Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0011206 (delirium)
 5,996 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Surveys of psychiatric population had previously shown a high incidence of patients with low serum vitamin B12. A variety of psychiatric syndromes have been described, ranging from mild disturbance in mood state like depression to maniacal excitement; psychotic conditions like paranoid states and schizophrenia; and cognitive dysfunctions such as memory defect, delirium and dementia. A case of a 67-year-old Chinese lady suffering from pernicious anaemia, but presenting with prominent paranoid delusions is reported. Treatment with cyanocobalamine and anti-psychotic medication led to prompt resolution of her psychotic experience. Subsequently she developed a transient depressive syndrome which also responded well to a short course of antidepressant.
 ...
PMID:Psychiatric syndromes in pernicious anaemia--a case report. 159 18

Two patients with chronic alcohol abuse and central pontine myelinolysis are described. One developed a Korsakoff syndrome 2 days before admission to our hospital and the other showed signs of a incipient delirium without Korsakoff syndrome. Diagnosis of incipient central pontine myelinolysis was based on acute brain-stem dysfunction, serum electrolyte disturbances, malnutrition with vitamin B1 (thiamine), B6 (pyridoxine) and B12 (cyanocobalamin) deficiency in combination with typical neuroradiological findings. Hypokalaemia but no disturbance in serum sodium levels was found in both patients. After correction of hypokalaemia and vitamin deficiency the patients showed complete recovery of neurological and neuropsychological function. The findings are interpreted as suggesting that disturbances in serum potassium levels as well as rapid correction of hyponatraemia may be associated with pontine swelling and dysfunction which, if undetected, leads to central pontine myelinolysis.
 ...
PMID:Central pontine myelinolysis associated with low potassium levels in alcoholism. 239 53

Psychiatric symptoms attributable to vitamin B12 deficiency have been described for decades. The earlier reports are for the most part in accord with more recent ones, despite being diagnostically less specific in psychiatric and hematologic terms. These symptoms seem to fall into several clinically separate categories: slow cerebration; confusion; memory changes; delirium, with or without hallucinations and/or delusions; depression; acute psychotic states; and (more rarely) reversible manic and schizophreniform states. While there still remain abundant hematologic, psychiatric, neurologic, or nutritional reasons for obtaining a serum vitamin B12 level, its use in the investigation of the etiology of a patient's dementia seems unjustified. However, acute or subacute changes in a demented patient's mental status, specifically a clouding of their consciousness, may make such testing advisable as part of the complete workup of their delirium regardless of a normal hematologic picture.
 ...
PMID:What are the psychiatric manifestations of vitamin B12 deficiency? 275 65

We describe two patients with methylmalonic aciduria and homocystinuria (Cbl C). The disorder was not diagnosed in patient 1 until 4 1/2 years of age; he had a history of fatigue, anorexia, delirium, and spasticity. Moderate megaloblastic bone marrow changes were observed, and there was hyperreflexia of the lower limbs. His condition improved clinically with hydroxycobalamin therapy. Patient 2 was hospitalized at 6 weeks of age because of lethargy and poor feeding. She was found to have macrocytosis. Despite an initial good clinical response to hydroxycobalamin, she developed a striking pigmentary retinopathy. Methylmalonic aciduria persisted in both patients, and homocystinuria persisted in patient 1 despite therapy. The diagnosis of Cbl C disease has been confirmed in both patients by biochemical studies of cultured fibroblasts, including complementation studies. The differences in age of onset and clinical findings together with the similar biochemical findings in these two patients demonstrate the heterogeneity of phenotypic expression in patients with apparently identical abnormalities of vitamin B12 metabolism.
 ...
PMID:Clinical heterogeneity in cobalamin C variant of combined homocystinuria and methylmalonic aciduria. 395 Aug 20

We report a retrospective study of 59 patients for whom our university hospital nursing service had required the use of lay sitters because of the need for constant observation. Of 54 charts examined, 28 noted a need for psychiatric consultation, mostly because of delirious states. Quality of care deficits discerned included (1) inadequate pharmacotherapy of alcoholic and nonalcoholic delirium, (2) inadequate search for treatable causes of delirium (thyroid, B12, and folate deficiencies), (3) insufficient awareness of persistent cognitive deficits, which influence the patient's ability to care for himself or give informed consent. The knowledge and skills deficits we found are not unique to this hospital and reflect the failure of most graduate programs to reinforce basic psychiatric teaching. The quality of care issues indicate that more serious consideration should be given to providing necessary psychiatric training.
 ...
PMID:Recognizing and treating delirium in patients admitted to general hospitals. 820 86

Laboratory investigations were performed in group of 60 psychogeriatric patients on their admission into hospital, in order to elucidate the interdependence of erythropoiesis and the concentrations of albumin and several vitamins in blood or serum. The results of albumin concentration and ETK activity show that 47 out of 60 the patients (= 78%) are in a poor nutritional condition. In 13 of these 47 subjects (= 28%) deficiency with respect to vitamin B12 or folic acid is presumed from decreased serum concentrations. In 6 of the 47 patients in poor nutritional condition (= 13%) decreased reticulocyte concentrations are shown. Further evaluation of differences between the respective subgroups revealed significantly reduced ETK activity and lower reticulocyte concentrations in the group of delirium patients compared to the other patients groups and to the reference group.
 ...
PMID:[Decreased erythropoiesis and biochemical deviations in psychogeriatric patients]. 953 10

Deficiency of cystathionine beta-synthase (CBS) is the commonest cause of primary homocystinuria. Homocysteine metabolism is intimately linked with the metabolism of folate, vitamin B12 (cobalamin) and pyridoxine. It is hypothesised that the pathogenesis of neuropsychiatric manifestations in homocystinuria, folate and cobalamin deficiencies are related to imbalance neurotransmitters in the CNS through disturbances in the pathways linking the metabolism of homocysteine and these vitamins. Although neuropsychiatric disorders are relatively common among patients with homocystinuria, it is not well recognised as the causative factor among patients presenting with neuropsychiatric disorders. A 31 year old woman presented with a three week history of delirium and inappropriate and labile affect. There was no history suggestive of drug or alcohol abuse, nutritional deficiency or organic disorders. EEG, cerebral CT, MRI and microbiological investigations did not reveal any organic causes. Because of a diagnosis of pyridoxine-responsive homocystinuria seven years previously, the possibility of homocystinuria was considered and investigated. Laboratory tests revealed macrocytosis and a high concentration of urinary total homocystine. Commencement of pyridoxine at 400 mg/day resulted in disappearance of homocystine in urine within four days with remarkable clinical improvement. Homocystinuria should be considered in the differential diagnosis of unexplained neuropsychiatric disorders in patients who have past or family history of homocystinuria, mental retardation, thromboembolic episodes, vascular diseases or clinical and laboratory features resembling folate and/or vitamin B12 deficiencies. Homocystinuria-associated neuropsychiatric disturbances can easily be treated with pyridoxine in 50% of cases.
 ...
PMID:Homocystinuria and psychiatric disorder: a case report. 1050 67

We investigated the relation between cobalamin deficiency, clinical changes and brain function in dementia patients. On admittance to the clinic, 24 patients had cobalamin deficiency, and dementia with additional symptoms of delirium. During cobalamin supplementation, the patients underwent repeated regional cerebral blood flow (rCBF) studies, psychiatric evaluations, and in some cases assessment with MMSE and the Organic Brain Syndrome scale. Fifteen patients who showed mild to moderate dementia improved clinically, and also showed a concomitant increase in their general CBF after treatment. In contrast, 9 patients who were severely demented showed no obvious clinical improvement, and no general blood flow change, although some regional flow increases were seen in sensory motor areas. We conclude that symptoms which probably indicated superimposed delirium such as clouding of consciousness, disorientation and clinical fluctuation, responded to the vitamin B12 supplementation, while the underlying dementia condition remained basically unchanged. The clinical improvement was also mirrored in general and focal rCBF changes.
 ...
PMID:Treatment of cobalamin deficiency in dementia, evaluated clinically and with cerebral blood flow measurements. 1096 78

Vitamin B12 is an essential micronutrient required for optimal hemopoetic, neuro-cognitive and cardiovascular function. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. It presents with diverse clinical manifestations ranging from impaired memory, dementia, delirium, peripheral neuropathy, sub acute combined degeneration of the spinal cord, megaloblastic anemia and pancytopenia. This review article offers a current perspective on the physiological roles of vitamin B12, proposed pathophysiological mechanisms of vitamin B12 deficiency, screening for vitamin B12 deficiency and vitamin B12 supplementation among patients with diabetes mellitus.
 ...
PMID:Vitamin B12 deficiency among patients with diabetes mellitus: is routine screening and supplementation justified? 2365 30

Vitamin B12 deficiency can manifest with haematological, gastrointestinal and neuropsychiatric signs. The neuropsychiatric symptoms may be concurrent or precede the other symptoms. The reported case is a clinical case of delirium due to vitamin B12 deficiency in a female vegetarian patient. The patient was treated with vitamin B12 supplementation. Initially, it was difficult to diagnose this patient, who presented with delirium that could have been due to multiple causes. The finding underlines the importance of conducting a complete laboratory test panel for delirium, including the blood levels of vitamin B12.
...
PMID:Delirium as a result of vitamin B12 deficiency in a vegetarian female patient. 2385 97


1 2 Next >>