Postepy psychiatrii neurologii最新文献

Purpose: Migraine without aura is the most common type of the condition, whereas migraine with aura is substantially less common. Several features of aura symptoms may help us to define a different management approach. The aim of the study is to describe the characteristics of migraine aura and assess its impact on the daily lives of Polish patients. The characteristics assessed included type and severity of aura as well as the risk of migraine chronification.

Methods: The study included a group of 111 (87.4% female and 12.6% male) consecutive patients from the Headache Treatment Outpatient Clinic at Bielański Hospital in Warsaw diagnosed with episodic (72%) and chronic (28%) migraine with and without aura. The patients were diagnosed according to the International Classification of Headache Disorders 3rd edition of the International Headache Society.

Results: The final analysis was performed on the selected 28 patients (22 female and 6 male) with migraine with aura. Three patients with aura were diagnosed with chronic migraine. Twelve percent of all 111 migraine patients had migraine attacks both with and without aura. The most common (86%) aura type was the typical aura.

Conclusions: The study confirms that visual symptoms are the most common manifestation of aura among the patients studied. In some cases, the visual symptoms can be accompanied by other features of the typical migraine aura such as paraesthesia and speech disturbances. Other types of aura, such as vestibular and hemiplegic symptoms, occur very rarely. Only 10.7% of patients with migraine with aura transformed into the chronic type of the disease in comparison to 33.7% of patients with migraine without aura.

Purpose: Adolescent suicidal behaviour is a serious and concerning public health problem that requires ongoing attention. The study aimed to assess the prevalence of suicidal thoughts among 14-15-year-olds in Lviv (Ukraine) and Warsaw (Poland) and to identify associated psychosocial factors.

Methods: Self-report data were collected online in Autumn 2020 in two randomly selected samples of adolescents aged 14-15 living in Lviv (N = 1085) and Warsaw (N = 794). School classrooms were the source of the randomized samples. Differences in the prevalence of suicidal thoughts and risk/protective factors in the two study locations were analysed. The questionnaire and methodology were taken from the Polish Mokotów study.

Results: Significantly more adolescents in Warsaw (25.0%) declared having had suicidal thoughts at least once or twice in the previous year than those in Lviv (16.3%). In both locations, suicidal thoughts were significantly more prevalent among girls. Regression analyses indicated that symptoms of depression, lack of energy, emotional or mental health problems that prompted consultation with a specialist, online victimisation, and being in the company of peers who use drugs were associated with an increased frequency of suicidal thoughts both in Lviv and Warsaw. Alcohol use/abuse and feeling unsafe at school appeared to be risk factors in Lviv only. Positive family relationships reduced the frequency of suicidal thoughts and buffered the negative impact of symptoms of depression in both samples. Religiosity was a statistically significant protective factor in Lviv.

Conclusions: Despite some limitations, such as the use of a single-item tool to measure suicidal thoughts and the cross-sectional design of the study, the results provide support for preventive measures that include early detection and treatment of adolescent depressive disorders and other mental health problems, helping families maintain good relationships with their teenage children, countering cyberbullying, and increasing the sense of security at school as well as preventing risky behaviours.

Purpose: Progressive cognitive disorders are not always caused primarily by neurodegenerative diseases. This case report emphasizes the importance of taking rare metabolic disorders into consideration in the differential diagnosis in patients of all ages. It also shows the possible risk of corticosteroids in the treatment of unexplained neurological symptoms.

Case description: We report on the case of a 60-year-old female who presented mild dementia with progression and fluctuations for the last 5 years, scanning speech and wide-base gait. Due to a significantly elevated level of anti-thyroid peroxidase antibodies, steroid responsive encephalopathy in autoimmune thyroiditis (STREAT) was suspected and steroids were administered. This was a trigger factor for the patient developing coma with severe hyperammonemia. Consequent genetic testing identified a pathogenic variant of the OTC (ornithine transcarbamylase) gene.

Comment: Late-onset ornithine transcarbamylase deficiency can be a rare cause of cognitive impairment. It is reasonable to determine the level of ammonia in patients with non-specific symptoms, as hyperammonemia can cause permanent brain damage.

Purpose: The aim of the case is to present the significance of a thorough analysis of the cases of patients with newly developed memory disorders accompanied by epileptic seizures.

Case description: We present a case of a 61-year-old male patient who was admitted to the hospital due to unexplained memory disorders and seizures. Further examination showed the presence of anti-LGI1 (leucine-rich glioma-inactivated 1) antibodies. Computed tomography of the abdominal cavity revealed a mass located between the stomach and the spleen. Histopathological examination identified the mass as a gastrointestinal tumour (GIST). After the surgical removal of the tumour the symptoms were significantly reduced. The early diagnosis and treatment of the tumour contributed to favourable neurological and oncological outcomes for the patient.

Comment: Paraneoplastic neurological syndrome is a clinical condition in which the functioning of the nervous system is impaired, not resulting from local tumour growth or metastases. The currently recognized underlaying mechanism of this condition is an autoimmune reaction occurring in the patient's body. In response to the presence of tumour, the antibodies called onconeural antibodies are produced, which are then directed against antigens present on the nervous system cells. To the best of our knowledge this is the first and so far only anti-LGI1-antibody autoimmune encephalitis as a neurological paraneoplastic syndrome associated with GIST.

Purpose: Deep brain stimulation for Parkinson's disease (PD) is an established treatment modality for disabling Parkinsonian motor symptoms in off medication condition and levodopa-induced dyskinesia in on medication condition.

Case description: We report on the case of a 70-year-old woman with a 22-year history of PD diagnosis who had been treated with dopaminergic medication over this period. At age of 59, she underwent a staged bilateral implantation of deep brain stimulation (DBS) leads targeting the subthalamic nucleus (STN) with good control of Parkinsonian motor symptoms and the reduction of her daily levodopa dose by 50% after bilateral STN DBS. The patient damaged her DBS system after the standard replacement of a depleted left implantable pulse generator, which resulted in the removal of the entire deep brain stimulation system on the left side.

Comment: To our knowledge, this is the first report of probably self-injurious behavior in the context of a deep brain stimulation system related to the longstanding dopaminergic treatment of PD. Patients in advanced stages of PD require special care for the follow- up maintenance of sophisticated treatment modalities like DBS.

Purpose: Everyday difficulties, but also new threats experienced by individuals and whole societies, are sources of stress that, due to their intensity, occurrence over time and in the absence of adequate support, can trigger crises and traumatic experiences. Examples of the latter are COVID-19 or military action in Europe, among other things, and the related wave of refugees who have sought refuge in many Western European countries since February 2022 in particular. This is why it is so important to cultivate resilience and the ability to cope effectively cope with stress not only at the individual level but also in entire social groups, and to nurture the resources not only of those already experiencing crises and mental health disorders, but also of entire populations.

Views: The BASIC Ph model devised by Prof. Mooli Lahad (2013) is a tool for effective crisis communication and thus building individual and social resilience. It has been successfully implemented for several decades in the process of educating individuals and social groups about stress and forming new, effective ways of coping with it, thereby building mental resilience in situations such as natural disasters, epidemics, wars, migration, and refugee crises.

Conclusions: The article presents the application of the BASIC Ph model in the example of the refugee crisis and its use for people experiencing the trauma of war and forced migration, as well as citizens of host and migrant-supporting countries.

Purpose: Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) syndrome is a rare autoimmune disorder affecting brainstem structures and the cerebellum, first described in 2010. Its characteristic feature is a particularly good response to glucocorticoid treatment.

Case description: A 65-year-old male presented with double vision and dizziness of approximately five weeks duration prior to hospital admission. Brain magnetic resonance imaging (MRI) with gadolinium enhancement revealed a T2-weighted hyperintense, diffused lesion in the brainstem, with no evidence of restricted diffusion. The clinical presentation and the MRI features indicated CLIPPERS syndrome, which was diagnosed after excluding other causes of brainstem encephalitis.

Comment: Considering the fact that CLIPPERS syndrome is a rare and under-researched condition, it is important to include it in the differential diagnosis of numerous brainstem disorders, especially when the patient exhibits characteristic symptoms and radiological features. As CLIPPERS syndrome is a treatable disease, it cannot be neglected.

Purpose: Since 2022, Poland, particularly Krakow, has been at the forefront of providing assistance to Ukrainian refugees, displaced by military operations. The mental health impact of war trauma, notably post-traumatic stress disorder and acute stress reaction (ASR), necessitated immediate psychiatric interventions. To provide psychological support for refugees, a team of nine specialists was formed within the Department of Adult, Child, and Adolescent Psychiatry at the University Hospital in Krakow. This study aims to present the functioning of our crisis center and challenges it has faced, while comparing our approach to mental health care for refugees in other countries.

Methods: Data were collected from the center's activities and collaborations with partners, focusing on psychiatric care for Ukrainian refugees. Each patient was diagnosed by a psychiatrist based on ICD-10 classification.

Results: 107 visits were held, primarily with females aged 8 to 75 and males aged 2.5 to 65. The visits mostly took place at the crisis center. Patients presented with mental health concerns including suicidal ideation, sleep disorders, and self-mutilation. Among females, the most common diagnoses were ASR (45.45%), autism spectrum disorder (14.29%), depressive disorder, and recurrent depression (total 14.29%). For males, these were ASR (35.00%), autism spectrum disorder (35.00%), and attention deficit hyperactivity disorder (20.00%). Challenges such as language barriers and the fact that the center was unprepared for the influx of refugees were identified.

Conclusions: Given the considerable challenges encountered, the study emphasizes the need for mental health support for refugees and indicates the need to integrate the preparation for refugee crises into civil protection strategies.

Purpose: This review aims to emphasize the diagnostic value of functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) tractography in detecting and diagnosing central post-stroke pain (CPSP).

Views: CPSP is a debilitating form of chronic neuropathic pain that develops in patients with a history of stroke. CPSP has a wide range of onset and non-specific clinical presentations, making it difficult to detect. Until now, CPSP has been considered a diagnosis of exclusion, often leading to delays in the initiation of the appropriate treatment plan. fMRI and DTI tractography are valuable tools for assessing cerebral metabolic activity and the structural characteristics of the spinothalamic tracts, respectively. By combining these sets of information, physicians can detect CPSP early and implement more effective treatment strategies.

Conclusion: Diagnosing CPSP has been challenging for physicians due to its complex nature. However, fMRI and DTI have the potential in enabling earlier detection of CPSP, giving physicians more time to initiate treatment. This review highlights the capacities of fMRI and DTI in identifying alterations in the spinothalamic pathways associated with CPSP.