Psychiatry: a philosophy of cognitivism and/or clinical medicine (methodological discourse 1)

Based on the philosophy and methodology of science are discussed two provisions of article by Y.P.Sivolap and A.A.Portnova Psychiatry: scholastic philosophy and clinical medicine? the subject of psychiatry and expansion of neurologists in clinical psychiatry organic dementia. Differences between neurologists and psychiatrists in the concept of dementia are analyzed. Discussed proposed by E.V.Makushkin and L.E.Pischikovа The Concept of understanding late age for clinical gerontopsychiatry and all of the clinical neurosciences.

337 - Pseudodementia, pseudopseudodementia and pseudodepression

While most older people who develop problems with their memory and thinking that are severe enough to impair their ability to function in everyday life typically, are found to have Alzheimer’s disease or other neurodegenerative diseases, some have an undiagnosed and treatable psychiatric disorder masquerading as dementia. These conditions including depression can affect memory and thinking and, when severe, create a clinical picture similar to dementia. This phenomenon, known as “pseudodementia”, is encountered in clinical practice. It is important to identify because it may be reversible with appropriate treatment.There is controversy about what the longer-term prognosis is for people diagnosed with pseudodementia. This has implications for how to manage patients, what advice to give to patients and their family, and how to conceptualise the disorder. Some studies found that people with pseudodementia eventually develop organic dementia, so called pseudo-pseudodementia. To address this, we conducted a systematic review of studies that had been conducted on pseudodementia and which followed up patients over time.Eighteen studies followed patients from several weeks to 18 years. Overall, patients with pseudodementia were at greater risk of later developing organic dementia. Importantly, not all patients did; many patients remained stable or improved, albeit some still impaired by their psychiatric disorder. Our review showed possible treatment benefits and differences with age; patients diagnosed with pseudodementia at a younger age had better outcomes.Finally, people with apathy (which is the commonest behavioural symptom in dementia) can be misdiagnosed as having depression, so called pseudo-depression and then often treated for the wrong condition. Patients with apathy do not respond to antidepressants.Receiving the correct clinical diagnoses are crucial to patients receiving the correct treatment for their condition. A missed diagnosis of a potentially reversible depressive pseudodementia can have tragic consequence for the patient and family.Recent research has neglected the study of pseudodementia. Our findings reveal a clear need for better diagnostic skills, further research with modern investigative tools, such as neuroimaging and genetic sequencing, and clinical trials to better understand underlying mechanisms and determine effective treatment strategies.

Cognitive ability in young adulthood predicts risk of early-onset dementia in Finnish men

ObjectiveTo test if the Finnish Defence Forces Basic Intellectual Ability Test scores at 20.1 years predicted risk of organic dementia or Alzheimer disease (AD).MethodsDementia was defined as inpatient or outpatient diagnosis of organic dementia or AD risk derived from Hospital Discharge or Causes of Death Registers in 2,785 men from the Helsinki Birth Cohort Study, divided based on age at first diagnosis into early onset (<65 years) or late onset (≥65 years). The Finnish Defence Forces Basic Intellectual Ability Test comprises verbal, arithmetic, and visuospatial subtests and a total score (scores transformed into a mean of 100 and SD of 15). We used Cox proportional hazard models and adjusted for age at testing, childhood socioeconomic status, mother's age at delivery, parity, participant's birthweight, education, and stroke or coronary heart disease diagnosis.ResultsLower cognitive ability total and verbal ability (hazard ratio [HR] per 1 SD disadvantage >1.69, 95% confidence interval [CI] 1.01–2.63) scores predicted higher early-onset any dementia risk across the statistical models; arithmetic and visuospatial ability scores were similarly associated with early-onset any dementia risk, but these associations weakened after covariate adjustments (HR per 1 SD disadvantage >1.57, 95% CI 0.96–2.57). All associations were rendered nonsignificant when we adjusted for participant's education. Cognitive ability did not predict late-onset dementia risk.ConclusionThese findings reinforce previous suggestions that lower cognitive ability in early life is a risk factor for early-onset dementia.

Bipolar Disorder: Clinical Perspectives and Implications with Cognitive Dysfunction and Dementia

Introduction. Cognitive dysfunction as a core feature in the course of bipolar affective disorder (BPD) is a current subject of debate and represents an important source of psychosocial and functional burden.Objectives. To stand out the connection and clinical implications between cognitive dysfunction, dementia, and BPD.Methods. A nonsystematic review of all English language PubMed articles published between 1995 and 2011 using the terms “bipolar disorder,” “cognitive dysfunction,” and “dementia”.Discussion. As a manifestation of an affective trait or stage, both in the acute phases and in remission, the domains affected include attention, executive function, and verbal memory. The likely evolution or overlap with the behavioural symptoms of an organic dementia allows it to be considered as a dementia specific to BPD. This is named by some authors, as BPD type VI, but others consider it a form of frontotemporal dementia. It is still not known if this process is neurodevelopmental or neurodegenerative in nature, or both simultaneously. The assessment should consider the iatrogenic effects of medication, the affective symptoms, and a neurocognitive evaluation.Conclusion. More specific neuropsychological tests and functional imaging studies are needed and will assume an important role in the near future for diagnosis and treatment.