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Hotz T, Sharma M, Narapareddy B. A Case of Posterior Cortical Atrophy Presenting with Mood and Psychotic Symptoms. Case Rep Psychiatry 2024; 2024:2220082. [PMID: 38362124 PMCID: PMC10869182 DOI: 10.1155/2024/2220082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
Posterior cortical atrophy (PCA) is a rare neurodegenerative disorder characterized by predominant visual deficits due to its atrophy of the occipital lobes. Patients typically have preserved cognitive function during the early stages, making diagnosis more difficult when compared to other neurocognitive disorders. In this case, the patient presented predominantly with mood symptoms, delusions, and visual hallucinations. The disease course began 5 years ago with anxiety and insomnia. It developed into depressive symptoms including two suicide attempts (SAs), paranoia, and hallucinations. The diagnosis was eventually reached utilizing a thorough clinical exam, neuropsychological testing, MRI, positron emission tomography (PET), and dopamine transporter (DAT) scans. We conclude that mood or psychotic symptoms that emerge, escalate, or change dramatically at later ages merit further workup to evaluate for underlying neurodegenerative disorders.
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Affiliation(s)
- Tremearne Hotz
- Department of Psychiatry, Institute of Living, 400 Washington Street, Hartford 06114, CT, USA
| | - Manu Sharma
- Department of Psychiatry, Institute of Living, 400 Washington Street, Hartford 06114, CT, USA
| | - Bharat Narapareddy
- Department of Psychiatry, Institute of Living, 400 Washington Street, Hartford 06114, CT, USA
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Hamina A, Paljärvi T, Tanskanen A, Lähteenvuo M, Tiihonen J, Taipale H. Use of antipsychotics and antidepressants in first-episode psychotic depression: A nationwide register-based study. Acta Psychiatr Scand 2023; 148:416-425. [PMID: 37674331 DOI: 10.1111/acps.13616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND According to guidelines, psychotic depression should be treated with both antipsychotics and antidepressants, but current practice is largely unknown. We investigated the prevalence of antipsychotic and antidepressant use in first-episode psychotic depression and factors related to antipsychotic use after the diagnosis. METHODS We identified individuals aged 16-65 with a first-episode diagnosis of psychotic depression (ICD-10 codes F32.3, F33.3) from nationwide data linkage of Finnish healthcare and population registers during 2000-2018. Point prevalence was measured as 2-week time windows every 3 months, investigating whether the individual had a modeled drug use period ongoing during the window or not, censoring to death and end of data linkage. RESULTS The study population included 18,490 individuals (58.0% women; mean age 39.9 years, standard deviation 14.7). The prevalence of use for antidepressants (75.0%), antipsychotics (56.4%), and both (50.0%) were highest at 3 months after the diagnosis. The prevalence declined to 51.8%, 34.1%, and 28.7%, respectively, at 3 years after the diagnosis. In a logistic regression analysis, younger age (adjusted odds ratio < 25 vs. ≥55, 0.82 [95% confidence interval 0.73-0.91]), eating disorders (0.78 [0.66-0.92]), substance use disorders (0.80 [0.73-0.87]), and occupational inactivity (0.80 [0.73-0.87]) were associated with decreased odds of using antipsychotics at 3 months after diagnosis. Increased odds were found for diagnosis from inpatient care (1.74 [1.62-1.86]), and later year of cohort entry (2010-2014 vs. 2000-2004, 1.56 [1.42-1.70]). CONCLUSION At most, half of the individuals with newly diagnosed psychotic depression used both antidepressants and antipsychotics. This likely has a negative impact on treatment success.
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Affiliation(s)
- A Hamina
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
- Norwegian Centre for Addiction Research (SERAF), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T Paljärvi
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - A Tanskanen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - M Lähteenvuo
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - J Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - H Taipale
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Therapeutic Implications of microRNAs in Depressive Disorders: A Review. Int J Mol Sci 2022; 23:ijms232113530. [PMID: 36362315 PMCID: PMC9658840 DOI: 10.3390/ijms232113530] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
MicroRNAs are hidden players in complex psychophysical phenomena such as depression and anxiety related disorders though the activation and deactivation of multiple proteins in signaling cascades. Depression is classified as a mood disorder and described as feelings of sadness, loss, or anger that interfere with a person’s everyday activities. In this review, we have focused on exploration of the significant role of miRNAs in depression by affecting associated target proteins (cellular and synaptic) and their signaling pathways which can be controlled by the attachment of miRNAs at transcriptional and translational levels. Moreover, miRNAs have potential role as biomarkers and may help to cure depression through involvement and interactions with multiple pharmacological and physiological therapies. Taken together, miRNAs might be considered as promising novel therapy targets themselves and may interfere with currently available antidepressant treatments.
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Akhter-Khan SC, Au R. Why Loneliness Interventions Are Unsuccessful: A Call for Precision Health. ADVANCES IN GERIATRIC MEDICINE AND RESEARCH 2020; 2:e200016. [PMID: 36037052 PMCID: PMC9410567 DOI: 10.20900/agmr20200016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Background Loneliness has drawn increasing attention over the past few decades due to rising recognition of its close connection with serious health issues, like dementia. Yet, researchers are failing to find solutions to alleviate the globally experienced burden of loneliness. Purpose This review aims to shed light on possible reasons for why interventions have been ineffective. We suggest new directions for research on loneliness as it relates to precision health, emerging technologies, digital phenotyping, and machine learning. Results Current loneliness interventions are unsuccessful due to (i) their inconsideration of loneliness as a heterogeneous construct and (ii) not being targeted at individuals' needs and contexts. We propose a model for how loneliness interventions can move towards finding the right solution for the right person at the right time. Taking a precision health approach, we explore how transdisciplinary research can contribute to creating a more holistic picture of loneliness and shift interventions from treatment to prevention. Conclusions We urge the field to rethink metrics to account for diverse intra-individual experiences and trajectories of loneliness. Big data sharing and evolving technologies that emphasize human connection raise hope for realizing our model of precision health applied to loneliness. There is an urgent need for precise, integrated, and theory-driven interventions that focus on individuals' needs and the subjective burden of loneliness in the ageing context.
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Affiliation(s)
- Samia C. Akhter-Khan
- Department of Psychology, Humboldt University of Berlin, 10117 Berlin, Germany
- Department of Psychology & Neuroscience, Duke University Graduate School, NC 27705, USA
| | - Rhoda Au
- Departments of Anatomy & Neurobiology and Neurology, Boston University Alzheimer’s Disease Center, Framingham Heart Study, Boston University School of Medicine, Boston, MA 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
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Qi L, Zhang Y, Wang L, Wang R, Wu J, Zhou X, Chen J, Zhang S, Zhou Y, Zhang XY. Sex differences in psychotic and non-psychotic major depressive disorder in a Chinese Han population. J Affect Disord 2020; 268:55-60. [PMID: 32158007 DOI: 10.1016/j.jad.2020.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/15/2020] [Accepted: 03/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sex differences between psychotic depression (PD) and non-psychotic depression (NPD) have received little systematic study. This study was conducted to investigate sex difference in patients with psychotic and non-psychotic major depressive disorder in a Chinese Han population. METHODS In this cross-sectional study, a total of 1718 first-episode and drug-naïve outpatients with major depressive disorder were recruited. Demographic and clinical characteristics were collected. All subjects were rated on the Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA) and the Positive and Negative Syndrome Scale (PANSS). RESULTS The prevalence of PD in female patients (10.97%) was higher than that in male patients (7.99%). Analysis of variance (ANOVA) showed that female patients were older compared with male patients in NPD group, but there were no significant differences in demographic and clinical variables between female and male PD patients. Further, there were no sex differences in the scores of HAMD, HAMA and positive symptom subscale of PANSS in both PD and NPD groups. Two-way ANOVA showed that PD patients had significantly higher scores on the HAMD, HAMA and positive symptom subscale of PANSS than non-PD patients. However, there were no significant effects of sex and sex* subtypes. LIMITATIONS The main limitations are cross-sectional design and inability to control selection bias. CONCLUSIONS Our findings show significant differences in clinical profiles between PD and NPD patients; however, no sex difference has been observed in the either PD or NPD patients.
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Affiliation(s)
- Ling Qi
- School of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | - Yaping Zhang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center,Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Liewei Wang
- Wuhan Xinzhou District Mental Health Center, Wuhan, China
| | - Ruoxi Wang
- School of Medicine and Health Management,Tongji Medical College of Huazhong University of Science & Technology,Wuhan, China
| | - Jiang Wu
- Medical Department, Wuhan Youfu Hospital,Wuhan, China
| | - Xin Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Jing Chen
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center,Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Shufang Zhang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center,Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Yongjie Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center,Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China.
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Lisanby SH, McClintock SM, Alexopoulos G, Bailine SH, Bernhardt E, Briggs MC, Cullum CM, Deng ZD, Dooley M, Geduldig ET, Greenberg RM, Husain MM, Kaliora S, Knapp RG, Latoussakis V, Liebman LS, McCall WV, Mueller M, Petrides G, Prudic J, Rosenquist PB, Rudorfer MV, Sampson S, Teklehaimanot AA, Tobias KG, Weiner RD, Young RC, Kellner CH. Neurocognitive Effects of Combined Electroconvulsive Therapy (ECT) and Venlafaxine in Geriatric Depression: Phase 1 of the PRIDE Study. Am J Geriatr Psychiatry 2020; 28:304-316. [PMID: 31706638 PMCID: PMC7050408 DOI: 10.1016/j.jagp.2019.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is limited information regarding the tolerability of electroconvulsive therapy (ECT) combined with pharmacotherapy in elderly adults with major depressive disorder (MDD). Addressing this gap, we report acute neurocognitive outcomes from Phase 1 of the Prolonging Remission in Depressed Elderly (PRIDE) study. METHODS Elderly adults (age ≥60) with MDD received an acute course of 6 times seizure threshold right unilateral ultrabrief pulse (RUL-UB) ECT. Venlafaxine was initiated during the first treatment week and continued throughout the study. A comprehensive neurocognitive battery was administered at baseline and 72 hours following the last ECT session. Statistical significance was defined as a two-sided p-value of less than 0.05. RESULTS A total of 240 elderly adults were enrolled. Neurocognitive performance acutely declined post ECT on measures of psychomotor and verbal processing speed, autobiographical memory consistency, short-term verbal recall and recognition of learned words, phonemic fluency, and complex visual scanning/cognitive flexibility. The magnitude of change from baseline to end for most neurocognitive measures was modest. CONCLUSION This is the first study to characterize the neurocognitive effects of combined RUL-UB ECT and venlafaxine in elderly adults with MDD and provides new evidence for the tolerability of RUL-UB ECT in an elderly sample. Of the cognitive domains assessed, only phonemic fluency, complex visual scanning, and cognitive flexibility qualitatively declined from low average to mildly impaired. While some acute changes in neurocognitive performance were statistically significant, the majority of the indices as based on the effect sizes remained relatively stable.
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Affiliation(s)
- Sarah H. Lisanby
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC (Now at the National Institute of Mental Health),Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health
| | - Shawn M. McClintock
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC (Now at the National Institute of Mental Health),Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | - George Alexopoulos
- Department of Psychiatry and Behavioral Sciences, New York Presbyterian/Weill Cornell Medical Center, White Plains, NY
| | - Samuel H. Bailine
- Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York, NY
| | | | - Mimi C. Briggs
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - C. Munro Cullum
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | - Zhi-De Deng
- Noninvasive Neuromodulation Unit, Experimental Therapeutics Branch, Intramural Research Program, National Institute of Mental Health
| | - Mary Dooley
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Emma T. Geduldig
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Mustafa M. Husain
- Division of Brain Stimulation and Neurophysiology, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC (Now at the National Institute of Mental Health),Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | - Styliani Kaliora
- Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York, NY
| | - Rebecca G. Knapp
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Vassilios Latoussakis
- Department of Psychiatry and Behavioral Sciences, New York Presbyterian/Weill Cornell Medical Center, White Plains, NY
| | - Lauren S. Liebman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - William V. McCall
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
| | - Martina Mueller
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Georgios Petrides
- Department of Psychiatry, Zucker Hillside Hospital/North Shore-LIJ Health System, New York, NY
| | - Joan Prudic
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY
| | - Peter B. Rosenquist
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA
| | - Matthew V. Rudorfer
- Division of Services and Intervention Research, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Shirlene Sampson
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Abeba A. Teklehaimanot
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - Kristen G. Tobias
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Richard D. Weiner
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
| | - Robert C. Young
- Department of Psychiatry and Behavioral Sciences, New York Presbyterian/Weill Cornell Medical Center, White Plains, NY
| | - Charles H. Kellner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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Abstract
INTRODUCTION Electroconvulsive therapy (ECT) is associated with memory deficits on neuropsychological assessment. The association of ECT with nonmemory cognitive deficits has been poorly studied. METHODS We present a 40-year-old woman who showed a bizarre form of spatial cognition impairment on a subtest of the Tactual Performance Test (TPT) after recovering from depression with 6 alternate day, thrice-weekly, inpatient ECT treatments. This woman was part of a naturalistic, nonblind study that examined nonmemory cognitive deficits in antidepressant-treated depressed patients who did and did not receive ECT. RESULTS The impairment was in the form of bizarrely drawn reproductions of differently shaped wooden blocks that had been presented to the patient when she was blindfolded. The impairment was still evident when she was retested (3 hours later) under substantially simplified conditions but was much attenuated approximately 2.5 weeks later. CONCLUSIONS On the surface, it seems that ECT had induced severe impairment in spatial cognition and that the impairment showed the familiar pattern of attenuation with the passage of time. However, another recovered patient in the study, who did not receive ECT, also showed substantial spatial deficits on the same subtest of the TPT, and the attenuation of the deficits across time in the ECT-treated patient was probably a result of repeated exposure to the task. We suggest that not all patients who seem to experience spectacular cognitive impairment after ECT have deficits that are attributable to ECT.
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Bjølseth TM, Engedal K, Benth JŠ, Dybedal GS, Gaarden TL, Tanum L. Baseline cognitive function does not predict the treatment outcome of electroconvulsive therapy (ECT) in late-life depression. J Affect Disord 2015; 185:67-75. [PMID: 26143406 DOI: 10.1016/j.jad.2015.06.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 06/15/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND No prior study has investigated whether impairment of specific cognitive functions at baseline may predict the short-term treatment outcome of electroconvulsive therapy (ECT) in elderly non-demented patients with major depression (MD). METHODS This longitudinal cohort study included 65 elderly patients with unipolar or bipolar MD, aged 60-85 years, treated with formula-based ECT. Treatment outcome was assessed using the 17-item Hamilton Rating Scale for Depression (HRSD17). Cognitive function at baseline was assessed using nine neuropsychological tests or subtests measuring information processing speed, verbal learning and memory, and aspects of executive function. RESULTS A poorer performance on the word reading task of the Color Word Interference Test rendered higher odds of achieving remission during the ECT course (p=0.021). Remission was defined as an HRSD17 score of 7 or less. There were no other significant associations between the treatment outcome of ECT and cognitive performance parameters assessed at baseline. LIMITATIONS The limited number of subjects may have reduced the generalizability of the findings. Multiple statistical tests increase the risk for making a type I error. CONCLUSIONS How well patients perform on neuropsychological tests at baseline is most likely not a predictor of, or otherwise not significantly associated with the treatment outcome of formula-based ECT in elderly patients with MD.
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Affiliation(s)
- Tor Magne Bjølseth
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Pastor Fangens vei 18, 0854 Oslo, Norway.
| | - Knut Engedal
- Norwegian Centre for Aging and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Norway; HØKH, Research Centre, Akershus University Hospital, Norway
| | - Gro Strømnes Dybedal
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Pastor Fangens vei 18, 0854 Oslo, Norway
| | - Torfinn Lødøen Gaarden
- Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Pastor Fangens vei 18, 0854 Oslo, Norway
| | - Lars Tanum
- Department of Research and Development in Mental Health, Akershus University Hospital, Norway
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Dybedal GS, Tanum L, Sundet K, Bjølseth TM. The Role of Baseline Cognitive Function in the Neurocognitive Effects of Electroconvulsive Therapy in Depressed Elderly Patients. Clin Neuropsychol 2015; 29:487-508. [DOI: 10.1080/13854046.2015.1050457] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Woudstra FH, van de Poel-Mustafayeva AT, van der Ploeg MV, de Vries JJ, van der Lek RFR, Izaks GJ. Symptoms mimicking dementia in a 60-year-old woman with bipolar disorder: a case report. BMC Res Notes 2014; 7:381. [PMID: 24951023 PMCID: PMC4078009 DOI: 10.1186/1756-0500-7-381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/18/2014] [Indexed: 11/25/2022] Open
Abstract
Background Dementia is generally considered an irreversible process of cognitive decline that can be caused by different neurodegenerative diseases. However, in some cases, dementia is caused by a non-neurodegenerative disease, such as an affective disorder. In these cases, the dementia can be reversible. Nevertheless, cognitive symptoms due to an affective disorder are often difficult to distinguish from a depressed mood due to a neurodegenerative disease. Especially in elderly patients with a history of affective disorder, a potentially reversible cause can be missed. Case presentation We describe a 60-year-old white woman with bipolar disorder, depressive symptoms, a movement disorder and severe cognitive impairment, in whom a neurodegenerative disease was seriously considered. She was referred to our clinic for further investigation because initial treatment of the depressive episode with antidepressants, mood stabilizers and electroconvulsive therapy (ECT) had not been successful. However, despite extensive evaluation, we could not find evidence for a neurodegenerative disease and the patient mostly recovered after discontinuation of different psychotropic medications and treatment with nortriptyline. Conclusions Our case shows that improvement of severe cognitive impairment in individual cases is possible. In our opinion, this underlines the necessity of a careful re-evaluation of the patient’s symptoms at presentation and the course of the disease as well as a critical review of the prescribed medications.
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Affiliation(s)
| | | | | | | | | | - Gerbrand J Izaks
- University of Groningen, University Medical Centre Groningen, University Centre for Geriatric Medicine, Internal Postcode AA43, P,O, Box 30,001, Groningen 9700 RB, The Netherlands.
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Misselhorn C, Pompe U, Stapleton M. Ethical Considerations Regarding the Use of Social Robots in the Fourth Age. GEROPSYCH-THE JOURNAL OF GERONTOPSYCHOLOGY AND GERIATRIC PSYCHIATRY 2013. [DOI: 10.1024/1662-9647/a000088] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The debate about the use of robots in the care of older adults has often been dominated by either overly optimistic visions (coming particularly from Japan), in which robots are seamlessly incorporated into society thereby enhancing quality of life for everyone; or by extremely pessimistic scenarios that paint such a future as horrifying. We reject this dichotomy and argue for a more differentiated ethical evaluation of the possibilities and risks involved with the use of social robots. In a critical discussion surrounding the capabilities approach to the ethical evaluation of quality of life, we develop an ethical framework that is more appropriate to the situation of the oldest old. We urge employment of a context-dependent approach to the ethical evaluation of new technologies in the care and therapy of older adults, and using the example of the robotic seal Paro, we show how this can be accomplished in a sensible and practical way.
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Affiliation(s)
| | - Ulrike Pompe
- Institute of Philosophy, University of Stuttgart, Germany
| | - Mog Stapleton
- Institute of Philosophy, University of Stuttgart, Germany
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Successful electroconvulsive therapy for major depression misdiagnosed as Alzheimer dementia. Am J Geriatr Psychiatry 2012; 20:909-10. [PMID: 22771953 PMCID: PMC3592561 DOI: 10.1097/jgp.0b013e318254619a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Early-onset dementia, presenting before age 65 years, is increasingly recognized. It is often difficult to diagnose, since non-Alzheimer's etiologies and unusual dementias are common. These conditions are more commonly genetic, and important potentially inherited causes of early-onset dementia include early-onset Alzheimer's disease, frontotemporal dementia, Kufs' disease, and Niemann-Pick disease type C. For each of these diseases, this review provides information on common clinical presentations, etiology, pathophysiology, and current and experimental treatments. A discussion of the diagnosis and workup for early-onset dementia is included with an emphasis on conditions that may have other involved family members.
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Affiliation(s)
- Brian S. Rogers
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Carol F. Lippa
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA
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