Normal Pressure Hydrocephalus: Psychiatric Findings Before and After Shunt Operation Classified in a New Diagnostic System for Organic Psychiatry

Abstract

23 patients with normal pressure hydrocephalus (NPH) underwent psychiatric examinations prior to and 80 days to 10 months after a ventriculo-peritoneal shunt operation. A global evaluation of the effect of the operation on the patients' mental symptoms indicated appreciable improvement in 10 cases and slight improvement in a further 4. 8 patients were assessed as unchanged, and one as mentally deteriorated. The psychiatric analyses was based on a new diagnostic system created by two of the authors (G.L., H.M.). The patients manifested varying, often complex psychiatric symptom constellations with symptomatological components from two or more organic mental disorders. Before the operation a mild o r a moderately severe somnolence-sopor-coma disorder (SSCD) was diagnosed in 10 cases. After the operation all these patients became free from symptoms of SSCD. This was the most unequivocal change in connection with the operation, and the elimination of all symptoms of SSCD was the single factor which most effectively contributed to the total therapeutical result in these patients. All 23 cases were considered to have symptoms of a more or less severe astheno-emotional disorder (AEI)) preoperatively. The degree of severity of this disorder could not be determined with satisfactory certainty in some of the patients with complex symptoms. Amongst the 17 cases where the preoperative symptomatology allowed for a reasonably precise calculation of the degree of severity of AED, 6 were assessed as markedly improved after the operation and 10 as largely unchanged. In one patient, symptoms of the AED increased when the postoperative course was complicated by a subdural haematoma. Symptoms of an emotional-motivational blunting disorder (EMI)) were diagnosed in 5 cases before the operation. After the operation 3 of these patients were symptom free in this respect while 2 were unchanged. Slight o r moderately severe symptoms of Korsakoffs amnestic disorder (KAD) were before the operation found in 7 cases: at the postoperative examination 6 of these cases were improved, of which 4 were free from such symptoms; one was unchanged. According to our experience, confident prognoses concerning the effect of the shunt operation on symptoms of SSCD can be made preoperatively, while, for a particular patient, the therapeutic effect on AED, EM11 and KAD is often difficult, or sometimes impossible, to foresee. This article contains three case reports which represent different forms and courses of the mental symptom patterns.,.

Psychiatric symptoms are present in most of the patients with idiopathic normal pressure hydrocephalus

“…It is already stated that patients with NPH may exhibit certain neuropsychiatric symptomatology 8,9,10,11 , possibly related to alterations in central neurotransmitter activity 12 . NPH patients may develop symptoms with frontal dominance, such as personality changes; anxiety; depression; psychotic syndromes, like delusional states, hallucinations and aggressive states; obsessive compulsive disorder; Othello syndrome; shoplifting and mania 13,14,15,16 .…”

“…. There is wide scientifical evidence pointing association between normal pressure hydrocephalus and psychiatric symptoms 8,9,10,11 . This study aims to recall main psychiatric involvements in NPH patients and describe specific experience of patients with idiopathic normal pressure hydrocephalus from Hospital do Servidor Público Estadual de São Paulo.…”

Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus Guidelines From the Guidelines Committee of Idiopathic Normal Pressure Hydrocephalus, the Japanese Society of Normal Pressure Hydrocephalus

“…86,87) Neurologically, bradykinesia, hypokinesia, paratonic rigidity, glabellar reflex, snout reflex, and palmomental reflex are exhibited with high frequency. 57,62) The combination of akinesia and tremor at rest is observed to a greater degree in iNPH than in sNPH. 50) Psychiatric symptoms are seen in 88% of cases of iNPH, 59) with easy fatigability, impatience, emotional instability, and drowsiness, and a tendency …”

“…59,62) When the patients grasp objects to lift, the build-up of fingertip forces causes slow lifting movement. CSF removal improves the lifting movement and reduces the grip force overshoot.…”

Correlation between Intrathecal Sulfatide and TNF-α Levels in Patients with Vascular Dementia

“…Psychiatric symptoms such as impairment of wakefulness, asteno-emotional disorder and emotional-motivational disorder were registered according to Lindqvist and Malmgren [28,29] on a fourstep scale (none, slight, moderate, and severe) [30]. The asteno-emotional disorder in its mild ('neurasthenic') and moderate forms is characterized by impaired concentration ability, memory difficulties, increased mental fatigue, irritability and emotional instability.…”