scholarly journals Treatment of Anxiety and Depression in a Patient with Brugada Syndrome

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Jasper J. Chen ◽  
Rajbir S. Sangha
Keyword(s):  
Brugada Syndrome ◽  
Psychiatric Symptoms ◽  
Medication Management ◽  
Clinical Manifestations ◽  
Physical Symptoms ◽  
Clinical Findings ◽  
Panic Attacks ◽  
Anxiety And Depression ◽  
Presenting Symptoms ◽  
Channel Blocking

Background. Brugada syndrome is rare and has been a clinically diagnosable entity since 1992. Its clinical manifestations are highly variable, and while some patients remain asymptomatic, others endure sudden cardiac death. Initial presenting symptoms may include palpitations, seizures, syncope, and nocturnal agonal respiration. The diagnosis of Brugada syndrome relies on both clinical findings and characteristic ECG patterns that occur spontaneously or are induced by usage of sodium-channel blocking agents.Aims of Case Report. Many psychiatrists may be unaware of the possibility of medical cocontributing etiologies to physical symptoms of anxiety and depression. We present a case of a patient who was treated psychiatrically for anxiety and panic attacks and who was subsequently diagnosed with Brugada syndrome and treated medically with an implantable cardioverter defibrillator (ICD), the only treatment option demonstrated to be effective. Her psychiatric symptoms predated her diagnosis of Brugada syndrome by at least fifteen years.Conclusion. The patient's eventual diagnosis of Brugada syndrome altered the course of her psychopharmacologic medication management and illustrates the utility of a psychosomatic approach to psychiatric symptom management.

scholarly journals New-Onset Panic, Depression with Suicidal Thoughts, and Somatic Symptoms in a Patient with a History of Lyme Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Amir Garakani ◽  
Andrew G. Mitton
Keyword(s):  
Depressive Symptoms ◽  
Lyme Disease ◽  
Psychiatric Hospitalization ◽  
Psychiatric Symptoms ◽  
Physical Symptoms ◽  
Panic Attacks ◽  
Depression And Anxiety ◽  
Chronic Lyme Disease ◽  
History Of

Lyme Disease, or Lyme Borreliosis, caused byBorrelia burgdorferiand spread by ticks, is mainly known to cause arthritis and neurological disorders but can also cause psychiatric symptoms such as depression and anxiety. We present a case of a 37-year-old man with no known psychiatric history who developed panic attacks, severe depressive symptoms and suicidal ideation, and neuromuscular complaints including back spasms, joint pain, myalgias, and neuropathic pain. These symptoms began 2 years after being successfully treated for a positive Lyme test after receiving a tick bite. During inpatient psychiatric hospitalization his psychiatric and physical symptoms did not improve with antidepressant and anxiolytic treatments. The patient’s panic attacks resolved after he was discharged and then, months later, treated with long-term antibiotics for suspected “chronic Lyme Disease” (CLD) despite having negative Lyme titers. He however continued to have subsyndromal depressive symptoms and chronic physical symptoms such as fatigue, myalgias, and neuropathy. We discuss the controversy surrounding the diagnosis of CLD and concerns and considerations in the treatment of suspected CLD patients with comorbid psychiatric diagnoses.

A case of neurosyphilis in a patient presenting with bipolar mixed episode suggestive symptoms

2017 ◽  
Vol 41 (S1) ◽  
pp. S347-S347
Author(s):  
M. Martins ◽  
R. Fernandes
Keyword(s):  
Bipolar Disorder ◽  
Mental Illness ◽  
Psychiatric Symptoms ◽  
Transmitted Disease ◽  
Previous History ◽  
Clinical Manifestations ◽  
Presenting Symptoms ◽  
History Of ◽  
Clinical Records ◽  
First Admission

IntroductionSyphilis is a sexually transmitted disease caused by Treponema pallidum. Early invasion of the central nervous system might occur early in the course of the disease. Clinical manifestations may include acute meningeal syphilis, meningovascular syphilis, paretic neurosyphilis and tabetic neurosyphilis. Psychiatric symptoms are often the presenting symptoms of this illness and the correct diagnosis involves both a high degree of suspicion and adequate diagnostic tests.ObjectivesThe authors report a case of a patient, with no previous history of mental illness, initially admitted in a psychiatric unit with a clinical picture suggestive of a mixed bipolar disorder episode who has been diagnosed with neurosyphilis a year after.MethodsReview of clinical records and complementary exams.ResultsBy the first admission, the patient presented with depressed and irritable mood, emotional lability, aggressiveness, grandiose and racing thoughts. Upon discharge, he was diagnosed with bipolar disorder and referred to ambulatory unit. The following year he starts presenting cognitive deficits and a progressive loss of autonomy in daily living activities, being referred to neurology evaluation. A year after the first admission, he is admitted in a neurology unit and diagnosed with neurosyphilis.ConclusionsCurrent prevalence of symptomatic neurosyphilis in Western Europe is unknown. Atypical cases presenting with heterogeneous psychiatric and neurologic symptoms, with no previous history of mental illness, should raise a high index of clinical suspicion, since consequences for the patient's health might be severe if not properly diagnosed and treated.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals A clinical and biochemical laboratory profile to measure the severity of dengue fever in paediatric population and their outcome

2021 ◽  
Vol 8 (3) ◽  
pp. 535
Author(s):  
Sandhya Rani Talari ◽  
Gangadhar Belavadi
Keyword(s):  
Dengue Fever ◽  
Dengue Infection ◽  
Elevated Serum ◽  
Clinical Manifestations ◽  
Paediatric Population ◽  
Positive Outcome ◽  
Clinical Findings ◽  
Total Leukocyte Count ◽  
Presenting Symptoms ◽  
Elevated Liver Enzymes

Background: Aim of the study was to assess various clinical manifestations of dengue fever, and complications, to establish the diagnosis of dengue fever based on dengue antigen (NS 1) and antibody (IgM, IgG) and to find the association between the clinical findings with laboratory findings.Methods: 100 cases of suspected children below 18 years of age with clinical features suggestive of dengue infection and children presenting with fever of acute onset (<2 weeks), pain abdomen, vomiting, rash, flushed appearance and bleeding manifestation were studied. The cases were followed up for the clinical and laboratory parameters and were treated according to WHO guidelines.Results: Out of total 100 cases studied 36 were classified as classical dengue fever, 33 as DHF, 15 as DSS, 16 as DLI. It was observed that the disease was common in age group of 5-11 year (54%). Most of the patients were male (66%) with an M:F ratio of 1.94:1. The common presenting symptoms were fever (96%), vomiting (49%), abdominal pain (42%), headache (12%), myalgia (7%), arthralgia (4%), retro orbital pain (1%). General physical examination revealed presence of hypotension, tachycardia, rashes, facial puffiness (28%), pedal oedema (21%), and conjunctival congestion (18%). The skin bleeding was the most common manifestation noted in 12 cases (12%) followed by GIT bleeding like hematemesis 4 cases (4%) followed by epistaxis 4 cases (4%), haematuria 2 cases (2%) and gum bleeds 2 cases (2%). In systemic examination patients were found to have hepatomegaly (53%), ascites (13%), splenomegaly (8%), and pleural effusion (27%). 36 (36%) patients in the study had leucopoenia and mean total leukocyte count of 6014.5 cells/cu mm. The highest and lowest TLC was 22000 and 1400 cells/cumm respectively. 85% cases had thrombocytopenia in the present study. The mean platelet in the present study was 41870 cells/cu mm. Elevated liver enzymes and elevated serum creatinine count was found in complicated forms of disease.Conclusions: The treatment of dengue is mainly supportive, but early institution and meticulous monitoring are the corner stone for positive outcome. Much more awareness, vigilance and research in the diagnostic modalities is further needed to avoid unnecessary panic and platelet transfusions.

SPECT Findings on Neuropsychiatric Symptoms Caused by Nitrous Oxide Abuse

2021 ◽  
Author(s):  
Li Wang ◽  
Lijie Yin ◽  
Qian Wang ◽  
Renbin Wang ◽  
Zunjing Liu ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Psychiatric Symptoms ◽  
Neuropsychiatric Symptoms ◽  
Clinical Manifestations ◽  
Brain Regions ◽  
Clinical Findings ◽  
Lower Limbs ◽  
Motor Impairments ◽  
Limb Weakness ◽  
Obvious Effect

Abstract Objective To investigate the clinical, neuropsychological and changes of regional cerebral blood flow (rCBF) perfusion in patients with neuropsychiatric symptoms caused by nitrous oxide (N2O) abuse. Methods Sixteen patients with neuropsychiatric symptoms caused by nitrous oxide abuse were recruited. 25-30mci 99mTc-ECD was administered intravenously. the SPECT/CT images were collected with low-energy and high-resolution collimator. The region uptake statistics of different brain regions of interest between patients with N2O abuse and normal people of the same age group from background software database were calculated automatically. Results The clinical manifestations of the 16 patients with neuropsychiatric symptoms were mood lability, anxiety, hallucination, delusion, Agitated, Confusion, and other psychiatric symptoms. In addition, 15 patients of them also complained their memory decline. 14 patients manifested as numbness or paresthesias. 14 patients developed limb weakness, whose motor impairments were more severe in lower limbs than upper limbs. 8 patients also accompanied by urinary and defecation disturbance. Neuropsychological examination: BPRS score was 54.69±11.48, the score of HAMD was 30.00 ± 11.06, the score of HAMA was 18.06 ± 5.77, the score of MMSE was28.06 ± 2.29, and the score of MoCA was 25.06 ± 3.40. SPECT showed hypoperfusion in the frontal lobe and the temporal lobe, which consistent with the clinical findings. Conclusion It was the first study to demonstrate obvious effect of N2O abuse on CBF in patients with neuropsychiatric symptom. CBF perfusion imaging is helpful to detect the changes of local brain functional activity in patients with N2O abuse.

Nutritional B12 Deficiency in Infants of Vitamin B12-Deficient Mothers

2011 ◽  
Vol 81 (5) ◽  
pp. 328-334 ◽  
Author(s):  
Oya Halicioglu ◽  
Sezin Asik Akman ◽  
Sumer Sutcuoglu ◽  
Berna Atabay ◽  
Meral Turker ◽  
...  
Keyword(s):  
Megaloblastic Anemia ◽  
Maternal Diet ◽  
Clinical Manifestations ◽  
Serum Vitamin ◽  
Failure To Thrive ◽  
Clinical Findings ◽  
Vitamin B ◽  
Animal Products ◽  
Hematological Evaluation ◽  
Nutritional Vitamin

Aim: Nutritional vitamin B12 deficiency in infants may occur because the maternal diet contains inadequate animal products. Clinical presentations of the infants who had nutritional vitamin B12 deficiency were analyzed in this study. Subjects and Methods: Patients with nutritional vitamin B12 deficiency were enrolled in the study between 2003 and 2010. The diagnosis was based on a nutritional history of mothers and infants, clinical findings, hematological evaluation, and low level of serum vitamin B12. Results: Thirty children aged 1 - 21 months constituted the study group. Poverty was the main cause of inadequate consumption of animal products of the mothers. All infants had predominantly breastfed. The most common symptoms were developmental delay, paleness, apathy, lethargy, anorexia, and failure to thrive. Hematological findings were megaloblastic anemia (83.3 %), thrombocytopenia (30 %), and severe anemia (13.3 %). All of the mothers had low serum B12 levels; eight of them had megaloblastic anemia. Conclusion: The unusual clinical manifestations of vitamin B12 deficiency may also be seen apart from neurological and hematological findings. Nutritional vitamin B12 deficiency due to maternal deficiency might be a serious health problem in infants. Therefore, screening and supplementation of pregnant and lactating women to prevent infantile vitamin B12 deficiency should be considered.

Family Environment and Its Correlation with Anxiety and Depression: A Study on Heart Patients

2016 ◽  
Vol 3 (2) ◽  
Author(s):  
Dr. Meena Jain ◽  
Saloni Chandalia
Keyword(s):  
Heart Disease ◽  
Family Environment ◽  
Heart Attack ◽  
Psychiatric Symptoms ◽  
Disease Risk ◽  
Positive Association ◽  
Anxiety And Depression ◽  
Depression And Anxiety ◽  
Increased Risk ◽  
Artery Disease

This research paper deals with the Family Environment and its Correlation with Anxiety and Depression level among persons with Heart Disease. There had been a number of researches that investigated that ischemic heart disease patients who suffer significant anxiety have close to a 5-fold increased risk of experiencing frequent angina and those with depression have more than a 3-fold increased risk for these episodes. This observed link between psychiatric symptoms and angina underlines the importance of treating anxiety and depression in cardiac patients, according to study co author Dr Mark D Sullivan (University of Washington School of Medicine, Seattle). To gather the needed data, Hamilton Anxiety Scale and Becks Depression Inventory were used. As stated from literatures, for people with heart dysfunction, depression and anxiety can increase the risk of an adverse cardiac event such as a heart attack or blood clots. For people who do not have heart disease, depression and anxiety can also increase the risk of a heart attack and development of coronary artery disease. Researchers have also emphasized on the role of family psychosocial environment and its positive association with the Coronary Heart Disease risk.

Comparative characteristics of educational stress and mental health of senior medicine students at different universities (results of an interregional study)

2020 ◽  
pp. 34-46
Author(s):  
Victoria Ruzhenkova ◽  
Irina Sheremet’eva ◽  
Viktor Ruzhenkov
Keyword(s):  
Mental Health ◽  
Medical Students ◽  
The State ◽  
Panic Attacks ◽  
Stress Factors ◽  
Anxiety And Depression ◽  
State University ◽  
The Future ◽  
Training Stress ◽  
Medical University

Stress negatively affects the mental health of students, causes anxiety and depression, leads to poor academic performance, lowers level of professional training and success in the future. The purpose of the research is to study the state of mental health of medical students to develop recommendations for the prevention of maladaptation. Materials and methods. 252 5-year students aged 20–29 (22 ± 1,1) years, 168 (66,7 %) females and 84 (33,3 %) males (137 students of Belgorod State University and 115 of Altay State Medical University (ASMU)) were examined by medico-sociological and psychometric methods. Results. It was established that every fifth student of the Belgorod State University and every third of the ASMU did not enter the medical university on their own initiative. Less than half (43 %) of Belgorod State University students and 30.4 % of the ASMU ones are convinced that the choice of profession was correct, 35 and 37.4 % are, consequently, completely disappointed with it. Students of Belgorod State University dealt with training stress factors poorer and, as a result, have more pronounced mental symptoms of training stress, difficulties in organizing the daily regimen, irregular nutrition, and fear of the future. Regardless of the region of studying, the number of students not committed to the medical profession, after 5 years of study, is more than 3 times higher among those who enter the university not on their own initiative. Students of the ASMU hit substances, skipped classes, played computer games and took sedative drugs more often to overcome academic stress. The degree of anxiety before the exams in students of Belgorod State University was higher (9 points) than in their peers from the State Medical University (7 points). An extremely high (8–10 points) level of anxiety before exams was characteristic of 75,9 and 44,3 % of students, respectively. The former were more likely to experience clinically significant panic attacks: 27,7 and 6,1 %. Conclusion. Given the high incidence of social phobia (19,1–24,1 %), depression (22,6–32,2 %) and anxiety (21,9– 27,8 %) among medical students, the development and implementation of psycho-correctional programs aimed at the formation of adaptive ways to overcome stress, reduce anxiety and depression is required. This will prevent the development of psychosomatic disorders and addictions.

Scabies: A Neglected Global Disease

2020 ◽  
Vol 16 (1) ◽  
pp. 33-42 ◽  
Author(s):  
Alexander K.C. Leung ◽  
Joseph M. Lam ◽  
Kin F. Leong
Keyword(s):  
English Language ◽  
Clinical Manifestations ◽  
Skin Lesions ◽  
Sarcoptes Scabiei ◽  
Clinical Findings ◽  
Effective Control ◽  
Search Term ◽  
Skin Contact ◽  
Intense Pruritus ◽  
Meta Analyses

Background: Scabies is a skin disease caused by an obligate human parasite mite Sarcoptes scabiei var. hominis. Children under the age of two and elderly individuals are at the greatest risk. Knowledge of this condition is important for an early diagnosis to be made and treatment to be initiated. Objective: The review aimed to familiarize physicians with the clinical manifestations, diagnosis, evaluation, and management of scabies. Methods: A search was conducted using Pubmed with the built-in "Clinical Queries" tool. The search term "Scabies" was used. The categories of "epidemiology", "diagnosis", "therapy", "prevention" and "prognosis" had a limited scope for primary clinical studies. Meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews were included. Only papers published in the English language were included. A descriptive, narrative synthesis was provided of the retrieved articles. Results: Worldwide, scabies affects 200 to 300 million individuals annually. The average prevalence is estimated to be 5 to 10% in children of developing countries. Transmission usually occurs after close prolonged skin-to-skin contact. Classic scabies is characterized by an erythematous papular eruption, serpiginous burrows, and intense pruritus. Sites of predilection include the webs of the fingers, volar wrists, lateral aspects of fingers, extensor surfaces of elbows and knees, waist, navel, abdomen, buttocks, groins, and, genitals. A clinical diagnosis of classic scabies can be made on the basis of the history and clinical findings. Other clinical variants include crusted scabies, nodular scabies, and bullous scabies. Finding the mite, ova, or fecal pellets on microscopic examination of scrapings taken from skin lesions confirms the diagnosis of scabies infestation. For eradication of scabies mites, the drugs of choice are topical permethrin and oral ivermectin. Conclusion: Scabies is a highly contagious parasitic cutaneous disease that is stigmatising and debilitating. Increased awareness, accurate diagnosis, and prompt treatment are essential for the effective control of scabies and for the prevention of the spread of the disease.

scholarly journals Autoimmune encephalitis in a South Asian population

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nilanka Wickramasinghe ◽  
Dhanushka Dasanayake ◽  
Neelika Malavige ◽  
Rajiva de Silva ◽  
Thashi Chang
Keyword(s):  
Sri Lanka ◽  
Psychiatric Symptoms ◽  
South Asians ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Autoimmune Encephalitis ◽  
Asian Population ◽  
South Asian Population ◽  
Clinical Presentations

Abstract Background Autoimmune encephalitis (AE) is now considered a main, potentially curable cause of encephalitis, but remains conspicuously underreported from South Asia. We studied the clinical characteristics in relation to their antibody status and outcomes of patients presenting with AE in Sri Lanka. Methods Patients admitting to government hospitals who were clinically suspected of AE by an on-site neurologist were prospectively recruited over a period of 12 months. Sera and cerebrospinal fluid were tested for NMDAR, AMPAR1, AMPAR2, LGI1, CASPR2, GABARB1/B2 antibodies (Ab) using commercial cell-based assays. Demographic, clinical and laboratory data were compiled into an investigator-administered proforma. Patients were reviewed at 1 year follow up either in person or via telephone. Results One-hundred and forty-two patients from 21 of 25 districts in Sri Lanka (median age = 20.5 years; range 1–86 years; females = 61.3%) were recruited. Of them, 65 (45.8%; median age = 19 years; range 1–86 years; females = 64.6%) fulfilled diagnostic criteria for probable NMDAR-antibody encephalitis (NMDARE) and 6 (4.2%; median age = 44 years; range 28–71 years; females = 83.3%) limbic encephalitis (LE). Abnormal behaviour (95.3%), seizures (81.5%) and movement disorders (69.2%) were the most frequent clinical manifestations of probable NMDARE. NMDAR-antibodies were detectable in 29 (44.6%) and not detectable in 36 in CSF of probable-NMDARE patients. Abnormal EEG was more frequent (p = 0.003) while a worse outcome (OR = 2.78; 95% CI = 0.88–9.09) and deaths (OR = 2.38; 95% CI = 0.67–8.33) were more likely in antibody-negative than antibody-positive probable-NMDARE. Most patients with LE had amnesia (50%) and/or confusion (100%) with agitation (83.3%) and seizures (100%) but none had detectable antibodies to any of the antigens tested. Conclusions NMDARE is the commonest type of AE among South Asians as is the case worldwide. Clinical presentations of NMDARAb-positive and NMDARAb-negative AE patients do not significantly differ but EEG may be a useful marker of an autoimmune basis for psychiatric symptoms.

scholarly journals Neuralgic amyotrophy: an underrecognized entity

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110065
Author(s):  
Tae Uk Kim ◽  
Min Cheol Chang
Keyword(s):  
Clinical Practice ◽  
Magnetic Resonance ◽  
Clinical Manifestations ◽  
Clinical History ◽  
Cervical Radiculopathy ◽  
Sudden Onset ◽  
Clinical Findings ◽  
Magnetic Resonance Neurography ◽  
Essential Information ◽  
Neuralgic Amyotrophy

Neuralgic amyotrophy (NA) is markedly underdiagnosed in clinical practice, and its actual incidence rate is about 1 per 1000 per year. In the current article, we provide an overview of essential information about NA, including the etiology, clinical manifestations, diagnostic investigations, differential diagnosis, treatment, and prognosis. The causes of NA are multifactorial and include immunological, mechanical, or genetic factors. Typical clinical findings are a sudden onset of pain in the shoulder region, followed by patchy flaccid paralysis of muscles in the shoulder and/or arm. A diagnosis of NA is based on a patient’s clinical history and physical examination. Gadolinium-enhanced magnetic resonance imaging and high-resolution magnetic resonance neurography are useful for confirming the diagnosis and choosing the appropriate treatment. However, before a diagnosis of NA is confirmed, other disorders with similar symptoms, such as cervical radiculopathy or rotator cuff tear, need to be ruled out. The prognosis of NA depends on the degree of axonal damage. In conclusion, many patients with motor weakness and pain are encountered in clinical practice, and some of these patients will exhibit NA. It is important that clinicians understand the key features of this disorder to avoid misdiagnosis.

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