1/15. Quetiapine as an alternative to clozapine in the treatment of dopamimetic psychosis in patients with Parkinson's disease.There are many difficulties associated with the late stages of Parkinson's disease (PD), but psychosis and agitation may be the most disturbing for both patients and care givers, and often precipitate the pivotal decision for long-term nursing home placement. While the addition of antipsychotic drugs or the withdrawal of antiparkinsonian drugs may improve the behavioral problem, these strategies usually worsen the motor difficulties. clozapine has been studied in PD for over a decade, and while it appears to be effective, there are safety and tolerability concerns associated with it. In addition, in new jersey, medicaid no longer pays for the home blood draws that are required for home-bound patients. This led to a situation in which we had patients who needed to stop clozapine and begin an alternative therapy. Because quetiapine seems particularly well suited to patients with PD based on in vitro and in vivo studies we have begun to try this medication in PD patients who need to stop clozapine. This article reports three case histories of patients with PD, confusion and dopamimetic psychosis who had been previously managed with clozapine and who were successfully switched to quetiapine. At doses from 12.5 to 150 mg/day quetiapine was well tolerated, resulting in behavioral improvement and no real increase in parkinsonism. These case histories raise the possibility that quetiapine may represent a viable alternative to clozapine in PD patients with dopamimetic psychosis and behavioral disturbances.- - - - - - - - - - ranking = 1keywords = parkinson (Clic here for more details about this article) |
2/15. Chronic subdural hematoma with vasogenic edema in the cerebral hemisphere--case report.An 80-year-old male with a history of hypertension presented with chronic subdural hematoma manifesting as progressive consciousness disturbance and left hemiparesis. T1-weighted and fluid attenuation inversion recovery (FLAIR) magnetic resonance imaging showed a fresh hematoma in the right subdural space with a midline shift of 15 mm. FLAIR and diffusion-weighted imaging showed a hyperintense area in the right paraventricular white matter compressed by the hematoma. Apparent diffusion coefficients (ADCs) corresponding to the hyperintense area in the central area of the affected cerebral hemisphere on FLAIR images were measured before and one month after the operation. The motion probing gradient was applied in the right-left direction to the body axis. Since the central area in the cerebrum includes nerve fibers perpendicular to the direction of the gradient, the measured ADC appeared to be anisotropic. Preoperative ADC in the right paraventricular white matter was anisotropic and greater than in age-matched normal subjects, so the edema was identified as the vasogenic type. The edema in the right paraventricular white matter resolved promptly with improvement of the midline shift and normalization of the ADC.- - - - - - - - - - ranking = 2.2975419775395E-5keywords = body (Clic here for more details about this article) |
3/15. limbic encephalitis presenting with topographical disorientation and amnesia.A case of paraneoplastic limbic encephalitis presenting with topographical disorientation is reported. A 70 year old woman became unable to identify familiar buildings and landscapes and could not recall the way to destinations she had known very well for years. She also showed attentional disturbance and severe anterograde amnesia. Her retrograde amnesia extended for one year at most. No other neuropsychological deficits were noted. Thus her topographical disorientation was of the primary form. Specific tests related to topographical disorientation showed that her two main symptoms seem to fall into the categories of landscape agnosia and heading disorientation. T2 weighted magnetic resonance imaging revealed high intensity signals in the anteromedial temporal lobes bilaterally, in the right posterior parahippocampal gyrus, in the right retrosplenial region, and in the right inferior precuneus. Anti-Hu antibody was found in the serum. This case shows that topographical disorientation can be a primary symptom of limbic encephalitis.- - - - - - - - - - ranking = 2.2975419775395E-5keywords = body (Clic here for more details about this article) |
4/15. confusion as the presenting manifestation of vertebral osteomyelitis: a case report.A 44-year-old patient presented with increasing confusion. He was first diagnosed as having intermittent pressure hydrocephalus but a further evaluation showed CSF pleocytosis and hypoglycorrhachia. Five weeks later, his physical examination was unrevealing. Nuclear imaging techniques were conflicting, with negative gallium- and indium-labelled white blood cells scans but a Tc scan pointing towards a vertebral infection. A well-demarcated lesion in the T9 vertebral body, demonstrated by CT scan, confirmed the diagnosis of vertebral osteomyelitis. Although we were unable to recover the causative organism, antibiotic treatment for presumed staphylococcal osteomyelitis resulted in full recovery. This case indicates that vertebral osteomyelitis may cause significant meningeal inflammation even in the absence of epidural or subdural abscess. We recommend that in patients with meningitis without a clear etiology vertebral osteomyelitis should be considered and pursued with CT scannings of the vertebrae, a procedure that can yield positive findings even when other scanning modalities are negative.- - - - - - - - - - ranking = 2.2975419775395E-5keywords = body (Clic here for more details about this article) |
5/15. Mental models and language registers in the psychoanalysis of psychosis: an overview of a thirteen-year analysis.The author suggests that the use of mental models and language registers may help an analysis to proceed, especially in psychosis, when the patient has not yet developed a mental space that will allow him/her the functions of knowledge and containment of emotions. Models, according to Bion, are a primitive approach to abstraction and a manifestation of the analyst's reverie that enables him/her to transform sense data into alpha-elements. Ferrari, in a further development of Bion's theories, hypothesises a relationship between the transference and the internal level of body-mind communication, and proposes the use of language registers to sustain the psychoanalytic process. The author presents several clinical examples from a thirteen-year, four-session-a-week analysis of a psychotic analysand who was initially confused, paranoid and altogether unable to bring self-reflective thought to bear on her overwhelming emotions and had, by the end of the analysis, completely recovered from her psychotic symptoms. The clinical material shows how the technical tools of mental models and language registers helped in the construction of a mental space and spatio-temporal parameters, permitting the patient to tolerate overwhelming concrete emotions and finally to recognise and work through the emotions of an intense transference.- - - - - - - - - - ranking = 2.2975419775395E-5keywords = body (Clic here for more details about this article) |
6/15. Dissociation between personal and extrapersonal neglect in a crossed aphasia study.Abstract Several reports document crossed aphasia following a right cerebral infarct. However, few of them provide a detailed investigation of associated neuropsychological disorders. A personal neglect disorder with no difficulty in orienting attention in the contralesional space has not been frequently reported independently of lesion side for the language deficit. In most cases, the deficit is described in the acute period. We report the case of a patient who showed severe crossed aphasia several months after cerebral damage. In addition to his language deficit, he suffered from finger agnosia, acalculia, and right/left confusion. Although he was able to orient attention in the contralesional space, he had a persistent personal neglect disorder with severe difficulty in attending to his own body. Results suggest that right hemisphere language dominance does not preclude ipsilateral specialisation for other functions. Furthermore, the dissociation between the two spatial functions provides further confirmation that they are subserved by two independent systems.- - - - - - - - - - ranking = 2.2975419775395E-5keywords = body (Clic here for more details about this article) |
7/15. Presentation of illness in older adults.Although people age at different rates, changes to the composition of the human body are a hallmark of aging. As a result of such changes, disease can present differently in a person over 65 years old than it would in a younger adult or child. This article identifies the critical indicators of underlying conditions, including changes in mental status, loss of function, decrease in appetite, dehydration, falls, pain, dizziness, and incontinence. It also describes the presentation of diseases common to older adults, including depression, infection, cardiac disease, gastrointestinal disorders, thyroid disease, and type 2 diabetes.- - - - - - - - - - ranking = 2.2975419775395E-5keywords = body (Clic here for more details about this article) |
8/15. Psychiatric presentation of voltage-gated potassium channel antibody-associated encephalopathy. Case report.Voltage-gated potassium channel antibody encephalopathy, a rare cause of limbic encephalopathy, typically presents with memory impairment and seizures. Psychiatric symptoms have not been emphasised in the literature. Here we describe a 58-year-old man who presented with panic attacks and psychogenic non-epileptic seizures and, later on, developed delusions and hallucinations and then confusion. He was found to have antibodies to voltage-gated potassium channels. Treatment with immuno-modulatory therapy resulted in almost complete recovery.- - - - - - - - - - ranking = 0.00011487709887698keywords = body (Clic here for more details about this article) |
9/15. Acute postoperative confusion and hallucinations in parkinson disease.STUDY OBJECTIVE: To determine whether patients with parkinson disease are at an increased risk for postoperative confusion. DESIGN: Retrospective chart review of patients with parkinson disease who remained in the hospital at least 48 hours after their surgery. Current data were compared with published historical controls. SETTING: Recent medical records of a university-affiliated hospital, veterans Administration hospital, and community hospital. patients: Available charts of patients with parkinson disease who had had surgery in the last 2 years. patients were excluded if they were disoriented at admission or had serious metabolic disturbances. MEASUREMENTS AND MAIN RESULTS: Fifteen of twenty-five postoperative patients with parkinson disease (60%; CI, 39% to 78%) suffered significant acute confusion, and 9 of these patients had documented hallucinations. Neuropsychiatric changes were frequently delayed after surgery. The acute confusional state lasted an average 2.5 days; several patients, however, were discharged before resolution. These disturbances did not appear to be related to type of anti-parkinsonian medication or anesthetic. CONCLUSION: In comparison with historical controls, the relative risk of patients with parkinson disease having an acute postoperative confusional state is between 2.8 and 8.1. These patients may need environmental supports during the postoperative period.- - - - - - - - - - ranking = 0.5keywords = parkinson (Clic here for more details about this article) |
10/15. Postburn delirium associated with use of intravenous lorazepam.A case of delirium with persecutory delusions is reported, which occurred three days after a previously healthy male suffered burns over 30% of his total body surface area. Routine evaluation was negative for other etiology of delirium, and the symptoms spontaneously remitted within seven hours with no sequella. We found that the benefits and potential side effects of intravenous lorazepam are similar to but of longer duration than those of intravenous diazepam. The effects of intravenous lorazepam should be recognized in the differential diagnosis of postburn delirium in patients given this medication.- - - - - - - - - - ranking = 2.2975419775395E-5keywords = body (Clic here for more details about this article) |
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