical outcomes, including surgical site pain (p=0.93) or treatment efficacy (p=0.88).ConclusionsCannabis use is relatively low in this surgical population, yet cannabis users have higher clinical pain, poorer scores on quality of life indicators, and higher opioid use before and after surgery. Cannabis users reported similar surgical outcomes, suggesting that cannabis use did not impede recovery.

scholarly journals Epidemiological and clinical characteristics of three family clusters of COVID-19 transmitted by latent patients in China

2020 ◽  
Vol 148 ◽  
Author(s):  
Jing Li ◽  
Jiguang Ding ◽  
Li Chen ◽  
Liang Hong ◽  
Xiaoqi Yu ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
First Generation ◽  
Clinical Symptoms ◽  
Clinical Manifestations ◽  
Third Generation ◽  
Illness Onset ◽  
Family Cluster ◽  
The Family ◽  
Sporadic Cases ◽  
Index Cases

Abstract From 21 January 2020 to 9 February 2020, three family clusters involving 31 patients with coronavirus disease 2019 were identified in Wenzhou, China. The epidemiological and clinical characteristics of the family cluster patients were analysed and compared with those of 43 contemporaneous sporadic cases. The three index cases transmitted the infection to 28 family members 2–10 days before illness onset. Overall, 28 of the 41 sporadic cases and three of 31 patients in the family clusters came back from Wuhan (65.12 vs. 9.68%, P< 0.001). In terms of epidemiological characters and clinical symptoms, no significant differences were observed between the family cluster and sporadic cases. However, the lymphocyte counts of sporadic cases were significantly lower than those of family cluster cases ((1.32 ± 0.55) × 109/l vs. (1.63 ± 0.70) × 109/l, P = 0.037), and the proportion of hypoalbuminaemia was higher in sporadic cases (18/43, 41.86%) than in the family clusters (6/31, 19.35%) (P < 0.05). Within the family cluster, the second- and third-generation cases had milder clinical manifestations, without severe conditions, compared with the index and first-generation cases, indicating that the virulence gradually decreased following passage through generations within the family clusters. Close surveillance, timely recognition and isolation of the suspected or latent patient is crucial in preventing family cluster infection.

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