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.

‘Who are you today?’ Problems of identity in psychiatry

Our attributes change. Sometimes they are changed so dramatically (for instance by organic brain disease, traumatic brain injury or psychiatric disease) that it is hard to see any significant continuity with the premorbid person. Sometimes this can have important ethical and legal consequences, but the problems are often ignored. This article highlights some of the difficulties.

МИКРОПОЛЯРИЗАЦИЯ - ЭФФЕКТИВНЫЙ НЕИНВАЗИВНЫЙ МЕТОД НЕЙРОСТИМУЛЯЦИИ ПРИ ОРГАНИЧЕСКИХ ПОРАЖЕНИЯХ ГОЛОВНОГО МОЗГА У ДЕТЕЙ

Резюме. Органічні ураження головного мозку у дітей є однією з найбільш актуальних медико-соціальних проблем у сучасній педіатрії та неврології. До сих пір ведеться пошук ефективних методів корекції пошкоджених функцій ЦНС. Цей огляд присвячений сучасним поглядам на проблему органічних уражень головного мозку у дітей та аналізу можливості застосування неінвазивного методу нейростімуляції - мікрополяризації - у комплексному лікуванні дітей з органічними ураженнями головного мозку. Матеріалом для дослідження слугували сучасні вітчизняні та зарубіжні наукові джерела з питань етіології і патогенезу органічних уражень головного мозку у дітей, а також власні клінічні спостереження з використанням методів електроенцелографії, транскраніальної доплерографії судин головного мозку на базі «Неврологічної клініки доктора Яценко», м. Київ. Результати сучасних досліджень розкривають ряд напрямків і можливостей для корекції і лікування органічних уражень головного мозку у дітей. Одним із перспективних і ефективних методів лікування може бути транскраніальна мікрополяризація. Результати наших досліджень свідчать про те, що комплексна терапія з використанням транскраніальної мікрополяризації позитивно впливає на показники мозкової гемодинаміки і покращує електроенцефалографічну картину у дітей з органічними ураженнями головного мозку. Отримані дані дають підстави стверджувати, що включення в комплексне лікування дітей з органічними ураженнями головного мозку методу транскраніальної мікрополяризаціі збільшує ефективність лікування і позитивно впливає на клінічний перебіг захворювання. Ключові слова: транскраніальна мікрополяризація, органічні ураження головного мозку. UDC 616.831: 615.841 DIRECT CURRENT STIMULATION IS AN EFFECTIVE NON-INVASIVE METHOD OF NEUROSTIMULATION IN TREATMENT OF CHILDREN WITH ORGANIC BRAIN DISEASE Yatsenko K. V. Bogomoletz Institute of Physiology of NAS of Ukraine, Kyiv, Ukraine; "Neurological clinic of doctor Yatsenko", Kyiv, Ukraine ORCID ID: https://orcid.org/0000-0002-2924-539X, e-mail: [email protected] Abstract Organic brain disease in children is one of the most significant medical and social problems in modern pediatrics and neurology. This disease in children is most often associated with perinatal brain damage. This is a whole group of pathological conditions caused by the negative impact of adverse factors on the fetus or already a newborn child. The high level of plasticity of the brain in a newborn allows in most cases to overcome these pathological changes, therefore often the child does not have any symptoms after such a lesion. But in some cases, residual effects remain that may be transient or develop into more severe pathology - cerebral palsy, hypoxic-ischemic encephalopathy, epilepsy and other. A search for effective methods of restoration of injured CNS functions is still underway. This review is devoted to modern views on the problem of organic brain disease in children and to the analysis of the possibility of including of a non-invasive neurostimulation method - direct current stimulation - in the complex treatment of children with organic brain disease. Transcranial direct current stimulation is a form of neurostimulation that allows to change the functional state of various parts of the CNS under the action of a low direct current (up to 1 mA). The directional influence of current stimulation is achieved through the use of small areas (100-600 mm2) of electrodes. Direct current stimulation can be used as a separate therapeutic method, or in combination with standard physiotherapy to correct the excitability of the cerebral cortex and improve motor activity in patients with various neurological disorders. Modern domestic and foreign scientific sources on the etiology and pathogenesis of organic brain disease in children, as well as own clinical observations using methods of electroencephalography, transcranial Doppler ultrasonography of cerebral vessels based on the “Neurological Clinic of Dr. Yatsenko” (Kyiv, Ukraine) was the material for the study. The results of modern research reveal a number of areas and opportunities for the correction and treatment of organic brain disease in children. The results of our study indicate that complex therapy using the transcranial direct current stimulation in children with organic brain disease had a marked improvement in the electroencephalographic pattern, and also transcranial direct current stimulation significantly reduced the high mean cerebral blood flow velocity per cycle in the basilar artery, middle and anterior cerebral arteries; in the comparison group no statistically significant positive dynamics was observed. The findings suggest that the inclusion the method of transcranial direct current stimulation to the complex treatment of patients with organic brain disease improves the effectiveness of treatment and may also positively influence the clinical course of the disease. Keywords: direct current stimulation, organic brain disease.

Delirium, dementia, and other cognitive disorders

Organic psychiatric disorders result from brain dys­function caused by organic pathology inside or outside the brain. Dementia is the most common condition, with Alzheimer’s disease alone affecting 1 per cent of the population at 60 years, rising to 40 per cent over 80 years. Many of the rarer organic psychiatric dis­orders tend to affect a wider age range, but present in similar ways. Given the changing demographics of most developed countries, disorders producing cognitive im­pairment in older adults are becoming increasingly important for provision of healthcare services and in daily clinical practice. This chapter will cover the more common causes of cognitive impairment, and there is additional information in Chapters 18 and 20 on psych­iatry of older adults in psychiatry and medicine. There are three common clinical presentations of or­ganic psychiatric disorders: … 1 Delirium— an acute generalized impairment of brain function, in which the most important feature is impairment of consciousness. The disturbance of brain function is generalized, and the primary cause is often outside the brain; for example, sepsis due to a urinary tract infection. 2 Dementia— chronic generalized impairment, in which the main clinical feature is global intellectual impairment. There are also changes in mood and behaviour. The brain dysfunction is generalized, and the primary cause is within the brain; for example, a degenerative condition such as Alzheimer’s disease. 3 Specific syndromes— which include disorders with a predominant impairment of isolated areas; for example, memory (amnesic syndrome), thought, mood, or personality change. These include neurological disorders that frequently result in organic psychological complications; for example, epilepsy…. Table 26.1 lists the main categories of psychiatric disorder associated with organic brain disease. The following sections describe these syndromes and the psychiatric consequences of a number of neurological conditions. Organic causes of other core psychiatric conditions (e.g. anxiety and psychosis) are covered in the relevant specific chapters. Delirium is characterized by an acute impairment of consciousness producing a generalized cognitive impairment. The word delirium is derived from the Latin, ‘lira’, which means to wander from the furrow. Delirium is a common condition, affecting up to 30 per cent of patients in general medical or surgical wards, with the primary cause often being a sys­temic illness. The term ‘acute confusional state’ is a synonym for delirium.

Forty years of structural brain imaging in mental disorders: is it clinically useful or not?

Structural brain imaging was introduced into routine clinical practice more than 40 years ago with the hope that it would support the diagnosis and treatment of mental disorders. It is now widely used to exclude organic brain disease (eg, brain tumors, cardiovascular, and inflammatory processes) in mental disorders. However, questions have been raised about whether structural brain imaging is still needed today and whether it could also be clinically useful to apply new biostatistical methods, such as machine learning. Therefore, the current paper not only reviews structural findings in Alzheimer disease, depression, bipolar disorder, and schizophrenia but also discusses the role of structural imaging in supporting diagnostic, prognostic, and therapeutic processes in mental disorders. Thus, it attempts to answer the questions whether, after four decades of use, structural brain imaging is clinically useful in mental disorders or whether it will become so in the future.

Extreme Psychospiritual States Versus Organic Brain Disease: Bringing Together Science and the Human Factor

Extreme states can be psychospiritual and “functional” in origin or they can be “organic” and driven by biological dysfunction. Contemporary psychiatry largely rejects this distinction, preferring to insist that everything “extreme” is biological in origin; but the distinction is important for understanding and helping people. Psychospiritual crises, including those labeled bipolar or schizophrenic, are “functional” and express meaning. As “bizarre” as the language or the symbols may seem, meanings that often reflect childhood abuse can be explored in a trusting, kind, and caring therapeutic relationship. The more that a real biological or organic dysfunction, such as traumatic head injury or neurotoxic exposure, is the root cause of the extreme state, the less sense its manifestations will make. Nonetheless, drug-induced extreme states, even when caused by hallucinogens or by psychiatric “medicines,” often leave sufficient brain function operational to reveal important meanings about the person’s experience, along with the otherwise senseless intoxication. With so many people prescribed psychiatric drugs, these neurotoxic chemicals are now the most common cause of extreme states in clinical practice, and withdrawal from these offending agents is critical to recovery (Breggin, 2013). However, even when the extreme state is driven by neurological dysfunction, a safe space and skilled therapists can help relieve the individual’s otherwise overwhelming feelings of anxiety or terror.

Psychiatric Symptomatology as the Initial Presentation of Brain Cancer

Glioblastoma multiforme is the most common primary adult brain tumor. Clinically, non-specific psychiatric symptoms may arise as their first and only manifestation, prior to any neurological deficits. The most form of psychiatric presentation of neurological diseases are depressive complaints, although these may also be accompanied by behavioral and/or cognitive, anxious and psychotic symptoms. By explaining this case report we aim to emphasize the importance of considering the diagnosis of an organic brain disease, even when only primary psychiatric symptoms are evident. The bibliographic research was made using PubMed and Scielo, and analysis of the electronic patient process. Man of 68 years with a history of hypertension, nephrectomy, splenectomy and left brachial plegia after a car accident. He had been previously seen by a psychiatrist for a 6-month history of depressive symptoms, which had been successfully treated. He later developed new behavioral changes such as heteroaggressiveness, social maladjustment and disfasia, for which he was sent to the emergency room. Brain-CT scan displayed a left front temporal expansive injury. Admitted to the Neurology Department for further diagnostic investigation. Subsequent MRI, detected massive infiltrative lesion with significant mass effect and cystic/necrotic area. The anatomopathology disclosed a glioblastoma grade IV. This case reinforces the importance of carrying a imagiologic workup in cases like this, especially on patients with atypical presentation of psychiatric symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Depression as an interdisciplinary problem

Traditionally depression was defined as a mental illness. Acknowledgment of biopsychosocial model in modern medicine brought about a number of interdisciplinary studies. In the meantime, a number of correlations in the onset, cause and prognosis between depression and other somatic as well as mental illnesses were discovered. The research results showed that from one hand, depression could be an independent factor of the possible development of heart infarct, on the other hand it can influence the recovery process in cardiological patients. The conducted studies established some common pathways in depression and vascular diseases development. Psychoneuroimmunological research gives the data about the influence of anxiety and depression on the interleukine profile that could be a matter of further investigation of the possible links between depression and cancer diseases. The other dimension is the addiction impact on depression onset. The interrelationship between epilepsy as organic brain disease and depression is also worth of attentional. Hypercortisolemia and low-grade inflammation plays an important role both in depression and dementia. There is also a strong correlation between personality traits and depression itself and as response to unfavorable circumstances and somatic illness as well. We propose to apply to depression the principles of pathological stable circuits with the self-sustained reverbation engram chains mechanisms. All these data calls for consideration of depression as an interdisciplinary phenomena.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Deep brain stimulation for psychiatric disorders: where we are now

Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned. Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry. This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.