scholarly journals Naloxone Alleviate the Severity of Delirium in Hospitalized Patients With Parkinsonism: Three Case Reports

2021 ◽  
Vol 12 ◽  
Author(s):  
Haiyan Jin ◽  
Jie Zhang ◽  
Qiongyue Hu ◽  
Junjiao Ping ◽  
Tingyun Jiang ◽  
...  

Purpose: Delirium is common in geriatric with Parkinson's disease (PD). Treatments for delirium have generally been neuroleptics; however, antipsychotics have potential effect to block striatal dopamine D2 receptors and worsen symptom of parkinsonism. We explored whether naloxone can alleviate delirium in PD and other forms of parkinsonism.Patients and Methods: Patients with parkinsonism who met the delirium criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) received naloxone infusions once or twice daily. Treatment effects were evaluated by the delirium rating scale–revised 98 (DRS-R98), including non-cognitive and cognitive subscales; the Richmond agitation–sedation scale (RASS); and the mini mental status examination (MMSE).Results: Two patients with primary parkinsonism, one with vascular PD were observed. The daily dose of naloxone was 2.08 ± 0.64 mg (range: 1–4 mg). Medication time last from 1 h to 7 days without side effects observed. Following with naloxone infusions, DRS-R98 scores decreased within 12 h and MMSE scores increased. The psychotic symptoms, disorientation, and attention deficits were alleviated significantly, while RASS scores decreased with naloxone treatment.Conclusion: Naloxone alleviated psychotic symptoms, improved cognitive dysfunction, and irritability in patients with delirium in the context of PD. The preliminary findings point out that the opioid system may be involved in the pathophysiology of delirium, which may be one of potential treat targets for delirium of PD.

2016 ◽  
Vol 23 (10) ◽  
pp. 1126-1135 ◽  
Author(s):  
Josep Antoni Ramos-Quiroga ◽  
Viviana Nasillo ◽  
Vanesa Richarte ◽  
Montserrat Corrales ◽  
Felipe Palma ◽  
...  

Objective: The aim of this study was to assess for the first time the criterion validity of the semi-structured Diagnostic Interview for ADHD in adults (DIVA 2.0), and its concurrent validity in comparison with the Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID) and other ADHD severity scales, following the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria. Method: A transversal study was performed on 40 out-patients with ADHD to check the criteria and concurrent validity of the DIVA 2.0 compared with the CAADID. Results: The DIVA 2.0 interview showed a diagnostic accuracy of 100% when compared with the diagnoses obtained with the CAADID interview. The concurrent validity demonstrated good correlations with three self-reported rating scales: the Wender Utah Rating Scale (WURS; r = .544, p < .0001), the ADHD-Rating Scale ( r = .720, p < .0001), and Sheehan’s Dysfunction Inventory ( r = .674, p < .0001). Conclusion: The DIVA 2.0 is a reliable tool for assessing and diagnosing Adult ADHD and is the only one that offers free online access for clinical and research purposes.


2019 ◽  
Vol 33 (5) ◽  
pp. 243-249 ◽  
Author(s):  
Faik Ilik ◽  
Hüseyin Büyükgöl ◽  
Fatih Kayhan ◽  
Devrimsel Harika Ertem ◽  
Timur Ekiz

Objective: We investigated the effects of inappropriate sexual behaviors (ISBs) and neuropsychiatric symptoms (NPSs) of patients with Alzheimer disease (AD), and of caregivers’ depression, on the caregiver burden. Method: One hundred forty three patients with AD and their caregivers were included in the study. Sixty-five patients without AD who needed care due to their disability and their caregivers were enrolled for the comparison. Depression in caregivers was diagnosed using The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (SCID-I). The Mini-Mental State Examination (MMSE) and Clinical Dementia Rating Scale were used to evaluate the severity of AD. The Neuropsychiatric Inventory (NPI) was used to assess the NPSs of patients. Caregiver burden was evaluated using the Zarit Burden Interview (ZBI). Results: Inappropriate sexual behaviors were found in 13 (9.1%) of the AD group. Inappropriate sexual behaviors were more common in moderate or severe AD ( P = .009, χ2 = 9.396). The prevalence of depression (n = 38, 26.6%) was higher in caregivers of AD group with ISBs ( P = .000, χ2 = 24.69). The ZBI scores of caregivers of patients with AD were higher than the comparison group. In addition, the ZBI scores of caregivers of patients with AD were significantly higher in the AD group with ISB, a high total score of NPI, and a low score of MMSE. The caregivers of AD group with depression had higher ZBI scores ( P < .05). Conclusions: The severity of AD, the presence of NPSs in patients, and major depression in caregivers were risk factors for an increased caregiver burden.


1997 ◽  
Vol 12 (4) ◽  
pp. 190-193 ◽  
Author(s):  
J Cohen

SummaryThe understanding and classification of persistently depressed mood has undergone many changes since the term ‘dysthymia’ was first used nearly 150 years ago. Originally it was applied to both melancholia and mania; later it was applied to depressive personality. The Diagnostic and Statistical Manual (DSM)-III in 1980 and in subsequent updates classified dysthymia as a mood disorder, characterized by a frequently insidious onset and a course that is chronic and unremitting. The assessment of clinical response in the pharmacologic treatment of dysthymia has been more difficult than that for major depression. The Hamilton Rating Scale for Depression, among others, is oriented towards episodic rather than chronic states of depression. A new rating scale, the Cornell Dysthymia Rating Scale, has been developed to better assess milder symptomatology in chronically depressed patients. Early studies suggest its utility, but further validation of the scale is needed in patients with dysthymia and without major depression.


2020 ◽  
Author(s):  
Elizabeth Lehinger ◽  
David E Reed ◽  
Paul Nabity ◽  
Nicole Brackins ◽  
Robert Villarreal ◽  
...  

ABSTRACT Introduction Chronic pain and post-traumatic stress disorder (PTSD) comorbidity is prevalent among veterans and is associated with increased levels of pain severity and pain-related disability. An improved understanding of the relationship between these co-occurring disorders, in addition to effective integrated treatments, will develop by considering the changes to the PTSD diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The current study examined the relationship between the revised PTSD Checklist for DSM-5 (PCL-5) symptom clusters (i.e., intrusion, avoidance, negative alterations in cognition and mood [NACM], and arousal) and chronic pain measurements (i.e., pain severity, interference, and disability). Materials and Methods Participants included 103 veterans (ages 26-70, mean = 45.33) participating in a randomized clinical trial examining the efficacy of an interdisciplinary pain management program for chronic musculoskeletal pain. The study was approved by a university system Institutional Review Board and affiliated healthcare system. Results The participants with a provisional PTSD diagnosis based on PCL-5 responses (N = 76) had significantly greater pain severity, interference, and disability than the participants without a provisional diagnosis (N = 23). Correlations between symptom clusters and pain measurements were mostly significant and positive with varying strengths. The avoidance symptom cluster, however, had relatively weaker correlations with pain measurements and was not significantly associated with the numeric rating scale of pain severity. Path analyses revealed that, after controlling for avoidance symptoms, significant associations remained between NACM and all the pain measurements. After controlling for NACM symptoms, however, there were no significant associations between avoidance symptoms and pain measurements. Conclusion The current study highlights a need to re-examine the leading theories about the mutual maintenance of these disorders in order to develop effective integrative treatment approaches. PTSD-related avoidance may have a relatively weaker role in co-occurring chronic pain than the other symptom clusters and may have a qualitatively different role than chronic pain–related avoidance. Future research should explore the relationship between the avoidance in PTSD and the avoidance in chronic pain as well as identify which chronic pain measurements are the most useful when examining the relationship between PTSD and chronic pain. The potential impact of trauma-related cognition and mood on chronic pain indicates that this is an important area for intervention and should be considered in the development of integrated treatments for chronic pain and PTSD among veterans.


2015 ◽  
Vol 24 (9) ◽  
pp. 1237-1245 ◽  
Author(s):  
Adil Zorlu ◽  
Gulsen Unlu ◽  
Burcu Cakaloz ◽  
Mehmet Zencir ◽  
Ahmet Buber ◽  
...  

Objective: The aim of the present study was to explore the prevalence and comorbidity rates of ADHD in a community sample of school-age children. Method: Participants were 1,508 children aged 6 to 14 years. Parents and teachers of each child completed the Turgay Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) Disruptive Behavior Disorders Rating Scale (T- DSM-IV-S). Screen-positive cases were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version (K-SADS-PL). Diagnoses were based on DSM-IV criteria. Results: The prevalence rate of ADHD was 8%. Children from extended families had extremely high rates (46.4%) of ADHD. Sixty percent of children with ADHD had one or more comorbid diagnoses. The most common comorbidities were learning disorders (35.7%) and oppositional defiant disorder (22.6%). Conclusion: The prevalence and comorbidity rates of ADHD in school-age children in Turkey are similar to those found in previous studies in other countries.


Author(s):  
Jingjie Zhao ◽  
Xu Guo ◽  
Yi Du ◽  
Yu Han ◽  
Yongzhi Wang ◽  
...  

AbstractBackground:Major depressive disorder (MDD) frequently co-occurs with other psychiatric problems. Our previous study showed thatMethods:All participant patients were diagnosed by Diagnostic and Statistical Manual of Mental Disorders – 4th edition (DSM-IV). Hamilton rating scale for depression (HAM-D) and anxiety (HAM-A) were applied to group patients into different categories.Results:expression levels of all MDD subgroups showed significant reduction compared to the control group (p<0.01). Further, the trend ofConclusions:expression level reduction is related to MDD anxiety score, which may be an explanation for the clinical manifestations and the underlining physiological mechanisms.


2016 ◽  
Vol 33 (2) ◽  
pp. 127-138 ◽  
Author(s):  
Samantha L. Ward ◽  
Karen A. Sullivan ◽  
Linda Gilmore

Objective: Limited time and resources necessitate the availability of accurate, inexpensive and rapid diagnostic aids for Autism Spectrum Disorder (ASD). The Autistic Behavioural Indicators Instrument (ABII) was developed for this purpose, but its psychometric properties have not yet been fully established. Method: The clinician-rated ABII, the Autism Diagnostic Observation Schedule (ADOS), the Childhood Autism Rating Scale – Second Edition, Standard Version (CARS2-ST), and Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnostic criteria were individually administered to children with an independent paediatrician DSM-IV-TR or DSM-5 autism spectrum diagnosis, aged 2-6 years (n = 51, Mchildage = 3.6 years). The agreement between each of the measures on autism diagnostic classification was calculated and compared, and the intercorrelation between the instruments examined. Results: There was significant moderate agreement for the classification of autism between the ABII and the DSM-5, and significant fair agreement between the ABII and ADOS and ABII and CARS2-ST. True positive diagnostic classifications were similar across the ABII (n = 47, 92.2%) and ADOS (n = 45, 88.2%), and significantly higher than the CARS2-ST (n = 30, 58.8%). The ABII total scale score was strongly positively correlated with both the ADOS and CARS2-ST total scores. Conclusion: The ABII's test characteristics were comparable to those of established measures, and the intercorrelations between selected measures support its convergent validity. The ABII could be added to the clinician's toolbox as a screening test.


Author(s):  
Hicham Laaraj ◽  
◽  
Mina Ouhamou ◽  
Omar El Omari ◽  
Jalal Doufik ◽  
...  

The relationship between the menstrual cycle and mood disturbances has been described in the literature and is linked to changes in the secretion of sex hormones. Rare studies have reported the exacerbation of obsessions during menstruation, while no case reports the onset of premenstrual Obsessive-Compulsive Disorder (OCD). Nosographically, obsessive symptoms are not part of premenstrual syndrome, and no specification of the menstrual cycle for obsessive disorders was mentioned in DSM 5 (Diagnostic and Statistical Manual of Mental Disorders). We report a 39-year-old patient followed for panic disorder since adolescence, and who currently presents for obsessive symptoms that meet the diagnostic criteria for an obsessive-compulsive disorder, and which have the particularity of occurring exclusively during menstruation. Our case emphasizes the importance of establishing a new nosographic framework that takes into account the development of obsessive-compulsive symptoms related to the menstrual cycle. Keywords: Obsessive-compulsive disorder; menstruation cycle; nosography.


2018 ◽  
Vol 23 (10) ◽  
pp. 1101-1110 ◽  
Author(s):  
Michael J. Silverstein ◽  
Stephen V. Faraone ◽  
Samuel Alperin ◽  
Terry L. Leon ◽  
Joseph Biederman ◽  
...  

Objective: The aim of this study is to validate the Adult ADHD Self-Report Scale (ASRS) and Adult ADHD Investigator Symptom Rating Scale (AISRS) expanded versions, including executive function deficits (EFDs) and emotional dyscontrol (EC) items, and to present ASRS and AISRS pilot normative data. Method: Two patient samples (referred and primary care physician [PCP] controls) were pooled together for these analyses. Results: Final analysis included 297 respondents, 171 with adult ADHD. Cronbach’s alphas were high for all sections of the scales. Examining histograms of ASRS 31-item and AISRS 18-item total scores for ADHD controls, 95% cutoff scores were 70 and 23, respectively; histograms for pilot normative sample suggest cutoffs of 82 and 26, respectively. Conclusion: (a) ASRS- and AISRS-expanded versions have high validity in assessment of core 18 adult ADHD Diagnostic and Statistical Manual of Mental Disorders ( DSM) symptoms and EFD and EC symptoms. (b) ASRS (31-item) scores 70 to 82 and AISRS (18-item) scores from 23 to 26 suggest a high likelihood of adult ADHD.


2019 ◽  
Vol 25 (2) ◽  
pp. 293-303
Author(s):  
Renee D Rienecke ◽  
Amy Drayton ◽  
Rebekah L Richmond ◽  
Kathleen A Mammel

Avoidant/restrictive food intake disorder (ARFID) was introduced in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. Three different subtypes of ARFID are described: individuals who seem disinterested in eating, those who avoid certain foods because of a sensitivity to specific characteristics of the food, and those who are concerned about an aversive experience associated with eating. There is currently no first-line treatment for ARFID. Three case studies are presented of patients with ARFID who participated in a family-based partial hospitalization program/intensive outpatient program for eating disorders. A description of the course of treatment is included, as well as ways in which the eating disorder program adapted treatment to more closely meet the unique needs of these patients. An approach with emphasis on parental involvement seems promising, although research is needed to investigate this more fully.


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