Schizophrenia with Good and Poor Outcome

1985 ◽  
Vol 146 (4) ◽  
pp. 348-357 ◽  
Author(s):  
T. Kolakowska ◽  
A. O. Williams ◽  
K. Jambor ◽  
M. Ardern
Keyword(s):  
Cognitive Impairment ◽  
Psychiatric Symptoms ◽  
Stable Condition ◽  
Neurological Dysfunction ◽  
Brain Disorder ◽  
Developmental Abnormalities ◽  
Poor Outcome ◽  
History Of ◽  
Organic Brain ◽  
Treatment Deficits

SummaryFifty-six patients with RDC schizophrenia (42) or schizoaffective disorder (14), of two to 20 years' duration, were assessed for neurological ‘soft’ signs and cognitive impairment when in a stable condition—the ‘outcome’. Neurological dysfunction (46% of 50 examined patients) was associated with a history of developmental abnormalities, but was unrelated to outcome, psychiatric symptoms, or treatment. Deficits in particular cognitive fields were related to two independent factors: overall severity of residual psychiatric disorder (outcome) and neurological dysfunction. There was no relationship between the size of the lateral brain ventricles on CT scan and either ‘soft’ signs or cognitive impairment.The findings do not provide evidence for an association between the presence of organic brain disorder (as indicated by the joint occurrence of neurological dysfunction and cognitive impairment) and either poor outcome or particular symptoms of schizophrenia.

Voltage-gated potassium channel limbic encephalitis presenting as functional cognitive impairment

2020 ◽  
Vol 13 (12) ◽  
pp. e233179
Author(s):  
Eric Garrels ◽  
Fawziya Huq ◽  
Gavin McKay
Keyword(s):  
Cognitive Impairment ◽  
Case Report ◽  
Potassium Channel ◽  
Limbic Encephalitis ◽  
Psychiatric Symptoms ◽  
Differential Diagnoses ◽  
Visual Hallucinations ◽  
Voltage Gated ◽  
History Of ◽  
Impaired Cognition

Limbic encephalitis is often reported to present as seizures and impaired cognition with little focus on psychiatric presentations. In this case report, we present a 49-year-old man who initially presented to the Psychiatric Liaison Service with a several month history of confusion with the additional emergence of visual hallucinations and delusions. Due to the inconsistent nature of the symptoms in the context of a major financial stressor, a provisional functional cognitive impairment diagnosis was made. Investigations later revealed a positive titre of voltage-gated potassium channel (VGKC) antibodies, subtype leucine-rich glioma inactivated 1 accounting for his symptoms which dramatically resolved with steroids and immunoglobulins. This case highlighted the need for maintaining broad differential diagnoses in a patient presenting with unusual psychiatric symptoms.

Selective Mutism and Abnormal Electroencephalography (EEG) Tracings

2011 ◽  
Vol 26 (11) ◽  
pp. 1377-1382 ◽  
Author(s):  
Keren Politi ◽  
Sara Kivity ◽  
Hadassa Goldberg-Stern ◽  
Ayelet Halevi ◽  
Avinoam Shuper
Keyword(s):  
Clinical Picture ◽  
Selective Mutism ◽  
Brain Disorder ◽  
Co Morbidity ◽  
Epileptic Discharges ◽  
History Of ◽  
Organic Brain ◽  
History Of Epilepsy ◽  
Work Up ◽  
Benign Epilepsy

Epileptic discharges are not considered a part of the clinical picture of selective mutism, and electroencephalography is generally not recommended in its work-up. This report describes 6 children with selective mutism who were found to have a history of epilepsy and abnormal interictal or subclinical electroencephalography recordings. Two of them had benign epilepsy of childhood with centro-temporal spikes. The mutism was not related in time to the presence of active seizures. While seizures could be controlled in all children by medications, the mutism resolved only in 1. Although the discharges could be coincidental, they might represent a co-morbidity of selective mutism or even play a role in its pathogenesis. Selective mutism should be listed among the psychiatric disorders that may be associated with electroencephalographic abnormalities. It can probably be regarded as a symptom of a more complicated organic brain disorder.

scholarly journals Rasmussen's Encephalitis. A Case Report

2018 ◽  
Vol 3 (2) ◽  
pp. 849-854
Author(s):  
Tania Licona ◽  
Alejandra Mazariegos-Rivera ◽  
Morgan Medina
Keyword(s):  
Secondary Trauma ◽  
Intractable Epilepsy ◽  
Personal History ◽  
Neurological Dysfunction ◽  
Brain Disorder ◽  
Rasmussen’S Encephalitis ◽  
Intractable Seizures ◽  
Immune Mediated ◽  
History Of ◽  
Rasmussen’S Syndrome

Rasmussen's encephalitis (RE) is a rare but severe immune-mediated brain disorder leading to unilateral hemispheric atrophy, associated progressive neurological dysfunction with intellectual decline, and intractable seizures. It is a well-established cause of pharmacologically intractable epilepsy. The report is on a 17-month-old infant, treated at the Mario Catarino Rivas Hospital Honduras. Family history: grandfather epileptic secondary trauma from 20 years. Personal history: two previous emergency visits (at 16 months and 16 months 8 days) for convulsions for which she was admitted three days and was treated with valproic acid 30 mg/kg per day. The infant is admitted in the emergency, with a history of about three hours after onset of tonic convulsions, focused on left-side with drooling, oculogiros and relaxation of sphincters and fever of 38.5 ° C. Entered as convulsive syndrome in the study, however, as the days passed the number of seizures increased to 60 per day and was gradually presenting alterations in neurodevelopment. MRI reported leukoencephalopathy of undetermined origin and biopsy reported findings consistent with Rasmussen's syndrome. She was treated with immunoglobulin every two weeks for six doses after two months of hospitalization with achieved improvement. Currently, episodes of seizures have decreased significantly and almost not convulsing, she presented alterations in neurodevelopment.

scholarly journals S63. CLINICAL AND DEVELOPMENTAL CHARACTERISTICS OF COGNITIVE SUBGROUPS IN A TRANSDIAGNOSTIC SAMPLE OF SCHIZOPHRENIA, SCHIZOAFFECTIVE DISORDER AND BIPOLAR DISORDER

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S57-S57
Author(s):  
Emre Bora ◽  
Burcu Verim ◽  
Ozge Akgul ◽  
Ayşegül Ildız ◽  
Köksal Alptekin ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Cognitive Impairment ◽  
Normal Subgroup ◽  
Cognitive Functioning ◽  
Healthy Controls ◽  
Developmental Abnormalities ◽  
History Of ◽  
Neurodevelopmental Abnormalities

Abstract Background Evidence suggests that neurocognitive dysfunction is a transdiagnostic feature of individuals across continuum between schizophrenia and bipolar disorder. However, there is a significant heterogeneity of neuropsychological and social cognitive abilities in schizophrenia, schizoaffective disorder and bipolar disorder. In recent years, several studies have investigated cognitive subgroups in schizophrenia-bipolar disorder continuum using data-driven methods and found that bipolar disorder includes several subgroups including a severely impaired and a neurocognitively intact clusters. However, neurodevelopmental and clinical characteristics of cognitive subgroups are not clear. Methods 147 clinically stable patients with schizophrenia, schizoaffective or bipolar disorder were assessed using clinical rating scales for current psychotic and affective symptoms, schizobipolar scale, and a comprehensive neuropsychological battery including measures of ToM (Hinting and Reading the mind from the Eyes (RMET) task)). Developmental history and premorbid academic functioning were also evaluated. The study also included 37 healthy controls. Neurocognitive subgroups were investigated using latent class analysis (LCA). The optimal number of clusters were determined based on Bayesian information criterion. Logistic regression analysis were conducted to investigate the predictors of the membership to globally impaired subgroup. Results LCA revealed two neurocognitive clusters including generally impaired (n=89, 60.5 %) and near-normal cognitive functioning (n=58, 39.5 %) subgroups. The generally impaired subgroup significantly underperformed both groups in memory, executive functions, processing speed, attention and both aspects of ToM. The near-normal cognitive functioning subgroup did not significantly underperformed healthy controls except RMET (p=0.01). The generally impaired subgroup had a history of increased number of developmental abnormalities (p=0.03) and more severe disorganised speech (p=0.02) compared to the near-normal cognitive functioning group. The near-normal subgroup had a significantly higher percentage of individuals with a history of good academic performance in childhood than the globally impaired group (p=0.002). Compared to the near-normal subgroup, the globally impaired subgroup was significantly older (p<0.001) and had mothers who were less educated (p=0.02). While relatively higher percentage of patients with bipolar disorder than schizophrenia were members of the near-normal functioning subgroup (and opposite for the generally impaired subgroup), the between-group difference was not significant. Logistic regression analysis suggested that both the number of neurodevelopmental abnormalities (p=0.02) and disorganised speech (p=0.05) were significant predictors of being included in the globally cognitive impaired subgroup (Log likelihood=144. 4, R2=0.23, p=0.003, percentage correctly identified as globally impaired 81.1 %). Discussion History of developmental abnormalities and persistent disorganisation rather than diagnosis are the significant predictors of the subgroup of individuals with global cognitive impairment in schizophrenia-bipolar disorder continuum. Studies investigating neurobiological and genetic underpinnings of the relationship between cognitive impairment, neurodevelopmental abnormalities and persistent disorganised speech might be important to develop a more valid classification of disorders presenting with psychotic and mood symptoms.

Schizophrenia with Good and Poor Outcome. I: Early Clinical Features, Response to Neuroleptics and Signs of Organic Dysfunction

1985 ◽  
Vol 146 (3) ◽  
pp. 229-239 ◽  
Author(s):  
T. Kolakowska ◽  
A. O. Williams ◽  
M. Ardern ◽  
M. A. Reveley ◽  
K. Jambor ◽  
...  
Keyword(s):  
Psychiatric Symptoms ◽  
Age At Onset ◽  
Plasma Concentrations ◽  
Stable Condition ◽  
Social Impairment ◽  
Psychotic Episode ◽  
Unfavourable Outcome ◽  
Chronic Patients ◽  
Poor Outcome ◽  
Organic Dysfunction

SummarySeventy-seven patients with diagnosis of schizophrenia (62) or schizoaffective disorder (15) were studied 2–20 years since onset of illness, when in a stable condition. The investigation included clinical assessment, measurement of plasma concentrations of neuroleptics and prolactin, computed tomography brain scan, neuropsychological and neurological examination. Outcome of illness was classified according to the presence of chronic psychiatric symptoms and social impairment, and response to neuroleptics according to the effect of treatment in the most recent psychotic episode. Neither outcome nor response to neuroleptics was related to duration of illness. The groups with good and poor outcome differed in premorbid adjustment, age at onset and symptoms of the initial episode, but not in drug bio-availability or prolactin response. Large cerebral ventricles and cognitive impairment, but not neurological ‘soft’ signs, were associated with unfavourable outcome. The three measures of organicity were not inter-related. No clinical differences were found between chronic patients with and without signs of organic dysfunction. The findings suggest that schizophrenia with good and unfavourable outcome may be separate sub-types. However, the role of organic factors in the latter group remains unclear.

Enhanced Vocational Rehabilitation: A Pilot for Veterans With Cognitive Impairment and a History of Mild TBI

2012 ◽  
Author(s):  
Maureen K. O'Connor ◽  
Lisa Mueller ◽  
Alicia Semiatin ◽  
Charles E. Drebing ◽  
Shihwe Wang
Keyword(s):  
Cognitive Impairment ◽  
Vocational Rehabilitation ◽  
Mild Tbi ◽  
History Of

An audit and insights from clinical exome sequencing in psychiatry: genotype-phenotype correlation

2020 ◽  
Author(s):  
Jayant Mahadevan ◽  
Reeteka Sud ◽  
Ravi Kumar Nadella ◽  
Vani P ◽  
Anand G Subramaniam ◽  
...  
Keyword(s):  
Exome Sequencing ◽  
Psychiatric Symptoms ◽  
Pathogenic Variant ◽  
Clinical Exome Sequencing ◽  
Mapt Gene ◽  
Nf1 Gene ◽  
Novel Variant ◽  
History Of ◽  
Atypical Presentations ◽  
Minor Physical Anomalies

BACKGROUND:Psychiatric syndromes have polymorphic symptomatology, and are known to be heritable. Psychiatric symptoms (and even syndromes) often occur as part of the clinical presentation in rare Mendelian syndromes. Clinical exome sequencing reports may help with refining diagnosis and influence treatment decisions, in addition to providing a window into the biology of brain and behaviour. We describe a clinical audit of 12 individuals who sought treatment at our hospital, and for whom targeted sequencing was ordered. Three cases are discussed in detail to demonstrate correlations between genotype and phenotype in the clinic.METHODS:Targeted Next-Generation Sequencing (NGS) was done using Clinical Exome Panel (TruSight One, Illumina) covering coding exons and flanking intronic sequences of 4811 genes associated with known inherited diseases. Variants detected were classified according to the American College for Medical Genetics (ACMG) recommendation for standards of interpretation and reporting of sequence variations.RESULTS:Ten out of twelve cases had at least one pathogenic variant. In one of these cases, we detected a known pathogenic variant in MAPT gene in a suspected FTD case, which helped us to confirm the diagnosis. In another case, we detected a novel variant predicted to be deleterious in NF1 gene. Identification of this mutation suggested a change in treatment for the patient, that was of benefit. The same patient also harboured a novel variant in the TRIO gene. This gene may be involved in biological processes that underlie the patient’s psychiatric illness.CONCLUSIONS:The cases discussed here exemplify different scenarios under which targeted exome sequencing can find meaningful application in the clinic: confirming diagnosis (MAPT variant), or modifying treatment (NF1). We suggest that clinical exome sequencing can be a helpful addition to a clinician’s toolkit when there are expediting factors to consider— such as early-onset, strong family history of mental illness, complex/atypical presentations and minor physical anomalies or neurocutaneous markers.

Computed Tomography and Magnetic Resonance Imaging-aided Diagnosis of Primary Essential Cutis Verticis Gyrata: A Case Report with 5-year Follow-up and Review of the Literature

2019 ◽  
Vol 15 (9) ◽  
pp. 906-910
Author(s):  
Hongzhang Zhu ◽  
Shi-Ting Feng ◽  
Xingqi Zhang ◽  
Zunfu Ke ◽  
Ruixi Zeng ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Three Dimensional ◽  
Stable Condition ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Cutis Verticis Gyrata ◽  
Essential Form ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

Background: Cutis Verticis Gyrata (CVG) is a rare skin disease caused by overgrowth of the scalp, presenting as cerebriform folds and wrinkles. CVG can be classified into two forms: primary (essential and non-essential) and secondary. The primary non-essential form is often associated with neurological and ophthalmological abnormalities, while the primary essential form occurs without associated comorbidities. Discussion: We report on a rare case of primary essential CVG with a 4-year history of normal-colored scalp skin mass in the parietal-occipital region without symptom in a 34-year-old male patient, retrospectively summarizing his pathological and Computer Tomography (CT) and magnetic resonance imaging (MRI) findings. The major clinical observations on the CT and MR sectional images include a thickened dermis and excessive growth of the scalp, forming the characteristic scalp folds. With the help of CT and MRI Three-dimensional (3D) reconstruction techniques, the characteristic skin changes could be displayed intuitively, providing more evidence for a diagnosis of CVG. At the 5-year followup, there were no obvious changes in the lesion. Conclusion: Based on our observations, we propose that not all patients with primary essential CVG need surgical intervention, and continuous clinical observation should be an appropriate therapy for those in stable condition.

scholarly journals 335 - BEHÇET DISEASE PRESENTING WITH ACUTE PSYCHOSIS

2020 ◽  
Vol 32 (S1) ◽  
pp. 94-94
Author(s):  
A.M. Carvalheiro ◽  
A.R. Fonseca ◽  
J. Maia
Keyword(s):  
Psychiatric Symptoms ◽  
Retinal Vasculitis ◽  
Posterior Uveitis ◽  
Neurological Involvement ◽  
Behçet Disease ◽  
Acute Psychosis ◽  
Behcet Disease ◽  
Persecutory Delusions ◽  
Starting Point ◽  
History Of

ObjectivesUsing as a starting point a clinical case, the authors performed a literature review to clarify the relationship between Behçet disease and acute psychosis.MethodsAnalysis of the patient's clinical process and brief review of the latest available literature on the subject, published in PubMed/Medline databases.ResultsMale patient, 55 years old, brought to the emergency room by fever, headache, hetero-aggressive behavior, disinhibited behavior, mood swings, euphoria, persecutory delusions and insomnia, in the last 4 days. He had no insight into his illness. There was no personal or family history of psychiatric illness and toxicological habits were irrelevant. Due to the personal history of posterior uveitis with bilateral macular edema, retinal vasculitis, genital aphthosis, papulo-vesicular lesions and recurrent bipolar aphthosis, the hypothesis of neuro-behçet was raised.ConclusionsBehçet's disease can present with neurological involvement - neuro -behçet - and can manifest itself with several psychiatric symptoms (euphoria, lack of insight, disinhibited behavior, agitation or psychomotor retardation, persecutory delusions, obsessive thoughts, anxiety, depression, insomnia or memory changes). Fever and headache usually appear in the prodromal stage and can be signs of onset or recurrence of the disease. The prevalence of neuro-behçet ranges from 2 to 50% and usually occurs 1 to 10 years after the first symptoms of the disease. Since it appears as the first manifestation of the disease in only 3% of cases, it is difficult to diagnose. The literature suggests that symptoms are generally resistant to treatment with conventional psychotropic drugs and so it is an important cause of morbidity and mortality.”

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