1/43. A unique case of vibroacoustic disease: a tribute to an extraordinary patient.This paper describes the case of a patient, Mr. A, who died in 1987. The information provided by Mr. A in life, and his insistence on making a will demanding an autopsy on his death, has given us invaluable data on Vibroacoustic Disease (VAD). Mr. A was an intellectually curious man who researched the medical literature related to his condition, and compared it to his own experience. He would describe all his sensations during his many epileptic seizures. Solely because of the results of Mr. A's autopsy, new avenues of research were initiated. These have led to new concepts and exciting new perspectives on noise-induced extraaural pathology. VAD is today a well-established and easily diagnosed entity. This paper is a tribute to Mr. A, in whose honor we have an on-going commitment to establish VAD as an occupational disease, reimbursable by Worker's Compensation.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/43. hallucinations and delusions. 2: A dual diagnosis case study.This article, the second of two parts, describes how evidence-based psychological interventions were used to help a client suffering from treatment-resistant delusions and substance misuse, allied to a chaotic lifestyle, that had previously presented a substantial challenge to services. The first part (Vol 8(15): 998-1002) Investigated how the neurobiological, social and environmental factors involved in the course and treatment of schizophrenia have helped to establish a pathway to recovery or remission that does not involve pharmacological therapy alone.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
3/43. Oneiroid syndrome: a concept of use for western psychiatry.Oneiroid syndrome (OS), or dream-like fantastic delusional derangement of consciousness, is characterized by a kaleidoscopic quality of psychopathological experiences, wherein reality, illusions and hallucinations are merged into one. It is typically accompanied by motor and, in particular, catatonic disturbances. This syndrome is an uncommon psychiatric state, which is hardly mentioned in standard psychiatric textbooks. OS is a neglected entity among DSM-oriented psychiatrists because it deals with a phenomenological approach in contrast to the European attitude, which deals with detailed clinical descriptions. Here, we propose detailed clinical descriptions with a number of consecutive stages of the OS development, illustrated by two vignettes with typical variants of oneiroid syndrome, in order to raise the awareness of psychiatrists who are not familiar with this state, and to try to open a window to the inner life of those patients suffering from this syndrome. These cases may also serve as illustration of certain principles which, when understood, may be found to lead in turn to a deeper knowledge of the psychopathology of other more commonplace conditions.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
4/43. Atypical neuroleptic malignant syndrome associated with olanzapine.neuroleptic malignant syndrome (NMS) is a potentially life-threatening adverse effect of antipsychotic agents. It generally is characterized by fever, altered mental status, rigidity, and autonomic dysfunction. A 53-year-old man developed NMS without rigidity while taking olanzapine. Such atypical cases may support either a spectrum concept of NMS or the theory that NMS secondary to atypical antipsychotics differs from that caused by conventional neuroleptics. More flexible diagnostic criteria than currently mandated by the the diagnostic and statistical manual of mental disorders, Fourth Revision, may be warranted.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
5/43. Presenilin 1 mutation in an african american family presenting with atypical Alzheimer dementia.BACKGROUND: alzheimer disease (AD) is characterized by memory and visuospatial deficits with relative sparing of personality. Mutations in 3 genes (presenilin 1 and 2 and amyloid precursor protein) are associated with presenile AD. Presenilin 1 gene mutations have not been described in african americans. methods: We studied an African American family with autosomal dominant rapidly progressive dementia and psychosis occurring early in the fifth decade of life. We performed neurologic evaluations, psychometrics, and neuroimaging. We sequenced the amyloid precursor protein gene, presenilin 1 and 2, and tau in affected and unaffected family members. One patient underwent a brain biopsy and subsequent autopsy. RESULTS: personality change, auditory and visual hallucinations, delusions, memory impairment, word-finding difficulties, and subsequent rigidity, dystonia, myoclonus, and mutism developed in 2 brothers. Neuropsychometric testing in one was consistent with frontotemporal dementia or atypical AD. neuroimaging studies showed diffuse cortical involvement. A clinical diagnosis of familial non-Alzheimer dementia was made. However, results of temporal lobe biopsy in one revealed amyloid neuritic plaques, and autopsy results confirmed the diagnosis of AD. Gene sequencing revealed a presenilin 1 point mutation (M139V) cosegregating with the disease. A tau polymorphism in exon 7 (A178T) was found in an affected brother and unaffected relatives. CONCLUSIONS: We report the first documented presenilin mutation in African American patients presenting with early personality change, psychosis, and memory loss with preserved praxis. The M139V mutation can present differently between kindreds, with some features suggestive of a frontal lobe syndrome. The M139V mutation can lead to atypical AD, and genetic background may have a role in determining the phenotype of genetically defined AD.- - - - - - - - - - ranking = 1220.9934476863keywords = family, member, life (Clic here for more details about this article) |
6/43. Central anticholinergic syndrome in a pediatric patient following transdermal scopolamine patch placement.A 9-year-old child was admitted to the hospital with congenital left ureteropelvic junction obstruction with massive left pyelocaliectasis and underwent dismembered pyeloplasty of the left kidney under general anesthesia without complications. Postoperatively, the child was placed on patient-controlled analgesia, with morphine as the drug of choice. The patient was discharged to the ward with adequate pain control and no complaints of nausea or vomiting. Once on the ward, a transdermal scopolamine patch was placed for nausea and vomiting. More than 24 hours after patch placement, the child experienced central anticholinergic syndrome (CAS) with hallucinations and incontinence. The scopolamine patch was promptly removed, and all symptoms of CAS rapidly ceased. A transdermal scopolamine patch should not be used in the pediatric population, and with extreme caution in the elderly. Treatment of CAS includes prompt removal of the patch, cleansing of the area, and possible physostigmine administration.- - - - - - - - - - ranking = 1.4467548910501keywords = member (Clic here for more details about this article) |
7/43. Visual, tactile, and phobic hallucinations: recognition and management in the emergency department.OBJECTIVES: The purposes of this case series are to review the acute manifestations of hallucinatory phenomenon in young children, with a focus on visual, tactile, and phobic hallucinations (VTPH) as an important part of the differential diagnosis; and to describe 10 children who presented to the Children's National Medical Center Emergency Department (CNMC ED) with VTPH. methods: The medical records of children identified with VTPH who were evaluated during a 20-month period in 1998 to 1999 were reviewed. The diagnosis was established if the hallucinations were well documented as being anxiety-related, not auditory, and with no evidence of underlying organic etiology. All cases were initially screened in the emergency department. Demographic information included age, gender, duration, and description of symptoms, stressors, family psychiatric history, and outpatient treatment. RESULTS: Ten children with this disorder were encountered. VTPH can be differentiated from other causes of hallucinations in that the children are preschool to young school age; their hallucinations are tactile and visual, presenting at night; and symptoms are anxiety-based but short-lived. When toxins, drug reactions, central nervous system, and febrile etiologies are ruled out, timely consultation with the psychiatry team can eliminate costly and time-consuming procedures and avoid further emotional distress for the child and family. CONCLUSIONS: VTPH is a more commonly occurring disorder than previously reported in the pediatric emergency medicine literature. Emergency physicians who recognize the characteristics of this diagnosis are encouraged to seek psychiatric consultation rather than performing unnecessary and costly diagnostic tests.- - - - - - - - - - ranking = 406.18223093176keywords = family (Clic here for more details about this article) |
8/43. Intravenous ketamine infusion as an adjuvant to morphine in a 2-year-old with severe cancer pain from metastatic neuroblastoma.A 2.8-year-old female patient (11.6 kg) was admitted to the hospital for uncontrolled pain and swelling in the left leg relating to a metastatic neuroblastoma. Initially, her pain was managed with oral morphine 2 mg (approx. 0.2 mg/kg) every 4 hours. Because she was quite somnolent but still in significant pain, analgesia was then changed to methadone 1 mg orally every 6 hours (approximately 0.1 mg/kg/dose) and was eventually increased over 36 hours to 2 mg every 6 hours (approximately 0.2 mg/kg/dose). She received oral methadone 0.6 mg (approximately 0.05 mg/kg) every 4 hours as needed for breakthrough pain. She continued to have severe pain and experienced side effects, including respiratory depression, sedation, visual hallucinations, and vomiting. An intravenous ketamine infusion was started at 100 microg/kg/hour. Regular opioid administration was ceased, but she was given intravenous morphine 0.5 to 0.75 mg for breakthrough pain. She required only zero to three doses of breakthrough morphine per day, initially. After starting the ketamine infusion, her pain control improved and her symptoms of opioid toxicity abated. She was more alert and able to partake in limited activities. As a result of pain from progressive disease, the ketamine infusion was increased to 200 microg/kg/hour after 6 days with positive results. Her condition continued to deteriorate. An intravenous morphine infusion was initiated 2 weeks after starting the ketamine infusion and was eventually increased to 50 microg/kg/hour. One week later, she died with reasonable pain control. This case illustrates the use of ketamine as an effective analgesic in an adjuvant setting in a pediatric patient with advanced poorly controlled cancer pain. ketamine not only eased the child's suffering while preserving life but also improved her quality of life by maintaining the child's ability to communicate and engage in activities.- - - - - - - - - - ranking = 2keywords = life (Clic here for more details about this article) |
9/43. Acute inhalant-induced neurotoxicity with delayed recovery.OBJECTIVE: To report a case of neurotoxicity and subsequent hospitalization due to abuse of an ethyl chloride inhalant. CASE SUMMARY: A 41-year-old African American male presented to the emergency department due to mental status changes and an inability to walk. After the blood alcohol and urine drug screen returned negative, a family member revealed that the patient frequently abused an inhalant containing the volatile solvent ethyl chloride. DISCUSSION: inhalant abuse is common and is facilitated by the widespread availability of volatile solvents that have legitimate commercial or household uses. Most inhalants are central nervous system depressants and are highly lipophilic. Maximum Impact, which contains ethyl chloride, is sold in stores and is readily available over the internet. While the product has a legitimate use as a VCR head cleaner, it is often illicitly marketed over the internet as a means of getting a "rush" or "high" and for enhancing sexual pleasure. Neurologic symptoms have been reported after deliberate inhalational exposure to ethyl chloride, and 2 deaths have been associated with its use. An objective causality assessment using the Naranjo probability scale revealed a probable adverse drug event. CONCLUSIONS: Inhalants should be included in the differential diagnosis of patients presenting with acute mental status changes and neurologic impairment that resolve over less than one week.- - - - - - - - - - ranking = 204.53787035693keywords = family, member (Clic here for more details about this article) |
10/43. Auditory hallucinations after right temporal gyri resection.The authors present a case study on the development of auditory hallucinations secondary to right temporal lobe damage. Surgical resection in the study patient was of the right superficial middle and inferior temporal gyri. carbamazepine at a dosage of 800 mg daily was the most effective medication used. A multidisciplinary approach involving the neurosurgeon, psychiatrist, family, and rehabilitation specialist is necessary in managing the psychiatric sequelae of brain injury.- - - - - - - - - - ranking = 203.09111546588keywords = family (Clic here for more details about this article) |
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