NEUROPSYCHIATRIE最新文献

Apathy is a frequently overlooked yet disabling neuropsychiatric symptom in dementia syndromes, often misdiagnosed as depression. We describe a diagnostically challenging presentation of subcortical ischaemic vascular dementia in a 48-year-old Middle Eastern man, whose primary symptom was progressive apathy rather than overt cognitive decline or focal neurological deficits. Despite repeated emergency visits and antidepressant trials, his condition deteriorated until detailed neuropsychiatric evaluation and neuroimaging revealed right temporal gliosis/encephalomalacia, left frontal periventricular change, and multiple chronic lacunar infarcts in the left thalamus and bilateral centrum semiovale, on a background of small-vessel disease. Autoimmune workup confirmed previously undiagnosed systemic lupus erythematosus (SLE) with antiphospholipid markers, providing a unifying explanation for his vascular pathology. The clinical course was stepwise over ~ 18 months, with intermittent falls. Management included psychosocial interventions, behavioural support planning, and cautious pharmacological strategies; anticoagulation and rheumatological therapy were considered in light of his autoimmune risk. The patient showed modest improvements in affective responsiveness and engagement. This case highlights how apathy can be an early and dominant manifestation of vascular dementia when frontal-subcortical circuits are compromised. It underscores the need to differentiate apathy from depression using behavioural observations, collateral history, and cognitive testing, and to consider autoimmune vasculopathies in younger patients with unexplained vascular lesions. Timely neuroimaging and autoimmune screening could enable earlier diagnosis and intervention, improving outcomes in autoimmune-associated cognitive disorders.

Background: Electroconvulsive therapy (ECT) is a widely used and effective treatment for refractory depression. Patients hospitalized for ECT regularly take antidepressants or adjuvant antipsychotics, both can influence the quality of seizures. Adaptation of the seizure threshold during an ECT series necessitates adjustments in treatment parameters to ensure adequate seizure quality.

Methods: We report the case of a 46-year-old man with treatment-resistant depression treated with bupropion and ECT, who developed a spontaneous seizure after first-time etomidate anesthesia induction, as previously induced seizures under thiopental were considered insufficient. Serendipitously, an electroencephalogram (EEG) of the seizure was recorded.

Results: The characteristics of the EEG captured after this spontaneous seizure were similar to those of regular ECT seizures under thiopental anesthesia in this patient. After returning to thiopental anesthesia, the remaining ECT course was unremarkable, and the patient's depressive symptoms improved partially.

Conclusion: Accordingly, the use of etomidate as an anesthesia induction agent for ECT in patients who are concomitantly using bupropion needs to be cautiously considered. The case of a documented etomidate-induced seizure could indicate the relatively benign course of such events.

Background: The aging global population has led to an increase in the number of dementia diagnoses, with projections indicating a continued upward trend. This demographic change presents profound challenges for patients, their families, and healthcare systems worldwide. Consequently, the demand for reliable and user-friendly screening tools that can detect dementia at early stages and monitor its progression is more critical than ever. The International Neurocognitive Test Profile (INCP), developed at the Medical University of Vienna, aims to address this need by offering a digital test battery for the early detection of dementia. This study forms a part of the INCP's ongoing development and evaluation, specifically investigating the influence of gender on test outcomes.

Methods: Seventy participants, recruited through flyers at the Vienna General Hospital, completed the INCP assessment using tablets as part of the study. The effect of gender on performance across various INCP subtests was analyzed using Mann-Whitney U tests. For further exploratory analysis, a correlation matrix was calculated encompassing demographic variables (age and education), screening data, and all INCP subtests.

Results: The analysis revealed significant gender differences in two INCP subtests related to executive functions. Males outperformed females on the Figure Fluency Test (r = 0.30, indicating a moderate effect) and the Dice 2‑n Back Test (r = 0.29, indicating a small effect). However, when correcting for multiple comparisons, no significant gender disparities were observed in the scores of the subtests.

Conclusion: The identification of possible gender differences in specific subtests underscores the importance of considering gender as a variable in the further development and evaluation of the INCP. These findings offer valuable insights for the design and planning of future studies involving the INCP.

Urbanization and digitalization are reshaping the landscape of mental health, contributing to increased social isolation, stress, and the emergence of novel psychopathologies. This paper explores the impact of urbanization on mental health, with a particular focus on two contemporary phenomena: "Hikikomori" (severe social withdrawal) and "Modern-Type Depression (MTD)." These conditions highlight the need for psychiatrists to adopt innovative, interdisciplinary approaches that integrate sociocultural understanding and technological advancements. By utilizing digital tools such as metaverse and communication robots, mental healthcare can evolve to effectively address these emerging challenges. Moreover, following the COVID-19 pandemic, hikikomori may hold the potential to evolve from a pathological condition into a new lifestyle for human beings.

Purpose and research question of the review: Despite its substantial therapeutic efficacy-particularly in the acute treatment and relapse prevention of bipolar affective disorders-lithium is associated with a broad spectrum of side effects, among which potential nephrotoxicity represents one of the most significant long-term risks. In clinical practice, particularly in the treatment of older adults, physicians are often faced with the question of whether lithium therapy can or should be continued, or whether initiation is feasible, given comorbid somatic illnesses, polypharmacy, or reduced glomerular filtration rate (GFR). The aim of this review is to provide practical, evidence-based recommendations for clinical decision-making.

Methods: A comprehensive literature search was conducted using PubMed, Web of Science, and Google Scholar, focusing on the treatment of patients with bipolar and unipolar affective disorders with lithium and its potential effects on renal function, particularly in the context of long-term therapy and aging. A case report is included to illustrate clinical application.

Results and conclusions: Lithium remains a cornerstone in the pharmacological treatment of bipolar and unipolar affective disorders, despite its known nephrotoxic potential. Optimizing the balance between therapeutic benefit and potential renal risks necessitates close monitoring and individualized treatment adjustments. The risk of lithium-induced nephropathy increases with the duration of therapy, patient age, and the frequency of episodes of lithium toxicity or overdose. Current guidelines recommend maintaining serum lithium levels within a range of 0,6-0,8 mmol/L. In older patients with good treatment response, target levels at the lower end of the therapeutic window (0,4-0,6 mmol/L) are advised. Lithium therapy should be monitored at regular intervals, including laboratory testing and 12-hour serum level checks every three months, or every 8-10 weeks in elderly patients. If GFR falls below 30 ml/min/1,73 m², nephrology consultation is warranted, and the continuation of lithium treatment should be critically re-evaluated. In patients with a GFR below 45 ml/min/1,73 m², initiation of lithium therapy in old age is not recommended. Decisions regarding the discontinuation or initiation of lithium therapy should always be made on an individual and interdisciplinary basis, carefully weighing the therapeutic benefit against the risk of affective relapse and the potential for progressive renal impairment.

Background: Vocalizations in dementia patients are repetitive verbal expressions that, due to their volume, frequency, and/or social inappropriateness, cause negative effects on patients and other individuals present. The prevalence ranges up to 30%. Given the increasing global incidence of dementia and the limited number of randomized controlled trials about treating repetitive vocalizations, this systematic review provides a summary of existing works on the effectiveness of potential pharmacotherapeutic and nonpharmacological therapies.

Methods: The systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on the International Prospective Register of Systematic Reviews (PROSPERO) registration page (registration number: CRD42023486344). Literature search was conducted in PubMed and Embase databases. Due to insufficient data, case reports were also included.

Results: Of 2635 articles, 25 studies were included in the review. Efficacy was demonstrated for selective serotonin reuptake inhibitors (SSRIs), pregabalin, gabapentin, and the antipsychotics haloperidol and risperidone based on a few case reports, albeit with associated side effects. Nonpharmacological interventions also showed efficacy.

Conclusion: Both pharmacological and nonpharmacological interventions are effective treatment approaches for repetitive vocalizations in dementia patients. Due to the fact that there are hardly any randomized controlled studies available, the results of this systematic review must be interpreted with caution. The results of this review show that randomized controlled trials are required for many interventions.

Background: Psychological constructs of individual autonomy (IA) and emotional connectedness (EC) differ between patients with anorexia nervosa (AN) and bulimia nervosa (BN); however, it is unclear whether objective family factors modulate these associations.

Methods: In a cohort of 445 participants from the FamFINED study (FAMily Factors INvolved in Eating Disorders) with eating disorders (EDs) diagnosed as AN (n = 232) or BN (n = 213), we assessed objective psychosocial family factors as well as the IA and EC constructs using the self-rated Subjective Family Image Test (SFIT) questionnaire.

Results: While the two ED entities did not differ with respect to IA in univariate analysis (p = 0.355), patients diagnosed with AN had higher perceived EC than participants with BN, as assessed by a lower score for the difference between the actual and desired family image (16.0 ± 15.8 vs. 21.6 ± 17.6, p < 0.001). In a regression model adjusted for age, body-mass index, living in parental home, and parental separation, we found that the EC score used as the dependent variable differed significantly between the two ED entities (expβ = 4.8, 95% confidence interval = 0.54-9.11, p = 0.028). In contrast, no association was observed between IA and ED diagnoses using the same set of confounders (p = 0.717).

Conclusion: The higher perceived EC in AN patients compared to those diagnosed with BN indicates more intense feelings of family solidarity, regardless of objective family factors.