Purpose: The initial presentation of autoimmune encephalitis (AIE) may resemble other disorders and a comprehensive investigation is required. In this paper we emphasize the challenges faced by a treating team performing a differential diagnosis and the ne- cessity for insightful multidisciplinary collaboration. Case description: We report on the case of a 67-year old man who developed transient disturbances of consciousness in the course of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, which was the first manifestation of malignant myeloma. To our knowledge, this is the first case of anti-NMDAR encephalitis associated with multiple myeloma described in the literature. Comment: AIE with anti-NMDAR antibodies has become a well-characterised variant of the condition. AIE may or may not be associated with tumour; therefore it is necessary to use the screening approach for primary malignancy. A proper diagnosis is essential in management due to AIE’s potential to respond to immunotherapy and tumour removal if one is present.
目的:自身免疫性脑炎(AIE)的初始表现可能与其他疾病相似,需要进行全面的调查。在本文中,我们强调面临的挑战,治疗团队进行鉴别诊断和必要的有见地的多学科合作。病例描述:我们报告一例67岁男性患者在抗n -甲基- d -天冬氨酸受体(抗nmdar)脑炎过程中出现短暂性意识障碍,这是恶性骨髓瘤的第一个表现。据我们所知,这是文献中第一例与多发性骨髓瘤相关的抗nmdar脑炎。评论:带有抗nmdar抗体的AIE已成为该病的一种特征明确的变体。AIE可能与肿瘤有关,也可能与肿瘤无关;因此,有必要对原发性恶性肿瘤进行筛查。由于AIE可能对免疫治疗和肿瘤切除有反应,因此正确的诊断在治疗中至关重要。
{"title":"Autoimmune encephalitis with anti-NMDAR antibodies in multiple myeloma – case report and literature review","authors":"Anna Stanowska, Barbara Wach, M. Wnuk","doi":"10.5114/PPN.2019.86259","DOIUrl":"https://doi.org/10.5114/PPN.2019.86259","url":null,"abstract":"Purpose: The initial presentation of autoimmune encephalitis (AIE) may resemble other disorders and a comprehensive investigation is required. In this paper we emphasize the challenges faced by a treating team performing a differential diagnosis and the ne- cessity for insightful multidisciplinary collaboration. Case description: We report on the case of a 67-year old man who developed transient disturbances of consciousness in the course of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, which was the first manifestation of malignant myeloma. To our knowledge, this is the first case of anti-NMDAR encephalitis associated with multiple myeloma described in the literature. Comment: AIE with anti-NMDAR antibodies has become a well-characterised variant of the condition. AIE may or may not be associated with tumour; therefore it is necessary to use the screening approach for primary malignancy. A proper diagnosis is essential in management due to AIE’s potential to respond to immunotherapy and tumour removal if one is present.","PeriodicalId":39142,"journal":{"name":"Postepy Psychiatrii i Neurologii","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5114/PPN.2019.86259","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70510224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: The article aims at presenting the current state of knowledge concerning the relationship between psychomotor retardation, balance control and modulation of bioelectric brain activity and the patient’s mental state, temperament traits and selected cognitive functions in patients suffering from recurrent depressive disorder. Views: The article contains an overview of research published between 1998 and 2018 based on PubMed, Google Scholar databases on both the main symptoms of depression with particular focus on psychomotor functions, and the relationship between motor activity and temperament traits (in particular neuroticism, trait anxiety, depressive temperament and the dominance of the BIS – Behavioral Inhibition System over the BAS – Behavioral Activation System), as well as selected cognitive functions (e.g. processing speed, attention span, operating memory and visual-spatial memory). The latter, as reported by studies both in this group of patients (recurrent depression) and in other groups (e.g. schizophrenia) may also be lowered during the remission period. The article lists simple and easily available tools that have been used for years in neurological and psychological clinical work, along with quantitative methods of data collection (QEEG, actigraphy, posturography). Conclusions: In patients with recurrent depressive disorders, a change in motor functions is observed, manifested by a motor retardation and changes in the balance and gait dynamics, as well as changes in the quantitative assessment of bioelectric brain activity. The relationship between these biological parameters and clinical symptoms of depression and their usefulness as biomarkers of depression is currently being evaluated in an experimental study conducted by the authors.
{"title":"Psychomotor retardation in recurrent depression and the related factors","authors":"K. Romanowicz, K. Kozłowska, A. Wichniak","doi":"10.5114/ppn.2019.89129","DOIUrl":"https://doi.org/10.5114/ppn.2019.89129","url":null,"abstract":"Purpose: The article aims at presenting the current state of knowledge concerning the relationship between psychomotor retardation, balance control and modulation of bioelectric brain activity and the patient’s mental state, temperament traits and selected cognitive functions in patients suffering from recurrent depressive disorder. Views: The article contains an overview of research published between 1998 and 2018 based on PubMed, Google Scholar databases on both the main symptoms of depression with particular focus on psychomotor functions, and the relationship between motor activity and temperament traits (in particular neuroticism, trait anxiety, depressive temperament and the dominance of the BIS – Behavioral Inhibition System over the BAS – Behavioral Activation System), as well as selected cognitive functions (e.g. processing speed, attention span, operating memory and visual-spatial memory). The latter, as reported by studies both in this group of patients (recurrent depression) and in other groups (e.g. schizophrenia) may also be lowered during the remission period. The article lists simple and easily available tools that have been used for years in neurological and psychological clinical work, along with quantitative methods of data collection (QEEG, actigraphy, posturography). Conclusions: In patients with recurrent depressive disorders, a change in motor functions is observed, manifested by a motor retardation and changes in the balance and gait dynamics, as well as changes in the quantitative assessment of bioelectric brain activity. The relationship between these biological parameters and clinical symptoms of depression and their usefulness as biomarkers of depression is currently being evaluated in an experimental study conducted by the authors.","PeriodicalId":39142,"journal":{"name":"Postepy Psychiatrii i Neurologii","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5114/ppn.2019.89129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70510844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: One of the tasks that court experts in the field of forensic sexology have to perform is the assessment of secured pornographic materials involving minors. Forensic experts use their specialist knowledge to answer questions posed by the procedural authorities, including whether the material may induce sexual stimulation and whether an offender may be identified as having a disorder of sexual preference in the form of pedophilia. The aim of the article is to present the possibility of using neural networks in forensic sexology. Views: Neural networks are mathematical structures whose basic elements are artificial neurons modelled on the work of biological neurons. They are used in a variety of commercial and scientific tasks. Models for classifying pornographic materials (both images and films) and for estimating the age of the minors presented in these images are introduced. Neural networks can be used to categorize pornographic materials in the context of the growing levels of sexualization of minors. Moreover, the training of neural networks to classify specific objects in the pornographic material shown in these images could allow for the differentiation between the various categories of pornographic materials involving minors. Conclusions: Neural networks can be widely used in forensic sexology as an element supporting the work of forensic experts. The presented research results seem to be very promising, but the area requires further research.
{"title":"The application of neural networks in the work of forensic experts in child abuse cases","authors":"W. Oronowicz-Jaśkowiak","doi":"10.5114/ppn.2019.92489","DOIUrl":"https://doi.org/10.5114/ppn.2019.92489","url":null,"abstract":"Purpose: One of the tasks that court experts in the field of forensic sexology have to perform is the assessment of secured pornographic materials involving minors. Forensic experts use their specialist knowledge to answer questions posed by the procedural authorities, including whether the material may induce sexual stimulation and whether an offender may be identified as having a disorder of sexual preference in the form of pedophilia. The aim of the article is to present the possibility of using neural networks in forensic sexology. Views: Neural networks are mathematical structures whose basic elements are artificial neurons modelled on the work of biological neurons. They are used in a variety of commercial and scientific tasks. Models for classifying pornographic materials (both images and films) and for estimating the age of the minors presented in these images are introduced. Neural networks can be used to categorize pornographic materials in the context of the growing levels of sexualization of minors. Moreover, the training of neural networks to classify specific objects in the pornographic material shown in these images could allow for the differentiation between the various categories of pornographic materials involving minors. Conclusions: Neural networks can be widely used in forensic sexology as an element supporting the work of forensic experts. The presented research results seem to be very promising, but the area requires further research.","PeriodicalId":39142,"journal":{"name":"Postepy Psychiatrii i Neurologii","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5114/ppn.2019.92489","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70511390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Błądziński, A. Kalisz, P. Adamczyk, A. Arciszewska, Dagmara Mętel, A. Daren, A. Cechnicki
Purpose: Analyze insight and adherence to medication in patients with chronic schizophrenia and undergoing psychiatric occupational rehabilitation as well as to assess the relations between these two factors and employment ability. Methods: A group of 51 participants diagnosed with chronic schizophrenia according to DSM-V criteria were divided into those employed in social firm (SF, n = 22) and participants of occupational therapy workshops (OTW, n = 29). Insight was measured with item G12 of PANSS scale and with “My thoughts and feelings” subjective insight scale, adherence to medication with MARS scale, symptom severity with PANSS and BNSS scales, general functioning with GAF and SOFAS scales; cognitive functions with MoCA, RAVLT, RHLB scales and Tower of Hanoi task. Results: The group of employed subjects had significantly higher level of insight, lower symptom severity and better general and social functioning. In the group of unemployed participants lower insight was related to lower functioning and much higher number of clinical symptoms and cognitive impairments. Level of adherence to medication was related to symptom severity and presence of cognitive impairments. No correlation between adherence and insight was observed. Patients’ subjective assessment of insight correlated with psychiatrists assessment. Conclusions: Subjective assessment of insight measured by “My thoughts and feelings” self-assessment questionnaire correlates with its objective assessment by item G12 PANSS scale. Higher level of insight, lesser symptom severity and general and better social functioning are associated with employment, whereas adherence to medication is not. The study findings revealed that the most important factors which may be associated with employment status in were related to better insight, lesser symptom severity and better general and social functioning, whereas adherence seemed to be irrelevant.
目的:分析慢性精神分裂症患者接受精神科职业康复治疗的洞察力和服药依从性,并评估这两个因素与就业能力的关系。方法:将51例符合DSM-V诊断标准的慢性精神分裂症患者分为社会企业(SF, n = 22)和职业治疗工作坊(OTW, n = 29)两组。洞察力采用PANSS量表G12项和“我的想法和感受”主观洞察力量表,药物依从性采用MARS量表,症状严重程度采用PANSS和BNSS量表,一般功能功能采用GAF和SOFAS量表;MoCA、RAVLT、RHLB量表和河内塔任务的认知功能。结果:就业组患者的洞察力水平显著提高,症状严重程度显著降低,一般功能和社会功能显著改善。在失业的一组参与者中,较低的洞察力与较低的功能和更多的临床症状和认知障碍有关。药物依从性水平与症状严重程度和认知障碍的存在有关。没有观察到依从性和洞察力之间的相关性。患者对内省的主观评价与精神科医师的评价相关。结论:“我的思想感受”自评问卷对内省的主观评价与G12 PANSS量表对内省的客观评价存在相关性。更高水平的洞察力,较轻的症状严重程度和一般和更好的社会功能与就业有关,而坚持药物治疗则无关。研究结果显示,与就业状况相关的最重要因素与更好的洞察力,较轻的症状严重程度和更好的一般和社会功能有关,而依从性似乎无关。
{"title":"Associations of insight and treatment adherence with employment status of people with schizophrenia","authors":"P. Błądziński, A. Kalisz, P. Adamczyk, A. Arciszewska, Dagmara Mętel, A. Daren, A. Cechnicki","doi":"10.5114/PPN.2018.81364","DOIUrl":"https://doi.org/10.5114/PPN.2018.81364","url":null,"abstract":"Purpose: Analyze insight and adherence to medication in patients with chronic schizophrenia and undergoing psychiatric occupational rehabilitation as well as to assess the relations between these two factors and employment ability. Methods: A group of 51 participants diagnosed with chronic schizophrenia according to DSM-V criteria were divided into those employed in social firm (SF, n = 22) and participants of occupational therapy workshops (OTW, n = 29). Insight was measured with item G12 of PANSS scale and with “My thoughts and feelings” subjective insight scale, adherence to medication with MARS scale, symptom severity with PANSS and BNSS scales, general functioning with GAF and SOFAS scales; cognitive functions with MoCA, RAVLT, RHLB scales and Tower of Hanoi task. Results: The group of employed subjects had significantly higher level of insight, lower symptom severity and better general and social functioning. In the group of unemployed participants lower insight was related to lower functioning and much higher number of clinical symptoms and cognitive impairments. Level of adherence to medication was related to symptom severity and presence of cognitive impairments. No correlation between adherence and insight was observed. Patients’ subjective assessment of insight correlated with psychiatrists assessment. Conclusions: Subjective assessment of insight measured by “My thoughts and feelings” self-assessment questionnaire correlates with its objective assessment by item G12 PANSS scale. Higher level of insight, lesser symptom severity and general and better social functioning are associated with employment, whereas adherence to medication is not. The study findings revealed that the most important factors which may be associated with employment status in were related to better insight, lesser symptom severity and better general and social functioning, whereas adherence seemed to be irrelevant.","PeriodicalId":39142,"journal":{"name":"Postepy Psychiatrii i Neurologii","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5114/PPN.2018.81364","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70509745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Clozapine-induced myocarditis","authors":"Piotr Jahołkowski, P. Mierzejewski, P. Świtaj","doi":"10.5114/ppn.2018.81365","DOIUrl":"https://doi.org/10.5114/ppn.2018.81365","url":null,"abstract":"","PeriodicalId":39142,"journal":{"name":"Postepy Psychiatrii i Neurologii","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5114/ppn.2018.81365","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70509813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: The article attempts to answer the question whether a drug-therapy of challenging behaviours in paediatric patients with autism is warranted. If so, how should it be implemented, including mainly the choice of agent, dosage, length of therapy and drug’s expected efficacy and safety. Views: Challenging behaviours (CB) are common problems in discussed population that additionally aggravate the level of individual functioning. When a drug-therapy of CB is concerned, there is an alarming tendency of increasing antipsychotic use and polypharmacy which exceeds the body of evidence. Out of many agents studied, only risperidone and aripiprazole exhibit established evidence for effectiveness and safety during a short-term use. Research shows comparable efficacy of these drugs and several particularities in secondary outcomes profile. It is established that in pedopsychiatric patients with autism and challenging behaviours both agents equally increase body weight in a statistically significant way; however, risperidone is associated with bigger risk of metabolic changes and extrapyramidal symptoms than aripiprazole. In addition, risperidone significantly augments the risk of hyperprolactinaemia while aripiprazole exhibits no such an action. Aripiprazole, on the other hand, is linked with higher frequency of sedation. Conclusions: Drug-therapy of CB in autism should be considered only as an addition to comprehensive interventions when behavioural and psychosocial measures lack effectiveness. The safety/efficacy profile in long-term use remains undetermined and needs further studies.
{"title":"Pharmacotherapy of challenging behaviours in children \u0000and adolescents with autism spectrum disorder","authors":"D. Puzio, A. Gmitrowicz, I. Makowska","doi":"10.5114/ppn.2019.86257","DOIUrl":"https://doi.org/10.5114/ppn.2019.86257","url":null,"abstract":"Purpose: The article attempts to answer the question whether a drug-therapy of challenging behaviours in paediatric patients with autism is warranted. If so, how should it be implemented, including mainly the choice of agent, dosage, length of therapy and drug’s expected efficacy and safety. Views: Challenging behaviours (CB) are common problems in discussed population that additionally aggravate the level of individual functioning. When a drug-therapy of CB is concerned, there is an alarming tendency of increasing antipsychotic use and polypharmacy which exceeds the body of evidence. Out of many agents studied, only risperidone and aripiprazole exhibit established evidence for effectiveness and safety during a short-term use. Research shows comparable efficacy of these drugs and several particularities in secondary outcomes profile. It is established that in pedopsychiatric patients with autism and challenging behaviours both agents equally increase body weight in a statistically significant way; however, risperidone is associated with bigger risk of metabolic changes and extrapyramidal symptoms than aripiprazole. In addition, risperidone significantly augments the risk of hyperprolactinaemia while aripiprazole exhibits no such an action. Aripiprazole, on the other hand, is linked with higher frequency of sedation. Conclusions: Drug-therapy of CB in autism should be considered only as an addition to comprehensive interventions when behavioural and psychosocial measures lack effectiveness. The safety/efficacy profile in long-term use remains undetermined and needs further studies.","PeriodicalId":39142,"journal":{"name":"Postepy Psychiatrii i Neurologii","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5114/ppn.2019.86257","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70510518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}