- Is cannabis a risk factor for suicide attempts in men and women with psychotic illness? [Journal Article]
- PPsychopharmacology (Berl) 2018 May 16
- CONCLUSIONS: Associations between past-year cannabis use and suicide attempts were confounded by other factors (depression, loneliness, homelessness and hallucinations). The possibility of greater risk of suicidal behaviour with regular cannabis use for older men should be considered.
- Reality testing of the efficacy of tDCS on auditory hallucinations in schizophrenia. [Letter]
- SRSchizophr Res 2018 May 12
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- A seizure is a symptom that refers to episodic, excessive and disorderly neuronal activity in the brain. Traditionally seizures have been classified into partial and generalized. Partial seizure refe...
A seizure is a symptom that refers to episodic, excessive and disorderly neuronal activity in the brain. Traditionally seizures have been classified into partial and generalized. Partial seizure refers to abnormal neural activity localized to one area of the cerebral hemisphere and having a discernible focal or localized onset. When there is no associated impairment in consciousness, it is called simple partial seizure, and when it is associated with impairment in consciousness, it is called a complex partial seizure. When a partial seizure becomes generalized, it is referred to as a "partial seizure with secondary generalization." New terminology for a simple partial seizure is "focal onset aware seizure." Partial seizures are the most common type of seizures in patients with epilepsy. Complex partial seizures occur more often than simple partial seizures, although most complex partial seizures start as simple partial seizures. Patients with simple partial seizure remain awake and aware throughout the seizure, and some patients can even talk during the episode. It may be difficult to distinguish them from complex partial seizure in infants and patients with cognitive and speech difficulties, as impairment in consciousness can be difficult to assess in these patients. The term "aura" refers to signs and symptoms that occur with a seizure before consciousness is lost and for which memory is intact afterward. Auras that are not followed by seizure should be considered focal aware seizures or simple partial seizures. Depending on clinical signs, symptoms, and EEG localization, focal seizures can be further subdivided into four types: (1) focal motor seizures, (2) focal sensory seizures, (3) autonomic seizures, and (4) psychological seizures. Focal Motor Seizures Focal or partial motor seizure occurs due to an epileptogenic lesion on the contralateral frontal lobe. Motor symptoms constitute the primary clinical manifestation. Typically, consciousness is not impaired in seizures of discrete motor areas. They usually originate from the supplementary motor area and cause turning movements of head and neck to the opposite side and sometimes tonic contractions of the limbs and trunk on the same side. This may or may not be followed by generalized clonic movements. Subdivisions of ictal motor symptoms include elementary (tonic, clonic, dystonic, versive) and automatism (coordinated, repetitive motor activity like lip smacking, tapping, and swallowing). Another classification based on clinical symptomatology uses the terms like focal clonic, focal tonic, or versive seizures. Focal motor seizures are more common on the face, hands, and toes because these areas have disproportionately large cortical representation. The excitatory focus is usually around the rolandic (motor) cortex. If there are accompanying sensory symptoms, the focus may be on post-rolandic convolution. Temporal lobe origin seizures sometimes have head-turning movements on the same side followed by the forceful contraversive turning of the head and body. Clonic seizures refer to repeated, short contractions of various muscle groups characterized by twitching movements or rhythmic jerking that recur at regular intervals of less than 1 to 2 seconds. These seizures are brief, lasting less than 1 to 2 minutes. In focal clonic seizures, there is epileptic activation of a restricted area of the precentral gyrus. Tonic seizures refer to sustained contractions that last for more than 5 to 10 seconds and result in the posturing of the limbs and whole body. Focal tonic seizures refer to tonic contractions restricted to a part of the body on one side. Focal tonic seizures are attributed to activation of Brodmann area 6, particularly mesial frontal region. There may be some involvement of the premotor areas in some cases. Versive seizures consist of sustained, forceful, involuntary turning of head and eyes to one side due to tonic contraction of head and eye muscles. Usually, they are accompanied by loss of consciousness, but occasionally patients may be aware of the forced involuntary eye and head turning. The version can result from seizures originating from various locations and spreading to premotor cortex. Following convulsions with predominant focal motor symptoms, patients may have transient, functional, and localized paralysis of the affected limbs. This is known as Todd paralysis and can last minutes to hours, usually in proportion to the duration of the convulsion. This postepileptic paralysis occurs due to persistent focal dysfunction of the affected epileptogenic area and is the signature of a focal seizure. It has significant clinical value in lateralizing the hemisphere of seizure onset. Jacksonian march seizure Jacksonian march seizure starts with tonic contractions in one hand or on one side of the face or the muscles of one foot. This is followed by clonic movements in these parts and sometimes a series of clonic movements with increasing frequency that builds up to a tonic contraction. These movements may spread ("march") from the muscles affected to the other muscles on the same side of the body. In classic Jacksonian march, the seizure spreads from hand to arm to face and then down the leg ipsilaterally, or if it started in the foot, then seizure marches up the leg, down the arm, and then to the face. This typically happens over a short time (20 to 30 seconds). There can be other associated symptoms like automatism (lip smacking or tapping movements), hallucinations, muscle cramping, head-turning, etc. Symptoms are usually mild. These seizures rarely become generalized, and typically consciousness remains intact. Jacksonian march seizure can be mistaken for a transient ischemic attack, migraine, or other condition. Focal Somatosensory Seizures Sensory seizures present as numbness, tingling, crawling sensation, "pins and needles" feeling, and rarely, as pain or thermal sensations. They can be focal or can march to other ipsilateral body parts and usually have focus in or around post-rolandic convolution of the contralateral cerebral hemisphere. Visual seizures are rare but have localizing significance. Visual hallucinations and visual loss are typical of occipital lobe epilepsy but sometimes can occur with seizure foci in anteromedial temporal and occipitotemporal regions. Auditory hallucinations are a rare initial manifestation of seizure and have sometimes been noted with lesions in posterior temporal lobe on one side. Olfactory hallucinations often occur with a lesion in inferior and medial parts of the temporal lobe. Gustatory hallucinations can occur in temporal lobe disease with lesions in the insula and parietal operculum. Autonomic seizures Autonomic seizures manifest with predominantly altered autonomic function. Some common autonomic signs and symptoms include diaphoresis, shivering, piloerection, rising sensation in epigastrium, nausea, changes in blood pressure and heart rate (commonly tachycardia), and pupillary changes. Autonomic features are common in several nonepileptic conditions, making autonomic seizures harder to diagnose. Some specific epilepsy syndromes with prominent autonomic features include neonatal seizures, epilepsy of infancy with migrating focal seizures, Dravet syndrome, benign epilepsy with centrotemporal spikes, and early-onset benign occipital epilepsy. Psychological seizures Psychological seizures manifest with affective and cognitive symptoms like memory flashback, dream-like events, Deja Vu feeling, hallucinations, anxiety, agitation, and uncontrolled laughter or crying. They arise commonly from the temporal area rather than extratemporal.
- [Hypertensive crisis and anticholinergic toxidrome secondary to accidental consumption of datura stramonium in two children]. [Journal Article]
- ACAnn Cardiol Angeiol (Paris) 2018 May 11
- CONCLUSIONS: Hypertension crisis and other anticholinergic clinical signs of Datura stramonium intoxication achieve favorable outcomes in children.
- Bereavement hallucinations after the loss of a spouse: associations with psychopathological measures, personality and coping style. [Journal Article]
- DSDeath Stud 2018 May 14; :0
- Bereavement hallucinations (BHs) were assessed in 175 conjugally bereaved participants four years post loss, to explore whether BHs were: a) associated with psychological distress and b) predicted by...
Bereavement hallucinations (BHs) were assessed in 175 conjugally bereaved participants four years post loss, to explore whether BHs were: a) associated with psychological distress and b) predicted by sociodemographic variables, personality and/or coping style. Participants with BHs scored significantly higher than those without BHs on prolonged grief, post-traumatic stress, depression symptoms, and emotional loneliness. Hierarchical logistic regression analysis showed avoidant coping, openness to experience, and length of marriage to significantly predict BHs, while detached coping was negatively associated with BHs. This study suggests that BHs may be an indicator of psychological distress in bereavement.
- Onset and Remission of Psychosis in Parkinson's Disease: Pharmacologic and Motoric Markers. [Journal Article]
- MDMov Disord Clin Pract 2018 Jan-Feb; 5(1):31-38
- CONCLUSIONS: Our findings suggest that in the context of standard therapy, PD-related psychotic disorder can remit at a frequency of approximately 27%. Additionally, akinetic-rigid motor impairment was more strongly associated with psychosis than disease duration, independent of cognitive impairment and medications.
- A Mobile Multimedia Reminiscence Therapy Application to Reduce Behavioral and Psychological Symptoms in Persons with Alzheimer's. [Journal Article]
- JHJ Healthc Eng 2018; 2018:1536316
- The goal of this project is to develop a novel and innovative mobile solution to address behavioral and psychological symptoms of dementia (BPSD) that occur in individuals with Alzheimer's. BPSD can ...
The goal of this project is to develop a novel and innovative mobile solution to address behavioral and psychological symptoms of dementia (BPSD) that occur in individuals with Alzheimer's. BPSD can include agitation, restlessness, aggression, apathy, obsessive-compulsive and repetitive behaviors, hallucinations, delusions, paranoia, and wandering. Alzheimer's currently affects 5.4 million adults in the United States and that number is projected to increase to 14 million by 2050. Almost 90% of all affected with AD experience BPSD, resulting in increased healthcare costs, heavier burden on caregivers, poor patient outcomes, early nursing home placement, long-term hospitalizations, and misuse of medications. Pharmacological support may have undesirable side effects such as sedation. Nonpharmacological interventions are alternative solutions that have shown to be effective without undesirable side effects. Music therapy has been found to lower BPSD symptoms significantly. Our study is based on combination of the reminiscence and the music therapies where past memorable events are recalled using prompts such as photos, videos, and music. We are proposing a mobile multimedia solution, a technical version of the combined reminiscence, and music therapies to prevent the occurrence of BPSD, especially for the rural population who have reduced access to dementia care services.
- Language Lateralization and Auditory Attention Impairment in Young Adults at Ultra-High Risk for Psychosis: A Dichotic Listening Study. [Journal Article]
- FPFront Psychol 2018; 9:608
- Objectives: Impaired attention and language functions are common in psychosis, but have been less explored in subjects with ultra-high risk for psychosis (UHR). The aim of the study was to investiga...
Objectives: Impaired attention and language functions are common in psychosis, but have been less explored in subjects with ultra-high risk for psychosis (UHR). The aim of the study was to investigate differences in language lateralization and auditory attention in UHR subjects compared to healthy controls with a dichotic listening paradigm. In addition, symptoms from The Structural Interview for Prodromal Syndromes (SIPS) were explored in relation to performance on dichotic listening. Methods: The UHR subjects (n = 46, female = 28, mean age = 17.9) were compared to a group of healthy controls (n = 40, female = 20, mean age = 16.8). A split-plot repeated measures analysis of covariance was conducted with group as between-subjects factor and attention conditions (non-forced, forced-right, forced-left) and side (right ear, left ear) as repeated measures factors (2×3×2 design) using gender, age and handedness as covariates. SIPS symptoms were subjected to Spearman's r correlations with laterality indexes and attentional gain in each ear. Results: There was a statistically significant three-way interaction of group (UHR, healthy controls) × forced condition (non-forced, forced-right, forced-left) × side (right ear, left ear), p = 0.048. The effect was due to an interaction between group × side in the forced-left condition. There were no significant differences between UHR subjects and healthy controls in the non-forced condition. Right ear gain correlated with "Perceptual abnormalities/Hallucinations" (P4), r = 0.486, p = 0.001. Conclusion: UHR subjects demonstrated impairment in top-down attentional mechanisms, but showed no language lateralization abnormalities. Impairment in top-down attentional mechanisms are frequently reported from dichotic listening studies in patients with schizophrenia. Higher levels of perceptual abnormalities and hallucinatory experiences were associated with enhanced report from the right ear in the forced-right condition.
- Miscommunication in Doctor-Patient Communication. [Journal Article]
- TCTop Cogn Sci 2018; 10(2):409-424
- The effectiveness of medical treatment depends on the quality of the patient-clinician relationship. It has been proposed that this depends on the extent to which the patient and clinician build a sh...
The effectiveness of medical treatment depends on the quality of the patient-clinician relationship. It has been proposed that this depends on the extent to which the patient and clinician build a shared understanding of illness and treatment. Here, we use the tools of conversation analysis (CA) to explore this idea in the context of psychiatric consultations. The CA "repair" framework provides an analysis of the processes people use to deal with problems in speaking, hearing, and understanding. These problems are especially critical in the treatment of psychosis where patients and health care professionals need to communicate about the disputed meaning of hallucinations and delusion. Patients do not feel understood, they are frequently non-adherent with treatment, and many have poor outcomes. We present an overview of two studies focusing on the role of repair as a mechanism for producing and clarifying meaning in psychiatrist-patient communication and its association with treatment outcomes. The first study shows patient clarification or repair of psychiatrists' talk is associated with better patient adherence to treatment. The second study shows that training which emphasizes the importance of building an understanding of patients' psychotic experiences increases psychiatrists' self-repair. We propose that psychiatrists are working harder to make their talk understandable and acceptable to the patient by taking the patient's perspective into account. We conclude that these findings provide evidence that repair is an important mechanism for building shared understanding in doctor-patient communication and contributes to better therapeutic relationships and treatment adherence. The conversation analytic account of repair is currently the most sophisticated empirical model for analyzing how people construct shared meaning and understanding. Repair appears to reflect greater commitment to and engagement in communication and improve both the quality and outcomes of communication. Reducing potential miscommunication between psychiatrists and their patients with psychosis is a low-cost means of enhancing treatment from both the psychiatrist and patient perspective. Given that misunderstanding and miscommunication are particularly problematic in psychosis, this is critical for improving the longer term outcomes of treatment for these patients who often have poor relationships with psychiatrists and health care services more widely.
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- Complex visual hallucinatory experience in an elderly blind woman with glaucoma: revisiting Charles Bonnet syndrome. [Journal Article]
- CCClin Case Rep 2018; 6(5):859-862
- For fear of being ridiculed, individuals with visual hallucinations hide their experiences and thus remain unrecognized and miss treatment. An elderly blind woman secondary to glaucoma experienced vi...
For fear of being ridiculed, individuals with visual hallucinations hide their experiences and thus remain unrecognized and miss treatment. An elderly blind woman secondary to glaucoma experienced visual hallucinations accompanied by gross behavior disturbances. She improved with sodium valproate after haloperidol failed and remained relatively improved upon 3 months follow-up.