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.

Questions of the Moment are derived from notes created by S. Hinds, M.D.

Questions of the Moment are derived from notes created by S. Hinds, M.D.

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.

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 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.

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.

See U.S. News & World Report – Health.

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.

Playing For Change | Song Around The World “Stand By Me” from Concord Music Group on Vimeo.