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de Miranda Santos IKF, de Barros Cardoso CR. Commentary on "Complement C3 vs C5 inhibition in severe COVID-19: Early clinical findings reveal differential biological efficacy" by D.C. Mastellos et al. Clin Immunol 2021; 222:108618. [PMID: 33127564 PMCID: PMC7588791 DOI: 10.1016/j.clim.2020.108618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 10/23/2020] [Indexed: 11/24/2022]
Affiliation(s)
| | - Cristina Ribeiro de Barros Cardoso
- Department of Clinical Analysis, Toxicology and Food Sciences, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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Jayamohananan H, Manoj Kumar MK, T P A. 5-HIAA as a Potential Biological Marker for Neurological and Psychiatric Disorders. Adv Pharm Bull 2019; 9:374-381. [PMID: 31592064 PMCID: PMC6773935 DOI: 10.15171/apb.2019.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/08/2019] [Accepted: 04/14/2019] [Indexed: 11/21/2022] Open
Abstract
Neurological and psychiatric disorders occur in about 6 percent of the global population
indicating a significant amount of people suffering from neurological disorder on a varying range
in day to day life. On an extensive view, there is a critical requirement for the development of
an alternative biomarker for these conditions. The thwart found in developing a biomarker is
the difficulty in identifying a serum biomarker as these are mostly limited to the central nervous
system (CNS). Serotonin being a neurotransmitter synthesized in the raphe nuclei of the brain
could serve as an alternative biomarker. Here, the limitation is that it’s quickly metabolized
by the mitochondrial enzyme MAO to 5-hydroxy indole acetic acid (5HIAA). This subsequent
metabolite can be used for the analysis of serotonin levels in brain by analysing its concentration
in the cerebrospinal fluid (CSF). Many theories suggest that the variations in serotonin level
could lead to the development of many neurological and psychiatric disorders like Alzheimer’s
disease (AD), schizophrenia, depression and so on. A decreased level is noticed in these patients
but this could either be due to decreased production or increased reuptake of serotonin from
the neuronal synapses. For instance, we know that a patient with depression shows a significant
reduction in the levels of 5HIAA, due to the location of the raphe nuclei within regions of
memory and cognition. Similarly, it does shows variation in AD and mild cognitive disorder.
Evolving of 5HIAA as a biomarker, could be more delicate and enhanced strategy for monitoring
these disorders.
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Affiliation(s)
- Hridya Jayamohananan
- Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, India
| | | | - Aneesh T P
- Amrita School of Pharmacy, Amrita Vishwa Vidyapeetham, AIMS Health Sciences Campus, Kochi, India
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First-presentation with psychotic behavior to the Emergency Department: Meningitis or not, that is the question. Am J Emerg Med 2018; 36:2068-2075. [PMID: 30190242 DOI: 10.1016/j.ajem.2018.08.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/12/2018] [Accepted: 08/20/2018] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Meningitis is a potentially life threatening medical emergency. Psychotic behavior may be a presenting feature in patients with meningitis. We aimed to determine the value of various clinical and laboratory features at ruling-out meningitis in the patient presenting with a first-episode of psychotic behavior. METHODS Medical records of 159 subjects presenting to a tertiary academic hospital over a 6-month period with one or more psychotic features for the first time were prospectively gathered. Pathological cerebrospinal fluid findings as well as clinical and other laboratory findings were tabulated and discussed retrospectively. RESULTS Cerebrospinal fluid was obtained in 153/159 (96.2%) subjects. Meningitis was confirmed in twenty-eight (18.3%) subjects. Of these, a) one or more clinical feature of meningitis (headache, neck stiffness, photophobia or focal neuropathy) was present in 21 subjects (75.0%), b) visual hallucinations in 15 subjects (53.6%), c) pyrexia >37.5 °C in 7 subjects (25.0%), d) CRP >10 mg/L in 21 subjects (75.0%), e) HIV seropositive status in 19 subjects (67.9%) and f) an absence of illicit substances on urinalysis in 23 subjects (82.1%). Various combinations of these variables, where the presence of ≥1 variable was regarded as positive, were unable to rule-out meningitis in all study subjects. CONCLUSION The absence of these six parameters; alone or in various combinations, was unable to rule-out meningitis in all patients presenting to our ED with a first-episode of psychotic behavior. When the underlying etiology of psychotic behavior is not obvious, the clinician should adopt a low threshold to perform a lumbar puncture.
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Kerr CW, Luczkiewicz DL, Holahan T, Milch R, Hang PC. The Use of Pentobarbital in Cases of Severe Delirium. Am J Hosp Palliat Care 2013; 31:105-8. [DOI: 10.1177/1049909112474111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Delirium is a common syndrome present at the end of life and causes significant distress for patients and families. Sleep disruption is a common precipitating factor for delirium and restoration of sleep may be instrumental in attenuating symptoms. In this cases series, we present three patients who were unresponsive to escalating doses of standard delirium medications, but whose delirium resolved once improved sleep was achieved using Pentobarbital. In a fourth patient, delirium was successfully treated where neuroleptics were contraindicated. Pentobarbital has been shown to reduce the time to sleep onset, decrease the number of body movements during sleep and spontaneous awakenings and increase the total sleep time. Pentobarbital may provide an additional treatment option for patients whose delirium is refractory to standard management approaches.
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Affiliation(s)
- Christopher W. Kerr
- Department of Research, Center for Hospice & Palliative Care, Cheektowaga, NY, USA
| | - Debra L. Luczkiewicz
- Department of Research, Center for Hospice & Palliative Care, Cheektowaga, NY, USA
| | - Timothy Holahan
- Department of Ethics, Humanities and Palliative Care, University of Rochester Medical Center, Rochester, NY, USA
| | - Robert Milch
- Department of Geriatrics and Palliative Care, Veteran’s Affairs Medical Center, Buffalo, NY, USA
| | - Pei C. Hang
- Department of Research, Center for Hospice & Palliative Care, Cheektowaga, NY, USA
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Abstract
PURPOSE OF REVIEW Since the publication of DSM-III in 1980, the essential criteria for delirium have been reduced progressively through DSM-III-R to DSM-IV. As the field moves toward DSM-V and ICD-11, new data can shed light on the nosological changes that are needed so that diagnostic criteria can reflect empirical data. In this study, we reassess the existing or potential criteria for delirium. RECENT FINDINGS Phenomenological studies in recent years have informed the criteria for delirium, including the appropriateness of the term 'consciousness' as a core symptom of the diagnosis, additional symptoms of delirium that are frequent but are not currently part of the diagnostic criteria, subsyndromal delirium, motoric subtypes of delirium (hyperactive, hypoactive), and the association of delirium with dementia. SUMMARY Recent studies suggest that motoric subtypes should be included as a subtype for delirium but that subsyndromal delirium, although a useful research construct, should not be included in clinical diagnostic criteria given the frequent fluctuation in symptoms over short periods. In addition, though the core symptoms are probably adequate to make the diagnosis, clinicians must be aware of the frequency of other symptoms, for symptoms such as profound sleep disturbance or psychotic symptoms may dominate the clinical picture.
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Onwuameze OE, Schultz SK, Paradiso S. An initial study of modifiable and non-modifiable factors for late-life psychosis. Int J Psychiatry Med 2011; 42:437-51. [PMID: 22530403 PMCID: PMC3626263 DOI: 10.2190/pm.42.4.g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine rates of psychotic symptoms and associated modifiable and non-modifiable factors among elderly long term nursing home residents without prior history of psychiatric illness. METHOD A cross-sectional design using the Scale for the Assessment of Positive Symptoms (SAPS) to measure psychotic symptoms, the Folstein's Mini-Mental State Exam (MMSE), and Mattis Dementia Rating Scale (DRS) to evaluate cognitive impairment. Frequency and rates of global psychotic symptoms and hallucinations, delusions, formal thought disorder, and bizarre behavior were calculated. Logistic regression was used to examine modifiable (e.g., medication use) and non-modifiable clinical characteristics (e.g., older age) associated with late-life psychosis. RESULTS There were 15.9% of subjects reporting delusions and 7.3% reporting hallucinations. History of stroke, poorer cognition, and receiving multiple medications showed significant association with late-life psychosis. Only stroke (OR = 9.12; 95% CI: 1.58-52.74) and receiving different classes of medications (benzodiazepines, neuroleptics, and antidepressants) (OR = 13.17; 95% CI: 2.10-85.82) remained significantly associated with psychosis after adjusting for Mattis DRS total score. Further analyses excluding subjects with MMSE scores of 24 or lower (n = 24) showed essentially the same results but subjects with better cognitive function suffered a less severe form of psychosis, essentially constituted by one symptom type (i.e., visual hallucinations). CONCLUSIONS Rates of late-life psychosis in this sample of nursing home residents without previous psychiatric history were high. Simultaneous use of medications including antidepressants, sedatives, and stimulants may be a clinically relevant modifiable factor to be targeted in prevention studies. Severity and type of psychosis is dependent on the severity of cognitive impairment.
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Affiliation(s)
- Obiora E Onwuameze
- University of Iowa Carver College of Medicine, Department of Psychiatry, Iowa City, Iowa 52242, USA
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Trbovic SM. Schizophrenia as a possible dysfunction of the suprachiasmatic nucleus. Med Hypotheses 2010; 74:127-31. [DOI: 10.1016/j.mehy.2009.07.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 07/06/2009] [Accepted: 07/06/2009] [Indexed: 10/20/2022]
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Leonard M, Spiller J, Keen J, MacLullich A, Kamholtz B, Meagher D. Symptoms of Depression and Delirium Assessed Serially in Palliative-Care Inpatients. PSYCHOSOMATICS 2009. [DOI: 10.1016/s0033-3182(09)70844-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Charlton BG, Andras P. The Sleep Elaboration–Awake Pruning (SEAP) theory of memory: Long term memories grow in complexity during sleep and undergo selection while awake. Clinical, psychopharmacological and creative implications. Med Hypotheses 2009; 73:1-4. [DOI: 10.1016/j.mehy.2009.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 03/12/2009] [Indexed: 12/01/2022]
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Abstract
Clinical subtyping of delirium according to motor-activity profile has considerable potential to account for the heterogeneity of this complex and multifactorial syndrome. Previous work has identified a range of clinically important differences between motor subtypes in relation to detection, causation, treatment experience and prognosis, but studies have been hampered by inconsistent methodology, especially in relation to definition of subtypes. This article considers research to date, including a number of recent studies that have attempted to address these issues and identify a means of achieving greater consistency in approaches to subtyping. Possibilities for future work are discussed and a research plan for the field is outlined.
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Affiliation(s)
- David Meagher
- Department of Adult Psychiatry, Midwestern Regional Hospital, Limerick, Health Systems Research Centre, University of Limerick, Limerick, Ireland.
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Gupta N, de Jonghe J, Schieveld J, Leonard M, Meagher D. Delirium phenomenology: what can we learn from the symptoms of delirium? J Psychosom Res 2008; 65:215-22. [PMID: 18707943 DOI: 10.1016/j.jpsychores.2008.05.020] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2008] [Revised: 05/11/2008] [Accepted: 05/15/2008] [Indexed: 01/23/2023]
Abstract
OBJECTIVES This review focuses on phenomenological studies of delirium, including subsyndromal and prodromal concepts, and their relevance to other elements of clinical profile. METHODS A Medline search using the keywords delirium, phenomenology, and symptoms for new data articles published in English between 1998 and 2008 was utilized. The search was supplemented by additional material not identified by Medline but known to the authors. RESULTS Understanding of prodromal and subsyndromal concepts is still in its infancy. The characteristic profile can differentiate delirium from other neuropsychiatric disorders. Clinical (motoric) subtyping holds potential but more consistent methods are needed. Studies are almost entirely cross-sectional in design and generally lack comprehensive symptom assessment. Multiple assessment tools are available but are oriented towards hyperactive features and few have demonstrated ability to distinguish delirium from dementia. There is insufficient evidence linking specific phenomenology with etiology, pathophysiology, management, course, and outcome. CONCLUSIONS Despite the major advancements of the past decade in many aspects of delirium research, further phenomenological work is crucial to targeting studies of causation, pathophysiology, treatment, and prognosis. We identified eight key areas for future studies.
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Affiliation(s)
- Nitin Gupta
- South Staffordshire and Shropshire Healthcare NHS Foundation Trust, Burton on Trent, United Kingdom.
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Tabet N, Howard R. Prevention, diagnosis and treatment of delirium: staff educational approaches. Expert Rev Neurother 2006; 6:741-51. [PMID: 16734522 DOI: 10.1586/14737175.6.5.741] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Delirium is a common disorder especially among older people admitted to medical and surgical units. Research has demonstrated that many cases are underdiagnosed, misdiagnosed or not properly managed. Some of the difficulties encountered in the diagnosis, treatment and prevention may, in part, stem from a historical low emphasis on delirium in medical and nursing education. In recent years, attempts have been made to understand the impact of education on the prevention and management of delirium. In this review, diagnosis, treatment and prevention of delirium are considered in relation to the difficulties encountered in each of these areas. The role of increasing doctors' and nurses' awareness in the understanding of delirium through educational programs is also reviewed. The outcome of many cases of delirium is not changed by current treatment; however, there is increasing evidence that strategies employing appropriate multicomponent and/or educational staff intervention programs may decrease the prevalence of delirium.
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Affiliation(s)
- Naji Tabet
- University of Brighton, Postgraduate Medical School, Faculty of Health, Brighton, BN1 9PH, UK.
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