To conduct a comprehensive comparison of behavioural and psychological symptoms of dementia (BPSD) in Chinese people with early‐onset Alzheimer's disease (EOAD) and late‐onset Alzheimer's disease (LOAD) and analyse the factors of differences.
{"title":"Behavioural and psychological symptoms of early‐onset and late‐onset Alzheimer's disease among Chinese adults: analysis of modifiable factors","authors":"Shuyan Fang, Shuang Zhang, Wenxia Wang, Yijing Li, Xu Zhang, Haisong Yu, Jiao Sun","doi":"10.1111/psyg.12829","DOIUrl":"https://doi.org/10.1111/psyg.12829","url":null,"abstract":"To conduct a comprehensive comparison of behavioural and psychological symptoms of dementia (BPSD) in Chinese people with early‐onset Alzheimer's disease (EOAD) and late‐onset Alzheimer's disease (LOAD) and analyse the factors of differences.","PeriodicalId":20784,"journal":{"name":"Psychogeriatrics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43238714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. Otsuka, M. Nishikawa, Akinori Kinoshita, S. Deguchi, Atsushi Okita, K. Deguchi
Although drug packages are known to be a risk for upper gastrointestinal injury by accidental ingestion, they are not a common cause of rectal foreign bodies. Recently, we experienced a potential first case of a rectal foreign body caused by trans-anally inserted suppository packaging. A 78-year-old woman, diagnosed with Parkinson’s disease 6 years ago, was administered droxidopa and pyridostigmine for orthostatic hypotension over the course of a month. However, she developed diarrhoea and had to be admitted to adjust her dosage. The pyridostigmine dosage reduction improved the diarrhoea, but she developed constipation thereafter. Therefore, we decided to use a sodium bicarbonate and anhydrous sodium dihydrogen phosphate suppository. The patient insisted on self-insertion, due to which the nurse peeled off half the package and gave it to her. Immediately afterward, the patient complained of pain in the anal region and when we interviewed her, we found that she had inserted the suppository with the packaging still intact. The package could be felt upon rectal examination, but it was difficult to remove manually. Hence, the surgeon was consulted and it was removed through bedside anoscope (Fig. 1). No rectal ulcer or perforation occurred and, as planned, the patient was discharged two days later. Rectal foreign bodies are potentially dangerous due to a risk of gastrointestinal perforation and require prompt removal. Most are intentionally inserted via the anus during sexual activity, but sometimes they can be any of the following: accidental ingestion of toothpicks, meat or fish bones, or drug packages that get caught around the rectoanal transition. However, there are no reported cases of rectal foreign bodies developed after accidental insertion of suppository packages via the anus. Accidentally ingested suppository packages, as well as other drug packages, are a reported rectal perforation risk. If the packages are inserted in open position from the anus, they are difficult to remove because the flipped part of the package gets stuck like a fishhook. Since suppository packages are small and not visible on x-rays, elderly patients might be unable to reveal the history of insertion and consequently, delayed detection can lead to rectal ulceration or perforation. Therefore, we need to be aware of the potential risks of self-insertion of suppositories among the elderly, especially those who are cognitively
{"title":"Rectal foreign body of suppository package: risk of self‐insertion of suppositories among elderly","authors":"Y. Otsuka, M. Nishikawa, Akinori Kinoshita, S. Deguchi, Atsushi Okita, K. Deguchi","doi":"10.1111/psyg.12826","DOIUrl":"https://doi.org/10.1111/psyg.12826","url":null,"abstract":"Although drug packages are known to be a risk for upper gastrointestinal injury by accidental ingestion, they are not a common cause of rectal foreign bodies. Recently, we experienced a potential first case of a rectal foreign body caused by trans-anally inserted suppository packaging. A 78-year-old woman, diagnosed with Parkinson’s disease 6 years ago, was administered droxidopa and pyridostigmine for orthostatic hypotension over the course of a month. However, she developed diarrhoea and had to be admitted to adjust her dosage. The pyridostigmine dosage reduction improved the diarrhoea, but she developed constipation thereafter. Therefore, we decided to use a sodium bicarbonate and anhydrous sodium dihydrogen phosphate suppository. The patient insisted on self-insertion, due to which the nurse peeled off half the package and gave it to her. Immediately afterward, the patient complained of pain in the anal region and when we interviewed her, we found that she had inserted the suppository with the packaging still intact. The package could be felt upon rectal examination, but it was difficult to remove manually. Hence, the surgeon was consulted and it was removed through bedside anoscope (Fig. 1). No rectal ulcer or perforation occurred and, as planned, the patient was discharged two days later. Rectal foreign bodies are potentially dangerous due to a risk of gastrointestinal perforation and require prompt removal. Most are intentionally inserted via the anus during sexual activity, but sometimes they can be any of the following: accidental ingestion of toothpicks, meat or fish bones, or drug packages that get caught around the rectoanal transition. However, there are no reported cases of rectal foreign bodies developed after accidental insertion of suppository packages via the anus. Accidentally ingested suppository packages, as well as other drug packages, are a reported rectal perforation risk. If the packages are inserted in open position from the anus, they are difficult to remove because the flipped part of the package gets stuck like a fishhook. Since suppository packages are small and not visible on x-rays, elderly patients might be unable to reveal the history of insertion and consequently, delayed detection can lead to rectal ulceration or perforation. Therefore, we need to be aware of the potential risks of self-insertion of suppositories among the elderly, especially those who are cognitively","PeriodicalId":20784,"journal":{"name":"Psychogeriatrics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2022-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42636323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Although increasing evidence indicates that even variations in normal range thyroid function are associated with Alzheimer's disease (AD), the association between serum thyroid hormone levels within the reference range and AD biomarkers remains unclear. This study examined whether variations in thyroid hormones within the reference range are associated with brain amyloid burden and cortical glucose metabolism in older adults without dementia.
{"title":"Association of serum thyroid hormone levels with positron emission tomography imaging in non‐demented older adults","authors":"M. Goto, N. Kimura, E. Matsubara","doi":"10.1111/psyg.12825","DOIUrl":"https://doi.org/10.1111/psyg.12825","url":null,"abstract":"Although increasing evidence indicates that even variations in normal range thyroid function are associated with Alzheimer's disease (AD), the association between serum thyroid hormone levels within the reference range and AD biomarkers remains unclear. This study examined whether variations in thyroid hormones within the reference range are associated with brain amyloid burden and cortical glucose metabolism in older adults without dementia.","PeriodicalId":20784,"journal":{"name":"Psychogeriatrics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2022-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48941173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Noriko Marutani, S. Akamine, D. Kanayama, S. Gotoh, K. Yanagida, Rikiya Maruyama, Kohji Mori, Tesshin Miyamoto, Hiroyoshi Adachi, Yukako Sakagami, K. Yoshiyama, Maki Hotta, Aki Nagase, J. Kozawa, N. Maeda, M. Otsuki, T. Matsuoka, H. Iwahashi, I. Shimomura, N. Murayama, Hiroshi Watanabe, Manabu Ikeda, I. Mizuta, Takashi Kudo
Patients with diabetes are at a higher risk for cognitive decline. Thus, biomarkers that can provide early and simple detection of cognitive decline are required. Neurofilament light chain (NfL) is a cytoskeletal protein that constitutes neural axons. Plasma NfL levels are elevated when neurodegeneration occurs. Here, we investigated whether plasma NfL levels were associated with cognitive decline in patients with type 2 diabetes.
{"title":"Plasma NfL is associated with mild cognitive decline in patients with diabetes","authors":"Noriko Marutani, S. Akamine, D. Kanayama, S. Gotoh, K. Yanagida, Rikiya Maruyama, Kohji Mori, Tesshin Miyamoto, Hiroyoshi Adachi, Yukako Sakagami, K. Yoshiyama, Maki Hotta, Aki Nagase, J. Kozawa, N. Maeda, M. Otsuki, T. Matsuoka, H. Iwahashi, I. Shimomura, N. Murayama, Hiroshi Watanabe, Manabu Ikeda, I. Mizuta, Takashi Kudo","doi":"10.1111/psyg.12819","DOIUrl":"https://doi.org/10.1111/psyg.12819","url":null,"abstract":"Patients with diabetes are at a higher risk for cognitive decline. Thus, biomarkers that can provide early and simple detection of cognitive decline are required. Neurofilament light chain (NfL) is a cytoskeletal protein that constitutes neural axons. Plasma NfL levels are elevated when neurodegeneration occurs. Here, we investigated whether plasma NfL levels were associated with cognitive decline in patients with type 2 diabetes.","PeriodicalId":20784,"journal":{"name":"Psychogeriatrics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2022-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44181843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Delirium is an acute condition characterized by impaired consciousness and attention, and accompanied by agitation and visual hallucinations, and could be caused by drugs, especially those with anticholinergic effects. Olanzapine (OLZ) is an atypical antipsychotic drug with various side-effects such as weight gain and drowsiness. Therefore, to take advantage of these effects, OLZ is occasionally used to treat decreased appetite and nausea in cancer patients. While the medication is also known to have a therapeutic effect on delirium, its anticholinergic effects have been found to actually cause or worsen delirium in rare cases. Nevertheless, there are only a small number of reports regarding OLZ-induced delirium, especially in patients that received a low dosage, with a few reports known to be presented. We report here details of a case of delirium with vivid visual hallucinations in an uncomplicated lung cancer patient, which was clearly induced by low-dose OLZ treatment. The patient was a 70-year-old Japanese female with no history of mental illness or dementia. Her activities of daily living were normal. Two months prior to hospital admittance, she was diagnosed with lung cancer, adenocarcinoma clinical stage T4N2M1. The patient was admitted for pain control related to lung cancer and bone metastasis (Day 1). On Day 2, oral administration of sustained-release oxycodone (Oxycontin) was increased from 20 to 30 mg, and oral immediaterelease oxycodone (OxyNorm) at 5 mg was added for face and lower back pain caused by bone metastasis. Oral gefitinib was also started at 250 mg oral on Day 3. Left temporal bone irradiation (30 Gy/10 fractions) was performed daily from Day 4 to 17. OLZ at 5 mg was added on Day 19 due to loss of appetite caused by mouth ulcers and pain that developed during hospitalization. The next day, she showed noticeable wobbling and fell, though she could not remember the incident. On Day 21, she stood on the bed, pointed to the curtain and said, ‘There is someone behind there. Don’t talk to him. It will be dangerous if he finds out!’, along with other statements that did not make sense. Furthermore, insomnia was also noted. Delirium Rating Scale (DRS) (Table 1) and Mini-Mental State Examination (MMSE) scores were 22 and 19, respectively. Due to suspicion of delirium, OLZ was discontinued, while suvorexant at 15 mg was added for insomnia. On Day 22, the visual hallucinations and delirium were resolved, and then on Day 26 the DRS and MMSE scores were 6 and 25, respectively (Table 1). The patient remembered approximately half of the hallucination episode and said with a laugh, ‘It was very scary when the soldiers held up their guns. It was a good experience’. Thereafter, no symptoms of delirium were observed until discharge on Day 27. We report a case of delirium caused by low-dose OLZ with vivid hallucinations. Two distinguishing points in this case were vivid and frightening hallucinations and the development of delirium consiste
{"title":"Delirium with visual hallucinations induced by low‐dose olanzapine","authors":"Nobuyuki Takeuchi, T. Makino, Makoto Nishihara","doi":"10.1111/psyg.12824","DOIUrl":"https://doi.org/10.1111/psyg.12824","url":null,"abstract":"Delirium is an acute condition characterized by impaired consciousness and attention, and accompanied by agitation and visual hallucinations, and could be caused by drugs, especially those with anticholinergic effects. Olanzapine (OLZ) is an atypical antipsychotic drug with various side-effects such as weight gain and drowsiness. Therefore, to take advantage of these effects, OLZ is occasionally used to treat decreased appetite and nausea in cancer patients. While the medication is also known to have a therapeutic effect on delirium, its anticholinergic effects have been found to actually cause or worsen delirium in rare cases. Nevertheless, there are only a small number of reports regarding OLZ-induced delirium, especially in patients that received a low dosage, with a few reports known to be presented. We report here details of a case of delirium with vivid visual hallucinations in an uncomplicated lung cancer patient, which was clearly induced by low-dose OLZ treatment. The patient was a 70-year-old Japanese female with no history of mental illness or dementia. Her activities of daily living were normal. Two months prior to hospital admittance, she was diagnosed with lung cancer, adenocarcinoma clinical stage T4N2M1. The patient was admitted for pain control related to lung cancer and bone metastasis (Day 1). On Day 2, oral administration of sustained-release oxycodone (Oxycontin) was increased from 20 to 30 mg, and oral immediaterelease oxycodone (OxyNorm) at 5 mg was added for face and lower back pain caused by bone metastasis. Oral gefitinib was also started at 250 mg oral on Day 3. Left temporal bone irradiation (30 Gy/10 fractions) was performed daily from Day 4 to 17. OLZ at 5 mg was added on Day 19 due to loss of appetite caused by mouth ulcers and pain that developed during hospitalization. The next day, she showed noticeable wobbling and fell, though she could not remember the incident. On Day 21, she stood on the bed, pointed to the curtain and said, ‘There is someone behind there. Don’t talk to him. It will be dangerous if he finds out!’, along with other statements that did not make sense. Furthermore, insomnia was also noted. Delirium Rating Scale (DRS) (Table 1) and Mini-Mental State Examination (MMSE) scores were 22 and 19, respectively. Due to suspicion of delirium, OLZ was discontinued, while suvorexant at 15 mg was added for insomnia. On Day 22, the visual hallucinations and delirium were resolved, and then on Day 26 the DRS and MMSE scores were 6 and 25, respectively (Table 1). The patient remembered approximately half of the hallucination episode and said with a laugh, ‘It was very scary when the soldiers held up their guns. It was a good experience’. Thereafter, no symptoms of delirium were observed until discharge on Day 27. We report a case of delirium caused by low-dose OLZ with vivid hallucinations. Two distinguishing points in this case were vivid and frightening hallucinations and the development of delirium consiste","PeriodicalId":20784,"journal":{"name":"Psychogeriatrics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43574971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Gobbi, P. Morelhão, B. Branco, S. Tufik, M. Andersen
Dear Editor, Human life expectancy is increasing and is generally projected to continue to rise. However, ageing can cause functional incapacities which present a growing challenge to health professionals. One significant problem associated with ageing is a reduction in sleep duration and quality as the areas of the brain that regulate sleep tend to slowly degenerate with age. This can negatively affect the body’s homeostasis, which is restored by a good night’s sleep. The reduced sleep quality and duration associated with ageing may have a significant impact on body weight in older adults. The endocrine system is influenced by both circadian rhythms and sleep– wake state, and sleep disorders can lead to hormonal dysregulation, resulting in endocrine abnormalities that affect the control of hunger and satiety. These include a decrease in the levels of the hormone leptin, responsible for notifying the central nervous system how much fat is available within the cell, and an increase in ghrelin, responsible for stimulating appetite, food intake and fat storage. There has, therefore, been a search for strategies that can help to improve sleep in this population without resorting to the use of medications, which can themselves have significant negative impacts. The review by Vanderlinden et al. reported that moderate intensity exercise programs, with a frequency of three times per week and a duration of between 12 weeks and 6 months, were associated with the greatest number of significant improvements in different sleep outcomes in older adults. In respect of adults with obesity, a systematic review found that exercise reduced the apnoea/ hypopnoea index in cases of mild and severe obstructive sleep apnoea (OSA). OSA is associated with excess adipose tissue present in the pharyngeal airway. However, the effects of exercise training on OSA appear to be superior to weight loss, that is, patients improved their OSA levels without a significant change in body mass index. One hypothesis to explain this phenomenon would be that the increase in slow wave sleep, caused by exercise, would facilitate the activation of motor units of the genioglossus muscle, decreasing OSA. On the other hand, it is possible that there is a complex interaction of factors associated with exercise training that leads to improvement in the severity of sleep apnoea. Besides that, these reviews were of studies of adults aged 18 years or older, rather than specifically being on older adults. Unfortunately, there are few studies on the effects of exercise programs on the sleep quality of overweight older adults. Although it is known that sleep disorders are caused by several factors, particularly in older individuals, their treatment is often neglected by many professionals due to a lack of information, treatment difficulties and the absence of relevant health policies and resources.
{"title":"Does exercise improve the sleep quality of older overweight or obese adults?","authors":"C. Gobbi, P. Morelhão, B. Branco, S. Tufik, M. Andersen","doi":"10.1111/psyg.12820","DOIUrl":"https://doi.org/10.1111/psyg.12820","url":null,"abstract":"Dear Editor, Human life expectancy is increasing and is generally projected to continue to rise. However, ageing can cause functional incapacities which present a growing challenge to health professionals. One significant problem associated with ageing is a reduction in sleep duration and quality as the areas of the brain that regulate sleep tend to slowly degenerate with age. This can negatively affect the body’s homeostasis, which is restored by a good night’s sleep. The reduced sleep quality and duration associated with ageing may have a significant impact on body weight in older adults. The endocrine system is influenced by both circadian rhythms and sleep– wake state, and sleep disorders can lead to hormonal dysregulation, resulting in endocrine abnormalities that affect the control of hunger and satiety. These include a decrease in the levels of the hormone leptin, responsible for notifying the central nervous system how much fat is available within the cell, and an increase in ghrelin, responsible for stimulating appetite, food intake and fat storage. There has, therefore, been a search for strategies that can help to improve sleep in this population without resorting to the use of medications, which can themselves have significant negative impacts. The review by Vanderlinden et al. reported that moderate intensity exercise programs, with a frequency of three times per week and a duration of between 12 weeks and 6 months, were associated with the greatest number of significant improvements in different sleep outcomes in older adults. In respect of adults with obesity, a systematic review found that exercise reduced the apnoea/ hypopnoea index in cases of mild and severe obstructive sleep apnoea (OSA). OSA is associated with excess adipose tissue present in the pharyngeal airway. However, the effects of exercise training on OSA appear to be superior to weight loss, that is, patients improved their OSA levels without a significant change in body mass index. One hypothesis to explain this phenomenon would be that the increase in slow wave sleep, caused by exercise, would facilitate the activation of motor units of the genioglossus muscle, decreasing OSA. On the other hand, it is possible that there is a complex interaction of factors associated with exercise training that leads to improvement in the severity of sleep apnoea. Besides that, these reviews were of studies of adults aged 18 years or older, rather than specifically being on older adults. Unfortunately, there are few studies on the effects of exercise programs on the sleep quality of overweight older adults. Although it is known that sleep disorders are caused by several factors, particularly in older individuals, their treatment is often neglected by many professionals due to a lack of information, treatment difficulties and the absence of relevant health policies and resources.","PeriodicalId":20784,"journal":{"name":"Psychogeriatrics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2022-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46716762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dear Editor, Elderly patients taking antidepressants may be brought to the emergency room with an emergency serotonin overload condition such as serotonin syndrome or self-injurious behaviour. I read with interest the report by Fukushima et al. on self-injurious behaviour in an elderly patient with burning mouth syndrome (BMS). I would like to point out that this could be prevented by paying attention to drug interactions and doses of antidepressants. Taking up the case of Fukushima et al., an elderly BMS patient was treated with amitriptyline 30 mg/day, sulpiride 150 mg/day, and some herbal medicines along with general psychotherapy. However, the glossalgia did not disappear and became persistent, so paroxetine 20 mg/day was added. The patient then cut off the tip of her tongue with scissors. There are potential problems with this combination therapy. Amitriptyline, sulpiride, and paroxetine are all mainly metabolised by cytochrome P450 2D6 (CYP2D6) in the liver. Paroxetine has the highest inhibitory constant for the CYP2D6 isoenzyme of all antidepressants (Ki = 0.065–4.65 μmol). This high affinity explains its high inhibitory interaction profile with substrates for CYP2D6. Paroxetine’s potent CYP2D6 inhibition also implies significant inhibition of the metabolism of CYP2D6 substrates including amitriptyline and paroxetine, and increase in their serum levels, causing excess serotonin in the patient’s brain. As a result, the patient’s impulsiveness increased, and oral selfmutilation of cutting the tongue may have emerged. BMS is a chronic intraoral burning sensation or dysesthesia without clinically evident causes, which can lead to a significant disease burden. More than half of the patients with BMS are older than 50 years, and some of them have comorbid depression and anxiety. Pharmacotherapy for BMS is mainly based on tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and selective serotonin reuptake inhibitors, which stimulate descending pain inhibitory pathways via serotonergic neurotransmission. However, the effectiveness of single-agent pharmacotherapy is limited, and skilful polypharmacy is currently being used to reinforce it. Therefore, the occurrence of side effects due to drug–drug interactions and agerelated decreases in drug metabolism should be considered. In our study, the concentration of amitriptyline in BMS was found to be effective at doses as low as 10–20 mg/day, and higher doses were associated with increased side effects. The mean effective dose of amitriptyline in BMS patients older than 75 years is 13.2 5.8 mg/day, and the therapeutic dose of amitriptyline may be lower in older BMS patients than in younger patients. A polymorphism in the CYP2D6 gene (CYP2D6*10 allele) has been shown to significantly increase plasma paroxetine concentrations in a Japanese population, so a genetic polymorphism with low CYP2D6 activity may further increase serotonin levels in the patient’s brain. Although much less tha
{"title":"Beware of serotonin overload in pharmacotherapy for elderly patients with burning mouth syndrome","authors":"T. Nagamine","doi":"10.1111/psyg.12823","DOIUrl":"https://doi.org/10.1111/psyg.12823","url":null,"abstract":"Dear Editor, Elderly patients taking antidepressants may be brought to the emergency room with an emergency serotonin overload condition such as serotonin syndrome or self-injurious behaviour. I read with interest the report by Fukushima et al. on self-injurious behaviour in an elderly patient with burning mouth syndrome (BMS). I would like to point out that this could be prevented by paying attention to drug interactions and doses of antidepressants. Taking up the case of Fukushima et al., an elderly BMS patient was treated with amitriptyline 30 mg/day, sulpiride 150 mg/day, and some herbal medicines along with general psychotherapy. However, the glossalgia did not disappear and became persistent, so paroxetine 20 mg/day was added. The patient then cut off the tip of her tongue with scissors. There are potential problems with this combination therapy. Amitriptyline, sulpiride, and paroxetine are all mainly metabolised by cytochrome P450 2D6 (CYP2D6) in the liver. Paroxetine has the highest inhibitory constant for the CYP2D6 isoenzyme of all antidepressants (Ki = 0.065–4.65 μmol). This high affinity explains its high inhibitory interaction profile with substrates for CYP2D6. Paroxetine’s potent CYP2D6 inhibition also implies significant inhibition of the metabolism of CYP2D6 substrates including amitriptyline and paroxetine, and increase in their serum levels, causing excess serotonin in the patient’s brain. As a result, the patient’s impulsiveness increased, and oral selfmutilation of cutting the tongue may have emerged. BMS is a chronic intraoral burning sensation or dysesthesia without clinically evident causes, which can lead to a significant disease burden. More than half of the patients with BMS are older than 50 years, and some of them have comorbid depression and anxiety. Pharmacotherapy for BMS is mainly based on tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and selective serotonin reuptake inhibitors, which stimulate descending pain inhibitory pathways via serotonergic neurotransmission. However, the effectiveness of single-agent pharmacotherapy is limited, and skilful polypharmacy is currently being used to reinforce it. Therefore, the occurrence of side effects due to drug–drug interactions and agerelated decreases in drug metabolism should be considered. In our study, the concentration of amitriptyline in BMS was found to be effective at doses as low as 10–20 mg/day, and higher doses were associated with increased side effects. The mean effective dose of amitriptyline in BMS patients older than 75 years is 13.2 5.8 mg/day, and the therapeutic dose of amitriptyline may be lower in older BMS patients than in younger patients. A polymorphism in the CYP2D6 gene (CYP2D6*10 allele) has been shown to significantly increase plasma paroxetine concentrations in a Japanese population, so a genetic polymorphism with low CYP2D6 activity may further increase serotonin levels in the patient’s brain. Although much less tha","PeriodicalId":20784,"journal":{"name":"Psychogeriatrics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2022-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48242835","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Food art therapy (FAT) has multiple modalities in which cognition, emotion, and social changes are stimulated. The purpose of this study was to design a multimodal approach to a food art therapy (MM‐FAT) program and identify its effects on cognitive ability, daily living functioning, depression, self‐esteem, self‐efficacy, self‐expression, and social functioning in individuals with mild cognitive impairment (MCI) and mild dementia by employing a mixed methods research design.
{"title":"Effects of a multimodal approach to food art therapy on people with mild cognitive impairment and mild dementia","authors":"Hyojin Lee, Eunjoo Kim, J. Yoon","doi":"10.1111/psyg.12822","DOIUrl":"https://doi.org/10.1111/psyg.12822","url":null,"abstract":"Food art therapy (FAT) has multiple modalities in which cognition, emotion, and social changes are stimulated. The purpose of this study was to design a multimodal approach to a food art therapy (MM‐FAT) program and identify its effects on cognitive ability, daily living functioning, depression, self‐esteem, self‐efficacy, self‐expression, and social functioning in individuals with mild cognitive impairment (MCI) and mild dementia by employing a mixed methods research design.","PeriodicalId":20784,"journal":{"name":"Psychogeriatrics","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2022-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45556894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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