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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report an autopsy case of a 73 year-old female with idiopathic parkinsonism, characterized pathologically by the wide spread appearance of Lewy bodies (LBs) not only in the pigmented neurons in the midbrain and brainstem but also in the cerebral cortex. Initial symptoms at the age of 62 were finger tremor and gait disturbance, which were followed mainly by mental deterioration, such as regression, dependency, auditory hallucination, depression, emotional incontinence, and a personality change. In the terminal stage, nuchal stiffness in extension, one of the hallmarks of progressive supranuclear palsy, and slow and generalized tremor in all 4 extremities were noted. She died of aspiration pneumonia. The brain was somewhat small and weighed 1100 g after the fixation by formalin. Macroscopical findings included mild cerebral atrophy with mild pial thickening both in the frontal and temporal lobes and slight expansion of the ventricular system. Histopathologically, severe loss of neuronal cells in both the pallidum and Luy's body and moderate loss of large cells in the putamen were noted in addition to the typical findings of Parkinson's disease in the substantia nigra and locus caeruleus including neuronal cell loss, depigmentation, and gliosis. These findings in the basal ganglia were more conspicuous than the two controls of classical Parkinson's disease. The distribution, stainability in the routine methods of staining, and shape of Lewy bodies in the cerebral cortex conformed to those of previous reports. The similar case reports in the literatures do not seem to have paid much attention to the findings of the basal ganglia observed in our case.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[An autopsy case of idiopathic parkinsonism with numerous Lewy bodies in the cerebral cortex--diffuse Lewy body disease]. 165 48

Behavioral abnormalities and psychiatric symptoms were assessed in 178 patients diagnosed as having Alzheimer's disease by NINCDS/ADRDA criteria. The subjects were selected from a defined catchment area and therefore were representative of a group of patients with Alzheimer's disease of varying severity. Auditory hallucinations were found in 10%, visual hallucinations in 13%, and delusions in 16%. Symptoms suggestive of depression were reported by 39% of the patients and features of depression observed in 25%. Twenty percent were aggressive, and 7% were sexually disinhibited. Nineteen percent exhibited excessive walking behavior and 10% binge eating. Nearly 50% of the sample were incontinent. Patients in the hospital were more often aggressive, incontinent, and seemingly less depressed. Patients with severe dementia displayed excessive walking behavior, were more likely to be incontinent, and reported less depressive symptoms than those with moderate or mild dementia.
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PMID:Behavioral abnormalities and psychiatric symptoms in Alzheimer's disease: preliminary findings. 210 Dec 95

Hallucinations may occur in any sensory modality. Auditory hallucinations, usually ascribed to psychiatric illness, take various forms including the perception of voices, cries, noises, or rarely, music. Formed musical hallucinations, (ie, the perception of either vocal or instrumental melodies), reported in the English literature to date have typically been associated with marked hearing loss, advanced age (average 67.8 years), female sex (71%), lack of response to treatment, and general lack of associated psychopathology. We have collected data on seven additional patients with musical hallucinations. The average age of these patients was 72.9 years; all were women. Six had significant hearing problems. All reported onset of musical hallucinations after the age of 60. Interestingly, all seven had major psychiatric illnesses. Four had major depression, two had late-onset schizophrenia, and one had multi-infarct dementia. Of the five who had CT scans, one was normal and the rest demonstrated varying degrees of brain pathology. Neuroleptics were used with varying results in three cases; antidepressants were used in two depressed patients and were temporally related to the onset of musical hallucinations in one patient. Electroconvulsive therapy (ECT) was very effective in treating depression and musical hallucinations in the three patients for whom it was used, usually providing relief from hallucinations after only two treatments. Our collection of cases demonstrates that musical hallucinations can occur in association with psychiatric illness, and perhaps unlike the hallucinations associated with isolated hearing loss, may respond to conventional treatments for the underlying psychiatric disorder. Hearing loss is neither a necessary nor sufficient condition for the occurrence of musical hallucinations.
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PMID:Musical hallucinations. The sounds of silence? 256 62

Cranial epidural abscesses are unusual in neurosurgical practice. Mostly they are secondary to skull bone osteomyelitis of foreign body implantation as a result of trauma, or infection of paranasal sinus, otitis, and mastoiditis in adults or late adolescents. The purulent inflammatory process of the epidural abscess, thrombophlebitis of the venous drainage, septic thrombosis, direct extension into the orbit, carvenous sinus, superior orbital fissure give the epidural abscess a high mortality and morbidity. We present an interesting case, who has had psychiatric symptoms such as bizarre behavior, auditory and visual hallucination for about two years. Incidental brain computed tomograms, to exclude the organic-somatic disorder, revealed a huge brain abscess. Emergent surgical intervention was carried out and the episodes of talking to himself and auditory hallucination subsided. The removal of the epidural abscess eliminated the symptoms and cured the patient. All the right amygdata, entorhinal area, cingulate gyrus, hippocampus and parahippocampal gyrus of this patient were compressed by the huge abscess. All these structures belonged to limbic system. Diseases involving the limb system may cause emotional disturbances, such as delusions, illusions and hallucinations, emotional lability, pathological laughing and crying, rage reaction and aggression, apathy and placidity, even endogenous fear, anxiety, depression and euphoria. Dramatic improvement of the patient was found after surgical removal of the abscess. We highlight this interesting case for it will undoubtedly bring together a large cooperation of psychiatrists, neurologists and neurosurgeons.
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PMID:Epidural abscess presented with psychiatric symptoms. 934 37

We report a series of alleged ingestions of razor blades and other metal objects by prisoners presenting to an inner city Emergency Department. Fourteen claims of ingestions of razor blades or other metal objects involving eight prisoners occurred in a 5-week period. The motives behind the ingestions varied. Auditory hallucination was the most common reason given for the ingestions. Other motives included efforts to leave prison, depression, and accidental razor blade swallowing. Attempts were made in all patients to verify ingestions by radiograph. Some ingestions could not be confirmed by radiograph and were considered to be factitious. Only 1 of the 14 incidents resulted in hospital admission. All others were either treated in the Emergency Department or the patient was returned to jail with no treatment. No patient had a poor clinical outcome as a result of the ingestion, indicating that diagnostic radiographs and invasive procedures may not always be necessary. A review of treatment of foreign body ingestions is given as well as a summary of the treatment and outcome of these cases.
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PMID:Foreign body ingestions in the Emergency Department: case reports and review of treatment. 1033 52

This paper reports the characteristics and psychopathology of alcohol dependents with alcohol induced psychotic disorder admitted to the Seremban Hospital. The method is that of a case study of all alcohol dependents with alcohol induced psychotic disorder admitted to the Psychiatric Ward, Hospital Seremban over 3 years (1993-1995). There were 34 subjects, 30 Indians, 3 Chinese and 1 Malay with a mean age of 43 years. 32 were men and predominantly of Social Class IV and V (91%). They had a mean duration of drinking of 14.2 years and had a mean weekly consumption of 69.5 units of alcohol. There was a family history of alcohol dependence in (44%). The majority (68%) consumed samsu with beer the second choice. Auditory hallucinations (26) and delusions (16) were common while visual hallucinations (3) and depression (2) were less frequent. Speech disorder occurred in 4 subjects. 2 developed delirium tremens and 1 died. Liver function test was normal in 55%. All except the death from delirium tremens responded to treatment with a combination of anxiolytics, thiamine and antipsychotics and were rapidly discharged. The mean stay was 7 days. However, (68%) did not return for follow up and only 4 were abstinent from alcohol at the time of follow up.
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PMID:A 3 year case study of alcohol related psychotic disorders at Hospital Seremban. 1096 57

Neuropsychiatric symptoms are prominent clinical features of dementia with Lewy bodies (DLB). Visual hallucinations have been reported to be particularly common. Auditory hallucinations, delusions, and depression also may be characteristic to DLB. Misidentification delusions may be more common than with other types of delusional syndromes. Supersensitivity to neuroleptic drugs is common, making treatment of these symptoms difficult, and newer, atypical compounds have been recommended. However, supersensitive reactions to these medicines have been reported. Patients with DLB, especially those with visual hallucinations, are reported to have a marked cholinergic deficit, and cholinergic drugs may be beneficial in reducing the neuropsychiatric symptoms.
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PMID:Neuropsychiatric aspects of dementia with Lewy bodies. 1112 9

1,363 high school students were solicited to complete a personality disorder questionnaire and were encouraged to continue in the study by signing up for interviews with Master's level psychology students. 107 students (7.8%, 34 males, 73 females, mean age = 16.7 +/- 1.8) manifested themselves for the interview and were assessed by using structured diagnostic interviews for borderline personality disorder and major depressive disorder (DIB-R, Revised Diagnostic Interview for Borderlines; MINI, Mini International Neuropsychiatric Interview). The interviews were audiotaped. Interrater reliability was determined by independent ratings of 12 borderline subjects and 12 non-borderline subjects (kappa: 0.795). The distribution of the 107 subjects based on the number of DSM IV borderline personality disorder criteria indicated a gradual dispersion suggesting a continuum from normality to borderline personality disorder: 8% of the subjects met none of the criteria; 16% met one criterion; 17% met two; 12.5%, three; 13.7%, four; 8.4%, five; 5.6%, six; 9.3%, seven; 4.6%, eight; 4.6%, nine. Thirty-five of these 107 subjects (32.7%, 6 males, 29 females, mean age = 16.7 +/- 1.7) received a diagnosis of borderline personality disorder according to DSM IV criteria. The most frequent symptoms were paranoid ideation or dissociative symptoms (97.1%), affective instability (88.6%), inappropriate, intense anger (85.6%), suicidal gestures or automutilation (82.9%), followed by frantic efforts to avoid abandonment (77%), impulsivity (65.7%), unstable and intense relationships (62.9%), identity disturbance (60%), and emptiness (57.1%). The comparison between borderline and non-borderline subjects showed that all borderline personality disorder criteria discriminated significantly between the two groups. The high incidence of paranoid ideation (97.1%) and dissociative experiences (65.7%) in the borderline group suggests the pertinence of criterion 9 in the diagnosis of borderline personality disorder in adolescents. Two criteria of schizotypal personality disorder were also frequent in this group: 68.6% of the borderline group reported odd beliefs or magical thinking, in particular beliefs in clairvoyance or telepathy and 88.6% reported unusual perceptual experiences, in particular sensing the presence of a force or person and bodily illusions. Moreover, 31.4% of the borderline group reported transient "quasi" psychotic experiences, mainly "quasi" visual hallucinations. Auditory hallucinations or delusional ideas were not observed. This symptomatology suggests a "quasi" psychotic dimension of adolescent borderline personality disorder. Affective instability was the next most frequent symptom which was usually marked by a cyclothymic appearance. Comorbidity with major depressive disorder was high: 85.7% of the borderline subjects had a concurrent diagnosis of major depression versus 45.8% of the non-borderline subjects. Thus, major depression is more frequent than most of the borderline personality disorder criteria, with the exception of the already noted paranoid ideation and affective instability. Hypomanic symptoms were frequent in the borderline group (65.7%) as well as in the non-borderline group (38.8%). This symptomatology suggests that adolescent borderline personality disorder is linked to an attenuated bipolar spectrum characterised by major depressive episodes and soft signs of bipolarity. However, hypomanic symptoms, which were quite frequent in non-borderline subjects, might also be due to a mechanism of defence, i.e. the denial of depression. Comorbidity with anxiety disorders appeared also to be high: anxiety symptoms were found in 91.4% of the borderline subjects who reported symptoms of generalised anxiety disorder, panic disorder, and somatoform disorders. The overall clinical appearance of these borderline adolescents not referred for treatment seemed to be quite similar to that of borderline adolescents in clinical samples. This study shows that adolescent borderline personality disorder in non-clinical population is a serious disorder characterised by the importance of mental suffering and behavioural disturbances the disorganising power of which may fix the developmental process in a pathological pathway. Adolescent borderline personality disorder appears in this study to be strongly associated with major depressive disorder and at-risk behaviours linked to impulsivity, affective instability, and suicidal ideation. However, this study found an absence of precise cut-off between borderline and non-borderline subjects. Two factors might have contributed to the appearance of a continuum. First, some degree of impulsivity and instability in affectivity, self-images and interpersonal relationships is part of normal adolescence. (ABSTRACT TRUNCATED)
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PMID:[Symptoms of DSM IV borderline personality disorder in a nonclinical population of adolescents: study of a series of 35 patients]. 1140 63

The present study was aimed at exploring the prevalence and factor structure of methamphetamine (MA) psychotic symptoms. The data were obtained from a cross-country evaluation of substance use, health, and treatment in MA psychotic in-patients. The prevalence rates of lifetime and current psychotic symptoms were determined by using Mini-International Neurospychiatric Interview-Plus, Module M. The Manchester scale was used to assess the severity of psychotic symptoms during the week prior to assessment. All eight items of the Manchester scale were subjected to principal-component analysis, eigenvalue one test, and varimax rotation. The data of 168 patients (127 male and 41 female) included in the analyses were obtained from Australia, Japan, the Philippines and Thailand. Persecutory delusion was the most common lifetime psychotic symptom found in 130 participants (77.4%), followed by auditory hallucinations, strange or unusual beliefs, and thought reading. Auditory hallucinations were the most common current symptom found in 75 participants (44.6%), followed by strange or unusual beliefs and visual hallucinations. Current negative symptoms were also found in 36 patients (21.4%). Apart from a factor of anxiety and depression, the results yielded a two-factor model of MA psychotic symptoms, which were negative and positive/disorganized syndromes. The negative syndrome comprised poverty of speech, psychomotor retardation, and flattened/incongruous affects. The positive syndrome consisted of delusions, hallucinations, and incoherent speech. Both positive/disorganized and negative syndromes should be taken into account in assessing MA psychotic symptoms. The clinical findings do not support the shortcomings of amphetamine-induced psychosis in modelling the negative symptoms of schizophrenia.
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PMID:Psychotic symptoms in methamphetamine psychotic in-patients. 1460 49

The present article investigated clinical symptoms and their longitudinal clinical course following pharmacological treatment in 32 female incarcerated patients suffering from methamphetamine (METH) psychosis who were referred to psychiatric consultation. The length of METH-abuse periods of the patients ranged from 2 to 31 years. A total of 31 patients suffered from psychosis at abstinence after 5-31 months from the self-injection of METH. Nine of these 31 patients experienced episodes of psychotic relapse. The following symptoms were observed: auditory hallucination (29 cases), delusion of persecution (29 cases), thought broadcasting (24 cases), visual hallucination (22 cases), depressive mood (29 cases), and suicidal idea (22 cases). Patients exhibited symptoms of psychosis and depression, which persisted for more than several months despite commencement of administration of antipsychotics and antidepressants. There were significant correlations among length of periods required for improvement in total Brief Psychiatric Rating Scale (BPRS) scores, and BPRS subscale scores representing positive symptoms and depression/anxiety dimensions. Three groups of patients, according to severity of positive and depressive/anxiety symptoms, showed apparent differences in prognoses during pharmacological treatment. Average degree of extrapyramidal symptoms significantly correlated with average daily dose of antipsychotics and length-of-treatment period required for improvement in BPRS subscale scores representing positive symptom dimension. These results suggest that both psychotic and affective symptoms are involved in therapeutic response and prognosis of METH psychosis.
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PMID:Longitudinal clinical course following pharmacological treatment of methamphetamine psychosis which persists after long-term abstinence. 1710 10


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