Psychotic Features Among Patients in the Prodromal Stage of Dementia with Lewy Bodies During Longitudinal Observation

Background: Many cases of dementia with Lewy bodies (DLB) present with various psychotic features, including hallucinations, depression, catatonia, and delusions before the onset of cognitive impairment. However, the characteristic features of these psychotic symptoms in prodromal DLB have not been sufficiently described. Objective: To clarify and describe the psychotic features of prodromal DLB before overt cognitive impairment. Methods: The authors analyzed the characteristic psychotic features of prodromal DLB in 21 subjects who developed severe psychotic symptoms without dementia and were diagnosed as DLB after the longitudinal observation period. They were then confirmed to have DLB through indicative and supportive biomarkers of scintigraphy. Results: The psychotic features included a wide variety of symptoms, but convergent to three principal categories: catatonia, delusions-hallucinations, and depression and/or mania. Catatonia was observed in nine cases, five were delusional-hallucinatory, and seven were manic and/or depressive. Seven of the 21 cases exhibited delirium during longitudinal observation. A psychotic state repeatedly appeared without any trigger in 20 of the 21 patients. All subjects developed cognitive impairment at 9.1±4.6 (mean±SD) years after the initial appearance of psychotic symptoms, and subsequently diagnosed with DLB at 71.3±6.1 (mean±SD) years. Conclusion: Elderly patients with psychotic symptoms, such as catatonia, delusion-hallucination, manic and/or depressive features, and delirium without dementia, could indicate symptomatic psychosis or a prodromal stage of any neurocognitive disorder such as DLB. Therefore, further extensive workout (e.g., radioisotope neuroimaging) is required to avoid misdiagnosis.

Associations between socioprovincial factors and self-reported mental disorders among students from grade 4 to 8 in rural China

Background The focus on child mental health in developing countries was increasing. However, little was known in China. This study aimed to explore the associations between socioprovincial factors and self-reported mental disorders in rural China. Methods Data were from a publicly available survey with 54,498 students from Grade 4 to 8 in rural China. Chi-square test was used for descriptive analysis. Self-reported mental disorders included overall mental disorder, study anxiety, personal anxiety, loneliness, guilt, sensitivity, symptomatic psychosis, phobia, and impulsivity. Multiple logistic regressions and errors-in-variables regression models were employed to explore the associations between socioprovincial factors and mental disorders. Poisson regressions and errors-in-variables regression models were adopted to reveal the associations between socioprovincial factors and number of self-reported mental disorders. Results Descriptive statistics showed that mental health was poor in rural adolescents in China. Logistic regression showed that the odds of overall mental disorder and study anxiety were 189% (AOR = 2.89, 95%CI: 2.76, 3.02) and 92% (OR = 1.92, 95%CI: 1.84, 2.00) in Gansu more than those in Anhui, while the odds of personal anxiety, guilt, sensitivity, symptomatic psychosis, and phobia were 92% (AOR = 0.08, 95%CI: 0.08, 0.09), 71% (AOR = 0.29, 95%CI: 0.27, 0.30), 88% (AOR = 0.12, 95%CI: 0.11, 0.13), 69% (AOR = 0.31, 95%CI: 0.29, 0.32), and 78% (AOR = 0.22, 95%CI: 0.21, 0.23) in Gansu less than those in Anhui. Moreover, Gansu (Poisson regression: IRR =1.45, 95%CI: 1.42–1.47; errors-in-variables regression: Coefficient = 0.26, 95%CI: 0.16, 0.36), Ningxia (Poisson regression: IRR =1.63, 95%CI: 1.60–1.67; errors-in-variables regression: Coefficient = 0.43, 95%CI: 0.32, 0.53), Qinghai (Poisson regression: IRR =1.65, 95%CI: 1.60–1.69; errors-in-variables regression: Coefficient = 0.44, 95%CI: 0.34, 0.55), and Shaanxi (Poisson regression: IRR =1.28, 95%CI: 1.25–1.30; errors-in-variables regression: Coefficient = 0.11, 95%CI: 0.00, 0.21) were significantly associated with the number of self-reported mental disorders. Conclusion Class and provincial disparities in self-reported mental disorders were reported among the students from Grade 4 to 8 in rural China. Mental health care supported by governments and schools could be an effective way to reduce the disparities in mental disorders among the adolescents.