Delirium And Visual Loss After İntravenous Ondansetron Application in a Pediatric Patient: A Case Report

Ondansetron is a selective 5-hydroxytryptamine receptor (5HT-3) antagonist caused by cancer treatment and put into clinical practice as an antiemetic for anesthesia-related nausea and vomiting. Delirium is an organic mental disorder that develops in a short period of time and manifests itself with impairments in various cognitive functions, especially consciousness. In this case report, we aimed to present the patient who presented to the another hospital due to vomiting, who received intravenous (IV) ondansetron treatment, followed by blurred consciousness and vision loss, and to draw attention to the side effects that may occur after ondansetron

The role of statins in the management of delirium: Recent advances.

Background & Objective: Delirium is a clinical syndrome characterized by a temporary organic mental disorder, as well as abnormal attention and cognition. It is a very common, serious, and costly disease with high misdiagnosis and death/disability rates, especially for older patients after surgery. Several factors, such as systemic neuroinflammation, neurotransmitters, cerebral hypoperfusion and microthrombosis, contribute to the progress of delirium; however, the exact pathophysiologic mechanisms are not well known. Therefore, there are no specific therapeutic approaches that can treat delirium effectively. Statins, as inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, have been identified as potential medications for the treatment of delirium because they can significantly reduce the incidence of delirium. The major objective of current review is to summarize recent advances in the understanding of the effects and mechanisms of statins on delirium. Conclusion: In basic research, statins can alleviate delirium via attenuation of neuroinflammation, neurotransmitters, cerebral hypoperfusion, and microthrombosis, which may highlight their potential clinical application for the treatment of delirium. Despite this, the clinical effects of statins still provoke debate.

Pathocharacterologic features as predictors of impulsive aggression

In the original study, in order to identify predisposition factors and mechanisms of criminal impulsive aggression, psychometric testing was performed with further evaluation of the dependence of the probability of impulsive aggression on the results of psychometric testing by constructing a binary logistic regression model. On groups of mentally healthy individuals and individuals with organic mental disorder, the dependence of the presence or absence of the fact of impulsive aggression and the diagnosis (mentally healthy/organic mental disorder) on the variable test results was evaluated. The results prove the extra-nosological nature of the formation of propensity to impulsive aggression, the contribution of pathocharacterological predictors of aggressive behavior, but not clinical ones. The specificity of mechanisms of formation of propensity to impulsive aggression in mental health and organic mental disorder is determined. A method for determining probability has been developed.

Excess Mortality and Risk Factors for Mortality Among Patients with Severe Mental Disorders Receiving Home Care Case Management

Background: Home care case management (CM) is the main intervention for patients with severe mental disorders (SMDs) requiring outreach care. The present study investigated the long-term mortality outcome and associated risk factors in patients who received home care CM. Methods: In this nationwide study, we enrolled patients who received home care CM (n=10255) between January 1, 1999, and December 31, 2010; data of these patients were derived from a Taiwan health insurance database. We calculated the standardized mortality ratio (SMR) as the ratio of observed deaths in the study cohort to expected deaths in the general population and presented by diagnosis. Multivariate regression was performed to assess independent risk factors for mortality. Results: Among 10255 patients who received home care CM, 1409 died during the study period; the overall SMR was 3.13. Specifically, patients with organic mental disorder had the highest SMR (4.98), followed by those with schizophrenia (3.89), major depression (2.98), and bipolar disorder (1.97). After adjustment for confounding factors in the multivariate analysis, patients with organic mental disorder or dementia had the highest risk of mortality, whereas the mortality risk in patients with schizophrenia was comparable to that in patients with bipolar disorder or major depression. Deceased patients had a significantly higher proportion of acute or chronic physical illnesses, including cancer, chronic hepatic disease, and pneumonia. Conclusion: This study presented the gap of mortality in patients with SMDs receiving home care CM in Taiwan. We highlight the need for more effective strategies to improve medical care for this specified population.

Pro- and Anti-aggressive Personality Factors in Defendants with Mental Disorders in Crimes Against Individual

The pro- and anti-aggressive personality factors of individuals with personality disorder (64 subjects), with organic mental disorder (147 subjects), mentally healthy (114 subjects), accused of crimes against individual were tested. At the first stage the distributions of subjects who possess and do not pro- and anti-aggressive personality structures were compared with each other using the χ2 - Pearson criterion. A hierarchical cluster analysis with the use of the average intra-group communication method was applied at the second stage with the indicted in crime as subjects and the combination of all pro- and anti-aggressive factors as clustering parameters. It was revealed that the predominance of pro-aggressive factors with insufficient formation of personality inhibitors of aggression is typical for offenders with personality disorder. For mentally healthy offenders, on the contrary, the opposite is true. Аt the same time insufficient formation of personality inhibitors of aggression is revealed in defendants with an organic mental disorder with unexpressed personality traits that contribute to the manifestation of aggression.

Psychotic disorder of organic etiology, in the context of sarcoidosis. A case report

IntroductionNeurosarcoidosis is an uncommon cause of psychosis. It courses with an affectation of the brain, the spinal cord and other areas of the nervous system. It associates both neurological and psychiatric symptoms: cranial mononeuropathy, myelopathy or radiculopathy meningitis, neuroendocrine dysfunction, dementia, delusions, hallucinations.ObjectivesTo review in Pub-Med about neuropychiatric manifestarions of neurosarcoidosis.MethodsWe describe the case of 60-year-old woman diagnosed with long evolution schizoaffective disorder with a recent decompensation in the context of a stressful situation. As somatic background to highlight: cognitive impairment (encephalic bilateral and symmetrical frontal atrophy in cranial magnetic resonance) and a probable sarcoidosis with hilia and mediastinal lymph nodes without histologic confirmation. She was hospitalized at the acute care unit because of a descompensation of her schizoaffective disorder. The patient was distressed, with delirious speech, sensoperceptive hallucinations, hypothymia and weigth loss.ResultsFirstly we evaluate the lack of clinical improvement with an anti-psychotic drug in previous hospitalizations. For that reason, we thought in organic mental disorder as an alternative diagnosis. We started treatment with corticosteroids in spite of we did not observe a decompensation of sarcoidosis. In a few days it was remarked a clinical improvement and remission of the delusional and affective clinic.ConclusionsIt is needed to complete the study and continue the monitoring of the patient to see the evolution and drug response. The diagnosis of neurosarcoidosis should be kept in mind for patients with both neurologic and psychiatric symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Pathopsychological predictors of contraindications to driving for persons with mental disorders

The present article contains the research data of pathopsychological predictors of contraindications to driving for persons with mental disorders. The data of 60 outpatient charts of patients-drivers and driver candidates who underwent a psychiatric examination in order to reveal the presence or absence of contraindications to driving was analyzed and resulted in a psychiatric diagnosis setting for the first time. The analysis was conducted with considering the following parameters: the commission decision on the presence or absence of contraindications to driving; age; mental illness diagnosis; results of pathopsychological research and data on driving experience. It was revealed that the 'criticality violation' parameter was the universal pathopsychological predictor of contraindications amongst the drivers and driver candidates surveyed. At the same time, nosospecific abnormalities of mental processes have been identified that in overall affect on the making of a medical decision on the presence of contraindications to driving. Attention disorders (its instability) were significantly more frequent, whilst the patients with organic mental disorder also had criticality violations, and the patients with personality disorder were characterized by instability of emotional reactions. Additional record of pathopsychological features can significantly improve the accuracy of the ability to safe driving assessment for drivers and driver candidates, and more effectively predict the risk of an accident.