QotM (Question of the Moment):
In a study of haloperidol versus trazodone to treat agitation in dementia, which had a sustained effect on agitation?
Answer to previous QoTM:
Huntington’s Disease.
Questions of the Moment are derived from notes created by S. Hinds, M.D.
QotM (Question of the Moment):
Which neurological disorder is thought to have the highest rate of suicide?
Questions of the Moment are derived from notes created by S. Hinds, M.D.
Answer to previous QotM:
Dorsolateral frontal lobe.
Questions of the Moment are derived from notes created by S. Hinds, M.D.
No, not pandas…PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections). PANDAS describes the phenomenon of some children developing OCD, Tourette’s Syndrome, or other tic disorders after infection with group A Beta-hemolytic streptococcus (GABHS) – typically tonsillopharyngitis.
It may be that these children were already genetically prone to OCD or tic disorders. It seems to occur more in children before puberty. Characteristically, there is a sudden, “overnight” onset of symptoms. Besides classic obsessive-compulsive behaviors or tics, children with PANDAS may exhibit choreiform movements, irritability, hyperactivity, severe nightmares, separation anxiety, daytime urinary urgency without associated UTI signs, and age regression.
The mechanism of action is unknown but may be related to autoimmune antibodies or a toxin affecting the basal ganglia. Treatment of the GABHS infection seems to result in a decrease or resolution of symptoms for most. Exacerbations of symptoms may be from re-infections with GABHS (which can be subclinical).
I could not find any good data about the incidence/prevalence of PANDAS.
from Technology Review: A Skin Test for Alzheimer’s Disease
Researchers at the Blanchette Rockefeller Neurosciences Institute (BRNI), in Morgantown, WV, have developed a test that detects enzymes that are dysfunctional in patients with Alzheimer’s disease. These enzymes (PKCs) are involved in long-term memory storage and are found in both the brain and in skin cells. Large scale clinical trials are about to begin. In a preliminary trial with 600 patients, the test correctly diagnosed 36 out of 37 patients confirmed on autopsy to have the disease, as well as 5 patients confirmed on autopsy not to have it. [ed.: Does this mean that they incorrectly diagnosed 5 patients or that they correctly confirmed 5 cases that were suspected to have something other than Alzheimer's?]
A “real” test for Alzheimer’s…I hope we get to see this or another accurate test in the relatively near future.
The ICD-10 mentions the “haltlose” personality type in its discussion on personality disorders. It was not a term with which I had been familiar. It seems to be related to the German phrase “die haltlosen.”
The haltlose personality has been used to refer to someone with an aimless and irresponsible lifestyle. This type of person seems to “lack a hold” on life. Slater & Roth described the haltlose personality as “the unstable psychopath.” Schneider used the phrase “Willenlose Psychopathen.” These people seem to display a lack of will or purpose, with no interest in the future and little grounding in the past. Some with chronic substance dependence have been said to have haltlose personality disorder.
Sorry for the lack of posts. I have been busy preparing for a small DMH presentation.
It is common knowledge that many typical antipsychotic agents can cause blurred vision; this is likely due to the anticholinergic activity that many of them possess. However, I recently had a patient that seemed to get blurred vision from taking moderates doses of ziprasidone. The blurred vision resolved after ziprasidone was discontinued. Ziprasidone is said to have very little anticholinergic activity. However, visual changes are listed as a relatively common side effect (3-6%). It seems unclear to me if this is still related to anticholinergic activity.
A new study is reporting that descendants of people with a history of depression displayed large expanses of cortical thinning across the lateral surface of the right cerebral hemisphere. Tests on the participants showed that those with more thinning had greater difficulty with arousal, attention, and visual memory for social stimuli. Could cognitive problems lead to a greater chance for depression? Or is the thinning tied to a predisposition for depression in other ways?
Just a quick note/reminder. Valproic acid can cause an increase in the concentration of phenobarbital and should be used with caution in those already on phenobarbital.
The use of valproic acid with other antiepileptic medications can also cause a decrease in the level of valproic acid itself because enzyme-inducing antiepileptic medications, such as carbamazepine, phenytoin, phenobarbital, and primidone, will increase the metabolism of valproate.
I just saw this video and thought I would share…
Playing For Change | Song Around The World “Stand By Me” from Concord Music Group on Vimeo.