Efficacy and Safety of Citalopram Compared to Atypical Antipsychotics on Agitation in patients with BPSD

Background: The psychomotor agitation of the behavioural and psychological symptoms of dementia (BPSD) is one of the common issues in aged care facilities, leading to the poor functional and medical consequences. Psychotropic interventions are the preferred choice of treatment, but which medication should be the prescribers first preference? This review aims to compare pharmacological interventions for psychomotor agitation, judging them according to their effectuality and justifiability profiles. This is to be achieved by retrieving information from Randomised Control Trials (RCTs) and systematic reviews. Objectives: This review evaluates evidence from RCTs, systematic reviews, and meta-analyses of BPSD patients who have taken agitation treatments. Assessing the efficacy of selective serotonin reuptake inhibitors (SSRI) and antipsychotic treatments when compared to each other for the purpose of improving agitation outcomes. Methods: This review includes RCT that compared one or more active ingredient medications with another medication or with a placebo, along with systematic reviews comparing citalopram (SSRI) with antipsychotics such as quetiapine, olanzapine, and risperidone. Studies were extracted by searching and accessing databases, such as PubMed, OVID, and Cochrane with restrictions of date from 2000 to 2021 and English language. Conclusion: There is still limited studies of SSRIs for the treatment of agitation in BPSD. SSRIs such as citalopram were associated with a reduction in symptoms of agitation, and lower risk of adverse effects compared to antipsychotics. Future studies are required to assess the long-term safety and efficacy of SSRI treatments for agitation in BPSD.

New Hope for Behavioural and Psychological Symptoms in Dementia (BPSD): A Narrative Review of Clinical Studies Conducted in the Symptomatic Treatments for Agitation and Psychosis Episodes in Alzheimer’s Disease/Dementia

Background: The psychomotor agitation of the BPSD is one of the common issues in aged care facilities, leading to the poor functional and medical consequences. Psychotropic interventions are the preferable choice of treatment. But which medication should be the prescribers first preference? This review aims to compare pharmacological interventions for psychomotor agitation, judging them according to their effectuality and justifiability profiles. This is to be achieved by retrieving information from RCTs and systematic reviews. Objectives: This review evaluates evidence from RCTs, systematic reviews, and meta-analyses of BPSD patients who had taken agitation treatments. Assessing the efficacy of antidepressants and antipsychotic treatments when compared to each other for the purpose of improving agitation outcomes. Methods: This narrative review includes RCTs and retrospective studies that were comparing one or more active ingredient medications with another or with a placebo, along with sys-tematic reviews comparing antidepressants with antipsychotics such as quetiapine, olanzapine, and risperidone. Studies extracted by searching accessing databases, such as PubMed, OVID, and Cochrane with restrictions of date from 2000 to 2021 and English language. Quality of evidence: The quality of systematic reviews was judged against AMSTAR score, and RCTs were judged according to CONSORT checklist for RCT protocols. Conclusion: There are still few studies of serotonin targeting treatment of agitation in BPSD. The SSRIs such as citalopram were associated with a reduction in symptoms of agitation, and lower risk of adverse effects compared to antipsychotics. This review also illustrates brexpiprazole as a target of multimodal neurotransmitters such as dopamine, serotonin, and norepinephrine; and dextromethorphan, OR dextromethorphan associated with bupropion or quinidine as a blockade of NMDA receptors. The outcome of this review suggests that further studies involving more dementia/Alzheimer’s participants should be conducted. Future studies are required also to assess the long-term safety and efficacy of SSRI, brexpiprazole, dextromethorphan treatments for agitation in BPSD.

Encephalitis, a Rare Manifestation of Human Herpesvirus 7 Infection

Human herpesvirus 7 (HHV-7) infection typically occurs in childhood and is frequently asymptomatic. Some clinical manifestations include fever and exanthem subitum. There have been rare reports of invasion of HHV-7 into the central nervous system. Here we report a case of encephalitis associated with HHV-7. A 16-year-old girl presented with headache, vomiting, disorientation, and psychomotor agitation. Glasgow Coma Scale on arrival was 9. Cerebrospinal fluid tested positive for HHV-7. Electroencephalogram showed intermittent slowing and rare sharp waves in the left frontal region. She recovered well after appropriate treatment for encephalitis.This case added to the few existing reports of encephalitis due to HHV-7. Physicians should be aware of this rare neurological manifestation of HHV-7 for prompt management. Similar cases should be reported to further our knowledge about this virus and its role in neurological disease.

Clinical and pathogenetic aspects of acute pancreatic encephalopathy

Pancreatic encephalopathy is a formidable complication of acute pancreatitis, significantly aggravating the course and increasing the mortality rate in this disease. For pancreatic encephalopathy, an acute onset and fluctuating course with subsequent cyclic progression are typical, and the severity of neurological symptoms may be directly dependent on the activity of the pancreatic process. The risk of having residual symptoms, primarily in the form of cognitive impairment, increases with repeated episodes of acute pancreatic encephalopathy. In the pathogenesis of pancreatic encephalopathy, an important role is played by a combination of enzymatic and hormonal dysfunction of the pancreas, systemic microcirculation disorders due to hypovolemia, typical for acute pancreatitis, and changes in glucose metabolism associated with the effects of secondary hepatocellular insufficiency and pancreonecrosis. Microscopically, gross changes in the vascular link are revealed in the form of plasmorrhages and diapedesic hemorrhages in the Virchow-Robin spaces and the white matter of the brain, desquamation and dystrophy of endothelial cells, swelling of the adventitia membrane, sludge of blood corpuscles, plasma impregnation and segmental necrosis of the vascular wall with predominant involvement and small caliber. The presence of pancreatic encephalopathy should be suspected if neurological symptoms are detected in patients with symptoms of acute pancreatitis, such as psychomotor agitation, visual and auditory hallucinations, delirium, followed by episodes of deafness, adynamia, drowsiness, up to a state of catatonia and coma. In most cases, psychomotor agitation is combined with manifestations of the syndrome of irritation of the meninges. Focal neurological symptoms, myoclonia, hyperkinesis may be associated with mental and general cerebral symptoms. Mortality in acute pancreatic encephalopathy is due to shock, hemorrhagic complications, ketoacidosis, fatty embolism of cerebral vessels or renal failure (bibliography: 35 refs)

Psychiatric emergency admissions during and after COVID-19 lockdown: short-term impact and long-term implications on mental health

Background The ‘lockdown’ measures, adopted to restrict population movements in order to help curb the novel coronavirus disease 2019 (COVID-19) pandemic, contributed to a global mental health crisis. Although several studies have extensively examined the impact of lockdown measures on the psychological well-being of the general population, little is known about long-term implications. This study aimed to identify changes in psychiatric emergency department (ED) admissions between two 8-week periods: during and immediately after lifting the lockdown. Methods Socio-demographic and clinical information on 1477 psychiatric ED consultations at the University Hospital of Geneva (HUG) were retrospectively analyzed. Results When grouped according to admission dates, contrary to what we expected, the post-lockdown group presented with more severe clinical conditions (as measured using an urgency degree index) compared to their lockdown counterparts. Notably, after the lockdown had been lifted we observed a statistically significant increase in suicidal behavior and psychomotor agitation and a decrease in behavior disorder diagnoses. Furthermore, more migrants arrived at the HUG ED after the lockdown measures had been lifted. Logistic regression analysis identified diagnoses of suicidal behavior, behavioral disorders, psychomotor agitation, migrant status, involuntary admission, and private resident discharge as predictors of post-lockdown admissions. Conclusions Collectively, these findings can have implications concerning the prioritization of mental health care facilities and access for patients at risk of psychopathological decompensation in time of confinement policies, but above all, provide a foundation for future studies focusing on the long-term impact of the pandemic and its associated sanitary measures on mental health. Trial registration Research Ethics Committee of Geneva, Registration number 2020–01510, approval date: 29 June 2020.

Worsening of the Toxic Effects of (±)Cis-4,4′-DMAR Following Its Co-Administration with (±)Trans-4,4′-DMAR: Neuro-Behavioural, Physiological, Immunohistochemical and Metabolic Studies in Mice

4,4’-Dimethylaminorex (4,4’-DMAR) is a new synthetic stimulant, and only a little information has been made available so far regarding its pharmaco-toxicological effects. The aim of this study was to investigate the effects of the systemic administration of both the single (±)cis (0.1–60 mg/kg) and (±)trans (30 and 60 mg/kg) stereoisomers and their co-administration (e.g., (±)cis at 1, 10 or 60 mg/kg + (±)trans at 30 mg/kg) in mice. Moreover, we investigated the effect of 4,4′-DMAR on the expression of markers of oxidative/nitrosative stress (8-OHdG, iNOS, NT and NOX2), apoptosis (Smac/DIABLO and NF-κB), and heat shock proteins (HSP27, HSP70, HSP90) in the cerebral cortex. Our study demonstrated that the (±)cis stereoisomer dose-dependently induced psychomotor agitation, sweating, salivation, hyperthermia, stimulated aggression, convulsions and death. Conversely, the (±)trans stereoisomer was ineffective whilst the stereoisomers’ co-administration resulted in a worsening of the toxic (±)cis stereoisomer effects. This trend of responses was confirmed by immunohistochemical analysis on the cortex. Finally, we investigated the potentially toxic effects of stereoisomer co-administration by studying urinary excretion. The excretion study showed that the (±)trans stereoisomer reduced the metabolism of the (±)cis form and increased its amount in the urine, possibly reflecting its increased plasma levels and, therefore, the worsening of its toxicity.

A case report of Morvan syndrome

ABSTRACT Authors describe the case of a 22-year-old Caucasian male who presented acutely with psychomotor agitation, insomnia and muscle twitching with painful cramps. Autonomic symptoms were as well present, with profuse sweating, blood pressure fluctuations and tachycardia. He presented a miliary rash in his left forearm as well as in the neck. Electromyography documented myokymic movements bilaterally at both gastrocnemii and pretibial muscles. Brain imaging had no abnormalities, and anti-LGI1 and anti-CASPR2 resulted positive; this data together with electrophysiological findings suggested a Morvan syndrome. High-dose steroid therapy and plasma exchange improved substantially the clinical picture of the patient.

Post-abortum Anti-N-Methyl-D-aspartate encephalitis mimicking herpetic encephalitis: a case report and literature review

We describe the case of a 32-year-old-woman, who developed psychomotor agitation and memory disorders.The Clinical, biological and radiological findings initially showed an infectious etiology.The presence of Anti-N-Methyl-D-aspartate receptor (NMDA) antibodies allowed the diagnosis of a dysimmune etiology of the disease