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10 results

  • Post-COVID condition: a focus on psychiatric symptoms and diagnoses in patients with cognitive complaints

  • Matteo Cerioli, Luca Giacovelli, Chiara Nostro, Luca Larini, Michele Castiglioni, Carolina Scarpa, Niccolò Cassina, Alessia Nicotra, Giorgia Maestri, Valentina Cucumo, Federico Masserini, Simone Pomati, Giovanna Cirnigliaro, Leonardo Pantoni, Bernardo Dell’Osso
  • Journal:
    CNS Spectrums , First View
    Published online by Cambridge University Press:
    11 November 2024, pp. 1-7
    • Article
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  • Objective

    Cognitive and psychiatric symptoms are frequently reported after SARS-CoV-2 infection, but their interplay has been only partially explored. We investigated frequency and severity of psychiatric symptoms in patients with persistent cognitive complaints after COVID-19.

    Methods

    We conducted a cross-sectional study. Neurologists assessed 101 patients reporting cognitive symptoms after COVID-19. Patients were invited to fill a screening battery with self-reported psychometric scales (Depression Anxiety Stress Scales-21, Impact of Event Scale-Revised, Insomnia Severity Index). Patients scoring above validated cut-offs in ≥1 scale were referred to psychiatrists who administered the Mini-International Neuropsychiatric Interview (M.I.N.I.), Hamilton Anxiety (HAM-A), and Hamilton Depression (HAM-D) rating scales and asked to complete the Personality Inventory for DSM-5-Brief Form (PID-5-BF).

    Results

    Out of the 57 referred patients, 38 (64.4%) accepted to undergo the psychiatric examination. Among these, 18 (47.4%) were diagnosed with adjustment disorder (23.7%), anxiety disorder (10.5%), major depressive disorder (7.9%), and post-traumatic stress disorder (2.6%). Pharmacologic treatment before post-COVID condition (present in 12 patients, 31.6%) was associated with a score above cut-off on the HAM-A and HAM-D scales. A longer duration of untreated psychiatric illness after COVID-19 was associated with worse scores on the same scales. Patients with a higher PID-5-BF total score had a higher probability of receiving a psychiatric diagnosis.

    Conclusion

    Almost half of patients with post-COVID-19 conditions reporting cognitive symptoms were found to suffer from a psychiatric condition after psychiatric evaluation. The application of a psychiatric screening in a population suffering from long-term effects of COVID-19 can lead to early diagnosis and timely treatment.

  • Chapter 10 - Attention-Deficit/Hyperactivity Disorder

  • Edited by David Kingdon, University of Southampton, Paul Rowlands, Derbyshire Healthcare NHS foundation Trust, George Stein, Emeritus of the Princess Royal University Hospital
  • Book:
    Seminars in General Adult Psychiatry
    Published online:
    04 April 2024
    Print publication:
    18 April 2024, pp 539-545

  • Summary

    Traits and symptoms of ADHD, which can potentially lead to a diagnosis, are highly prevalent in the general population. In any typical town in the UK, there may be thousands of people who would potentially match the symptom descriptions set out in the diagnostic criteria. Such a screening approach could potentially pathologise normal human experience or mislabel symptoms of a comorbid mental disorder, which should take precedence in treatment. There has been a sudden increase in the number of people seeking an assessment for adult ADHD at least in the West and a shift in their expectations about the outcome of their assessment. The demands of modern life may lead people to seek cognitive enhancement to allow them to perform. Some recent routes to seeking an assessment and treatment for ADHD may be linked to that; the ethics around neuroaugmentation are still being debated.

    In the minds of clinicians, ADHD should remain a clinical disorder that can only be reliably diagnosed if the specified number of pervasive symptoms is present and another condition cannot better explain the impairment directly attributed to these symptoms. The primal purpose of this medical diagnosis is to provide access to evidence-based treatments aiming to reduce symptoms and not to validate a person’s understanding of themselves through self-diagnosis.

  • P03-47 - The Differences in Producing Cognitive Deficit Between First and Second-Generation Antipsychotics - Our Experiences

  • J. Djedovic, A. Tomcuk, N. Radoman, M. Roganovic, B. Cizmovic, N. Matkovic
  • Journal:
    European Psychiatry / Volume 25 / Issue S1 / 2010
    Published online by Cambridge University Press:
    17 April 2020, 25-E1157
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  • Objectives

    Contemporary researches of the cognitive impairment in schizophrenic patients were conducted in three directions: Cognitive declining as a developmental precursor of schizophrenia, evolution of the cognitive deficit during the illness, and at last, impact of pharmacological treatment on cognitive functioning. The main aim of our study is to evaluate differences between first and second-generation antipsychotics in manifestations and course of the cognitive declining, in patients with first episode of paranoid schizophrenia.

    Material and methods

    We conducted open label, prospective trial, at the sample of 12 patients during first episode of paranoid schizophrenia. Diagnosis was made according to the criteria of the International classification of diseases 10th revision. The sample was divided in two clusters with 6 patients in each one. In the first cluster, patients received first-generation antipsychotics, and in the second one was administered second-generation antipsychotic - risperidone. Cognitive functions was evaluated by Mini Mental State Examination Test which is modified with adding two simple neuropsychological tests: Clock Drawing Test and Test of Verbal Fluency.

    Results

    We found more prominent cognitive declining in first cluster patients - particularly mnestic deficit.

    Conclusions

    First-generation antipsychotics posses more prominent negative impact on cognitive functioning in comparison to second generation antipsychotic - risperidone.

  • 17 - Hydrocephalus shunts

  • from Section 4 - Treatment and outcomes
  • Edited by Daniele Rigamonti, The Johns Hopkins University School of Medicine
  • Book:
    Adult Hydrocephalus
    Published online:
    05 February 2014
    Print publication:
    06 February 2014, pp 190-206

  • Summary

    The recently updated Japanese guidelines draw attention to a specific MRI pattern of disproportionately enlarged subarachnoid space hydrocephalus (DESH), believed to be pathognomonic of idiopathic normal pressure hydrocephalus (iNPH). This chapter discusses why establishing the diagnosis of NPH remains a challenge fifty years after its classic description. The original diagnosis of NPH relied upon the presence of mild dementia, gait, and urinary difficulties (Hakim's triad) seen in association with ventriculomegaly on pneumo-encephalogram. More sensitive cognitive evaluation of iNPH patients requires specific tests for the assessment of subcortical frontal lobe deficits such as the Rey Auditory Verbal Learning Test, Stroop test, Grooved Pegboard, Trail Making A and B Test, and digit span test. This diagnostic test provides information about cerebrospinal fluid (CSF) dynamics and predicts outcome. It consists in either removal of CSF accompanied by pre and post functional evaluation, or an infusion (bolus or continuous) test.

  • A comparison of cognitive functioning in acute schizophrenia and depression

  • Tina Gooren, Peter Schlattmann, Peter Neu
  • Journal:
    Acta Neuropsychiatrica / Volume 25 / Issue 6 / December 2013
    Published online by Cambridge University Press:
    29 May 2013, pp. 334-341
  • Objective

    Even though cognitive deficits are well recognised in schizophrenia and depression, direct comparisons between the disorders are scarce in literature. This study aims to assess specificity and degree of cognitive deficits in inpatients with acute schizophrenia and unipolar major depression.

    Methods

    A neuropsychological test battery was administered to 76 schizophrenic patients, 102 patients with unipolar major depression and 85 healthy controls (HCs), assessing verbal learning [Rey Auditory Verbal Learning Test (RAVLT)], processing speed (Trail Making Test), verbal fluency and visual memory (Wechsler Memory Scale-Revised test).

    Results

    Both patient groups were significantly impaired compared with HCs with regard to all test outcomes. The schizophrenia group (SG) performed significantly worse in the Wechsler Memory Scale and verbal fluency than the depression group (DG). The DG reached significantly lower scores than the SG in the RAVLT delayed recall subtest. No significant group difference between SG and DG was found for the Trail Making Test and the RAVLT direct recall trails.

    Conclusion

    Our results indicate that cognitive impairment is present in both disorders. Schizophrenic patients performed worse than patients with unipolar depression in only two of the administered tests. Differences in cognitive performance between the groups are not as general as often assumed. Therefore, during the acute phase of illness, a diagnostic classification on the grounds of the patients’ neurocognitive performance has to be done with caution.

  • Case 15 - Young man with progressive speech impairment and weakness

  • Edited by Serge Gauthier, McGill University, Montréal, Pedro Rosa-Neto, McGill University, Montréal
  • Book:
    Case Studies in Dementia
    Published online:
    16 May 2011
    Print publication:
    21 April 2011, pp 105-114

  • Summary

    This chapter presents a case of a 54 year old man Mr. H who had some neurotic personality features associated with some impulsivity. A majority of patients develop neuropsychiatric symptoms, also called behavioral and psychological symptoms of dementia (BPSD) during the course of their illnesses. Neuropsychiatrie symptoms are primary manifestations of the disease process, but other psychological and social factors also play a role in determining which patients will manifest behavioral symptoms. For Mr. H, irritability, anxiety, and delusion are related both to the personal history of the patient and his wife. They are also the consequences of the cognitive deficit and the patient psychological reaction to the perception of his memory loss. Mr. H. has a major loss of self-initiated behavior and interest. However, he is able to respond to external cognitive and emotional stimulation. This helps in choosing the best non-pharmacological strategies.

  • Investigation of response inhibition in obsessive-compulsive disorder using the Hayling task

  • MARTIAL VAN DER LINDEN, GRAZIA CESCHI, ARIANE ZERMATTEN, DANIELA DUNKER, ALAIN PERROUD
  • Journal:
    Journal of the International Neuropsychological Society / Volume 11 / Issue 6 / October 2005
    Published online by Cambridge University Press:
    21 October 2005, pp. 776-783

  • This study investigates response inhibition deficits in obsessive-compulsive disorder (OCD) by using the Hayling task. Sixteen OCD washers, 16 OCD checkers, 16 social phobic patients and 16 nonanxious controls were asked to complete sentences with either the expected word (section A: “initiation”) or an unrelated word (section B: “inhibition”). The groups did not differ in terms of section B minus section A latencies. However, OCD washers and checkers made significantly more errors (sentence-related responses) in section B than social phobic patients and controls. In the OCD patients, the frequency of these errors correlates with the total OCD severity score and the compulsion subscore, but not with the depression and anxiety scores. These findings suggest that OCD patients might present a specific deficit affecting the inhibition of a prepotent response. (JINS, 2005, 11, 776–783.)

  • Cerebral volume loss, cognitive deficit and neuropsychological performance: Comparative measures of brain atrophy: I. Dementia

  • ERIN D. BIGLER, E. SHANNON NEELEY, MICHAEL J. MILLER, DAVID F. TATE, SARA A. RICE, HOWARD CLEAVINGER, LARA WOLFSON, JOANN TSCHANZ, KATHLEEN WELSH-BOHMER
  • Journal:
    Journal of the International Neuropsychological Society / Volume 10 / Issue 3 / May 2004
    Published online by Cambridge University Press:
    01 May 2004, pp. 442-452

  • There are several magnetic resonance (MR) imaging methods to measure brain volume and cerebral atrophy; however, the best measure for examining potential relationships between such measures and neuropsychological performance has not been established. Relationships between seven measures of MR derived brain volume or indices of atrophy and neuropsychological performance in the elderly subjects of the population-based Cache County, Utah Study of Aging and Memory (n = 195) were evaluated. The seven MR measures included uncorrected total brain volume (TBV), TBV corrected by total intracranial volume (TICV), TBV corrected by the ratio of the individuals TICV by group TICV (TBVC), a ventricle-to-brain ratio (VBR), total ventricular volume (TVV), TVV corrected by TICV, and a measure of parenchymal volume loss. The cases from the Cache County Study were comprised of elderly individuals classified into one of four subject groups based on a consensus diagnostic process, independent of quantitative MR imaging findings. The groups included subjects with Alzheimer's disease (AD, n = 85), no dementia but mild/ambiguous (M/A) deficits (n = 30), a group of subjects with non-AD dementia or neuropsychiatric disorder including vascular dementia (n = 60), and control subjects (n = 20). Neuropsychological performance was based on the Mini-Mental Status Exam (MMSE) and an expanded neuropsychological test battery (consortium to establish a registry for Alzheimer's disease (CERAD). The results demonstrated that the various quantitative MR measures were highly interrelated and no single measure was statistically superior. However, TBVC, TBV/TICV and VBR consistently exhibited the more robust relationships with neuropsychological performance. These results suggest that a single corrected brain volume measure or index is sufficient in studies examining global MR indicators of cerebral atrophy in relation to cognitive function and recommends use of either TBVC, TBV/TICV, or VBR. (JINS, 2004, 10, 442–452.)

  • 11 - Vascular dementia

  • from Part II - Neurological diseases
  • Albert Hofman, Erasmus Universiteit Rotterdam, Richard Mayeux, Columbia University, New York
  • Book:
    Investigating Neurological Disease
    Published online:
    29 September 2009
    Print publication:
    30 August 2001, pp 145-153

  • Summary

    After Alzheimer's disease, vascular dementia is the second most common cause of dementia. Depending on the instrument used in the diagnosis and the age of the study population the prevalence of vascular dementia in the geriatric population ranges from 1-5%. Any patient with cognitive deficit should be investigated to detect a treatable dementia. Basic investigations should include a thyroid function assessment, serum vitamin B12 level, syphilis serology, and computed tomographic scan or magnetic resonance imaging study of the brain. The diagnosis of vascular dementia requires the demonstration of socio-professional handicap and demonstrable causal link to vascular disease of the brain. Patients with vascular dementia are prone to recurrent stroke with further worsening of the cognitive state. In patients with known symptomatic cerebral infarctions, acetylsalicylic acid, ticlopidine and warfarin have been shown to reduce the risk of recurrent stroke. Antidepressants should be prescribed for patients with symptomatic or subclinical depression.