Neurologic Associations With Cardiac, Pulmonary, Renal, Hepatobiliary, and Hematologic Disease

The brain has a higher demand for cardiac output than any other organ, and it strictly relies on oxygen and glucose metabolism. Consequently, the brain is exquisitely sensitive to homeostatic disturbances and extraneural organ dysfunction leading to cardiac, pulmonary, renal, hepatobiliary, and hematologic diseases. The primary neurologic manifestation of extraneural organic dysfunction is diffuse bihemispheric dysfunction or encephalopathy, which often lacks lateralizing or localizing signs. Common clinical findings are lethargy, difficulty with attention and orientation, sleep-wake disturbance, and psychomotor slowing. As organic dysfunction progresses, a moderate encephalopathy ensues, with worsening cognitive function, gross disorientation, hypoactive or hyperactive psychomotor state, frontal release signs, asterixis, and myoclonus. If organ failure (eg, hepatic or renal) progresses further, stupor and coma may result unless organ function improves. Patients with underlying organic brain disease from degenerative dementia can decompensate out of proportion to neurologically normal counterparts, resulting in encephalopathy even from minor organ dysfunction or infection.

551 - Case Report: De Archambault’s syndrome in the early stage of dementia with Lewy bodies

Background:Dementia with Lewy bodies (DLB) is the second most common form of degenerative dementia after Alzheimer’s disease. In some patients with DLB, relatively rare delusions are known to emerge, such as Othello syndrome, delusional parasitosis and delusion of duplication. Erotomania, also known as de Clerambault’s syndrome, is characterized by the delusion that a person has fallen in love with the patient. It occasionally appears secondary to psychiatric disorders and organic brain diseases. However, there have been no reports on cases secondary to patients with DLB.Case presentation:The patient was an 83-year-old woman who lived alone. Mild cognitive impairment appeared at the age of 82 years. Soon after, she had the delusional conviction that her family doctor was in love with her. Her symptoms, such as gradually progressive cognitive impairment, cognitive fluctuations, and parkinsonism, indicated DLB. Although small doses of quetiapine, brexpiprazole and risperidone were prescribed for the treatment of the delusion, each of them was discontinued soon because of the adverse reactions. Finally, the delusion was successfully treated with a small dose of blonanserin without sever side effects.Discussions and Conclusions:This case report suggests the possibility of de Clerambault’s syndrome during the early stages of DLB. Recently, psychiatric-onset DLB has increasingly gained attention in recent years. Further accumulation of knowledge about delusions in patients with DLB for an early diagnosis.

Hypersexuality as a Manifestation of Various Disorders

The article deals with hypersexuality, which can be a manifestation of a wide variety of disorders. These include: consequences of a psychotrauma; premature psychosexual development; borderline personality disorder; submaniac and maniac states in bipolar affective disorder and schizoaffective type of the course of schizophrenia; disinhibition of libido, rough and naked eroticism in the initial stage of schizophrenia; consequence of advanced emotional volitional disorders in simple-type schizophrenia; temporal lobe epilepsy; dementia; mental retardation (oligophrenias); various organic brain lesions (resulting from neuroinfections, injuries, vascular damages, neoplasms) [the temporal and frontal lobes of the brain are indicated as regulators of libido]; consequence of disorders in the hypothalamic area and limbic system. It is reported that a correlation exists between development of hypersexuality and damages in certain cerebral areas in patients with non-traumatic brain damage. It is pointed out that hypersexuality may result from maldevelopment of the right hippocampus, anti-NMDA receptor encephalitis, in patients with disseminated sclerosis, Huntington’s disease, Kluver-Bucy syndrome as well as be caused by various hormonal disorders and consequences of premenstrual changes and effect of virilizing hormones during the childhood or intrauterine period. Numerous clinical illustrations of cases with hypersexuality, caused by various disorders, are given. The author holds the opinion that it is necessary to divide hypersexuality at least into two categories: true hypersexuality and sexual disinhibition, when with the normal or even reduced level of libido manifestation the hypersexual behaviour results from absence or insufficiency of inhibitory mechanisms (for example, in dementia).

‘A great and difficult thing, and full of hazard’

Chapter 17, ‘A great and difficult thing, and full of hazard: the discourse of the soul’, provides an analysis of Pathologiæ cerebri (1667), Affectionum quæ dicuntur hystericæ et hypochondriacæ (1670) and De anima brutorum (1672). The chapter starts with Willis’s description of perverted activity of the particles in blood and the animal spirits which converts ordered movement into convulsion. The concept includes epilepsy and disorders of movement with preserved awareness, and extends to cough. An account is given of Willis’s concept of hysteria and hypochondriasis as organic brain disorders. His further work on comparative anatomy and animal behaviour as the basis for distinguishing the corporeal soul of brutes from the rational soul of man is described. The chapter provides an analysis of Willis’s writing on the human senses and passions followed by additional accounts of brain diseases and those affecting the mind, together representing a foundational work in psychiatry and behavioural neurology. {150 words}

SPEECH DISORDERS OF GENETIC ORIGIN IN TEACHING PRACTICE

In recent years, there has been a significant increase in children with various speech disorders. Also, identifying the factors causing these disorders early and providing proper support is increasingly important. If the steps to correct such speech disorders are not taken quickly, secondary issues, such as communication, socialization, and educational problems, are observed. Training and corrective measures should be carried out while considering both the individual’s psychological and physiological characteristics. Identifying the cause and symptoms of a speech disorder plays an important role when developing a plan for a child’s education, upbringing, and development. These measures are crucial to providing the most suitable help to children with such disorders. The signs identified during diagnosis and those revealing the causes of the speech disorders are vital for outlining a pathogenetic description of the disorder and prescribing a set of corrective measures. Speech disorders indicate the intactness of a large part of the central nervous system, including motor and sensory areas. Moreover, they have diagnostic applications in cases of organic brain damage, malfunctions in the development of the nervous system, and mental retardation of various origins. The pedagogical process must include a full examination, as well as the proper combined support by speech disorder specialists. It is possible to carry out differential diagnoses of speech function disorders using the results of genetic studies and prepare correctional programs tailored to the identified disorders.

Case Report: De Clerambault's Syndrome in Dementia With Lewy Bodies

Background: Erotomania, also known as de Clerambault's syndrome, is characterized by the delusion that a person has fallen in love with the patient. It occasionally appears secondary to psychiatric disorders and organic brain diseases. However, there have been no reports on cases secondary to dementia with Lewy bodies (DLB).Case Presentation: The patient was an 83-year-old woman who lived alone. Mild cognitive impairment appeared at the age of 82 years. Soon after, she had the delusional conviction that her family doctor was in love with her. Her symptoms, such as gradually progressive cognitive impairment, cognitive fluctuations, and parkinsonism, indicated DLB. She was treated with a small dose of antipsychotic agents.Conclusions: This case report suggests the possibility of de Clerambault's syndrome during the early stages of DLB. Further investigations are required to clarify the mechanism and treatment of de Clerambault's syndrome in patients with DLB.

Fatigue as a symptom of neurological diseases

Objective. The aim of the work was to study the fatigue syndrome in various organic brain diseases. Materials and methods. Patients in the recovery period of hemispheric stroke, with Parkinson's disease and multiple sclerosis were examined. Along with the clinical one, there was conducted a study using the asthenia questionnaire MFI-20, FIS (Fatigue Impact Scale), FSS (Fatigue Severity Scale). Results. It has been established that patients with various diseases of the central nervous system have a syndrome of fatigue, which is a nosogenic one, that is, a consequence of organic brain damage.

Forensіc psychіatrіc evaluatіon of persons who have sexual offenses

Purpose: this research is devoted to solving scientific and practical problems, which is to develop forensic-psychiatric expert evaluation of persons who have committed sexual offenses. The author analyzed 287 sub-experts who committed sexual offenses and were on forensic psychiatric examination (FPE) at the Kyiv City FPE Center, during the period 2000— 2015 (16 years). Research methods used in the work: information-analytical, socio-demographic, clinical-psychopathological, experimental-psychological, expert, situational analysis, statistical. In the group of “limitedly sane” compared to “sane”, sub-experts significantly prevailed, in whom aggressive- violent psychopathological motivation was combined with the satisfaction of a perverted sexual desire. In the group of “sane” compared to “limitedly sane” the sub-experts with selfish, aggressive, selfish-violent motivations significantly prevailed. The majority of subjects found a compulsive sexual perversions (91.8 %): 65.8 % of subjects suffered from pedophilia, exhibitionism — 13.7 %, gerontophilia — 4.1 %, necrophilia — 1.4 %, sadism — 5.5 %. The majority of subjects were mentally healthy (71.2 %). In 13.7 % of cases, organic brain damage of residual genesis, personality disorder was observed in 5.5 % of cases, mild mental retardation — 5.5 %, dependence syndrome due to alcohol consumption — 4.1 %, simple schizophrenia, incomplete remission — 1.4 %.Most subjects did not have comorbid pathology (58; 79.5 %). The criterion for the use of coercive medical measures in the form of referral to a specialized institution for mental health care is the recognition of a person as “insane”, the provision of compulsory outpatient care — “limitedly sane" and suffering from a sexual desire disorder. The conducted research and the received results allow to improve forensic psychiatric expert research, cause increase of its quality and provability of expert conclusions, which is an additional guarantee of human rights protection, prevents unjustified appointment of re-examination, shortens the time of expert research.

DISTINCTIVE CHARACTERISTICS OF AGGRESSION IN ADOLESCENTS WITH MILD MENTAL RETARDATION

Introduction. This paper presents the results of a comparative analysis of aggressive behavior in adolescents suffering from mild mental retardation given its nature of origin, which could either be a character trait and/or a behavioral pattern, or result from organic brain syndrome. Materials and Methods. The methods used in the study are the method of expert assessment (pedagogic assessment of disordered behavior with the Teacher questionnaire for identifying children with disordered behavior (E. L. Indenbaum); monitoring; psychological diagnostic method (the projective technique Children’s Apperceptive Test (S. Bellak) (Fig.7); analysis of medical history and documents regarding the micro-social environment of the adolescent development; and the mathematical statistics method. Results. Aggressive behavior in adolescents with organic brain syndrome is characterized by a severe disorder of emotional self-control, inadequate responses to an irritator of a certain degree, affective rigidity, and a long time necessary to return to a normal state. Distinctive characteristics of aggressive behavior in adolescents with aggression as an inherent character trait suggest that aggression occurs based on a specific situation and could be self-regulated or managed by exterior regulation. Conclusion. The findings indicate that adolescents with mild mental retardation show aggression differently depending on the nature of its origin. Keyword: aggressive behavior, aggression, adolescents with mental retardation, aggression as a character trait, aggression as a result of organic brain syndrome