Confusion on a somatic basis is a dangerous problem mainly related with aging of the population. Data says that consciousness disorders concern 10-15% of patients in general wards, and up to 50% of patients admitted to geriatric wards. The persistence of the symptoms of confusion results in increase of agitation, disorganization, fear, which increases the risk of self-injuries of patients, it causes the need for parenteral feeding and hydratation, as well as maintaining water balance, and also disturbs cooperation, worsening the course and prognosis of the primary disease. It is believed that consciousness disorders are one of the most difficult diagnostic problems and the most difficult therapy problem among psychotic disorders. So far in Poland there have been no screening evaluation tools to assess the occurrence of confusion on the somatic basis. The purpose of this paper is to introduce the Polish translation of the widely used scale to assess consciousness disorders, intended also for middle personnel of health care – Confusion Assessment Method (CAM). Numerous studies over 16 years established the position of CAM as an exceptionally effective standardized diagnostic test, specifying the sensitivity of 94-100%, specificity from 90-95%, positive predictive value of 91-94%, negative predictive value of 90-100%. The questionnaire and instructions of its interpretation have been translated by doctors with active help from the original creators of CAM. Further studies are required in order to validate and determine the effectiveness of the newly formed diagnostic tool.
The corpus callosum plays a vital role in brain function. In particular, in the trunk of the corpus callosum, in the course of various diseases, there may be temporary, reversible changes (reversible splenial lesion syndrome (RESLES)), as well as partially reversible and irreversible changes. This article discusses the differentiation of RESLES and other conditions with changes in the corpus callosum lobe, as well as the accompanying clinical symptoms. Moreover, a case report of a patient in whom the above changes appeared in the nuclear magnetic resonance (NMR) image is presented. A 20-year-old patient with the diagnosis of Ehlers–Danlos syndrome type VI was admitted to the psychiatric ward in an emergency because of psychomotor agitation, refusal to take food and fluids, delusional statements with a message, grandeur, and auditory hallucinations. In the performed magnetic resonance imaging (MRI) of the brain, the corpus callosum non-characteristic in T2-weighted images revealed a hyperintensive area, which was significantly hyperintensive in diffusion magnetic resonance (DWI) sequences and in apparent diffusion coefficient (ADC) sequences with reduced signal intensity and no signs of bleeding. The hypothesis of subacute ischemic stroke of the corpus callosum was presented. In the control MRI of the brain, changes in the corpus callosum completely regressed, thus excluding an ischemic etiology and favoring the diagnosis of RESLES. During hospitalization, the patient experienced significant fluctuations in mental status, with the dominant symptoms typical of the paranoid syndrome in the form of disturbances in the course and structure of thinking and perception, and a clear and stable improvement was obtained after the administration of long-acting intramuscular olanzapine. Taking into account the clinical and radiological picture, the age of the episode, the rapidity of the disease development, the persistence of its clinical symptoms after the withdrawal of radiological changes in the brain NMR image, as well as the significant improvement in the clinical condition after the introduction of antipsychotic drugs, the final diagnosis was made of schizophrenia.
Background: Multiple Sclerosis is one of the leading autoimmune disorders causing disability among young adults. Various types of mood, affect, and behaviour disorders along with cognitive impairment can be manifested in a course of MS, with affective and anxiety disorders being the most prevalent. Mental health challenges, in addition to the neurological burden of MS, significantly affect quality of life and the course of the underlying disease. Objective: The aim of this work was to determine the prevalence of mental disorders in a sample of MS patients during outpatient treatment in Zabrze, Poland, with a focus on those with mood and anxiety disorders, and to compare the results obtained in these groups with clinical and sociodemographic data. Method: The study was conducted between 2017 and 2018 on 103 MS patients of the Neurological Outpatient Clinic of the Medical University of Silesia Hospital No.1 in Zabrze, Poland. During the study, sociodemographic data were collected, as well as the type and course of the underlying disease, comorbidities, and medicines used. The MINI-international neuropsychiatric interview and a psychiatric examination were utilized to assess the occurrence of mental disorders. Result: 68% of all patients received a psychiatric diagnosis at some point in their life with only 4% having been hospitalized before; 49.5% met the diagnostic criteria for various psychiatric disorders. Measured by the MINI International Neuropsychiatric Interview, 33% of patients reported a past episode of major depression while 8.7% met the criteria for a current episode. The same number of patients admitted ongoing treatment due to recurrent depressive disorder. In regards to anxiety disorders, the most common was generalized anxiety disorder (10.7%), followed by agoraphobia (8.7%), panic disorder (7.8%), and social phobia (4.9%). Most of the patients (94.2%) at the time of the psychiatric evaluation presented a low level of suicide risk, while 1.9% of the patients presented a medium risk, and 3.9% - a high risk. Conclusion(s): The study confirmed a significantly higher prevalence of mental disorders among MS patients; thus, the psychiatric state of patients in this group should be investigated systematically, simultaneously with the assessment of their neurological state. Trial registration: N/A Key words: Multiple Sclerosis, psychiatric disorders, comorbidity, psychiatric care, clinical characteristics.
The mental health impact of SARS-CoV-2 infection is currently the subject of intense research. Mental disorders in the course of coronavirus infection are non-specific. They most often have a sudden onset and short-term course and resolve spontaneously or after the administration of low doses of antipsychotic drugs. At the same time, attempts have been made to develop recommendations for COVID-19 therapy. Single reports suggest the effectiveness of amantadine in the treatment. The mechanism of action of the drug in this case is not known; it is expected that amantadine, by reducing the expression of the cathepsin L gene, may interfere with SARS-CoV-2 replication. In addition, this drug stimulates dopaminergic transmission, which may result in numerous side effects, often of a neuropsychological nature, the most common of which are visual hallucinations. Therefore, it is extremely difficult to unequivocally diagnose the cause of mental disorders among patients with SARS-CoV-2 infection who took amatatide for off-label treatment. A clear assessment of whether the psychological symptoms in this group of patients are the primary or secondary clinical manifestation of the infection or a complication of amantadine treatment is difficult. In this context, we attempted to describe a case of a patient with psychotic symptoms who was confirmed with SARS-CoV-2 infection and treated with amantadine.
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