Early and Progressive Cognitive Disorder Imposes CADASIL Syndrome in the Diagnostic Assumption

The case presented is a diagnostic challenge considering the family and medical history of the 65-year-old patient with a family history of migraine depression, emotional lability, and gait disorders manifested at his grandmother, his mother, and his sister. After multiple hospitalizations for the described symptoms and multiple treatments with questionable results, the diagnosis was imposed by the appearance described by brain MRI to which were added the data from the patient's family and personal history. Of course, a full confirmation of the diagnosis would have required skin biopsies and genetic testing that the patient refused to perform. However, due to its peculiarities, the presented case tries to offer a diagnostic orientation path for practitioners in situations where previous diagnoses and treatments are not sufficiently conclusive either due to the impossibility of performing specific tests at that time or either because of the patient's indifference to his state of health.

Conduct problems among children in low-income, urban neighborhoods: A developmental psychopathology- and RDoC-informed approach

Conduct problems are associated with numerous negative long-term psychosocial sequelae and are among the most frequent referrals for children's mental health services. Youth residing in low-income, urban communities are at increased risk for conduct problems, but not all youth in these environments develop conduct problems, suggesting heterogeneity in risk and resilience processes and developmental pathways. The present study used a developmental psychopathology- and Research Domain Criteria (RDoC)-informed approach for conceptualizing risk and resilience for conduct problems among children from low-income, urban neighborhoods. Participants were 104 children (M = 9.93 ± 1.22 years; 50% male; 96% African American, 4% Latinx). We assessed four constructs reflecting cognitive and neurobiological processes associated with conduct problems using multiple levels of analysis and informants: autonomic nervous system reactivity, limbic system/orbitofrontal cortical functioning, dorsolateral prefrontal cortical functioning, and conduct problems. Latent profile analysis identified four profiles: typically developing (TD, n = 34); teacher-reported conduct problems (TCP, n = 14); emotion processing (EP, n = 27); and emotion expression recognition (EER, n = 29). External validation analyses demonstrated that profiles differed on various indices of conduct problems in expected ways. The EP profile exhibited lower levels of emotional lability and callous–unemotional behaviors, and higher levels of prosocial behavior. The TD profile demonstrated elevated emotional lability. Implications for etiological and intervention models are presented.

Some Predictors of Depressive Disorders in the Context of Clinical Patomorphosis

The purpose of the study was to study the clinical and psychopathological phenomenology of the initial stage of depressive disorders in the context of clinical pathomorphosis. Materials and methods. Features of clinical symptoms of the initial stage of depressive disorders in the comparative aspect in the context of clinical pathomorphosis based on the analysis of medical records of 236 patients who were treated for depressive disorders in 1971-1995 (ICD-9 codes 296.1, 296.3) and clinical examination of 245 patients with depressive disorders in 2015-2019 (ICD-10 codes F 31.3, F 31.4, F 32.0, F 32.1, F 32.2, F 33.0, F 33.1, F 33.2) are considered. Results and discussion. It was established that there is a predominance in the clinical picture of modern depressive disorders of low mood (in general in 91.4% of patients, 91.6% of men and 91.3% of women, p>0.05), dyssomnia (93.1%, 92.5% and 93.5%, respectively, p>0.05), anxiety, fear (84.5%, 78.5%, 89.1%, respectively, p<0.01), asthenia (82.4%, 77.6% and 86.2%, respectively, p>0.05), somatic vegetative symptoms (82.9%, 77.6% and 87.0%, respectively, p<0.01), apathy (78.8%, 69.2% and 86.2%, respectively, p<0.01) and ideas of self-humiliation and self-blame (69.8%, 72.9% and 67.4%, respectively, p<0.01), and the relatively low prevalence of obsessive symptoms (55.1%, 54.2% and 55.8%, respectively, p<0.05), emotional lability (51.0%, 54.2% and 48.6%, respectively, p<0.01) and cognitive impairment (45.3%, 43.9% and 46.4%, respectively, p<0.05) with a predominance of emotional lability and ideas of self-humiliation and self-blame in men, and manifestations of anxiety, fear, apathy, cognitive impairment, obsessive and somatic vegetative symptoms in women, which gives grounds to consider that the main predictors of depressive disorder at the initial stage of low mood are dyssomnia, anxiety fear, asthenia and somatic vegetative symptoms. The revealed features suggest the presence of a clinical pathomorphosis of depressive disorders. The clinical pathomorphosis of the initial stage of depressive disorders is in a significant reduction in the clinical picture of low mood, ideas of self-abasement and self-blame, emotional lability and cognitive impairment, and an increase in anxiety, fear, asthenia, apathy, obsessive symptoms and obsessive-compulsive symptoms, with significantly greater gender differentiation of clinical symptoms of depression. Conclusion. The identified patterns are embedded in the general trend towards polymorphism and clinical undifferentiation of modern depressive disorders, significant involvement of patients with sleep disorders, asthenic, apathetic and somatic vegetative symptoms, which requires revision of diagnostic strategies and individualization of diagnosis. The identified patterns can be used for early diagnosis of depressive disorders and prevention of depression

EXPERIMENTAL VERIFICATION OF THE AUTHOR'S PROGRAM OF PSYCHOCORRECTION OF EMOTIONAL STATES OF ELDERLY WOMEN WITH PARTICULAR HEART DISEASE

The article presents the results of an experimental test of the author's program of psychocorrection of emotional states of elderly women with coronary heart disease. The main psychophysiological indicators of the emotional state of elderly women, which affect the development of coronary heart disease, are determined. These include: alexithymia, depression, openness, anxiety, neuroticism, sociability, emotional lability. The following methods of processing the obtained results were chosen, in view of the small number of respondents: Spearman's rank correlation method, Student's T-test; T - Wilcoxon test). Methods used: "Toronto Alexithymic Scale", "Hamilton Scale for Depression", "Hamilton Scale for Anxiety", "Asthenic Scales", "Neuropsychiatric Stress Questionnaire", "Aggression Questionnaire", "FR Questionnaire , according to theoretically determined indicators of the emotional sphere of elderly women with coronary heart disease. It was found that for psychophysiological indicators of depression, anxiety, neuroticism, openness, emotional lability, significance was recorded using Wilcoxon's T-test, which indicates that the change in these indicators occurred as a result of our method with a probability of more than 99%. It is noted that the level of psychophysiological indicators of alexithymia and sociability did not change significantly. We explain the weak influence of the proposed method on these indicators by objective factors. Correction of alexithymia should include a focus on the patient's awareness of their feelings and the ability to express them and should be carried out on the patient comprehensively and over a long period of time. We have identified an important cause of coronary heart disease in elderly women, which is a combination of elevated levels of negative emotions with an intense tendency to suppress their expression in social contacts and interpersonal interaction. The effectiveness of the correctional program has been proved, which can be further used by psychologists as a psychocorrectional component of the general set of measures during outpatient treatment of coronary heart disease and its psychoprophylaxis. We see the prospect of further research in the improvement of the author's comprehensive program, expansion of its corrective spectrum of action and further testing.

Characterizing the features and course of psychiatric symptoms in children and adolescents with autoimmune encephalitis

Autoimmune encephalitis (AE) can present like a psychiatric disorder. We aimed to illustrate the psychiatric manifestations, course and management of AE in a paediatric cohort. Neuropsychiatric symptoms, investigations and treatment were retrospectively retrieved in 16 patients (mean age 11.31, SD 2.98) with an AE diagnosis at the liaison psychiatry services in two UK tertiary paediatric centres. Psychiatric presentation was characterised by an acute polysymptomatic (predominantly agitation, anger outbursts/aggressiveness, hallucinations, and emotional lability) onset. Antipsychotics produced side effects and significant worsening of symptoms in four cases, and benzodiazepines were commonly used. This psychiatric phenotype should make clinicians suspect the diagnosis of AE and carefully consider use of treatments.

Multimodal treatment strategies in Huntington’s disease

Huntington’s disease (HD) is an incurable neurodegenerative disease that causes involuntary movements, emotional lability, and cognitive dysfunction. HD symptoms usually develop between ages 30 and 50, but can appear as early as 2 or as late as 80 years. Currently no neuroprotective and neurorestorative interventions are available. Early multimodal intervention in HD is only possible if the genetic diagnosis is made early. Early intervention in HD is only possible if genetic diagnosis is made at the disease onset or when mild symptoms manifest. Growing evidence and understanding of HD pathomechanism has led researchers to new therapeutic targets. Here, in this article we will talk about the multimodal treatment strategies and recent advances made in this field which can be used to target the HD pathogenesis at its most proximal level.

The phenomenon of aggression in individuals with schizophrenia

Objective: to compare and identify differences in the psychopathological symptoms and domains of social cognition in groups of individuals suffering from schizophrenia with a high level of aggression with or without alcohol consumption.Materials and methods. In the period from 2014 to 2020, we performed a comparative, cross-section, one-stage, observational study with the formation of a sample by the method of directed selection at Gomel Regional Clinical Psychiatric Hospital. The following assessment methods were used: 1. Screening for alcohol use — ASSIST scale (Humeniuk R. et al. 2008), 2. Determination of the level of aggression — OAS scale (Yudofsky SC 1986), 3. Degree of severity of psychopathological symptoms — PANSS scale (S. Kay, L.Opler 1986), 4. Hostile attributive style of the AIHQ scale (Combs D. R. et al., 2007). 5. The research of emotional processing was performed using a computerized neuropsychological battery (PennCNP) to study the neuropsychological functioning of the Laboratory of Brain Problems of the University of Pennsylvania.Results and discussion: The group with a preclinical level of alcohol consumption revealed changes in emotional processing (″reduced facial memory″), a bias in the attributive style towards hostility, and changes in the psychopathological symptoms, such as an increase in ″emotional lability″ and ″decreased judgment and awareness of the disease″. In the group without alcohol consumption, an increase in ″false positive recognition of neutral emotions″ and an increase in the degree of manifestation of the symptom of ″delusion″ were revealed.Conclusion: Alcohol and aggression are in conjunction with the psychopathological symptom ″emotional lability″ (PANSS scale) and the domain of social cognition ″attributive style″ (″anger index″). In the group without alcohol consumption, aggression is related to the ″delusion″ symptom.

Two Facets of Emotion Dysregulation Are Core Symptomatic Domains in Adult ADHD: Results from the SR-WRAADDS, a Broad Symptom Self-Report Questionnaire

Objectives: Emotional dysregulation (ED) in adult ADHD is frequent but definition and tools for its evaluation are not consensual. Our aim was to determine the core ADHD symptomatic domains via the Self-Reported Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS) following its validation in a large clinical sample of adults with ADHD and controls. Method: Three hundred sixty-nine adult patients with ADHD and 251 healthy participants completed the SR-WRAADDS and questionnaires about ADHD, depression, and ED. We analyzed the psychometric properties of the SR-WRAADDS and a factor analysis yielded symptomatic domains. Results: The SR-WRAADDS has good reliability. The 30 symptoms were best organized in a four-factor solution: attention/disorganization, hyperactivity/restlessness, impulsivity/emotional outbursts, and emotional lability. Conclusions: The symptomatic structure of the SR-WRAADDS includes two distinct dimensions related to ED: “impulsivity/emotional outbursts” and “emotional lability.” The SR-WRAADDS is a reliable and clinically useful tool that assesses all ADHD symptom domains, including facets of ED.

Withdrawal Symptoms Following Discontinuation of Vortioxetine—Retrospective Chart Review

The efficacy of vortioxetine has been proven in many studies, but data concerning discontinuation symptoms (DS) after vortioxetine withdrawal is scarce. The aim of our study is to systematically evaluate the prevalence, determinants, and clinical features of vortioxetine DS in a retrospective chart review. Data were obtained from medical records of 263 adult patients with depressive disorders who discontinued former vortioxetine treatment. DS were observed in eight (3%) patients after 71–375 days (median 272) of treatment. DS emerged after median three days following vortioxetine withdrawal and lasted for median seven days. The clinical presentation of DS involved: emotional lability (100% of patients), irritability (75%), sudden worsening of mood (75%), nervousness (37.5%), and agitation (37.5%). Median DESS score was four (range of four to six). DS were significantly more prevalent after accidental vs. planned discontinuation (adjusted p = 0.011) and were less frequent after switching to a different antidepressant vs. ceasing pharmacotherapy (adjusted p = 0.0165). DS appeared more often if patients discontinued therapy without medical consultation (adjusted p = 0.033). The occurrence of DS was not associated with the dose and way of drug discontinuation (sudden vs. gradual). In sum, our results show that clinicians should be aware that vortioxetine withdrawal is associated with the possibility of DS.